14
Aug 09

A View From Your Sick Bed

American healthcare is hopelessly broken, and Obama’s healthcare reforms are not going to be able to fix the current system… they need something new. Patrick Appel at The Atlantic has collected some responses from Americans to an article about the View From Your Sick Bed, and they make for an enlightening and terrifying read about how terribly broken the American system is. For their sake, I’m looking forward to when the whole system inevitably comes crashing down, so they can start fresh and build something that’s sustainable and affordable for all Americans.

Go have a read of the responses yourself – well worth the time. My favourite:

[...] After I completed the detailed application and provided additional information over the phone, I received a letter telling me Blue Cross California was “declining” my coverage. Days later, I received another letter listing three reasons:

* Knee tendonitis and low arches treated with physical therapy (in 2002)
* Shin splints treated with physical therapy within the past year (which
cost me $3,000 out of pocket)
* History of treatment for sciatica (once-in 2004)

My blood pressure, heart rate, and cholesterol are all low, and I weigh less now than I did 20 years ago in college. I take no prescription drugs, have never been seriously ill, and have never received ominous test results. But I couldn’t get group coverage because I’d previously sought medical care while insured under COBRA or grad school policies. And a traditional individual policy would be prohibitively expensive. This is how we encourage people to become entrepreneurs?

Our system is clearly in need of reform.


13
Aug 09

CaRMS Visits UQ

Today, the University of Queensland’s School of Medicine was lucky enough to be visited by Sandra Banner herself, the CEO of CaRMS, the Canadian Residency Matching Service that is the gatekeeper to post-graduate medical training in Canada.

Overall, I thought her presentation was just about as useful as it could be – she immediately struck me as someone who had done this presentation many times before, and spoke with measured words about the many hurdles we would have to face in coming back to Canada, while staying within the limits of PCness.

I’ve listed some of my notes from the presentation below, for those who might be interested. Anyone not in med can safely quit reading now.

  • The current trend is that the gap between the number of Canadian Medical Graduates (“CMGs”) and number residency training spots will continue to increase, which is a good thing for us internationals!
  • In the last 5 years, the provinces have decided to make it policy to automatically increase residency spots to the same degree that they increase spots at Canadian medical schools. Common sense thinking from the government… imagine that.
  • They aim for a 40% Family Med to Everything Else ratio.
  • Manitoba lost the human rights battle to keep International Medical Graduates (“IMGs”) out of the first round of the match. So your best shot for matching is Manitoba, as an IMG. Downside being, you have to live in Manitoba.
  • In 2009:
    • 392 IMGs matched.
    • 2294 CMGs matched.
    • 2705 total positions available.
    • 126 unfilled spots after the second round, mostly in Quebec (which has onerous requirements for matching, hence the unfilled spots…)
    • 90% of Emerg matches were Canadians Studying Abroad (“CSAs”).
    • 52.5% of match graduated last year.
    • 39.5% of match graduated 2 years ago.
    • 84% of CSAs who matched did an elective in Canada.
    • 44% of CSAs matched.
    • 22.9% of immigrant IMGs matched.
    • 58% of Aussie CSAs matched.

13
Aug 09

The Engineering Song

A bit of nostalgia for the engineers in the crowd: I give you the Engineers’ Song!

Lyrics below, and I even found a version that I recorded of the MecE band performing at Geer Week in 2008.

CHORUS:
We are, we are, we are, we are, we are the Engineers,
We can, we can, we can, we can demolish forty beers,
Drink rum, drink rum, drink rum, drink rum,
Drink rum, and come along with us,
For we don’t give a damn for any damn man,
Who don’t give a damn for us.

Godiva was a lady who through Coventry did ride,
To show all the villagers her pretty bare white hide.
The most observant man on earth, an Engineer of course,
Was the only one to notice that Godiva rode a horse.

She said “I’ve come a long, long way, the man will go as far,
Who takes me off this goddamn horse and leads me to a bar.”
The man who took her off her horse and stood her too a beer,
Was a blurry-eyed old sapper from the corp of Engineers.

Godiva woke next morning and she had an awful head,
Decided to be sensible and spend the day in bed.
The only ones to visit her and brings her lots of cheer,
Were the broken-down surveyor and the bloodshot Engineer.

Godiva died, and where she fell a benchmark marks the spot -
In any engineering text it’s level can be got.
And in heaven everyday Godiva craves for beer, but
She’ll have to wait until the gates let in the engineers!

Godiva was a lady well-endowed there was no doubt.
She never wore a stich of clothes, just wound her hair about.
The first man who ever made her was an Engineer of course,
But on just one drink, and artsie fink once made Godiva’s horse.

My father was a miner from the northern Malamute,
My mother was a mistress in a house of ill repute.
They kicked me out at a tender age and never shed a tear,
“Get out of here you son of a bitch, and join the Engineers!”

An Artsman and an Engineer once found a gallon can,
Said the Artsman, “Match me drink for drink, let’s see if you’re a man”
They drank three drinks, the artsman died, his face was turning green.
But the Engineer drank on and said “It’s only gasoline”

I happened once upon a girl whose eyes were full of fire,
Her physical endowments would have made your hands perspire.
To my suprise she told me that she had never been kissed,
Her boyfriend was a tired Engineering Scientist.

Sir Francis Drake and all his men set out for Calais Bay,
They’d heard the Spanish Run fleet was headed up that way,
But the Engineers had beat them by a night and half a day,
And though ass tight as virgins, you still could hear them say …

Ceasar went of Egypt at the age of fifty three,
But Cleopatra’s blood was red, her heart was warm and free,
And every night when Ceasar said goodnight at one o’clock,
A Roman Engineer was waiting just around the block.

Venus is a statue made entirely of stone,
There’s not a fig leaf on her, she’s as naked as a bone.
On noticing her arms were gone, an Engineer discoursed,
“the damn thing’s busted concrete and should be reinforced.”

A maiden and an Engineer were sitting in a park,
The Engineer was busy doing research after dark.
His scientific method was a marvel to observe,
While his right hand wrote the figures down, his left hand traced the curves.

My mother peddles opium, my father’s on the dole.
My sister used to walk the streets, but now she’s on parole,
My brother runs a restaurant with bedrooms in the rear,
But they don’t even speak to me, ’cause I’m an Engineer.

After reading Kama Sutra, they tried position nine,
For proving masculinity, it truly was divine.
But then one day the girl rebelled, and threw him on his rear,
For he was a feeble artsman and she was an ENGINEER.

The Army and the Navy boys set out to have some fun,
Down at the local tavern where the firely liquids run,
But all they found were empties, for the Engineers had come,
And traded in their instruments for gallon kegs of rum.

An Engineering one came to school so drunk and very late,
Carry a load that you’d expect to ship by freight,
The only things that held him up and kept him on his course,
Were a boundary condition and the electromotive force.

Rapunzel let her hair down for two suitors down below,
So one of them could grab a hold and give the old heave-ho.
The prince began to climb at once, but soon he came out worst,
For the Engineer rode up a lift, and reached Rapunzel first.

We build all your bridges and we fix your roads too
There’s not a thing in the whole wide world an engineer can’t do
When your head is empty and your heart is full of fear
The first word out of your fucking mouth is call an engineer

The modern engineer must be politically correct,
No more motors lubricating, no more buildings rise erect,
No more electrical capacitors whose plates are high and fair
Instead of problem solving let’s just sit around and care.

A Commie and an Engineer were stranded on a boat,
One person too heavy though, the poor boat wouldn’t float.
The Engineer would flip a coin to settle the dispute,
So she flipped it in the water and the Commie gave pursuit.

Elvis was a legend; he’s the King of Rock ‘n Roll,
But the life he was leading – well, it finally took its toll.
He realized too late, he’d choose the wrong career,
So he faked his death and went to school – now he’s an Engineer!

When Mechs are feeling tired and when Civils are worn out
There;s just one place to go and that’s the bar, without a doubt
So the next time that you drink an ice-cold, golden, frothy beer
Get on your worthless knees and thank a chemical Engineer!

The artsie thought he had it all, his girlfriend disagreed.
One day she up and left him: He could not fulfill her needs.
“Where are you going?” the artsie cried, half-naked from the dorm,
“To find an engineer,” she said, “At least they can perform!”

Late one night, an engineer was lost in work and toil,
He set off to find a darling girl to help discharge his coil.
In no time at all he’d warmed her up, her resistance at a low
They fluxed until the morning’s light, when their fuses, did they blow

A man sat in a tavern with a lovely looking lass
And stared when for the nineteenth time time she raised and drained her glass
he said “You’ve out drunk four strong men, and half the bar, my dear.”
But the maiden smiled demurely and said “I’m an engineer.”

We love to sing, and rink, and sing: ‘We are the Engineers’
Too bad if we’ve offended you with any of our cheers
Sometimes we get too rowdy and we go harass the bands,
So you best make sure we always have a pitcher in our hands!

So now you’ve hear our story and you know we’re Engineers
And when we all shall graduate, we’ll all have great careers.
An engineer’s starting wage can pull in 60 G’s
While an artsie with a PHD can work at Mickey D’s.

Now you’ve hear our story and you know we’re Engineers,
And like all good jolly fellows we drink our whiskey clear,
We drink to every fellow who comes here from far and near,
‘Cause we’re a HELL-OF-A, HELL-OF-A, HELL-OF-A, HELL-OF-A HELL-OF-AN ENGINEER!


29
Jul 09

Insignificant

Each of us, so caught up in the everyday. God gave us the stars to remind us of our own insignificance – our lives as given to us are no bigger or consequential than a single atom in the tears streaming down your cheek.

We can take heart in knowing that each of us has been given the tools we need to make in impact in this life. Everyone unique, every toolbox handcrafted by chance and by God – some are compassionate, some relentless, some musical, artistic, or scientific. Don’t let the little roadblocks in life stop you from achieving what God put you here to do.


24
Jul 09

A Month, Disconnected

Everyone wants to know how my month offline was. They ask it casually, like “How’s work going?” or “What’d you do this weekend?” But it’s not a casual question. It was a huge, incredible, transformative experience. Those 30 days felt like six months. My habits changed, my relationships changed, my identity changed, my personality changed — hell, the physical shape of my body changed dramatically. I went through four legal pads trying to describe what it was like. I’m still not sure I really know.

Wonderful, thought-provoking article from Aaron Swartz. Read the rest if you please.


22
Jul 09

Fake Steve Jobs on Chinese Manufacturing

Even though he might be “fake”, Fake Steve Jobs, a.k.a. Daniel Lyons, former senior editor at Forbes magazine, tells it like it is:

We all know that there’s no fucking way in the world we should have microwave ovens and refrigerators and TV sets and everything else at the prices we’re paying for them. There’s no way we get all this stuff and everything is done fair and square and everyone gets treated right. No way. And don’t be confused — what we’re talking about here is our way of life. Our standard of living. You want to “fix things in China,” well, it’s gonna cost you. Because everything you own, it’s all done on the backs of millions of poor people whose lives are so awful you can’t even begin to imagine them, people who will do anything to get a life that is a tiny bit better than the shitty one they were born into, people who get exploited and treated like shit and, in the worst of all cases, pay with their lives.

(via fakestevejobs).


11
Jul 09

The Slow, Painful, Unionized Death of GM

Quoting this in full, because it’s absolutely excellent:

GM is apparently emerging from bankruptcy. It will have the same (though fewer) managers, employees, and assembly plants. It will have the same product designers, marketers, strategists, and planners. It will have roughly the same organization systems, the same culture, and the same history. Though it was able to shed some plants and employees, it will have most of the same stifling work rules on the shop floor. It did, however, manage to shed a lot of interest payments to creditors who entrusted their money to GM in return for claims on GM assets, only to be given the shaft by the Obama administration.

The main difference in the new GM is that it will have an ownership group whose primary concerns are NOT the financial success of the company. The UAW will be primarily concerned with keeping union members employed and happy and not shifting any manufacturing to lower-cost venues. The US Government will be primarily concerned with making sure the UAW is happy and promoting a number of its own goals, like “sustainable” plants and smaller cars, irrespective of whether these goals make business sense. It will be a company more concerned with whether plants have recycling programs and workers with American passports rather than cost or quality. Both the UAW and the US government can pursue such non-business goals secure in the knowledge that financial success is virtually irrelevant, as the US taxpayer can be counted on to make up any shortfalls.

(via tjic)


07
Jul 09

The Intensity of an Intensivist

Yesterday I attended one of the best talks of the AMSA Convention so far, entitled “The Intensity of an Intensivist”. Intensivist, for those who might not be familiar with the term, being a physician working in the Intensive Care Unit of a health care centre.

The talk was given by Jeffrey Lipman from my own School of Medicine here at UQ, and I found he was a very engaging and energetic speaker.

One of the first slides he showed us in his presentation was a man with a knife with about an inch and a half wide blade, stuck through the middle of his skull from ear to ear. The amazing part wasn’t the picture itself, but that, after they decided that the best thing to do would be to just pull the knife out, the man was fine and went home the next day. Crazy!

Of course, this didn’t happen in Australia, or any first world country for that matter – the same situation here would lend itself to teems of neurosurgeons crowding around the patient, and copious amounts of radiological imaging being done before they would even attempt such a maneuver. The slide Dr. Lipman showed us was from his time working in South Africa, just outside of Johannesburg at the world’s largest hospital, Baragwanath. Baragwanath has over 2000 hospital admissions per day!

That segued into speaking to us about running the ICU at Baragwanath Hospital, and the distributive justice and resource allocation issues that he had to deal with on a daily basis. He gave us an interesting day-in-the-life-of problem, and one I assume he had to deal with often in the ICU. He talked of starting the day with 5 requests from elsewhere in the hospital for admission to the ICU. Any of these patients would certainly die without the intensive care and supervision of the ICU ward, but the problem being that he only had 3 beds available for patients that day. So from that… how do you choose which two patients will die?

All five of these patients are different ages, have different diseases, injuries, complications, lifestyles, etc., and as the doctor in charge of the ward you need to “play God”. How does one deal with limited resources, and how can we ensure that those resources are distributed as fairly as possible? He then talked about the idea of building evidence-based criteria for ranking potential ICU admissions, so as to give the best outcomes to the most patients. The guy with 5 organ system failure, on a ventilator, and 6 major surgeries in his future? Probably should rank lower on the list compared to a 5 year old male in a motor vehicle accident, two surgeries to fix shattered bones in his legs, but otherwise stable, conscious and alert, with a good prognosis.

Dr. Lipman has been practicing in Australia now since 1997, and finished up his talk by making the point that these kind of resource allocation issues will only get worse in Australia as well, although perhaps never to the same degree as what he experienced in South Africa. We as new physicians need to learn things beyond the traditional physician training, such as finance and administration, in order to know how much your resources cost, how they are being used by patients, and how best to allocate them in the future to ensure the best of patient outcomes. By resources, I mean everything that could potentially be in short supply in your practice: nursing staff, reception staff, consumables, equipment, drugs, and two of the most important ones: space, and your time!

What are your thoughts? When we inevitably face healthcare resource shortages, how best do we allocate those resources? What is the criteria we as physicians should be using to make those decisions?


07
Jul 09

Killing Time with Timekillers

My apologies to my (few) readers who subscribe to my blog through the RSS feed, as I’ve been playing around with the idea of including “timekillers” on this site, and I’ve switched back and forth a few times trying to decide how to go about it.

Timekillers is what I’m calling all the random and/or funny and/or interesting-but-not-relevant links and other tidbits that I find online… up until now I’ve been posting all of them at bandpass, but I’ve decided to integrate them into this blog to make a nice, single archive for myself in the future, and also to give them a bit more visibility, as (in my opinion, at least) lots of what I post for Timekillers is worth reading if you have the time!

So, not to dilute the posts where I actually bother to take the time and effort to write something original, I’ve decided to leave them in their own category, and not post them on the front page of the blog or in the main RSS feed. However, if you do want an RSS Timekiller feed, I’ve listed a link for that as well on the sidebar, for your convenience.

Now, I think this has all been a great diversion, but it’s back to studying for me. If you have comments and/or ideations of killing me for changing up the blog somewhat, please feel free to get a hold of me or use the handy comment form. ;)


06
Jul 09

The brilliant NFL overtime silent auction system

The Fifth Down brought to my attention a beautiful system that involves strategy, rewards the boldest head coach, does not lengthen the game, keeps the basic structure of a football game intact, and, perhaps most importantly, leaves no one with any room to whine.
Here’s how it would go. The sudden death system stays in place, and the first team to score still wins the game. If that happens on the first possession, so be it. That’s still the same.
However, we throw out the coin toss, and in its place, to determine which team gets the football first, we have a silent auction.
Each coach writes down the yard-line at which they’d be willing to accept the ball, and they put their bid in a sealed envelope. Both coaches hand the envelopes to an official at midfield, and the coach who’s written down the least advantageous yard-line gets the ball, at the yard-line he’s written down.

(via Yahoo! sports)