Getting old?

   Now that we are getting old-er, our family reunions, which we manage to arrange, usually for some family celebration a couple of times a year, become increasingly meaningful.  As we become older, the younger members of the family and some of the older ones too, insist that we, the siblings and spouses, are looking unbelievably young for our ages, and I guess that most other families have a similar tall story. 
   Talking to my brother on the phone the other night, we remarked on the phenomenon and reflecting on the appearances of many of the people who looked incredibly old to us in our youth, we decided that there is more to it than just the fact that we were the young looking at the old.
   "Well, what do you think accounts for people looking comparatively younger today?" I asked, "Better nutrition?" I added helpfully.
    "I thought Dad looked old when he was fifty," he said. "I remember him on the beach in a three piece suit."  That meant wearing what Americans call a vest and we used to call a waistcoat, in the old country.
   "Yes, " I agreed, "I remember him with his jacket off and his waistcoat unbuttoned on the beach on a nice hot summer's day at Malahide Beech. And it certainly wasn't modesty.  He was a strong swimmer and would go for a lengthy swim, to Malahide Island, which was a good mile of a swim.  Once he got back and dried himself off, he got back into his three piece suit again.  In fact, I have archival  photos in which the younger men and women were sitting on the beach dressed just as they dressed every day."
   "I think the clothes played a major role in making them look older.  I think when you see an old guy in a pair of jeans and no tie, just an open necked sports shirt, it does make him look younger."
   "I certainly couldn't imagine our grandfather in anything but a suit and tie, usually dark gray, even when he was sitting in the house doing nothing".  
    However, not all that long ago I couldn't imagine young women all dressed up to go out in something that looks strangely like my grandfather's winter underwear!  But then, not so long ago if one of my family medicine residents came into the office in a grubby pair of jeans, looking as though he hadn't shaved for three days and without a tie, he heard all about the dress code of our department and was told not to show up like that again.  In fact, their orientation stressed that they were expected to look professional. Those expectations no longer exist and would be considered an intrusion on personal freedom of expression.  The erosion of those basic standards is just one more minor sign of our decline.
   Despite the above comments, on perusing some of my archival photos, I think people do look younger, and not all due to botox and plastic surgery.  Nutrition, major scientific advances in health care, easier life styles, less worry, less poverty, better education all play a part.  Last, but not least so do clothes and some of the crazy and unattractive styles.
   Personally, I owe my youthful appearance mostly to my failure to mature over the years.
  

Health Care Hypocrites.

   The folks really put up with too much bullshit from the so-called 'elites'.    Unfortunately, the 'elites' have managed to convince the folks, through some magic I don't understand, that they are looking out for them, when really they are looking out for themselves.  Take the 'two-tiered system' that they are always telling the electorate will result in their getting a lesser quality of care.  They know perfectly well that they are lying and that the politicians and the administridiots have been enjoying a two tiered system for a longer time than I remember, and I'm over eighty.  They hang onto this benefit come hell or high water and all  their civil service satraps enjoy a greater or a less degree of the benefits as supplementary (i.e. tier #2) health care.  Why, those benefits are so valuable that a disgraced senator who had been abusing her expense account whined most piteously at the loss of her special health care benefits that would have put her in the same category as the poor one tiered slobs.  So our government and their employees will defend the so-called one tiered system, to the last drop of your blood as long as their privileges are maintained.   And just in case you think this is hurting the rich, it ain't. They can go private by slipping across the border or to a list of countries where the health care is as good or better than Canada's failing system.  
   In the lower levels of the civil service, in teaching establishments and Universities, those tier-2 privileges are already being whittled away.  A friend of mine was voicing her dissatisfaction recently regarding the fact as soon as she became a 'geriatric' (reached 65) her extended benefits cut back in favour of the public drug plan,  Until reaching that age her drug plan paid all her prescription fees and the mandatory first $100 that she now has to pay herself.  So, in fact, the government penalized her for reaching the grand old age of 65.    She, being a woman of action, tried to call her member of parliament, but they didn't want to know.  She was told: "That's the way it is."  End of conversation.
   So, if the government is totally committed to the Canada Health Act, let them lead by example and do away with all the special benefits associated with being 'the Peoples Servants' and let them have the benefits the Canada Health Act makes available to each and every citizen and nothing more.  
   Don't hold your breath! 

Ethicists for the Third Reich

Ethicists for the Third Reich.

Professors of medical ethics at Queens University in Canada and Oxford University in England say doctors' beliefs have no place in the health care system!  The names of these morons and you should not forget them are Udo Schuklenk, chair in bio-ethics in Queens University in Canada, and Julian Savulescu at Oxford, in England. Their opinion lends credence to George Orwell’s quote that there are some ideas so absurd that only an intellectual could believe them. These pinheads go on to say that ‘authorities’ should bar doctors from refusing services like abortion and assisted death on moral grounds and screen out potential medical students who might impose their (or perhaps any) values on the practice of medicine and the care of patients. Conscientious objection, they state is clearly unprofessional.  They go on to state, "Doctors must put patients' interests ahead of their own integrity".  These are dangerous academics, who have no understanding of health care, medical professionalism, integrity or morality.  They would shut down the argument, as most of the left wing academics would if they could, by either not allowing admission to medical school or failing those whose opinions differ from theirs.  They propose exactly what was required of physicians in the Third Reich.  They are a menace to the future of medicine.  They may be bio-ethicists, they certainly are not medical ethicists.

Docs for Dope!

Is this what physicians are doing now?
   A proud tradition of medical practice is being sacrificed to a group who feel that their every whim should be satisfied and that their opinion of drug availability and use, is equal  to  the opinion of the experts in  the field.  Incredibly, they do find physicians who agree with them.  The politicians and the administridiots are only too  pleased to grant their wishes because adequately drugged citizens ask fewer questions and are more easily manipulated than those with a clear mind. I understand what the pot seekers want and how they feel, but it is difficult to understand how a group of physicians pander to these people and profit from their addictions.  A generation ago, most physicians were sufficiently principled  to take a stance in dealing with such  drugs of addiction and were not easily led astray by easy money.  Pushing drugs was viewed very seriously and the consequences were very serious.  Many a physician lost his license or went to jail for the offense.   Could these modern purveyors of pot really believe that they are doing good?  I doubt it.  In another era they would have lost their license or worse.
   Unfortunately, those screening applicants for medical school  are probably as misinformed as many of those they recommend for acceptance.  High marks alone are not enough.  Honesty, integrity and good judgement in the practice of medicine are at least as important.  Sadly, it is  patients who will pay the price.

Immortality, who needs it?

   Living longer - and longer, seems to be the objective of an increasing segment of  humanity.  Everyone wants to be rich and everyone wants to be happy, but quality apart, longevity seems to be a major objective almost regardless of the quality of life.  In response, you may quote the growing number of 'euthanasia enthusiasts' and certainly such a group exists, but they are far from being the majority and most folks want to live to a ripe old age and some would like to live forever. Despite the assertions of groups of fringe loonies, as medicine progresses, longevity certainly increases,   People live longer healthier lives and life expectancy has increased beyond our wildest expectations.  A lifespan of 104 or so seems to be tossed around  and regarded as a normal achievable goal by both physicians and patients.  All that sounds sweet, but.............
   We seem to be having increasing problems with people living as long as they do now, often into their eighties.  The health care system is  having great difficulties with  providing for  many of our  elderly people now.  Lengthy waiting lists  for patients requiring urgent care is the norm, and anything less than urgent is treated with a level of  indifference (unless just before an election!) that is downright callous.  Yet, our politicians are quite indifferent as long as the whole situation can be kept low key, until  before the election.  Then, an unlikely and never to be put into effect solution is paraded out in the hope of garnering votes.  Even at our present population levels, many old folks, and I am talking about people in their seventies and eighties, go without adequate attention and care.  Those who do  not have family members to care about them and act as advocates, suffer most.  Many live in conditions that we would not tolerate for jail inmates.  Indeed, having provided both geriatric care and correctional institutional care, I think I can say with all honesty that the latter get better care and attention.  
   Even those with families often become a burden in a two earner family, and that results in them having to live in an assisted living environment situation.  Despite our avowed dislike of 'two-tiered' systems they avail of the level of care depending on  what they and their families can afford or are prepared to  spend., because this can  be a multi- tiered system, the lowest of which is dreadful.
   Prolongation of life, which  to a variable degree in available today, can be greatly enhanced, but it will be expensive.  Very expensive.  The quality of the expanded life, is and will be variable.  Very variable.  As the population gets older - and older, who is going to pay for the incredible increase in expense that will  keep these people alive.  Living expenses, medical expenses, special care expenses.  We can barely keep our present second-rate health care system running.   The pyramid has become inverted and the younger population resents and will  increasingly resent supporting more and more elderly people.  Because, although we can prolong life and will become increasingly skilled in doing that, we still won't be able to turn old  people into young people and old brains into young brains.  Body parts wear out and though we may be able to repair them or replace them. they will be old replaced or repaired organs.   Pension plans and benefits are bankrupting countries already, think about who is going to provide for a bunch of centenarians! 
   Maybe I'll have to review my views on euthanasia!

Please don't make any comments unless you wish to live into your eighties!
  

The Great Canadian Medical Dictatorship.

   Dr. Brian Day, a Vancouver orthopedic surgeon, runs a clinic that combines a private practice with his medicare practice.  Dr. Day has the temerity to challenge the Canada Health Act and is fighting for Canadians right to health care free of lengthy waits for consultations or care, by paying for it out of their own pockets.  In a country that prides itself on its democratic principles, that would seem to be a perfectly reasonable position to take but many Canadians seem to think that other people's right to buy health care with their own money, somehow depreciates what they have come to regard as the entitlement of 'free' health care.  Instead of considering the injection of private funds into the health care system a benefit, they are irrationally afraid that the second class health care they are getting now, will become third class.  They are afraid that some folks would be able to buy better health care than they can get 'free'. (There is no free health care!)  The wealthy already have a two tiered system in that they go to the United States or other places and inject their funds into their systems instead of our own.
   A significant part of our health care budget does not go to health care at all.  It goes toward supporting an  ever growing hierarchy of politicians and administridiots who look after themselves obscenely extravagantly and who are more interested in appearances than in  the quality of health care.  It funds programs that are politically popular even when they have little (or  sometimes nothing) to do with health care.  In face, the administration of health care in this country is a disgrace.
   Dr. Day is fighting for a principle, even though a concurrent private system would benefit him financially, the litigation costs will be so outrageous that he could lose everything.  (The cost of legal proceedings is so expensive that it is the most explicit example of the fact that equality for all  is a myth perpetuated by the ruling classes to try to 'fool all of the people all of the time', a goal in which have largely succeeded.)  Dr. Day is simply saying that Canadians should have the right to buy health care as they have the right to buy anything else and that the additional money they would inject into the health care system would free up resources for others.  Those who would pay for the services are not looking to get more than their share.  To the contrary, they are offering to contribute additional funds to support the health care system in addition to the taxes they already pay.  In fact, as mentioned above, wealthy and not so wealthy patients already have a two tiered system.  They can and do leave Canada for their care and contribute to other countries.  In 2014,  52,513 Canadians traveled abroad to get health care and the number is rising and will continue to rise until we take the control of the health care system out of the  hands of self-serving politicians and administridiots and place it back into the hands of those who provide it and understand it.
  Our health care in Ontario is declining rapidly.
   Is no one interested??  Apart from the sick, that's the way it looks and if the folks don't smarten up, they are going to get some very nasty surprises.  Soon.  Good luck, Dr.Day.

 “If you think health care is expensive now, wait until you see what it costs when it's free.”
― P.J. O'Rourke
  
 
 

Medschool 1- Reflections of a dumb GP.

The Anatomy Theatre at TCD.

The type of artistry that Professor Cecil Erskine's painted of Versalius' diagram's that adorned the panels surrounding the theatre

Medical School.  Day 1.

   Nineteen years old and here I was.  Medical School.  Day one! 

   The University environment was not strange to me, I’d spent two years doing ‘pre-med’.  The medical school at Trinity College, Dublin, which was founded in  1711, was the venue in which we studied the basic sciences of chemistry, physics, botany and zoology.  We were privileged, even at this stage to have been instructed by some of the leading scientists in each of those disciplines.   

   Ernest Walton, nobel laureate, deigned to educate us first year medical students in physics.

   Bronte Gatenby.  James, (Golgi body discoverer) was an eminent zoologist, of the famous literary family, the Brontes.

   Gatenby Peter - James' son. Ireland’s first full time professor of Internal Medicine.  (In those days a Professorships were rare and meant something, unlike N.America, where it means little more than teacher.)   

   Men, with international reputations, bothered to teach, pre-medical students, the lowest form of academic life.  I suspect that they recognized that the most important thing they could do was teach and inspire a bunch of  kids to study science and what honorable human behavior was in relation to science and medicine.  Don’t get me wrong, there were almost as many fakes, frauds and con men around then as now, but it was much harder to get away with  it.  When they were caught, there were dire consequences.

   But I diverge, Trinity College, Dublin, in the sixties was still one of the notable European seats of knowledge, comparable to Oxford and to Cambridge, and was educating  many of the future world leaders and scientists, as it had done for several centuries.

      Here I was, a nice son of an upholsterer eking out a living, starting his medical  studies at Trinity College, Dublin

   The anatomy lecture theatre at Trinity College Dublin, was an impressive sight for a young man (see above picture).  The terraced layers of seats were numbered, so that should a student be absent, it was immediately apparent.  The walls of the huge lecture theatre, were adorned with large hand painted reproductions of the great sixteenth century Anatomist, Andreas Versalius, still recognized as the father of modern anatomy.  His book, 'De humini corporus fabrica', was fully illustrated with drawings of his own dissections of the human body and his erudition and artistic genius are unequaled.  The paintings around the lecture theatre, were painted by our anatomy professor, a gifted artist, who would draw such beautiful illustrations on a blackboard, with multi-coloured chalks, that we hated to see them erased at the end of the lecture.  If only we all had smart-phones with quality cameras to capture those educational and artistic diagrams for posterity!

    There I sat, placed under S, as our seats were allocated based on  our initials.  To my left, Spencer, to my right Stavely O’Carroll.

    Brian Spencer, to my left, was an unexceptional pleasant young Englishman with not quite the right accent for the Trinity Anglo-Irish, who, in those days were proud of their Protestant British upper class origins even though most of them were born in Ireland.   His main claim to fame was that somewhere in the North of England, from whence he came, he had an old Bentley car, that he liked to refer to whenever the opportunity arose.  To someone like myself, whose main ambition was to get a small engine that drove two hundred mile per gallon, screwed onto his pedal bike, owning any sort of car was near miraculous.,

   On the other hand, to my right, sat the very exceptional Maud Stavely O’Carroll, who was to become one of my closest friends.  She turned out to be one of the most remarkable women I ever met.  She was one of perhaps a dozen women in our class of about eighty, she looked terribly old (to me) and she was about six months pregnant! She was the proto- type of the liberated woman, before that term had even been invented, had three young children and  one on the way and a husband who was a doctor in the Canadian Air Force.   Their agreement was that once he graduated and started earning she would commence medical school.  They were both Irish Catholic, who attended. Trinity College, a staunchly British foundation.  In those days the Catholic church frowned on Catholics going to Trinity, and  I remember Maud telling me of a visit by her parish priest, who told her she was a poor Catholic for going to Trinity, instead of University College, Dublin, the Catholic University.  Maud was not a woman to be intimidated by anyone and continued on in her own determined way.