May 9, 2013 - Lessons with Dr. J

These days either I'm forgetful or there has not been any new significant 'lessons' for me to post in this blog.
Perhaps, it could be that I have been preoccupied.






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Dr.J makes a very careful approach in treating his patients.
He is polite but says things that are appropriate in bull's eye manner. I would think it would take me forever to say things in that kind of manner or comes up with the vocabulary that can adequately leaves both the patient and myself perfectly content in communicating the patient's problem. Not exaggerating, but also not undermining - making my observation know if the patient shows discontent know when to move on or 'release the patient'.


The tone, the hand gesture, body language and words he choose seems to be all carefully planned.
I wonder how long and how many times you have to say it that way consciously in order to make it completely yours, which is more automatic, second-nature in a sense. Having the 'right' manner seems to be so difficult.




I have been told I think too much and over-analyze. I do, especially when it concerns what I say or do to people around me. I try to analyze how this person might have perceived me, did I creep that person out? I wonder what our next encounter will be alike? I hope this person doesn't talk about me... along that line almost obsessively. It goes both ways actually. Certain vocabs, words or things that a person says I take it as a hint.




Anyway, back to the lesson. On Thursday -  my late night, we had  one patient over who used own grocery store in a small town. The grocery store has been in family for 3 generations and he has sold it because such good offer came through. However, due to the effect of giant corporation, a la costco, a la walmart, a la target and etc, the new owners also had 2 other grocery stores but had to close those stores and was struggling with the store this patient sold to them.
Dr.J was more lively when he was talking to the patient during the surgery.
I was thinking that they must have lot of common because Dr.J and patient seemed to find each other pretty engaging when it came to certain topic.




However at the end of the day, Dr.J told me the reason why he kept the conversation going. The patient was on anxiety pill and that the local-anesthetic was not only the mixture of xylocaine and marcaine (6:4) but also the conversation.






I kept thinking I wonder how much Dr.J knows about me, how much he has analyzed me and etc.

Conversation in OR - May 1 2013

Gag order.

Whenever I see this word, I think about media - when socially outrageous, high-profile case takes place in a court house, judge typically "gag order" which  bans journalists, juries or anyone associated with the case to not to speak a word of it outside the court.

Would you believe it if there is a similar thing in a contract that your physician signs when they sign with a big hospital ( such as hospital privileges)?
I didn't know about this until today and I also learned that you are not to divulge anything that will harm the hospital's image or which taints the institution, or it's leader's competence or reputation.
You are not allow to criticize for some of the obvious dumb things that executives do and you are not to voice any opinion if something is not working out (ie.// new policy, hospital culture) or mistakes made (non-negligence or honest mistakes due to communication error) or...
The list would be endless because you are simply not allowed to discuss anything.

This seemed counter-intuitive to me, especially because hospital is publicly-funded and thus it should be more transparent than private.
It should be more progressive because it is publicly-funded.

And then, I thought about common sense (who can criticize the system best other than ones who are directly involved with it - on front-line) and I also thought about big-brother, an Orwellian society.

I live in Canada and Canada treasures its 'Charter of Right and Freedom'. It's a fundamental rights and freedom and we as a Canadian have, respect and extend to others.

So, why is it that freedom of speech should be banned when you are a consultant working for the hospital or directly involved with the care for patients, who are Canadians, who pays tax which pays for the service?

If there is inefficiency in the system, it should be voiced and fixed.
If something should be reported, it should be made known to all and fixed.
Why can't we think about fundamentals? Why does the hospital exist in the first place? Who actually does the work at the hospital? Why can we think about the common sense?

There is a really easy-going doctor from South Africa.
He is a practicing physician here and he once said, "South Africa is a 3rd world country with 1st class medical care and Canada is a first class country with 3rd world medical care."








To make things more grim, apparently when you go to a meeting at the teaching hospital, the most discussed subject is Research. That's good... step for innovation and all... and second, which is very, seldom, discussed is teaching....ok....hmmm...skepticism here. Then, what's the third and last thing that is NEVER discussed during these meetings? patient.









I just can't understand the logic...
it seems so blatantly obvious to me that people at that stage should be able to differentiate priorities and discuss about it.
You should save, be efficient and innovate like a private company. There is an absence of any 'push' to get things done in a public system, because after all there's no fiscal year report that sets out the profits or loss, you will forever be paid the salary which increase with every year you are with the government and get pensions and health care. You don't work on holidays, oh wait bank holidays and holidays that are not quite 'red colour' yet. Sounds like a dream job, but at the same time, a leech.

Best of all, the people who are at the management level at the hospital has nothing to do with health or medicine. They have not been fully exposed to front-line work.
They are oblivious about what works and what does not  and what leads to inefficiency, and they are controlled by politicians who are then controlled by big companies, who are subsidized by the governments.
This is a loop but for some reason majority of number lose out, sort of like a lottery.



I end my thoughts and discovery I made with this video.

And then just because of the way I am (...) and because I just found this...critique of the above video

... but I realized about half in, he was nit-picky about things that were not so critical and completely missed the point... saying that even if we seize all assets of top 1% it will still not be enough to cover the deficit and so on when Anne was clearly talking about principle, how the subsidy has contributed to the deficit.
Thus, I decided to unpost the critique video because it did not have a nutritious value in my opinion.

Gallery a la Mari 2: Hieronymus Bosch

Hieronymus Bosch, born Jheronimus van Aken was a Dutch Painter from 1500. Moral and Religious concepts and narratives.

Most well known art work: Garden of Earthly Delights.

Retinoschisis, ARMD

Retinoschisis (RS): Disease of the nerve tissue  in the eye - affecting retinal cells in the macula
It is a form of a macular degeneration but many people with macular degeneration does not have retinoschisis.
Genetic eye disease; male

****- schisis: splitting; breaking up of attachement or adhesion***

Symptoms

• Decreased vision (central vision can be affected)
• Loss of peripheral vision

Different from retinal detachment.

Retinal detachments can occur if the anchoring of the outer layer of the retina to the eye wall is impaired (bubble inside the wall paper)

Macular degeneration: breakdown or damage to the macula
1) Dry type: Common +++  - tissue becomes thinned and cease to function properly
2) Wet type: damaging +++ caused by the growth of abnormal bv behind the macula. The bv hemorrhage or leak and scar tissue forms if left untreated. Dry type can turn to wet type.

Symptoms

• The loss of the ability to see objects clearly
• Vision that is noticeably distorted
• Straight lines appear wavy
• Objects may appear as the wrong shape or size
• The loss of clear, correct colors
• Difficulty reading or seeing objects up close
• A dark, empty area in the center of vision 

Syndrome

Ramsay-Hunt Syndrome

Shingles infection (Herpes zoster) affects CN7 (facial nerve) near your ear.
Main symptoms: painful red rash with fluid-filled blisters on, in and around one ear; facial weakness
Results in: painful shingles rash, facial paralysis and hearing loss.
Treatments: high dose anti-viral treatment and corticosteroids


OCP (Ocular cicatrical pemphigoid)

OCP - stage 2

Subset of the mucous membrane pemphigoid (MMP);
Autoimmune disease characterized by T-lymphocyte dysregulation - the production of circulating autoantibodies directed against a variety of adhesion molecules in the hemidesmosome-epithelial membrane complex --> can affect the skin and other mucous membranes (oral, pharynx, larynx, trachea, esophagus, vagina, urethra, anus); chronic cicatrizing conjunctivities.
Characteristic: Slowly progressive and bilateral blinding
Average age of onset: 50-60 y.o



Aarskog syndrome

Heritable disease (x-linked), distinctive facial feature 
Facial feature: such as widely spaced eyes (hypertelorism), a small nose, a long area between the nose and mouth (philtrum), and a widow's peak hairline. They frequently have mild to moderate short stature during childhood, but their growth usually catches up during puberty. Hand abnormalities are common in this syndrome and include 

Some people with Aarskog-Scott syndrome are born with more serious abnormalities, such as heart defects or a cleft lip with or without an opening in the roof of the mouth (cleft palate)

Hand abnormalities are common in this syndrome and include Short fingers (brachydactyly), curved pinky fingers (fifth finger clinodactyly), webbing of the skin between some fingers (syndactyly), and a single crease across the palm

 .
Affects development of many parts of the body.

Just 10.

Just 10 companies in the world making pretty much every day essential items that EVERYONE eats and uses.

Just 10.

Corruption in Canada 2013 Edition:

While it is reassuring to know that Canada ranks within the top 10 in perceived corruption index (which means, it is perceived clean), there are definitely rooms for much improvement.

Note: This shows merely a 'perception' of corruption. 

Perhaps people in countries such as Canada are better at hiding their corruption or have legalized it*.

The reason why I'm writing about this issue is because I am passionately against public-sector corruption and waste of tax money as I have seen many cases of inefficient, irresponsible, incompetent government employees wasting away hard-earned income of Canadian (gathered through Canadian income tax paid to both federal and provincial government as well as sales tax - harmonized tax).

Not coming from the privileged class that benefits or have benefited from these corruptions and scandals  and being a mere common citizen, I find that it is outrageous when a country like Canada (which I have very high esteem for) show layers of corruption decaying and destroying social safety net slowly but...surely 

The recent scandal I would like to talk about have a very alluring title for all readers:  Senator's husband put $1.7 M in an offshore tax haven - titled 'The Lawyer, The Senator and The Government.'

To summarize, media-friendly and therefore high-profile class action suit lawyer Tony Merchant has been carefully stowing away money offshore- in Cook's island- to evade tax in Canada.

Senator Pana Merchant, left, was named as a beneficiary of a trust set up by her husband, lawyer Tony Merchant.

He was very clever about it - so in order not to get caught, he managed to avoid any paper trail or tried extremely hard to do that. No fax, no e-mail, no phone calls - correspondence through mail only and he would pay the bank fee in cash in mail - no wire-transfer. He and his wife Pana Merchant, current senator, was so careful that Pana Merchant didn't declare herself beneficiary, which she was - and she also did not report any foreign income.

CRA has actually been on his case for years and to evade this, Tony Merchant took this outrageously disgusting plan to action... Isn't making over 120 million from suiting government 'on behalf of natives' not enough that you have to avoid paying tax? are you forgetting that your wife's also getting paid by the government, with tax payers' money in a form of salary of 130K? for doing....what exactly? what does she do exactly? 

This came in light as soon as the massive leak of document revealing undisclosed financial records of more than 100,000 people around the world in relation with offshore tax havens - suspected to include hundreds of Canadians.

And the media, CBS, has not disclose the name of all 450 Canadians yet, and there is an excuse article for this: Why CBC isn't naming all 450 Canadians in offshore leak

And delicately tread they must, as CBC's Amanda Lang is the niece of the recent headliner, Tony Merchant, 'the lawyer' in the above mentioned article - meaning the list must be comprised of very high-profile people very closely connected with the politic. And as in Anna Karenina, where Vronsky is begging other high socialite to invite Anna and include her, the lady says: if she broke the law I don't care, but she broke the rule!! - which means that rule of upperclass people must work differently than us commoners. This hypothesis was actually validated by Senator Downe who is seeking answers from Pana Merchant, 'the senator' in above article that

 "The government is not taking any action," he asserted. "You go on the CRA website and you'll see all kinds of examples of Canadians from coast to coast to coast charged and convicted with domestic tax evasion. You'll see carpenters in Eastern Canada, doctors in Western Canada. What you will not see is one person charged with overseas tax evasion….

"Domestically, Canadians are treated one way, and people who hide money overseas — very rich Canadians trying to avoid taxes — are treated completely different. It’s grossly unfair." - files from CBC's Curt Petrovich ---Click here for the full article 

The reason why I cry foul, is not because of this recent incident - politician, public sector employees and corruption has always been a synonym. Hardly anything new.

For example, Merali's sinister orchestration with e-health in Ontario which costed previous early retirement of then health minister and millions and millions to tax payer in Ontario, and then our incompetent government not taking any action - despite the fact that it was all OVER the MEDIA!!! but of course in another province, the same corrupt people welcomes him and then gives him all-expense paid by the tax-payer card and he racks up huge expense- big cost to the government. There's an old idiom from sage, "Bitch's habit does not leave the Bitch" and yes, Merali is a living example to that idiom. 

All the while, CRA (Canadian Revenue Agency) is understaffed with recent cut introduced by the finance minister Tom Flaherty, and what's more, the CRA has a disgusting habit in that they go after the small fish that does not have political power or the wealth to defend themselves.

They would go for cases that are easy win - independent business owners, doctors and etc - not that they should let them get away - but if someone's evading tax by millions and millions and not thousands, shouldn't you go after those millions and not the thousands?

* Referring to the inefficient and horrible life-time appointment of the senate system (changes made to limit the age of participation/retirement as there were senators who had Alzheimer's who still took part of the discussion making it a laughing stock, as well as sexual assault convict and senate who could possibly be dyslexic as he 'made mistake' from ticking the box asking for yes/no answer (Mike Duffy) and etc)

* Also referring to Toronto Transit Commission ticket collector who makes over 100K, although this is bad management than 'corruption' - but people let it slide were being very noncontinuous with the tax money, thus mismanaging public purse would also mean corruption.