warriorsavant: (Chimerae)
DuckDuckGo. Does anyone else use this? It's an alternative search engine to The Borg. Their claim to fame is that they don't keep track of you/don't create a profile that follows you around. So far, their searches seem to give reasonable results, but I haven't done a head-to-head comparison with other search engines.

Office & Staff. Evil Secretary was actually out sick for almost 2 days. She takes sick days about once every 7-8 years. I came in Monday and she looked green, told me she'd just thown up, and needed to go home. Fortunately we have T on board now. Even though she's here as a nurse, she has secondary duties of filling in when ES isn't here. Also fortunately, it was a little slow, so she jumped in and did just fine. Yeah, lots of small things weren't perfect, but so what, this isn't her primary job and she's only been here a month. ES had initially told me she thought she'd need to come in for 1 day to clean up whatever mess was left, but there wasn't any. Good. Not having reliable back up of ES has always been a slightly worrisome issue for me, but this is another instance of T seeming to work out well.

RAMQ, fighting with. That's the government medical insurance bureaucracy in Quebec. Despite all our complaining (both as patients and providers), they generally get things done with a minimum of fuss. Had a couple of issues that I had to fight with them about yesterday, which is to say had to get on the phone with someone. Doesn't happen often (as best I can tell, most doctors in US spend more time fighting with gov't and/or insurance companies than actually seeing patients), and at least I got to speak to a human being.
     The Good. A patient who was falling between the cracks. He has horrible psoriasis, was put on one of the new biological medications with great results when he lived in Ontario. He moved back here, and the requirements are a little different, and I've been trying for > 6 months to get him approved. Discussed with them for 10 minutes, and today got the approval. They generally figure that if a doctor is willing to take the time to call them directly, it must be important.*
     The Bad. Only "medically necessary" acts are insured, which is reasonable. (Some of the backstory is not reasonable, but irrelevant here.) For example, a cyst that is not inflamed, infected, or physically troublesome is not covered for removal, so the patient has to pay. They may not like the cyst (or other benign growth), but the world is full of things one doesn't like, and that doesn't mean someone else has to pay for it. Anyhow, removed a cyst from a patient this past summer, duly warned him he'd have to pay for it, which he seemed to accept, duly charged him… and then he complained to RAMQ asking for reimbursement. Last fall they sent me a nastygram, asking for my notes on the patient and my justification. I sent that back, including a direct quote from their manual. They just sent me a letter saying basically, "illegal charge, we're collecting it back from you with a penalty." I spoke to someone who took the info, "and will get back to me." This is seriously annoying, but I am going to smack them down. If I let it go, besides the money immediately involved, it sets a really bad precedent. I've gotten the Assoc. Derm. Quebec involved, and they will help me for the same reasons. We'll win, but annoying.

*More on fighting for patients. It's part of the job. I'd hate to have to do it for every patient. Frankly, wouldn't have time to earn a living if I had to do that, but every 2-3-4 weeks, something comes up and I need to do it. It comes with the turf. Sometimes it really shouldn't be my job on a particular patient, but if he/she has been bounced around enough times, and is sitting in my office, I figure that morally it has defaulted to being my job, and I'll at least take the time for find out who should really be the one to see him/her, and make sure it happens.
warriorsavant: (Default)
Had a power outage in the building today. Apparently they were doing work, and didn't warn me this was going to happen (some people seem to have gotten the word). Since I had a visual specialty, that made things rather interesting to say the least. Fortunately large windows (with discrete shear curtains). Also fortunately wasn't needing to cauterize any bleeding, so managed. (BTW, can't wait for Revenue Canada challenging my writing off dry cleaning bills. "Now, doctor, do you really claim dry cleaning as a deduction?" "Yes, it was to get blood off my shirt.")

Varia

Oct. 13th, 2018 09:06 am
warriorsavant: (Cafe)
Whimsy of the day:  OMG, Friday the 13th comes on a Saturday this month. Everybody knows that's worse.

Cuteness of the day:  We were talking about going to work and going to school and teaching, and what Hedgefund would do someday. (Spoiler Alert: doctor). Then she said something about when she was big, she was going to be a daddy. (Pause). "Well, a girl daddy."

Weather of the day (month, season, etc):  On the positive side, the leaves are changing, and it's pretty. On the negative side, it's turned cold. Despite having been born here, the kids, especially Wallstreet, don't like the cold. Neither does my tropically-born darling wife. Come t' think of it, more and more, neither do I. We live here why? Although when I think of moving south, my heart goes out to friends living in a hurricane zone. On the other hand, those are intermittent, rather than lasting 11.5 months/year, like winter does here. We keep saying the kids they are going to go to med school at U. Hawaii or at least UBC.

Bureaucracy of the… (whatever, enough with this theme):  [personal profile] ravensron  sent me a picture of the passport of Pharaoh Ramses II (1279-1213 BC). No, it wasn't written on papyrus, and they didn't actually have passports back then. Seems that His Pharonic Majesty's mummy was sent from Egypt to France in 1974 for preservation work. French law requires that anybody entering the country have a passport. The Egyptian government complied, including a properly formatted picture of the mummy's face in the block for picture. First time we traveled with Hedgefund, we had to get a passport, complete with photo. She was 3 months. Still required to pose eyes open, no smiling, no one holding her head. Managed to get the photo - she was actually lying down with the photographer holding the camera over her pointing downwards. What is the point? 80% of the babies in the world look like enough like that photo that it was meaningless. Even more ridiculous is that passports are good for 5 years. When she was 3 years, took her someplace, and the border control agent actually was looking back and forth between her and the photo.

Tree, also in the past tense:  Our neighbor's tree died. The other morning, there was a crew taking it down (before it fell on one of our houses). The kids were fascinated. “Why man in tree? What he doing?” I sent my condolences to the neighbors (it was a beautiful, huge ash tree, but had been attacked by Emerald Ash Borers). Then I wondered, if one sends a bouquet of flowers (plants) when an person or animal dies, does one send a bouquet of animals when a tree (plant) dies? The neighbors declined, but I think that was unreasonable. True they already have a cat and a dog, but maybe they would have liked a nice basket of mice - I'm sure the cat and dog would have.

Tech:  Once upon a time (say 2-3 years ago), if someone wanted you to sign a document, they printed it out, mailed or handed it to you, and you signed it. Now they send you a pdf, which you have to print out, sign, then rescan back to them. Much more convenient… for them. Recently realized that having Adobe Acrobat Pro (which creates pdf, doesn't just read them), I can do a digital signature. Still requires a few steps, but all mouse clicks, no wasteful printing and rescanning. (If you want to do it on a phone, there is an app called "fill and sign.")

Grrr

Aug. 24th, 2018 05:29 am
warriorsavant: (Meh)
I'm fed up today. Fed up with having to remind people (I'm talking about adults, not my pre-schoolers) 5 times to get anything done. Fed up with everything being 3 steps forward 2 steps back. Fed up with everything having additional meaningless paper requirements added each yaer. Fed up with nothing ever getting done without that extra step, and then one more, and one more, and one more…

Adding to this, I finally hired a nurse (which I'd been contemplating doing for 20 years). Who quit after three weeks because the workload was too much, or possibly too little, or because she actually wanted to work in an OR.
warriorsavant: (Composite)
Some time ago… hmmm, rather quite some time, just found a draft of this buried somewhere, I mentioned I was putting together my academic CV. Why the CV you ask? Highly belated response to (auto-rhetorical) question. I'd gotten an email that I can apply for academic promotion. Academics are more jealous of their ranks than military folks. Last time it came around, I got promoted from Assistant Prof to Associate Prof. I was surprised when I got that email; since they don’t actually pay me, I never paid much attention or thought about academic promotion.

Regarding the pay issue, I'm CAS (I think that stands for Contract Academic Staff). Rather like the Reserves/Guard in the military, it is part time. Since when I was in the Reserves, I was a fairly senior leader, "part time" was a bad joke; I spent almost as many hours/week on the Army as did most full time Commanders.. As CAS, I mostly do clinical teaching. I get paid for whatever patients I see by the Province (same as if I saw patients in my office). Teaching slows me down, so make less, but I enjoy doing it, so I do it. I get zilch for whatever administrative work I do, but it's part of the game. Within limits.

For whatever reason, I’d done enough “stuff” that they promoted me. As noted, it is really an ego thing to get the promotion, since they aren’t paying me, I do it for the pleasure of teaching and the "glory" of being university faculty. It is way too soon to put in for Full Professor, and frankly, I haven’t done enough stuff to get it, and probably never will. However, I put together my CV in the format they want, and had a meeting with the Chief of Medicine (Derm is a division within the department of Internal Medicine), because I thought it was time to talk to him about my academic “career.” Is there anything for me to move forward and upward into? Is it worth it? When I got out of the Army, I thought I would move up in Academia in a similar fashion. In the Army, I moved up in rank, and also in authority (for doctors, not always the same; most don’t want to Command anything. I did). I thought I’d get more involved in teaching and research, and move up from Undergraduate Training Director (eg medical students) to Residency Director (could have had that 2-3 years ago) to Chief of Dermatology (maybe). Why didn’t I take Residency Director 2-3 years ago and move forward and upward? Something - or rather someone - more important came along. Now 2 someones. In a couple of years, the someones are going to be starting school, and I might want, or be willing, to do more academically-administratively. On the other hand, it’s a pain in the butt, and I’m not sure I care.

Doctor-Professor-Chief of Medicine easy to talk to, and I enjoyed the conversation, although the upshot is that it is very, very unlikely I will ever get selected for full Professor (which would rather like being full Colonel in the Army). As for Residency Director or Chief, he wasn't encouraging about what would be involved: too much work, not enough resources, little-to-no pay. Even disregarding the "I tend to piss people off" part, the small amount of ego gratification is not worth my time commitment when I have more important priorities. I screwed up one marriage (no kids involved) by devoting too much time to an organization; not going to make the same mistake twice. Many years ago, a wise friend said something about not needing to grab any more brass rings; she already had a whole drawerful. Maybe if I'd never done anything else in my life, I would be more tempted., but I what would it add besides lots of aggravation and one more line on my obituary.
warriorsavant: (Warriordaddy)
Children's games can be a preparation for real jobs and adult life. Mine have a number of favorite games, but one special favorite is "run around in circles babbling incoherently and screeching at the top of your lungs." I didn't quite get the point of it, but they seem to really enjoy it. Then I realized that it is perfect training for working in most bureaucracies. Corporate, government, military, non-profit… pretty much all of them involve running around in circles, shrieking and babbling, and accomplishing nothing useful at great effort.
warriorsavant: (Quebec sait faire)
I haven't lived in NH since I moved up to Montreal, shortly after the glaciers receded, but that is still my official US state of residence. In the US, being a federal system, one cannot be a citizen of the country at large, one has to have a state or territory also. NH being where I was living before I moved, and having no state income tax (the state motto: "live free or die live in Quebec"). I like their small-government, libertarian attitude. People from high tax states will sneer at the lack of services, but it seemed to me that the state provided the essential services with much less waste. Consider a less essential service, such as funding the arts. Consider the New York Council on the Arts (whatever it is properly called). Big budget, huge building, huge staff, huge overhead. NH's Council has 2 permanent members (Director & Receptionist). Everyone else comes in once/year or as needed to audition the artists, gets paid for their time, then goes back to their real jobs. (Come t' think o' it, the state legislature works the same way.) Even the funding to an artist is not absolute. They have to get half their money from whatever community agency (school, town, arts festival, whatever), then the state will match it up to whatever agreed upon amount. That is, the state helps support the actions of the localities. The localities, being closer to the people, take charge, and have to give something of their resources, then the state will help support it. That's how it should be; the lowest possible level is in control, the higher levels provide some guidance and lots of support.

I still keep my NH medical license, and my CME is recorded there. Most docs up this way keep their CME with the Royal College (of Physicians and Surgeons of Canada). In order to do that, and thereby put FRCPC after your name, you have to be a Fellow of the Royal College, which means paying them dues. I refuse to give someone good money just to put more letters after my name. Some docs keep their CME filed with the Province. I was keeping mine with NH before I came here, and saw no reason to change unless and until the Quebec College des Médecins makes me do so (so far, they've been uncharacteristically non-bureaucratic and accept that as long as I meet the requirements of some place real, they will accept that).
warriorsavant: (Renovations)
So had a coupla people today call us from outside the building where we are going to be moving, "you're not here." Yup, we're not moving until late Jan or early Feb. "But I can't get in/there's no buzzer/no entrance." Yup.

Had some address kerfuffle with the city. The unit is legally #XXXX - Unit YYY, and there's a buzzer at the front door of the building (6 story building). That's fine for individual residences or low flow businesses, but won't work for me. I'm installing a separate entrance (ground floor unit, not hard), which I want to have a separate address: XXXX-B. The city said okay. I sent out letters. The city was supposed to notify the post office. Then they told us, "why no, you can't have that, we only meant you could call it that internally within your building (which they'd have no control over), so sorry we forgot to actually write that on the permit, but you have to be XXXY." My attack-trained cat (a long-haired Vietnamese named Nom) got on the phone. Eventually, after talking to enough people, she got the supervisor at the city to compromise (which is to say, he'll do things our way).
warriorsavant: (Renovations)

1. Silly people. I frequently tell the young'uns that they are silly children. Tonight, I spilled a glass of water, and muttered something like, "silly Papa." Hedgefund responded that "we're all silly in this house." Uh, yeah kid. Astute of you to notice.

2. That makes sense. I noticed that my office phone bill was 20$ higher than usual (for base charges). I called them, and they said it was because I was no longer on contract, I was month-to-month. Say what? I've been with them for 20? 25? years, and as far as I knew, there was no lapse of contract (not even sure I was aware there was a contract, as opposed to standard charges). They found a note that I, being an old and valued customer (not quite how they phrased it) was eligible for a promotional (which they hadn't bothered to tell me about up until that very point). If I put in a 3rd phone line, my base chargers would be 35% cheaper/month, plus have more free long distance than I actually use. I wouldn't have to actually use that third line, or even connect it. Uh, okay, that makes complete sense (not), but I'm all for saving money.

3. Illness in the household. WS has been very cranky lately. Part is the "terrible twos," if such a thing actually exists. But really, really cranky past few days. Clearly sick yesterday. Took to Peds today, who found he had strep throat. Ah, the joys of kids in day care.d

4. Slowing down a bit. Things are always a bit slower mid-winter and mid-summer. More mid-winter, as the snow birds are away. Now is when it hits the slow down. (Not actually "slow," mind you, just not-constantly-frantic at work.) Snow birds are starting to leave town, and people are gearing up for the overly-busy, overly-stressed, depressing time known as "the holidays." There will be a sudden rush of people calling me just before said holidays, when they realize they've been neglecting whatever in the rush of preparations, and now-it's-urgent-and-what-do-you-mean-you're-too-busy-to-see-me. My last week is usually fille with follow-ups that I wanted to check on before I'm closed for 2 weeks, and if you were silly enough to prioritize parties and shopping over your medical problems, then said problems weren't really very urgent. (Or, as we say in the Army, "p*** poor planning on your part does not constitute an emergency on my part.")

5. Speech. HF is displaying same. He's had a few scattered words for a while, but now is starting to fairly consistently string 2-5 words together. Sometimes intelligibly.

6. Renos2. Final bit of reno finished at the house. Well, never really finished, there's always something, but have installed the cabinets and connected the sink in the extension. The office renos are moving swiftly, expecting to move mid-January, reopen for business Feb 1.

7. Renos (addendum). Had to have the HVAC (Heat Ventilation Air Conditioning) system rebalanced in the house. It's been installed and running, but some rooms were way too hot, and some too cold. It's really a matter of adjusting various control valves on the system to route the heat where it is more needed. The tricky part is that opening the flow to one part of the house decreases it everywhere else, so it is literally a balancing act. Couldn't really be done until the heat went on to really know where the flow had to be re-directed. Likely will have to do it again in summer when A/C comes on, but at least I now know how to do it.

warriorsavant: (Default)
Hedgefund likes to help her Papa. Even (or especially) giving me pills, whether antibiotics or vitamins, or anything else, she likes to hand them to me, if not actually put in my mouth. (Hold that thought for when I'm 90+, kid.) I don't take many, but not even really pleased with taking Lipitor. Today she handed me my pills, then asked "are you sick?" What ran through my mind was, "no kid, just old." *Harrumph*

BIL came over with his kids today for a couple of hours. We like them, and we really like that the cousins get together. HF loves it, WS sort of does, and their cousins do too. I think they (the cousins) enjoy it for a couple of hours, but as they're getting older, if they spend too much time, it feels like babysitting. A couple of hours seems about right. BIL helped me with a few things setting up the house that were too heavy or bulky for me to do alone, or even me and Nom to do. First, was setting up a huge parasol on the deck.* BIL was the provenance of that also, in that it had been left at a house he'd bought to rent out. When he rented it, he'd told his tenants that it was to go to me and Nom, whenever we actually had our house renovated. (When we moved, the movers made a stop to pick it up, as well as a stop to pick up stuff we'd stored and Nom's parents house. Apologies if already posted about this.) Between the two of us, we managed to assemble it, and man-handle it into a position where it shaded the deck when open, but didn't block the doors from opening. We also carried a large table down to the basement, put the TV on its stand, the stand on said table. They're set up in front of the exercise area, which was the plan all along.** He also helped set up some other stuff. Really very kind of him.

Even before got the TV set up, I managed to do some exercise the other day. Was watching the kids downstairs.*** If they are playing well, this is mostly boring. Brief flashes of "aww, they're so cute," but mostly boring. So I finally plugged in the treadmill, and got on it. As exercise goes, it was rather lame, barely getting up to a normal walking pace. My heart rate went up, but scarcely aerobic training level. On the other hand, it was actual exercise, for the first time in I-don't-know-how-long.



*Or umbrella if your prefer. Basically same thing, depending on whether the weather is sunny or rainy.
**Only just got cable installed. In our old place, Bell provided both internet and cable, via "Fibe" (fiber optic connection). Fibe doesn't reach our new place, and the city limits satellite dishes to 18". Which would be fine, but the smallest one they have (which they tried to install) is 24" and we couldn't get a variance from the city. (Well, they would have let us install one on the roof, as long as it was bolted to the roof, thereby breaking the waterproof membrane and voiding our roof warrantee.) In the end, we're keeping Bell for internet (because that's my email and it's too much trouble to change), and going with Videotron for cable. I'm sure you found this tale of bureaucratic nonsense fascinating.
***Don't know if I mentioned, but in a flash of brilliance, we covered the concrete basement floor entirely in gym mats. No more expensive than even cheap tiles or carpeting (and way cheaper than most), plus when kids fall down, they bounce and laugh, instead of break and cry.
warriorsavant: (Infantry haircut)
Two things lately made me realize I'd had had enough of the Army. (Important realization when one has been retired, for, oh, 5-6 years.) No, not Hedgefund and Wallstreet, although they would have been enough to keep me from doing anything silly like trying to re-up, or deploy.

The first is talking with someone I knew from the Army. He is a full-time Reservist (called an AGR), I first knew as a Captain when he was my Adjutant (= S1 = Personnel & Admin Officer) when I Commanded a CSH (Combat Support Hospital - like a MASH, but bigger). He's now a Colonel himself, in charge of major training site (I'd trained there more than once). It was not a very happy call, in that I'd heard 3rd hand that he'd recently lost his wife of 32 years (cancer, spread quickly) and was calling to offer my condolences. We chatted for a while, and he was mentioning getting ready for 3 CSHs moving into his training site for their summer training. I was thinking, "yeah, I understand what that involves (huge planning & paperwork for those personnel and logistics) and am so glad I don't have to be doing that anymore.

The second is a book I'm reading, Christie Blatchford's Fifteen Days about her time as a reporter embedded with the Canadian Forces in Afghanistan a few years ago. I'm only so-so enjoying it. Basically war stories, I suppose good insight if you've never been there. Again, the feeling of "glad it's not me anymore." Not the getting shot at part (although not a big fan of people trying to kill me), but the moving into, and staying in, some godforsaken, dusty patch of barely habitable real estate and calling it home for the day/week/month. Nope, glad I don't have to be doing that anymore.

I did my time doing those things. Didn't mind them at the time, proud of it, very glad to have done it, but have done enough of it, and getting too long in the tooth to want to do more.
warriorsavant: (Springtime in Canada)
Some years back, to get a passport in Canada, you had to have it signed by a "guarantor " someone who knew you for at least 2 years, held a Canadian passport and was considered a respectable member of civil society, such as post master, school principal, or physician. I was happy to do it, was kinda cool. Later, for a while, I didn't have a Canadian passport (the US Army felt it was incompatible with my having a US security clearance), so couldn't anymore. By the time I got out of the Army and again got a Canadian passport, they had changed the rules to make it more egalitarian (or something), and any Canadian citizen and passport holder could do it.

Something similar about marriages. (Touched on this around time I married Nom, but bears repeating because analogous.) Years ago marriages could only be officiated by clergy. In New France, that meant Roman Catholic, later any clergy. Later, any clergy or civil official (eg a judge). In Quebec, following a form of French Civil Code, you could also be married by a Notary. (Note: In Roman-derived systems, a Notary is not just someone who witnesses signatures, a Notary is a type of Lawyer. Notaries do non-contested legal matters, such as wills and deeds, somewhat like an English Solicitor.) More recently, the option for "presiding official" was broadened to "any citizen in good standing." (I think "good standing" means "not currently in jail.") If you went that route, you submitted the name to city hall, they checked the standing of said citizen, then sent him the "how to" guide. We were originally going to have Nom's brother do it, but then had second thoughts. First of all, no telling how long it would have taken city hall to get the documents to BIL. Second, although he's a bright man, he's never done this, and we didn't want to risk he'd make some minor but crucial error in the bureaucratic paperwork. In the end, we had my Notary come to our place and do the legal parts ceremony (not to mention all the paperwork). I actually rather liked that we were taking part in a "traditional" way of doing things. In addition to the bits of Buddhist ceremony, Jewish ceremony, and jumping over the broom. (Yup, married x 4, and all to the same woman.)
warriorsavant: (McGill)
l've mentioned teaching, and coordinating the teaching for, the Derm part of the medical school curriculum. There are two blocks (well, bits) one each first and second year, as part of those courses.  Got a very touching and personal thank you letter from one of the courses. Well very touching and personal thank you email. Well a mass form email, addressed to "Dear XXX course instructor / site supervisor," thanking me/us for our dedication, hard work, etc, etc. Being well-raised, I told them they were welcome, addressing the email to "Dear XXX course director / administrator." I resisted the urge to tell them just how warm and fuzzy their email made me feel. 
warriorsavant: (Composite)

I've mentioned that I go to the Ste Anne's Veterans Hospital once/month to see patients. It's sometimes an interesting variation on my usual practice, sometimes depressing, but I'm always proud and a bit humbled to be taking care of these WW II vets. When the previous Derm gave up the position because she was stretched too thin, I took it over because as a veteran myself, I felt it was right that I be the one to do so. 

 

About a year ago, as the number of eligible vets continued to decline, ownership of the hospital passed from the federal government to the province, who is using it for chronic care of the elderly, not just veterans. This is a population who deserves service too, but I'm here specifically for the vets. A few months ago, the provincial health care system underwent a typical bureaucratic reshuffling of the deck chairs on the Titanic ("to serve you better"), so support services have declined even further. In the hall where I come in, they had a series of paintings depicting Canadian military aviation history. Today when I came in,they were gone. The sour taste that left, combined with my needing to consolidate my activities has me starting to look for a replacement for myself to cover the Ste Anne's. I'll be a little sad to leave, but only a little. The reason I came there is fading, and other priorities are growing. 

warriorsavant: (Computer-steampunk)
After my computer crash, I could access emails on my phone, and was able to answer many of them. Others required access to files on my computer (or were to be saved on said computer), and I put them in a "hold" file on my server until such time as was back up and running. In the 10 or so days I was doing this, I accumulated 130+ emails. In between more important tasks such as nibbling toes, I spent hours yesterday and today dealing with them (plus paper files I'd set aside). I'm down to single digits. It's amazing how much stuff has to be dealt with in modern life in that short period of time. I think we spend half our lives just doing the administrative side of having a life.
warriorsavant: (White Lion - Jabulani)
I may have bitched, whined, and moaned about mentioned the new provincial guidelines about charging fees in offices (see Jan 24). As part of the ban on that, I have stopped doing patch tests (a form of allergy testing), because the materials cost more than they would be paying me to do the testing. Today I did the last readings (determining if positive reaction). It is standard to consider that if you have 50% positives, then you're threshold for testing is about right. (That is, if you have fewer positives, you are testing too many people who don't need it, and if you have more positives, you're not testing people who should have had it done.) I'm usually at a lower level than that, because I test patients referred by other Derms, some of whom are just referring annoying patients to get them out of their hair. Of my own patients, I've been about at the 50% level. Today, between my own patients and those referred to me, most of them were positive. It's satisfying to get a positive result, because then I have something useful to tell the patient (and because it's just generally more fun to see a result). Today was a good patch test day for me, but it's my last (unless something changes). It's good to go out on a high note.

Tidbits

Jan. 27th, 2017 11:36 am
warriorsavant: (Sword & Microscope 1)
medical practice )                Food )                      Reading )
Weather and such )
Renos )
warriorsavant: (Quebec sait faire)
I alluded to this issue Jan 13. Here's the story. The current provincial health minister is named Gaetan Barrette. On the positive side, he is trying to clean up some issues with the Quebec Medicare system. On the negative side, he is not consulting with anyone before he issues his ill-thought-out fiats. Lately he has taken a page out of Donald Trump's book and is sending out late-night and weekend tweets of questionable veracity when he is annoyed by someone. Before getting into the current problems he's caused, some background is needed on how things are done here in the True North Brave and Free.

Medicare-how she works )

A consideration about any law or regulatory framework is that there are always gray areas (or grey areas as it is spelt in Canada and the UK). No matter how carefully you write the law, there are always ambivalences. Putting in more regulation doesn't eliminate those loopholes, it just creates more. Up until now, we've dealt with these gray areas by ignoring them, and everyone gives a little on their side: doctors accept that not everything is paid for, patients pay a little out of pocket for things questionably required, and the government ignores the situation.

Medicare-how the Minister is screwing things up )

I'm not sure why all this is happening. Is it purely Minister Barrette's incompetence? Is it a back-handed way for the province to dis-insure some services? (Instead of dis-insuring them, they make them impossible to get, and put the burden on the doctors to be the heavies to explain it to the patients.) Is it the companies that provide drug and supplemental insurance got tired of paying for these supplemental (but legal) charges and pressured the government to outlaw them? Always hard to know if something is driven by avarice or stupidity (my bet is usually on stupidity which is harder to outsmart than avarice). In the end, me and every other doctor will find a way to protect ourselves without hurting our patients. Like most smart people, Minister Barrette fails to account for the fact that other people are smart also, and there are more of us than there are of him, and that we're motivated because it's our livelihood.

Stay tuned to this blog for further updates.

The footnotes )
warriorsavant: (Computer-steampunk)
Why do they make lightbulbs in so many odd shapes and sizes? Even in one small condo, I must have 8 types of lights. I had to go to three places to find the replacement for one particular bulb I have now that burned out. I think when we start installing lights in the new house, my rule will be “only one type of bulb, everywhere.” No cutesy decorator lights, not halogens here and incandescents there, etc.

I understand in the interest of saving the environment (or something), in the US, incandescent bulbs are now illegal (just like toilets that actually flush properly), because what the country needs are a good 5-cent cigar and a good $15 dollar lightbulb. Oh, yes, it saves energy, b/c the 5-watt LED is actually the equivalent of a 40-watt incandescent. Yeah, like I ever use 40-watt bulbs. If I wanted to live in the dark, I wouldn’t have electric lights in the first place; I used 60- or preferably 100-watt bulbs. When we want soft romantic lighting, we use candles.
warriorsavant: (McGill)
Am surrounded by annoying bureaucracy on all fronts. (Is there any other kind?) Extra things demanded to get permit for house renovations, extra things demanded to get permission for a small clinical trial (even though using an approved drug in a reduced dose). Grrr.

Fortunately have extremely cute kids. Hedgefund now likes being girlie. As we speak, she just had me put flower-shaped clips in her hair. I hope a remember all the adorableness of them now, as the years go by.

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