Tuesday, 13 November 2018

The Old quack Reminisces. Pt 4.

   The Medical Arts Clinic, where his Canadian medical career began, far exceeded his expectations.    Situated in a clean new medical building, it housed about sixty physicians representing general practice and most of the major specialties of the day.  About fifteen general practitioners worked shoulder to shoulder with general surgeons, thoracic surgeons, internists,pediatricians, radiologists, pathologists working together in an atmosphere of collegiality that, I am sorry to say, no longer exists.  Many of the doctors who founded the clinic, were WW2 veterans from the prairies, whose goals were to come back to Canada and establish a clinic comparable to the renowned Mayo Clinic, in Rochester, Minnesota.
   They were motivated primarily by idealism, not money and were largely successful in their endevours.  I was impressed, not only by their standard of medical practice, but by their decency as human beings.  As a new doctor in the clinic, I was assigned to a mentor, to whom I could turn when I had questions or problems and whose mission included 'keeping an eye on the new man'.   His name was Jamie MacIntosh and to me he was the quintessential Canadian.  Tough, no-nonsense, kind and compassionate, I can still hear his clipped Canadian accent - at least that's how it sounded to  this recent immigrant from the Emerald Isle.  A fighter pilot in WW2, he stayed lean and mean, smoked like a trooper and when  in  later years he sustained a heart attack, he got into his car and drove down  to  the emergency room and told them they better see him quickly because he was having a 'coronary'.  They did, and shortly after he had a cardiac arrest, was resuscitated, went back to work and practiced medicine for several more years.
   The young docs at the bottom of the totem pole in the Medical Arts Clinic got the house calls.  

He awoke a moment before the phone rang knowing it was going to scream at him if he didn't get it immediately. He got it at the first ring before it woke anyone in the house. She moved, turned and resumed her quiet snoring. He looked at the bedside clock. It was 2.55 am. He slid out of bed as he put the phone to his ear. It was the answering service "we have a call for you, doctor"  the operator said. 
"Take a number and tell them I’ll call back immediately" he said. He didn't want to wake the baby; he’d call back from the spare room.  Two minutes later he was wide awake and calling the number back. 
A female voice said "I have terrible stomach pains, doctor, can you send me something out?" 
 "I can’t send you something without seeing you" he said knowing he had just committed himself to a house call. "What's your address?" 
She gave him an address on the seamy side of town. He sighed "I’ll be right over. "

      A few minutes later he was in his car, braced by the cold Canadian winter. He hadn't a garage in those days, and after he had scraped the icy night from his windscreen, the frozen the base of his tires thudded him awake. The car thumped along the street, the bright moon throwing it's bluish white light against the snow, reflected back towards the sky. The car traveled across the city quickly, despite the icy roads as Stan piloted the car with the confidence of someone used to driving in these conditions, which he now was.  Not bad for a guy from the Emerald isle! As he approached South Railway and the CN station where he had first set foot in Regina the neighbourhood became perceptibly seedier, until he found himself outside a run down hotel. He checked the address.  There was no mistaking it, he thought gloomily, this was it. He pulled his car into the parking lot, left the engine running (he wanted it to be warm when he came out: if someone stole it, too bad), threw his cigarette away, picked up his medical bag and walked through the door into the dimly lit hall. There was no sign of any sort of caretaker or watchman around. He did have a room number, 23a, and he guessed that might be on the second floor. As he walked up the creaky staircase it seemed to get darker. He got a sour smell, a combination of beer, urine and tobacco. He walked along a stark landing and looked at the numbers. 23a somehow seemed to look worse than the adjoining rooms. The smell of urine seemed  overwhelming and the whole building seemed unbearably hot. He loosened his down parka and he felt the body heat it had captured waft past his face. He hoped it would be cooler in the apartment.  He decided to try one more time then he was going home. He banged on the door loudly this time, hopeful that it would not be answered. It was.

      The man who opened the door was a dirty and disheveled  and smelled of booze.
   ” Come in, Doc" he slurred. 
   Stan hesitated, and then walked into the sparsely furnished, dimly-lit room. He looked around. The room was shabby and untidy with a torn, shapeless sofa, on which a woman of about 35 reclined. She was clad in a black slip and not much else, held a smoking cigarette in her hand and took a deep drag on it before she spoke.
"Am I ever glad to see you, doc" she said.

"Good evening” said Stan,” I’m Dr.Smith. What seems to be the trouble" He wondered whether he should have framed his word differently, in the circumstances.

“I was to see one of the doctors in the clinic the other day and he said I have gall-stones, and if I get the pain again I am to call up the doctor on call for a shot of Demerol.  I've been in terrible pain all night" she said.   

      "Why did you wait until three o'clock in the morning to call me?” he asked.

"Oh, I didn't want to bother you, doctor," she said.

Stan sighed, "okay, step into the bed-room and I’ll examine you." 
 "oh,I don't think I need an examination right now, just give me the shot and I’ll come into the office tomorrow for a check-up."

Stan looked at the woman, apart from looking tired and dissipated, it was obvious that this woman was in no distress.

Stan, young, but not inexperienced, assessed the situation and now decided the time had come to be firm. This woman was obviously looking for drugs. He hadn't decided exactly what her relationship was with the shabby looking man.

He was now sitting in the room's solitary armchair chatting incoherently either with himself, or to Stan.  Stan caught "Party in Seattle and then this guy pulled out a gun." He decided it was time to be firm, deal with the situation and get out of the apartment as soon as he could.

"You either let me examine you or I'm leaving without prescribing anything. You don’t seem to be in any pain right now"

She looked as though she was about to tell him to fuck off but then seemed to think better of it.

"Well, if you could just leave me a few Demerol or Talwin pills in case the pain comes back during the night, then I’ll come into the office tomorrow for an examination" 
Stan was about to tell her that he was leaving nothing and if the pain came back she could go to the emergency room, when there was a loud knock at the door. All three occupants of the room froze. Stan clutched his medical bag with its considerable variety of drugs, tightly in his hands. No one attempted to open the door. Again a loud knocking, this time more insistent, demanding an answer. Stan was just on the point of quickly opening the door, walking down the corridor and getting into his still running car, when with a loud crack, the door flew open. Two men stood in the doorway. Stan sized them up quickly. One tall, fairly well dressed, tough looking, the other fat and rather shabby. Stan noticed that as the short, fat one burst into the room, his jacket swung open revealing a holstered gun. (Tomorrow's Leader Post headlines flashed in front of his eyes. "Young Physician shot in Drug Shootout") He clutched his house call bag firmly in his hands. If they got that it was going to be over his dead body! He decided that it was now or never. He pushed past the two men, hoping they would be so busy with the occupants of the rooms they wouldn't bother with him. He walked briskly down the corridor, head down making for the car, engine still running to keep it warm. He knew once he got there he would have no problem. He glanced over his shoulder - my God, they were after him. He broke into a trot, and so did they! He felt a heavy hand laid upon his arm as he was spun around. The small shabby man's hand went to his holster. Stan wondered whether to run for it.

"Sgt. Sam O'Hanlon, Regina City Police Dept." he said. ”Afraid you got caught up in a drug bust, doc." He shoved his police department badge under Steve's nose. "I just have to establish for the record that you didn't leave any narcotics at the address, so that when we lay charges they can’t say that it was just stuff the doc left."

Stan said, "no, I didn't leave anything"

"We may have to call you for evidence, doc."

Stan nodded "Okay, will that be all?"

"Yeah, that's all, doc".

       Stan walked out to his car. It was warm and cozy, as he drove himself home. He parked his car in his carport and plugged in the block heater so the car would start in the morning. He crept up the stairs so as not to waken the baby. On the landing he removed his clothes, slipped into the bedroom and felt the cozy warmth. As he snuggled up beside her she stirred.
       "Have you got to go out? " she asked.
       "No” said he.

Thursday, 1 November 2018

Good-bye Canada.,hello Cannabis!!

Looks like the Future of Canada is in the hands of Big Pharma.  This is what I  received in my mail today:

Medical Cannabis: The Future is Now
Realities and Practicalities for Prescribers

Dear Doctor,

We are pleased to invite you to join Shoppers Drug Mart for an exciting educational event, Medical Cannabis: The Future is Now; Realities and Practicalities for Prescribers.
Shoppers Drug Mart will be hosting evening events in the following cities:
  • Calgary on November 6th
  • Vancouver on November 8th
  • Toronto on November 12th
  • Ottawa on November 15th
Each city will offer a unique, educational, and engaging experience. You will walk away with a better understanding of the science behind medical cannabis, including practical tips and clinical tools to capably and confidently authorize medical cannabis for your patients. You will also gain a solid understanding of the authorization process and of the next steps in treating your patients.
Shoppers Drug Mart is dedicated to providing the highest level of care to patients and wants to include you in this effort.
Please click the link below for more information and to register to attend.
Anyone who scans through my blogs knows I am no supporter of legal weed. It is a gateway drug that predisposes to addiction, psychosis, lung damage and probably brain damage. That the Canadian Prime Minister who was probably born with a high THC level and who witnessed the devastating effect the drug had on his own mother has so aggressively pushed this program forward must be more than a coincidence. Turning Canada, a nation with a devastating record of drug addiction into a major purveyor of marijuana is a great mistake. The hurried manner in which this was introduced assures us there will be no adequate technology to measure impairment in the automobile or the workplace. The combined effect of pot and alcohol will surely increase traffic fatalities and injuries as it did in Colorado. The health system spent millions of taxpayers dollars in guiding smokers to give up the habit, only to replace it now with a more dangerous one. Last week an alert mother picked up a weed impregnated candy that was given to her seven year old.
There are only two reasons for this unconscionable action. One is money and the other is votes. Some might suggest a third, to make segments of the population more easily manipulated.
The decline continues.

Tuesday, 30 October 2018

The Old Quack Reminisces. Pt.3

     He stopped and thought for a while before proceeding.  After all, when you are an Octogenarian surely you are entitled to settle into obscurity?   He and a colleague once felt inspired to write a book that they thought was significant, but when he had sent it to an old friend from  the long past in the old country for a preliminary review the reply said, "unless you are prepared to strip yourself naked to the world , body and soul you can't write a real book.  Your manuscript is an account of all you are prepared to make public and that's okay, but it is not enough!"   He knew that was true..  Nowadays,his scribbles were mainly to entertain himself and to leave a trail, if anyone cared..  

     Mac Chase picked him up at precisely 9 am. as promised.   As he climbed into the car, Mac said,       " You know I forgot to take you out to pick up a few groceries when I dropped you off yesterday,  I hope you got by okay.."
    "Oh yes, no problem." he lied.
     It was about a fifteen minute drive to the Canadian Imperial Bank of Commerce on 11th Avenue in Regina.  It was directly across the street from the Medical Arts Clinic in Regina.  They parked the car and walked into the bank.
     " We have an appointment to see Jack," said Mac.
     They were shown into the  manager's office, which looked to Stan like a Hollywood "executive office".
     "Hi Jack" Mac said, "Stan just arrived from the old country yesterday.  He's on the clinic payroll as of the first of last month.  He has no money, so he'll need something to live on, a car, an apartment and some cash."
   "Stan, this is Jack Ink, the bank manager!"  
     Jack Ink, yes, that really was the manager's name.  In retrospect, maybe it was that name that turned Stan into a lifelong Fountain Pen and Ink aficionado!
     After shaking hands and settling Stan across from his desk Jack said, "Stan, how much do you think you will need?".
     Stan thought for a moment.  In London, England, when he needed to borrow twenty pounds (about $60 in those days), for a kerosene oil heater, the bank manager frowned at him and said, "You're just a newly graduated man, we'll have to have some security for a loan of this amount.  Do you have any life insurance?"
     "Yes, I  have one thousand pounds of life insurance. (3000$) "
     "Well, you'll have to turn it over to us until the debt is paid off."
      His baby daughter was turning blue-ish on those cold London nights and he thought he had detected a slight mitral systolic murmur when he  listened to her heart, so he was prepared to hand over his life insurance and anything else he owned.   He still thought that was the crucial moment when he decided he really didn't want to spend his life in England.  Perhaps that was good, because, shortly after he had settled in Canada, he had a letter from the practice he had worked in, in London England, asking him to come back and be  partner in the practice.  He had no doubts when  he  refused the offer.
      "Er, I really don't know," Stan said.
     Jack thought for a moment. "How about $5000?"
     Stan felt the room starting to swim a little.  Five thousand dollars!  How could he handle  loan  like that?   He almost fell off the chair.
    "Five thousand dollars," he stammered,"I don't think......"
     Jack Ink cut him off.  Don't worry, if you don't think  that's enough we can increase it to whatever you need to get started.."
     "Thanks, thanks very much," was all he could say.  It would have been too complicated to say more.
      They left the Canadian Imperial Bank of Commerce, an institution that Stan dealt with for the rest of his life.  Just shows what a Bank Manager can do!!
     "Now that you have a bank account, we have to get you a car, "said Mac, as they climbed into the car and took off for Regina Motor Products. He bought a used huge Chevrolet Biscayne, no power steering or brakes (He didn't know of such things) without even a radio.  Even now he recalled listening to reports of the Kennedy assassination on a tiny portable radio that slid around his dash!
    The next day he started work.


Wednesday, 24 October 2018

The Old Quack Reminisces. Pt 2.

It's just about twenty years since the old quack moved to Ontario after thirty five years in Saskatchewan. He had come to Regina from the old country in January 1963, arriving at four in the morning at the CPR station with a wife, a little girl and forty dollars Canadian. They were supposed to be able to sleep in the Regina sleeper until eight in the morning when they were to be picked up by the manager of the Medical Arts Clinic where he was to work. It was so cold that they were unable to uncouple the Regina sleeper so they were evicted into the huge empty CP station that was totally deserted. It was four a.m. and still four hours until they were going to be picked up by the clinic manager.
"I'm hungry, daddy" the little girl said..
He looked around the huge Hall. Nothing. Absolutely nothing. Not even a bloody dispensing machine. He walked over to the door and looked across South Railway St. Everything looked white and frosty. He could almost hear the cold. Across the street, which in more temperate weather conditions served as "Hooker Row" he could see a neon light. A little restaurant, perhaps? He pulled open the heavy door and stepped outside to get a better look. The cold air hit him like a sledge hammer! He'd never felt anything like it before. Still, there it was! A dancing florescent light advertising a restaurant.
"There's a little restaurant right across the road, let's make a dash for it," he said. wrapping the little girl inside his coat and taking his wife's hand. He wished them across the road to what turned out to be the ubiquitous little Chinese convenience store restaurant that exists everywhere in Canada.
"Come in, warm up,. You just got off the train? Where you come from?"
I told him we had just arrived in Saskatchewan from England.
"Welcome to Canada," said the little old Chinese gentleman.
His wife came over and hugged our daughter. "Little girl must be hungry." And without further ado brought a bowl of cereal. "She can start with this then we'll see what she wants to eat.".
They danced around us, fed us well and didn't want to give us a bill. Of course I insisted. I've always loved Chinese people ever since.

About 8 am, Mac Chase, the clinic manager picked us up. He was horrified that we had been there for several hours.
"Why didn't you phone me?" He asked.
"I wouldn't phone anyone at 4am."
He bundled us into his car to drive us to the house the clinic had rented from someone who has gone South for the winter. The drive along Albert Street in Regina was spectacular. The leafless trees that bridged that regal Street were encrusted with jewel like bracelets that were magnificent. He drove us to a nice house on Angus Crescent, that still looked nice when I drove by when I visited my sister a couple of years ago.
"I'll pick you up in the morning," Mac Chase said when he dropped us off. "Have you any money?'
"Oh yes," I said, "about forty dollars".
"Well, we'll have to do something about that," he said, "Our first stop will be at the bank, then we'll have to get you a car and see about setting you up with an account so you can buy some furniture when you find an apartment."
As he walked out the door he said, "Pick you up about 9 am."
All of a sudden everything was quiet. The baby was asleep. Irene was unpacking her hand baggage. The rest of their baggage would arrive in a couple of days. Stan opened the fridge to check on the supplies for the next day or so. There we precious few.
"Hey, I have to go and get some basic provisions," he said. "We need some stuff to carry us over until we can do a proper grocery shop tomorrow. Right now the only things in the fridge are some bread, milk, butter and some Old Port cigarillos! There has to be some sort of convenience store I can walk to and pick up some essentials. I'll be back soon."
He put on his coat, scarf and gloves and walked out into the brilliant white sunlight. The sun glistened on the snow and the cold was so refreshing after the overheated house that he felt invigorated. But not for long,. He walked around Angus Crescent and onto College Avenue looking out for any sort of convenience store but saw nothing. He kept walking and was starting to feel a little cold now. He'd never experienced anything quite like this before and in addition, his ears were starting to hurt. He stepped up the pace. His ears were getting so painful that he was actually considering knocking at the door of one of the houses and asking if he could phone for a taxi,, but if he did that sort of thing his forty dollars wasn't going to last long. Then, saved! Right on the corner he saw a little convenience store. The Chinese woman behind the counter greeted him with, "You look so cold, better warm up!"
Saved by the Chinese twice in a twenty four hour period, he thought gratefully.
Soon after he staggered back into the house with his groceries he noticed some sensation returning to his ears. Two minutes later he was writhing in agony as his frozen ears thawed out. For years after his ears remained excessively sensitive to the cold. When the pain settled a little he took one of the Old Port cigarillos from the fridge and wished he had a rum and coke to sip on while he smoked it.
At precisely nine in the morning Mac Chase picked him up.
After the usual greetings Mac said, "Okay Stan, first thing we have to do is get you some money. We're going to the bank!".

Monday, 15 October 2018

Physician dissatisfaction and CMA incompetence.

The results of the biennial 2018 Survey of America’s Physicians, intended to “take the pulse” of doctors in the U.S., were recently released and tallied from responses of 8,774 physicians (along with 2,472 written comments). And the findings leave much to be desired.

Here are some of their findings: 
  • 80% of physicians are working at full capacity or are overextended
  • 62% are pessimistic about the future of medicine
  • 55% describe their morale as somewhat/very negative, while 78% report sometimes/often or always experiencing burnout
  • 23% of their time is spent on non-clinical paperwork (meaning unrelated to patient care)
  • 49% would not recommend medicine as a career to their children

    Depressing as the above may be I have no doubt that physician morale in Canada is much worse and declining rapidly.

  News release from Concerned Ontario Doctors 

The Canadian Medical Association Abruptly Resigned 
from the World Medical Association

Why is Canada Alone?
October 10, 2018, (Toronto, ON) - On October 6, 2018, the Canadian Medical Association (CMA) abruptly left the World Medical Association (WMA) Meeting being held in Iceland and resigned from the WMA. 

In 1946, Canada was one of only ten counties to establish an Organizing Committee of international medical doctors, then founded the World Medical Association in 1947 with 29 countries. The World Medical Association developed the modernized Hippocratic Oath with the Declaration of Geneva in 1948 after the World War II atrocities and has since had the highest standard of International Code of Medical Ethics. Now in 2018, the WMA includes 114 countries and represents more than 10-Million physicians globally. Just days ago, the CMA abruptly resigned Canada from the WMA following absolutely no consultation with Canada’s physicians.

The CMA is claiming that their sudden resignation from the WMA is about an “ethical” stand on “plagiarism”. But there is far more to this than meets the eye and this will impact all Canadians. 
     The CMA had been founded in 1867 (about 100 days after confederation) as a non-profit organization of physicians for physicians. However, the CMA’s resignation comes after nearly two years of physician membership resignations nationally from the voluntary organization as the CMA has increasingly acted against the best interests of Canada’s patients and frontline doctors. More recently, the CMA encouraged the legal loss of physicians’ conscience rights, unilaterally removed physicians from the CMA's mission and vision statements, secretly sold physicians’ MD Management financial firm (founded in 1957 by physicians for physicians and their families) to Scotia Bank for $2.6-Billion with absolutely zero consultation with CMA Council or CMA Membership, and is soon to implement an unethical Code of “Ethics”.

On October 4, 2018, while at the WMA Meeting in Iceland, the CMA and the Dutch Medical Association (KNMG) had planned to put forth a motion for the WMA to be neutral on (i.e. not condemn) all physician assisted suicide and euthanasia of patients (i.e. unrestricted). The CMA and KNMG had withdrawn their motion due to lack of international support.

    The CMA claimed it was withdrawing and walked out  because of because of a speech plagiarism by the newly elected chair of the organization - the speech  had been written  by a professional speech writer, the chair-elect admitted and apologized.  I think the CMA walked out because it was criticized for the disastrous job it has done in protecting the ethics of physicians in exercising their conscience, in refusing to be  party to killing and perhaps refusing to become part of the 'drug  pushing' community.  (When the president of the CMA cautioned regarding the dangers of wide spread marijuana use, she was forced to walk back her very real concerns!)
     The $2.6 billion  sale of MD Management to Scotia Bank without consultation with the membership is appalling and surely requires further investigation.

Monday, 1 October 2018

Knee. Gimme a knee!

   As I sat waiting for my bagel and cream cheese in Williams Coffee Pub,on Saturday morning, I found myself inadvertently drifting into my role as honorary medical consultant to the London (Ontario) Pen Club.  It's a role I quite enjoy, because like Marcus Welby, I have a manageable patient population to look after, (about a dozen) unlike the days when I actually had to make a living practicing medicine.  Although few of the members of our club are actually as mature as myself, most of them are old enough to have an impressive list of maladies that they appreciate discussing with an old-fashioned curmudgeon of an ex-physician.  Since this is once again my vocation, as once it was and not the way I make a living, I am free to express my convictions and views, without deference to the political correctness, that has distorted medical practice beyond recognition, as it does in so many other walks of life. Today's topic was  triggered by the story a friend told me regarding the distress his son was suffering as a result of knee  pain that is increasingly disabling him.  He is an otherwise healthy guy who has been told he will need knee surgery but not yet.  As working becomes a growing problem he wonders if he is going to be suffering for another couple of years before he goes back to the Orthopedic specialist to be put on the list to wait  an additional couple of years before his knee is replaced.   
   It is difficult to comment, because of insufficient information, but the above expectation is realistic if patient does or shortly will need surgery.   If it was me and my job depended on it, I would  seek a second consultation outside of the public system.   I'd probably go to the Cambie Clinic in Vancouver.
   The most recent damage to health care occurred in the Province of British Columbia, which is proposing to enforce prohibitions against private medical care, despite a long running constitutional challenge to the legal claim.  The provincial government is planning to close down all private clinics while the B.C. Supreme Court hearing is still proceeding.  This would close down approximately sixty clinics and close down the service to tens of thousands of patients per year.  The sort of private care that the government is prohibiting is already legally available to some, such as RCMP members, tourists, Workers Compensation cases and Federal prisoners.  The lawyer for the Clinics pointed out that adult patients are often waiting weeks and months beyond the maximal acceptable waiting time.
   "We say it is a punitive action taken by the government for no health care reason but to inflict harm on the private clinics during the course of this trial into the constitutionality on the prohibitions to access to private health care," he added.
  Simply put this is applying punitive measures to the administration of health care for purely political reasons.

   The Cambie Surgery Centre was opened in 1996 by a group of nationally and internationally renowned doctors and independent investors.  Dr.Brian Day, its founder is a British- trained Orthopedic Surgeon, who  wanted to build a facility where top  notch surgeons could perform surgery on their patients in an environment that offered the latest technology in a setting that emphasized exceptional patient care.  The clinic does indeed have an exceptional reputation and attracts patients from around the world.  The Worker's Compensation Board was one of the  first supporters of the Clinic, because patients were treated within weeks instead of the unreasonably lengthy waits of the public system.  This saved time, suffering and money by reducing recovery time and disability.  The CSC is one of the most technologically advanced surgical centres in Canada and has more operating theatre capacity than most hospitals in Canada.
   Unfortunately, much of the  Canadian public fails to realize just how rapidly our heath care system is failing.   Thriving private clinics emphasize the gross mismanagement of health care by the government and its armies of well paid, well pensioned administridiots.  
    No wonder they want to shut it down!

Saturday, 15 September 2018

The Old Quack Reminisces.

   Many of the people I know (or knew) couldn't wait to retire.  I never felt like that and it was with mixed feelings that I managed to convince myself at the age of seventy-eight that it was time to hang up my red cardiology stethoscope that I had grown so fond of.  It was not that I heard any better than I did with the bottom-of -the-line old grey stethoscope, but it looked so much more robust and the strong red colour inspired a level of confidence that an insipid grey or black could never do.   It could have been a traumatic experience, quitting after fifty-five years of practice, being a creature of habit that the strict routine of medical practice demanded.  It wasn't.
   I didn't miss the cloud that many physicians live under a lot of the time, concerned about the welfare of their patient, the adequacy of their management and indeed, the influence of the health care system itself.  I didn't miss the pre-occupation with medicine that frequently results in physicians doing less than justice to their own families.  And though I was never even threatened with a law suit, I didn't miss the growing tendency for the medico-legal lottery to attract frivolous legal suits and to adversely affect the practice of medicine.
   I didn't miss the Political Correctness that thwarts free speech where anyone in medicine, or any other position of responsibility is  threatened by job loss when are true to themselves (for example refusal to accept the risible new pronouns that some pseudo-scientific simpleton puts forward.)   I didn't miss the self satisfied pronouncements of the administridiots, who thought they knew everything and actually knew little about health care and how it should be administered.
   Frequently, friends or acquaintances who knew my previous life-style would ask me if I was bored.  The answer is always no.
   "Well, what do you do all day?  Have you a hobby or something?"
   "I go swimming several times a week and have developed a circle of friends and we lunch together fairly frequently  I meet some very interesting folks from diverse backgrounds and become friends with a few."
   "Do you have a hobby?"  they often ask.
   "Yes," I say, then " I collect fountain pens.  I belong to a Pen club that meets weekly."  I wait for the blank look on the face.
   "What?  What do  you do when you meet every week?"
   "We talk about pens. You know, pens that you write with."
   If the person is old enough, "Oh yeah, I had one of those in school.  I didn't think they make them anymore."
   Then I throw out, "Oh yes, many are collectors items, these days.   Some of them are worth quite a lot of money."
   That usually wakes them up.  "Like what?"
   " Anywhere from a few dollars to thousands."
   I wait for the next inevitable question.  It comes.
   "You know I think we have a couple at home, belonged to my dad, think they could be worth anything ?"
   "What make are they?" I ask.
   "Er, I think one may be a Parker," he pauses for a moment, "or maybe a Sheaffer?"
   "You should look on Ebay."
     Another common topic of conversation may go something like this:
   " I have a son/daughter thinking of going into medicine.  You used to be a  professor, didn't you?"
   "What's your specialty?"
   "Family medicine."
   They try not to show their disappointment and say," Maybe you would have a chat with him/her."   Occasionally, they would add, "you may have a few tips on how to get accepted into medical school: you must know the ropes."  The more subtle ones left that unsaid, trusting me to get the message.
   My answer often  caught  them by surprise.  It would go  like this:
   "Be delighted to talk to him/her.  I enjoyed my lifetime of medical practice, though I must tell you my briefing will be painfully honest and I will spend as much time on the downside as on the upside."
   A surprised look.  "You would do it again,wouldn't you?"
  "Extremely doubtful considering the decline in  the health care system, notwithstanding the miraculous technical advances, some of which I owe my life to."  I say.
   Astonished "What decline are you talking about?"
    Me, getting a bit bored with this whole conversation, "Listen, I have written three hundred and eighty one blogs many of them dealing with this very topic.  Read 'em and I'll be delighted to discuss the topics with you.  In the meanwhile, I'll be delighted to discuss choice of a medical career with your kid!"  I try to say all that with as charming a smile as I can muster!
   Needless to say, I never hear from father or offspring again!

PS. I did recently run into one such father.  When I asked him what his son had decided he told me he was studying Law!