tag:blogger.com,1999:blog-82244886654117741072023-11-15T08:41:50.009-08:00First, do no harm (was Beattie Babble)Zimble:http://www.blogger.com/profile/10471279519215056939noreply@blogger.comBlogger19125tag:blogger.com,1999:blog-8224488665411774107.post-20007424039371432542009-06-22T17:16:00.000-07:002009-08-06T16:01:47.101-07:00Says who?<p class="MsoNormal"><span style="FONT-SIZE: 16pt;font-size:12;" lang="EN-US" >My silence on this blog should not be read as a sign of acceptance of the status quo nor one of contrition. <?xml:namespace prefix = o /><o:p></o:p></span></p><p class="MsoNormal"><span style="FONT-SIZE: 16pt;font-size:12;" lang="EN-US" >Recently, the office of the Director General of Health sent to all Q health employees an email message about medical outpatient clinics.<o:p></o:p></span></p><p class="MsoNormal"><span style="FONT-SIZE: 16pt;font-size:12;" lang="EN-US" >“The activities of general medical outpatient clinics are to be revised so that only core activities are undertaken. A greater clinical load will be shifted from public hospitals to general practitioners.” <o:p></o:p></span></p><p class="MsoNormal"><span style="FONT-SIZE: 16pt;font-size:12;" lang="EN-US" >Adult internal medicine is a ‘specialty’ but its alternative title, ‘general medicine’, suggests inclusivity. If a person’s condition is simple, it is usually easy to sort; if it is complex, then it needs to be sorted.<o:p></o:p></span></p><p class="MsoNormal"><span style="FONT-SIZE: 16pt;font-size:12;" lang="EN-US" >General physicians don’t define “core activity”. That is for bean counters and director generals. <o:p></o:p></span></p><p class="MsoNormal"><span style="FONT-SIZE: 16pt;font-size:12;" lang="EN-US" >In Australia, the state governments fund public hospital medicine. The federal government funds most other health care. There is an obvious duplication of bureaucracy, but also, there is between the two sectors a constant battle of costs. Moving clinical load to general practitioners is ‘cost shifting’; something, which we workers have always been told, is illegal.<o:p></o:p></span></p><p class="MsoNormal"><span style="FONT-SIZE: 16pt;font-size:12;" lang="EN-US" >Shifting of clinical load from one sector to another also means that lines are drawn, in this case, between general practitioners on one side and hospital doctors on the other. The result: patients falling between the cracks (um...quacks).<o:p></o:p></span></p><p class="MsoNormal"><span style="FONT-SIZE: 16pt;font-size:12;" lang="EN-US" >If someone is turned away from a medical outpatient clinic with a condition that is not strictly “core business”, it is dangerous to assume that general practice will provide the needed care.<o:p></o:p></span></p><p class="MsoNormal"><span style="FONT-SIZE: 16pt;font-size:12;" lang="EN-US" >As much as the Director General would like to think so, the interface between patients and their GPs is not always reliable. The opportunity to give good care should be captured whenever and wherever it happens.<o:p></o:p></span></p><p class="MsoNormal"><span style="FONT-SIZE: 16pt;font-size:12;" lang="EN-US" >Unless this impractical, dangerous DG wants to sit in on every consultation I do, my clinic’s core activity will remain exactly as it is: “general”. Bring it on.<o:p></o:p></span></p><!--EndFragment-->Zimble:http://www.blogger.com/profile/10471279519215056939noreply@blogger.com0tag:blogger.com,1999:blog-8224488665411774107.post-17911783525942553372008-09-26T03:46:00.000-07:002008-09-26T14:19:18.558-07:00Avast pirates! Aarrr!The vernal equinox has passed. A winter of 'flu and ague has warmed into a spring of seasonal rhinitis.<br /><br />[I just plugged "ague" into dictionary.com to check the spelling. The computer said, "Bargain ague! Find, bid, win it on eBay Australia.com."]<br /><br />Every year, winter causes bed block. That is because the community, via the electoral system and the Q health decision makers, via their parietal lobes do not place value on the care of the sick elderly and therefore do not pay for extra beds and nurses for hospitals and staffing and <span class="blsp-spelling-error" id="SPELLING_ERROR_0">GPs</span> for nursing homes.<br /><br />One Thursday not too long ago, the public hospital where I work, "A", was "<span class="blsp-spelling-error" id="SPELLING_ERROR_1">ramping</span>". That is, ambulances were unable to deposit their patients to trolleys in the Emergency Department because there were no more empty trolleys. In fact, every hospital in the city was "<span class="blsp-spelling-error" id="SPELLING_ERROR_2">ramping</span>".<br /><br />One of Captain Bligh's Q health band of bilge rats rang to ask me if I would admit public patients to the co-located private hospital in order to take the pressure off another hospital, "B", located about 20 km South West of "A".<br /><br />"Well, that would be fine," I said. "How will you pay me?"<br /><br />Silence at the other end.<br /><br />"I mean, are you going to pay me for time in attendance and all the associated on call work on an hourly rate or will I bill you with item numbers on a case by case basis?"<br /><br />"Um, well, <span style="font-style: italic;">we</span> thought, since you are an employee of Q health, that you would just sort of, you know, <span style="font-style: italic;">do</span> it. "<br /><br />Silence at my end.<br /><br />But not for long.<br /><br />I pointed out to my caller, Hook 'n crook, that Q health had given me no understanding or support over the past six years in my efforts to juggle a private practice and a public hospital appointment, so, although of course I'd like to help Q health, he had better go away and think up a better agreement and put it to me in writing.<br /><br />Surprisingly, Hook 'n crook did that and came back with an offer to pay me Australian Medical Association schedule rates on a case by case basis. This was a surprise because the AMA rates are ludicrously high and have little or no relevance to the market place. Then it hit me: this is how my taxes are being spent.<br /><br />Anyway, I said "yes" and the game was on. Several hours passed and I heard nothing and then a night and then a whole next day. Where were all these patients I was supposed to be admitting?<br /><br />It came back to me that twelve patients at hospital "B" had been asked to make the ambulance journey to the private hospital, the one near hospital "A" and twelve of twelve had refused to budge an inch from their trolley in the corridor of their local facility.<br /><br />Aye, me hearties!!Zimble:http://www.blogger.com/profile/10471279519215056939noreply@blogger.com0tag:blogger.com,1999:blog-8224488665411774107.post-38595151134113914682008-02-08T22:35:00.000-08:002008-03-08T22:32:23.413-08:00Wake up.<p style="color: rgb(0, 0, 153);" class="MsoNormal">There was this sheep, you see and I can’t remember its name.</p> <p style="color: rgb(0, 0, 153);" class="MsoNormal"><span style=""></span>‘Fang’?</p> <p style="color: rgb(0, 0, 153);" class="MsoNormal">No.</p> <p style="color: rgb(0, 0, 153);" class="MsoNormal"><span style=""></span>Perhaps it didn’t have a name?</p> <p style="color: rgb(0, 0, 153);" class="MsoNormal">I remember it was an older sheep and quite large too. It was for our third year physiology experiment.</p> <p style="color: rgb(0, 0, 153);" class="MsoNormal">Might be just as well it didn’t have a name, then?</p> <p style="color: rgb(0, 0, 153);" class="MsoNormal">We had to anaesthetise it, venesect it, resuscitate it and then when it was dead, haul it into a large garbage bin: a big black plastic one with wheels and a lid.</p> <p style="color: rgb(0, 0, 153);" class="MsoNormal">You mean you had to put it to sleep?</p> <p style="color: rgb(0, 0, 153);" class="MsoNormal">No, we killed it. <span style=""> </span></p> <p style="color: rgb(0, 0, 153);" class="MsoNormal">What’s wrong with that? You had to do it. It was part of your learning. It’s only a sheep.</p> <p style="color: rgb(0, 0, 153);" class="MsoNormal">Did you know that sheep are hard to keep alive? It takes a lot of effort to ventilate an anaesthetised sheep with a piece of garden hose and a large plastic bag. </p> <p style="color: rgb(0, 0, 153);" class="MsoNormal">How did you do it?</p> <p style="color: rgb(0, 0, 153);" class="MsoNormal">What?</p> <p style="color: rgb(0, 0, 153);" class="MsoNormal">Kill the sheep.</p> <p style="color: rgb(0, 0, 153);" class="MsoNormal">Lethobarb. Sodium pentobarbital. It’s bright fluorescent green so you can’t mistake it for anything else.</p> <p style="color: rgb(0, 0, 153);" class="MsoNormal">Is it painless?</p> <p style="color: rgb(0, 0, 153);" class="MsoNormal">Supposedly so.</p> <p style="color: rgb(0, 0, 153);" class="MsoNormal">Still. Poor old sheep.</p> <p style="color: rgb(0, 0, 153);" class="MsoNormal">Yep.</p> <p class="MsoNormal">Since the 1970s, when capital punishment resumed in the US, articles about lethal injection have appeared in the medico-legal literature; about one or two a year. <span style=""> </span>Recently, however, there has been a string of comments turn up in the New England Journal of Medicine and, to a lesser extent, in Lancet.</p><p class="MsoNormal"> The editorials discuss the ins and outs of execution methodology, what is or isn’t “cruel and unusual punishment” and the ethics of physician involvement, from research to actually pushing the drugs (thiopental, an anaesthetic drug, pancuronium, a paralysing agent and potassium chloride, to induce cardiac arrest).</p> <p class="MsoNormal"><o:p> </o:p></p> <p class="MsoNormal">Certainly, the authors and the people to whom these articles are directed may be ill-educated or psychologically conditioned by the society in which they live. However, they are not ‘un’-educated, they <i style="">do</i> live in a democracy (or, so they say) and they <i style="">are </i>physicians. <span style=""> </span>How can they not see that capital punishment is spiritual delinquency? Medically sanitised or not, execution is an atrocity, reflecting human nature at its most base. <span style=""> </span></p> <p class="MsoNormal">Intellectual posturing on the pros and cons of lethal injection is no moral relief. The physician's absence of protest against capital punishment and therefore complicity is an abhorrence in itself. </p> <p class="MsoNormal"><br /></p><p class="MsoNormal"><br /></p>Zimble:http://www.blogger.com/profile/10471279519215056939noreply@blogger.com2tag:blogger.com,1999:blog-8224488665411774107.post-36498520748795154572008-01-25T19:07:00.000-08:002008-03-08T22:37:24.891-08:00More cow bell!I <span class="blsp-spelling-error" id="SPELLING_ERROR_0">thiik've</span> <span class="blsp-spelling-error" id="SPELLING_ERROR_1">gured</span> t <span class="blsp-spelling-error" id="SPELLING_ERROR_2">ut</span>.<br /><br /><span class="blsp-spelling-error" id="SPELLING_ERROR_3">Agh</span>. My keyboard's '<span class="blsp-spelling-error" id="SPELLING_ERROR_4">Eveready</span>' batteries suddenly turned into '<span class="blsp-spelling-error" id="SPELLING_ERROR_5">Nolongeready</span>' batteries.<br /><br />That's better.<br /><br />I think I've figured it out: why a suburban public hospital is the last place any rational person would want to work.<br /><br />You see, it's because the energy balance is all wrong; <span class="blsp-spelling-error" id="SPELLING_ERROR_6">Feng</span> <span class="blsp-spelling-error" id="SPELLING_ERROR_7">shui</span>, Yin/Yang, the rainbow connection, call it what you will: it's all snafu.<br /><br />On the one hand, disease drains energy away. No one can do anything about that; it is the way of things. On the other, the soulless culture of public hospital governance and its perpetual holding back of common sense and resources causes a cosmic constipation. 'In' does not replace 'out'. Making matters worse is the lack of any inbuilt reserve and flexibility within the hospital itself. There is no capacitor in this system. It exists in a perpetual state of attrition punctuated by frequent crises.<br /><br />I saw Avril again the other day. She's 70 and she's dying of heart failure. It's all down to inoperable coronary artery disease and hypertension. She knows it and I know it. In the whole scheme of things, there's not a lot of time left for Avril. She comes to hospital quite often with everything from a serious bout of gout to a casual VF arrest. Bit by bit, her heart is going, taking her other vital organs with it.<br /><br />One might say, with Avril, we're rearranging the deck chairs on the Titanic, or, while you're skating on thin ice, you're not falling through. Either way, it's serious stuff.<br /><br />Naturally, Avril generates a lot of paper work: progress notes, test results, medication charts, correspondence with her GP and other odds and ends. Every time I see Avril, her hospital file has grown a few centimetres thicker.<br /><br />"Is that all about me?" she once exclaimed, spying her file.<br /><br />"It is indeed, Avril," I replied.<br /><br />"Well I must be either very important or very sick," she said.<br /><br />"I think it's a bit of both, Av."<br /><br />The real problem is that the hospital has completely run out of chart covers. "Central", the place where chart covers come from, says we can't have any more until the beginning of March. (We ran out in about November last year).<br /><br />Normally, Avril's chart would have been split into two manageable volumes long ago. As it is, it is bursting at the seams (or it would be, if it had any seams at which to burst). A flimsy plastic <span class="blsp-spelling-error" id="SPELLING_ERROR_8">doo</span>-dad tries valiantly to hold all the pieces in place while every so often, the hundreds of pages explode in a fountain of parchment all over the unwary intern. It's as though the file is making its own personal protest at being so unwieldy.<br /><br />"I'm so fat, I can't take it any more!" it cries.<br /><br />The reason why I worry about Avril's chart is that it is symbolic of this energy imbalance I'm blogging on about. It represents a world which should be orderly and safe but is slowly crumbling into a quagmire.<br /><br />I can't do anything about Avril's chart cover. However, there is a need for someone, anyone, to add some positive energy to the system. I think there are ways to do this. For instance, I was reading an article in Lancet this morning where a Melbourne physician had decided to, each day, place in her medical ward a pile of photocopied poems beside a bowl of fruit with a sign saying "please take one of each". How brilliant is that!<br /><br />In my own small way, I've tried to address the imbalance by bringing some favourite tea bags; lemon zingers, chamomile, Earl Grey and the such like to the outpatient clinic for all to share. If tea in the afternoon can happen, then, perhaps, other good things can follow on.Zimble:http://www.blogger.com/profile/10471279519215056939noreply@blogger.com0tag:blogger.com,1999:blog-8224488665411774107.post-30525769646986749232008-01-19T19:22:00.000-08:002008-10-23T03:57:57.238-07:00Scum of the Earth.Everybody has a heart sink phrase. For firemen, it might be “We’<span class="blsp-spelling-error" id="SPELLING_ERROR_0">ve</span> run out of water”. If one worked in a department store, it might be, “The <span class="blsp-spelling-error" id="SPELLING_ERROR_1">manchester</span> sale starts tomorrow” and if you were an actor it might be, “The committee of the <span class="blsp-spelling-error" id="SPELLING_ERROR_2">Augathella</span> Township and District Ladies Auxiliary would like to see you after the matinee. They’<span class="blsp-spelling-error" id="SPELLING_ERROR_3">ve</span> brought you some <span class="blsp-spelling-error" id="SPELLING_ERROR_4">lamingtons</span> and knitted coat hanger covers.”<br /><br />For me, the heart sink phrase used to be, “Dr <span class="blsp-spelling-error" id="SPELLING_ERROR_5">Zimble</span>, there’s a drug rep waiting to see you.” It <span class="blsp-spelling-error" id="SPELLING_ERROR_6">doesn</span>’t bother me anymore though and I’ll tell you why in a moment. But first, let’s be clear: the marketing of pharmaceuticals is an odious business. The only people who benefit are the profit makers and the drug reps they employ.<br /><br />For the last few years, the college of physicians (<span class="blsp-spelling-error" id="SPELLING_ERROR_7">RACP</span>) has advised us not to accept gifts from drug companies. The gifts range from a very average <span class="blsp-spelling-error" id="SPELLING_ERROR_8">biro</span> to an overseas holiday. Over the years, I might have collected enough items to furnish an entire house: the Astra <span class="blsp-spelling-error" id="SPELLING_ERROR_9">Zenica</span> towel set, the Merck Sharp and <span class="blsp-spelling-error" id="SPELLING_ERROR_10">Dohme</span> bread knife, the Eli <span class="blsp-spelling-error" id="SPELLING_ERROR_11">Lilley</span> wall clock, the <span class="blsp-spelling-error" id="SPELLING_ERROR_12">Evista</span> ice cream scoop, the <span class="blsp-spelling-error" id="SPELLING_ERROR_13">Norvasc</span> solar powered calculator and the Viagra red silk <span class="blsp-spelling-error" id="SPELLING_ERROR_14">mens</span>’ boxer shorts to name but a few.<br /><br />A while (several years) ago, I did something I now regret. I accepted a pharmaceutical company invitation to attend a “scientific meeting” on diabetes management. It was an all expenses paid three day trip. I was given a local flight to Brisbane airport, a transfer to a domestic flight to Sydney, overnight accommodation in Sydney, a transfer to an international flight to Christchurch and a transfer to another local flight to <span class="blsp-spelling-error" id="SPELLING_ERROR_15">Queenstown</span>. At <span class="blsp-spelling-error" id="SPELLING_ERROR_16">Queenstown</span>, a coach took me to a luxury golf resort. The accommodation in New Zealand was amazing: a country hotel, with heated floors, nestling by a picturesque brook, ringed by snow capped mountains. Bill Clinton’s cottage was over there on the edge of the course.<br /><br />About one hundred delegates from across Australia attended the conference. We did listen to some speakers, for a few hours. The rest of the time we were wined and dined at the finest <span class="blsp-spelling-error" id="SPELLING_ERROR_17">Queenstown</span> restaurants and even had time to take a tourist flight over the glaciers to beautiful Milford Sound.<br /><br />Two things made the meeting quite odd (over and above the fact it was free). The first was a 4 kg bar of <span class="blsp-spelling-error" id="SPELLING_ERROR_18">Toblerone</span> for each delegate. If we <span class="blsp-spelling-error" id="SPELLING_ERROR_19">didn</span>’t have diabetes when we arrived, we would by the time we left. The second was the launch of the “novel anti-diabetic medication” <span class="blsp-spelling-error" id="SPELLING_ERROR_20">pioglitazone</span>. As chance would have it, the day before the launch, <span class="blsp-spelling-error" id="SPELLING_ERROR_21">pioglitazone</span> was busted in the world media for inducing fatal liver disease. I guess even multinational drug corporations have bad days.<br /><br />As nice as it was to have a break from the everyday and a chance to catch up with interstate colleagues, the trip was a pointless exercise. I <span class="blsp-spelling-error" id="SPELLING_ERROR_22">didn</span>’t hear anything I <span class="blsp-spelling-error" id="SPELLING_ERROR_23">didn</span>’t already know and the new drug was a dud. The money, let’s say $2000 per person (and that’s conservative), could so easily have been spent on worthwhile causes: mosquito nets for malaria prevention, wells for clean water in the Sudan, seedlings for Indonesian subsistence farmers and so on.<br /><br />I flew home feeling a little guilty but then I thought, maybe this is all normal in the corporate world. Maybe this is what I deserve. That was stupid.<br /><br />Far more subtle and, to my mind, more sinister than the gifts, are the drug rep visits. A mid-twenties woman, who could pass for an air hostess any day of the week, arrives at a suburban hospital medical clinic. She is dressed to the nines in <span class="blsp-spelling-error" id="SPELLING_ERROR_24">Georgio</span> Armani corporate attire with the latest and most expensive laptop computer in one hand and a polished Italian leather satchel in the other.<br /><br />Here comes the heart sink.<br /><br />“Doctor, Miss Armani is here from Super-Duper Pharmaceuticals and would like five minutes?”<br /><br />Damn. It’s one fifteen, I have four more patients to see, three calls to return to <span class="blsp-spelling-error" id="SPELLING_ERROR_25">GPs</span>, an abdominal <span class="blsp-spelling-error" id="SPELLING_ERROR_26">paracentesis</span> to do and my own ophthalmology appointment to get to by three.<br /><br />“Okay then, send her in.”<br /><br />“Dr <span class="blsp-spelling-error" id="SPELLING_ERROR_27">Zimble</span>! Charlotte from Super-Duper Pharmaceuticals. Thanks for seeing me. It’s so lovely to see you again! We missed you at the Super-Duper Pharmaceuticals dinner last Friday. I know how busy you get though. I’<span class="blsp-spelling-error" id="SPELLING_ERROR_28">ve</span> been run off my feet myself!”<br /><br />The idea is, if I prescribe super-duper drug, I too will have designer suits; I too will have my shiny hair coiffed and my makeup flawless and I too will have beautiful young friends like Miss Armani. Heck, I'll <span style="font-style: italic;">be</span> Miss Armani!<br /><br />Fortunately, these days, <span class="blsp-spelling-error" id="SPELLING_ERROR_29">Zimbles</span> come with a built in <span class="blsp-spelling-error" id="SPELLING_ERROR_30">bullshitometer</span>. Miss Armani has absolutely no idea when I ask her questions like: how many patients do I need to treat with super-duper drug to save one life? Is super-duper drug safe if my patient falls pregnant? Does super-duper drug work if it is crushed or chewed? What is the absolute benefit of super-duper drug versus its relative benefit? What is the cost benefit of super-duper drug over tried ‘n true drug in this condition?<br /><br />About three years ago I decided enough was enough. I said ‘no’ and stopped seeing the Miss Armani’s of the world. They could leave me printed matter if they desired but no appointments would be made.<br /><br />Nothing terrible happened. No one from Super-Duper Pharmaceuticals came with a shot gun to blow out my porch light; no one sent me orange overalls and a one way ticket to Cuba; and my colleagues <span class="blsp-spelling-error" id="SPELLING_ERROR_31">didn</span>’t end up knowing anymore about super-duper drug than I did. I'm certain I can live without the Super-Duper golf umbrella.Zimble:http://www.blogger.com/profile/10471279519215056939noreply@blogger.com0tag:blogger.com,1999:blog-8224488665411774107.post-26437125091616492522007-12-19T03:35:00.000-08:002007-12-20T00:22:40.260-08:00Ho! ho! ho!Somewhere, someone in administration has developed a sense of humour.<br /><br />Each morning, we print out a computer list of our patients that tells us how long they have been in hospital and when we are really lucky, where they are.<br /><br />This morning, my resident showed me my list. Admitted at midnight to my unit was Santa Claus, with travellers' diarrhoea!<br /><br />We went to see Santa (who looked amazingly like the resuscitation training manikin with cotton wool taped to his chin). At the bedside, we noted very prominent auditory and visual hallucinations (he sees elves and flying reindeer) and also unshakable delusions of grandeur (he is the <em>only</em> one who can make sure every child has a gift).<br /><br />With these things in mind we sent off an urgent referral to the psychiatry <span class="blsp-spelling-corrected" id="SPELLING_ERROR_0">liaison</span> and consultation service.<br /><br />Meanwhile, a parking permit application form was sent back to admin for processing.Zimble:http://www.blogger.com/profile/10471279519215056939noreply@blogger.com0tag:blogger.com,1999:blog-8224488665411774107.post-17699659040690560222007-12-14T12:26:00.000-08:002007-12-15T03:29:35.805-08:00Lighten up, ok?For more than six months now, I've been regularly sniping at my employer. At first it was a way to let off some steam and indulge in the occasional irony. Really though, it is a hollow solution and it's tiresome. Looking back over the posts, the blog makes me sound bitter and twisted, which I'm not... I don't think...well not much.<br /><br />Even if I'm simply writing to myself, I'd like to make this here blog (ugh, get out of it, Jethro...) Where was I? Yes, turn this blog into a more open discussion of Western medicine as it appears from my tiny corner of the profession.<br /><br />I'm sure Q Health hasn't changed a bit but I think, maybe, I have.Zimble:http://www.blogger.com/profile/10471279519215056939noreply@blogger.com0tag:blogger.com,1999:blog-8224488665411774107.post-30115667327932468452007-12-04T19:25:00.000-08:002007-12-15T02:47:04.804-08:00Crunch time.<div align="left">My employer and I may be rapidly approaching crunch time. Three local health districts are to be amalgamated into one mega district. All senior medical staff have been 'invited' to a lunch-to-afternoon tea long meeting at a suburban motel. The email reads "Please be advised you have been invited..." Has the ring of a summons, don't you think?<br /><br />The only reason Frank Burns would serve lunch and afternoon tea would be to ameliorate bad news. What bad news? Most likely, my colleagues and I will be asked/required to provide after-hours on-call services to more than one hospital at the same time and take weekend rounds at more than one hospital. In my mind, 'amalgamation' is simply a shorthand for decreased services and cost cutting.<br /><br />I've just Google-Earthed the journey. A round trip through the burbs, from home to each of the three relevant hospitals and back, will mean driving about 84 km. Now, I like driving, I do, and I like Brisbane but I can think of better ways to spend a Saturday or Sunday morning. Oh, you can always listen to the radio or to talking books....yeah....yeah.<br /><br />Traffic aside, covering more than one hospital at a time is not safe for patients. Murphy dictates that if more than one problem can take place at the same time and in different locations they most certainly will. It is also unfair on junior staff because of the increased pressure caused by removing an immediate source of supervision. I've tried it before and I can tell you: remote control medicine doesn't work.<br /><br />As for myself, taking the added responsibility of supervising an increased number of junior staff when on call, particularly when I won't have worked with them on a day to day basis is not a good thing. The money side of things is always last on my list but the eleven dollars and two cents per hour I receive for fielding calls after hours is not enough if the number of calls is to be trebled.<br /><br />As it is, I cannot attend the meeting. Sorry Frank. I'll have to wait and see the outcome. I might be trying to cross bridges before I come to them but on the other hand, just because you are paranoid doesn't mean they're not out to get you. A request to cover two or more hospitals at the same time will mean my resignation.</div>Zimble:http://www.blogger.com/profile/10471279519215056939noreply@blogger.com2tag:blogger.com,1999:blog-8224488665411774107.post-17366866542612877692007-11-22T21:27:00.000-08:002007-11-24T17:08:24.081-08:00You've got to be joking.This is an old joke (and I agree, a morally dodgy one): A GP, a physician, a psychiatrist, a health <span class="blsp-spelling-corrected" id="SPELLING_ERROR_0">bureaucrat</span>, a surgeon and a pathologist go duck hunting.<br /><br />The GP sees a bird in the sky and says, 'It <em>might</em> be a duck but I'm not sure' and the bird flies off.<br /><br />The next bird is spotted by the physician who raises his gun but then hesitates and says, 'It <em>is</em> extraordinarily duck-like but we do need to consider other possibilities.'<br /><br />He turns to the psychiatrist who says, 'Well, <em>I</em> know it's a duck but the question is, does <em>it</em> know it's a duck.'<br /><br />The health <span class="blsp-spelling-corrected" id="SPELLING_ERROR_1">bureaucrat</span> cuts him off and says, ' I don't care what it is and in any case you've run out of shot'.<br /><br />The surgeon suddenly raises his gun and <span class="blsp-spelling-error" id="SPELLING_ERROR_2"><span class="blsp-spelling-error" id="SPELLING_ERROR_0">BLAM</span></span> <span class="blsp-spelling-error" id="SPELLING_ERROR_3"><span class="blsp-spelling-error" id="SPELLING_ERROR_1">BLAM</span></span>, the bird falls to the ground. The surgeon turns to the pathologist and says, "Do us a favour mate and go and see if that was a duck.'<br /><br />Now, for something really funny: regional Bundaberg health execs, the office of the Director General of Health and the Queensland Medical Board accredit an Indian-American surgeon to work at Bundaberg base hospital under an 'area of need' program.<br /><br />They then ignore and or threaten clinicians who are telling them he is a psychopath (a fact a simple Google search of the man's name would have confirmed).<br /><br />The story eventually hits the headlines and before a Royal Commission gets underway, Uncle <span class="blsp-spelling-error" id="SPELLING_ERROR_2">Beattie</span> buys the surgeon-psychopath an airline ticket back to the States.<br /><br />Now it has got even funnier. The erstwhile Deputy Director General of Health is now the head of our new watch dog: the 'Health Quality and Complaints Commission.' <span class="blsp-spelling-error" id="SPELLING_ERROR_3">Quacc</span>! <span class="blsp-spelling-error" id="SPELLING_ERROR_4">Quacc</span>! indeed.Zimble:http://www.blogger.com/profile/10471279519215056939noreply@blogger.com0tag:blogger.com,1999:blog-8224488665411774107.post-49886543414554125912007-11-18T01:02:00.000-08:002007-12-06T23:41:28.388-08:00Seeing and hearing.If you are reading this, then go to <span class="blsp-spelling-error" id="SPELLING_ERROR_0">Jem's</span> blog, here:<br /><br /><a href="http://www.jemshaw.blogspot.com/">http://www.jemshaw.blogspot.com/</a><br /><br />Find Saturday 17<span class="blsp-spelling-error" id="SPELLING_ERROR_1">th</span> November, 2007, "Health and Safety Costs Lives"<br /><br />and<br /><br />READ IT NOW.<br /><br /><br />My heart goes out to <span class="blsp-spelling-error" id="SPELLING_ERROR_2">Jem's</span> son, someone half way around the world away whom I've never met. At the same time, I do know him. He could be the nice lad I saw at clinic last Friday afternoon or my friendly next door neighbour whose little son and daughter run around in the backyard squealing with delight when it rains or the young man who does my accounting and jokes with me about the rising cost of Bic <span class="blsp-spelling-error" id="SPELLING_ERROR_3">biros</span>.<br /><br />And I know <span class="blsp-spelling-error" id="SPELLING_ERROR_4">Jem's</span> frustration and anger. In 2003, I lost a dear friend to uterine cancer. She was living with her husband in the UK. She started bleeding and was told by her GP, after already waiting some time for it to stop, that she should wait some more time for it to stop and then come back for a pap smear. It didn't stop and so eventually the next plan was an ultrasound. The waiting time for an "urgent" scan was about six weeks for an outpatient. By this stage, she was sick and in pain, so they packed up and headed home. A few months later it was too late.<br /><br />I have also seen my own patients die on cardiac surgery waiting lists, on <span class="blsp-spelling-error" id="SPELLING_ERROR_5">interventional</span> radiology waiting lists and waiting for specialist clinic consultations and it makes me want to throw things, or worse. The cold rationing of resources and the fiscal waste the politicians and administrators lumber us with never ends.<br /><br />However, my rage and outrage at the bureaucrats is outweighed by my own guilt. Some of it is vicarious to be sure; a collective shame. Some of it is personal and immovable.<br /><br />Collectively, as physicians, I ask, why can we not see properly? Why can we not hear properly? Years of training, science galore, every whiz bang tool imaginable and we are still blind and deaf to our patients' needs. It should be so easy to listen and to look and to "be there" and yet we don't and we are not. What <span class="blsp-spelling-corrected" id="SPELLING_ERROR_6">makes</span> us so distant that we lose our own humanity?<br /><br />The following are pieces of my own experience.<br /><br />In 1991, as a second year resident, I spent some weeks working in a remote mining town on the edge of <span class="blsp-spelling-error" id="SPELLING_ERROR_7">Sturt's</span> Stony Desert. It was New Years Eve, so about 41 C and at about eleven pm I was called to see a young indigenous man who had got drunk, punched a wall and broken his right hand. He was loud and threatening and offensive. I was hot and tired and fed up. I splinted his hand and wrist and told him to come back in the morning so I could x-ray his hand and see if anything further was needed. At about 2.30 am I was called again, this time to see a 16 year old girl who had been raped and dragged by her hair out to a railway camp on the outskirts of town. She had got away and had walked bare foot back to town. A policeman came and told me that they had apprehended the perpetrator because the girl had described a brand new splint on the man's right hand. If I had been more tolerant, more culturally aware and had organised the young man with the broken hand a meal and a hospital bed for the night, that girl would have been alright.<br /><br />Then, in about 1998, I was a registrar in Far North Queensland. It was monsoon season, hot and humid. I started a weekend shift on Friday morning and finally got to bed at about 1 am on Monday morning. The night resident rang me at 2am about a young man with pneumonia. He wasn't doing well and so I ordered some changes to his treatment and went back to sleep. The resident rang again. It's now about half past four. We didn't speak for long. She just said, get here, now. It was only a five minute drive. When I got to his bed side he was in <span class="blsp-spelling-error" id="SPELLING_ERROR_8">extremis</span>. I <span class="blsp-spelling-error" id="SPELLING_ERROR_9">intubated</span> him and got him to ICU where he died a day or so later. I should have gone in to see him at 2 am when an earlier <span class="blsp-spelling-error" id="SPELLING_ERROR_10">intubation</span> would, most likely, have made a difference.<br /><br />These are just the things that come to mind at the moment. There are other things and I'm sure there are some things I'm not even aware have gone wrong. You might say that these things were due to systemic problems such as inexperience, isolation, under-staffing or fatigue. In fact, the real cause was not seeing, not hearing and not being able to care enough. You have to learn to live with the guilt of such things. There's absolutely no room here for intellectual rationalisation, some sort of quasi-existential self pity.<br /><br />There are times when, because of the deficiencies of medicine, I've thought seriously about leaving the profession altogether or at least leaving the public hospital system but where does that leave the people whom I might help, despite my limitations? For the moment, I try to accept the uncertainties and hope to improve things through teaching and by trying very hard to see and to hear and to "be there".<br /><br />(A bottomless pit of loathing for health bureaucrats, pharmaceutical company <span class="blsp-spelling-corrected" id="SPELLING_ERROR_11">representatives</span> and politicians also helps).Zimble:http://www.blogger.com/profile/10471279519215056939noreply@blogger.com8tag:blogger.com,1999:blog-8224488665411774107.post-44691705070213509672007-10-02T00:26:00.000-07:002007-11-21T02:44:23.073-08:00As the sun sinks slowly...And as the sun sinks slowly in the west, we say a fond farewell to Uncle Beattie. Hard to believe but true. Uncle Beattie has finally retired leaving his top henchwoman, Anna Bligh, at the helm. It is difficult to imagine how she could make us more at sea but I have a sinking suspicion she will. Bligh doesn't even pretend to be a benevolent captain, no Macleans grin from her. The Queensland Labor Party ethos won't have budged a hundreth of a fathom. No mutiny in the works. No Rum Rebellion on the cards. It's going to be life jackets on and every man for himself.Zimble:http://www.blogger.com/profile/10471279519215056939noreply@blogger.com0tag:blogger.com,1999:blog-8224488665411774107.post-6539180128057392562007-08-14T22:57:00.000-07:002007-08-16T20:01:01.458-07:00QANTAS ClubA long time ago, Uncle <span class="blsp-spelling-error" id="SPELLING_ERROR_0">Beattie</span> decided to rid all public hospitals of their doctors' lounges. These were quiet places of varying sophistication where a cup of tea and a sweet biscuit were served each day at 10 am and 3 pm, without fail.<br /><br />It was, of course, on the basis of removing all traces of professional elitism that the lounges were turned into things like <span class="blsp-spelling-error" id="SPELLING_ERROR_1">pre</span>-admission clinics and administrative offices. (I'm sure Uncle <span class="blsp-spelling-error" id="SPELLING_ERROR_2">Beattie</span> employs a band of builders whose only job is to partition larger hospital spaces into smaller ones).<br /><br />What Uncle <span class="blsp-spelling-error" id="SPELLING_ERROR_3">Beattie</span> didn't realise was that these quiet spaces were an integral part of the medical staff's work routine. It was the place you would go to find that elusive visiting colleague for a consultation for one of your patients. You knew exactly where and when he would be for at least ten minutes of the day and you could get the answer to whatever the problem was quickly, efficiently and with privacy for your patient ensured.<br /><br />(Uncle <span class="blsp-spelling-error" id="SPELLING_ERROR_4">Beattie</span> could not possibly understand such a way of working because it would mean doing away with the layers of faceless decision makers that absolve him from responsibility).<br /><br />Beyond work efficiency, it was the place where the expertise of a wide range of specialists could be brought to difficult cases and the place where junior staff would hear their seniors discuss difficult problems in real time rather than at retrospective case review hearings and formal grand rounds. This teaching on the hoof was much more effective than any tutorial or text.<br /><br />Finally, it was the place where you went to crash on a vinyl lounge chair when for some reason the night duty was long but quiet. It was the place where a half cold cheese and hummus toasted sandwich from the Lebanese deli across the street could drip down your blouse because you were too tired to hold it upright without a complaint ensuing and it was the place where you went to fall apart in safety and privacy when the day went horribly pear shaped if that's what you needed to do.<br /><br />It's not all bad though. My latest registrar, seconded from a major teaching hospital told me that with the return of a clinician to the chief executive officer role at his hospital, the new staff work contract included the building of a new tea room. An empty space was allocated and quite mysteriously, the budget was left open, as in the sky's the limit sort of open. Further to that, the design was left in the hands of one unusually talented and enthusiastic senior registrar who took his brief to design the new tearoom firmly in both hands and set forth.<br /><br />The new lounge, christened "The QANTAS Club" after the airline's swanky $600 per year establishment, has been built with smokey sliding glass doors, mood lighting, a full bar, media and Internet connections, telephones, elegant bathrooms and bedrooms with en suites. I gather there is also modern art gracing the walls and ceiling!<br /><br />I think this is where the pendulum has finally started to swing back. Uncle <span class="blsp-spelling-error" id="SPELLING_ERROR_5">Beattie</span> has run people into the ground so far that there is nowhere else for them to go and for the medical staff, at least, there-in lies a strength. The only way is back again. For our patients, this is a very good thing.Zimble:http://www.blogger.com/profile/10471279519215056939noreply@blogger.com0tag:blogger.com,1999:blog-8224488665411774107.post-49073442158023931982007-07-16T22:48:00.001-07:002007-07-19T15:03:47.987-07:00The jetty to heavenI was doing rounds with my registrar and resident the other day, looked out the window and what should I see? On the lawn outside, there was a brand new, modern sculpture! The new installation has a glass and steel construction in the shape of an off-kilter helix heading up towards the sky. With its many horizontal glass panels, it would do nicely for DNA, in an abstract sort of way but I am told it represents a jetty.<br /><br />One of my older, less grounded patients volunteered that this new structure was not in fact a jetty but a rocket launcher! Under his bed was where the nuclear warheads were stored. I considered his interpretation for a while, before deciding it wasn't very likely. I think it may have been the computer-timed fairy lights, which illuminate the sculpture at night that put old Joe on the wrong track.<br /><br />So, while we don't have anyone to file the charts, or a visiting neurologist more than once per month, or a Holter monitor, or bone marrow aspirate needles, or a dedicated procedure room, or enough chairs for people to sit on, or anything with which to treat fungal ear infections, we do have a very lovely "jetty to heaven" to appreciate. Thanks Uncle Beattie.Zimble:http://www.blogger.com/profile/10471279519215056939noreply@blogger.com0tag:blogger.com,1999:blog-8224488665411774107.post-23502275373011560432007-07-09T21:01:00.000-07:002007-07-27T19:52:07.418-07:00The case of the disappearing pigeon hole.Just the other day, I <span class="blsp-spelling-corrected" id="SPELLING_ERROR_0">received</span> an email written by admin. For <span class="blsp-spelling-corrected" id="SPELLING_ERROR_0">argument's</span> sake, let's call admin "Frank Burns". The email wasn't addressed to me. Rather, it had been forwarded to me by my helpful and reliable colleague and boss, Y.<br /><br />The email referred to x [that's me] and it said, "X's pigeon hole is full. Please have someone open X's mail and move it on." That was all.<br /><br />Well, this was all rather curious, I thought. In about mid 2004, I went, one day, to collect my mail from my pigeon hole only to find that my pigeon hole had disappeared, completely. I went to Frank Burns to find out what had happened to it (a stray worm hole perhaps?) and was told it had been 'reassigned'. (If this is starting to sound familiar to a previous post then it should.)<br /><br />At the time, I asked Frank Burns how I was going to receive my mail. Now, we're not talking pen pal letters, postcards and deliveries of <span class="blsp-spelling-corrected" id="SPELLING_ERROR_1">Cd's</span> and <span class="blsp-spelling-corrected" id="SPELLING_ERROR_2">DVDs</span> from Amazon here. This mail was important and urgent correspondence concerning patients and their care and, I admit, the occasional pay sheet.<br /><br />Frank Burns, suggested my mail would come directly to my outpatient clinic. Fair enough, I thought and come it most certainly did - piles of it, week after week.<br /><br />Then, recently, whilst I was on holidays and involved with a rather nasty <span class="blsp-spelling-error" id="SPELLING_ERROR_3"><span class="blsp-spelling-error" id="SPELLING_ERROR_1">adeno-virus</span></span> for a time, the mail apparently stopped. When I got back to work, what should have been a jammed to overflowing manila file was empty. Nothing. Nada. Perhaps the mail too, was now disappearing into the ether, just as my pigeon hole had done three years earlier.<br /><br />Reading between the lines (which was a bit difficult as there was only one), Frank Burns' email suggested that my pigeon hole had reappeared. I was <span class="blsp-spelling-corrected" id="SPELLING_ERROR_4">intensely</span> curious to see if it now looked anything like a blue police telephone box emitting a loud "<span class="blsp-spelling-error" id="SPELLING_ERROR_5"><span class="blsp-spelling-error" id="SPELLING_ERROR_2">whaa</span></span>! <span class="blsp-spelling-error" id="SPELLING_ERROR_6"><span class="blsp-spelling-error" id="SPELLING_ERROR_3">whaa</span></span>!" noise with a flashing light on top. Sadly, it didn't but it was there, just where it had been three years before, stuffed with mail.<br /><br />I replied to Frank Burns in my most polite tones. I assured that I would be happy to empty my pigeon hole regularly should someone forward to me a schedule of when it was likely to exist or alternatively provide me with a pigeon hole divining rod.<br /><br />The lack of existence of a pigeon hole might not be a big deal to some. (It was a big deal to my patients whose correspondence was missing in action, let me tell you). However, it is yet another symptom of the malevolence that is Uncle <span class="blsp-spelling-error" id="SPELLING_ERROR_7"><span class="blsp-spelling-error" id="SPELLING_ERROR_4">Beattie</span></span>.<br /><br />It is said that for a community of any sort to work well, there needs to be a careful balance between government, governance and the governed. For instance, in Iraq, there is a powerful government in the form of George <span class="blsp-spelling-error" id="SPELLING_ERROR_8"><span class="blsp-spelling-error" id="SPELLING_ERROR_5">Dubbelya</span></span>, no governance because he blew it all up and the huge uncared for, <span class="blsp-spelling-error" id="SPELLING_ERROR_9"><span class="blsp-spelling-error" id="SPELLING_ERROR_6">un</span></span>-governed masses.<br /><br />In Q Health, we have a domineering Uncle <span class="blsp-spelling-error" id="SPELLING_ERROR_10"><span class="blsp-spelling-error" id="SPELLING_ERROR_7">Beattie</span></span>, whom I'm sure, rues the day his mother failed to call him George <span class="blsp-spelling-error" id="SPELLING_ERROR_11"><span class="blsp-spelling-error" id="SPELLING_ERROR_8">Dubbelya</span></span>, a morbidly obese, philosophically bankrupt bureaucracy and then the sick people and the people who care for them.<br /><br />And it's not just the balance between the three, it's the whole culture of the structure, from <span class="blsp-spelling-error" id="SPELLING_ERROR_12"><span class="blsp-spelling-error" id="SPELLING_ERROR_9">Beattie's</span></span> bald head to the sole of my shoe, that's important.<br /><br />If I were to say to Frank Burns, "Can you see why it might be important for me to know when my mail is going to a pigeon hole instead of to my clinic?", Frank Burns would say, "No."<br /><br />If I were to say,"Would it be a polite thing to call me on my mobile phone and tell me I have been re-assigned a pigeon hole?", Frank Burns would say, "The correct <span class="blsp-spelling-corrected" id="SPELLING_ERROR_10">procedure</span> was to send an email to your supervisor."<br /><br />If I said, "Do you care what happens to my patients?", Frank Burns would say, "They're not patients, they're clients."<br /><br />Frank Burns wouldn't be lying or be being obtuse. It is simply that admin doesn't know and doesn't have the ability to think there might be a better way. Uncle <span class="blsp-spelling-error" id="SPELLING_ERROR_13"><span class="blsp-spelling-error" id="SPELLING_ERROR_11">Beattie</span></span> could change that but he doesn't want to and he won't.Zimble:http://www.blogger.com/profile/10471279519215056939noreply@blogger.com0tag:blogger.com,1999:blog-8224488665411774107.post-69399493928513863062007-06-13T03:18:00.000-07:002007-07-08T04:38:17.651-07:00Not alone.In the June 2007 edition of "Doctor Q", the monthly magazine of the Queensland Branch of the Australian Medical Association (AMAQ), Dr Zelle Hodge wrote in her president's report that two doctor members had resigned from Uncle Beattie's Queensland Health because of and I quote,"personal bureaucratic harassment inflicted on them".<br /><br /><br />I don't think I need to say anything else.Zimble:http://www.blogger.com/profile/10471279519215056939noreply@blogger.com0tag:blogger.com,1999:blog-8224488665411774107.post-89990540316719306952007-06-09T17:02:00.000-07:002007-11-21T02:53:38.526-08:00Trust no one.Under pressure (the use it or lose it sort) from Uncle Beattie to take annual leave, I planned four weeks. I even had a locum lined up.<br /><br />I should have known better. At the last minute, Uncle Beattie decided not to pay for my locum. I only discovered this change in plan during a chance conversation with a receptionist.<br /><br />The locum, being a sensible fellow, made a hasty exit for greener pastures. Uncle Beattie's deputy then suggested it might be difficult to spare me for more than two weeks without a locum. OK, so two weeks it was and the holiday plans fell through.<br /><br />I keep asking myself why I was surprised.Zimble:http://www.blogger.com/profile/10471279519215056939noreply@blogger.com0tag:blogger.com,1999:blog-8224488665411774107.post-28270353210868035332007-05-26T17:47:00.000-07:002007-05-26T17:54:28.242-07:00Medicare Gold: a bird without wings."Medicare Gold", was the grand notion that was supposed to win the federal opposition party and the ghastly Julia Gillard in particular, the last election.<br /><br />"All persons over the age of seventy-five will be eligible for free health care in private facilities", she boasted.<br /><br />If you haven't noticed, the world's population is aging. You only have to look around you to know there are already a lot, and I mean a LOT of people over the age of 75. Moreover, the number of sick over seventy-fives is set to explode as so many of the baby-boomers fall ill with obesity-induced diseases.<br /><br />Conveniently, the opposition party has forgotton that health care actually needs doctors. Not just surgeons but physicians as well.<br /><br />As one of those physicians who, presumably, was going to have to look after all those over seventy-fives in the private sector, my response was "Ha!! You and what army are going to make me!!"<br /><br />I'm sure most of my colleagues were thinking exactly the same thing.<br /><br />Thankfully, Medicare Gold seems to have gone the way of the DoDo.Zimble:http://www.blogger.com/profile/10471279519215056939noreply@blogger.com0tag:blogger.com,1999:blog-8224488665411774107.post-29067617683496452222007-05-21T22:42:00.000-07:002007-11-21T03:08:52.618-08:00The case of the disappearing office.If we put aside for one moment the very obvious benefits of staying well and not coming to hospital at all, I'm confident that most people in hospital would prefer that their medical staff (consultant, registrar and intern) discuss laboratory and radiography results in a private setting ie not in the middle of a corridor. Hence, an office for doctors, in which they could do this, would be useful.<br /><br />It would be particularly useful if the office contained a computer terminal, as that is where one has the greatest chance of finding laboratory and radiography results (since pride in the careful filing of hard copy results is as rare as it comes).<br /><br />There once was an office for doctors, with a computer terminal in it. Mysteriously, one day, the computer crashed and was unable to be resuscitated. I asked when it would be resurrected and was told "in due course".<br /><br />A couple of ward rounds later, the computer was gone leaving only a dusty footprint on the desk. 'How amazing', I thought, 'they are actually going to get it fixed.' Then, when I looked again after a week or so, there was still no computer. I asked when the computer would be back and was told, "Well, you weren't using it so it has been permanently removed. "<br /><br />The very next day, I found that a doughnut-hoovering senior-echelon nursing administrator had plonked herself, her computer, her filing cabinets and her pedestal fan in the office. When I asked about that, the reply was predictable as night following day: " Well, you weren't using the office, so it has been permanently reassigned."<br /><br />I 'reassigned' myself to another computer terminal, the one in full view in the middle of the corridor and thought, 'Oh well, the situation is unlikely to get worse.' How wrong could I be! Now, the corridor itself has started disappearing! It's being partitioned into more offices for more nursing administrators, their computers, their filing cabinets and their pedestal fans!<br /><br />You might think this is just a petulant whinge about a simple turf war and it's time I had a long hot cup of chamomile tea and a lie down. Although I readily admit I may have a few roos permanently residing in the top paddock (and the odd venomous hamster or two - thanks Jem), I'm pretty sure this sort of underhandedness portends a more malign state of affairs.<br /><br />Uncle Beattie sets an ugly tone in this current government and it filters all the way down to the workplace. Just as it is with any form of governance, all is well in a socialist democracy if no one takes the politico-philosophical credo too seriously. Here, however, we have a man who despises and probably fears anyone who is prepared to think, to challenge and to take responsibility for decisions. He buffers all decisions at all levels of government, right down to the work place with faceless, nameless working parties.He sees an office for doctors as elitist and therefore dangerous and by definition, to be avoided at all costs.<br /><br />If it were just about elitism, I could understand and agree. However, anti-elitism is, in this case, a label for dis-empowerment and subjugation.Historically, we have seen the tragic results of this sort of politics.<br /><br />Consider, firstly, Nazi Germany where the independence of the medical profession was completely lost to the state resulting in unethical practice drift. At the other end of the spectrum, consider the late Soviet era when Eastern bloc doctors earning less than street cleaners, completely worn down and isolated from their international colleagues, had to stand back and watch a perfectly good health system go down the gurgler.<br /><br />Some people ask me (when they're not suggesting the chamomile tea and the lie down), well, if you think it is so bad, why not go into full time private practice? I could do and would probably be happier and definitely wealthier but, you know, sometimes, it's not about me or about the money. Some of us need to stay and fight for proper filing and computers and offices and corridors because they contribute to getting people well again.<br /><br /><br /><a name="comment-7410404142725863470"></a>bm said...<br /><br /><br />Now now zimble... we've discussed this tendency to conflate socialism and bureaucratism. Perhaps some words from Che might help.<br /><br />The following is from 'Against Bureaucratism' (Feb 1963)"Bureaucratism, obviously, is not the offspring of socialist society, nor is it a necessary component of it. The state bureaucracy existed in the period of bourgeois governments with its retinue of hangers-on and lackeys, as a great number of opportunists — who made up the “court” of the politicians in power — flourished in the shade of the government budget. In a capitalist society, where the entire state apparatus is at the service of the bourgeoisie, the state bureaucracy's importance as a leading body is very small. The main thing is that it be permeable enough to allow opportunists to pass through, yet impenetrable enough to keep the people trapped in its nets."<br /><br />Those of us with long memories recall an era when the most rabidly right-wing government in our state's history presided over corruption, cronyism, and bureaucratic abuse that makes Beattie's (not-so-socialist) operation look like a sunday school picnic.<br /><br />BM<br /><br />P.S. Have you been reading Dr Miguel Faria's books? If so, you should know that when not railing about 'socialised medicine' he keeps busy by railing against gun control. He also described the British arrest of Pinochet as "holding Gen. Augusto Pinochet hostage".<br /><br /><br />BM many thanks for your comment.<br /><br />I know, I know. My name is Zimble and I am a conflater.<br /><br />In my totally inadequate defence, the 17th was a very bad day and who better to lash out at in the one breath than politicians and office stealing bureaucrats.<br /><br />And, you must admit I have been very good lately: I haven't tried to conflate or conflagrate (or detonate for that matter) anything for some time now.<br /><br />I really don't care whether Uncle Beattie is the re-incarnation of Mao Zedong or a descendant of Genghis Kahn. What I do care about is the loss of transparency in decision making and the devaluation of the small but important things that allow for good care.Zimble:http://www.blogger.com/profile/10471279519215056939noreply@blogger.com0tag:blogger.com,1999:blog-8224488665411774107.post-36914264856915587732007-05-21T22:26:00.000-07:002007-11-21T03:01:20.273-08:00The dark before it got darker.I first met 'Uncle' Peter Beattie in the dining room of the Jardin Hotel on Thursday Island, when, as then health minister for the state of Queensland, he was hosting a dinner for the launch of a new health exercise video across the Torres Straits.<br /><br />It was about 1995.It was buffet night at the Jardin. As I went back and back again to sample the various dishes on offer, the man introduced himself to me on no less than three occasions. "Hello, I'm Peter Beattie" his Macleans smile dazzled.<br /><br />Later that evening, as I pecked at a piece of coconut crumble, I looked over and there he was, lording it up at a table of local elders. There were no women in sight. The elders seemed to hang off his every word. Who was schmoozing whom, I wondered.It was interesting at the time, in a sneer inducing way, to see a politician in full flight.<br /><br />Little did I know the damage this man, as Premier, and his cronies would wrought on the state health system over the next decade.Zimble:http://www.blogger.com/profile/10471279519215056939noreply@blogger.com0