Though it makes me suspect they’re not suitable for small children or if you have to operate heavy machinery…
Archive for the 'nonsense' Category
All winter I see the birds, circling the tower in St. Patricks, roosting in the trees in the back garden. But it seems they lose their voice over winter and it’s only now with the first glimpse of spring that they find their vocie again.
About 10 days ago now someone pinched a couple of bags of coal from our back yard. In the middle of the night when we were sleeping.
This made me notice a few things:
1) i felt a sense of fear and violation and mistrust. Why would someone steal my coal? I started to suspect my neighbours just because they could see into my garden.
2) a move towards increasing security around the house. I got a lock and put it on the back gate, I’m a bit more cognisant about whether doors are locked. This is faulty on two levels. One – it’s closing the door after the horse has bolted and two – the way we do security makes us feel more secure but I doubt it really stops much.
3) it made me consider the idea that a peaceful society depends not on law or security but on a willingness to live peacefully (or a reluctance to steal) from one another.
Trains seem to have become extensions of the office for a lot of people. Especially the intercity to Sligo that I sometimes hitch a ride home on.
It’s one of the fancy new ones with the power points and trip switches so you can plug in your computer but not your hair straighteners.
There’s no plugs on the normal commuter trains. There’s sometimes no heat. Sometimes there’s no train. And there’s barely space to open a book never mind a lap-top.
On the fancy train it’s a different story and people come armed with lap tops with dingles, dangles and dongles hanging out of them.
So people are on their emails or on Skype or using the pinnacle of modern consumer electronics to play fullscreen minesweeper.
It does lead to some awkward moments and invasions of personal space.
People view the space up to the midline of the table as their rightful property. The back part of their lap top has every right to rest on that line. So does the person opposite.
And then comes the tilt in the screen. The tilt that’s needed to make the screen readable. Opposing screens touch. Everyone saw it, we just pretend it didn’t happen. It’s mere sabre ratlling. It’s like the bay of pigs all over again.
And in the unspoken and unwritten laws of train table ownership it’s not quite clear who has the right of tilt. I suppose it’s like those neighbors from hell who let their leylandii grow over your hedge and then you try and trim it back and it turns out you’ve no legal right and all of a sudden you’re putting out rat poison to knock off your neighbours dog and playing zeppelin at 4am to piss him off…
Something like that
If the New England Journal of medicine turn me down I might try the Journal of Silly and Unreproducible results
Introduction
Primary prevention forms a large part of a primary care physicians work load. Numerous guidleines exist to manage high cholesterol, high blood pressure etc. Many physicians are paid by results of such targets or at least by monitoring these markers as indicators of “performance”
Risk calculators use this data to provide a risk estimate of outcomes such as heart attack or stroke over a 10 year period
These calculators typically place paients int one of three risk categories high medium or low
Little evidence exists as to whether patients have the foggiest what we mean when we tell them thy are high risk and pack them off to the pharmacy with a script for an unpronounceable pharmaceutical
Methods
We (by which I mean me) conducted a survey (n= about 10 or so…) where individuals were asked “if a doctor told you you had a high risk of MI in the next ten tears what percentage would you attribute to this?”
Inclusion criteria included bored medical students in anatomy practical, mildly intoxicated people at a fancy dress party and hosts of a dinner party and my brother’s dog lily
Exclusion criteria included those who already knew the answer and those who could escape quickly enough to the bar before I got to them.
Results
There was 100% response rate though Lily had to be educated in the concept of numbers, self- awareness and the English language
Everyone in the study replied with a figure of between 70 and 90%
Using worst case scenarios in this calculator (selected from the top of a Google search) the highest risk was 30%
Discussion
Typical risk scores often generate a percentage of <30% for 10 year cardiovascular risk for those considered at “high-risk”. This high-risk category begins at 20%
Our (by which I mean mine) results show that there is a disconnect between what we as health care professionals mean by the term high risk
This reinforces the need to do the unthinkable and actually talk to our patients about what this actually might mean
Further research is needed in order to keep us so busy that we don’t actually find ourselves in the position of actually having to talk to the patients
Competing interests
I received no funding for this study but did find it passed an amusing half an hour on the train to Dublin on a monday morning
No individuals revived remuneration for participaing in the study though Lily received a munchie roll
Ray Moynihan writes in the BMJ on the epidemic of pre-hypertension. At it’s simplest this is best described as a pre-disease. Your blood pressure isn’t high yet but it’s on the upper level of normal.
You don’t have to look far to see whose interest such a category might serve.
Until now the definition of what constitues a condition or pre-condition, and the guidelines for treating it, have been left largely to senior members of the medical profession and their esteemed societies, often meeting in drug-company sponsored forums like the coming Vienna conference. But for people like Professor Furberg, the profession has become too close to industry. He wonders whether it may time for society at large to take more of a role in deciding who should be classified as sick.
I was back in work on Saturday for another shift and some time on-call.
It was lovely actually, which always surprises me. Good bunch of new docs and it wasn’t as crazy as it often was. I came away having made a lot less of the compromises that I normally have to make that make me hate the job.
Our esteemed leadership had put this up in the tea room:
Many of you will be aware from this blog and general knowledge that we have a target of 4 hours from when the patient arrives at the ED until they are disposed of (an appropriate term for a target that dehumanises patients that much) at either admission to a ward or discharge.
We have lots of patients who breach on a marginal basis eg they get admitted at 4hrs 2mins or something like that.
So in their wisdom and cunning the powers that be have decided that telling us the target has changed to 3 hrs 30 mins will help cut out these marginal breaches.
The target of course has not changed (for now). Surely they must know that we know that. Though perhaps the fact this poster exists at all is a testament to how stupid they must think we are.
Incidentally i think it’s a great thing that patients should wait less than 4 hours in the ED but not because of a target, simply because it’s the right thing to do. I bust my ass in work to see patients in less than 4 hours, not because of a target but because it is the right thing to do.
And yes I am a better person than you.
I always feel odd walking round Lidl, it feels like a library or something and today I noticed it – there’s no music playing in the background.
Nelly And I 
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