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...
So last night we had some friends come over.
They own a pub so they often bring exotic or unusual beers.
I have been working on drinking minimally for the last couple of months.
We had people over Saturday night and I had 5 Peroni leggera.
I felt average for most of Sunday morning and recovered after planting about 12 trees on my property with my wife.
This was definitely a good outcome and significantly reduced the number of unplanted trees on the property…
And landscaping is HARD work.
I was sweating a lot!
Anyway, later that afternoon our friends came over.
They had helped out with loaning me a spare car when my starter motor blew up and I didn’t have a car for 3 days.
I had two of these special IPA type beers.
Then I had 4 red wine glasses.
The impact of this decision was fine last night.
The drinks tasted pretty good.
The buzz was fun.
Then the consequences kicked in.