Wednesday 16 September 2020

Armageddon Now!

   On numerous occasions recently in this time of Plague, acquaintances have complained about being penned up in their homes, hardly able to get out at all except for grocery trips and the like. Even at the height of the lockdown, that seemed to be in stark contradiction to my observations of what was going on all around me- but that's another story. Many complain of boredom and not having anything to do. They seem surprised when I tell them that I am busy ALL the time and never bored. I don't know how I ever found time to work. What am I busy with many ask? So, here in a couple of short paragraphs is what keeps me busy! Reading, Writing and Arithmetic -the old 3 Rs -and a few other things.

 As a teenager and before, I was a prodigious reader. I read fiction and non-fiction. There was no television, so when we read fiction we had to use our brains to create the characters (casting function) and our imagination to visualize the set. (Set Design). We had to draw on our own cultural background to discriminate between good and evil. Discriminate was a good word and meant to be able to tell the difference between things,  particularly between good and bad. It was a parent's job. to teach their children to discriminate.  We certainly had no difficulty in distinguishing the good guys from the baddys.  Most do not want to do that anymore and they have changed the meaning of that word because it made them accountable. They want all to be the same, but all are not the same at all. The tragedy today is that the evil ,have succeeded in convincing the good that there is no difference between good and evil.. Maintaining that all cultures are equal is insane.  Some cultures unquestionably place much greater value on life than others. Reading transmits depth of information and understanding in a way that sound-bytes and news clips never can and my reading of the National Post and the Economist offers a quality of comprehension that television cannot.   At least they make an attempt to present the facts fairly.

    "How can I know what I think till I see what I say?"
 Attributed to E.M.Forster in answer to the question - 'why do you write? I've been a scribbler for years, often in moments of frustration or tension for precisely that reason. Somehow, writing it down seems to clarify and sometimes stabilize a series of thoughts. The scribbles and thoughts are directed to myself only, although at times I have thought that I might have been able to scratch out a living as a writer. I discussed this with a very frank friend of mine long ago after having him read some of my stuff. Here's what he said, "To be a great writer you have to be prepared to strip yourself naked in public-and you have to be prepared to reveal things about yourself and others that may be distressing to both yourself and them." He was right, so I contented myself with an occasional short anecdote usually of a medical nature and even published a few. Now that I have more time I occasionally sort through some of my deeply buried notes and may yet try to put together "The Great Canadian Novel".  I also spend some time crafting my blog, mainly for myself, but which my children and brother and sister occasionally read. 

    It's easy to explain this one. I cashed in my pension when I left the University of Saskatchewan and I manage it myself, so this accounts for a few hours a week. 

MISCELLANEOUS. Pen Time. The London (Canada) Pen Club has a long and distinguished history. It meets every Saturday and as far as I know, it is the only pen club in the entire world to meet weekly, We have  been doing this for well over twenty (yes 20!) years. We meet in a local coffee pub, called Williams Coffee  Club.   After the Coronavirus hit and the Coffee Pub shut down I got a call from one of our club members with a software background. "We are going to carry on our meetings on line," he said. "I am going to set up a meeting every Saturday morning at nine a.m." So Covid or no Covid the meetings continue. Only last Saturday we spent two hours discussing black inks!  Go figger!

Photo Time.
   When my brother became obsessed with genealogy, little did I think his disorder was going to affect the whole family, but this disorder is more contagious than Covid! It really is in our genes. I come from a family of early twentieth century pioneer professional photographers. My father was an avid photographer as was his best friend - a gifted amateur movie photographer. (see his movie starring me at This led to the unearthing of enormous caches of photographs that various family members had safely stashed out of sight in their basements. Unfortunately, some of them were so old that individuals could not be identified. Being the Grand Patriarch i.e. the oldest living member of the Smith Family, that honour fell on me, I was elected chief identifier and commentator on photos that were peopled with unrecognizables. I accepted the responsibility gracefully notwithstanding the fact that it cuts into my already crowded schedule. All of this stimulated my dormant interest in photography and I found myself using my smart phone camera increasingly, as I don't have a regular camera any more. Now I'm looking for a smart phone with an excellent camera that doesn't cost $1000. And now that my short-term memory isn't quite what it used to be I think I may re-start my brain-training exercises. Despite all the skepticism I felt it was some use. It was a bit time consuming but now I may be able to find some time for it in my busy schedule. All in all, I wonder how I ever found time to work!! .

Dealing with 'modern messages."

 My phone woke me up at seven o'clock this morning. The days when I got up at seven are long since past and I was sorely tempted to ignore it. But I was awake so I picked it up. The conversation went like this, the caller was female with a foreign accent. "Mr Smith, this is Visa calling. We have some concerns that some false calls have been put through on your card." Visa calling me at seven a.m. to tell me about a possible false credit card. A likely story! "Have you got your card handy?" 
 "No," said I. 
 "Well, we need to check it out." 
 "You just tell me the purchases you are concerned about." 
 "'Well there are two. There is a meal here for fifty-eight dollars and a gift certificate for twelve hundred dollars." 
  I was starting to enjoy this. "No, I didn't make any purchases like that," I exclaimed in my most horrified voice. "What do I do now?"   "Oh, we can correct that for you. We just need your card number and the three digit security number on the back of the card."
I tried to sound relieved. "Thank goodness. Can you just hold on while I try to find my card?" 
  "Certainly, sir." " I'll just be a couple of minutes." 
 I gently put the phone down and said to my fast asleep wife, "Honey, just get the RCMP bunco squad on the other line for me." I could hear the holding party slam down the phone. For those don't know a Bunko squad was a police division that investigated fraud. Obviously the scammers knew what it was. I then phoned Visa to let them know. They weren't surprised and just wanted to make sure I didn't give them any card information, which I didn't. "I knew it wasn't Visa calling." He laughed heartily. "You'll never get a call from us at seven a.m. We have very strict rules about calling clients in the morning, before they know what they're doing. I guess the crooks know the best time to get a hit!" 
 The previous phishing expedition I was exposed to was supposed to be from the tax department - Revenue Canada. 
 "This is Revenue Canada, sir." Hmmm, CRA (Revenue Canada) never called me SIR before. This must be really serious - or a scam.
 "What's the problem?" said I. 
 "The Department is about to launch proceedings against you unless you are paid up in the next forty -eight hours. If you do that it will save you a lot of trouble and money. It's a fairly small amount but once proceeding get started it could end up costing you a lot in legal fees." "Oh okay," I said, "it will probably save me a lot of aggravation and money." I could visualize them licking their lips at finding such an easy mark. "Yes it will be much better for you." said the voice at the other end. 

 "Have you got a pen handy? I'll give you my accountant's phone number. He understands all that sort of stuff. I'm sure it won't take him long to sort it out." I heard the disconnection click before I finished the sentence! I particularly miss the calls I used to get advising me of the corrections that my computer required. They explained, usually in strongly accented voices how cluttered up my computer was and why it was so slow. (I never bothered to tell them that no matter how slow my computer was it was too fast for me!) They would then explain what a target I was for scammers and hackers. My assurances that I did not require their services did not seem to carry much weight until I hit upon a foolproof response to all such calls. As soon as I got the drift a simple polite sentence would chase them off. "Thank you. My son is a computer consultant."   It never fails to frighten them off!

Thursday 3 September 2020

An obsolete physician.

An Obsolete Profession. 

 Being a physician of almost any type requires the ability and the interest to listen and to talk to one's patients and to communicate like two adults talking to each other. This applies particularly in general practice. For about half of my career I was an academic trying to teach young men and women how to be family physicians or general practitioners, I use the two terms interchangeably. The term 'family physician' was introduced in the sixties to try to put general practice into a 'specialist' category, quite the opposite to what was really needed. What the well-intentioned founders of family medicine were aspiring to was a physician who was a specialist in everything, a super-doc of impossible breadth. The impossibility of the task became all too apparent fairly early on, as evidenced by the early necessity of providing 'certificates of special competence' in ever expanding areas. This is what gave rise to specialization in the first place. One of the most important requirements of general practice is the ability to elicit the relevant information, sometimes highly personal and /or embarrassing and sometimes not obviously related to health to make a diagnosis. People come into medicine with varying gifts. Long before they have any clinical knowledge I have seen students interact with patients with skill and alacrity. The conversation was enjoyed by both patient and student. Others are not so fortunate and do not easily establish rapport with patients. Of course a sound basis in clinical medicine is extremely important but equally important is knowing when to refer and to whom. (Not always as simple as one might think). Almost as important is the ability to live with ambiguity and uncertainty which every generalist has to do. In the 'olden days', the medical history and physical examination were the keystones to finding out just what was wrong with the patient. When I was a teacher of Family Medicine I used to tell my students that when they had taken a history if they didn't have a differential diagnosis (list of possible diagnoses) in their own mind of what ailed the patient, or at least in what system the disease originated, they better go back to square one and re-take the history. Rather glibly in retrospect, I would say ' listen, let the patient give you the diagnosis.' Most of those sophisticated tests that people tend to be subjected to today did not yet exist. The physician relied upon his eyes and ears and sense of touch to make a diagnosis. Because the science of medicine was so primitive, the art of medicine determined the exceptional physician from the merely competent. Conan Doyle, himself a physician, modeled Sherlock Holmes on one of his mentors, Joseph Bell, and I have had the privilege of being taught by such an individual myself. Such individuals were well aware of their exceptional skills and were as susceptible as any stage magician to displaying their magic. All of them emphasized painstakingly collecting the data and observing the evidence to come to the correct conclusion. In fact, I found them to be more akin to Columbo than to Holmes (who had his brilliant judgement clouded on occasion by his cocaine addiction). I sometimes suspect that his close association with Dr. Watson might have had ulterior motives. Then along came ultrasound, CT scans and MRIs and all of the miraculous technology that made clinical skills as irrelevant as gas lighting - no, as candle lighting. Overnight, a lifetime of clinical skills were replaced by a cookbook of algorithms.
   In the final medical examination in those distant days the candidate had to show he knew how to take a history and do a physical examination. Alone with the patient for up to 45 minutes, the candidate emerged from behind the curtain and presented his history and physical findings in detail to the examiner, as well a list of possible diagnoses. "My" patient was an affable older woman in a public ward bed and in the course of taking her history I asked her if she had any idea of what was wrong with her. To my surprise (and delight) she said "Yes, of course, but I am not supposed to tell you." she added mischievously, with a grin. She went on to tell me the diagnosis. "And when you examine me you'll find my liver and spleen just a little bit enlarged." I did! They were! That conversation certainly paid off! In all cases an appropriate history had to be taken before it was appropriate to move on to the physical examination. Physical examinations were divided into complete or regional. Massive textbooks were dedicated to clinical signs and symptoms and to have a new clinical test named after you was an assurance of immortality. The 'complete' physical examination involved a detailed organized examination of every system, cardiac, pulmonary, neurologic, gastro-intestinal, musculoskeletal, all of which were systematically documented. Every orifice was explored and omission of a rectal examination was almost negligence. Now such a complete examination is regarded as unnecessary and most physicians don't know how to competently do one anyway. I remember when as a young physician, a respected specialist in Internal Medicine said to me: "It's time to throw away the stethoscope. It's an obsolete instrument." It wasn't true then and it isn't true now but it reflects an attitude that continues to exist and indeed, to grow.. That is why GP/FM is dying and would already be dead if it wasn't the cheapest way the political hacks can pretend to provide what they have promised.
   I enjoyed my 55 years in medicine but if I was starting again I would be somewhere else in the medical establishment where I'd have a life outside of medicine.