Thursday morning presents some unusual challenges for my family as it is the only day with an early start for Sam.
Sam is in the senior band, playing Saxophone.
Wisely he has chosen the Alto, not the Tenor.
I chose the Tenor and it’s a lot more to carry.
Especially at 11years old…
So, at 7.07am this morning and Sam hops in the shower.
He is in there for 5, 6, 8, 11 minutes.
First up, we are on tank water, so while our tank is freaking massive (80K Litres)… It still can’t cope with everyone in the family having extended showers every day.
But more than this… the clock is ticking.
He is meant to be a band by 8 am to start.
The long shower meant we left our house at 7.57am.
It's a 12-minute drive.
Now if this was an unusual event I would be ok with it.
It's every bloody week.
So on the way through I start to ask him a few questions…
Why does he think this happens every week?
What is the impact on him of showing up late?
My patient today came in and said, “I want to give up smoking”.
He was smoking 20 a day.
He said he had tried everything…
…and the only success he’d had was not smoking for two weeks—after he broke three ribs.
Presumably, the pain was quite intense and filling his lungs with smoke was beyond his capacity to tolerate.
Nonetheless, he was back to smoking and so I suggested Champix.
I suggested nicotine patches.
He said I wish giving up ciggies was as easy as giving up a pot.
He had successfully done that 9 years ago.
But the ciggies had his balls.
He said he was just going to make a decision and he would quit.
But, if it was that easy…
Why hadn’t he done that already?
I asked him…
Why is it important for you to give up smoking?
Well, Doc…. Came the answer…
“I want to see my granddaughters 21st.”
“Or at least her 18th.”
“She is 3 right now.”
There was something...
I am back into General Practice after 10 days off.
The holiday itself was GREAT.
Coming back to work has been pretty good so far.
Yes! The wonderful backlog of results, tasks, letters, and faxes.
Ah, it might be 2019, but faxes are still definitely a thing in the medical world—although at least they now come through electronically…
So, the challenge is there is a lot of data to get through today.
And the temptation is to just click through, barely reading or half focusing on it.
The difficulty is that somewhere in one of the results, and it generally does not come with a great big red flashing light, is something important.
And if I miss that one…
It potentially causes me a lot of difficulties in the future…
What I am taking from all of this is, that even though it is repetitive and there is a lot of results to review—I still must do the work well.
By doing the work well now, I avoid...
I was transiting in Auckland Airport.
It had been an ok flight…
The next to me was empty but still LAX to Auckland is a long 12 hours and we got in around 7 am.
I disembarked and walked through Auckland airport.
It’s all very done up and fancy and really quite nice.
I went to the new “Homegrown” place—they were promoting their green smoothies although most people seemed to be ordering alcohol.
Disappointingly the green smoothie I had was not up to scratch…
There was a bunch of big chunks through it, suggesting it was quite a rarity for people to order smoothies for breakfast!
In fact, the gentlemen before me were quite happy ordering champagne and beer, even though it was breakfast time.
Now it’s important because no one blinks an eyelid at the airport, yet in any other situation, people would be questioning just when they should be checking in for AA.
But as long as it’s the...
A couple of years back my sister had come over and stayed for a couple of days.
This was many years ago and I was living with my girlfriend (now wife!!) Emma and we were big into cooking.
My sister knew this and went, ok, Tom would love a new cookbook.
So as a thank you, she gave me a Gordon Ramsay cookbook.
Now the food looked amazing in the pictures.
The difficulty was that the recipes were insanely hard.
Except one… the tomato soup.
I think I could cook the tomato soup but the others…
As far as I could tell you had to be a full blown chef to take them on.
Not just the techniques required either, although generally, I had no idea what many of them actually were.
But even at the ingredient level, the recipes all had ingredients that I had never even heard of, let alone knowing where to find or get them.
So, unfortunately, this recipe book has become a very nice looking picture book of food that I will likely never be able to cook.
The thing that I take from this...
I was at a conference for the last 3 days and this conference was a demanding experience.
It was run by Wake Up Warrior, who has a rather unusual but highly effective approach to learning.
There were lots of “out of my comfort zone work” to do—speaking, sharing, creating…
The general atmosphere was a mixture of intense focus with chunks of fear and fun…
I had already been struggling due to the difficult time zone difference—Huntington Beach is 7 hours ahead of Byron Bay and even though I did get to lie down on the plane, my sleep has been limited between the flight and the jet lag.
So, late into the afternoon, I was tired and hungry.
Not ridiculously hungry, but just from the amount of focus and attention that had to go into the workshop.
Then, from the corner of my eye, I caught sight of a hand holding a chocolate bar.
Now I am not normally a chocolate bar lover, but at this time this was like mana falling from Heaven.
And it was not just an...
We were out to dinner tonight as a family, and right at the end, Emma was combing through Sam’s hair.
Our little friends are back.
Yes… the nits.
Now, we have been going pretty well so far this year as I believe this is only the second time we have had to deal with them.
As Sam is 11, we have had about 6.5 years of experience with the nits.
For some reason, he never got them at daycare, as far as I can remember.
But within 2 weeks of starting primary school… there they were.
The first ones were almost cavalier in their approach, dancing over the top of his hair as if nothing could touch them.
So, we are no strangers to the nits and we have tried a LOT of options.
Some seem to work.
Some definitely do not work.
And then we found Nyda.
That stuff is the best.
The nits just die.
It is incredibly frustrating to pay money for nit cream and have it not work.
Or even worse, to think that it has...
The RACGP has definitely been subject to widespread criticism of its 3 Fellowship exams.
Doctors who sit the exams feel they are at times unfair, irrational and more like a “Guess the Examiners Mind” than an actual exam.
The RACGP hold that the exams are validated and fair and access the competency for doctors to be recognized to be able to work independently as a GP in Australia.
Now any doctor who passes tends not to question the process.
“Ok, that was pretty fucking horrible, but I made it through. Thank God and now I can get on with the rest of my life as a GP”.
But for those that fail, what awaits them is a whole different experience.
And here is where the real problem actually lies.
For doctors that fail, they get two major pieces of feedback.
1. The exam report.
These are released after each exam and have common errors for questions.
They are definitely helpful.
So my father has early onset dementia.
Signs were probably present from around age 65.
He is now 73 and late stage.
It is a very tough disease.
People say it is not hard on the actual people with dementia.
But I do wonder if there is still some remnant of his spirit still trapped inside, deeply frustrated with his inability to have any significant cognitive function.
Then again… perhaps it is ok for him...
The world just existing solely at the moment with no capacity for recall of events and just a continual sense of wonder that he finds himself in this new location with no connecting events of how he got there.
There does seem to be some faint emotional memory of who I am.
He says “yes” when I ask him if he knows who I am, but that is all he can answer.
I don’t know if he really does know me, his eldest son, or whether he just says yes to most things these days.
Perhaps I am just...
Basically, all of the patients are on long term S8 medications.
NSW has requirements for any patient who is on S8 regularly for more than 2 months to have approval from the Pharmaceutical Regulatory Unit.
Part of the application is that the patients are reviewed by a pain specialist.
The interesting thing is that opiates are clearly out of favour for long term pain management as the pain specialists are continually recommending to reduce to zero.
This is great of course in theory.
The only problem is, what to treat their chronic pain with?
Most often I am asked when will Medical Marijuana be available.
I say go head up to the Gold Coast… there are clinics up there.
What about you? Why won’t you prescribe?
My answer… we already have enough problems with chronic pain and opiates…
I have ZERO interest in prescribing marijuana unless it is recreationally legal.
Up until that point… Its just not worth the hassle.
There are already enough challenges in GP...