Of maps...

So, on a lazy Saturday morning, I begin an impromtu jouney of maps on the web, it all started with an alternative simplified map of London, then on to the blonde map of Europe, followed by if the world was a tube map (also with explanation) - which could lead to some rather delightful train journeys. Subsequently, I spotted if Australia was the land of the Ring, then checked out the United Pumpkins of America, followed by a map of the WWW.
Geographical fun, from 1869, had various European countries outlining their national stereotypes of the time accompanied by a little poetry.
A political depiction of 1937 .
Synthetica - new world map of new materials (1940)
And finally, a very charming face map

the museums of London

While I knew London was a city of many museums and art galleries, I didn't realise there were 264 of them dotted around the city.
Which leaves Londoners with even less reason to get bored in their home town.

real food

there was a comic here, but it was an incorrect link, which i only realised 2 months after sticking it up. I've forgotton how to delete posts (ha!) so unfortunately this post of nothingness is posted upon the web for hapless passers by to wonder why on Earth they are reading it.

the other posts are far more interesting. really.

newly qualified docs

tongue-in-cheek take on the working conditions of a newly qualified doctor
with more than a few grains of truth.

citroen 2cv

For those in the know, a beautiful car, of classic design, with the perfect balance of curves and angles, and generally lovely.
and for those who don't - a little wikepedia explanation.

new version, probably set to come out in 2009/2010.

I don't think I like it. I feel so disappointed.

Iraq win the Asian cup!

Iraq ride wave of support to lift Asian Cup

Something from Mother Teresa...

People are often unreasonable, illogical, and self-centered;
Forgive them anyway.

If you are kind, people may Accuse you of selfish, ulterior motives;
Be kind anyway.

If you are successful, you will win some false friends and some true enemies;
Succeed anyway.

If you are honest and frank, people may cheat you;
Be honest and frank anyway.

What you spend years building, someone could destroy overnight;
Build anyway.

If you find serenity and happiness, they may be jealous;
Be happy anyway.

The good you do today, people will often forget tomorrow;
Do good anyway.

Give the world the best you have, and it may never be enough;
Give the world the best you've got anyway.

You see, in the final end,
it is between you and God;
It was never between you and them anyway.

Take your head for a spin...

A passage of medical acronyms - hits the nail on the head.

I think I've just found my favourite new website

digsmagazine - 'a home + living guide for the post-college, pre-parenthood, quasi-adult generation'.
Quite a few handy tips.

Just found something that brings back good memories

Intro to the Charlie Brown and Snoopy show
snoopy and woodstock dancing
It's a mystery, Charlie Brown

Sesame street!

Kermit and the African Alphabet

Subway!

Kermit - put the lime in the coconut!

Never smile at a crocodile=

News flash!
Wolf chases little red riding hood!

Cookie monster..
... in the bakery
then the library

From How Now and the Moo Wave...
The wet paint song
Danger's No Stranger

and from the Surfin' Monsters
Love the Ocean - yeah dude!! be excellent and do what it says!


Not forgetting Little Jerry and the Monotones
Telephone rock!
Mad - yeah we're angry, very very angry

Boo Hoo, Wah Wah, Sob Sob - Big kids cry

Dr Thad and the medications with...
The 10 commandments of health - succinct, accurate, and fun!!

orange singing carmen

Computer cookie song - things really have changed...

Manamana

Sad

Team of doctors, technicians and pilots die as plane crashes - they had been transporting a dontated organ for transplant.

this should be everywhere

rolling on water in a ball

A good philosophy...

Mutts

my problem exactly..

Sherman's lagoon

on clouds and free running

the rolling carpet cloud=

the sine wave cloud

Don't ask me about the technical details. They just look funky. Who ever thought cloud watching could be this much fun!

some more parkour, 'cos it's cool.
all very artistic

I want to make some dandelion root coffee!!!

It sounds like fun, and with a potentially tasty result.
But I don't know anywhere nearby where I can get some dandelions which a dog hasn't used as a toilet.
Blah.
But if, one day, in the future, I happen upon a place with plenty of fresh (unlikely-to-be-peed-upon) dandelions, I shall be able to refer to these instructions.
mmmm...

oh, and a dandelion profile from the early 1900's for the interested.

i'm not a fan of northern lights, but...

as inspired by cal of Short White Coats.

no such thing as a free lunch

Drug reps in hospitals offer free lunch's, cheap pens and goodies to doctors in hospitals. They usually appear once or twice a week. Something about this form of advertising just doesn't sit quite right with me. I haven't really thought deeply enough about the subject to come out with an eloquent answer when asked why I don't touch the food provided by the drug reps during some 'grand rounds'. I should, and I imagine I probably will at some point. I understand why drugs are advertised, but I also think that medical practice and treatment should be guided purely by what is the best treatment for the patient, and not necessarily guided by advertisement of the latest drugs. I think, as humans, whether we realise it or not, are affected by gifts. Someone does you a good turn/gives you something, you can't help but a feel indebted. I just feel that feeling is badly placed when it comes to commercially orientated companies.
The 'no free lunch' position is explained in these websites: (US version and UK version) better than I ever could.

For good evidence:
UK - drugs and therapeutics bulletin
Canada = therapeutics initiative
US - The medical letter

I confirmed a death for the first time today...

I've been avoiding this for so long. It's strange how a person can become so still, how their eyes have this vague opaque haze, how that unusual silence on the other end of the stethoscope means you hear your own breath and wonder momentarily if it's their's, how the quiet pulsations of your own fingertips transmit up and make you wonder if their heart is actually still beating. Disconcerting. I wanted to run away. I didn't. I came away thinking of kids in war zones and famines. I hit google looking for solace and guidance. I found an article in the BMJ.
I don't want to do it again. But I know I will. I know I will eventually get used to it. I don't know whether that's a good thing.
And so life continues...

Poem: I AM A GIRL OF THE 21st CENTURY

During the storm I create Peace in my soul
I close my eyes until the storm is over
Like an eagle I try each day in my life
To reach where my heart is.
Hope that I have inside, to give me
Strength to be what I want to be
I let no one harm my soul
I always focus on my future.
During the night I dream about freedom
During the day I build happiness in my soul
Each day I shape my life.
Trying my very best to do only the right thing.
I am born to be bold and brave
To have faith in everything I do
To help those who are being criticised everyday
To renew hope in their lives.
Even if it may seem to dark
My heart will lead me to a place of Peace.
I am living for tomorrow.
Not for today
Only because
I am a girl of the 21st century

Zandile Sylvia Mazibuko

Impressive...

Man scales world's highest peaks... without colon.

For a warm and fuzzy feeling...

The Toronto Star (Toronto's paper) has a section called Acts of Kindness - where people send in nice things other people - often random strangers - have done.
Would be nice if every paper did that...

on matters of resusitation

chest compressions alone appear to be more effective than chest compression and rescue breaths resusitation.

MMC resignations...

It's not just the students going through the process who are unhappy with the system - so are the people who set it up and were contributing to running it.
Resignations seem to be propping up left, right and centre. To be fair, those resigning are the ones who were probably doing their best to improve a system. Just a shame it didn't work out.
The latest is from one of the student representatives - his letters are a good read and summary of the situation:

letter of resignation, as sent to Professor Crockard 18/03/07.

Dear Alan,

I am sorry to inform you at what must be an impossibly busy time that I wish to resign from my position as medical student advisor.
When I took the position I had many reservations with the MMC systems but believed that I would be able to help students get the best deal from these changes. Seven months on, I retain these reservations and regret that I have not been able to have the impact I had imagined.Now as then (when I presented you with a petition signed by 1300 students), I believe:

• The nature of the new application system effectively randomises medical students to jobs across the country
• The importance of academic achievement has been downgraded
• The importance of other achievements at medical school has been nullified by the nebulous nature of questions and the lack of a CV
• Two years is not long enough to decide on one’s specialty, to gain a broad enough range of experience, to become a good enough doctor: pressure is on to decide early, but the random nature of the application leaves no scope for strategising or planning ahead
• Morale at medical schools is low; they are not the aspirational, centres of excellence they should be, rather ‘centres of competence’
• This anxiety has filtered down to those students considering applying for a place at medical school

Through contact with a wide range of students over the last seven months, I know that these views are widely held. Just two nights ago, I talked to a Bristol student representing a group of 40 who echoed my above sentiments. I have, however, come to realise that continuing to transmit such views to the MMC team can have no effect as it is focused on the successful implementation of a system rather than the guiding principles and details of that system.
In my limited experience, the role of student advisor is not used, as MMC aspires, to ‘encourage dialogue with the stakeholders’. Instead the role seems to be a token attempt to suggest the involvement of students in MMC strategy; a publicity vehicle to lend validity to a system that has not, in fact, considered student opinion and insight at all.When I was asked recently to find some students / SHOs who were happy with the new system to help build some positive press, I knew this role was not for me. I am not interested in spin or image, in making something seem other than it is. I am interested – perhaps naively - in getting the popular voice heard and acted upon and in standing by my own personal, political and professional principles. I now realise that in order to do this effectively, I need to be working within a different framework.
I would like to thank you for giving me the opportunity to fill the role and personally wish you all the very best for the future. I can honestly say that I have enjoyed meeting you and having the chance to work with you and the team as a whole.

Yours Sincerely,
Alex


letter as sent to the CMO 31/03/07:

Dear Professor Sir Liam Donaldson,

I recently resigned as medical student advisor to MMC.
Despite claims from the health minister that the new Foundation Programme has ‘widely been acknowledged as a success’ there are, and always have been, huge misgivings about it at student, junior doctor and all other levels. I hoped that access to the MMC team would give me an opportunity to make these views heard. I was wrong. Although you continually tell us that you are ‘working with the profession’ you are not, at any level, listening to it. This is why I resigned: please find enclosed my letter of resignation to Professor Alan Crockard.

From a grassroots level upwards, your recruitment of those from the profession has been tokenistic at best. My role was little more than a publicity stunt. You want to be seen to be involving us but care little for the reality of what we actually have to say.Even at the highest levels you have been seen to charge professionals with responsibility but withhold authority.It is not my job to outline the infinite professional, personal and philosophical problems that blight your new systems – the 12,000 junior doctors who recently marched through London could do this more eloquently than I could ever hope to – but it is my job to expose the growing chasm between yourself and the profession.
Your agenda does not meet with the approval of the profession. You must acknowledge this. It is not acceptable for you to enlist members of the profession from all levels and to then ignore them. It is not acceptable to use your implementation team – MMC – as a vehicle for spin, as a way to convince the profession that things are other than they are. It is not acceptable for you to hide behind the responsibility you have dispensed to MMC and at the same time maintain your authority so you can push through your own agenda.
And yet, this is what you are doing. No matter what the profession says, no matter how vociferously it protests, no matter what damage is done to families up and down the country, this is what you will continue to do. How kind of Lord Hunt – at a time when faith in your systems is at its nadir - to illustrate the DoH’s utter contempt for the profession, by saying “I would like to reconfirm our commitment to MMC which aims to recruit and train the best doctors to provide the best possible patient care.”
This is your project. Everyone else – from MMC to MTAS, from the royal colleges to PMETB, from the advisors to the spin doctors – are merely your implementation tools. Ultimate authority rests with you. It is now time for you to take responsibility. If you continue to force through these reforms, I want you to know that it is obvious - even from a medical student level - that you are a million miles away from being the ‘bridge between the profession and the government’ that you claim: you could not be acting more undemocratically if you tried.
If you find this image unappealing, your options are clear: take heed of the groundswell against you and your agenda and cede your authority back to the profession. If this is also unpalatable to you, then you must resign.

Yours Sincerely,

Alex Liakos


(picked up from the lost doctor)
more news on mmc

Poem: SONG OF THE GALLEY-SLAVES

We pulled for you when the wind was against us and the sails were low.
Will you never let us go?
We ate bread and onions when you took towns, or ran aboard
quickly when you were beaten back by the foe.
The Captians walked up and down the deck in fair weather
singing songs, but we were below.
We fainted with our chins on the oars and you did not see
that we were idle, for we still swung to and fro.
Will you never let us go?
The salt made the oar-handles like shark-skin; our knees
were cut to the bone with salt-cracks; our hair was stuck
to our foreheads; and lips were cut to the gums, and
you whipped us because we would not row.
Will you never let us go?
But, in a little time, we shall run out of the port-holes as
the water runs along the oar-blade, and though you tell the
others to row after us you will never catch us till you
catch the oar-thresh and tie up the winds in the belly of the said. Aho!
Will you never let us go?

Rudyard Kipling

modern slavery

not comfortable reading

It's been 4 years now...

and these are some (probably very conservative) figures of what has happened over the past 4 years in Iraq.

Somewhere in the Golan heights...

a Bride can never go back home, courtesy of politics.

Poem: I love me mudder

I love me mudder and me mudder love me
we come so far from over de sea
we heard dat de streets were paved with gold
sometime it hot sometime it cold,

I love me mudder and me mudder love me
we try fe live in harmony
you might know her as Valerie
but to me she is my mummy.

She shouts at me daddy so loud some time
she stays fit and she don’t drink wine
she always do the best she can
she work damn hard down ina England,

She’s always singing some kind of song
she have big muscles an she very very strong.
she likes pussy cats an she love cashew nuts
she don’t bother with no ifs and buts.

I love me mudder and me mudder love me
we come so far from over de sea
we heard dat de streets were paved with gold
sometime it hot sometime it cold,

I love her and she love me too
and dis is a love I know is true
my family unit extends to you
loving each other is the ting to do

Benjamin Zephaniah

World health check up

Poem: the caged bird in springtime

What can it be,
This curious anxiety?
It is as if I wanted
To fly away from here.
But how absurd!
I have never flown in my life,
And I do not know
What flying means, though I have heard,
Of course, something about it.
Why do I peck the wires of this little cage?
It is the only nest I have ever known.
But I want to build my own,
High in the secret branches of the air.
I cannot quite remember how
It is done, but I know
That what I want to do
Cannot be done here.
I have all I need –
Seed and water, air and light.
Why then, do I weep with anguish,
And beat my head and my wings
Against those sharp wires, while the children
Smile at each other, saying: “Hark how he sings”?

James Kirkup

Poem: War

Cigarette smoking is dangerous
not a good habit at all
climbing unknown walls is hazardous
because the wall might fall.
If you walk down the street be the walk quite brisk
you and I know you’re taking a risk.
And if de same time you feel your belly start to swell
chances are you eat too well.
One could dream about a life of peace
one can try to bring peace to the beast.
Everybody seeking some utopia
what we need is the will to come over.
War is a danger to your health
don’t care if you have much wealth.
War is a dangerous ting,
even if you’re not partaking.

Workin’ on a building site is cruel
you take a risk if you ride on a mule
if you walk on the left and you see one fight
the best ting to do is walk on the right.
Racin’ driving is a serious business.
Be careful of your liver if you drink too much Guinness
and if you live on LSD
blame nobody if your mind don’t free
all we hear is war, more war
I and I know that can’t get far
just because dem live in the West
dat don’t mean dey is de best.

War is badder dan cigarettes
war is worse dan racin’ driving
remember dis and don’t forget
World War Three means no surviving.
Unity is a strong foundation
love is better than fear
what we need now is good relations
as politicians don’t care.
So I talk to the young and old
come take a peaceful stroll
don’t care if you have much wealth
war is a danger to your health.
War is a dangerous ting,
even if you’re not partaking
just smoking
not partaking.

Benjamin Zephaniah

International journal of epidemiology

Published in The Dread Affair. Arrow Books 1985.

Poem: You wake up in the morning

You wake up in the morning, and lo! Your purse is magically filled
with twenty-four hours of the magic tissue of the universe of your life.
No one can take it from you. No one receives either more or less
than you receive. Waste your infinitely precious commodity as much as you will, and the supply will never be withheld from you.
Moreover, you cannot draw on the future. Impossible to get into debt.
You can only waste the passing moment. You cannot waste
tomorrow; it is kept for you.

Arnold Bennett

a charming new animation

shaun the sheep. Makes me want to be a kid again, just so that I can rush home from school to watch this gem.
But no. I'm grown up now. And come home late. Blah.

CBBC behind the scenes

MTAS and West Midlands deanery pulling out of the system

Picked up from howithappened.com - the formal statement:

"The ST3 Interview Panel for General Surgery in the West Midlands have unanimously come to the conclusion that the MTAS procedure for recruitment to ST3 in General Surgery, has not been implemented according to agreed guidelines.

We have therefore declined to continue with the interviews today.We have come to this conclusion after considerable debate. We feel that this is the right course of action, which has at its heart the best interests of surgical trainees, training and our patients.

A serious procedural flaw, which came to light this morning, has been the complete lack of a longlisting process prior to selecting candidates for interview. This alone is sufficient grounds for postponement or cancellation and makes the entire recruitment process open to criticism and challenge.

Our meeting at 8.00 am today was the first available reasonable opportunity for the panel members to meet, discuss the process and air their concerns and reservations. With the limited information available today on-site, the longlisting process could not be completed satisfactorily. In addition we feel that the recruitment process for ST3 in its current format is in contradiction to equal opportunities legislation and NHS best practice guidelines.

We have in addition, wider concerns about the current MTAS process as follows,

As far as we are aware, the shortlisting application form has not been validated or demonstrated to be suitable for appointments to ST3 in General surgery which in effect is a pre-consultant appointment.

The application form domains available to the shortlisters and its accompanying scoring system have not been shown to select candidates best suited to be surgeons. It fails to distinguish adequately between candidates, giving credibility to creative writing skills rather than hard evidence of competency.

The time-scale imposed nationally has ensured that the whole process has been rushed. The unrealistic deadlines and sheer number of applications caused the MTAS computer system to crash. Changes in process have been implemented in order to meet deadlines. The marking system for shortlisting has been inconsistent throughout the country with forms being marked by a varying combination of members of the medical profession and lay people. There has been a lack of cross validation between markers and different marking methods (horizontal and vertical) have been used in different deaneries. Therefore there has been no standardisation or quality control.

The staff in the West Midlands deanery have worked tirelessly without adequate resources in place to try to meet the deadlines set. This has meant working holidays and weekends repeatedly entering marks onto an unreliable MTAS Website. They have finally provided a shortlist of candidates for ST3 in General surgery on the Friday evening prior to the Monday morning interviews. In all, the deanery has received 11500 applications, well in excess of the projected 8000.

We owe it to our patients and the profession that we are able to select and appoint the best candidates to surgical training posts and felt strongly that this was impossible today.

We have agreed to return to help re-shortlist and interview once the entire process has been proved to be reliable, robust, reproducible and has been validated and agreed upon nationally.

Above all we have carefully considered the plight of the candidates outside today, waiting to be interviewed. We have stayed and spoken to all the candidates about our decision with honesty, openness and integrity. We have been at pains to assure them of our best intentions towards trainees and surgical training as a whole. We share their concerns and the concerns of the hundreds of other young doctors who haven’t been shortlisted for any job. We share their anxieties at a system, which is being described and unjust and unfair. We have been overwhelmed by their positive responses to our action and are humbled by their words of support. We have provided support for all the candidates with the offer of contact email and telephone numbers if they require any further assistance."

BNP stockpiling explosives

http://uk.news.yahoo.com/13022007/344/bnp-candidate-stockpiled-explosives.html

the joys of MTAS

There are alot of very unhappy doctors about at the moment, angry with an application process that doesn't look at academic/clinical ability to any significant degree - but concentrates on the ability to waffle one's way through a series of questions, with a limited number of words. On top of that, certain specialities have set job interviews in different regions of the country, at the same time, and refusing to shift them when interviewees inform them of the clash. 'If you're not committed enough to come to an interview, we don't want you'.
All very reassuring. hrmph.

I am not generally a reader of the telegraph, but here's their story.
a doctor dealing with the system.

the questions for the final year application form for first job (points in brackets). 150 words each. The questions themselves at first glance don't seem so bad. But attempting to answer them was a nightmare. There was also no mark sheet, so you didn't know what was wanted. And the total result was given - not a breakdown - so you can't figure out where you went right, or wrong. Slightly frustrating to say the least.

1 - Give an example of a non-academic achievement explaining both the significance to you and the relevance to foundation training. (6)

2 - List your academic achievements (4)

3 - Describe an example (not necessarily clinical) of a time when you had to deal with pressure OR overcome a setback/challenge. What did you do and what was the outcome? (6)

4 - Describe an example from your clinical experience where your behaviour enhanced the experience of the patient as the central focus of care. What did you do and what was the outcome? (6)

5 - Describe an example from your own experience (either clinical or non clinical) that has increased your understanding of the importance of team working. What was your role and contribution to the team? (6)

6 - Describe an example of how your organisation and planning skills have contributed to a significant personal achievement in the last five years. What did you learn from this which is relevant to foundation training?

6 - Describe an example of a situation where you had to demonstrate your professionalism and/or integrity. What did you do and what was the outcome?

Anyhoo, better get on with some work.

lunar eclipse

including a story of an excited 8 year old in London
Eastern Canada - with pic
another...
and one more

and I'm off to take some photographs...

The autumn windows scene

seen on many a computer - turns out it's a lane in Burlington, Canada. A town not far from Toronto.

a medical case...

A Previously Healthy Woman with Sepsis

One year of blogging!

Woohoo!

30 days as a Muslim

That documentary by Morgan Spurlock, a really good watch.

Quoth the server, "404!"

This was a little bizarre... Pressed a link, and instead of the usual '404 error, page not found' type of thing staring at me, I get this instead:

'It is said, "To err is human,
"To quote from alt.times.lore,
Alas, you've made an error,
So I must say, "404."

Double-check your URL,
As we all have heard before.
You wanted a file that wasn't there
And I respond, "404."

You may have made a typo--
Your fingers may be sore.
But 'til you get the location right,
You'll just get 404.

Maybe you followed a bad link,
Surfing some foreign shore;
You'll just have to tell that author
About this 404.

I'm just a lowly server
(that speaks in metaphor),
So for a request that I don't know,
I return 404.

Be glad I'm not a mainframe
That might just dump its core,
'Cause then you'd get a ten-meg file
Instead of 404.

I really would like to help you,
But I don't know what you're looking for,
And since I don't know what you want,
I give you 404.

Remember Poe, insane with longing
For his tragically lost Lenore.
Instead, you quest for files.
Quoth the server, "404!"

With apologies to Edgar Allen Poe '

A nice change methinks. Don't know the author...

Pachelbel Rant

comedian/musician Rob Paravonian rants away. tee hee.

Poem: Jabberwocky

(an odd one, i know)

`Twas brillig, and the slithy toves
Did gyre and gimble in the wabe:
All mimsy were the borogoves,
And the mome raths outgrabe.

"Beware the Jabberwock, my son!
The jaws that bite, the claws that catch!
Beware the Jubjub bird, and shun
The frumious Bandersnatch!"


He took his vorpal sword in hand:
Long time the manxome foe he sought --
So rested he by the Tumtum tree,
And stood awhile in thought.

And, as in uffish thought he stood,
The Jabberwock, with eyes of flame,
Came whiffling through the tulgey wood,
And burbled as it came!

One, two! One, two! And through and through
The vorpal blade went snicker-snack!
He left it dead, and with its head
He went galumphing back.

"And, has thou slain the Jabberwock?
Come to my arms, my beamish boy!
O frabjous day! Callooh! Callay!'
He chortled in his joy.

`Twas brillig, and the slithy toves
Did gyre and gimble in the wabe;
All mimsy were the borogoves,
And the mome raths outgrabe.

Lewis Carroll


and a jokey version:

Chemowocky

'Twas Boron, and the Silicon
Did Carbon in the Cadmium;
All Merc'ry were the Lanthanides
And the Molybdenum.

"Beware the Hydrogen, my son!
The teeth that bite! The chops that chum!
Beware the Bismuth bird,
and shunThe dread Beryllium!"

He Gold his Cobalt blade in hand,
Long time the Fluorine foe he Zinc,
Till rested he by a Krypton tree
And Strontiumed to think.

And as in Argon thought he stood,
The Hydrogen, with Iodine,
Came Radon through the Tungsten wood
And Sulfured Astatine!

One two! one two! and through and through
The Cobalt blade went Scandium!
He left it dead, and with its Lead
He went Gallium back.

"And hast thou slain the Hydrogen?
Come to my arms, Antimony!
O Copper morn! Neon! Xenon!"
He Nickeled in his glee.

'Twas Boron, and the Silicon
Did Carbon in the Cadmium;
All Merc'ry were the Lanthanides
And the Molybdenum.

Mark Stewart

How to be Scottish

Apparantly, it'll do wonders for your career.

some good ideas for secondary education from the government

For once - I agree! - if you read down, there is a suggestion that the British slave trade is taught to 11-14 year olds. History is something so important to know - and the best history is stuff that's relevant.

good quote...

The book you don't read won't help.
~ Jim Rohn

Operation healthcare

a brief insight into the US healthcare system

 Saturday, 27 January 2007, 12:03 GMT 

Caring for America's health

By Justin Webb  BBC, Washington Senator Barack Obama, an early frontrunner in the 2008 presidential race, advocates something the US has never had - universal health care, but just how bad a state is America's health care service really in? Senator Barack Obama believes health care is a right for everyone It was the summer of 1981. Mrs Thatcher was only two years into her first term and Ronald Reagan only months into his. I was starting out as well. Writing stories for the Beaver newspaper at the London School of Economics (LSE) about students throwing eggs at government ministers and the iniquities of low-cost coach travel to Greece. I had arrived in London from a boarding school in the West Country and a black and white world had suddenly burst into colour. My room mate in our hall of residence was a cheerful American with lively eyes and a vague resemblance to Bruce Springstein (a resemblance of which he was enormously proud). Bo Nora was exotic. My friends at school had been called Patrick or Adrian, and mostly hailed from Somerset. Bo came from Chicago and studied at the University of California. He was at the LSE for only a few months. Parting company Bo and I never felt the slightest bit mortal. I remember us listening to a programme on the local London radio station where people with emotional problems would call in for counselling. We laughed. We had no problems. I said goodbye to Bo on Great Portland Street tube station and we stayed in touch for a few years. And then life took over and Bo Nora became a memory. I moved to Northern Ireland, back to London, to Brussels and here to the US. Insured but unwanted A few months ago, 25 years after that central London goodbye, I tracked Bo down. I found his e-mail address and sent him a message. His reply talked of marriage and career and children and then came these words: "After several years of increasing physical difficulties, I saw a doctor in 1991 and was diagnosed with multiple sclerosis. I retired due to further disability and incapacity. Presently, I am spastic quadriplegic."  Bo is expensive and the insurers do not want him... and they make it obvious  I went to see Bo the other day in his home on the outskirts of Chicago. We had supper. Bo's eyes flashing with recognition as we talked about London and university and people we had known. His wife fed him. Bo is not a bitter person - funny how happiness is wired into some people whatever life brings - but one subject genuinely pained him. Bo has health insurance, I presume provided by the law firm he worked for when he was diagnosed. This is good news for Bo - bad news for the insurance company. Bo is expensive and the insurers do not want him... and they make it obvious. 'Cut no slack' Every year Bo gets a letter asking him if he is still ill.  The story of American healthcare is one of huge expenditure for little obvious benefit  Someone has to fill in a form for him: "Yes, I am quadriplegic; no, no miracle appears to have happened." He told me recently he had to have a minor procedure associated with the condition. The bill was $78,000 (£40,000). In the end he paid only a small part of it himself but of the various entities that chipped in - the state, the insurer, the hospital - you can bet that no-one wanted to, and everyone would have got out of it if they could. Americans who fall ill are cut no slack. A society which expects everyone to pay their way, expects it of them as well. As a jolly man selling life insurance pointed out to me the other day, most personal bankruptcies in the US are the result of illness. Endless letters The story of American healthcare is one of huge expenditure for little obvious benefit. By head of population America spends twice the amount Britain does on health. But life expectancy here is lower and infant mortality is higher, way higher in some ethnic groups. Most of the money seems to go on overheads and on profits for the many private companies providing care, the hospital groups, the drug manufacturers, and above all the insurance companies which write letters to Bo inquiring about his MS and write incessantly to all their other customers as well, endlessly negotiating, fussing, harassing. As the costs spiral upwards and private employers ditch their health care schemes to stave off bankruptcy, increasing numbers of Americans have reduced their health insurance to the barest minimum, and when something goes wrong they are dependent on the back-up provided by the state. So in a nation where socialised medicine is a phrase to be spat out contemptuously, Americans are on course by the year 2050 to spend every cent the government takes in tax, on health-related claims. Nothing left even for the tiniest war. For the time being, Bo Nora will go on getting his annual letter but all of America is cottoning on to what Bo has known for years: there must be a better way of looking after sick Americans. If Iraq is eventually resolved, the issue waiting next in line for the president, or more likely for his successors, is restoring health to American health care. From Our Own Correspondent was broadcast on Saturday, 27 January, 2007 at 1130 GMT on BBC Radio 4. Please check the programme schedules for World Service transmission times.

a refreshing med blog

While I blog things I find interesting on my internet trails, I tend to avoid blogging medical matters, or day to day stuff. It's a difficult area to blog well - I always get paranoid about betraying patient confidentiality or something, so avoid the area completely.
Having said this, some people do a brilliant job - like this London medical student:

arachnodactyly

in a tizz

A world in one city

London! Woohoo!
A Guardian newspaper special

London by religion

London by ethnicity

(and Toronto data for comparison)

and totally unrelated:
baby names in 2006 , office of national statistics, and other data

elective memories - eh?

you may have surmised from the title i spent my elective in Canada. and i miss it. a lot.
today i found the coolest site - pictures of Toronto by street in the virtual city.

makes taking a trip down memory ever so much clearer.
thank you virtual city!!!

i googled 'bored medical student'...

(as you do) and found the following:

surprisingly topical article written in 1905 about the state of the new breed of medical student

some very academic letters about how medical students learn - the highlight being: 'Assessing the quality of repeated theatre experience is difficult. We suspect that surface learners are uninterested the first time they see an operation, bored the second time, and do not turn up the third; that deep learners compare and contrast first with second and second with third, and that strategic learners ask what is going on in the theatre next door. That, however, is speculation; it is time someone measured these things properly.' (yup, that was the highlight)

medical students and their career preferences - with the enlightening statement (with regard to choices): 'Students differed from college students, the women differed from the men, and the Asian Americans differed from the other groups. ' .
would never have guessed.

Dylan Wilson , a medical student back in 1999, recommends medical students have experience as an inpatient. He relates his experiences...

So, this is medical school . I read this a few years ago, was quite nice to find it again. (Liam Farrell, GP, relating experiences, and giving advice).

on a different note...

jay-walking - don't even think about it!
a tram in San Francisco in the early 20th century (1905)
what happened to a bunch of people who only ate fresh fruit and veg for 12 days
in pursuit of happiness - not the movie, but what ppl want from a job

a truely brilliant idea...

women only theatre

in places where the staff exist - a bit of reorganisation could do so much for patient comfort and ease. i only hope people see it for the logical idea that it is.

i googled 'last page of the internet'...

... and found more than 1... (606,000,000 to be precise, mmmm)

1
2
somewhat snazzy no. 3
the relief of 4
ta DAA (and a fanfare!! of numero 5)
claiming to be the one true end... no.6
awesome! at no. 7
and even wikipedia has a say on this matter... being very matter of fact 'Strictly speaking, such pages would be the first or last page of the World Wide Web, not the Internet.'

clearly, i have reached a state beyond even ordinary boredom. eugh.

stuff you could try out when it gets *really* cold...

pot of boiling water thrown at -45F

... and from a tall building=

shooting at super-soaker at -45F

never gets that cold round here...

scorpions and cigarettes...

scorpion on a plane

NICOGEL - cigarettes in a hand gel