Kiwiology

Use a bougie; its damn near impossible to fail with a bougie and it means you dont have to piss around using a stylet, I don't like them.

We have to cover and understand them, but we are not expected to be able to regurgitate them from memory on a standardised test. Oh and just to stay on topic .... refusing to see people because they are not vaccinated is bad *wags finger

Medical school here is cheap, only about $70,000 for five years none of this fight to the death for a spot in a four year $300,000 program And we don't even have to learn Krebs cycle intermediaries ... Acetyl CoA, something, oxyaceteate or something, 2x AMP > 2x ATP then next minute NAD + H+ > NADH ... yes I think that sounds about right The only problem is you do not use doctors on the helicopter (very few places) ... I'm trying to get a year in the US during school, I'd come to the Great Mitten but you'd make me pay my half of the check and then dump me on Nine Mile Road or something so I'd get shot by gangbangers from Harper Woods ... prick .. so its off to California or Florida or something where Doctors are treated like celebrities

Sounds pretty fucked up bro

I know you're going to absolutely hate me now, but like 90% of the population has a General Practitioner here and in the UK it's even higher where GP's do not operate as private businesses with a fee-for-service like in NZ but are free to the patient under the NHS. General Practice is a very endangered speciality here and it has taken several years and tens of millions of dollars of funding to reverse that problem; when you become a GP Registrar here the Government gives you like $50,000 or something fucking mental, that's probably over half to 2/3 of your medical school bill paid off *clicks fingers, just like that. There are problems attracting and retaining GPs in rural areas here because of extremely high workload and limited break fro that workload. And why do you think I want to do a year or two of my post-graduate training in the US? Because medicine has a strange alure in your land almost somewhere between celebrity and godliness; and heck it pays too I know a surgeon who had to "settle" for half a million a year, poor bloke

Public health is important no arguing it; it was really the first major breakthrough in medicine and had the greatest impact on morbidity and mortality; more than surgery and anaesthesia and infection control combined; sorry Semmelweis, Baron Lister, Davey and Morton I am sure you understand I hate to say it but this phenomenon seems to only be occurring in the US ... I do not see any of the Royal Colleges of Paediatrics or their equivalent bodies screaming that their Physician members are unhappy about seeing unvaccinated children. It should be noted for general medical care unlike appears common in the US that internationally children do not see a Consultant Paediatrician they will see a General Practitioner (Family Physician). To see a Paediatrician or paediatric sub-specialist (surgeon, oncologist, psychiatrist etc) you must be referred by your GP as having something paediatrics can offer a specialist service for or opinion on ... and no, those awesome tasting lollipops do not count, bugger, I want to know where they get those, my tax dollars at work! Does that change anything? No, probably not, but I thought I would add it for reference because it was interesting to note in some Googling that news articles mentioned parents taking their children to a Paediatric practice.

See, I told you to hire me as your business manager, but nooo you had to hire some Australian, prick The Fire Service gets 4x the funding of Ambulance but does 1/4 the work; that is totally fair .... IAFF and IAFC are totally bullshit; they spin some bullshit and flash marketing to get ambulance contracts and generally provide pretty piss poor EMS And they are on record as opposing increases in paramedic education

So how does that work? Do you take them out on every call or do you have to go back to the ambulance to get them? I mean you never know when you're going to need a bit of morph or ketamine or something right?

Physicians are not employees of the state here either nor in any other public health care system I know of with the exception of the National Health Service in the UK (England) where Doctors are employed the specified NHS Trust, but with the NHS GP's are the exception they are private entities contracted by the NHS. Physicians have the right to choose who they see here too but once they have taken that person on as their patient then they can only get out of it by discharging them as care is no longer required or can end being their Physician but must do so only if they are incompetent to care for that patient (see my previous posts). When I say a Physician has a right to choose who they see, I am generally referring to GP's who most of the time are closed to accepting new patients because they are full. A Consultant Physician in private practice e.g. a surgeon can also not see you but must refer you to the most appropriate person if he's not it. The Centre for the Advancement of Kiwiology in Medicine ain't doing too flash hot either ow pretty stink bro no ghost chips required I believe all people are entitled to autonomy and free choice, except you, you must take me on as your Registrar, there will be no arguing about it, it does not matter that I answered "ask the Consultant" 372 times on USMLE Step 1 and that all my stations for Step 2 consisted of "I don't know this is the House Surgeon's job, I would be on a break or chatting up the nurses or female house surgeon or something ..." No I don't think free choice is being taken away from the Physician, I am of the view that it is unethical not to continue to see a patient because they decline a single, isolated piece of the healthcare pie based upon their beliefs. I will agree that if the parent or patient is being consistently unreasonable and/or non compliant with all treatment to the point where the Physician is truly unable to care for them because they are so unreasonable and/or non compliant then that is different. I've been seeing my GP for nearly 30 years, I didn't fill a prescription she gave me once, so should she terminate me from her practice?

I know the Fire Service (here) has to respond to any call for assistance, I think in your parts the ambulance service cannot not respond (whereas we can) um, those are just two examples off the top of my head, maybe not the best ones. Selective interpretation - persistently being unreasonable or non compliant is not the same as choosing to not take one piece of the healthcare pie; I didn't fill a prescription from my doctor once but have agreed to every other investigation or course of treatment she has recommended in the nearly thirty years I have been seeing her. Does that make me unreasonable and should she stop seeing me? What are you, my two ex wives? I did not say that you had to do what the AMA said, but it would be considered professionally prudent to listen to their advice and perhaps abide by it considering they are the professional association. So who actually sets professional/ethical standards around such things as these for Physicians in the US that are enforceable? I tried to find a professional statement from the governing body equivalent to the Royal Australasian College of Paediatrics and found no less than 3-4 different organisations. I have run across this problem before with Emergency Medicine, you have the American College of Emergency Physicians, American Board of Emergency Medicine, American College of Osteopathic Emergency Physicians, American College of Osteopathic Emergency Physicians, American Osteopathic Board of Emergency Medicine and the American Academy of Emergency Medicine!!

Aeromedical evacuation from various shit hole pacific islands is common place, either to Australia or New Zealand and usually by fixed wing aircraft. One of my mates is a retrieval registrar for two days a week that he is not earning $1,000 per elective procedure as a non-training anaesthetist (MOSS)

Dwayne got froggy in Vegas when he found out the prostitute he picked up was a transvestite and tried to run, I was playing blackjack quite successfully at the tables at the Bellagio when I saw him on the live overhead stream of COPS being chased down the street by this tranny and it's pimp with the LVMPD in tow So I had to go rescue his ass .... Yes pethadine is quite potent but it's fallen out of fashion in favour of much better drugs like fentanyl

Haemaccel is an intravenous colloid which in theory should be better than normal saline or any other like fluid e.g. ringers lactate which are crystalloids; however the evidence does not seem to support this view conclusively if I understand correctly. A colloid and a crystalloid are different in that the colloid contains large particles which do not dissolve and exert a pressure (oncotic pressure) whereas a crystalloid does not. Remember the old addage that only about 1/3 of your infused saline will remain in the intravascular space? that is because the crystalloid fluid will diffuse out across the vascular membrane but this does not happen with a colloid because the particles are too large. This is best explained by the answer I wrote in Paramedic (ICO) Assignment # 5 back in 2009 No we do not use it nor do we plan to

pethidine is an old school narcotic analgesic that hasn't been used here in years ... like since forever

it'll cost you a 24oz tim's mocca eh?

$30 +/hr for a Primary Care Paramedic is fairly standard +/- a little in places like Ontario, Alberta and British Columbia

Now you know I have much respect for you mate, you seem like an excellent, model Consultant Physician (not like that Dwayne bloke, I don't respect him at all after he made me rescue him from the transvestite hookers in Las Vegas ...) but even you must agree we need to carefully balance the patients' right to choice in their (or their childs) healthcare and the right not to be discriminated against with whatever rights are applicable to you as a Physician in your respective jurisdiction around the subject of choice of patient and terminating having that patient on your book? Sort of, but can't we say the same about Gramps in the waiting room who is hacking up flu droplets because he did not take the antibiotics for his lower lobar pneumonia? I provided the wrong link for which I apologise; the correct source is Cole's Medical Practice in New Zeal which does on page 40 state that a physician may terminate a relationship with their patient only when they are incompetent to care for the patient ; see here http://www.mcnz.org....0-%20george.pdf NB termination of a relationship and discharge are not the same thing as I wondered about that but it seems they're separate Physicians should not be subject to any law, rule or standard less natural or fair than any other member of the community and should not be "held hostage" but we must carefully balance the right of the patient to have their beliefs and choices respected and whatever right is applicable to the physician that would apply in this circumstance. I couldn't find that reason on the GMC documents, perhaps I am not looking in the right place or you are referencing another? Paragraph 38 of Good Medical Practice states a relationship may only be ended in "rare circumstances" citing theft, assault or violence as specific examples; see here http://www.gmc-uk.or...lationships.asp To the subject of the non complaint patient, if a patient is persistently non compliant with all treatment and is making it impossible for the Physician to treat the patient then I think it is reasonable that the Physician be allowed to find another Physician for that patient because they (the first Physician) is actually incapable of caring for the patient because they are so non compliant. Not taking a vaccination is not the same thing. if a patient is persistently non compliant with all treatment and is making it impossible for the Physician to treat the patient then I think it is reasonable that the Physician be allowed to find another Physician for that patient because they (the first Physician) is actually incapable of caring for the patient because they are so non compliant. That's a bit snobbish is it not; if your professional association advises against something (whatever it may be) wouldn't is be a bit foolish to tell them to pound sand as you say? Next minute .... tens of millions of dollars lawsuit; I need me a new private jet That is a very difficult line to define I also agree with this and I think this is what various international medical ethics guidelines (or in the UKGood Medical Practice which is the standard) are trying to say. I also interpret that as being a fair standard. I think there is a reasonable argument for disagreeing with that parents individual choice but I don't think there is an argument for not providing care to that parents child. I could say oh international evidence supports my view and personally I think it does, but that is how I've chosen to interpret it, certainly the correct guidance from here and the UK seems to make it quite clear. For some reason I couldn't quote all of systemet's post but regarding our compensation system, clinical need determines what you get here. The treatment injury or medical misadventure compensation provisions from ACC provide what would be awarded in a system which allows you to sue for damages and costs but rather does so in a way that avoids frivolous lawsuits and all that is entailed with that. We have a pretty darn good system for public disability care which makes the system so much easier to work; a family member is in a wheelchair and got their house and bathroom converted; although they only require minimal assistance that is paid for, they are on disability for life (which is really generously paid here), gets rent assistance and help with any extra costs like new tires for the wheelchair etc. Every hospital appointment or procedure is free (but that's the same for anybody here) so it works very well This is a tricky subject here and there is no clear legal definition; more broadly speaking anybody can refuse care/treatment until found mentally incompetent My personal view? It is the right of the parents to decide until such time as the child is reasonably capable of deciding for themselves Oh and to sum up this entire issue, a good piss take .... remember that Pasteur said a disease only infects a susceptible host, so don't become susceptible and there is no need for a vaccine or this whole debate!

Snap on account of you supposedky getting told by dwayne Um so do I have to do anything like make you dinner before I can eat you?

Two reasons (1) a patient (or their parent if its a paediatric patient) has the right to decline treatment and/or care and (2) a Physician must not discriminate or deny health care to a patient based on their beliefs Now depending on which international jurisdiction you are in the wordings and flavour of the above from regulators differ slightly but the same basic principles apply Just because a patient chooses not to get vaccinated does not mean they are "shunning" medical care but rather they are making a choice about one aspect of the care they or their child receives and to judge them based solely on that choice is not appropriate. I have admitted to my General Practitioner that I once did not fill a prescriptions she has given me; so should she refuse to see me any more; I mean how is that different than what we are discussing here?

I am sure such sensible measures would be quickly discredited as "unconstitutional" and end up the subject of much piss-taking (mocking) by Jon Stewart. Not at all mate, don't worry about it but I must warn you, if you spot a funny talking Kiwi person who swans out the sky on the Lifeline helicopter (if it ever comes north to you) watch out, it might just be me, be sure to get the local farmers turned volunteer fire chief who is over talking to Earl the County Deputy to hog tie me like he does to his swine so I can't cause no trouble, you hear me boy? .... On the topic at hand, I would be interested to see what our other member Physicians think of it.

Perhaps, I'm not sure but there are lots of places around the world where OP based agricultural products are used and/or stored in sufficient quantities to cause poisoning if ingested. New Zealand is a farming nation (no bloody lame ass jokes please...) That he was not however I thought I'd cover it as well

I do not know of any ambulance service outside North America that carries anything for organophophate poisoning; either for the patient or the crew. Personally I think the massive over-subscription of various services' within the US to atropine auto-injector for "biochemical terrorism" might be conducive to ingestion of the Kool Aid

You'd have loved having me as a patient; Nurse: Have you passed urine yet? Me: No, this oral fluid you want me to drink so I take a slash is just making my gastroenteritis much worse Nurse: Well, look you have to drink it or I'm going to catheter you Me: Bloody hell no you're not, may I speak with the House Surgeon please? Nurse: She is tubing somebody, I'll get her to come see you when she is free Next minute ... House Surgeon Me: Can you prescribe me a litre of fluid so I go pee and if that doesn't work you can catheter me? House Surgeon: Sure, why you ask tho? Me: Coz I don't like having a plastic thing shoved up my dick, you know ... House Surgeon: Hmm yes ... are you a doctor or something? Me: Something like that Oh and a sternal rub is great for painful stimulus