On mothers and caring

I’ve had to bite my tongue in the last few weeks not to comment on some of the injustices I see happen in this world, especially when it comes to family – and especially our mothers. But I’ve seen a TV program recently about child carers of ill parents and my faith in humanity has again been restored! It felt to me so amazing to hear such grateful and selfless adolescents speak of the help they render to their parent and the sacrifices they make in their lives – and yet they are able realise that these things are to help a fellow human being and that the universe isn’t all about them. How refreshing! How amazing and admirable and such mature behaviour from these young souls. These young people spoke not about themselves and not about chores or burdens, but about something that seemed natural and dutiful to them – the way our parents didn’t whinge or throw a tantrum whenever we needed to be fed or clothed as babies, it was just a fact of life that the stronger person looks after the weaker one.

One of the most truthful quotes I have heard in the last week from a patient of mine was that “some parents have great children, and some have children that stay children”. Most of us grow out of the belief that the world revolves around us and we are the most important creature in the universe, but it may take other people up to the day that they have their own children to realise this (if they ever do).

In the last week my older patients have been telling me the stories of how their children did this or that for them or gave them presents in whatever form for mother’s day celebrations. And it’s great to hear. And yet I can’t help but also think of this as a sad thing that a lot of these parents have had to wait 12 months to get this kind of attention from the people for whom they have sacrificed so much time, efforts, money, and opportunities. On days when I feel particularly pessimistic, I think that for some of us offspring out there Mother’s Day should be renamed Hypocrite’s Day. Now, I use that particularly strong word purposely because I believe it is wrong to neglect or ignore a person except for one day a year when the media and commercial entities force us to remember them. I mean, sometimes our parents may have no need for flowers or chocolates, but they would be absolutely grateful if only we brought them a bit of food when they’re sick and are unable to meet their needs alone. When we were younger, every day was ‘Our Day’ and our parents fussed over us.  I wish so much that for those of our family (at least) we can be bothered to fuss over them when they’re in need – even if it doesn’t fall on a “special day”, and even if their problem isn’t cured by just flowers, chocolates, or material gifts.

You know what most of these mothers tell me they wish more than anything they get on Mother’s Day? That every day was like it so they would get to see their children more; that their children called them more often and asked how they are and how they may help;  and that their children showed appreciation and love for them more often.

But let me tell you also about a question I was asked recently too: Do I believe in Karma? Well, I guess I call it differently as I don’t have a traditionally Buddhist or Hindu belief system, but aside from my theo-philosophical beliefs, there are my social psychology beliefs. I once heard the story of a woman from my family who had several children but in her elderly years lived alone and was left to fend for herself for food, money, and all basic needs. But where were her children? Well, when these children were very young, this now-elderly woman abandoned her young family and left them to fend for their own. Now you ask why are her children not looking after their elderly mother? Well, because she is to them just another person whom they barely know but happen to share 50% of their DNA with. It’s hard to feel sorry or help a stranger who many many years ago only taught you that those that are weaker don’t deserve your help. I don’t call that karma but setting an example, reaping what we sow. It’s sad, but sometimes the truth is also sad.

What is wrong with this world? I don’t know. All I know is that nothing changes if nothing changes. I know that if you want to see different then you have to do things differently, and not wait for them to happen. I want there to be mothers out there that are loved and appreciated by their children. I want there also to be children out there who are shown by their mothers how to love, how to care, and what things are right and how to do them right. I want to set a good example. I want to have good rewards for my deeds. I want one day to be both a good daughter and a good mother.

On being religious

You know, I’ve always described myself not only a spiritual person, but also a religious person. Which is not to say that I am a divisive person of the view that ‘my religion is right and all others are wrong’ but a person who thinks that religion and theology are fascinating topics of intellectual consideration! But it is hard being religious. It is hard for so many reasons and on so many levels.

You know what I consider the single greatest detriment to the standing of religion in our world? Humans; other members of our religions. I don’t believe it is extremism or the varying beliefs, not the names of our Gods, not our values, but our fellow worshippers. Those other things may turn off a great many people off religion, but it is our co-worshippers who turn off those of us who are already believers. People often ask me if I am Christian because my mother is and she’s forced it on me or because my culture almost demands it. And my answer is I am Christian despite my mother and despite my culture and despite a lot of other Christians I have known.

It is incredibly difficult to remain a Christian, or a member of any other religion for that matter, without feeling an element of shame in admitting that part of our identity because of the negative connotations of some religious people’s acts. We live in a very well-informed society, in a very scientifically-advanced society, in a society where knowledge on almost everything is easily accessible to everyone. The “sins” of our religious co-worshippers and of our leaders are exposed and become common knowledge – and yet how do we maintain dignity in acknowledging association with such people, with certain practices, with unusual or seemingly illogical beliefs? In my case it isn’t “blind faith” or ignorance but rather a choice.

And what makes it particularly hard for me to call myself a Christian? The judging attitudes of my co-worshippers. For some reason a lot of members of organized religion consider that they become holier the more they judge others, like digging up and speaking of others’ faults somehow bleaches their own soul of sin. I don’t remember reading about that in the bible! I do remember reading all those verses about judgement belonging only to God, that our duty was only to love our fellow humans and not to pass judgement on them, and about the hypocrisy of any imperfect human judging others since we are all sinners. It always strengthened my faith to know that God is a loving God, that he knows our deep intentions, and that he knows we are imperfect and does not ask of us any more than we are able to give. Yes, God has great qualities – but, oh boy, our fellow worshippers are a lot harsher! They often judge those outside of our belief system and those within our religion with a wrath that is all so ungodly! In fact I believe it is so ungodly that it is evil.

I remember one of the first accounts in the Bible being about Adam, Eve, and the serpent. The serpent’s deal was that he thought, ‘hey, how come this God dude gets to be boss? Why can’t I be boss? Why should only he get the worship from these humans and angels and such?’ He wanted to be God. And you know what our religious co-worshippers are really good at? Trying to do the same thing: to rob God of his unique role of being the rightful judge of human behaviour since he is the only one who knows our deepest inner thoughts and intentions.

I made the choice some time ago to answer only to God. I made the choice to consider all humans, and not just those that call themselves Christians or belong to my particular denomination, as my equals. I made the choice to place my trust in only one God and accept that those who claim to represent him here on Earth are still only my equals and are not interchangeable with God.

On why I haven't been blogging

Wow! It seems like forever since I’ve written. What has been happening with me? Someone pointed out to me that I am someone who doesn’t just like things, but I apparently obsess about the things I like. Well, I admit that that is at least partly true. And what I have been obsessed with of late is learning to play guitar, taking my guitars apart and putting them back together, building a display case for them, reading about some very talented guitarists, learning about guitar construction, etc. I guess I can get carried away – but I enjoy every second of it! It is such a buzz at the stage I am now, and one day it may fade, but at the moment it is so fun to let my curiosity and enthusiasm carry me away.

But that’s not all I’ve been doing, of course. I’ve had difficulties with some of my interpersonal relationships, with my previous job, with money, but I figure that in the big picture I am actually quite blessed and none of that stuff is worth giving up my momentum for. I choose not to remain stagnant. I have so much, and the most valuable thing anyone possesses is our potential – and I’m not forgetting that!

A prison story

I haven’t written in a few weeks. Frustration, anxiety, pesky illnesses, and new passions really take a toll on you. I still feel partly censored in what I can divulge here, so let me tell you about the new passion I’m trying to develop. I’m learning to play guitar. And more than learning to play it, I want to know everything about them, about music, and just really feel my blood pulsate differently when I think of it. I have even bought an electric guitar I’m taking apart, modifying, and (hopefully) put back together again. I love the feeling it gives me to be in control of such a versatile instrument. Just thinking about it gives me a buzz…

Another passion of mine is humanity, yet I say that more in the Fyodor Dostoevsky sense of “The more I love humanity in general, the less I love man in particular”. I like watching prison documentaries for the stories about a different version of humanity you may or may not encounter every day. And there is one story that keeps bouncing around in my head which I would like to share because I found it so intriguing.
There’s this prisoner serving a sentence that will mean he spends the rest of his life in prison with no possibility of parole. He starts off by telling the story of how he has been a criminal for a very long time. He was selling drugs, stealing, using drugs, etc. He had been in and out of prison since he was a teenager until eventually he managed to score his final life-long sentence.

Anyhow, while he was in prison, his son got arrested for murder. At one point the son was in the jail next to the prison his father was in. What the prisoner’s son and some other men had done was they killed someone, and for that crime they were up for the death penalty. But the son's lawyers organized for his father to testify at his son’s trial, saying how he gave a bad example to him, and that he wasn't there to teach him right because he was always in and out of prison or high and drunk as the son was growing up. Also, the family was very poor because the father wasn’t able to work because of his criminal lifestyle, drug and alcohol abuse, etc. The co-defendants in the son’s murder trial didn’t have the opportunity to have their sentenced reduced from the death penalty because their fathers weren’t in prison.

 When the son's trial date came up, the lawyers thought they'd do a charitable act by both father and son and organized to pick them up in the same prison van so they could ride together to the courthouse. In the prison van, the guards and lawyers were all feeling very warm and fuzzy that they had granted this father and son to sit together even for a short trip (though no one knows who specifically asked for this). While in the prison van, the son held his father’s hand through the handcuffs behind their backs. He was grateful to his father for helping get him off death row. Afterwards everyone who had helped organized this great gesture between father and son, were feeling really good about themselves.

Then someone asked the father if he was happy to see his son, and was he excited to be able to help him out, etc. The father answered and said he'd never ever felt worse in his life! He said never had he felt more ashamed and like an absolute worthless human being. He had never felt as low as he felt that day. He said he was disgusted at himself; truly hated himself for the experience. He said he would have preferred never to have seen or heard or touched his son again in his life than to see him like that: in the back of a prison van while up for the death penalty for the disgusting crime he had committed. He said never had he felt like the worst father and the worst person in the world than that day. He said to him that it felt like it was his own death sentence that day, knowing he had failed as a human being. That day he truly repented of all his own wrongdoing and he wished he had never been born so at to give life to someone like or worse than him, even if he was his own blood.

He cried at how embarrassed of himself as a human being he was, and the fact that people thought of him as a hero or a good man for having gotten his son off death row. (Yes, the son had his sentence reduced to life without the possibility of parole.)

Wow, this story touched me very much and I can’t even really explain why.

The goals and business of general practice

In the last week I have been involved in the recruitment of a new nurse to the primary care clinic I’ve been working in. (And I should note that the terms general practice, general medicine, and primary care, are been interchangeably here) I suggested that we ask applicants in the job interview what, in their opinion, are three goals of (private) general practice medicine. This is a question that potentially has dozens of answers! To patients, up to 95% of the time it is about helping them deal with immediate, though generally non-urgent, health problems. The rest of the time it is about preventing ill or worse health. To governments, the goals of general practice medicine are to keep people healthy so that they utilize less government-funded health resources. General practice is meant to keep patients out of hospitals. But what are the goals of primary care medicine if you happen to work in a primary care clinic? I think that if you understand the way the business of general practice, the goals of general practice are fairly straightforward - from a business perspective, because this is an industry just like many others.

How does general practice work? Well, patients require a service so they contact the practice’s administration staff to book this service: a medical review with a doctor. Booking appointments is just one of the tasks of the admin staff, and their tasks are fundamental to the proper and smooth running of the practice as a business and also in optimizing the clinical interaction between the patient and the doctor. The doctor takes the patient’s clinical history and requests investigations and treats their condition, etc. To do this more efficiently and effectively, they often enlist the help of the practice nurse. The nurse has a very important part in the running of the practice too. They are there to advocate for the patient, to help carry out a lot of the preventative activities related to medical practice, they administer medications and immunisations, they perform some of the tests the doctor needs to help clarify the patient’s diagnosis, etc. They do all this in the background so the doctor doesn’t need to do it herself – and in this time the doctor may see another patient or take care of another clinical activity. That’s it. At the end, the patient pays one fee to cover the cost of seeing the doctor, the nurse, and having administration staff assist them.

How General Practice Works

Now, how does the money side of general practice work? There is one source of money coming into the practice: patients. That’s right, the only income-generating activity in general practice occurs in the interaction between the doctor and the patient in that room. For example, talking to the receptionist doesn’t attract a fee (as a patient you could theoretically come in and talk to one all day and she can’t bill you for anything as she hasn’t sold you anything).  

Where the money in General Practice comes from.

What then? Well, the money generated by the doctor’s fees is pooled and is meant to cover the cost of paying the practice’s staff, the building rental fees, insurance costs, medical and non-medical equipment costs, etc. And that exactly is why it is important for practice managers, for administration staff, and for nurses to help doctors see more patients and to see them efficiently and effectively.

Where the money in General Practice goes to.

So what are the business goals of general practice? I believe they are so closely related to the duties of general practice that you could be forgiven for mistaking them. The first priority of (any) medical practice are the patients. Keeping them well, that is giving them what they pay us for (assistance with health problems), is and needs to be the first goal. The second goal is to optimize the interaction between the patient and the doctor; the “service” being sold. It is the task of everyone working alongside the doctor to make sure this happens well, smoothly, and in a time-efficient manner. The third priority is to the community in which we work. This makes sense not just in a humanistic ideal but because general practice, as opposed to other medical specialties, often deals with people who are well and healthy – and who want to remain that way! Healthy patients don’t attend cardiologists, for example, to prevent cardiac disease. No, they would go see the cardiologist once cardiac disease is diagnosed or suspected and they need secondary prevention or treatment. But general practice does see well people for this and many other preventative activities.

It makes so much sense from a business point of view to fulfil our duties in general practice, that is to patients, to the staff, and to our community. Patients that are well-cared for and feel/know that they are being prioritised want to continue using that service. If you optimise the doctor-patient interaction (in business terms: time), you make the business more profitable. And if you cater to the local community, that community gets to know and trust your service and seek it out amongst the other dozens of similar practices around. What is there to lose by fulfilling the duties of our jobs in general practice, really?

On responsibility

I remember one of the greatest lessons taught to me both at home and at school was about responsibility. It was such a good trait in a person that even if you owned up to wrong-doing, there would be an incentive for the admission (e.g. reduced punishment). I wonder now what happened to make taking responsibility for almost anything such a dirty affair.

Do you know when people are quick to claim responsibility for things? When things go right! Politicians, for example, are a great at speaking of their triumphs in war, claiming they achieved this or that target. For a moment it would be possible to convince yourself that Barack Obama was literally holding the firearm that killed Osama bin Laden, such was the claim that “we got him”. In science journals a string of names appear as the “researchers”, and if the discovery or finding is big news enough, the person giving the interview will be the person who runs the research institute or the head of the lab – not the little guy who actually did all the intellectual and physical work. Similarly in medicine, especially in teaching hospitals, the name of the consultant will always be quoted as the guy who did the surgery or who treated a patient’s complex medical problems – where in reality the consultant probably has never laid eyes on the patient. But I am, of course, talking about when things go right, the successes. The culture extends all the way to clinical records, as I have had to explain to patients in the past:  “I know the information is about you, and it was collected and written by me, but it belongs neither to you or me apparently but to the person who lent me the pen and paper (or computer) with which I recorded the information”. Or at least this is what I have been told in the past by previous employers… Imagine if the same had been done to the great poets and writers of the past. Mark Twain would not have made a cent from the proceeds of the sale of Huckleberry Finn but the manufacturer of the pen and paper he wrote with would have made some very easy money!

Now, when things go wrong in medicine, it’s not the hospital’s or the clinic’s fault, it’s not the consultant’s fault – then it is all about the little guy. When competitions are won, a whole nation claims victory; but when they are lost, it’s the one competitor or team who is the loser. When corruption is uncovered, it is always said it was just one person’s fault, not the institution or the culture that drove him to it, etc. We have become very quick to deny responsibility for ourselves and distance ourselves from all negative events. Unfortunately, this has come to extend to our personal lives too.

If there is one thing I pride myself on is trying to be an understanding and non-judgemental human being. I have met people, though, who confuse taking responsibility with admitting fault, and therefore they refuse/avoid/delay taking responsibility at all. We are all shaped by our childhood experiences, past relationships, our genetics, formal and informal education, etc. All these things together shape how we are today. Now, one or more of those things may have been a profound traumatic negative experience that has gone on to shape us significantly – and maybe even negatively. As a result of that experience perhaps we become highly attuned to certain words people say (perhaps words bullies may have used) or to misinterpreting body language or we come to expect that certain words will be followed by physical abuse, etc. When you experienced those things before it was perhaps appropriate to retaliate or go on the defence. The thing is when you are no longer in that situation and you continue to react as if you were, that is when our own actions/defence become our offense. That is when we hurt ourselves more, or others too. Now, as I said, I can understand this and I can forgive this. No one is saying it is your fault you are the way you are; and it’s certainly not your fault those negative things may have happened to you (emotional or physical abuse, etc.), but it is each individual’s responsibility to decide whether they want to continue to be and act the same or to change. I see the person who refuses to change, who points out how it’s not their fault, who perhaps feels guilt but not motivation to change, as someone caught up in victimhood. And as I have stated many times before, we are not victims of our past but rather the creators of our own future. And trust me, there are still plenty of incentives out there for those that do stand up courageously and take responsibility.

On global warming

I  haven’t written in a little while because I have been quite busy with organising things for a change in job (location, not career) and also some personal difficulties which I won’t go into just yet. But I have managed to give myself 2 weeks off work to just settle the pace in the last few months, and I have been watching some mostly mind-numbing television but also some interesting stories. One that particularly surprised me was a debate on nuclear versus fossil fuel derived energy. Here’s the link if anyone is interested in watching it.

What I found particularly interesting about the debate on fossil fuels versus nuclear energy are the premises and assumptions the debate (for both sides) are founded on. You see, every debate argues that one “thing” is better than the opponent’s “thing”, but there is also common ground – there has to be. So one opponent may say, for example, “I’m trying to do the most just thing for everyone and this ‘thing’ I represent is better for justice than the thing that my opponent is backing. The other opponent goes and makes the same argument, but proposes his thing is better for justice. The debate is interesting and relevant because it focuses on a common ground: justice. And you know what I found interesting in this fossil-fuel vs. nuclear energy debate? That the common ground that both parties were intent on protecting was climate change. Yes, here were big energy industry representatives arguing that they wish to protect the environment, prevent further climate change / global warming, and therefore nuclear energy is bad. On the opposite side of the debate were nuclear energy proponents arguing that they wish to protect the environment, prevent further climate change / global warming, and therefore fossil-fuel energy is bad (and also that other non-fossil-fuel energies are non-viable). I was fascinated not by the points of argument each team debated, but that suddenly global warming and climate change was a given, not the point of argument itself. No one was debating whether climate change was real in and of itself!

In political and legislative forums, the existence of this concept of global warming is negated by representatives of the fossil fuel industry. Now, in a debate whether on whether nuclear energy or fossil fuel energy is worse, global warming and climate change is taken as a fact – and the people arguing these both these things are almost the same people. That is what I find quite interesting. Environmentalists get invited to these events to present the debate on behalf of nuclear power companies, mining companies, and “green energy” companies (which are usually owned by the mining companies themselves). Of course, for the sake of arguments such as this, all the types of energy companies claim to have one thing at heart: the environment. In reality we all know that thing at the heart of any company are monetary profits. I mean, that is exactly the reason why mining companies invest heavily in “green energy”: because if the market happens to shift and “green energy” becomes more profitable than fossil-fuel energy, then you want to be the guy that owns this market already...

It’s all nice and interesting, but now I’m more confused. Is global warming considered a real thing or not in Australian politics? If so, then what are we (including the energy industry and other big carbon emitters) doing about it? If not, why not if even the energy industry can at times concede that it is a real thing?