Wednesday 30 November 2016

DSM and Profile of a sociopath.

Profile of a Sociopath.

 Today more than ever we need to brush up on antisocial personality disorder, as so many of our world leaders exhibit them to a greater or lesser degree.

 This website ( summarizes some of the common features of descriptions of the behavior of sociopaths.

  • Glibness and Superficial Charm
  • Manipulative and Conning
    They never recognize the rights of others and see their self-serving behaviors as permissible. They appear to be charming, yet are covertly hostile and domineering, seeing their victim as merely an instrument to be used. They may dominate and humiliate their victims.
  • Grandiose Sense of Self
    Feels entitled to certain things as "their right."
  • Pathological Lying
    Have no problem lying coolly and easily and it is almost impossible for them to be truthful on a consistent basis. Can create, and get caught up in, a complex belief about their own powers and abilities. Extremely convincing and even able to pass lie detector tests.
  • Lack of Remorse, Shame or Guilt
    A deep seated rage, which is split off and repressed, is at their core. Does not see others around them as people, but only as targets and opportunities. Instead of friends, they have victims and accomplices who end up as victims. The end always justifies the means and they let nothing stand in their way.
  • Shallow Emotions
    When they show what seems to be warmth, joy, love and compassion it is more feigned than experienced and serves an ulterior motive. Outraged by insignificant matters, yet remaining unmoved and cold by what would upset a normal person. Since they are not genuine, neither are their promises.
  • Incapacity for Love
  • Need for Stimulation
    Living on the edge. Verbal outbursts and physical punishments are normal. Promiscuity and gambling are common.
  • Callousness/Lack of Empathy
    Unable to empathize with the pain of their victims, having only contempt for others' feelings of distress and readily taking advantage of them.
  • Poor Behavioral Controls/Impulsive Nature
    Rage and abuse, alternating with small expressions of love and approval produce an addictive cycle for abuser and abused, as well as creating hopelessness in the victim. Believe they are all-powerful, all-knowing, entitled to every wish, no sense of personal boundaries, no concern for their impact on others.
  • Early Behavior Problems/Juvenile Delinquency
    Usually has a history of behavioral and academic difficulties, yet "gets by" by conning others. Problems in making and keeping friends; aberrant behaviors such as cruelty to people or animals, stealing, etc.
  • Irresponsibility/Unreliability
    Not concerned about wrecking others' lives and dreams. Oblivious or indifferent to the devastation they cause. Does not accept blame themselves, but blames others, even for acts they obviously committed.
  • Promiscuous Sexual Behavior/Infidelity
    Promiscuity, child sexual abuse, rape and sexual acting out of all sorts.
  • Lack of Realistic Life Plan/Parasitic Lifestyle
    Tends to move around a lot or makes all encompassing promises for the future, poor work ethic but exploits others effectively.
  • Criminal or Entrepreneurial Versatility
    Changes their image as needed to avoid prosecution. Changes life story readily.

Other Related Qualities:

  1. Contemptuous of those who seek to understand them
  2. Does not perceive that anything is wrong with them
  3. Authoritarian
  4. Secretive
  5. Paranoid
  6. Only rarely in difficulty with the law, but seeks out situations where their tyrannical behavior will be tolerated, condoned, or admired
  7. Conventional appearance
  8. Goal of enslavement of their victim(s)
  9. Exercises despotic control over every aspect of the victim's life
  10. Has an emotional need to justify their crimes and therefore needs their victim's affirmation (respect, gratitude and love)
  11. Ultimate goal is the creation of a willing victim
  12. Incapable of real human attachment to another
  13. Unable to feel remorse or guilt
  14. Extreme narcissism and grandiose
  15. May state readily that their goal is to rule the world

(The above traits are based on the psychopathy checklists of H. Cleckley and R. Hare.)

NOTE: In the 1830's this disorder was called "moral insanity." By 1900 it was changed to "psychopathic personality." More recently it has been termed "antisocial personality disorder" in the DSM-III and DSM-IV. Some critics have complained that, in the attempt to rely only on 'objective' criteria, the DSM has broadened the concept to include too many individuals. The APD category includes people who commit illegal, immoral or self-serving acts for a variety of reasons and are not necessarily psychopaths.

For more information.
DSM 1V and DSM V 
DSM 5 Criteria- becomes increasingly  amorphous and were reviewed in 2012, but here is the essence as plagiarized by me.  ( I  am all in favour of plagiarization as long as it is freely confessed.  How else are we to progress?)

 Criteria for  the Personality Disorder antisocial Personality Disorder:

There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three
(or more) of the following: having hurt, mistreated, or stolen from another.
1. Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest.
2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.
3. Impulsivity or failure to plan ahead.
4  Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
5.Reckless disregard for safety of self or others.
6.Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.
7.Lack of remorse..   

Obviously there are various degrees of affliction with  this disorder, nevertheless the salient points are recognizable in many past and present  leaders.  If you can't name half a dozen you need to  read more history and news.  My comments column sits empty!

Sunday 27 November 2016

Transgender and Plastic Bottles.

Sydney, age 7, was born female but identifies as a boy. He was photographed Nov. 3, 2016, at his home in Calgary.

National Post Headline.

‘I feel like a boy, mom:’ Doctors seeing an increase in preschoolers convinced they are in the wrong body.

Monday 21 November 2016

Hemorrhaging heathcare & the Free Market.

   You're living in Regina, Saskatchewan and after waiting for several weeks to see your family doctor, you just recently saw the specialist he sent you to, after several more weeks of waiting.  The specialist determined that you need an MRI and the hospital told you it might take several months before they could 'fit you in'.  By now you are getting acutely anxious, even a little desperate.  Then your friend informs you that she heard that you can have it done privately. You make some inquiries and find out she is right.  The Saskatchewan government recently announced that two MRI clinics have been licensed to do MRIs privately, for a fee.  You phone and find that instead of waiting months, that you can have it done within a week.

   Wow!    In the land of Tommy Douglas, which gave birth to Canadian medicare, they realize that to give the folks the option of buying the care they need when the government can't afford is a no brainer.  I practiced in NDP Saskatchewan for almost thirty years and thought I'd never see the day.   Amazingly, the Saskatchewan Medical Association is opposed to what they label a two tiered system. Now the whole country is recognizing that if the folks can't buy it here in their own province or in Canada at all, they'll buy it somewhere else, thus making it even more exclusive.  That is, the whole country except our chosen political servants, who have appointed themselves our political masters.  In every province in Canada there are private facilities, obviously more available in the densely populated parts of the country.
   Waiting time for medically necessary treatment in Canada is not improving.  A specialist survey reported a median waiting time of 18.3 weeks to treatment, from the date of referral by the GP.  This is almost double the time it took in 1993. For less urgent problems or procedures, it is not unusual for the  delay to be a year or greater.  Many of these waits subject patients to pain and suffering and sometimes outcome risks.
   So, you may ask, how much is an MRI going to cost me?   Here are the rates from one private MRI Clinic.

All scans include radiologist’s report and a CD Rom copy of the images.
Routine Brain $895
Brain for MS $895
Brain for Seizure $895
Facial Bones (no brain included) $895
Temporomandibular Joints (no brain included) $895
Brain & Facial Bones $1,120
Brain & Orbits $1,120
Brain & Sinuses $1,120
Brain & Pituitary $1,120
Brain & Circle of Willis MRA $1,120
Brain & Internal Auditory Canals $1,120
Brain & Trigeminal Nerves $1,120
Brain for Tumor (contrast included) $1,195
Brain Trauma with Susceptibility Weighted Imaging (SWI) (for mild traumatic brain injury) $1,245
Brain Stroke (includes SWI) $1,245
Carotid MRA (contrast included) $1,470
MS Brain & Cervical Spine Combination $1,500
Brain & MRA Circle of Willis, Contrast Enhanced Carotid $2,270
Brain & Spinal Cord for MS Combination (cervical & thoracic) $2,395

Chest (mediastinum, chest wall) $895
Soft Tissue Neck $895
Sternum, SC Joints $895 each
Brachial Plexus $895
Specific Muscle $895
MRCP $895
Pelvis $895
Abdomen $1,095
MRA (renal or aorta) $1,200
Dynamic Liver(contrast included) $1,395
Abdomen/Pelvis Combination $1,545

Whole Body Health Screening Program (see video)
(2000+ detailed images including specific screening for brain, aortic & abdominal aneurysms, compression fractures of the spine, gyneacological cancers, liver lesions and pancreatic, kidney, biliary disease/malignancy)

All Extremities (ie. knee, wrist, ankle, etc.) $895 each
Foot/Ankle Combination $1,590

All rates subject to change without notice.

Feel free to comment.

Thursday 17 November 2016

Hemorrhaging medical care and the two tiered system.

 The hemorrhaging medical care system and private clinics.

"With regards to international comparison, the 2014 Commonwealth Fund report on the health system performance of 11 countries ranked Canada 10th overall, indicated particularly low scores in quality, safety, access, timeliness, efficiency and equity."

   Despite the fact that the hubris of the government of Canada results in attempts to violate the rights of citizens to buy health care, government either refuses or cannot afford to give, private clinics continue to quietly surface.  They do so with a minimum of publicity, just enough to be visible to those who seek it and hopefully not enough to bring them to the attention of the "health commissars".  If they can keep their heads below the radar for the present, perhaps they will thrive as the public gets used to better, more timely care.  The fact that many people are prepared to pay from their own pockets, in addition to the considerable taxes they pay, surely makes it clear that the system is unsatisfactory and this is the only way they can get better care.  When I started looking to see what already exists, I was surprised.  As  I  started searching it became  apparent that private medical care is already more developed  than I had imagined.   I had only been looking a short time when I hit upon:  Their web site attempts to list all of the private health care facilities available.  If you are prepared to pay, that MRI that was going to take a year can be obtained this month, or maybe even this week.  Need to see an orthopedic surgeon Instead of waiting a year you can do it this month, or possibly this week.  You can even get your hip or knee replaced in short order, if you are prepared to pay for it.  Most of these services are available in Canada but for some it may be necessary to travel to the U.S.   In some cases the U.S. has come to us.  The Cleveland Clinic, a global non-profit academic medical centre opened a 26,000 sq foot medical facility in Toronto in 2006.   Located in a prestigious building in Bay Street, the Cleveland Clinic Canada, is a part of a clinic that enjoys an international reputation.  Have a look at their web site : is an easy to use comprehensive web site that lists most of the private facilities in Canada.  Obviously, they tend to be clustered in the most populous parts of the country, but they are found everywhere. Because private health care keeps a low profile for obvious reasons, some are a little slow to come to light.  The facilities are listed by province and the opening menu lists by specialty icons, starting at A for Allergy and ending with W for weight loss.  Just click on the subject of your interest and voila, the clinics are listed, most of which have a detailed web site of their own.  Even if you are not contemplating using private health care facilities, this is worth taking a look at.  The site gets about eight thousand monthly visits.  The only thing I could not easily access was cost.   So, the much maligned two tiered  system is already here.  The government doesn't want to admit it because it emphasizes their failure The doctors and other health professionals like to keep a low profile, for fear of waking up government.  The folks who need it and can afford it want to see it thrive and prosper.

Do you think we need a two tiered health care system? 


Saturday 12 November 2016

The Medical Dictatorship violating my rights.

"With regards to international comparison, the 2014 Commonwealth Fund report on the health system performance of 11 countries ranked Canada 10th overall, indicated particularly low scores in quality, safety, access, timeliness, efficiency and equity."

   The government is violating my rights. Publicly funded health care is a wonderful and necessary thing.  No civilized country should be without such a safety net.  However, that should not preclude me from spending my own hard earned money on aspects of my or my family's health, particularly with regard to services the government cannot afford or chooses not to cover.  The header above this article makes clear that the government finds it satisfactory for us to rank tenth out of eleven health care systems (though by now, we may be eleventh).   The only reason imaginable for their reluctance to allow willing providers to provide service to patients on a voluntary insurance or cash basis is that it is a de facto admission of the failure of the public system to  provide adequate care. It is not as though those who would like to avail of such a system are seeking to avoid the large tax burden of the public system.  Quite to the contrary, they are offering to subsidize the system by buying their own care through cash or private insurance.  They are shortening waiting lists for the public system and saving it money.  When they buy services or investigations such as MRI they are making space in the public system.  Folks with money do this already, they shop, they frequently go across the border and leave their money in  other country's exchequer.  Our government addresses these problems by systematically introducing layer after layer of bureaucrats, each layer draining funds for salaries, benefits and pensions.  None of these administridiots contribute anything to the delivery of health care or the care of patients.  It would be interesting to know what proportion of the health care budget goes to maintaining this hierarchy. There is an urgent need for services the government cannot provide in a timely fashion.  There is no consolation in constraining the availability of service to the lowest common denominator to satisfy government ideologues. Patients die while on waiting lists.                                         Fifty two thousand five hundred and thirteen Canadians traveled abroad for medical care in 2014.  The large number coming from Ontario is not entirely explained by the larger population of the province.  Private health care clinics are springing up all over the country, while keeping as low a profile as possible to avoid the consequences of  contravening the Canada Health Act.  In Quebec in 2005 the Court ruled that a one year wait for a hip replacement violated the provincial human rights law.  Dr.Brian Day, an orthopedic surgeon has a Charter challenge going on in BC, that is finally before a judge after an eight year wait.

  I believe the private clinic concept is going to thrive despite attempts to  prevent it doing so.  In the meantime, those who can afford it will just continue to go abroad when they can't get satisfaction at home.  Next, we will explore some of the services that are available in Canada - right now!                                                  



Tuesday 8 November 2016

Why waste leisure time on eegits?

   I'm getting fed up trying to educate a few interested in health promotion and politics, who don't need education or a disinterested majority who are either ineducable or just not interested until they are seriously ill themselves and wonder why  the health care service is not working  for them.  Having spent a lifetime as a physician trying to promote awareness in health care to patients and professionals alike, I have decided the time has come to stop trying to help the folks allocate the health care budget in a constructive way and to try to stop them from depreciating our second class health care system into a third class one..  So, instead of continuing to attempt to educate the public re health care, I am going to direct my efforts in a different direction.  This will require a much less delicate approach than the one I have availed of in, so expect something entirely different.  I will continue medicalmanes for the  moment, although not as frequently as before.  The new blog I am considering will be politically inclined (surprise, surprise!) and not to everyone's liking.   It will focus on the prejudices and politically incorrect behaviour of  the   holier than thou Canadians and others who in the name of political correctness behave in a wholly prejudiced and hateful way.  There is a rapidly growing hate movement in Canada.  We need to look at it carefully and to address it aggressively. I'll let you know when I come up with a name!

Family Medicine Curriculum. A Letter to my doctor.

   I recently sent this letter to my doctor whom I have known and appreciated for many years.  I sent it because I  think she should know how resources are wasted and how a procedure well within the scope of any family doctor was being referred on to a specialist by a family medicine resident who should have known how to punch biopsy a small lesion and if she didn't should have been taught to do it on the spot by her preceptor. A ten minute procedure.  Instead, a costly consultation was to be set up over a year away.   It is time to re-visit the core curriculum of family medicine.
Dear *****
   Hope you are keeping well.  This note is just for your information to make a point about our rapidly dissipating health care industry, regarding which I frequently blog.
   About two months ago I came in with a small lesion on my ear which was bleeding and not healing.  Unable to convince your very pleasant resident to punch biopsy it, she suggested a consultation with an ENT specialist.  
   Having heard nothing after a month I phoned in, still no word about even approximately how long the appointment might take.  Yesterday, well after two months I got a call from your office telling me Dr ENT, after triaging the request said she could fit me in over a year.  Hard to believe this was not a joke!
   Meanwhile I had this dealt with  ( it took ten minutes or less).  Without having met her, I find Dr. ENTs attitude on taking over two months to inform me she could not see me for over a year, inconsiderate at the least.  I could go on, because I really think the procedure was well within the scope of an average GP, but I don't want to sound like the old curmudgeon that I am.
   I hope you are not upset by this letter, but I think you need to know about it.
   Regards as always,
     I never did get a reply to this letter and I choose to think it must be because it got lost in cyberspace.  


Wednesday 2 November 2016

Destroying the Medical Profession!

  Despite my resolution to reduce medical blogging, it's hard to do. You see, I see my previous profession as being deliberately denigrated, belittled and manipulated by a regiment of obtuse politicians and administrators who know little about medicine but think they should be able to dictate to those who provide health care, not just how to organize medicine but how to practice it.  They call their new bill. Bill 41 and it is designed to remove all power in health care from the people who provide it, to the administridiots. Not only do they want to dictate how medicine is practiced, they want to be the arbiters of what is moral and ethical in the practice of medicine.  It is difficult to think of a group less fit to do this, since many of them seem to be utterly lacking in both morals and ethics.  As they have taken over admissions to medical school they have eroded the personal and ethical values of the candidates in the interests of social engineering.  I know, I spent many years on admissions committees  and have seen many excellent candidates excluded.  Unfortunately, most of the candidates had to lie to get into medical school and tell the admissions body what they wanted to hear.  The ones who were honest often didn't get in because despite being appropriate candidates they didn't tell the committee what they wanted to hear.  Some of them learned by the following year! 
   I spend a good deal of time thinking about how the influence of the administridiots can be diminished and other than very major action, I don't think it can be done.  
   Medical students and physicians need to be guided by Rudyard Kipling's poem "If".  Read it if you're not familiar with it and particularly pay attention to the following few lines which sums up the situation so well:
   If you can bear to hear the truth you've spoken
Twisted by knaves to make a trap for fools,
     Or watch the things you gave your life to, broken,
And stoop and build 'em up with worn-out tools: 

   I'm glad I'm not a doctor anymore!

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