Wednesday 29 July 2015

For Sale: Fetal Parts (freshly butchered).

      The intrauterine decimation, decapitation,destruction and  other means of dehumanization of the unborn human baby is so horrible that it  is reminiscent of the savagery and inhumanity of the Third Reich.  It is truly a symptom of decline and fall.  Particularly horrifying is the manner in which some physicians of the 'Planned Parenthood' coven discuss these issues in the callous and indifferent manner we have heard  recently, as though the lives they are extinguishing are meaningless pieces of protoplasm.  Unfortunately, 'Planned Parenthood' is often a euphemism for  planned infanticide.  Here we are not primarily talking about abortions that have any medical indication at all, not young girls who were impregnated, not women who were raped or distressed by some other circumstance that led to their  pregnancy.  Frequently, we are referring to abortion as a form of  birth control, a convenience.  The 'Planned Parenthood ' group see this as right and receive federal funding, forcing the taxpayer to support their barbaric practices.  In fact, they are so comfortable with it they are devising methods that do not destroy the baby's organs so they can be sold for good hard cash.  They are, in effect, bargaining over the price of dead baby parts.  Hard to get much more barbaric than that..  I thought there were laws prohibiting such practices. Some doctors, apparently see this as right too.  The principals of  modern medicine  have changed.  I can  no longer unreservedly recommend medicine as a career to the thoughtful and principled young people who sometimes ask me about it.  The demands of a significant portion of the population want medicine to be something other than  a humane healing art, something to satisfy  their immediate needs or desires and that  is changing a profession I  have dedicated my life to into something else.  Technology, as wonderful as it is, is far from being the be-all, end- all, of what medicine is about.   The politicians are pleased to grant these wishes in the hope of garnering votes. The control of medicine by administridiots, bureaucrats and politicians is accelerating the decline of medicine into what is called the  Health Care Industry.  Not a step in the right direction.
                Comment if you dare!

Sunday 26 July 2015

Alzheimers - are we any nearer?

     Alzheimer's Disease, medically speaking  is the sort of medical dilemma that AIDS was a few short years ago. Incurable, untreatable, with any effective treatment seeming a long way off in the future.
    So what is it?  Well, it used to go by a lot of names.  Senile dementia, presenile dementia, losing one's mind, old age and various other inaccurate names.
     A progressive, neurodegenerative disease characterized by loss of function and death of nerve cells in several areas of the brain, leading to loss of cognitive function such as memory and language. The cause of nerve cell death is unknown but the cells are recognized by the appearance of unusual  protein filaments in the nerve cells.  Plaques form when protein pieces called beta-amyloid clump together. Beta-amyloid comes from a larger protein found in the fatty membrane surrounding nerve cells.  Beta-amyloid is chemically "sticky" and gradually builds up into plaques.
   The most damaging form of beta-amyloid may be groups of a few pieces rather than the plaques themselves. The small clumps may block cell-to-cell signaling at synapses. They may also activate immune system cells that trigger inflammation and devour disabled cells.
       The oldest category of medications are known as cholinesterase inhibitors  some of which are named below.
Cholinesterase inhibitors help by improving the ability of impaired nerve endings to transmit messages from one nerve cell to another.  The drugs are only temporarily effective, if they are effective at all and the benefits gradually wear off.
    The good news is that there are some promising new drugs currently being researched but not yet ready for general use. 
    Three drugs being highlighted at the Alzheimer's Association International Conference are called solanezumab, aducanumab and gantenerumab. (The "mab" at the end of the drug name stands for monoclonal antibody). They are antibodies that specifically attack amyloid thought to be the cause of much  of the damage.
     Aducanumab, also known as BIIB037 and made by Biogen, appears to be clearing the amyloid from the brains of patients, researchers told the meeting. There's also some evidence that this might be improving test scores in the patients who got the very highest doses.  Biogen is moving ahead to a phase III study - the very last stage before seeking Food and Drug Administration approval. 
      The second drug group presented at the meeting is a BACE inhibitor that's being developed by Merck, . Researchers don't know exactly how it does what it does. They don't yet know whether it will help patients.  BACE inhibitors block an enzyme that fragments a large protein in the brain into smaller pieces of sticky beta amyloid, a substance that forms telltale plaques in the brains of Alzheimer's patients. Blocking the enzyme blocks production of beta amyloid.  This drug has been under development for ten or more years.
     In a study, which was mainly designed to check the safety of the drug, researchers assigned 30 patients to take one of three drug dosages or a placebo for seven days. Patients on the highest doses of the drug saw reductions in beta amyloid in their spinal fluid of over 80 percent. Researchers say they saw no evidence of adverse effects.   "We can reduce amyloid to unprecedented levels," said Dr. Mark Forman, a senior principal scientist at Merck, the company that's developing the drug.
   The problem, skeptics say, is that medications have been used to reduce beta amyloid before, and those had no clinically meaningful benefits for patients, at least for those already diagnosed with the disease. There have been some signs that lowering beta amyloid may be helpful for people who haven't yet begun to show symptoms of memory loss.  Forman said he thinks BACE inhibitors have a better chance of working, however.
    "BACE inhibitors blocks the generation of amyloid at the very first step in its production. It's very different from what some of the other studies have done with antibodies that are really promoting the clearance of beta amyloid after it's formed," he said.  Experts agreed that the drug seems to work well to lower beta amyloid, but, "It remains to be seen when you can do that whether  it will produce a useful, lasting clinical benefit,"

The third category of medication  are known as Biologic Response Modifiers.
       ENBREL  was the first biologic approved for  severe rheumatoid arthritis. is grouped within a class of medications called biologic response modifiers, or biologics. By working on the immune system, biologics block proteins that contribute to the disease process.  Tumor necrosis factor (TNF) is a substance made by the body's immune system. People with inflammatory diseases such as rheumatoid arthritis, plaque psoriasis, psoriatic arthritis, juvenile idiopathic arthritis, and ankylosing spondylitis have too much TNF in their bodies. ENBREL reduces levels of the active form of TNF.. It exercises an anti-inflammatory effect.  Because ENBREL suppresses the immune system, patients are at a greater risk for getting serious infections..
     This is exciting stuff and although we don't yet know where it is going to lead, it is hopeful  that a combination of some of these drugs will have as beneficial an effect on Alzheimers Disease as the drug cocktail used for treating aids have had on that disease.

Wednesday 22 July 2015

Financial Incentive Programs - the Use less Tax.

Can we bribe patients to adopt a healthy life style with financial Incentive Programs?

          I don't think so, but some randomized clinical trials suggest otherwise.   In one study involving 878 GE employees, incentives  worth $750  for smoking cessation tripled quit rates from 5% to 14.7%.  This led to a program developed by GE for its employees.   In another more elaborate study the authors divided the candidates into different groups.  They felt that if they could get participants to put some of their own money at risk that they could recoup, they would be more highly motivated.   No doubt, but needless to say, the participants were much more likely to accept the reward-based incentive programs (acceptance rate, 90.0%) than the deposit-based programs, in which the candidates had to put up some of their own money , which they would earn back together with  their reward (acceptance rate 13.7%).  In standard per-protocol analyses, 52.3% of those who accepted deposits versus 17.1% of those who accepted rewards had sustained abstinence through 6 months.  Not surprising, when you consider that this cohort were sufficiently motivated to  put up their own money in the first instance.

         To cut to the chase, these  studies are asking if the tax payer should be paying individuals to cease doing things that they know perfectly well are harmful to their health. It is about what we use our limited resources on.   It is asking whether people who don't sufficiently care about their  health to avoid behaviours that they know are harmful but they find pleasurable, can be bribed to change their behaviour pattern.  And if this works, even on a temporary basis, then perhaps we can extend the program.  First we could start on marijuana (worth at least 50% more than tobacco), then we could move on to the oxycodone cessation reward program (100% more), then onto the cocaine, heroine and meth reward programs.    The programs could be financed by the hard-working abstemious citizens who don't know how to enjoy themselves anyway.  Or we could put a tax on  health care foods and products  and call it the 'use less tax'.

Sunday 19 July 2015

Stranger than Fiction. Pt.2.

Stranger than Fiction. Pt 2.

            When I next ran into Tom walking along a corridor in the hospital, he exuded an air of insouciance
            “How are things?” I asked him
            “I’ve just been to see my lawyer.  Did you know that they're trying to get rid of me as department head?” he said.
            “No, I hope things work out all right,” I replied.
            "We'll have a coffee sometime soon and I'll tell you all about it and we both continued on our separate ways.
            My encounter with Tom continued to play on my mind throughout the day and when I got home that night I told Maureen  about it.
            Why don’t we invite them over for dinner?” Maureen said.  It will give us an opportunity to see if there is anything we can do to help.”
            “I think that's a great idea,"  I said.  “Now, what’s for our supper tonight?   Whatever it is, it sure smells good.”
            Two weeks later Tom and Ann and the two children Kenny and Elizabeth, neither of whom looked like their father arrived for dinner. They looked like a typical happy family.  Kenny, a mischievous little five year old and Elizabeth a couple of years older with a quiet, reserved manner, smiled as they walked in into the warmth  from the outside. 
            Tom handed me a bottle of wine and Ann looked for somewhere to put down the cake she had brought for desert.
            They introduced the children and greetings were exchanged all around.
            “Have a drink before dinner,” I said.
            Having filled our glasses and provided the children with soft drinks, we chatted for a while.  I don't know if it was just my imagination, but throughout the evening I couldn’t help noticing Tom’s distance from the children.  It was as though they were someone else's mildly irritating kids.  Which I guess is what they were.  After dinner Tom and I sat down in the den.  He told me that he had been summoned to a hearing by the College to determine whether they were going to renew the provisional license to practice he had been issued under the aegis of the University.
"If they don't I don't know what I am going to do," he said miserably. "I'm worried sick."
             "What will you do  if they don't renew your license?" I asked.
              "Well, I would just have to go back  to England.  I kept up my license there, thank God,"  he said.
              We joined the ladies and children and most of the evening he managed to put on a sociable front,
           “We really find the winters here are hard to take,” Ann said, as we sat chatting over coffee.  “I really think we should be looking for something in Vancouver.”
            No word about Tom's plight and the fact that he might soon not be licensable in Saskatchewan let alone Vancouver.  Frequently, Canadian graduates couldn't get a billing number that would allow them to practice in Vancouver. Tom said nothing.
            “My brother in Vancouver keeps begging us to move there,” she added. 
            Again Tom said nothing.
            “But first,” Ann said, “I think we will go back to the U.K. for a while.  Tom has some business to complete there.” 
            I knew that the business he had to complete was related to maintaining his license to practice medicine hoping that there was no communications between the licensing authorities here in Canada and in the U.K.
            “Oh, you really must be looking forward to a reunion with your family and friends,” Maureen said enthusiastically.
            “Yes we are.” Ann answered.
            We continued chatting for a little while and then we bid them farewell and they left.   We only saw them once more after that..
           Three or four months later that I received a call from Randy Stern, a young English neurosurgeon who came to Saskatoon at the same time as Tom and had been a friend of his for many years dating back  to  their student days in the old country..  He dropped a bombshell;  Tom had returned to the UK and had committed suicide there a few days later.
            Randy told us the following story, learned from Ann.
            Randy had seen Tom and his family just before they left because Tom wanted someone to talk things over with.  He had gone to a meeting of the Provincial licensing body with his lawyer and came home worried and very depressed.
            “It looks as though there is nothing I can do,” he said.  “The Canadian licensing authority won't renew my license and worse still they sent a transcript of the whole hearing to the licensing authority back home in the U.K-- and now they are going to hold their own hearing there to see whether they're going to revoke my license.”
            “Oh Tom,” Ann said, “surely they wouldn't do that.”
            “I'm going to have to go back to England to defend myself before the licensing committee.  Ever since I lost the medical malpractice case they are out to get me.  Now after that, I really won't have a chance.  I don't help much left to live for.”
            Ann went to put her arms around him but he shrugged her off.
            “Darling, you everything to live for,” she said, “We’ll get this sorted out and you have me and two lovely children to stand by your side whatever happens”
            He raised his voice angrily, “those children aren't really mine who are you trying to fool?”.
“What?” she said, taken aback,speechless.  then,after a few moments, “you really are crazy.  How can you say something like that?”
              With a look of anguish on his face, Tom said hoarsly, “I had a vasectomy when I was 28, before we were married.  I was afraid to tell you in case you’d have called the whole thing off.  I had arranged to try to have it reversed and came home one night to tell you about it.  It was that very same night that you told me you were pregnant.”
             She looked at him in amazement.  “You bloody fool,” she shouted.  “You're accusing me of having our two children by someone else.  All these years you’ve lived with us, harboring a grudge and never having the guts to say a thing about it.  I’m not putting up this for another minute. Tomorrow I’ll phone my brother in Vancouver and the children and I will go and spend some time with him. In the meantime you can go home and get yourself out of this mess.” 
            “You bitch,” Tom yelled furiously, you know you had those two children by your lover.”
“Listen to me, you lousy bastard, “Ann screamed back,” we’re going to resolve this once and for all by DNA testing.  Meanwhile you go back there and you get yourself out of this mess.  I’ll need some time to think if I ever want to see you again.”
            A few days later, she and the children left for Vancouver, but not before she had dragged  Tom for a DNA test.  She never saw Tom again.
            Tom went back to the U.K..  He pleaded his case to the Medical Board and lost his license to practice medicine.  Soon after he overdosed and died of some unspecified medication. 
            The DNA results proved beyond any reasonable doubt that both the children were Tom's.

Wednesday 15 July 2015

Caveat Emptor.

       When I was a young doctor, long long ago, in a land far away,(Ireland,England) doctors were forbidden to advertise.  It was a cardinal sin, unprofessional behaviour for which you might lose your license permanently and certainly at least a suspension.  Indeed, physicians were often disciplined for getting themselves into the press without overt advertising or extravagant claims.   I was amazed on arrival in  the New World to find that American doctors (not so much in Canada) thought advertising their own skills was quite acceptable, although they frequently sounded quite extravagant to  me.  In more recent years, as the hyperbole increased, many of these physicians sounded increasingly like snake oil salesmen in their claims and fraudulent in their promises.  Listening to claims on both radio and television suggested that  they had something special to offer above and  beyond what I know is justifiable.   
          Therefore I was disturbed but not as surprised as I might have otherwise been to read of the strange case of Dr.Farid Fata, aged fifty.  Dr.Fata, a Lebanese American physician, pleaded guilty to giving cancer treatments to many patients who did not have cancer in the first place and misdiagnosing many more.   He dishonestly collected $17.6 million from medicare, (did that not arouse some suspicion?), received kickbacks and was also charged with money laundering.  His patients, many of  them without any form of cancer received dangerous chemotherapy for years.  The testimony of his patients read like horror stories.

 “Rather than use his medical degree to save lives, Dr. Fata instead destroyed them in pursuit of profit,” said Assistant Attorney General Caldwell.  “Time and again, Dr. Fata ca llously violated his patients’ trust as he used false cancer diagnoses and unwarranted and dangerous treatments as tools to steal millions of dollars from Medicare, even stooping to profit from the last days of some patients’ lives.  While no sentence can restore what was taken from his patients and their families, the sentence imposed ensures that never again will Dr. Fata lay hands on another patient.”
“Health care fraud has been a serious problem in Michigan, but no case has been as egregious as the conduct of Dr. Farid Fata,” said U.S. Attorney McQuade.  “Dr. Fata did not care for patients; he exploited them as commodities.  He over-treated, under-treated and outright lied to patients about whether they had cancer so that he could maximize his own profits.”
        He was sentenced to 45 years in prison but  that does little to help the patients who's lives he destroyed.  
          It amazes me that Fata got away with this for years and was apparently apprehended because a newly hired young physician noted something amiss and sought advice.  He had  many associates who apparently failed to notice any irregularity.
       How an army of health care administridiots can have missed millions of dollars of fraudulent billing to medicare is another story that needs extensive investigation.
        Unfortunately, his exposure and imprisonment, for the rest of his life, does little to compensate for the suffering and health consequences to his former patients.
Caveat Emptor!

Sunday 12 July 2015

Gender Bender.

      In the state of Oregan the age of consent is fifteen years.  Last year it was decided in that state that sex-change operations would be state subsidized.

      In a statement, Oregon Health Authority spokeswoman Susan Wickstrom explained it this way: "Age of medical consent varies by state. Oregon law -- which applies to both Medicaid and non-Medicaid Oregonians -- states that the age of medical consent is fifteen." 
     While fifteen is the medical age of consent in the state, the decision to cover sex-change operations specifically was recently made by the Health Evidence Review Commission (HERC). 
Members are appointed by the governor and paid by the state of Oregon. With no public debate, HERC changed its policy to include cross-sex hormone therapy, puberty-suppressing drugs and gender-reassignment surgery as covered treatments for people with gender dysphoria, formally known as gender identity disorder. 
      The fact that the age of consent could be fifteen in a country where children remain on their parents health plan until their late twenties is remarkable.  For some reason the administridiots who control health care in that state seem to favour giving fifteen year old children, many of whom are grossly  immature, the option of starting sex change initiatives (on their parents health care plan) without even requiring that the parents are aware of what is taking place.
       What is wrong with these folks??  Let me tell you, they do not understand what normal means.
       Gender dysphoria is a mental disorder in  which a person identifies as the sex opposite of his or her birth. (Definition of the American Psychiatric Association).  It is RARE, affecting  one out  of every twenty-five thousand males and one out of every fifty thousand females. Further, a major study has shown "most children with gender dysphoria will not remain gender dysphoric after puberty."   There is no evidence to show that radical irreversible treatment has a good long-term outcome.   So, let us not jump from the frying pan into the fire, let us not sacrifice sound, intelligent medicine for political correctness.    Good medicine is not always popular medicine.

If you disagree with  me, let me know.  In  fact, even  if you agree with me you can let me knoow.

Thursday 9 July 2015

Stranger than Fiction.

                                                  Strange than Fiction.   Pt.1.
            When I got home there was a message that Tom had been admitted to hospital again  and he wanted to talk to me.  I dropped in to see him the following  morning.    I could see he was quite agitated as well as depressed.
            "How are you?" I asked.  It was obvious he was not good.
            "Not so good," he said.  He looked awful.  "I wanted to talk to you".
            "About what?"
            "Well, remember the last time I was in hospital with depression and you came to see me?"
              I nodded
            "I told you that there were three major problems that were troubling me,” he said.
              I nodded again.
            "I told you about two of them. One was the upsetting circumstances around my father's death, and the other related to a medical malpractice case, still ongoing in the old country.”.
            "Yes, I recall," I said.
            "The third issue I've never told you or anyone else about," he said diffidently.  "I want you to promise me you'll never breathe a word of this to anyone.  I think this has a lot to  do with my depression."  He looked at me expectantly, awaiting an answer.. 
              If  he'd never told this to anyone before. I wondered why he had decided to tell  me.  We always got on well enough together but we'd never been particularly close friends.
            "All right," I said.
            "I was about twenty-eight at the time and I'd had a really severe couple of bouts of depression that required hospitalization.   I had decided I would never want children, depression ran in the family.  My father had committed suicide.  After a lot of talking and support by my psychiatrist,  I managed to convince one of urologists that I should have a vasectomy.   That done, I went about the business of living, my disorder under control and things going along quite satisfactorily.
            He looked at me as though expecting some sort of comment.  I said nothing.
            He continued, "Soon after that I met Ann and fell in love with her.  We had a whirlwind romance and I asked her to marry me.  I told her about my depression but not about my vasectomy.   I decided to have the vasectomy reversed and knew the technique was improving daily."
            He stopped, took a drink of water from the bedside table and then continued.
            "I talked about a reversal of the procedure to a urological colleague and he agreed.  I made up my mind to tell Ann that weekend.  Now the idea of starting a family seemed desirable and with the progress psychiatry had made  in the management of depression I decided that was what I'd  like to do.  It had suddenly become urgent that I explained all this to Ann.  
            His gazed expressionlessly at me as he thought about the way things had unfolded. He told me he had come home ready to discuss and explain.  It was a Tuesday night and he came into the house as the sun was setting. 
            "Hi darling," Ann called, cheerfully.
            "Hello," he said Putting his arms around her as she stood at the sink.
            “Darling,” she said, “I have some wonderful news for you.” 
            He had no idea what she was about to tell him, he felt nervous, for some reason.
            “Oh what? he asked.
            “Darling, I went to see Dr. Woolfe today and guess what.  I'm pregnant!”
            He felt his heat racing and he said he thought for a moment he was going to faint. 
            He stopped his narrative and came back to the present.  He looked at me for a moment as  and tears seemed to well up in his eyes.
            Then he went on.  “I couldn't say anything to her, and I told her I was delighted..  We went to dinner that Saturday night and Ann had a wonderful evening.”
            I stole a look at my watch.  I had a clinical conference due to start five minutes ago.
            He saw me.  “Just give me another minute,” he said, “There’s worse to come. We had a lovely little boy and I grew to love him, even though I knew he wasn’t mine. She got pregnant again a year later and I didn't say anything then, either.  I was desperately afraid of  losing her.  Of course I hadn't had my vasectomy reversed and so here I am with two children who weren’t mine and a wife who was impregnated by someone else..
            The story certainly surprised me and I didn't have much to say.   I muttered that if there was anything I could do, to let me know and I'd got to go now.
            A couple of weeks later Tom seemed to have responded well to his treatment and seemed to be functioning normally again.  I thought might be able to function in  his normal capacity as the head of the Department of Neurosurgery.. However, when I talked to my friends who worked in the same department, the Department of Neurosurgery, they seemed to feel differently and thought he was functioning marginally at best.
            Some days later, I was sitting in my office going through the mountain of useless mail that department heads waste a great deal of time reading carefully in case of missing something of vital importance.  I was not disturbed by a knock on my office door.
            “Come in,” I said relieved to be interrupted. 
            The door opened and Hugh Dalton edge round it.
            “Listen. old man,” he said,”  I hope it’s not inconvenient but can I have a few moments of your time?”
            He surreptitiously pulled his still smoking pipe out of his pocket.  This was just at the beginning of the days when the witch hunt against smokers was gathering momentum.
            “Certainly, sit down,” I said. “Can I get you a cup of coffee?”
            “No,” he said.  I want to talk to about Tom; I know you're a friend of his.”
            “Somewhere between a friend and an acquaintance,” I said, “but we have had some social and professional interaction and he does confide in me on occasion.”
            Hugh looked serious. “As you probably know, the department members are not wildly enthusiastic about him as a department head.  I think they're prepared to give him a chance but they are certainly not unanimous in their support of him.  Recently there have been some funny goings on and as a previous department head they asked me to look into the situation.  Maybe the job is just too much for him.” 
            “What sort of goings on, Hugh,” I asked.
            “Well there was a Board Meeting going on, on April the first, to discuss the future of the Neurosurgery Department.   When Tom finished up in the operating room,  he excused himself for a few moments, apparently for a bathroom break and then came back and remarked with a grin on his face, in an inappropriate manner, that April fools day was a very appropriate day for the board to be meeting.  Just as he was saying this an acute emergency call came over the intercom directing the 99 Team to the boardroom.  Of course all the emergency measures were put into action and when the emergency team burst into the boardroom with the crash cart and all the paraphernalia, the astonished board members assured them that no one was ill or had collapsed or was in danger.  After the confusion subsided it was recognized that this was someone's sick idea of an April Fool's joke”.
             He paused and a grave look crossed his face. 
            “The problem is,” he continued, “that one of the operating room nurses who was passing by the phone outside the operating room heard Tom making a call and overheard the words “emergency in the board room”.
            He stopped and looked as though he expected me to say something.
            “What are you going to do about it? I asked him.
            “Look Old  Man,” he said pulling his pipe out of his pocket again, “do you mind if I smoke?.”  Hugh closed the door.
            “No I don't mind.” I said. I still enjoyed the aromatic smell of pipe tobacco although I had given up my pipe a couple of years earlier.
            He tamped down the partially smoked tobacco in his pipe, pulled out his matches and puffed pleasurably at his pipe, all the time in deep thought.  For a moment he seemed to vanish in a cloud of bluish smoke and then he continued. 
            “To tell you the truth, the members of the department really want to get rid of this fellow.  To make things worse, he recently wrote his Canadian Fellowship and failed.  Since his license is only provisional the question arises as to whether it will be renewed at the end of the year.  I really don't know what the outcome of this will be.”
            I had promised Tom I would tell no one of his personal problems and didn't know how much of this, if any, Hugh was aware of.
            “Perhaps,” I said,” the solution would be to have him step down as department head and to function as a surgeon within the department.  I think all this administrative responsibility may be just too much for him.”
            “That's another problem,” Hugh said, “his surgical skills are also in question, at least by some members of the department.  We recently found out that there is some medico- legal matter in U.K. that is still unresolved.
            Of course I knew about that but said nothing and was thinking about how to reply when there was a knock at the door.
            The nurse opened the office door, looked shocked at the cloud of smoke within, and had the obligatory coughing spell that non-smokers feel compelled to display in the presence of a smoker before speaking.
            “Dr.” she said, “you have patients waiting.” 
             I said, “I’ll be right there.”
            Hugh stood up to leave, stuffing his still fuming pipe back into his pocket.
             “I better let you carry on with your work,” he said and a thin line of smoke followed him out of the room.
            “Yes,” I said and went back to work.
Look next week for the rest of this Stranger than Fiction  story!

Saturday 4 July 2015

The Anesthesiologist, the Surgeon, the medical team and Respect.

          Respect - The Essential Ingredient.

          In a recent legal action a man in Virginia was awarded half a million dollars after being ridiculed and insulted by a forty-two year old anesthesiologist and her associates. The man recorded the incident while being prepared for the procedure, apparently to make sure he had the doctor's instructions recorded.  It appears he left his phone running and found he had captured the entire conversation, including that which took place whilst he was anesthetized, during the procedure.  Apparently, soon after he was asleep, the anesthesiologist, Dr. Tiffany Ingham,said to the anesthetized patient, "after talking to you for five minutes in pre-op, I wanted to punch you in the face and 'man' you up a little bit."  When an assistant noticed  the patient had a rash, the anesthesiologist told her not to touch it saying she might get syphilis on her arm.  Then she added, "It's probably tuberculosis in the penis, so you'll be alright."   Other medical personnel added similar derogatory remarks.  The whole recording is available on the net. 

          I have no doubt that some will regard this as typical of many physicians and tar us all with the same brush.   That is far from the truth and these few rotten apples do inestimable damage, to what for the most part has been a noble and caring profession.  Because they betray the trust of their patients and debase the profession, they need to be dealt with most severely and certainly should not have free reign to practice unsupervised medicine for a very long time.  A penalty, probably totally paid for by malpractice insurance, ends up by upping the premiums for the good guys and letting these miscreants off with little penalty.   It surprises me that our admission policies, our four years of undergraduate medical training and several years of post-graduate training does not enable us to cure or expel such individuals from the system.  But as most of us who have been in the medical educational system for any length of time know, once a student gets in to the system it is almost impossible to get him out without an M.D. after his name.  

          It was not always thus.