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!


Tuesday, 4 September 2018

Peer contagion and Gender Bending.

Gender Bending and Peer contagion

 Peer contagion (From Wikipedia, the free encyclopedia) refers to the "mutual influence that occurs between an individual and a peer", and "includes behaviors and emotions that potentially undermine one's own development or cause harm to others".[1] Peer contagion refers to the transmission or transfer of deviant behavior from one adolescent to another. It can take many forms, including aggression, bullying, weapon carrying, disordered eating, drug use and depression.[1] It can happen in natural settings where peer dealings occur as well as in intervention and education programs.  Awareness of influence is uncommon and it is often not intentional. Rather,"they engage in relationship behaviors that satisfy immediate needs for an audience or companionship" unintentionally.[1] Many processes of peer contagion have been suggested, including deviancy training.  Recent research has suggested that youth who are treated together for anti-social behavior may experience negative effects through deviancy training which occurs when peers reinforce each other for delinquent or aggressive behavior with the result that the 'group therapy' has the opposite affect to that intended.
  When I was physician to a Corrections Canada maximum security institution, I was sometimes surprised by the rapidity with which something I prescribed for an inmate (not allowed to use that nasty non-PC word any more!) was requested by a group of inmates who attended a subsequent clinic.  I am not particularly referring to drugs of addiction or indeed any drug at all, sometimes it could be for a knee brace or a tennis elbow splint or most frequently a particular type of footwear.  The aggressiveness of the requests was sometimes threatening.  So, when I read Dr. Lisa Littman's  (Brown University) paper entitled "Rapid-onset gender dysphoria in adolescents and young adults: a study of parental reports", and saw peer contagion addressed as a serious perpetuator of the problem, I knew she was on the right track.
   The entire paper is available on line free.  It is well worth reading and makes it clear that sensible well-balanced parents who resist this sort of medical abuse exercised on children are under attack by the aggressive Lunies of the Left as is Dr. Littman.
   In this study 256 parents completed a survey, the details of which are available.  The disorder predominantly affects females (82.8%) and the mean age was 16.4 years. Many of the young adult group (62.5%) had been diagnosed with at least one mental health disorder or neurodevelopmental disability prior to the onset of their gender dysphoria.  The internet and social networks provide a rich forum for transgender identification and encouragement to "come out". Their range of behaviors included expressing distrust of non-transgender people, stopping spending time with non-transgender friends (i.e. normal people), trying to isolate themselves from their families and only trusting information about gender dysphoria from transgender sources.
   The American Psychology Association (APA) Task  Force on the treatment of gender identity disorder notes that adolescents with gender dysphoria  'should be screened carefully for any disorder such as schizophrenia, mania, psychotic depression that may produce gender confusion. 
   Unfortunately, many health care providers including physicians have abandoned their professional vows in favour of political correctness and are encouraging 'social engineers' to undermine the commonsense precepts of normalcy.
   The decline accelerates.

Addendum.  Britain's Royal Academy, one of the ultimate arbiters of artistic merit is to ensure that its next exhibition of nudes has an equal gender split of naked men and women.  How politically incorrect !  What about gays, trans, lesbians etc. etc?
It would make me laugh if I wasn't crying!!

So what do you think,if anything? 

Tuesday, 28 August 2018


Rapid Onset Gender Dysphoria. (ROGD).
    I've dealt with many strange disorders in my fifty-five years of medical practice, both physical and mental.  In most instance the medical and allied health care professions were helpful in bringing some degree of relief and comfort even in those that they could not cure.  Occasionally we made things worse,  through lack of knowledge or understanding but most of those errors were well intentioned blunders and were quickly remedied as soon as they were recognized. 
   But that was before Politically Correct Disorientation Disease (PCDD) became endemic in our society and the PCU (Political Crimes Unit) established Common Sense as one of the most dangerous and heinous crimes.
   The latest addition to the new encyclopedia of potentially fatal non-diseases is:
 Rapid Onset Gender Dysphoria.  This disease was invented by a seriously disturbed group of so-called health care workers, including, I am ashamed to say physicians, who interpreted children's play at being the opposite sex (Am  I even allowed to say that?) as a serious disease to be taken seriously.  This normal phase in maturation was recognized by most normal parents for what it was and cured by nature by coursing testosterone through boys and estrogen through girls until they were ready to reproduce.
   There is no doubt that in some families,the roost is ruled by the children and the guidance that normal parents give their children is subjugated to the will of the child.    When a group of adults such as school teachers, social workers, including some health care workers undermine parents instead of supporting them, we truly have a recipe for disaster, both for the children and for society.  I will leave it up to you to arrive at your own conclusions as to the political motivations that underlie this.  
  Lisa Littman, a researcher at  Brown University recently published study entitled "Rapid-onset Gender Dysphoria in adolescents and young adults: A study of parental reports".  The report explores "the psycho-social context of youth who have recently identified as trans-gender with a focus on vulnerabilities, co-morbidities, peer group interactions and social media use."
   This study is of particular interest because it deals with adolescents and young adults, whereas most of the trans-gender literature deals with children.   ROGD is identified by some as a new disorder because it starts after puberty with no previous indication of confusion or unhappiness.  The study indicates a high incidence of internet and peer-group influence and it affects mostly teen-age girls within a group, who 'come-out' together.  A high percentage of these girls report heightened popularity, while parents report worse relationships and worse mental health.  There are groups that deliberately plot to undermine parental authority and to vilify those who try to protect their children from what many informed parents and physicians consider to be a particularly dangerous and malignant form of child abuse.  The extreme damage perpetrated by such groups seems to be advocated predominantly by Left Wing Loonies, whose objective seems to be to destroy the role of the nuclear family in preventing society from destroying itself.  This is in order to denigrate all social values that would impair their objective of 'instant gratification' as the goal of human existence.   
   I haven't yet completed my study of Ms Littman's erudite article, but you can be sure that when I do, you will hear from me. 
   I can remember 'dressing up' as a girl when I was a kid.  It was great fun!  I can't remember a single person recommending surgery or even hormone injections.    



Monday, 20 August 2018

Re-writing the Language2.....

Image result for pictures of disabled parking passes

Image result for disabled parking pass picture

 Cripple: A person who is unable to walk or move properly through disability or because of injury to their back or legs. (Oxford English Dictionary).

The disabled persons parking pass has always been known in our rigorously politically incorrect home as a 'cripple pass'.  It took me years to convince my wife that her Intermittent Claudication, that sometimes limited her from walking briskly without experiencing pain or discomfort merited one.It was excessively hazardous when walking across a vast skating rink-like parking lot, which is what many of our parking lots are in winter.  I was particularly aggravated when, during my ' people watching'  I found that many emerging from the parked vehicle displaying the so-called Accessible Parking Permit pass, were a good deal more spry than my eighty - something year old corpus allows me to be.  Because we come a good deal closer to fitting the above definition than many of the persons I have observed abusing the demarcated spots, we have taken some pride in using this pass only for my wife who qualifies.  I do not regard myself as sufficiently crippled to merit such a privilege.
   To my horror, many Canadians have no such reluctance.  Horrified, I watch teen-agers screech into a designated accessible parking spot, sporting Grandma's 'cripple pass', laughing their way into Loblaws and knowing full well that as long as they display that pass, no-one is going to bother to check it.  I'm eighty three, a quintuple bypass patient, fibrillating and with degenerative disc disease of the lumbar spine and osteoarthritis of the right hip.  I don't have a 'cripple pass', because despite my disorders and the difficulties I  have to cope with, I can manage.  Unlike many of the folks I observe in the parking lots, abusing a 'cripple pass', I don't intend to apply for one until I fit into the Oxford English Dictionary definition that heads this article.  I will continue to ask my wife, during  the harsh arctic conditions that prevail in Canada's winter,
   "Hey honey, got the cripple pass?'  knowing full well that when we get there, most of the spots will be taken by folks who are far from cripples!!
   The decline continues.

Thursday, 16 August 2018

Re-writing the language.

   Here's a piece of 'educational research' that I  continue to get because  I  used to be a physician.    It is so tainted with 'political correctness' as to being  not only an opinion as to how a physician relates to  patients, but to suggest a whole new dictionary as to how physicians should record their interpretation of their interview with their patients.  George Orwell could hardly have dreamed up this piece.  
   Medical history taking is a highly skilled art, an art most physicians downplay today, because it is time-consuming and not rewarding.  Both the scientific community and the  masses grossly underestimate it, because in the long term, we all die.  History taking is not glamorous and much  of the time is routine grunt data collection, which is why in  our present health care system is almost exclusively done by medical students  and residents and even they realize that it is considered the 'scut work' and barely valued at all.  Although it is the bottom of the totem  pole, it holds the structure aloft.  I know the high tech stuff is much more exciting and achieves incredible results (sometimes!) but when the bottom of the pyramid is unstable, the whole damn thing is likely to topple.
   Remember, before Christ, the Romans were building bridges  that lasted a thousand years.  ( The Ponte Vecchio built in 1345 is still functioning today).


Stigmatizing language in chart notes creates negative impressions
Clinical question
Does negative language affect residents' and medical students' attitudes toward specific patients and influence their treatment decisions?
Bottom line
Think of how antagonistic common medical jargon is. Patients "complain." They "admit" or "deny." They "refuse" or are "noncompliant." The words we use can transmit, via a hidden curriculum, implicit bias to medical personnel in training. This study compared stigmatizing language with neutral language used to describe a patient with sickle cell disease that cast doubt on the patient's pain ("still a 10" vs "still a 10/10"), portrayed the patient negatively ("hung out at McDonald's" vs "spent the afternoon with friends"), or implied patient responsibility with references to uncooperativeness ("he refuses his oxygen mask" vs "he is not tolerating the oxygen mask"), Medical students and residents had more negative attitudes toward the hypothetical patient when described with stigmatizing language and suggested less aggressive management of the patient's pain. It's time to revise the medical scripts that convey negativity and bias about the patients in our care. (LOE = 1b)
Study design
Randomized controlled trial (double-blinded)
In this study, medical students (n = 233) and emergency or general internal medicine residents (n= 180) were randomly assigned, concealed allocation unknown, to read 1 of 2 chart notes with medically identical information about a hypothetical patient with sickle cell disease: one using neutral language (eg, "He has about 8 to 10 pain crises per year, for which he typically requires opioid pain medication in the ED") or stigmatizing language (eg, "He is narcotic dependent and in our ED frequently"). After reading the note, both the residents and medical students completed the Positive Attitudes toward Sickle Cell Patients Scale (range 7 - 35) and the residents selected a treatment for the patient from 4 options. Attitudes were significantly lower, on average, for participants presented stigmatizing language (25.1 vs 20.3; P < .001). Attitudes were progressively lower with years of training (correlation coefficient -.95). Residents were more likely to select less aggressive treatment (eg, a low-dose opioid or a nonsteroidal anti-inflammatory drug instead of higher dose opioid, along with less likelihood of redosing) if exposed to stigmatizing language (P <.001). Participants reading the stigmatizing note also were more likely to identify the physician who wrote the note as having a more negative attitude toward the patient.
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Friday, 10 August 2018

Canadian Medical Scavaging.

  The recent decision of the Saudi-Arabian government to withdraw funding of students being educated in Canada, although not admirable, is certainly understandable.  The present Canadian Government, lead by a multimillionaire capitalist pretending to be a socialist, trading on his father's name and who has never had a productive job, is a poor recommendation for the intellect of the less than half of the Canadian population, who voted for him and his wealthy elites.  He hopes to continue to buy power, and it is all about power, by changing the electorate of Canada.  His millionaire socialist father, and his millionaire socialist cronies, knew well that the way to fool the poor and needy and many others is to pretend to give them all they need, courtesy of the hardworking and creative segments of our society, that lifted us and them out of the poverty that was so ubiquitous in previous generations.  Scientists and physicians were penalized for their efforts and as a result many have undergone a fundamental attitude change.
   The withdrawal of many postgraduates in medically related fields won't go without consequences.  Students and residents play a much greater part in keeping the health care system running than most people realize.  In addition, foreign governments pay the Canadian government substantial sums of money above and beyond what it costs to train their residents.  We are not doing it out of the goodness of our hearts!
   Canada, as well as Britain and the U.S. have a shameful history of scavenging second and third world countries for their badly needed newly qualified physicians, not because we need them, but because it is cheaper than training our own.  In addition, they are much more easily controlled by the  University hierarchy, because they have control over the licensure of Foreign Medical  Graduates.   Incidentally, even the term 'Foreign Medical Graduate' is deemed politically  incorrect today.  I can  comment on  this because I am one!  Now the term is 'respectabilised' into INTERNATIONAL Medical Graduate.  They vary in quality from excellent to dangerous and often are not very carefully screened before being given positions in our health care system..
   Anyway the FMGs are at the mercy of the  University, who can pull their license if  they don't do as they are told!  They are certainly much more easily manipulated than Canadian graduates.   I was a medical educator for much of my life.  I know!
   For once our tweeting Foreign Minister got the message right as to how foreign countries should correct their deplorable human rights record but has done serious damage to the resources of the health care System in Canada and to the economy.  In our declining health care system which was only capable of giving mediocre care to citizens even before the intake of thousands of immigrants, the loss of funding and manpower resulting from the present fiasco can only do more damage. 
   Let's hope the Liberal  government puts their money where their mouths are and that Canadian health care is not going to accelerate its already rapid decline.  This government will not even allow Canadians to spend their own money in quest of better health care, without leaving the country.
   The government's first job is to look after the people who are paying their salaries. 
 Don't be afraid to comment.  I won't tell anyone

Friday, 27 July 2018

Great Canadian Physicians -Sir William Osler.

Dr.William Osler.

    Long long ago when I used to interview applicants for medical school I was often amazed that when I asked a candidate to name one great Canadian physician, how many of them started at me blankly and could not even make a guess. There have been many greats, but Sir William Osler, internationally renowned for changing the face of medical education in Canada, the United States and Great Britain and in the world, should surely have been known to any candidate aspiring to become a physician in Canada. Those giants of medicine on whose shoulders we stand, , of which Osler was certainly one, must be turning over in their graves at the direction their beloved profession has taken. I am, and I'm not even dead yet!
    Let me quote Osler to attempt to convey to you what embarking on a career in medicine meant in those days and into the days when I chose medicine as a career.
"The good physician treats the disease, the great physician treats the patient who has the disease". That, some hundred years before the College of Family Physicians began touting that concept as though it was something new.
    Another: "The greater the ignorance the greater the dogmatism".
    "Medicine is learned by the bedside and not in the classroom. Let not your concepts of disease come from words heard in the lecture room or read from the book. See and then reason and compare and control."
    Well, I venture to think this exceptional man, who established the Department of Medicine at McGill, who was a founder of Johns Hopkins Hospital, world famous for treatment, teaching and research and later professor at Edinburgh and and then Oxford, would have been finished before he began, had be existed in our time.
He said this: "The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head. Often the best part of your work will have nothing to do with potions and powders, but with the exercise of the strong upon the weak, of the righteous upon the wicked, of the wise upon the foolish.".
    This is a time in which everyone considers themselves to be an expert, no matter how little they know about a field, under the egregious misapprehension that all opinions are equal and should be treated with equal respect. Anyone who is not a total moron knows that isn't so. Unfortunately, the fear of confronting ignorance and the desire to re-write history politically correctly is a major contributor to the accelerating decline we are experiencing in the developed world.
Sir William said many wise and true things some of which today would bring about the rapid termination of his career, no matter how brilliant he might have been.
    "The uselessness of men above 60 years of age and the incalculable benefit it would be in commercial, political and professional life if they were to stop work at this age ....the plot hinges on the admirable scheme of a college into which at sixty, men retired , for a year of contemplation, before a peaceful departure by chloroform. "
    "The desire to take medicine is perhaps the greatest feature which distinguishes man from animals."

    Many today, think  that medical eponyms (naming a discovery or  a treatment after the discoverer) should be abolished, that they just complicate medicine.  I am strongly opposed to such action.  The giants of medicine deserve to have their names and their contributions respected.