WEEKENDER: Doctors in Distress, by Wiggia

The last couple of weeks or so have seen the NHS pushing back on the fact its services are falling further and further down the quality ladder that we who pay for it have the right to expect.

We have had the GP on television defending the almost non-existent service by blaming overwork and burnout as being a big part of the problem; for a branch of the medical profession that has had two years of near holiday you have to have some gall to come up with that one.

And only this morning, the 29th, Dr Hilary Jones on GMB was talking about doctors saying 1 in 4 were suicidal or that they all knew someone in the profession that felt that way. I would suggest if that many doctors are genuinely considering suicide they are in the wrong profession. Dr Jones spoke of how they all love their jobs etc. etc. despite himself not practising medicine in any meaningful way since 1989, being permanently on television and spouting the government guidelines and spreading misinformation for the last two years, especially about numbers in hospital that had Covid and were unvaccinated.

Since returning to normal, i.e. the poor service before Covid, for many it has deteriorated further, yes there are (if you are lucky) still surgeries operating in a manner that benefits the patient but increasingly they are not, and one has to ask how come those can perform at a near normal level as opposed to the majority that can’t or wont.

The government statement that two-thirds of GPs are working just three days a week, confirms what many of us have observed; though there is no mention of those working just one or two days a week, and I do actually know of one of the single day variety, not every week but most: she and her husband, a surgeon, spent the best part of two years not working or just turning up now and again, and now normal service means he is away working while she does a day a week. My own designated doctor is now doing two days a week at the surgery, as against the previous one.

The same surgery has eight doctors on its books yet on the infrequent visits there by me and others only two plus a duty doctor can be physically seen to be there at any one time. The large waiting area with just three or four waiting gives lie to the phrase we are back to normal: pre Covid you could not get an appointment easily but the majority of doctors, not all, were in attendance and the waiting area full.

The same goes for nursing staff. Pre Covid they had two nurse practitioners and four nurses on duty most days; now, a visit for a blood test my wife has to have on a regular basis was with the only one on duty or working - she said it was because of Easter! And they now have no nurse practitioners.

Last time the staff were not seeing people for blood tests, health checks etc. they were out helping to give jabs to people for extra income…

We now have the BMA proposing that surgeries will only be open from Monday to Friday between 9 and 5. Ours is only open those hours now with a lunch break, so what is new?

Another doctor interviewed on TV used the 'burnout' phrase to defend the slating many GPs are now getting. When asked how that could be if they are only working three days he referred to 12 hour working days as the problem; that is still only a thirty-six hour week if true and hardly likely to create burnoout.

This all goes back to before the pandemic. Many GP surgeries, for lack of a better explanation, have used the pandemic as an excuse to cut back their activities further. Yes, we are lacking GPs on a ratio of doctors per thousand people as compared to our European neighbours; that is not the fault of the patient who still pays for an ever-diminishing service: governments are at fault for that.

You cannot have an ever increasing population without catering for it and successive governments have failed to do anything about recruitment and training of extra doctors for decades, and everything else; now that fact is coming home to roost.

But that does not give the current protectors of the infirm (!) the right to cut their hours as they already have and receive the same salaries courtesy of the same patients and tax payers. Much of this goes back to the contract that they got from Blair who just gave them everything they asked for without any questions asked or consequences.

With that in mind and the fact they are in the top flight of pay compared with their European neighbours what is the problem? It's not pay or hours any more. Being paid for patients on the books should be scrapped; our surgery with the same number of GPs on its books has an increase in patients over ten years of roughly 50% The complaint that patients waste appointment time with trivial problems or no problems is valid, but the doctors who complain of this have never pushed for an appointment fee that would weed out that particular problem; a fee like that is normal almost  everywhere else in the world and there are no problems getting an appointment.

The NHS gives the impression that it has no will to change in any way that will help the patient. It  continually blames underfunding which has been dealt with in previous articles by many who know more about it than I do. If there is no change in the areas that are continually highlighted it will simply disappear, or will it? Remember the 1.3 million who work for it.

So how about our elected representatives getting their collective fingers out of their backsides and doing something about it? Vague promises of more doctors in ten years' time does nothing for the poor sod waiting three years in agony for a knee replacement as in this area and not being in a position to afford to go private and have the operation performed by the same burnt-out doctor; at this moment in time there is something completely immoral about that.

Over the last few years I have  been able to give stories of incompetence at all levels in the NHS. The bureaucracy has increased at the expense of patient care and unneeded positions are still being advertised and filled, the money for which could be better spent. I have spelled out that side of things before, and so have many others.

The latest tale of woe came last week from a close friend of the wife who lives in north London where she has resided for over forty years. She never had a problem getting to see a GP at her local surgery until four years ago when they amalgamated with two other surgeries to create a ‘medical centre’ (oh, the familiarity!) since when she has to get through the gatekeepers in the morning and failing, try the following morning, ad infinitum.

She has been suffering from shooting pains in her back whenever she moves and can hardly walk. It has not gone away and after three weeks of this persevered on the phone and got a telephone appointment.

The doctor phones and she gives an account of the problem, he immediately says it’s arthritis; she replies I don’t have arthritis; he says oh, it is common in people who are getting old and suggests she rest, which because she can hardly move is what she has been doing anyway; and that was that, really.

No sending for examination or an x-ray which without even seeing someone in person would be the only way one could say that arthritis was the problem. This dismissive flippant dismissal with phone consultations is anecdotally becoming more common, making the process completely pointless.

Footnote to this: the pain did not go away, she went private for a consultation and was sent for an x-ray: no arthritis - a suspected trapped nerve, collapsed disc, but a scan will tell. This is the second friend who because of a useless GP has had to go private at that level to discover the truth about a problem. Not only is it not good enough and a disgrace but we who pay should be able to claim back the costs from the NHS for failing to do the job they get paid for in the first place. Once again in that same situation in many other countries they can claim because they have an insurance input; here we have to put up with whatever is deemed good enough at the time, which now is not much.

And can anyone tell me why the surgeries are still carrying on with all this mask insistence when my own experience at the local hospital and others shows many medical staff are not wearing them? We now, because of the media and endless NHS mandates, have a substantial percentage of the population that will be wearing masks forever. These same people actually believe that not wearing a mask is risking everyone else's health despite being triple/quadruple vaccinated.

Mark Steyn’s blistering opener on the results of booster jabs is worth watching. Several medical professionals and a statistician have attempted to query aspects of what he said but the essence of what he shows stands up.

And just why are young children being urged to get a jab for something that doesn’t affect them in any meaningful way with something that has no long term testing results and won't for some time?

On the same theme,  this has to be one of the scariest videos by a total waddock that I have seen, and there are plenty of them. He and the grinning selected nodding donkeys on with him are a total disgrace. This has to be one of the most insidious propaganda videos of recent times. We haven’t quite reached that level here but not from lack of trying; I have seen quite a few of our medical professionals even at the fag end of this pandemic still urging jabbing every three months into the future and mask wearing the same.

So once again the NHS rightly claims it needs more front line staff while refusing to reduce the over bloated bureaucratic areas, or consider any reforms. What with the country saddled with enormous debt and inflation now a major problem it could be that the NHS becomes unaffordable in its current form. A paring back to basic healthcare may be the only way it can survive and have any relevance to people, because in its current form it is rapidly becoming an irrelevant behemoth that still devours huge quantities of taxpayer money.

FRIDAY MUSIC: Kate Price, by JD

 Music from Kate Price who is a hammered dulcimer player and vocalist born in Salt Lake City, Utah. Price's music fuses folk music with elements of classical, jazz, and ethnic music, using instruments from around the world.

https://en.wikipedia.org/wiki/Kate_Price_(musician)

This is her web page but it does not contain very much information and seems to have sort of faded away in around 2015 or 2016 so I have no idea if she is still recording and/or performing or if she has moved on to other ventures. I bought a couple of her CDs more than 25 years ago, can't remember how or why I found her music but it has retained for me its ethereal charm.
https://www.kateprice.com/home

Sonatina Montenegro - from the album sleeve notes:- "... dedicated to the memory of Milan Obradovich, an elderly Montenegran villager who spent many years of his life in a concentration camp. He taught me many things - what it is to savor life, how to dance with joy and the healing power of love.

The first movement is a traditional song. The second and third movements are based on dance rhythms from Macedonia and Bulgaria."

EMAIL FROM AMERICA (9): US medical price-gouging - you really want this for the NHS?

Tracking the chaos...

I came to the US from the UK in 1978 at age 21. Since I was relatively healthy growing up, I had only had minor experiences with the NHS, including a couple of visits to the emergency room for injuries.

I did see the mediocre treatment that my father had in an RAF hospital over 18 months of confinement in the 1960s, and remember by contrast the excellent treatment that my mother received when diagnosed with diabetes in the early 1980's.

All in all, it seemed to be a decent system for most people.

That is why I have been surprised to see so many negative comments about the NHS, and praise for private insurance.

All that I can do is to offer a different set of observations from my adoptive country.

Prior to the Affordable Care Act (aka Obamacare), we had the following:

• approximately 10% of the population too poor to afford insurance (and not granted it by their work), and too rich to be on Medicaid
• some insurers kept up to 54% of premiums, with huge incentives to refuse payment
• maximum lifetime benefits, amounting to 10-15 years of treatment for something like hemophilia
• refusal to cover 'pre-existing conditions', which could include anything from pregnancy to cancer risks

The ACA has not been a panacea, but everyone now has access to at least a bad policy. All must cover pre-existing conditions, and do not have a maximum lifetime amount. In addition, children can stay on their parents' policies until age 26.

That said, the costs for some relatively simple events can still be catastrophic even with 'good' insurance, and medical bills still cause up to 60% of bankruptcies.

One remaining problem is that of 'out-of-network' providers. Suppose that you need to go to the Emergency Department, and go to the hospital which your insurance requires. Without your knowledge, any of the doctors who treat you might not be contracted with that insurer, and you could receive a bill, weeks later, for thousands of dollars.

Or, as happened with our first son, your specialist might charge an 'unreasonable' fee, which you would only find out long after the service is performed. Our eventual bill for a normal c-section was $10,000 because my employer had contracted with a mediocre plan.

Scroll forward to 2017, when I had heart surgery. The bill for a 3-day stay in the ICU was $150,000, not counting the surgeon, anesthesiologist etc. Luckily, I had good insurance at that time, and our cost was 'only' a few thousand dollars. A month later, my insurance changed, and the deductibles and co-pays for my rehab therapy alone were almost $10,000 in a few months.

Right now, we have excellent coverage, so covering my medications at $6,000 per month is no issue. A slight change, and the cost to me could be on the order of $1,000 per month, which is coincidentally the cost of those same medications to the NHS.

In short, the US medical system is phenomenal if you have enough money or just have minor health issues.

Sackerson adds: for more examples of the US medical industry's exploitative practices, see here: https://www.instantlymodern.com/trending/overpriced-essentials-horrifying/

How volcanoes ended almost all life on Earth

 

'Permian-Triassic Boundary, notorious for being the most devastating extinction event in the planet's history (95% of life wiped out in a geological blink). It is located at Austinmer, a coastal suburb between Sydney & Wollongong, Australia.' Source 

About 252 million years ago the Permian–Triassic extinction event killed off the majority of Earth's species on land and sea.

At this time most of the world's landmasses were gathered into a supercontinent (not the first) called Pangaea:

https://cdn.mos.cms.futurecdn.net/RYzEqrgfyQPNGyeX7Wrh7f.jpg

It's thought that the cause of the 'Great Dying' was volcanic activity in what is now Siberia (at the top of the above picture.) Great volumes of 'greenhouse gases' were released into the atmosphere.

As the atmosphere warmed up - some say to well over 100°F across Pangaea - so did the oceans. Warm water can hold less oxygen than cold, so oxygen levels dropped. Marine species in cooler areas north and south, which were used to oxygen-rich water, asphyxiated; tropical species, which had already adapted to cope with less-oxygenated water, were more likely to survive.

As the oceans became less hospitable amphibians, which had dominated the Permian period, were displaced by

'reptiles—notably the archosaurs ("ruling lizards") and therapsids ("mammal-like reptiles"). For reasons that are still unclear, the archosaurs held the evolutionary edge, muscling out their "mammal-like" cousins and evolving by the middle Triassic into the first true dinosaurs like Eoraptor and Herrerasaurus.' 

- https://www.thoughtco.com/the-three-ages-of-dinosaurs-1091932

Ironically, an earlier mass extinction - 150 million years before the Permian-Triassic event - was caused by falling CO2 levels as a result of the spread of plant life:

'In the Devonian period the world was experiencing super greenhouse climate conditions. This means that it was very warm, there probably were no ice caps, there was a lot of carbon dioxide in the atmosphere (with estimates of 4,000 parts per million).

'"As plant communities expanded onto land to form the first forests, they depleted the carbon dioxide (CO2) that was in the atmosphere," Waters said. "CO2 levels dropped to 400 ppm toward the end of the Devonian. It got colder. There were glaciation events and the rapid change in the climate caused severe extinction in the tropics and the existing coral reefs became extinct." By comparison, the world's current CO2 level is very close to 400 ppm.'

The fall in CO2 levels is thought to have stimulated the development of woody plants and eventually trees. According to this video (see from 3:09), plants that breathe in CO2 through holes called 'stomata' gradually had to hold them open for longer to get enough of the gas; this also meant they lost more water through evaporation via the same holes. Woody structures were better at holding and transporting water though the body of the plants.

A lesson for us is that we need not worry about 'saving the planet' - life adapts. The question is, can we save ourselves?

P.S. This site says that an end-Permian-type ocean warming and marine extinction event is under way now: https://www.sciencealert.com/we-re-pummeling-towards-a-dinosaur-ending-scale-mass-extinction-of-marine-life

EMAIL FROM AMERICA (8): Gerrymandering to get the Right result

Tracking the chaos...

Gerrymandering is the process of drawing legislative maps so that the legislators drawing the maps get to select their voters, rather than the usual definition of democracy.

There are several such strategies employed, most of which have been refined by the use of extensive polling and computer models. One is to 'pack' voters of opposing parties into compact districts, another to dilute the effects of those voters by dividing up the areas in inventive ways.

These can result in districts which look like squashed bugs or slime trails. For reference, here is Ohio's current map:

https://news.yahoo.com/congressional-maps-split-akron-summit-100050951.html
'...Under the House proposal, Akron would be divided into two districts with one stretching into Portage, Ashtabula and Trumbull counties, while another extends into several Appalachian counties south of the city. Both districts would favor Republicans...'

While the tactic has been used by both major political parties over the years, it has been polished to perfection by the GOP.

Such redistricting occurs every 10 years, after the census.

In North Carolina, the state supreme court has just struck down the new proposed maps, on the grounds that they violate the principle of 'free and fair' elections.

In South Carolina, a lawsuit against the new maps is moving forward. The claim is that the maps are racially gerrymandered, diluting black votes. This falls on the heels of comments recorded on the floor of the state house of representatives some years ago, in which exactly this approach was proposed.

In Texas, a lawsuit against their new maps is moving forward, also on the grounds of racial gerrymandering.

In Florida, Governor deSantis signed their new maps into law, despite a lawsuit. Among other issues, the new maps eliminated all black districts in the north of the state in both Congress and the state House.

In Ohio some years ago, over 70% of voters amended the state constitution, demanding that maps reflect as closely as possible the preferences of voters. Instead, the 5 GOP members on the redistricting commission have passed 4 separate sets of maps without either of the Democrat votes on the committee. All of them have been thrown down by the Republican-majority State Supreme Court. The maps give an advantage of 70-80% in seats to the GOP in Congress and the state House, while actual votes in the state are approximately 56% GOP and 44% Democrat. Lawmakers have protested the court's actions, and have proposed impeachment of the Chief Justice.

These are not the actions of a party which believes that they can win fair elections.

EMAIL FROM AMERICA (7): GOP wannabe Presidential nominees in crazy-policy bidding war

Tracking the chaos...

As the US lurches towards the midterms in November, the Republican governors of many states are outdoing themselves in extreme moves, trying to capture the nomination for President in 2024.

Currently leading the pack are Governor Greg Abbott of Texas and Governor Rick deSantis of Florida.

Some of the highlights in Texas include a very restrictive abortion law, which includes an incentive of a guaranteed payday of at least $10,000 to anyone who turns in someone else for 'aiding an abortion', such criminals to include taxi drivers. The accused party, according to the law, will still end up paying all legal fees, even if they are found not to be responsible.

In a similar vein, Abbott has declared that anyone who tries to help transsexual people is committing child abuse, and can also be turned in to the authorities for rewards.

To show his toughness on immigration, he assigned the Texas National Guard and the State police to patrol the border. To date, it has resulted in no major arrests, but has cost several billion dollars, five times the original budget. It has also resulted in many complaints from those on the border about the lack of actual support, and the suicide deaths of at least four guardsmen.

He has also required extra searches of the thousands of trucks coming from Mexico, resulting in backlogs on the order of weeks, meaning that the fresh produce in the vehicles is rotting and costing up to $8 million per day. The net gain has been a handful of trucks pulled over for safety violations, and no illegal immigrants intercepted.

Not to be outdone, deSantis started during the pandemic by firing a statistician who was releasing the actual figures on Covid deaths, rather than those which made the state look better. The suppression of data emanating from the University of Florida is still under investigation. He went on to hire an anti-vaccine doctor whose predictions and pronouncements on the pandemic have proven to be spectacularly wrong as state medical director. At the height of the resurgence, he threatened the cruise ship industry with sanctions if they insisted on Covid passports for passengers and crew. He backed off a little when the industry threatened to move its base of operations from Miami and other Florida ports to other states.

One of his next actions was to demand that the Florida legislature resurrect a WWII-era civilian guard of several thousand answerable only to him. That came on the heels of a new state law which allows people to use their vehicles run over people at protests without sanction.

His latest has been to sign education bills which opponents have dubbed “Don't say gay” and “Don't mention slavery”(including measures to fire teachers, of course). When the Disney corporation, Florida's largest employer, stated their support for gay rights, deSantis demanded that his legislature remove the 'self-governing' status of the 40 square miles of the Disney property.

This will mean that responsibility for all of the roads, water ways, policing, fire service, etc will fall to Orange County, as well as electricity and sewer service to 40,000 hotel rooms and thousands of businesses. Finally, several billions in bonds for the construction will also transfer to the county.

Is this the party of business or is the GOP set to implode?

SUNDAY SUPPLEMENT: Madrid's El Escorial, by JD

 A few brief impressions after visit to El Palacio de El Escorial (on a day in winter, hence the lack of 'real' tourists):

El Escorial is the palace built by Philip II of Spain and is situated about an hour's train ride to the north-west of Madrid and one winter's day we decided to go and do the 'touristy' thing and look around but this is not a tourist guide to the building, it is more of an impression of what we found there.

If you want the history etc then full details are here (in Spanish)

http://es.wikipedia.org/wiki/Monasterio_de_San_Lorenzo_de_El_Escorial

and here (in English)

http://en.wikipedia.org/wiki/El_Escorial

The palace itself is huge and very impressive in every way; here you can see the scale of it:

 

First thing you see inside is a small display of architectural artefacts including some of the original drawings as well as a scale model of the wooden cranes used in the construction. It is easy to forget that before the industrial revolution everything had to be done by hand and lifting heavy stone blocks required a combination of hard labour and ingenuity.

The royal apartments are surprisingly small. The King's bedchamber is centrally placed within the building and very cleverly designed; from his bed he could see the surrounding countryside through two balconied windows and looking the other way he could see through his private chapel to the Basilica's high altar.

All of the rooms are beautifully designed, furnished and decorated but none more so than the Biblioteca. Despite a huge fire which destroyed part of the collection, there are still some 40000 manuscripts and books in Latin, Greek, Arabic and Hebrew. Some of these are open and on display in glass cases. The ceiling fresco is by Pellegrino Tibaldi http://en.wikipedia.org/wiki/Pellegrino_Tibaldi 
and, in my view, is much more impressive than the other frescos elsewhere in the building.

The Pinacoteca (art gallery) is divided into four rooms and displays works from the 15th, 16th and 17th century including this wonderful masterpiece by Rogier van der Weyden:

http://www.artbible.info/art/large/658.html

When I saw this painting I almost fell over because of the disorienting use of colour - red, which is a colour that comes forward, is used as a background and the two foreground figures (and two others on separate panels at the sides of the main picture) are bluish grey which is a receding, background colour. It appears as though there are four statues standing in front of the painting. The effect is startling and is not seen to quite the same effect in reproduction. You need to go and see it for yourself but don't blame me if you fall over; you have been warned!

Down in the Pantheon are the tombs of Spanish kings and various notable figures of Spain's history including the famous Don Juan (http://en.wikipedia.org/wiki/John_of_Austria) - the most handsome man in the world (so I am told!)

Part of the building is still used as a school and you have to admit that is one magnificent playground!

Shortly after this picture was taken an elderly tourist decided to join in, just to show these small boys how.... and with a muttered 'Dios mio' my compañera headed for the chapel to beg forgiveness for my foolish ways.

and only 6½ leagues and 1191 yards back to Madrid:

The return journey was my first and (so far) only ride on a double-decker train. Why don't we have things like that in this country?