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: (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: (Springtime in Canada)

Þ I wonder how long until: (a) I run out of synonyms for miscellanea, and (b) I have the time and energy to write a serious post.

Þ We are going to have a White Christmas. Meanwhile, have to find my heavy gloves! Had our first real snow fall 2 days ago, then today the temperature dropped to below zero on that archaic scale used south of the border (i.e. below -17 Celsius/real degrees). Actually there is one aspect of Fahrenheit I appreciate: below freezing (32º F) is cold; below zero is !︎&⚔☔&*#-ing cold.

Þ Montreal urban highway planning strikes again. Was my monthly visit to Ste Anne's (former- and still-partly, veterans hospital), which is in west end of the island. The entrance I usually take was closed, with a detour to the east. Got to the next entrance, which was also closed, with a detour back to the west, via a narrow street, which was having construction.

Þ One of the patients had a problem on her toe. Understand that she, as so many of these patients, was infirm, wheelchair-bound, & rather demented, who didn't have to go outside to see me. The floor staff dressed her in tights.

Þ We've sent out the letters for the change of address (the move will be next month). At least 5 people called Evil Secretary to ask, "so are you moving?" ("Uh, no. We only sent those letters out to patients we don't like, so in future they will go to the wrong address and stop bothering us, but since, darn it, you caught us, you can continue to be seen at the old address.") Over the past 20 years or so that we've been at this address, we've had patients who went to the wrong address blame us because: (a) we gave them the wrong address, and/or (b) we moved the building. ("Uh, yeah, it has wheels on it, but darn it, you caught us.")

Þ Finished reviewing the files for our residency applicants for next year. As promised (to Nom), I've started putting away the last boxes of stuff (with a slight detour to post this).

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: (Meh)
... and already have had 3 people who didn't get better.
"Did you use the medicine I prescribed?"
warriorsavant: (Computer-steampunk)
Finally did it. Got an iPhone. This completes the set: MacBook, iPad, and now iPhone. I've drunk the Apple Kool-Aid. "My name is warriorsavant, and I am an iSheep."

My old Blackberry was dying, plus there are very few apps still created for that operating system. Not that I buy many apps, but still, be nice to have the option to do so if I wanted one. Also, it was impossible to actually sync my BB with my other devices. (Yeah, there is an app that is supposed to do that. Uh, no.) When my last phone died, I had to make an immediate choice of what to replace it, as it had indeed died, and as is well known, the human brain can only survive for 4 minutes without connectivity. (Or is that oxygen?) I went with the BB b/c I really didn't like the touch keyboard on the iPhone as much (and really still don't).

I confess I love my new IamASheepPhone, mostly because it is lightning fast to connect to the internet. Also, I got everything properly synchronized between my devices: mail and contacts and bookmarks all show up on all three gadgets simultaneously. (Not interested in sync'g anything else right now. I do NOT keep my documents on their cloud.)

Changing over from my old phone went as smoothly as on can expect from the modern, we're here to serve you tech world. Which is to say I am lucky it all got done before I had a stroke or was arrested for homicide. Four hours in the Apple Store. Blood curdling tale of woe )When I got home, I loaded the few other apps I ever use (after looking up my passwords), and I'm in business.
warriorsavant: (Meh)
Nothing specifically wrong, just a case of the blahs. It is a holiday here, la fête de st-jean baptiste. We taught the kids to sing Gens du pays* and went to the festivities in the local park, which were unremarkable, but HF likes going to the park.

I even got enough sleep last night, which is rare.

Not sure if just cumulative stress, or paradoxically antsy because things are finally moving on the house renovations, or the Brexit is bothering me.

Brexit. I know it was a bout of colossal stupidity,** but unless that triggers more stupidity in Quebec (never far from the surface... maybe I should teach the kids the words to Gens du pays), it doesn't much actually effect me. However, emotionally, it seems to be doing so.

*Not really, but if you care the words are:
Lyrics )

**Among other scary facts, afterwards, the most-googled search in the UK was "What is the EU?" Uh, maybe you should have done that little bit of research before the vote?
warriorsavant: (McGill)
Friday was super busy. Good, but busy. I like being the Compleat Dermatologist, and Friday ran the gamut from routine, to Contact Allergies, to Botox, to excision of a Melanoma. The last was an add-on. Her biopsy had come back positive, and had no free time for weeks unless I added her on to the end of the day, so I did. I was already scheduled to meet with a medical student about a research project then, so when said student arrived, I told her I had both good news and bad news. The bad news was that there was an add-on, so she'd have to wait for our meeting; the good news was she could help with the surgery (patient had given permission).

I was supposed to got home for a couple of hours, then meet with 2 different contractors, followed by graduation dinner (for our Residents, not me). Was going to change into a suit, with my McGill lapel pin (which I'd never worn). With the delay at the office, only had about 40 minutes at home, so instead met Nom and the kids at the park. Had fun, got very dirty, then met with the contractors. (The results of one of the meetings was satisfactory, the other wasn't, but that's a detail.)

Never did get a chance to change, so after meeting the contractors, headed out to the graduation dinner for our Residents. Since I hadn't had time to change my clothes, much less shower, the first thing I did when I got to Thompson House** was head for the washroom, where, despite the name, I washed. Well, at least cleaned the dirt off my face and hands. And shoes. And pants. And hair.

Anyhow, all our Residents passed the Royal College exam, which is a brutal and rather stupid specialty exam.* I always attend the graduation dinner, whatever else I have doing. The Residents have busted their tails for 5 years, and deserve to be honored. I'm proud of them and glad to fete them.

*The Royal College exams are the Canadian Specialty exams. It used to be very clinically-based; they'd present you with clinical scenarios and make sure you could handle it appropriately. They could get into very picky, but it was geared around showing that you could act as a consultant in your field. The American Board Exams, on the other hand, were known to be the academic equivalent of Trivial Pursuits: show a picture of an insect and ask what disease it carries, many questions about enzymes and genes. In short, full of the stuff you cram for to pass an exam, then promptly forget. Canada, being a smaller country (in population, not land mass, thank you very much) bordering the US, of course has to show that everything we do is "better." So some years ago, the Royal College decided to prove that they could be better at being stupid and trivial than the US Board Exams and ask even more picayune questions. It's not that I don't think doctors shouldn't understand the basics of why a disease happens; they should. But unless you are doing research, you don't need to know the specific enzyme or interleukin. Our Residents end up spending most of their last year stressing and memorizing tables of trivia out of the standard textbook, all of which will be forgotten within a few months of the exam. End rant.

**It's the Graduate Students Union/Club building at McGill. Like a lot of the university buildings, it was an old mansion in the Golden Square Mile. The food is mediocre, but it is a lovely old building and a good place to hold our small receptions.

Uh... no!

Jun. 15th, 2016 11:25 am
warriorsavant: (Meh)
Just to break up the day, as if it weren't busy enough, just before lunch, the fire alarm went off. In the end, not a real fire. Probably triggered by the construction/renovations on the 2nd-4th floors. However, still had to evacuate the building until the fire department came to check things out.

As we were leaving the office and heading for the staircase, a patient, who at this point was already over 2 hours late for her appointment, walked up to us. She was absolutely indignant that I wouldn't see her then and there, fire alarms or no.
warriorsavant: (McGill)
McGill sent me an email, which for more information on the subject, and a link to click. Which brought up a page on which I had to select a tab, whose only info was a link to click, which brought up a document with links...

After six clicks, got to a broken link.

Finally emailed the person who'd sent me the original email, who then sent me a link to the page I actually needed to look at, which after reading it, realized it didn't apply to me anyhow.
warriorsavant: (Time)
Canada is a wonderful country, full of wonderful people, as is the US. Wonderful, but who have grown up sheltered, comfortable, and therefore a bit naïve, with sometimes sophomoric views on world problems. Is there an evil warlord somewhere? Sign an on-line petition against him. Other Problems somewhere? Demand that Someone Do Something. They take such pleasure in their righteousness and indignation and certitude of the good and evil in the world. They kinda forget that warlords don't exactly quake in their boots (well, sandals) because someone clicks 'dislike' on their Wastebook page, and that the Someone who is sent to Do Something often comes back in a body bag.

I was discussing this with a friend and colleague who had grown up in a developing country. His views are different from middle Canada/US because of that; as are Nom's, who was a war refugee; as are mine, having spent 3 decades in the military. We don't get to be naïve. I've been the Someone who was sent to Do Something more than once.

My friend mentioned his son's rapid maturing in the past year of being in University in another developing country. It is a good education at the University he is getting, and perhaps a better education in life. He said the first inklings of reality crossed his son's mind when he asked him how he was going to get around there.
"Oh, I'll just get a STM card" (Societé des transports de Montréal - our mass transit system).
 "Son, they don't have mass transit there."

I wonder about my children. Gentle Reader, did you ever see or read Apprenticeship of Duddy Kravitz by the late, great Mordecai Richler? Duddy Kravitz is a young man, growing up on the meaner side of Montreal, trying to make it in life. One of his plans goes horribly wrong, his friend is badly injured. Duddy is driving a taxi, guilt-ridden and depressed, and runs into an older, successful man he knew from when he was a waiter in a resort. The man takes him out for coffee and listens to what happens, and then says, "Listen, Duddy. Years ago there was an accident in my business. A man died. They said it was my fault. I could have gone to jail. But I had a partner who wasn't as bright as I was, so he went to jail and here I am. My son (a young teen) is a good boy. He'll go far. He'll never cheat a partner into jail. But he never came to this country with 5-cents in his pocket and 2 words of English."

I certainly don't mean I want to raise my children to be cheats and con artists. Like all parents, I want them to be happy. Although I claim I've already put in their applications for Medical School, in fact, if they grow up to be happy, productive, and honest citizens, I'll have done my job. But I don't want them to be naïve, even if there is sometimes pain in seeing reality. I don't look forward to the pain in their eyes when they are teens and young adults, when they won’t fit in with the happy, naïve, self-righteous people around them. But later they will have the cold, clear joy of knowing. "Know the truth, and the truth shall set you free."


Dec. 3rd, 2015 10:53 am
warriorsavant: (Meh)
First of all, you'd think the kids would have already been able to get out and about on their own: prepare dinner, run up to the store when we're out of beer, etc. Instead, all they do, especially the 2-month old, is sit around and look cute. Okay, they have other actions, such being the prince & princess of pooh (well, by rights make that the princess and prince), queen & king of kaka, empress & emperor of excrement, sultana & sultan of... well, never mind.

Anyhow, they are really cute. HF is starting to say letters. I don't think she actually knows what they are but has some idea that there is a sequence: if Nom says a, she says b, and so on (I think up to h). She can also "sing" the alphabet song, but wordlessly, just using baby-babble/nonsense syllables, but you hear the rhythm. And yes, elemenohpee is a letter. In French also. (Well, it's elemenohpay in French.)

Have some other big projects which will get into later, but they are being held up, which is really annoying. One of which is because of massive stupidity on the part of the other party. I am seriously not pleased, and if it falls through will be suing his butt at the very least.

Other petty annoyances include the fact that most people can't answer a simple question in their native language. I don't know why I'm still surprised. My late, great-uncle told me that many, many years ago. Also, world, when you go into someone else's office, you do not sit in their chair. I realize that since I set the desks and chairs in the exam rooms at an angle* it could be confusing to people, but somehow the people who sit in my chair have a higher than average chance of being pompous, self-important a**holes.

Oh, and hold off on the Christmas stuff for a couple more weeks. In the US, with Thanksgiving at end of November, only just starting, but some stores in Canada have been ramping up since just after Hallowe'en.

Yeah, grumble, grumble, whine, snarl. At least there's a scotch tasting at my accountant's tonight (annual good will towards the clients thing), so life will get better then. I'll take the kids, time to start them off right.

*I don't like sitting across the desk from someone, as it forms a barrier. In each exam room, I have a small, triangular desk (well, actually a short pentagon, with the point in the corner of the room), with the patient and I sitting at right angles. It's more personal, and if I need to see or feel something, I can just lean forward a little. That having been said, one chair is clearly at the of the desk, and one clearly at the side. It is possible for someone to be confused, but as noted, those who get confused are p, s-i a-h.
warriorsavant: (Cafe)
1. There are different ways of making coffee. Espresso is yummy, but despite what people think because of its stronger flavor, it actually has relatively less caffeine, because the steam shoot thru the coffee too fast to extract the caffeine properly. Old fashioned percolator coffee has a more bitter taste, because it usually ends up over-cooked, but has the most caffeine. Drip or French press are somewhere in between. Like many things in life, it's a trade-off.

2. Artificial flavorings in coffee are vile. Real flavorings (beit cinnamon, cardamom, or vanilla) can be a nice treat. If you add enough "stuff" to your coffee, it becomes coffee-and-dessert in one cup. I used to be rather addicted to Second Cup's (a local chain) mochaccino (basically a cappuccino with chocolate and whipped cream) with extra chocolate. There was a Second Cup en route to walking to work, and I'd stop there to get it as a treat. Was fond of it, until one day the counter girl said, "so what you really want is a hot chocolate, but that's not macho enough for you." Uh, yeah. Shut up. Still have it occasionally.

3. Have to be careful what you ask for in a coffee. Yes, you'll certainly get it, but too many adjectives, and you're a jackass. Small, medium, and large, do not count as adjectives in this case (although large, grande, vente, and super-sized might). I mean something like "I want a half-caf, double-soy, latte, with…" I actually was in line behind someone ordering this once, and almost got into a fight because I started laughing at him. He probably would've whopped me easily, as I was laughing so hard I could barely stand let alone fight. (My SO at the time dragged me out of the store.) It was his fault, if you don't want to be laughed at, don't wear clown suits in public, or order coffee with more than 2 adjectives.
warriorsavant: (Meh)
It's been a morning full of stupidity and it's barely 9 AM.

First, patient A needs to get the marbles out of his mouth. Yes, you are fighting to preserve the glories of the French language... try learning how to speak it correctly.

Second, referring doctor B needs a shorter name. It's lovely you are using your full name, including compound last name, but it actually doesn't even fit on the referral sheet.

Third, pharmacist C needs to understand that if I write a non-standard dose of a medicine on a prescription, then add a note explaining that's it's non-standard and why I'm doing it, he doesn't need to fax me to ask if I really want that dose, what with it's being non-standard.

Fourth, city D (otherwise known as Montreal) loves holding festivals. Apparently there's a mini-festival, encompassing one block of a major thoroughfare, which has been blocked to traffic for 4 days so that the restaurants in that block can put tables in the middle of the street. Yup, clearly those restos were not making enough money, so let's close a major street (it's only been a major route for about 200 years), inconvenience everyone who uses it, everyone who lives in the area, and all traffic for blocks around which gets secondarily backed up.

Fifth, oh never mind. That's enough ranting for one post. Have a lovely weekend, Gentle Readers, may your lives be devoid of stupidity.
warriorsavant: (Computer-steampunk)
Some years back our hospital decided to become more efficient and put records and everything else on computer. Just use the fingerprint scanner to log in, open Chartmaxx, and everything is there almost instantly. Unless the fingerprint scanner doesn’t work, which it usually doesn't. Unless something hasn't been scanned onto Chartmaxx yet. Or is in a different software package. Or it's all there, but the system is really slow. Or, like today, there's a power outage. Yup, we had a 5-10 minute blackout. I thought hospitals have emergency generators, but those are for vital functions only. I suppose for the administration, Dermatology, which generally sucks hind teat when it comes to respect from our colleagues, our clinic doesn't count as "vital." (That is, until they need us, then we're everyone's best friend.) I've been to hospitals where the Dermatology clinic was in a 40-year old "temporary" wooden building across the parking lot. Anyhow, we were sitting in the dark literally, and thanks to the dependence on IT metaphorically as well. Fortunately our most important tool, our brains, were still working, and "technology" came to our rescue to see patients, as everyone has an app on their smartphones that allow a several-hundred dollar device to act as a flashlight.
warriorsavant: (Venice)
No doubt some of my Gentle Readers are familiar with this, but I have just come across the Juliet Club. They respond to letters asking for advice to the lovelorn; letters addressed to Juliet Capulet. That is Juliet of "Romeo & Juliet," y'know, the play by Wm. Shakespeare. A fictional character. So people are asking for love and life advice from a 14 year old. Who's dead. And did I mention the fictional part? *Sigh*
warriorsavant: (Computer-steampunk)
So the Next BigThing is the "Internet of Things." Apparently this means putting Wi-Fi-connected microprocessors in everything. After all, it's important that your desk lamp be able to talk to your refrigerator. Or something. And since they learned their lesson from computers, security is built into all these devices. Except it isn't. Not even slightly. The potential for your life to be hacked will expand exponentially. Do you think it isn't already an issue? Tesla (the electric car company) just announced they were putting out a security update/patch for the computers in their cars. If they are doing that, then either there's already been an incident, or they at least recognize the potential for it.

There are at least two reasons to worry. First, if your microwave or furnace can be controlled from your phone, tablet, or laptop, then there is a link between them, and if there is a link between them, signals can go both ways and the cheap, commonplace, now-Internet-linked, household gadgets can be used to hack your phone, tablet, or laptop, and from there, your bank account and everything else you own.

Second, the devices can be directly hacked either for blackmail, or shear malice. As an example of the former with computers, consider reports of people having their computers hacked for blackmail/ransom. When you try to use your computer, everything is locked except a message from the hacker demanding money: pay up and they will unlock your computer, don't pay and they will wipe your hard drive. Now imagine you try to get into your entirely-wired house, and get such a message: pay up and we let you in, don't pay and we lock you out, and wipe all the Things-of-the-Internet you've connected together. Worse, imagine if you are "driving" your self-driving car, and your car display gives you a similar message: pay up, or we crash your car.

In a way, this is simply hacking-as-crime (or malice for the fun of it), egalitarian-ized, in the same way other crimes have been. Non-Internet examples? Armed Robbery for one. If you want to go in for Armed Robbery, you could follow Sutton's Law and rob a bank. It's high payoff, but also high risk and requires lots of planning. Because of the risk, there really isn't that much bank-robbery going on in the developed world. Much easier to knock over a gas station or convenience store: lower payoff, but almost no risk. Another example is kidnapping. In South America and the Middle East, kidnapping used to target only the rich. High payoff, maybe a million dollars a pop. However, requires lots of planning, good organization, and lots of risk; rich people can afford bodyguards, and they just might take out a contract on you later. Now, apparently, it is more common to grab the kids of local, middle-class or even poor people. Grab them, stuff them in a car, make them call their parents, and demand $100 ransom. Less payoff, but minimal planning needed and minimal risk.

So, I may be a Luddite, but I'll stick with my non-wired environment, Internet of the Internet, life. If my television set wants to talk to my stove, it will just have to walk into the kitchen on its own.
warriorsavant: (Sword & Microscope 1)
Subtitle:  "Did You Really Need That?"

Vancouver is a very green city in many senses of the word. This is generally a good thing. We only have one planet, yadita-yadita-insert-politically-correct-but-also-true-comment. However, there is a "get real" quality about some of what they are doing, or at least a "did you really have to point that out?" quality.

Example 1: I've stayed at hotels in other cities, where in addition to the trashcan, there is a green recycling box in the room. A small one, but it is there, and guests do throw out a fair amount of paper and occasional bottles or cans. In Vancouver, however, the small, covered, green box twinned to the trashcan, is a composting box. Really. They clearly say it is for food scraps and such. (BTW the cups at the Conference Centre are labeled as compostable. Not recyclable, compostable.) Maybe guests ordered room service (in fact I didn't, and more and more hotels don't have it), but shouldn't the composting then be the hotels business? I suppose guests could have ordered take out, but even so, how many are going to dutifully scrape their plates into a composting box?

Exmple 2: Non-potable water. You've seen the little graphic different places: a faucet, with a cup under it, and the red circle-slash superimposed. (What-the-heck do you call that thing?) Now, there is no reason to flush toilets or urinals with potable water; in fact, it makes good ecological and financial sense not to. However, all the toilets, and all the urinals, at the Convention Centre have the non-potable water graphic over them, with a little note saying that they are helping the environment by not using potable water in this wasteful way. How much resources did they waste manufacturing and posting those signs. More importantly… did they really think we were going to drink from the urinals or the toilets if they didn't tell us not to? 
warriorsavant: (Sword & Microscope 1)
I know you spend a long time with each of my patients who comes to consult with you. They sit in your office, and the two of you have a long and very attentive dialog, and you tailor your recommendations and treatments to the specific needs of the individual patient. As such, I know I should take your advice very seriously when the patient comes to my office armed with that.

However, may I point out that if you recommend a medication only available in New Zealand, it won't do much good. I understand New Zealand is a lovely country, but it is quite a long trip from here, and my license isn't valid there.

Thank you for your understanding.

Warmest regards,
Dr. WS
warriorsavant: (Space-horsehead nebula)
Despite the a fair amount of public health information (and my constant reminders), people still show up at my office with a tan, or even a sun burn. There is no sympathy here for the latter! One patient was referred to me yesterday for a patch test (a kind of allergy test, but using patches instead of needles). Since she was sunburned, couldn't do the test, and had to reschedule it. Evil Secretary tells me she left very annoyed. Perhaps we should have showed her the attached picture, which is now posted in my office in English & French.

Our new "public service" poster )


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