Thursday 31 January 2013

Baker-Bates-isms

For Liverpool graduates of a certain vintage who may still remember the great man;

1.Those DNUKers of a certain age may remember Baker-Bates' advice on retiring from the hospital. It was to buy a dog six months before retirement and on retirement present the dog to the telephonist (the former Liverpool Royal Infirmary switchboard was at the main hospital entrance). "It will be the only one to recognise you when you visit four weeks later".

2. mgbamber ->'I spent a year with Dr Baker-Bates and was well acquainted with 70 Rodney Street and the kitchen at the top where entire cooked chickens were put into a blender and various liquids added to make "soup" in which the bones made an interesting texture. I may be the only person to have left the flat by the webbing harness torque limiter device down the outside wall and then persuaded BB to follow my example.

A favourite comment was that which he attributed to Henry Cohen who was told that Maurice Pappworth had written 'A primer of medicine' to which Cohen was alleged to have replied, "I had always wanted to see my lecture notes in print".

One afternoon at the Providence Hospital in St Helens run by those nice nuns, he pulled the curtains around a patient's bed, then pulled off the bedclothes, exclaiming to us all, "Look, a man attached to a hydrocoele".

Howard Branley may not be old enough to remember Colin Ogilvie who was BB's houseman at one point.'

3. talbot ->'He indeed was a remarkable character. He was alleged to have a Luger pistol left over from the war. He was a consultant physician at several Liverpool hospitals and, for free, at 'The Providence' St Helen's run by the Little Sisters of the Poor, who worshipped the ground he walked on. He was prone to starting ward rounds by climbing on the table and asking "Whose the greatest" to which the nuns would all respond "You are Dr Baker-Bates." Long before they were fashionable, he wore short-sleeved shirts and took his dog on ward rounds. He once discharged his Luger into the ward ceiling.

He had a little doctor's bag which contained the most enormous Queen Square pattern patella hammer and a towel. I saw Sir Cyril Clarke say to him on the Friday afternoon Grand Round, "Ah, Eric, I see you are doing neurology on elephants now". The towel was for opthalmoscopy. He would put it over his and the patients head to produce an instant dark room!

He lived above his private practice in rodney street looked after by a housekeeper, who I managed to call Mrs Willy, after an evening's generous entertainment there (I was drunk). He was prone to manic episodes and the police would often find him wandering the streets at 4am and gently lead him home, knowing who he was. He would wake up his houseman at 4 am other mornings having put the radio by the phone, shouting "Listen to this boy, it's very interesting".

Considered the senior physician during the war, all of the consultants were drafted into the medical corps. So he put all the teaching hospital regs into his Roller and drove around all the Merseyside hospitals, dropping them off in turn with the instruction, "You be the consultant here" and the hospital boards never argued. Fabulously rich, his wife was alleged to have run off with the chauffeur, but, unfortnately the Roller crashed at the roundabout just outside Clatterbridge Hospital. The boot flew open and a suitcase stuffed with ten pound notes scattered its contents all over the Wirral countryside.

He loved teaching and, long after his retirement took clinical pathology classes in the mortuary of the Royal Infirmary and applied physiology classes at the med school. He was very good. He brought in patients to the latter (the other ones were dead) to illustrate some principle, and he paid for the services of a private nurse to tend to them while he taught.

How come there are no teachers around any more who are a little eccentric? I think we are all too boring and serious!

4. dphillips -> 'Ahh the "soup du jour" an endless pot that had things put in one after the other
My father was a butcher in Berry st round the corner from Rodney st and he used to sell BB ox tails mainly for his soup.
He was also medical officer for Guinness and had wonderful bottles ofexport guinness which he then put into a big jug filled it with lemonade and lime!!!

5. davidhewitt ->'Oh I remember him very well in the mid to late sixties. He was very good to me and made me drive his car when I was on his and Cyril Clarke's firm.

I remember one cold Feruary morning driving this four litre Jaguar to St Helen's with him and two other students to St Helens at over 90 miles an hour along the East Lancs Road with all the windows open. As we went over the brow of the hill by Pilkingtons there was a lorry stuck in the road. He yelled at me to stop and told me to change down as well as braking madly. As the gear lever moved he shouted "aeshack meshack and in we go". I managed to stop,.... just.

Once when confronted by a wellknown lady of doubtful character who said to him....

"Eh pot belly yer cock is hanging out" replied without a trace of irony or a glance downwards "Dead birds madam never fall out of their nest".

He often told us to remember to "Choose your parents wisely".

His outpatients were highly unusual for the cake, coffee, fruit and the binocular case concealing brandy that sat on the huge table.

When someone was particularly thick in their reply he would tell us to "get the malaena ready boys" He would refer to Lord Cohen as "The earthly Lord".

He was definitely bipolar, but they really don't make them like that any more.'


Ambergris and magnetic resonance

smell seemingly is a sense NOT actioned by 'lock and key' modalities but rather molecular vibration;


http://www.ucl.ac.uk/news/news-articles/0113/130113-secret-of-scent-lies-in-molecular-vibrations?utm_source=twitterfeed&utm_medium=twitter
whale vomit found on morecambe beach - Ambergris - and base of perfumery;

http://travel.aol.co.uk/2012/08/30/rare-whale-vomit-ambergris-worth-40k/

what is ambergris?;

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

Wednesday 30 January 2013

Meeting Lister house

meeting re creation of provider company
next meet 15th feb with nigel grinstead et al
need for project scoping group to be formed and CCG practices 'buy-in' philosophically and financially.

Friday 25 January 2013

Bee keeping au Naturale

Bee keepers spread diseases, here lies a 'no-touch' technique of looking after bees;

http://warre.biobees.com/

Thursday 24 January 2013

Origami

One doctors way of relaxing, praise be to Fishgoth;

http://www.fishgoth.com/origami/

Wednesday 23 January 2013

DermNZ

a very good website for derm conditions to display to pts [and self];

http://www.dermnetnz.org/

NHS Pension

some maths

LTA 1.5 million  drops to 1.25 million april 2014
AA 50K drops to 40k april 2014

pension grows by contributions + [CPI+1.5% if contributing/or CPI alone if not contributing]

1.25 divided by 23 = Max pension = 54K
40 divided by 16 = Max amount pension is allowed to grow tax free.

ask Fleetwood each year for a calculation of your pension and TFLS for 1995 schemers 23 = 20[pension] +3[TFLS], you have it in writing ! you also have a prediction of the annualized growth if you keep contributing at the same rate ie part of the AA question.

each year you get a reply plot a graph as to the accumulator.

CPI is defined each financial year in september.

for GP's your pension is 1.4% of your total career superannuated earnings.

pension x 23 = your LTA.

ie two sets of equations.

when you defer contributing is up to you.
when you crystallize your pension ie take cash is up to you - if before age 60 you lose about 3-4% each year look up the actuarial figures.

Actuarial tables as of nov 2011;

http://www.nhsbsa.nhs.uk/Documents/Pensions/Early_and_Late_Retirment_Factors_V0.1.Nov11.pdf

some advice from medical-money;

http://www.medicalmoney.co.uk/2012/11/pensions-your-questions-answered/

NHS pension and fixed protection 2014;

http://www.nhsbsa.nhs.uk/Documents/Pensions/Reduced_Lifetime_Allowance_and_Fixed_Protection__V3__03.2012.pdf

NHS pension and individual protection 2014;

http://www.nhsbsa.nhs.uk/Documents/Pensions/TN7_-_2013_-_Employer_Newsletter.pdf

NHS Pension and enhanced protection;

http://www.nhsbsa.nhs.uk/Documents/Pensions/Reduced_Lifetime_Allowance-How_this_affects_members_with_Enhanced_Protection_(V1)_03.2012.pdf

Screening for dementia

rather odd, im all for disease registers up to a point but this is beyond the point;

http://www.bmj.com/content/345/bmj.e8588

beggars the question is the Government dementing?

Locality meeting

DCC - 1-3:15
talks by Finance manager of CCG, PC and QES manager LH.
talks of savings on QP agenda and balanced budgets form PC - one does wonder .....
QES sounds like more smoke and mirrors, and internal incoherence.
No attempt to address burgeoning demand on primary care by speakers.
QP urgent care 'sounded' to see hoe practices are trying to address the requirements, essential tennant was we must keep trying to provide/deliver a quality service.
new planned care lead annointed -SK.
i do wonder how internally coherent this whole pantomine is .... perhaps time for some music .....

Music

Queen - another one bites the dust;

http://www.youtube.com/watch?v=rY0WxgSXdEE

the human league - mirror man;

http://www.youtube.com/watch?v=MMu1T_Tg5Fw

Tuesday 22 January 2013

Funk master

one of the originators of Funky Business;

http://jonasridderstrale.com/index.htm

and the other;

http://www.kjellnordstrom.org/

being bald is not obligatory!

Monopsonies and Monopolies

Monopsony;
http://en.wikipedia.org/wiki/Monopsony

Monopoly;
http://en.wikipedia.org/wiki/Monopoly

Monopsony = HMG
Monopoly = Providers of the product.

the existence of the relationship beholds both parties to understand why it exists and what efficiencies it generates.

to meddle with it creates more inefficiency at potentially greater cost [instant or over time as its consequences manifest].

GMC- Good Medical Practice

The web stem ->

http://www.gmc-uk.org/guidance/good_medical_practice.asp

Friday 18 January 2013

Drs Blogs

Fitz's blog

http://doctorfitz.wordpress.com/2012/12/05/nhs-eportfolio-workplace-based-assessments-in-core-medical-training-are-they-educationally-useful/

sounds like everyones thinking whats the point of 'standard' formats, and that a Blog is the answer.

and another;

http://nhseportfoliorevolution.wordpress.com/

and a rather wonderful one;

http://spoonfulsugar.wordpress.com/

and another;

http://www.eaglehousesurgery.com/pdp_ian/

and Midgleys Anti-Froth !;

http://defoam.net/wordpress/

18th jan lunch time meeting

45min meeting between attendant partners and PM
discussion re wednesday meeting and enacting - also a rolling agenda for both wed/fri meetings and monthly QUEST meets

Thursday 17 January 2013

Quest session 16th jan

1:30 -> 7:30
staff meeting
then partners meeting wrt staff issues - PN - future - Senior partner discussion re merits of position
decided chairman at meeting was an internal need and senior partner titleage was an external 3rd party need, such external needs would be brought to weekly partners meetings and delegated.
finances discuseed re capital accounts of past/current and 'to-buy' in partners.
need liason with accountant etc

Wednesday 16 January 2013

DNUK - Personal excellence tracker

in education fora - define time window - select options clinical/non clinical - select et voila a whole year [if selected] of your posts and what you have looked at and deliberated over.

Thursday 10 January 2013

10th January's 2013, Appraiser support meeting

10 Jan 2013 appraisers support meeting with Dr C.T at DES.
6:30 - 9pm
Talk about current requirement for appraisal revalidation.
Learnt Clarity, RCGP, mag, gp tools = available formats.
Documentation from meet.
Childprotection level 3 = aspiration.
Problems with msf and psq need rigour but poor utility, better to use case problems and analyze responses in real time more evidence for this and therefore utility.