Kiwiology

Yes hello my name is Kiwi I am one of the Consultants ... whats that? No I am not interested in paying any attention to the fact you are covered in faeces or that your sheet has fallen down or that your blanket is not working I'm here because that educated nurse gave me hard words about doing something to fix you up because the one kind of medicine I wrote for you hasn't worked even tho this is not an emergency and medicare won't be paying for it so we'll have to use generic substitutes, now let me write this prescription that you can't even read so God knows how the pharmacist will they'll probably get pronanalol and propofol mixed up and I'll end up being black doctor's cellmate Now while we are on the subject of all of this let me have a good firm palpate of your gizzard then it's off to radiology for lots of expensive tests and suchlike hang on, yes hello emergency department? i see, is it a shooting or a stabbing? well was he shot or stabbed? there is a difference, I see no no they didn't tell me that they made differential diagnosis a post-radio thing here in the great Mitten because if you spend too long on scene you might get shot or stabbed by gangbangers so its best to transport then ring us up ... well in that case hang on, what in the bloody hell do you want go away you underfed, dangerously fatigued House Surgeon no I can't tell you which side of the tummy the spleen is on what do I look like a doctor to you? ... righto, give him two amps of bicarb and transport! You don't need me here, lets see ... I need some house remodelling and shit done so that's five grand for the consult thanks.

It's really very simple down here in Kiwi land, we mix 1mg of adrenaline with 1 litre of NaCl and viola! It's so simple even a dangerously underfed, overworked and fatigued House Surgeon firefighter can do it!

True. What I was getting at was more most take little to no interest in the actual medical management of their patients, the reasoning behind what they do or generally fail to advocate for their patients which is where a little foundation knowledge comes in mighty handy. For example, this one bloke with horrendous nausea curled up in a ball in a half-upright position on the bed (ED trolley); the sheet under him had slipped halfway down the bed and he was clearly in much discomfort. Wanting an MSU out of him they loaded him up on oral fluid, which made his nausea and gastro much worse. The RN told him "well we can't do anything if the ondansetron and cyclizine haven't worked we need a urine sample out of you if you don't drink we're going to catheter you" and just walked off; I noted one of the students then whipped in and fixed his bed up for him ... bloody hell Now, being the educated type I hit up the House Surgeon to give the bloke some IV fluid and gravol ... not 200ml of NaCl later he was in the loo pissing like a race horse! See how easy that was ... and this bloke looked 2000% better, magic! Normally I tend to put the ED physicians offside a bit (most notably the House Surgeons) for being very brisk, walk in, palpate this, mumble something and walk out never mind that the patient is shivering cold or covered in faeces or something ... they look at the medical needs of the patient and some are quite bad at ignoring everything else but then you get those that are great at actually look after the non-medical needs of their patient, even if they are underfed, overworked and dangerously fatigued! Look mate you can't even speel Consultant bloody hell what are we going to do with you Oh and I'll come to Michigan, just not Flint or Detroit man I don't want to get murdered or nothing, bravo 711 calls radio, we're jamming this thing into overdrive and legging it ... oh but first you have to tell me the answers to USMLE Step 1 ... is it ask the Registrar? Like it's ask the Registrar 322 times over right? or is one of them "ask the consultant on-call because the registrar died from fatigue and malnutrition?" ... right? thats it right? I might have to go back to upstate New York but bloody hell all them blokes can't understand a word they say, for example Me: Yeah this is Little Timmy, he went into the football tackle sort of slightly abnormally and heard a loud crack in his neck, he has no neurological signs but the first person to him, this fella over here, is a Consultant Physician, he said he felt a step at C6 Rural upstate New York volunteer EMT: I see, yo can we get some subtitles up in here? Dramitisation may not have happened Gosh look at me getting all off topic and such

I agree mate; but Ambulance needs to take its own responsibility for learning and professional development and the global trend towards University over higher education is showing that some places are actively doing that. A good example is I was watching one of the underfed, horrendously overworked and dangerously fatigued House Surgeons' examine a patient's belly; she put one hand on top and one on bottom (the patient was lying down, so one anterior and one posterior) on the mid-lower right side and gave it a good push; I have no idea what she was palpating for, probably spleenamegly, spell, spelan, enlarged spleen or some shit ... damn underfed, dangerously fatigued and horrendously overworked House Surgeon's and their super sly super secret super fundamentals-of-medicine physical examinations not taught to dumbshit Ambo's! Or if you nick around to a GP's urgent and the GP hands (or tells you) lab values or such like ... most ambo's don't understand what they are, they might know "the patient needs a blood tests for their heart attack" but do not know a normal CKmb or trop-T is or the physiological significance Mind you a lot of nurses here probably can't either' I do some tutoring of our nursing students and their lack of appreciation for the basis fundamental of clinical medicine which have been established over thousands of years is just appalling; be it that everything has some sort of physiological end-point (that you can trace sign or symptom or condition back to some physiology) or that you should make sure the patient's bedsheet is not all wrinkled and that a shivering patient should get a blanket ... it just boggles the mind Some of those dangerously underfed, overworked and fatigued House Surgeons should be reminded of that too ... never hurts to rub the bell of your stethoscope between your hands to warm it up before you shove it down frail old Nana's hospital gown or not to walk away and put the bloods in the lab tray if the patient is talking to you; even if it is just two feet. Mind you, I am just a Consultant Kiwiologist (if only in my mind ....) so what do I know?

Indeed, there is nothing in that statement that is clinically unreasonable given the information and history presented. That is why I like it that you can't sue people here, cuts down on the frivolous lawsuits and defensive medicine

This is really a complex problem. I have been studying biochemistry for last five hours so excuse me if my thoughts run out my eyes .... Paramedics should be able to leave people at home, they do here, in AU, in UK as well. Mind you we have a lot more education than US it still doesn't make us perfect, we leave people at home they die, ED sends people home they die ... our Clinical Director Tony Smith (FANZCA FJCICM) and Fiona Moore from the LAS (FCEM(UK)) have stated you cannot simply transport every patient, and you cannot, I do not understand how US hospital system does not collapse and simply implode with you blokes not being able to refuse to take people bloody hell!! The balance of clinical risk will always be transporting some patients; e.g. OB/gynae I have a very low threshold for conveying to hospital; somebody who is in second trimester with diffuse abdo pain/cramp but pain free between cramps/watery diarrhoea/maybe a little fever/nausea and no vag bleeding I would let her stay at home but a multiparous black lady who has an IUD, multiple sexual partners, smokes like a train and has tummy pain is getting conveyed to hospital +/- red lights. Somebody who has BP >140 on 2 separate readings > 15 min apart technically has maternal hypertension and that's enough for me to tell them to go see the doctor. In reality again, most people who go to ED probably need to go to the hospital for some sort of hospital level diagnostic testing or procedure the GP can't do or so the research here in and in AU says (I'll see what I can find) and most people with acute minor problem e.g. splinter / tummy pain can be dealt with by an NP (or Nurse Consultant) and/or House Surgeon/House Officer and sent on their way very quickly; some of our EDs have a GP during the day or extended hours for minor things. In the UK they have NHS Minor Injuries and Walk in Centre which is like what you in US call a "community ER" However at the end of the day you should have access to the hospital if you need it; I will always choose to go to the hospital if I don't think my GP can handle the problem at their clinic; even if I'm seeing a dangerously overworked, underfed and horrendously fatigued House Surgeon they still have access to all the fancy machines (through their Registrar or Consultant) and it's just more reassuring honestly. Primary care in the US seems to be very different than here or in Commonwealth/universal access countries e.g. in NZ GPs are private business with some subsidies from Government for low income/young children/free for under 6's etc while in UK they are private too but with NHS contract making free to patient ... we can get an appointment in one to two days wait or sometimes same day. Some big GP clinics do x-rays/sutures/fracture casting etc but this is more the realm of the accident and medical clinic but these are very expensive so why not go to hospital , wait a while and see the dangerously underfed, overworked and fatigued House Surgeon? Truth be told you do not even see a doctor here for a broken arm unless orthopaedically complex or a surgical opinion required the nurse can order and interpret the x-rays, cast it and give some simple analgesia. The answer is not not sending people to emergency department; the answer is reforming how the system reimburses, to say "we will not pay" is stupid. Now, does that mean I am not going to rort the fuck out your totally screwed up privatised healthcare system for a few years to make a half million dollars a year as a Consultant Physician so I can retire at 45 and get me a boat? Hell no!

I don't drink

This shit is more fucked up than TAG fatty acid synthesis and you know that's just a whole bunch of screwed up right there, heck its so twisted it might even be a protein! How in the bloody hell can they say septicaemia is not en emergency? coz maybe if your leukocyte count goes up and does a bit of left shift it'll be ok coz it'll magic away the s. aureus or whatever but what about that s. pneumonae hiding in your lung from thirty years of smoking and eating shit food so now it just turns up whenever the fuck it feels like coz your immune system is so screwed up y'alls helper T cells can't help no more? huh? what if that decides to go on a vacation to your bloodstream? man, freaking bacteria .... never happy, always wanting to travel to places they don't belong and become all virulent and shit ....hmm not unlike Kiwi Same goes for status asthmaticus ... which if I remember correctly (you know each time I learn a new word like F0F1ATPase it pushes an old word out my brain like now I don't know what colour those red fire trucks are anymore...but when have they ever been important huh? huh? huh? hey IAFF go fuck yourself!) anyway so if I remember correctly status asthmaticus is severe, refractory asthma where oh I don't know the patient has a high chance of um, dying like right now like soon like where in the hell is the Consultant this bloke is nunngered up to buggery and my ass is puckering? Adbo pain is the same thing ... abdo pain can be gastroenteritis or it could be something serious in his gizzard has gone kaput I'm going to stop now because this shit makes me so angry ...

Then pay no attention to the small flightless bird; he will go back to doing communal chores n such

Let's not forget those Consultant Kiwiologists .... they are about the most evil bastards out there None of this makes sense period; it's just crazy; but this is what happens when you have a privatised health system .... Now, get me into that health system man I want to make a half million dollars a year for a lil' bit as a Consultant, the $120,000 I'd get here is just pale in comparison, heck I'll even learn what the bloody hell a bisphosphate is and how to look intelligent with that stethoscope thingo by putting it round my neck not up my ass!

Look I don't like wading through a forest during a monsoon mmmmk?

Sure; as long as I can walk around naked, take a shit with the door open, brush my teeth while taking said shit, have a wank and leave dishes soaking in the sink count me in I'll be respectful and play my music through headphones, see, I'm not a total bastard Oh and have somebody on 24 hour lookout for the ATF and other Federal people ...

Oh my god what in the bloody hell, have these people going mentally insane like psychologically in the noggin? Words are inadequate to describe the immense level of super-mega fail here; nothing in the fabric of the space time continuum or the known facilities of science-based-medicine (phosphofructokinase anyone?) even begin to pale in comparison with the uber nunngered brainboxology of this idea; not sweet as bro; not sweet as at all; pretty stink bro; no ghost chips required! This is even more nunngered than phosphofructokinase or why the two [H+] pumped from the mitochondria when Complex IV of the electron transport chain tip the electrochemical gradient so ATP Synthase can phosphorylate ADP and Pi into ATP when eight, yes read them, eight hydrogen protons (ions) are pumped out of the mitochondria by Complex I, II and III .... eight is a bigger number than two people! Wait just a second, this almost sounds dangerously like educated synthesis of information that comes from a ... a. ... a biochemistry book, if I keep this up I'm going to be burnt at the stake for being a witch or some shit .... Anyway, what were we talking about? I got side tracked ... oh yes, this idea is pretty buggered in the noggin bro, seriously; where are people supposed to go to get this "non emergent care"; what if they don't have a GP? The GP has no appointments? They have no insurance? The GP is 20 miles away and they have no car? Their GP told them to go to the hospital because said GP has not seen a sick person since their House Officer year when Semmelweis and washing your hands was considered the latest advent in medicine? Research here (and I think in AU too) shows that most people (exceptions apply) who go to ED actually need to go to ED and receive hospital services like diagnostic testing or sutures or something that their GP can't do (this is why the (UK) NHS Minor Injuries Centre and Walk Ins are great they can do stuff like that ... anyway) .... And just how is that dangerously overworked, underfed and fatigued House Officer doing his ED rotation expected to pay for his crippling $300,000 student debt for four years of medical school (when five here costs us NZ70,000 mwahahahaha!) if nobody pays him ... and let's not forget those Consultant Emergency Physicians like their fast cars and boats too y'know

Bottom line is mate, the world is pretty fucked in the head Now never mind the bottom line, how about that white line Laura Lynch and Garh Brooks are on about ... just keeps getting bloody longer

But I have the wandering eye (exotropia) so I am forever doomed not to be a Consultant Physician

See? Food makes you fat LOL The point is the fat bloke should have bought another seat

I am not insensitive or nothing and I agree with you. It's like my Consultant Physician friend says -- I am so bloody sick of people blaming being tubbo on glandular problem or having big bones, if there are so many people with medical causes for being obese how come there were no fat people at Auschwitz? And before you start getting all bent out of shape my Nana was in bloody Auschwitz (and she wasn't fat!)

You're a funny bugger ... and you talk like one of them Consultant Physicians too y'know

Mate are you serious bloody hell ow you can't not take some blind bloke's guide dog pretty stink bro not even beached and no ghost chups required I know of a crew who have transported seeing eye dog; can this guy get round (with help), take a shit and whatnot without said seeing eye dog? Fine, twist my arm, technically yes but I don't think its morally right to not take the dog Now I still reckon I want one of them helper monkeys

The law not require the dog to be trained but that doesn't mean it isn't trained; I mean lets think about it the AFB or ASPCA or whoever is not going to give some blind bloke a seeing eye dog that shits on the floor and leads him into rush hour traffic. When they used to run TV ads for the Blind Foundation here they knocked on about how it took something like 3,000 hours of training to become a guide dog. A guide dog has more than 4x the minimum required Paramedic training in Texas ... we should give the dog the drug box

The ADA may not however the agencies who supply service animals are a different story I want a helper monkey to start my drips and do the laundry n' shit y'know?

Tubbo is not "disabled" the ADA defines a disability as "a physical or mental impairment that substantially limits a major life activity" I'm not trying to be a bastard, you know you're grossly obese, buy another seat

Sorry? Are you fucked in the head or are you actually serious? I can't tell through the extreme fail it's just too strong mate! Of course the service dogs are properly trained. Lets not worry about it? Would you not worry about taking some other essential piece of equipment for the patient? Would you not take Grandpa's wheelchair?

Fuck that shit; the usual practice is for lardo to buy more than one seat but they pay for it

Your head ... what are you, a Consultant Physician? Psychogenic polydipsia eh? You've been into the E again haven't you