No fast -track for Montreal Medical Students

Montreal's two medical schools have thrown cold water on a proposal to fast-track the education of medical students to save money and help reduce the shortage of doctors.

An editorial in the latest issue of the Canadian Medical Association Journal recommends that the standard four-year curriculum be reduced by a year.

But officials at both McGill University and the Université de Montréal argue the proposal doesn't make sense in Quebec because many students in the province enroll in medical school straight out of CEGEP.

In the other provinces, most medical students already have an undergraduate degree in the sciences.

"CEGEP students have two years of schooling, and it doesn't make sense for them to then have only three years of medical education," said Raymond Lalande, vice-dean of undergraduate studies in the faculty of medicine at U de M.

He noted that 40 percent of U de M's medical students do not have an undergraduate degree, and at the Université de Sherbrooke, the proportion is 80 percent.

"We risk lowering the quality of medicine by doing this," Lalande added.

The editorial by three doctors observed that McMaster University in Hamilton, and the University of Calgary have for years offered three-year programs.

"Is this extra year necessary?" the editorial asked. "Training each medical student in Canada is costly both in time and money. Each student requires hundreds of hours of time from established family physicians, specialists and medical educators - time that otherwise could be spent on caring for patients."

By graduating students earlier, the editorial suggested, newly-trained doctors would be able to provide an additional year of care.

Joyce Pickering, associate dean of medical education at McGill, said any decision to shorten the school curriculum in Quebec would have to reflect the CEGEP system of junior colleges.

"We'd have to look at whether or not the rules would be different for students who come directly from CEGEP as opposed to students who have (an undergraduate) degree first."

At the U de M's medical school, students must study for 180 weeks. U de M medical students tend to score the highest overall marks in the country in year-end exams by the Medical Council of Canada.

In contrast, the programs at McMaster and Calgary are 130 weeks long - the minimum required to earn a medical degree. McGill's program lasts 160 weeks.

The Association of Faculties of Medicine of Canada, representing the country's 17 medical schools, is reviewing the standard curriculum in addition to the three-year proposal.

Its recommendations are due in 2009. If any decision is taken to reduce the curriculum by a year, it probably won't occur until five years from now, Pickering said, because of the lead time it takes to make changes of this nature.

Lalande said that the trend in medicine is to length the residencies of specialties like pediatrics and neurosurgery, not shorten them.

Before being being allowed to practise on their own, doctors must complete residency training in a hospital. For family medicine, it's two years. But for specializations, it's at least three years.

"Honestly, I can't see how three years of medical school, followed by a two-year residency in family medicine, is enough to train a family doctor to respond to all the needs of patients and an aging population," Lalande said.

"Any proposal to change the curriculum has to be made for pedagogical reasons. This proposal is being made for non-medical reasons."

The Quebec government has gradually increased enrollment in medical schools since 2003. Health Minister Philippe Couillard said the province will report a net increase of 1,200 doctors by 2012.

Source: The Gazette

Preventable death rate U.S.higher than Canada

Canada's health care system offers "excellent value for the money" says a British researcher who has studied preventable deaths in 19 industrialized nations.

The study, to be released today in Health Affairs, looks at "amenable mortality", deaths that would not have occurred if effective health care had been available.

Conditions that caused these deaths included bacterial infections, treatable cancers, diabetes, some cardiovascular disease and the complications of common surgical procedures. The study, which looked at figures from 2002-03, updated a similar report based on 1997-98 figures.
Its goal was to compare amenable deaths in the United States with 14 western European nations, plus Canada, Australia, New Zealand and Japan.

The study also tracked whether gaps in these countries had narrowed or widened. The figures were computed according to amenable deaths per 100,000 population under the age of 75.
In the first study, the researchers found that amenable deaths in the U.S. stood at 114.74 per 100,000 population, exceeded only by Ireland, Portugal, Finland and the United Kingdom.

In that time period, Canada's amenable mortality rate was 88.77, the seventh-lowest rate after France, Japan, Spain, Australia, Sweden and Italy.
In the most recent study, Canada's amenable death rate had dropped to 76.83, putting Canada sixth after France, Japan, Australia, Spain and Italy.

Meanwhile, amenable mortality rates in the U.S. have barely budged from 114.74 to 109.65 in 2002-03, taking the U.S. from 15th place to last place among the 19 countries.

"This study shows that Canada's health system has performed very well in its ability to prevent people from dying from treatable conditions," said Martin McKee, a researcher at the London School of Hygiene and Tropical Medicine, and co-author of the study.

"While everyone has to die from something, sometime, in an ideal world, no-one would die from the causes we have looked at, in the age groups we have included."

"Of course, we don't live in an ideal world," said McKee.
"However, the bottom line is that the Canadian health system delivers outcomes that are substantially better than those in its southern neighbour."

"More importantly, outcomes in Canada are improving more quickly than those in the U.S.," he said.
"Given that the U.S health care system is far more expensive, this suggests that Canadians are getting excellent value for money."

The researchers expect there will be further improvements in amenable mortality rates in industrialized countries, but the rate will slow down.

The most significant gains were made in the 1970s and 1980s, when drugs to treat common conditions such as hypertension became widely available, said McKee.
That raises questions about whether the U.S. will be able to narrow the gap between itself and countries with much lower amenable mortality rates, he said.

"Other research shows that many Americans are unable to afford the prescription drugs they need," said McKee.

"So, if some future administration can tackle this then we could see real improvements there." In countries like Canada, he expects the main gains will be less in amenable mortality and more the the quality of life, especially for older people.

Source: Ottawa Citizen

Saskatchewan wants better care for seniors

Saskatchewan Health will be exploring the grey matter of many groups to create a seniors' care strategy.

Health Minister Don McMorris wants to identify and address problems in current community-based care programs, from home care to facility care.

"The goal is to keep seniors at home as long as possible but we hear that there are some gaps in that process, so we want to ensure that those gaps are filled," he said.

"We'll be starting to work with the regional health authorities because they play a major role and also senior groups and all the parties that are involved to identify where are the breakdowns."

Dr. William Klassen, a retired physician and senior, applauds keeping seniors at home as long as possible. But he said the elderly often have special needs such as mobility problems, which require supports such as paratransit to be expanded to improve access to health-care services.

"Those who use paratransit say the services are very good but hard to get," he said.

"Timely access to physicians is important for all residents, but seniors often have chronic and acute diseases so they are more vulnerable," Klassen said.

"The health care and the independence of seniors face one issue that is unique to them and that is the changes that come with old age, that makes their health problems more difficult to diagnose and sometimes more difficult to manage," Klassen said.

"That's an area that geriatricians, a physician who is a specialist in dealing with old age, play a special part. Unfortunately our province has only one geriatrician and only one geriatric unit and that's in Saskatoon."

Read the full story here

Frustration builds up among Canadian family doctors

Faced with an aging population requiring increasingly complex care, overwhelmed Canadian doctors are feeling more and more frustrated by their inability to properly serve their patients' health needs, a national survey of physicians reports.

In the survey of more than 20,000 doctors and doctors-in-training from across the country, 75 per cent reported that inadequate funding of the health care system and an under-supply of physicians and other health professionals, along with paperwork and bureaucracy, are curtailing the amount and level of care they want to provide patients.

While that attitude was expressed by all the specialties, it is perhaps most pronounced among family physicians, simply because of their number and the nature of their practice, said Calvin Gutkin, executive director and CEO of the College of Family Physicians of Canada.

Almost half of Canada's roughly 60,000 doctors are family practitioners, and it's usually the specialty seen most often by patients, he said.

"I think the frustration remains related to just the capacity within the family medicine community to address all of the needs of the population," said Dr. Gutkin, whose organization conducts the triennial survey jointly with the Canadian Medical Association and the Royal College of Physicians and Surgeons of Canada.

"Physicians in most communities across the country are doing their best to try to see as many patients as they can," he said.

"But still many of them have had to ... limit the number of new patients they can take. And we have community after community with patients who are unable to access a family physician for themselves or for their families. "

Read the rest of the story here

A related story about Calgary doctors can be read in here

Unique mentorship program started in York Central Hospital

As part of building capacity at York Central Hospital in Richmond Hill, Ontario, a strategy was created to enhance the learning environment for staff, attract staff to the organization and reduce the significant turnover within the first year.

To this end a dynamic mentorship program, the first of its kind in Canada, was created supported by the Ministry of Health and Long-Term Care inter-professional education initiative and York Central Hospital (YCH) Foundation.

“The mentorship program has been extremely successful in recruiting and retaining staff nurses,” says Interim Professional Practice Leader Audrey Sheridan.

“Many new graduates told us that they chose YCH over other hospitals because of the mentorship program.
It speaks volumes about the value the organization places on nursing, both experienced and new graduates. The mentorship program has truly been a catalyst for YCH, raising the bar for nursing education and clinical development across the organization.”

This multifaceted program includes a number of components including mentorship development; supernumerary time for mentor support of newly hired staff; extended program development support for both experienced and new graduate staff; clinical fellowships; specialty certifications; national certifications and degree support bursaries.

New hires (experienced and new graduates) spend their first three weeks on the job learning in a classroom environment. Content includes: Assessment and Management of Pain; Risk Prevention and Assessment and Management of Stage I-IV Pressure Ulcers; Screening and Caregiving Strategies for Delirium and Dementia; Fall Prevention; Vascular Access and Diabetes Management drawn from the Registered Nurses Association of Ontario’s (RNAO) Best Practice Guidelines (BPGs).

Following the in-class portion, new nursing hires are assigned mentors and begin working with them on their specific nursing services. Further development components related to relationships include: providing and receiving feedback, responding to emotionally charged situations, building trust and Patient Focused Care which was based on the RNAO’s BPGs for Client Centered Care, Therapeutic Relationships and Leadership.

Read the rest of the story here

Editor's opinion:

“Mentorship is a key solution to transfer valuable knowledge in any kind of profession.
Recently, I came across a virtual community for health care Professionals that has a built-in mentorship program.
Health care professionals can share their knowledge in various ways on that community, such as on a forum and via private messaging.

It's called LinkHealthPro and is free to sign on. ”

Genetic mapping of Quebec commences

Efforts to create a genetic map of Quebec begin in earnest this month as researchers start recruiting people willing to offer up their bodies' blueprints.

The University of Montréal-driven project aims to sign up the first 400 people from Montreal, Monteregie and the Eastern Townships, with the aim of eventually collecting data on health and disease from just over 20,000 people.

The government-funded project is expected to create one of the largest data and biobanks in Quebec and will be made available to health researchers.

"The genome of each human being contains enormous quantities of information. The analysis of this information can increase our understanding of the underlying processes of health and disease," Dr. Claude Laberge, a geneticist and scientific director of the CARTaGENE project, said in a release.

The initial subjects, all between the ages of 40 and 69, will be selected at random using a list provided by the province's health insurance board.

Laberge says focusing on subjects in this age group means researchers know they will find that one-third are already coping with a variety of ailments including hypertension, cardiovascular diseases and arthritis.

Read the full story here

Insufficient warning dangerous drugs by Health Canada

Despite evidence indicating seniors are being prescribed potentially dangerous drugs, Health Canada says it can't do anything more to make its warnings about these medications more effective.

The department is responding to an investigation in December revealing that doctors continue to prescribe anti-psychotic drugs to seniors, despite Health Canada warnings in 2005 that the drugs increased the risk of heart attack, stroke and death.

The analyzed sales data for the drugs indicated that prescriptions increased from seven to 40 percent for a 24-month period after the warnings.

Dr. Marc Berthiaume, director of the Marketed Pharmaceuticals Division at Health Canada, said the department warns doctors and their patients about dangerous drugs through an increasing number of safety alerts such as letters, e-mails and its website.

"We have developed over the years different ways to increase our outreach of that safety information," he said.

But he acknowledges it is up to physicians to read the mailed material. "We cannot open the letter for them. We cannot make them read them."

He said that's because the department doesn't have the legal power to do anything more than publish warnings.

Terence Young, whose 15-year-old daughter Vanessa died seven years ago after taking the drug Prepulsid, said that is nonsense. "Health Canada claims their responsibility stops when the information gets into doctors' hands. I find that disingenuous on several levels.

"The safety warnings sent out to doctors simply don't work, and this was well established at the inquest into Vanessa's death."

Young said Health Canada is wrong to claim it has no legal authority to beef up health warnings, because the law makes it clear the minister's ultimate duty is to protect the safety of Canadians.

Michèle Brill-Edwards, a pediatrician and clinical pharmacologist and one of Health Canada's fiercest critics, agrees. "The minister has in the enabling legislation called the National Department of Health Act very broad powers for the protection of the public."

"I think Dr. Berthiaume is voicing the standard views of the department that seek to limit the department's responsibility for safety."

Although Health Canada refers to its drug alerts as risk communication, Brill-Edwards said that it's hard to call it communication when no one seems to be paying attention.

Source: CBC News

Related article:

Dangerous drugs still prescribed to seniors

Does Halifax get its own Mayo Clinic?

Liberal Leader Stephen McNeil's remonstrations in the legislature this month condemning a year-old memo from some Capital District Health Authority physicians proposing a new, doctor-driven, private-public, "Mayo Clinic-like" hospital facility in metro were an emblematic example of the sort of backward, stick-in-the-mud attitudes and reactionary, tunnel-vision thinking that keep Nova Scotia an underachieving backwater.

McNeil trotted out the customary boilerplate about defending the sacrosanct public health care system from the evils of profit motive or market accountability, trotting out the old FUD (Fear, Uncertainty and Doubt) about privatization of health care delivery leading to (horrors!) - two-tiered health care, with NDP leader Darrell Dexter chiming in with his labour-union constituency's pet trope about private hospitals and clinics supposedly luring doctors and nurses away from the public system.

The 2006 memo, reportedly authored and signed by Capital Health surgeon Robert Stone, lays out a concept for clinics or centres that "should not be staffed by 'unionized' personnel

It would focus on providing endoscopy; breast health services; prostate therapy; various other diagnostics; orthopedic surgery, other same-day surgeries, and executive preventive health - all procedures that do not require the facilities of a fully-equipped and staffed, acute-care surgical hospital.
For which there is a strong demand that isn't being met in a timely fashion by the current public system, and which helps keep waiting lists long for other, more complex surgeries and treatments.

It's just, plain inefficient and a misuse of scarce resources.

Read the full story here

Physician becomes Prince Albert Citizen of the Year 2007

"She is a physician who has gone above and beyond the call of duty, especially in the advancement of the health of women of Prince Albert and northern Saskatche-wan ... I find it simply amazing that she delivered approximately 270 (babies) in Prince Albert this past year," Ajay Krishan, one of her nominators, wrote in a letter to The Prince Albert Kinsmen Club and the Daily Herald.

Dr. Lalita Malhotra has won Canada's highest civic accolade and counts the 2007 Prince Albert Citizen of the Year as one of her greatest honours.

Last Wednesday she was named the Prince Albert Citizen of the Year by The Prince Albert Kinsmen Club and the Daily Herald.

Malhotra was awarded the Order of Canada in 2006 and the Saskatchewan Order of Merit in 2001.
But this new honour is very important to Malhotra, who has called Prince Albert home for 32 years.
"This is the biggest honour Prince Albert can give me ... When your own community honours you like this, it is totally different. I am very touched, very emotional."

As an obstetrician, Malhotra is known in the province for delivering an stunning average of 250 babies a year.

"Every baby is a thrill and it keeps me going. I feel every child is a challenge to me and it is a learning experience every day. I have no intention of giving up."

Read the rest of the story here

Battle over language in Winnipeg's St. Boniface General Hospital

A language battle is brewing at one of Winnipeg's leading medical institutions.

Since October 14th, nursing jobs posted for the Woman and Child program at St. Boniface General Hospital list the ability to speak French as one of the qualifications.

That has some nurses worried the ability to speak French is taking priority over skill and experience, possibly putting patient care at risk.

"They've started hiring people into positions and taking French language qualifications over top of nursing experience," said nurse Tamara Burnham, a 14-year nursing veteran who works in the St. Boniface program that includes obstetrics and gynecology.

"With all the things going on in health care, to focus in on that doesn't make sense."

Manitoba Nurses Union Local 5 says it's gone to court to fight the French language requirement because it violates their collective agreement and common sense.

The nurses union went to court October 23rd after the Labour Board refused to hear the matter.
Their suit said the Labour Board erred when it refused to hear their complaint that the hospital committed an unfair labour practice by changing the conditions of employment and refusing to negotiate.

The hospital has a hard time filling all of its nursing shifts, never mind requiring that they're filled by French-speaking staff, said Burnham.

Burnham said she has never seen a francophone patient's treatment hampered because of a language barrier.
Most Franco-Manitobans can also speak English, she said.

"A very real problem, however, exists with the growing number of immigrants who speak neither official language," she said.

"If the hospital wanted to address a real language barrier, it would hire interpreters who speak languages like Urdu, Hindi and Mandarin," she said.
The hospital has volunteer interpreters who speak 60 languages but they're not always available when you need them, she said.

Burnham said she has seen women in labour unable to get pain medication because of a language barrier.

"You can't get informed consent because you don't know if they understand," said Burnham. "If it's a delivery, you can't stop a baby from coming," she said.

"Too bad they couldn't spend this much time and energy to have interpreters on call."

Union local president Debbie Mintz said the hospital hasn't done a demographic study of the patient population since the early 1990s, and doesn't know how the client population in Winnipeg has changed.

The hospital says it has to expand services in French.

"St. Boniface General Hospital has a government-conferred responsibility to actively offer and provide services in French to its patients, their families and the public," hospital spokeswoman Helene Vrignon wrote in a statement.

"To meet our legislated responsibility, a small number of staff in direct patient care positions must be bilingual French and English.
In fact, health services in the language of your choice is a basic component of quality of care."

Violence in hospitals gets out of hand

Violence seems a part of life for those working on the front lines of this country's health care system.

The impact of workplace violence on the health care industry is enormous, exacting a heavy financial toll, according to a 2006 survey by the Workers' Compensation Board of British Columbia.

Facts in figures concerning violence against health care workers:

Injury claims

Nine percent of all B.C. health care workers' accepted claims are due to violence.

More than half of the accepted B.C. claims for health care workers are from nurses aides and licensed practical nurses.

One in five of the accepted B.C. claims for healthcare workers, due to violence in the workplace, is from registered nurses.

$24-million was spent from 2002 to 2006 in workers compensation claims involving violence against health-care workers, including physicians, nurses, care aides, pharmacists, housekeeping staff, technicians and administration.

162,934 days were lost in 2006 due to accepted claims of violence against health care workers in B.C.

Fourteen B.C. health workers were injured every week in 2006, as recorded in accepted violence claims.

Most often hurt workers' body parts in attacks

Arms, including wrists, fingers and elbows: 27 percent

Backs and shoulders: 25 percent

Head, including neck, face, eyes, ears and scalp: 14 percent

Violence against nurses in Canada:

A national survey of nearly 19,000 nurses done by the Canadian Institute for Health Information, Health Canada and Statistics Canada in 2005 found the following:

29.6 Percent of nurses working in hospital said they were physically assaulted by a patient over the past 12 months

49.6 Percent of nurses who worked in a long-term care facility, such as a nursing home, said they were physically assaulted by a patient over the past 12 months

43.6 Percent of male nurses have faced physical assaults, be they in hospital, nursing homes, a community health centre or other health care settings

27.9 Percent of female nurses have faced physical assaults in the same settings

46.3 Percent of nurses working in a hospital said they were emotionally abused by a patient over the past 12 months

48 Percent of nurses working in long-term care facilities, such as nursing homes, said they were emotionally abused by a patient in the past 12 months

54.3 Percent of male nurses have reported suffering emotional abuse over the past 12 months, be it in a hospital, nursing home, a community health centre or other health-care related settings

43 Percent of female nurses have reported suffering emotional abuse in the same settings

46.7 Percent of nurses under 35 reported they have been emotionally abused by a patient in the past 12 months

38.2 Percent of nurses over 55 reported they have been emotionally abused by a patient in the past 12 months

Tailor-made food supplements disputed by Science

From A to zinc, the choice is endless.
Should you choose single vitamins or a multivitamin? Or how about a special formula for stress, fitness, women, men or seniors?

Wouldn't it be great to know exactly which supplements are right for you?
That's what laboratories that specialize in 'body chemistry balancing' promise.
For several hundred dollars, they claim to identify vitamin and mineral deficiencies from a simple blood and urine test.

For David and Cheryl Solomon of Dollard des Ormeaux, nutritional testing takes the guesswork out of the perennial question of whether they're getting the proper vitamins.

Six months ago, the couple and their three sons, age 6 to 11, underwent testing by NutriChem, an Ottawa company founded by pharmacist Kent MacLeod that sells personalized nutritional supplements.

"The beauty of it is he'll customize the vitamin for the individual," said David Solomon, 38, who takes 20 capsules a day, containing vitamins, minerals, fish oils and amino acids.

Cheryl and the boys each take between seven and 10 capsules a day of custom-made supplements.

"This is not a jack-of-all-vitamins," said Solomon, an advertising manager for the Suburban newspaper.
"Until you get tested, you don't know what's right and what's wrong."

The family spends $1,000 a month on supplements. The initial test cost $600 per person.

"In the last few months I've been taking it, I feel fabulous," said Solomon, who used to suffer from chronic indigestion.

"Several doctors said, 'You're getting older. Your body is changing.' "

Solomon, who also takes prescription medication for his digestive problems, said the nutritional supplements have helped him digest food better and boosted his energy.

MacLeod provides personalized care that is sorely lacking in the health care system, according to Solomon, who regards the cost of the vitamins as a long-term investment in his health.

"It's about get in, get out as fast as possible," he said of mainstream medicine. "We wait until we break down before we take care of something."

"This is the future," said pharmacist MacLeod, who founded NutriChem in 1981 and now provides nutritional testing and supplements to 20,000 families around the world.
The company mails out kits for blood and urine samples, which customers return to Ottawa for testing.

Many people are vitamin-deficient because of poor diet or problems absorbing nutrients from food, said MacLeod, whose customers range from middle-aged women with depression to professional hockey players.

They hear about NutriChem from the Internet, referrals by alternative health practitioners and word of mouth.

"Ninety percent of the Canadian population is not getting one or more essential micronutrients," he said.
"There are people running around with no gas in the tank."

MacLeod got into the nutritional-supplement business 27 years ago by creating vitamin cocktails for children with Down syndrome.
He later expanded his practice to include children and adults with conditions from autism to depression, high-performance athletes and people simply seeking optimum health.

But experts dispute the claims of companies that perform nutritional testing......................

Read the full story here

Groundbreaking national health survey starting soon

In the next few days, a groundbreaking national health survey is planned to be starting in British Columbia.

The survey is initiated to discover what kinds of toxic chemicals are present in Canadians' bodies, as well as examining other health issues such as obesity and disease other diseases.
Nearly 700 residents in the province will be surveyed.

By the end of 2008, more than 5,000 Canadians between the ages of 6 and 79 will have been tested.
Participants must agree to a series of physical exams, fitness testing and blood and urine tests. They'll also be required to wear an activity monitor for seven days.

According to Jeanine Bustros, the director of the physical health measures division of Statistics Canada, the survey could have major significance for health policy, depending on the findings.

"This survey will allow us, for the first time, to have a benchmark," she said.

"To be able to measure: Are we getting better? Are we getting worse?, in terms of the levels of contaminants in the Canadian population."

StatsCan will put the findings together for Health Canada and Canada's Public Health Agency. The results will become the first-ever comprehensive health study that directly measures things like obesity, lung function, chronic disease and levels of toxic chemicals in the blood.

Individual health results will be , but will be provided to participants who request them, within weeks of testing.

Only Canadians who are contacted by Statistics Canada are eligible to participate.
The results of the survey are confidential and protected by privacy laws, but will be given to participants within weeks after testing on request.

Source: CBC News

Folic Acid should be used also BEFORE pregnancy

Health care professionals are urging women who could become pregnant to up their intake of folic acid.

A panel of experts from the Society of Obstetricians and Gynecologists of Canada and Toronto's Hospital for Sick Children, along with Health Canada say certain birth defects can be prevented if women who become pregnant are taking proper amounts of folic acid.
According to Health Canada, folic acid is important in the normal development of a baby's spine, brain and skull and can prevent defects such as spina bifida.

It is recommended that women take a supplement of 0.4 milligrams of folic acid daily, along with eating sufficient amounts of foods fortified with folic acid such as spinach, broccoli, corn, oranges, peas, beans and lentils.

The supplement should be taken at least three months prior to becoming pregnant and should continue to be taken through the first three months of pregnancy.

"Folic acid becomes critical near the end of the first month of pregnancy," said Heather McAvoy, public health nutritionist at the Prince Albert Parkland Health Region

"Often women don't even realize they are pregnant at this time so it's important to have already been taking the supplement."

McAvoy also pointed out that some women are at a higher risk of having a baby with a birth defect.

"If you have had neural tube defect pregnancy, or have a family history of that problem, or if you have diabetes, epilepsy or you are overweight, you should consult a doctor before planning a pregnancy,"

Source: P.A. Daily Herald