I apologize for the absence of updates, but we had several weeks of nothing happening and then a couple weeks of furious picture taking which needed a lot of uploading just when our internet went down harder than a drunk on a spiral staircase.
Then there was a further delay because our landlord needed to send us three different internet access passwords, which really were just one internet password which he gave to me after managing to change a single character three different ways. I'm pretty sure he has some sort of middling dementia. I suppose that explains why instead of fixing the cable when I told him there was something wrong with the cable connection he bought us a new TV... and also why he forgot his car keys here... and why he left his bank documents here... and why he didn't feel bad about giving me his credit card number, birthday, home address and his mother's maiden name...
Ah well.
So here are a few snaps of our visit to the Fremantle anchor museum. I wasn't kidding when I said we were running out of things to do around here. It gets better soon, I promise.
Check it out. It's an anchor.
They aren't attached to the ground but they're heavy enough that I don't think anybody would try to steal them.
Here's a lorakeet. These guys are really colorful. And SCREECHY, gatdamn.
Not like the crows. This is the fountain outside our apartment. There're usually 3, each occupying their own spot on the dais, but 3rd place crow kept flying away whenever I took a picture.
Alright enough with boring pictures.
The real reason why we've been AWOL is that 2 weeks ago Amy and I met up with our friend Shef to go to Bangkok for 1 week. Amy and Shef were there to attend the World Anesthesia Congress. I was there to attend the World Wake Up Late and Eat Spicy Food Congress.
Don't tell the hotel but I broke their curtain rod. It's not my fault I'm a hulking uncoordinated goon by Thai standards.
We got there later in the day on Saturday and found this restaurant recommended by the New York Times.
There are two menus. Spicy...
and Hot & Spicy.
Food in Bangkok is really cheap. 1 dollar gets you 30 baht and each plate costs around 60-90 baht. This was our first night in Bangkok. We didn't know at the time but the area we stayed in is popular for its cheap and tasty food.
After despicing ourselves, we went out and about after dark to see what the neighborhood was like.
Way fewer scooters than last time I was there 20 years ago, but still more than downtown Toronto. Even when you count all the hipsters.
Late night Siam Square Durian. In the stinky, stinky flesh.
Would you get a massage from Miss Puke? I read that everybody speaks English in the city but I didn't meet many people who did. This will be more of an issue when you see their t-shirt slogans later.
Next morning we decided to take a riverboat to see a few temples and the Grand Palace.
Central World is a massive mall attached to the hotel where the conference is. That's it to the left. It's like Yorkville if it was 7 stories with a 50 floor rooftop bar.
Out looking for breakfast our first morning before heading off to see some temples.
Waiting for a BK bus.
Drivers are so courteous here they share lanes with at least one other car and as many tuk tuks as possible.
So many Buddhas. Even on our way to see some Buddhas we ran into a bunch of Buddhas.
I can't see the Buddha for the Buddhas.
The two most popular temples, Wat Arun (Temple of Dawn) and Wat Phrakaew (Temple of the Emerald Buddha) are visible from the river, as is the Grand Palace. There are several riverboats that offer get-on get-off services for the day.
Decorating the front of the longtail boats for good fortune and to honor the river spirits.
Most of the boats on the river were driven by modified truck engines, rather than dedicated marine units.
There are seven kinds of offences. In the following list, pacittiya is not so serious and all a monk has to do is confess his fault to the abbot or at least two or three other monks.
-If a monk drinks intoxicating liquors, it is a pacittiya.
-If a monk tickles another monk, it is a pacittiya.
-If a monk swims in the water for pleasure, it is a pacittiya.
-If a monk frightens another monk, making him scared of ghosts, it is a pacittiya.
-If a monk, having shared a robe with another monk, uses it without the other party having relinquished his part-ownderhip, or given permission for its use, it is a pacittiya.
-If a monk hides any of the possessions of another monk, these being the bowl, robes, sitting-cloth, needle case and belt, even as a joke, it is a pacittiya.
I imagine April Fool's day is a somewhat muted affair at the monastery. Getting drunk? That's a pacittiya. Tickle fight? That's a pacittiya. Committing pacittiya? You better believe that's a pacittiya.
Wat Arun - very impressive in person. It's a lot bigger than pictures would make it out to be.
First stop off was the Grand Palace. You're not allowed to enter without wearing some sort of full leg covering, and there was no shortage of enterprising sarong vendors at the front to point out your bare leggedness which they will very kindly help you with.
This building houses the Emerald Buddha, which actually isn't made of emeralds. At least it comes in a nice building.
These pointy adornments of the roof are chofah, which represent mythical creatures known as garudas. A garuda is 50% human, 50% bird, 100% awesome roof decoration.
Seriously, look at these. Who wouldn't want to live in a building with a roof like that?
Soffit of the ubosot housing the Emerald Buddha.
Structural timbers holding up the roof. The security guards make you take off your shoes when you walk under the roof. For some reason, security guard shoes are allowed though...
Up close on the mosaic inlay on the exterior walls.
Nagas, half snake/humans, the sworn enemy of the garudas.
Just another day at the Grand Palace for this garuda.
Killing nagas and hanging with his peeps.
Unfortunately, no pictures of the actual Buddha are allowed. This particular Buddha has different garments depending on what time of year it is. This is understandable cause it was hella hot that day. April's the hottest month in Thailand. Also we had to wear pants on the temple grounds. I wore scrubs over my shorts and even then they were soaked through. Everywhere I sat there was a big sweat buttprint.
This is a stupa, which represents different stages in the life of Buddha. I think this one represents nirvana/death of Buddha.
Amy and Shef getting stupa-fied
This massive mural encircles the entire perimeter wall.
On the way out of the Grand Palace we ran into these two Yakshis guarding the temple gates, presumably to ward off any pantsless trespassers.
I could have used one of these Thai snow cones. Not a great picture but he's planing a block of ice with a stationary mandolin type apparatus.
This is how hot it was that day: One of the scams we heard of before we left was one where they tell you the location you want to see is closed for some made up reason. Then they offer to take you to some other location just as good, except it's way over on the other side of town and they'll charge you a hefty fee once you're there. One guy saw Amy looking at a map and tried to scam her. "Wat Arun closed half day. You come with me... I .... show you....ah..." Then he just walked away. Five minutes later he came back and said "I show you temple... ah... eh..." then just turned around and went to sit under a tree. So hot even the scammers can't be bothered to scam properly.
Wat Arun from the opposite bank.
2 dollar ferry ride across the river to see the Temple of Dawn.
These statues reminded of some Chinese statues I've seen before. I guess there must have been some common ancestry to their art styles.
So many Buddhas...
The main spire represents Mount Meru, a mountain that exists at the center of all universes. It's covered in porcelain and seashells.
The main spire is 250 feet high. You can see the ladder leading up to the top. I'm sure they give the job of cleaning bird poo off the porcelain on the main spire to the new guy.
CAW
Each terrace of the spire represents a different level - the first, all worldly realms. the second where all desires are gratified. I don't know what the last terrace represents because we only got to where my desire to climb further was gratified, then we left.
Crazy steep on the way down. I felt like a baby who broke through the toddler fence on the stairs.
Not a lot of room for your shoes, but a lot of room to fall.
Porcelain on the Wat Arun spires.
The next day while Amy and Shef were at the conference I decided to see the Queen Saovabha Memorial Institute Snake Farm. This is where a lab has been established to produce snake antivenom. Basically, they round up a bunch of poisonous snakes, stick em in a box and milk them for all they're worth. Just like Independence Day. You catch them, study them, then use their own technology to blow up their spaceship.
I think this one was a king cobra. They have very large occipital scales. Even though he wouldn't look at the camera, the nice thing about these snakes was they were all fairly active and moving around. Not like the snakes at the Science Center who lie under a rock so you can't see them.
There wasn't a lot of information on the displays where the snakes were kept. I don't know what type of snake this is, but presumably they're all poisonous.
This guy's skin looked like a china bowl.
It's not the real Whitesnake, just a cover band.
Snake venom extraction! The main snake handler is on the left with his three assistants to the right.
The first snake ready to be milked.
First they use this wooden ruler type device with a plastic shoe on the end of it to isolate the snake's head and pin it against the table.
Then they can grab it just distal to the head so it won't bite anybody.
The poison glass is prepared...
LET THE ENVENOMING BEGIN.
And for some reason, this snake didn't feel like deploying its fangs today. Next snake then...
squick
This snake didn't want to bite either. On to snake #3.
Finally some action.
It's sort of crazy how green/yellow the venom is. It even looks poisonous.
I wish I remembered more of the names... I think this may be a flying snake but I could totally be wrong. It's venomous but only if you're a frog or other small animal.
Oriental rat snake. Eats rats whole. Also hyperactive. I'll post a video later showing how much he moved around. Looked like he was trying to get at the child standing next to me. Such a ratlike child...
There was a snake demonstration after the venom milking, but it wouldn't have happened for two and a half hours. I wasn't willing to wait that long in the heat. Needed to find somewhere to take a break. This ramen shop on the way home wasn't too bad.
I guess some things are universal.
After meeting up with Amy and Shef, we were due to see Huong and her boyfriend at the conference hotel for dinner. They had pretty nice facilites at their location, so we took some time to poke around the upper deck.
BTS Siam station traffic. They have really long lights here. Like in the order of 5 minutes +.
Food vendors gearing up for peak selling hours - night time.
The merchandise looked fresh everywhere I saw it. No running water though.
Still, virtually every cart I saw had some pretty brisk customer turnover.
Ultraman in a mall, for some reason.
27th floor on the way to meet Huong and her boyfriend in the Central World hotel.
Central World candy shop - pulling candy in front of yo face. I don't know if those kids ended up getting some or not. They were as content as children would have been in a confectionary purchasing establishment.
50th or so floor of the hotel
Somehow a gecko made it all the way up to the top of the tower.
Oh I didn't see you there. Don't mind me. Just sticking to the window on the 50th floor . Ordinary day in the life of a Bangkok gecko.
If I had a halo, it would have to be a square one.
Street nightlife picking up next to our digs. Despite how busy it is in the daytime, at night it's even more crowded.
The next day I was on my own again and I decided to buy some new shorts since mine were coming apart at the seams. I asked this tuktuk guy how much to get to the Pratunam market and he quoted me 3 dollars. Pratunam was at least 20 minutes away.
Rode for about 20 minutes in really slow traffic.
Then got off and he drove away before I realized he took me to Platinum mall, which was pretty much less than 100 meters away, instead of Pratunam which is substantially farther. Ah well. I'm sure I'm not the only one to get hosed by a tuk tuk driver.
Congee for breakfast. Would take this over eggs and bacon any day.
Crunchy crepe desserts sold in stalls all over town.
I never realized where we ate breakfast most days because it was so cheap and good was actually known everywhere for being cheap and good. The area looks kind of run down but I suppose that's why it's cheap.
wut the
I didn't make it to Pratunam market but the three of us headed out on Saturday to the Chatuchak market, the biggest weekend market. It is IMMENSE. We spent half our time exploring probably 10% of the total area, and half our time trying to figure out how to get back to where we started. Wikipedia says it covers 35 acres, and I don't doubt it.
Figuring out the BTS train system.
Never a shortage of food at a market.
Typical stall in Chatuchak. Everyone loves the king. Disparaging the king, either through spoken word or through action is a crime. They also play the king's anthem and show a montage of the king's photo ops before movies. Everybody has to stand like it's the opening ceremonies of a baseball game. Very different.
I tried to buy from this guy but all he did was show me his fangs and turn invisible. Couldn't bargain to save his life.
Taser for sale. "Honey, I'm just going to pop over to the weekend market. Do you want anything" " Taser. We're all out of taser." "Oh yeah, I'll pick one up for you." I thought it was fake until the lady came over and buzzed it for me. It's definitely real. Zap crackle pop.
Amy dress shopping. "I'm looking for something my husband will like"
"It's not for me."
"It's for him."
There are a lot of people wearing t-shirts that I don't think they understand. I saw a guy who was wearing a shirt that proclaimed that he was addicted to "roosters". I don't think he actually had a "rooster" addiction, and even if he did I don't think he'd want the world at large to know. Judging from the number of people who spoke no English, I wouldn't be surprised if people wore these without any idea of what they mean.
Getting a Thai massage. I'm here because it was air conditioned and the temperature was too damn high.
I was wearing a golf shirt but as soon as I got to the market I looked for something without sleeves to buy. Couldn't take it anymore.
Got here on the shop's opening day. I think it was 8 dollars for an hour of massage? Not a bad deal.
The girls seemed to be getting a pretty good massage. I don't know if my masseuse was trying to hurt me or not but she had really strong fingers. And she used a stick to really dig into the feet. Nobody else used a stick. Why do I get the stick?
It was just nice to get out of the heat for an hour.
They definitely do sell butterfly knives here, right next to the machetes, katanas, and for some reason a softball bat. I take it the vendor doesn't intend for it to be used in softball.
Pithy.
From the pet section. The whole market is divvied up into different districts and departments.
Chef Tony in charge of the paella.
Creepy good luck cat window.
One of the things I was looking forward to the most about BK was seeing some Muay Thai. The biggest stadium was just down the road from our hotel so on our last day there we headed over to see a few bouts. I gotta say, I was not disappointed.
Couldn't find a way above the ropes, so unfortunately they're in pretty much every shot I took. Stupid autofocus kept putting the fight out of focus too, choosing instead to bring out the detail in the rope manufacturer's label. Frig.
Nice foot punch.
I think these guys weighed around 120lbs each. So basically one of me if you take away all the churros and fat pads.
I cringed every time I saw them check a kick with their shin. I don't see how taking a shin on the shin helps anybody. It's like saying I really don't want to be punched in the gut so I'll just block it with my face.
I read somewhere that vaseline application in Muay Thai was illegal but I saw both corners putting it on pretty liberally so I suppose it's not a big deal.
The next few rounds took place at close range and involved a lot of knees and jockeying for clinch position.
From this point on it was all clinch. Blue trunks looked like he was going to lose if it came to a decision.
Textbook kick checking.
No real KO yet, just some illegal judo sweeps.
Good clinch position, ready for a knee to the face.
I glanced down for a split second to check if my manual focus was working or not and I missed the KO. Red trunks blasted the guy in the chest with a front kick and he went down hard in the third round and didn't get back up. Unfortunately I didn't get it on photo or video.
Way Khru Ram Muay is a ritual performed by each fighter before competing. It often is individualized and can give hints about where and who they have trained with.
For the most part, each fighter seems to follow the same basic outline which includes walking around the ring and bowing.
Last minute prepping.
ROUND ONE. FIGHT.
It's like watching two mini Sagats from Street Fighter go at it, except fewer fireballs and eyepatches.
Well executed block.
Not so well executed weave.
Most of the times a fighter fell to the mat were because of tripping and slipping more than actual knockdowns.
This pair seemed to prefer clinching after the first round. The crowd was CRAZY. Every time one of them landed a knee their corner would erupt in a "OY" cheer. I'll post a video on it later. Really gets you into the fight.
Solid kick to the ribs.
This one in the blue trunks managed to kick so high his leg went over the ropes and he was sort of stuck there for a second. They're flexible like ballet dancers. In a ballet of brutality.
Getting attended to by the cutman.
That's right ladies. Try to restrain yourselves. Please. (Now that I think about it, I wonder if that excludes women from boxing at all if they're not allowed to touch the canvas.)
All the necessities to fight right here. A wheelchair, a stool to sit on, your water supply, a big steel tray to catch your drippings, and a spit/vomit funnel.
And I'm not 100% about this, but it looks a lot like a jock and some sort of sacred jock holder.
2nd row seats. We couldn't get any bleacher seats because they don't allow pictures in that area. Apparently it's where all the gambling takes place, which is illegal in Thailand. Don't trust themselves not to show up splashed all over someone's Pinterest page engaged in illicit conduct .
More Way Khru Ram Muay
Spitting water on each arm and leg.
Hard lick to the thigh. You could hear the sound of the kick impacts echo.
Getting stretched and massaged between rounds
It was hot just sitting in the stadium, let alone getting boxed for 4 rounds. I don't have any idea how they managed up there.
In one sense, you're both winners. In another, more real, sense, red trunks is the winner. Mainly because he beat you, the loser.
This was the best round of the night. Unlike the other rounds, this one had none of the usual clinch and knee business. Most of the time was spent lobbing high risk kicks and punches at each other from mid range with good energy until the bell. Red trunks kept his hands low, inviting kicks to the face throughout the round but managed to slip and effectively counter virtually all of them.
Another slip. Any close and he'd have toenails in his eyelashes.
A fresh fighter awaits his turn in the ring.
Last day in Thailand. Nothing much left to do in the city except a last minute walk through the mall.
Some white guy owning a Thai singing competition in Central World.
Double swiss cheese gelato! It had real cheese in a small dice in it. Surprisingly palatable! (the brown stuff is chocolate... insurance in case cheese was gross and needed dilution)
My series comparing anaesthesia in Australia to anesthesia in Canada continues with a blurb about their training system, and how everything is, well, backwards.
Even the stretchers are positioned backwards in the recovery room.
Introduction and disclaimer
I confess, my first impressions of Australia were not positive. Even before arriving in Australia, I got a strong impression that everything was redundant and didn't make any sense.
Example #1:
When applying for all the administrative stuff, the Australian Health Practitionner Regulation Agency (AHPRA), which is their national regulatory board, asked for photocopies of my original medical degree and other relevant documents to be notarized and stamped by a notary public, and then electronically scanned and sent by email to them. So they wanted me to prove that copies were true to the originals, then these notarized copies were again copied by scan, with no proof that they weren't tinkered with.
Example #2:
AHPRA asks for passport sized ID photos to be sent by mail. They lost Chris's photos and did not admit to it. They also asked him for high school transcripts to prove that he went to high school in Englsih. They had received his passport info, medical degree and certifications from Canadian medical schools and organizations. But they needed proof that this Canadian trained, born, and raised doctor went to high school in English. For some reason, they did not ask me for high school transcripts (ie, my name doesn't sound that Chinese but my husband's does). They might have freaked out if they saw my French-language high school transcripts.
Example #3:
Opening a bank account requires: ID, proof of a job, proof of an address in Australia. So logically, I bring my passport, job contract, and tenancy agreement. I then give the bank my money to hold safely. The next day, the bank says they need "bond papers", which requires me to give a lump sum of money to the treasury to insure that I won't wreck the apartment. So they lock my bank account and the money I thought I could keep securely, because a signed tenancy agreement with the landlord's signature is not enough. I thought I was stuck because I no longer had access to the money I could have used to pay the bond. I then went to my hospital administration office and get the person working there (a university student on a summer job) to sign a form saying that I am employed at the hospital and living at this address. That letter alone holds more weight than a tenancy agreement in the bank's eyes, and they finally unfreeze my account.
Example #4:
"Dim Sims"
Pardon me, but wtf are these?? Worse than the invention of North American "chicken balls" and "egg rolls", these "dim sims" illustrate either some lack of basic culinary knowlege or just the casual racism that many had warned me about. Overall, I could not help but feel both offended by this major grocery chain and embarrassed on their behalf.
But I digress... this is the background with which I started my "Great Australian Adventure". These experiences coloured my initial experiences doing my fellowship in Australia.
Anaesthesia training in Australia
1. How long does it take?
Australian anaesthetists undergo a different post-graduate training system than in Canada. Aside from the half of them who are U.K.-trained, the Australians go through roughly 7 years of post-graduate training before they are "fully qualified". Their training is overseen by the Australian and New Zealand College of Anaesthetists (ANCZA). After medical school, the trainees do one year of "internship". They then apply to do general "resident medical officer" (RMO) jobs in different specialties for at least 1 year. Many people do more than 1 year of RMO work. After the first 2 years of general post-graduate training, they can apply to ANCZA to complete a 5-year specialist training program. Once in a specialist program, trainees are known as "registrars". They are designated as "junior" or "senior" depending on their stage.
ANCZA training is broken down into 6 months of "introductory training", 1.5 years of "basic training", and 3 years of "advanced training". They have 2 major exams: "primary" and "fellowship". Both consist of written and oral sections. The primary exam is done at the end of basic training. It is focused on basic anatomy, physiology, pharmacology, equipment, and statistics. I hear that it is the most difficult exam and 40% of applicants fail the first time. The fellowship exam is done in the 4th year of training, so one year before fully completing the program. Although the 5th year of training is still a "senior registrar" year, it is also known as the "provisional fellowship" year in which subspecialty training can be done. So a fellow here is still a "senior reg".
2. Trainees are "real doctors"
As a contrast to Canada, Australian doctors are still seen as "real doctors" by the public. So the registrars are seen as doctors and usually perform with little supervision and often don't need to report to their consultants before making big decisions.
For example, senior registrars in surgical specialties will book operations without seeking approval from their assigned consultant. They also perform simple operations without the consultant ever seeing the patient or the outcome. They have their own assigned "registrar lists" of operations. This means the consultant doctor doesn't have to be in the hospital while the registrar is operating.
The same holds true for anaesthesia trainees. But there is a discrepancy between normal working hours and out-of-hours supervision. During the daytime, the trainees are heavily supervised. There is usually one consultant and one registrar assigned per operating theatre. After hours and on weekends, the consultant goes home, and the registrars run the theatres.
At my institution, they have an interesting way to handle weekend coverage. On the weekends, the fellow and the consultant start the morning running one theatre each. There is a junior registrar who carries the pager. At noon, a senior registrar comes in to relieve the consultant. The consultant then goes home if everything is under control, and is on-call from home until the next morning.
3. Safe work hours and the 40-hour work week
Trainees in Australia follow normal work hour rules. Gone are the days of 24-hour shifts. Trainee doctors are employees of the government. The government is obliged to pay "penalty rates" to their employees if they work more than the standard 40 hours per week. This usually means 1.5x on Saturday, 1.75x on Sunday, and 2x on public holidays. So it is cheaper for the government to employ more doctors than to pay fewer doctors overtime.
This has led to staggered registrar shifts, which are usually no longer than 10-12 hours. Overnight, the junior registrar is the only anaesthetist in the hospital from 8pm to 8am unless they are running a theatre. If they need to do so, they call the senior registrar who is on-call from home.
Overall, compared to the Canadian system (or at least in Toronto), it seems like the Australian training system is longer in number of years, but they work fewer hours per week. In the end, they all seem to be very well-trained.... aside from the fact that they always need an anaesthetic tech to set up their equipment.
A consultant chillaxin' on the massage chair in the "tea room"
4. Redundancy: Power in numbers = more safeguards?
There are always lots of people around.
On weekends at this institution, we run 2 theatres: one for orthopedic trauma and one for all the other urgent cases. There are always at least 3 people from the anaesthesia department around. In addition, for every theatre running, there has to be one anaesthetic technician, as per ANZCA guidelines. The techs need their breaks too though, so they need a relief person.
So for 2 operating theatres, by noon on a Saturday or Sunday, we have the following staff:
1 consultant, 1 fellow, 1 senior registrar, 1 junior registrar, 3 anaesthetic technicians... and a partridge in a peartree. The senior and junior registrars would also each be relieved by the night-shift people.
Total = 7 people from anaesthesia for 2 operating rooms. My guess is that this gives the consultant some comfort to go home. Plus, although the theatres are supposed to start at 8am, the surgeons are usually not around, so we usually don't really start until after 8:30am.
This is a contrast to where I was working in Toronto. We would start with 1 operating room, with 1 staff and 1 resident. We would only open a 2nd OR if we really had to, and call in another staff anesthesiologist for that one. We would also only call an anesthesia assistant if we had horrible difficult airway issues and poo were to hit the fan.
So for 2 operating rooms by noon on a weekend, we would have:
2 staff anesthesiologists and 1 resident. = 3.
5. Redundancy: Power in numbers or too many resources and money spent?
Some people may like to get paid to do nothing. I thought I would, but I don't. Overstaffing seems to be a more common occurence than understaffing in these parts.
This past wednesday, I had a half-day for office work, followed by an ERCP list. In fact, the ERCP list was staffed by both me and a consultant anaesthetist (and a tech as always), for 2 procedures in which we just had to provide sedation. Redundancy. A consultant, a fellow, and a tech for 2 sedations. If the endoscopy suite were quite remote from the main theatres, it might be justifiable, in case you need help quickly. But it is actually located directly between the theatres and the anaesthesia department.
The next day, 2 theatres were closed due to "lack of funding", which probably means "no nurses". I was rostered as "available" but not assigned to do any work. I was expected to be in the department so I was there all day. I also noticed at least 4-5 consultants in their offices in plain clothes.
If this situation were to happen in Toronto, we just wouldn't get paid in a fee-for-service model since we are not doing clinical work. However, in the public health care system in Western Australia, all doctors including consultants are salaried. Seeing the salary vs. fee-for-service models, there is definetly a difference in motivation and efficient use of resources. Indeed, I get the impression that this is a very wealthy state and government if they are paying doctors to sit around and wait. It's a far cry coming from a Canadian province where the government decided to unilaterally cut doctors fees.
Surgeons are not doctors
There is a reason why surgeons loose their medical title "Doctor" and become "Mister" instead.
The surgeons here only take care of surgery. They don't write post-op orders. If they are in the public system, they have RMO's around to manage the ward patients. So at the end of an operation, the anaesthetist writes orders for IV fluids, analgesia, and anti-nauseants, which continue unless written otherwise. The surgeons will review their patients only the next day.
The senior orthopedic surgeons are a different breed. They really want to be technicians and only technicians. The head honchos refuse to come to the theatre to perform a pre-op checklist with the nurses and anaesthetists. They believe their only duty is to show up once the patient is asleep and fix some bones. Because of this culture, the trainees don't learn how to prepare patients for surgery. They often don't order bloodwork, ECG's, or tell their patients to fast for 8 hours before surgery. That's the job of the anesthetist. This has lead to the culture where all patients going for surgery need to be seen pre-operatively by an anaesthetist, no matter how uncomplicated they are.
Ortho vs. Anaesthesia: an international new classic with some truth to the story.
I have a new appreciation for our Canadian surgeons. Even our orthopods are called "Doctor". They know how to order blood. Kudos to my colleagues who yield both knife and pen.
Since starting work here in Perth it's been hard finding time to write blog posts, mainly because I don't have time to do things to write blog posts about. Also, we seem to be running out of things to do. Perth is a fair bit isolated from the rest of Australia, and we won't be heading out east to see the other sights of the continent until July/August.
In the meantime I've been trying my best to learn how the Australian health care system works here. It's a bit more complicated than I had thought it would be. Before I got here, I thought the most difficult thing to adjust to was the range of exotic animal related injuries I would have to deal with. So far, I haven't seen any box jelly stings, shark bites or koala amputations. Instead, I've been trying to get my head around the way I get paid.
Back home, if you need something medical you can swipe your card, receive your service (albeit slow), and walk out the door. Here, if you're not impoverished or over 65 you're expected to pay extra when you see the GP, somewhere in the order of $60-$65. It feels so strange to tell people "Pay me", and watch them crack open their wallet and hand me a stack of bills. If I tried to do that in Toronto, I'm pretty sure I would be drawn and quartered, College style (College style means Lawyer style. Lawyer style means painfully and slowly).
It takes a fair bit of time to get used to this new system, especially since sometimes you have to decide if you want to charge someone the full $60 for their visit or just bill the government instead, which will net you only around $30. For things like returning to the clinic for results, billing the government makes sense. But other times it's hard to decide, like someone getting diagnosed with cancer. It might make you feel like a heel to charge someone the full rate to find out they have a serious disease, but if you spend an extra half hour with them which puts the rest of your day behind and makes you miss your bus that makes you miss your train that gets you home an hour late, do you think it's worth getting the full price of the visit? Or if somebody just needs to renew their birth control prescription. Here's a responsible adult ensuring they don't need to have repeated abortions which are time consuming, resource intensive and largely avoidable. Should they be penalized for acting like mature members of society?
We met an Aussie GP who said that I should see how my fees match up to what plumbers make, and see if the work I do is proportionate to the work they do for the same amount. Interesting comparison.
The upshot of all this private billing is that it seems like charging people extra to see their doctors really seems to clean up the waitlists. Everyone here seems able to get a specialist visit within a few weeks. People don't show up as often with non-medical problems. They also listen to what they're told. Not everyone, but for the most part they're better than Torontonians. Around here, charging a little extra doesn't just get you money. It gets you respect.
Amy's noticed the same thing. Patients listen when she asks for informed consent, but they never refuse a procedure or ask questions. They just say "Do what you think is best, doc". Their attitude is that they know you're going to do your best and if a complication happens, well, that's life. Nobody meant for it to happen. Contrast this with the culture at home where if a waiter serves someone the wrong amuse bouche they expect to eat for free.
Not every aspect of this private/public system is fantastic though. Turns out an ambulance here costs $700. Sure, some of that is covered if you have private insurance but I'm sure there're a lot of people who don't have ambulance coverage.
At any rate, so far it doesn't seem like the sky is going to fall on anyone if Canadians scrapped their solely publicly funded health care system. Just don't send them the wrong amuse bouche.
Over Easter we didn't get a chance to do much as the train from Fremantle to anywhere was shut down for four days. So we didn't get to really get pictures of anything interesting. Instead, I've stuck together some bits and pieces of things that weren't enough to be posts on their own. Check it.
Harbour from our apartment. This ship is the Costa Deliziosa, a cruise liner which stopped by for a night.
If you're wondering why the name might sound familiar, it's the sister ship of the Costa Concordia, the one that sunk because the captain wanted to impress a girl by showing her how to put holes in the hull with giant boulders.
Couldn't do anything about the massive building in the way but the lights are still nice.
Walkway to board the ship. We couldn't actually get on for some reason.
This is a roll-on/roll off vehicle carrier, which means cars drive on and off of their own accord. This distinguishes it from load-on/load off ships, which aren't built to have vehicles drive on and off. There are also load-on/roll off and roll-on/load off, and they all go by short forms like roro, rolo, lolo etc. It looks like a giant windowless factory built on an ocean. We seem to get a new one every couple of days. I'm not sure if the cars are going or coming but each of these ships carries a BUTTLOAD of cars. These ships are massive.
The beach near our house has a sculpture park. I'm not sure if these are part of the sculpture park or if they serve a function of some sort.
When I first saw this guy I thought hey cool there's a guy catching lobsters. Then I thought man he's really slow. Then I realized it's because he's made of bronze.
