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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by alexandra_k on November 19, 2016, at 19:53:15
I went for a walk, today.
The roads are a lot worse than I appreciated. Or maybe I'm looking at them with different eyes, now... They are very steeply hilly and often sloped high in the middle. Lots of patches worn smooth... Lots of ill-positioned manhole covers, and the like. Also... Road cones. Cardboard boxes. Like... WTF?? It almost looks like people go around strategically placing hazards...
There was this case in the papers recently about someone who got caught taking videos of people showering naked in a public shower (e.g., gym). There was this sign up in the gym 'will you be next?' It sounded... Like they were issuing a challenge... Or warning people not to get caught... There are signs up in hospital car-parks: Have you set a trap today? Traps aren't just about you' (then pictures of hazard stuff). It looks like they are reminding people to set traps for others...
We are at the stage of pretty women driving tanks. A lot of new construction around the harbour. A lot of new 'science building' infrastructure across multiple blocks... Auckland had a gully ring to contain the harbour / city centre. We've got a river ring, here to contain the harbour / student ghetto. The lighting has just gone up (tall poles easy to tack a fence to) and the solid roads that could see a tank very swiftly patrolling the perimeter...
I think I feel a bit safer here because... Things are a bit behind... And because also... I'm on the other side of the fence, here.
It is a lot harder to get out further up and away than I thought, though. The next ring of barrier, perhaps. You have to get up and through the greenbelts with the strategically placed hazards... Keep thinking about what kind of natural disaster might take out the roads... What kind of earth shake would make the roads impassable. I think with that greenbelt it might be more about getting people back in...
It wouldn't surprise me at all if the new infrastructure is about building a... Bunker... Containment facility... Fallout shelter... Something like that... Blocks of it underground... Auckland's new health building had that feel to it... Only 2 entry / exit points... A huge concrete containment facility... Construction has just started on that here...
It's made me determined to get my licence. Because it will take a few years to be competent, most probably. I guess I think that I will get the best safety gear I can (skid time rated) and a fluorescent vest... I mean, nothing says 'I'm not trying to be cool or renegade just please don't f*ck*ng hit me' like a fluorescent yellow vest... Then apparently you plan your routes... Figure them all out beforehand and identify the hazards and so on. And then stick to the roads you know.
Not carefree the way I had supposed.
I'm trying to find housing... It is hard... Apparently you just need to keep your eyes open and see them because they come up and then go away again fairly continuously...
Everything is really very mixed... You really need to go view...
It is hard because it feels to me like anything nice is priced out of my range. Because you will always get 2 or 3 or 4 international students who will pack themselves into that same space. I guess in my case it really is about viewing the property... Probably owner managed rather than through a letting agency... And they like me and want me to take it... Without their wanting to be all up in my business...
What are the chances? Really?
There is a smell... I think it is pheromones... Some kind of scent marking... Some guys give off creepy smells... There are usually places like that... You can smell it as you walk past... Most flat blocks have at least one... At least one adjacent to every public park or school. Or something like a shared washing line area so people can steal your underwear and / or otherwise take your washing and hold it ransom because 'they thought it might rain' and now you owe them... 'Being friendly' it's called... It's just... Awful...
I walked past some houses... Large perimeter fences and, in some instances, garages right up to the perimeter. Or (nicer) metal pole barbed pickets around shady trees and greenery...
I remember when I was staying with my friends in Wellington... How one of them would say that she needed to insist that I eat with them every night, or whatever, because 'Otherwise we'd never see you'. Apparently that is justification for not giving someone their independence...
Whatever happened to 'if you love something set it free...'? People can't love me if they want to control me because they would know that what is most lovable about me is only there because I am free to... Do what it is that I need. Most people don't love me... I know that. Most people aren't capable of loving other people... I don't know that I am either, truth be told. That's partly why I don't want to have a kid. I don't think I'd be capable of loving it the way it needs to flourish... I most certainly can't afford things it needs since I can't afford things I need...
I'm worried they will relegate me to the ranks of fanboy, here. Because there are people who are more interested in being fanboys than anything else. Whether it be fanboy musicians (groupies) or fanboy academics or fanboy medical doctors. Often allied health... But perhaps sometimes not... I think I want to stop going to public health seminars... Here, anyway... They really are just awful... Exercises in... What? Keeping the fanboys happy since they are public seminars? I don't know... I don't understand them...
Someone said to me... Do you know why the junior docs (for example) don't complain more and get them to change this and that stupid policy (e.g., one wasting both time and money)? Answer: Because they just replace this and that stupid policy with this and that other equally stupid policy - or perhaps with an even stupider one that additionally requires a bunch more paperwork / some retraining. Anyone with any brains learns to keep their mouth shut...
It's pretty frightening, actually. That.
Apparently there is this totally brand new notion of 'collaborative care' that involves doctors actually working together with patients for health.
It's totally unrelated to the notion of informed consent that came out of the legal trials held in response to the experiments and treatments conducted by Nazi medical doctors and scientists.
The notion of 'collaborative care' is new...
Apparently in times of peace progress is made on human rights etc... In times of war... Those progresses get taken away.
I can't break 30% for an essay in public health.
What more do we need to know?
I made it out to the private hospital, here. There were about 4 cars there. It's all day surgery and nothing on a Sunday, clearly. You can't even pay for healthcare, here.
No, I'm sure you can. I'm sure one or more of those private houses...
I thought the reason why we were supposed to be happy about only doctors being able to prescribe medicines and perform surgeries etc was supposed to be because of their expertise. The expertise was the only thing that justified it. Insofar as the expertise goes out of the training program (e.g., too many student docs so it is impossible to teach them anything useful / insufficient rotation time to make it worth teaching them to do anything useful) then... There really isn't any justification for it.
Here... They focus on all the things that people could prevent... The harms from people who choose to smoke or eat rubbish or whatever. All these preventable things. And yes I understand there are often social factors blah blah blah blah blah. But what I don't understand is how focusing on all that... And focusing on hunting down and treating (against their will) people from traditionally underprivileged backgrounds (or whatever) instead of focusing on expertly treating the people who are doing what they can to look after their own health but need some expert assistance.... Somehow that is the face of medicine.
Looks an awful lot like bullying, to me.
Only interested in treating those who don't want to be treated.
Only interested in giving self-sufficiency to people who won't let other people alone.Please someone help me see this as a matter of perspective... Do I really need a perimeter fence outside my shady tree to see a little joy and life in this world?
Posted by hiddenhurt on November 22, 2016, at 9:17:52
In reply to Walking..., posted by alexandra_k on November 19, 2016, at 19:53:15
I was reading old posts and found one by Raccoon that said if you're depressed, read something scientific. It made me think of your post because, although I don't know all the healthcare and other issues you're writing about, it does sound like you are dwelling on negatives and spiraling downward. For me, checking myself with facts sometimes shows me that not everything is hopeless and dismal. Hang in there!
Posted by alexandra_k on November 26, 2016, at 18:52:04
In reply to Re: Walking..., posted by hiddenhurt on November 22, 2016, at 9:17:52
Thank you :)
I found "Zen and the Art of Motorcycle Maintenance". It is a book that I remember from my childhood. We always had it in the house. I think it was one of the books that I picked up occasionally... But I could never get past the first paragraph or so. I'm pretty sure... I'm pretty sure I never read it. Didn't even know what it was about. I think I thought it was about a road trip on a motorcycle, which seemed uninteresting to me.
Sometimes when I read... I read looking for something that speaks to where I'm at. My predicament. Like how many people read the Bible, I suppose.
Anyway, quite a lot of it spoke to me. The superficial subject matter, and the deeper ones, too. I have never thought about this notion of 'quality' but it seems to be something like the notion of 'value'.
Wittgenstein was infamous for telling his students they should go and be engineers. His students were logicians, admittedly.
There is something in / to that.
Motorcycle maintenance... The stuff he said about that.
About the difference between an artist... A welder as an artist... And a disconnected hack. About starting out repairing motorcycles and then getting a hankering to modify / make / repair them better. About getting interested in the mathematics and physics that helps one do that.
About... The classical view of a motorcycle that you see in manuals. The different parts and so on... And then about how you generate hypotheses about what is wrong. And then about the problem of infinite hypotheses... About how you select intelligent hypotheses...
Maybe... If only you had enough computational power then you could just kludge through all the hypotheses...
How well is that working out? It is generating a lot of publications... People rotely applying the scientific method and coming up with a publication that is fairly indistinguishable from one produced by a machine... Even in social science fields. Perhaps especially in social science fields. Make it all about proper grammar and footnotes and... Indistinguishable from post-modernist essay generator... There are expensive books that publishing companies are selling that are that... People as machines...
And now (of course) I'm thinking about the art of medicine. And about machine diagnostics.
Robert M Pirsig
Robert M HsuingThe theraputic potential of the internet...
How f*ck*ng creepy similar is all of that???
The therapeutic potential is the art.
They are trying with the symptom checklist... Trying to make it all machine tractable...
Quality...
Value...
Meaning...All of these things drop out.
It is just... Freaky. It would make more sense if I had read it as a kid and if it had lodged itself deep down... But, I guess, We are products of our times. A lot of the same issues are still around. Technology... The neutrality of it... Ones relationship to it...
And then, of course, there isn't much of a step from there to people maintenance / medicine.
And it helps me understand what I've found so very hard about public health. I get, now, why I was so bothered that he thought there was something... On the down low... About my being a consumer. It was because nobody else in the room was or was expected to be. It was all about coming up with a system that other people and other people's kids would get to use.
I really do think that an awful lot that is wrong with public health would be put right if the people designing it were required to use it as well.
On the other hand... There are a constituency that seem attached to life being nasty bruitish and short. Life is about taking whatever you can get away with. They don't see any problem with their kids being subject to that, either. This becomes more true the more kids they have...
I need to not engage with this for too long.
I'm getting a motorcycle :) Just a baby one (Suzuki GN125). Enough to get my full on over the next couple years. Might see about maintaining it... That's what got me started on this... After my 6 month maintenance on my bike resulted in the seat being overgreased and the disk brakes continually shrieking. If you want something done properly...
It's hard to find a knowledgeable artist.
I miss you Dr Bob.
Posted by hiddenhurt on November 27, 2016, at 7:42:43
In reply to Re: Walking..., posted by alexandra_k on November 26, 2016, at 18:52:04
Maybe I'm way off base, but it sounds as if you are longing for real connections with, passion for, wonderment about, and pride in good work for its own sake (e.g., ZEN AND THE ART OF MOTORCYCLE MAINTENANCE). Maybe you are contrasting it to the efficient but impersonal, assembly line model that has saturated nearly every industry (from motorcycle repair to publishing to health care). If so, I bemoan exactly that myself. I write:
No, I was never "disqualified";
I just never made the team.
God made the world for fighters,
No place for the gentle, like me.God gave me gifts, but at war who cares
About music, art, and writing?
Even among artists is fighting, and truly
I've never been so close to dying.Is heaven to be after death or now?
I'll tell you after I die.
For we've never found much of heaven here,
Jonathan Livingston Seagull and I.I haven't read ZEN but I think JONATHAN LIVINGSTON SEAGULL maybe follows in a parallel vein--wanting more meaning in life than mere subsistence. I'm glad you are taking some action towards making your own meaning, even as you struggle.
Posted by alexandra_k on November 27, 2016, at 20:24:41
In reply to Re: Walking..., posted by hiddenhurt on November 27, 2016, at 7:42:43
I think you got it, exactly.
Jonathan livingston seagull is another of those books that I have childhood memories of. I think I read that one. Something about a seagull learning to fly... I'll read that next.
It is about... Arete. Virtue. Excellence. Being in the moment... Something something...
One of my friends told me that what I was looking for was something only very recent. That only some people in very recent society had the luxury of being able to afford.
And I said: Even if that was true... That wouldn't diminish the value of it to the people who valued it.
And also: I don't think that is true. I'ts something present in perhaps all of the worlds major religions.I said at tech that something was missing... The idea of excellence. They said 'not everybody can be the best, Alex'. I said 'it's not about everybody being the best. It's about everybody being the best they can be'.
Focused attention. Right attitude. All of that stuff...
Anything can be done in that spirit. Thinking of monks sweeping... Or of mindfully doing the dishes. Hands in warm and soapy water. Enjoying it... Like taking a shower... Enjoying caring for things that we spend our time with... Being part of the environment...
Posted by alexandra_k on August 19, 2017, at 17:11:05
In reply to Re: Walking..., posted by alexandra_k on November 27, 2016, at 20:24:41
Feeling a bit down after my public health test.
I was thinking... I don't feel like the public health people want me to do well. I don't mean that it is personal. I just mean that they seem to take some sort of quiet enjoyment in tripping people up. They genuinely don't seem to want their students to do well.
The whole testing situation is weird. I mean, if you are trying to bring out the best in people then you give them a surplus of time and so on. Like the cell biology and biochemistry people do. Then pick up the pace a little later after people have had more time to consolidate things. If you are trying to trip people up then you do things like... Have different coloured books (not just cover pages the whole test script (stroop-type interference anyone?) or write big letter A, B, C, D version numbers on the front and make that the answer to question number one (grade-type priming interference anyone?) and then provide lots of irrrelevant details and a lot of time pressure... The whole thing just seems designed to trip people up. To randomise things.
Regression to the mean. I suppose that is it. They want to see how the top people do when they regress to the mean through no fault of their own.
It doesn't even matter, you see, because you can take an 8th paper (statistics, usually) so the grade for this one doesn't matter.
I think it really is just designed to trip people up.
Perhaps that's like the public health system.
Anyway... There were thirty-something questions for 15% of the grade so one question wrong is only the loss of 1/2 a mark... Whatever... Just keep on keeping on. The thing to do with it, really, is to nail the formula definitions then skim the text (like a computer would) only searching for keywords that tell you where to put the numbers. Read it meaning-blind, in other words. The analysis (even the 'critique') is formulaic. Meaning-blind, again. The ability to do what you are told when you are told because you are told. Or something...
I keep thinking about this short clip I saw (on the news, I think) about this surgery simulator thing they were running up at Tamaki. There was this training exercise and it involved things taking an unexpected turn for the worst. They showed the clip where the surgical trainee just got out of the ER. He looked upset. Visibly. Beads of sweat on his forehead. Distressed look on his face like things had gone badly and so on. Then this blurb on how it was designed to teach him a lesson in communication. Because at the start of the scenario (before he came into the room) 2 of the support staff were given pieces of information that were crucial to the success of the operation. What he needed to have done, you see, was to focus less on the patient and the patients vital statistics, and to focus more on extracting information out of support staff.
I don't know how intentionally witholding they were vs how many times they freely offered the relevant information. If it's the later (and they weren't constantly streaming their irrelevant thoughts so he habituated to their pratter) then - fair enough. The trouble is... I could see it being more of the former 'to teach him a lesson'. Then glee when things start turning bad. Then joy at his distress.
And I think that somewhere along the way... The point gets lost.
Sometimes there is this whole thing of 'well, if they can't handle this then they can't handle that'. Only, that isn't the case. How is skill working with belligerant staff who are trying to stabotage you going to help you do better at working with cooperative staff who are similarly focused on getting the best possible outcome for the patient?
There really is very little medicine in public health. It's just a training ground for medicine, is all. Who bears the cost of people learning to practice medicine? The people who approach the public health system for help. I wonder how many people who approach the public health system for help have first party car insurance. Home and contents insurance for their rental property / their own home. How many are saving for retirement. People who think that the government / other people should provide healthcare for them while taking responsibility for other aspects of their life without complaint.
ACC (accident compensation authority) says a person should drive the 'safest car they can afford' where safety is measured by how well you fare in a head on collision with another car. Who should bear the cost of my learning to drive / my driving?
And then there are the people who don't have the means. Who have no choice. And they are forced to take company with the richer people who choose to live badly and the poorer people who choose to live well or choose to live badly it makes little difference when you are poor. It really is about having the means to get away. Do your time in the public health system. Wear the scratchy uniform with the pockets in the wrong places so the staff can have a snicker. Put up with them gossiping about how you don't care about their gossip so nobody needs to engage in hand hygeine since they can't see germs, anyway. Nod and smile and smile and nod... And maybe one day you get to practice medicine with a team of people who are simliarly focused on the practice of medicine for people who actually care about their health. I guess that is the idea. That's the dream.
And other people... Instead of embracing that dream, that ideal. Instead of doing what they can to develop themselves to be on that team... They decide to enjoy the power they have over people who don't have the power to get away. Do your time in public health. With all the managers... All the people who didn't do well at molecular biology or biochemistry despite everyone doing everything they could to help them succeed. Basically, people who are more focused on controlling / managing other people than on... Well... For me... Medicine is about flourishing. The power (knowledge) to live a healthy life. Many don't have that due to ignorance or not having the financial means to do what they should. But then all these people who have the power to live short nasty brutish lives. For themselves and also for those in their care...
I don't know why I get it into my head that it would be nice to be able to offer medicine that to more and more people irrespective of their income... Only there are special interest groups with a special interest in terrorising the poor so I don't know that that will be allowed...
I think this social media stuff is scary because it entrenches people. I remember reading stuff on how dissociative fugue became an option with the birth of the identity card in France. Something about how it was now an option to travel without an identity card. Then somebody asks to see your card and you can't produce it and can't remember who you are, you see. That's how to present with dissociative Fugue. Then you get hospitalised for a while while the doctors help you try and remember because otherwise they wouldn't know who you were, you see.
But now... Even if you personally opt out of Facebook other people will photograph you and tag you and upload you, anyway. So Google and all the other software programs are being trained to recognise your face so it is easier for people to know where you are and what you are doing 24/7. A combination of being able to see and hear everything in the vicinity of your phone from any time and being able to see and hear everything in the vicinity of anyones phone who was around you. Even if you are careful with your privacy what is the chance that the Hitler Youth are careful with your privacy? Increase the amount of spam and you train people to hold their phones up to their faces (with both cameras potentially uploading) on demand.
And these are the times we live in.
Posted by alexandra_k on August 19, 2017, at 17:28:44
In reply to Re: Walking..., posted by alexandra_k on August 19, 2017, at 17:11:05
The informed consent thing is the strangest thing...
Reading what Dr Bob had to say about informed consent on these boards... All the way back, however many years ago. The idea of a multiple-choice test to demonstrate informed consent.
We really aren't big on informed consent, here. In trying to get at why not the idea seems to be that we don't like to ask for informed consent because we don't think that we will get informed consent.
I just... Don't understand in what world this is okay.
I mean... I suppose I do understand if... It were an infectious disease that we are trying to contain in the interests of public health, or something like that.
But I'm talking about obtaining informed consent for things like cancer treatment or participating in scientific research (aka things that are not a matter of public health or public safety).
I mean... In laboratory the other day we were supposed to do blood smears (of our own blood). I got the impression typically they don't get people filling in informed consent forms. They got them specially... Then we were rushed / herded into signing them and getting started we were not at all encouraged to take a few minutes to read the forms. We were not encouraged to ask questions.
Which I find weird... Because I was pretty freaking keen to look at my blood cells even though I know there is a smallish risk of my getting a finger infection etc from drawing blood from myself.
So... Why not get us to do informed consent properly? I just don't undersetand.
Maybe it's because the pathology laboratory has blood samples from our entire population (since everyone has had a blood test at some point). I expect that is it.
There is this thing about how public health isn't so big on offering information about what things are healthy because the people capable of understanding the message are mostly okay and public health is about promoting the health of the people who aren't capable of understanding public health messages.
It's about inflicting ones will on those who lack the understanding / desire for that to happen.
It seems.
Who lets these people work in these fields...
I'm starting to understand how NZ has a culture of bullies. It isn't a Maaori thing (or, it isn't only a Maaori thing) our immigrants are playing along quite well...
Is it because of history of trauma in the people? In their own lives? In their recent history?
Jewish people... Didn't start victimising others after the holocaust, though, did they? I didn't think that was the cultural response... There is money there... Something something about wars... I really don't know anything...
Posted by alexandra_k on August 19, 2017, at 18:09:57
In reply to Re: Walking..., posted by alexandra_k on August 19, 2017, at 17:11:05
And, of course, to remember these aren't people who are working in hospitals. They are people who are working with first year students. And people working with trainee surgeons - in simulator situations not involving actual patients.
I just have to have some kind of faith in the world that things will progress for me from here. Because the contrary is unthinkable.
The developed world is receeding from here. We were starting to come through the demographic transition but we are being swamped by immigration. So... Infectious disease is on the rise etc. Infrastructure is swamped (literally - starting to have sewerage problems and people required to boil drinking water). And immigrants say (like good-old kiwis already) 'we don't know how lucky we are!'
(because they are from the slums of Mombai or because they didn't have refrigeration for their family/tribe on the islands etc).
Posted by alexandra_k on August 19, 2017, at 18:22:04
In reply to Re: Walking..., posted by alexandra_k on August 19, 2017, at 18:09:57
I guess there have always been people who took some kind of sadistic pleasure in inflicting pain / suffering on others - because they could while others take pleasure in helping things flourish.
I mean, people look after their pets differently. They clothes differently. Their houses differently. Their other material possessions. Their kids, sure. Their employees etc.
Even back to slavery... Some slaves were trained in medicine... Given time to write etc... Training in the arts... While others were beaten and thrown in ditches.
I don't know why some people will and some people won't. Whether it is relatively constant trait or whether it alters over the course of the life. Whether it can be taught.
I suppose it's a good motivator for people to keep their trap shut and do their mundane job. It starts to look like more and more and more of that... WHen they are people who would only abuse any more power then giving them power when there isn't anymuch actual harm they can do...
I suppose that is for the best.
Perhaps it really is a lesser of evils that so very many people push bits of paper around all day and don't do much in the way of anything more...
I don't know.
Anyway... Back to work..
This is the end of the thread.
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