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The most viewed discussions on doc2doc this month

Should The New Pope Allow Priests To Marry?

Posted in General at Wed, 17 Sep 2014 10:51:08

Odysseus

Posts: 4221
Joined: 24 Feb 2009

Do you think that it would be good or bad if the Pope Benedict XVI`s Successor allows the Priests to Marry?

Thank you for sharing your personal views.

Doctors Mess

Posted in General at Thu, 18 Sep 2014 04:31:41

Odysseus

Posts: 4221
Joined: 24 Feb 2009

Having just been down to our mess for Pizza I was wondering how messes shape up round the country, and round the world, and who is getting the best value for money. Let me start the ball rolling

QMC (nottingham UK) Mess is £10 per month. The mess has sofas as well as tables & chairs, and the new addition of 2 massage chairs. 2 pool tables, several hospital internet linked computers incase you feel the need to check that X-ray or blood result). a new 52" plasma screen TV with Sky HD, the old TV is now connected to a Wii. The kitchen has free Tea, coffee, milk and an unlimited supply of bread (for toasting), butter and a selection of jams. One fridge is dedicated to chocolaty biscuits and a time locked freezer provides free microwave meals out of hours. Fresh fruit is delivered once a week (in plentiful supply), and monday lunchtimes and sunday evenings there is Pizza delivered for those working. The mess also has an active social life with nights out at least once a month with money put behind the bar.

So how do things shape up where you work? What would you have in your fantasy mess? (one of our registrars recently suggested all we're missing is a jacuzi!

 

Ashya King case: breakdown of communication?

Posted in News & media at Tue, 16 Sep 2014 13:29:03

Pat Harkin

Posts: 60
Joined: 26 May 2010

For those outside the UK the news over the last few days has been dominated by the case of Ashya King: a five year old boy with a brain tumour who has been removed from hospital by his parents against medical advice. Ashya and his siblings are now in Spain where his parents were hoping to raise funds for private medical treatment. 

The parents have been arrested and face extradition back to the UK. They are in Madrid while Ashya and his siblings are in Malaga. You can see much fuller coverage of the story here: http://www.bbc.co.uk/news/uk-england-29009883

Social media has been a big factor with Ashya's father and brother posting videos explaining their actions and how they are caring for him - countering statements from the police. 

What are your thoughts on this case and how the authorities have acted and what the UK hospital could have done? There have been similar cases of parents disagreeing with doctors but few have been so dramatic. 

Do you let your junior colleagues call you by your first name?

Posted in General at Thu, 18 Sep 2014 14:35:15

Carolin

Posts: 1086
Joined: 16 Aug 2012

This thread was inspired by a comment on Twitter: @Duncan_Ross tweeted: "Always nice when a consultant says 'Call me (first name), I don't want to sound like a Grandpa."

This sounds extraordinary to me as someone who has never worked in such a hierarchy as a hospital! Do some consultants insist on Dr or Mr, Mrs, Ms So and So....?

What happens in your workplace? Is everyone on first names or do the senior doctors expect to be known by their title?

 

A patient with Acute Coronary Syndrome

Posted in Medicolegal at Tue, 16 Sep 2014 01:33:53

Dr.Chid

Posts: 629
Joined: 21 Feb 2012

This EKG is from a patient with Acute Coronary Syndrome, what is the most important finding that gives a clue site of occlusion

 

Would you support the introduction of a health tax?

Posted in News & media at Tue, 16 Sep 2014 20:30:37

Scheherazade

Posts: 76
Joined: 29 Jan 2009

Writing in the Guardian, Patrick Diamond, lecturer in public policy at Queen Mary, University of London, calls for the Labour party to propose a "hypothecated insurance fund to finance the NHS and social care", so voters can see a direct link between the taxes they pay and "investment in a prized institution" (ie, the NHS). 

Taxpayers could be issued with an annual statement, Diamond proposes, detailing how their money has been spent. 

Such a radical solution to NHS finances is needed, he argues, because an ageing population and therefore fewer taxpayers mean that questions of long-term funding of the NHS will soon arise. 

It is highly unlikely that any politican would propose an extra tax at election time but do you think this is a sensible or desirable idea?

MS relapse triggered by stress

Posted in Neurology at Thu, 18 Sep 2014 12:41:01

Loess

Posts: 29
Joined: 10 Nov 2013

It is generally common knowledge there is a link with stress and MS.  Relapsing remitting MS patients report occasionally stress as a trigger of relapses. 

Mind-body medicine is an area which MS research is currently exploring and I think will become a vital and increased area for MS research.  Stress management for MS patients is currently being researched.  This raises one of the previous discussions on this forum regarding the role of complementary and alternative medicine.  In MS I think a more integrative and holistic approach is required and it seems it could be heading that way. Any thoughts anyone?

Attitudes to rape victims

Posted in News & media at Tue, 16 Sep 2014 19:04:55

John D

Posts: 3230
Joined: 01 Feb 2010
An Indian women known as the 'Park Street Rape Victim' claims she had booked a table at a restaurant yesterday and arrived with her fiancé but was denied access because "you are the park street rape victim".
 
The restaurant denies this version of events saying amongst other things that she arrived after hours. Whatever the truth it brings into sharp focus the appalling attitude of many people in India to rape victims. The women is seen as being responsible for being raped. The 'Park Street Rape Victim'  (Suzette Jordan) said that on the night she was violently gang raped even her father was uncomfortable with her going to the Police.
 
Suzette Jordan went out with friends to have a couple of drinks at a nightclub in a five star hotel in Kolkata in February 2012. At the end of the night, she was thrown from a car onto the street, bruised, battered, gang-raped, her clothes ripped half off. The Chief Minister dismissed her case as a manufactured incident. Ministers made remarks about Jordan’s character – what kind of a mother would be out at discotheque so late at night? 
 
She described the medical examination standing naked, being poked and prodded, the finger testing, the swab testing even though the doctors tried to be comforting. One said she was lucky she was fair. The bruises were still visible. “I felt like a piece of meat, it’s like a re-rape,” 
 
To become so infamous and the subject of venom from the general public whilst in town is beyond my comprehension. It seems many men and women alike see women who have been raped as the guilty party - how can such societal attitudes be changed?
 
Kirked
 
 
 
 

Doc2doc meeting in the UK? Overdue or a pipe dream?

Posted in General at Thu, 18 Sep 2014 14:55:39

DuaneF

Posts: 1467
Joined: 09 Dec 2011

As one who has been on this site ab initio I wonder if consideration has been made for a meeting of interested members at a meeting in the UK such as a BMA meeting on general medicine. 

I would find it very interesting and recommend a special  dinner meeting. We might even present papers and have a special sub-meeting for doc2doc members. 

It  may be the first such  medical meeting generated by a common thread through the Internet.

What do you think? 

Odysseus

Research for Stethoscope Project

Posted in General clinical at Thu, 18 Sep 2014 07:42:16

DrS

Posts: 1486
Joined: 25 Jan 2009

I'm currently doing a project for school where I must improve upon the design of the stethoscope.

Does anyone have any personal experiences they could share detailing routine problems you encounter with using the stethoscope or just complaints in general about its design.

Also what kind of improvements would you like to see implemented on the stethoscope? 

Many thanks

What's your diagnosis? Jaundiced after a party

Posted in General clinical at Thu, 18 Sep 2014 16:15:49

Dr.Chid

Posts: 629
Joined: 21 Feb 2012

The case below was printed in the Endgames section of the BMJ. I will post the answer in a few days.

What's the diagnosis and what would be your first line of treatment?

A 24 year old male student from Poland attended the emergency department with a one week history of jaundice. He also had orange urine and non-specific abdominal pain, which he attempted to relieve by drinking alcohol. He had experienced no vomiting or change in bowel habit or stool consistency.

There was no history of jaundice, illness, surgery, or blood transfusion. He was not taking any regular drugs and gave no history of drug allergies. He denied intravenous drug abuse but admitted taking ecstasy at a party a fortnight ago. He had recently spent two weeks in Poland over Christmas. During the previous week he had drunk about 21 units of alcohol. He was homosexual but had not been sexually active for two weeks before presentation.

On examination he was afebrile and overtly jaundiced. His abdomen was soft, non-tender, he had no palpable masses, and bowel sounds were present. It was noticed that he had an abdominal piercing. There were no signs of hepatic encephalopathy.

On admission his liver function tests were deranged: alanine aminotransferase (ALT) was 2891 IU/L (reference value <40), alkaline phosphatase (ALP) was 246 IU/L (30-130), bilirubin was 285 μmol/L (<17), albumin was 40 g/L (35-51), and international normalised ratio was 1.2 (0.9-1.2).

New medico-legal development

Posted in General at Thu, 18 Sep 2014 12:16:48

sken

Posts: 733
Joined: 13 Oct 2009

An interesting legal test case in Belgium.  A 50 year old man has been in prison for 30 years for sexual assault and murder. He now argues that he will not be able to overcome his violent impulses – treatment has not succeeded and his application to be seen at a specialised unit in the Netherlands was denied. His life can be seen as unbearable and irreversible. For the past 3 years he has applied for euthanasia and this right has now been granted. (Capital punishment was outlawed in Belgium many years ago – over 40 years after the last execution in 1950). It seems there is a queue of some 15 prisoners who wish to go down this route.

 This will be essentially different from USA execution and a doctor will be involved . Currently Belgium is one of only 3 European countries that allow doctors to end a patient’s life by euthanasia. There is anyway the view held by at least one professor of ethics that doctors should not be able to refuse a patient to treatment , to which the patient is legally entitled , on personal moral or religious grounds. Usually abortion is the quoted example – but this is at least one step further down the line. In the UK we are very ambivalent about prisoners who wish to end their lives – we tolerate some appalling prison conditions with a number of inmates who by one means or another manage to commit suicide to end their suffering . Our response seems to be not to improve the conditions but simply to  put those seen at major risk on “suicide watch” – some have argued that those convicted should not be let off the hook of their sentence by dying…..  Perhaps those of us in the UK should be wary about casting the first stone at Belgium?

Medicolegal Case Report - Patient safety/Duty of care

Posted in Medicolegal at Thu, 18 Sep 2014 15:38:39

sken

Posts: 733
Joined: 13 Oct 2009

The following case raises many and varied issues - patients with Mental Health problems being 'managed' in A&E.  All of the information is in the public domain but I have nevertheless anonymised parts of it.

On 14th April 2010 Mr A was involved in a disturbance at his flat. His state of agitation and distress were such that his daughter, Samantha, called the police. What happened next is summarised in part 3 of an investigation report by Acting Detective Inspector Kirstie Masters, compiled in January 2011 for the Metropolitan Police Service Directorate of Professional Standards:

"3.1 On Wednesday 14th April 2010 at 8.45 pm police were called to A's address after a disturbance was reported by Mr A's daughter Samantha.. She stated that her father who suffers from mental health issues was having a heated argument with her younger brother Karl. 3.2 PC 110VW Spells and Special Police Constable 5763VW Geary were the first officers to arrive on scene. They arrived at 8.52pm.
3.3 An LAS [London Ambulance Service] crew was initially requested when officers first attended the scene. However, there were no free units able to attend London Road at the time. 3.4 Upon arrival PC Spells and SPC Geary were met by Mr B who explained that his father had recently been released from Hospital and that he was suffering from mental health issues. The sound of shouting and screaming were heard by officers coming from within the property at London Road. 3.5 PC Spells and SPC Geary entered the communal hallway and saw Mr A pacing up and down on the stairs, shouting. As the officers approached, he picked up a wooden chair and lunged at them. 3.6 PC Spells told Mr A  to put the chair down on a number of occasions. Mr Webley eventually did as he was told and the chair was taken away from him and placed outside the address. 3.7 At 8.57pm PC Spells requested further assistance from colleagues. She also noted what appeared to be blood on Mr A's arms and left toe.
3.8 PC Spells requested a further update as to the expected arrival time of the LAS.
3.9 At approximately 09:05 PC 799VW Way and PC 187VW Meade arrived on scene at London Road, followed by PC 113VW Burgess, SPC 5764VW Manning and PC 251VW Nicolaou who arrived at 09:10.
3.10 A's flat occupies the 2nd and 3rd floor of a residential building and there is an estimated 20-30 foot drop from Mark's bedroom window to the ground floor 3.12 Once inside the flat officers noted that Mr A was extremely agitated and pacing up and down. At one stage he has shouted to Karl "You owe me f.....g rent". This was followed by Mr A removing his right shoe which he held above his head in a threatening manner. 3.13 PC Burgess then removed his handcuffs and asked Mr A to calm down or he may face arrest. 3.14 Mr A calmed down and retreated to his bedroom and shut the door. A short time later shouting was heard coming from his bedroom. Officers both inside and outside the venue noted that Mr A was shouting down into the street whilst standing on the window ledge with the window fully open. 3.15 Officers entered the bedroom and Mr A was pulled away from the window ledge by PC Burgess and restrained. 3.16 PC Burgess took hold of Mr A's right arm, PC Way his left arm and SPC Manning assisted by taking hold of his legs to prevent Mr A from kicking out.
3.17 Mr A continued to struggle and hold his arms behind his legs preventing officers from applying handcuffs. He told officers "if you put those cuffs on me I will become more violent". 3.18 PC Burgess agreed not to handcuff Mr A if he remained calm and compliant. He agreed to this and sat on the floor of his bedroom with officers."
It seems to have been recognised from the outset by the officers involved that Mr A was mentally ill, but as he was not in a public place it was not within the police's powers to take him into custody pursuant to Section 136 of the MHA. Seven police officers were involved in arresting him (for Affray) and restraining him. It is accepted that this was a well-intentioned pretext to ensure his safety and no point is taken by A as to the lawfulness of the Claimant's arrest or of his subsequent detention at Wimbledon Police Station.
 
Whilst being detained at the police station the Claimant was kept on constant watch. His behaviour was described as obviously disturbed and he made several attempts to leave his cell. The duty Mental Health Assessment Team ['the MH Team'] saw Mr A at around 13:00 on 15th April 2010. The specialist doctors involved recorded their joint medical opinion that A was  a risk to himself and possibly others and in need of compulsory hospital admission. He was made subject to section 2 of the MHA. An ambulance was summoned to take Mr A to hospital.  PCs Thoms and Collinson were assigned the task of escorting him.
At 13:25 Mr A  was escorted from the custody suite towards an ambulance waiting in the rear yard. He was not handcuffed. On leaving the building he ran away from his escort and covered about 20 yards before being detained. He was then handcuffed and placed in the ambulance. When the ambulance arrived outside the hospital Mr A suffered a fit. After PC Thoms had consulted with staff on the ward it was considered best for Mr A to go to A&E. He was taken to Hospital.
The ambulance arrived at A&E at around 14.30 hours. Initial triage was performed by Sister Banting, the senior nurse on clinical duties within the 'Majors' section of A&E. Her notes written at 1439 record: "Arrested by police yesterday, sectioned today. On route to Mental Health hospital  tonic/clonic seizure. Not post-ictal. Alert and orientated." Mr A was given a triage category of '4 Green' in accordance with his physical status; this meant that he should be assessed by a doctor within one to two hours. A later note by Sister Banting, probably written at or shortly before the time of the Claimant's accident, includes the phrase "High risk patient, likely to abscond."
Mr A was then placed in Cubicle 9 within the 'Majors' section of A&E. Cubicle 9 was the room designated by the Trust for accommodating potentially disturbed or dangerous patients within A&E and had two doors. One ("the main door") gave access to the nursing station and opened outwards. The other ("the side door") gave access to a corridor and opened inwards. Neither door was capable of being locked. At the relevant time there appears to have been a sofa and three chairs within Cubicle.
 
HERE I HAVE GREATLY ABRIDGED THE EVENTS IN QUESTION:
 
The CCTV footage begins at 14:30 showing Sister Banting on duty at the nursing station in the middle of A&E. The main door of Cubicle 9 can be seen at the far end of the nursing station. At 14:40 LAS staff who had brought Mr A  to the hospital apparently begin a handover process with Sister Banting and a few minutes later PC Collinson can be seen in front of Sister Banting's desk. Just after 14:45 Mr A is escorted by the two police officers along the right side of the nursing station with PC Collinson in front of him and PC Thoms behind him. The three of them enter Cubicle 9 with the door left ajar. During the next few minutes first PC Thoms leaves Cubicle 9 briefly with PC Collinson remaining with the patient, then the other way around. A psychiatric nurse (who did not give evidence in this case) enters Cubicle 9, then leaves A&E seven minutes later. The CCTV camera is not trained on Cubicle 9 continuously. At 14:59 both police officers leave A&E through the double doors at the main exit.  At about 16.28:45 Mr A leaves Cubicle 9 by the side door, turns right and runs through the A&E department with the two security staff in pursuit.
 
There is no dispute about what happened after this, although it is not recorded on CCTV: Mr A ran out through the ambulance doors and across the ambulance roadway to the top of a ramp before climbing over low railings onto a ledge, then falling down a drop of some 15 feet. In addition to various fractures and internal injuries he sustained a serious head injury. He has since required secure hospital accommodation and is presently subject to an order pursuant to Section 3 of the MHA.
 
The Hospital Trust and The Metropolitan Police were sued - did they breach their duty of care to the patient?
 
Kirked

Differences between male and female doctors

Posted in General at Thu, 18 Sep 2014 12:45:32

AnneG

Posts: 435
Joined: 18 Mar 2014

There are a couple of interesting stories on BMJ Careers at the moment. One looks at the differences between male and female doctors' pay and this shows that female doctors earn 29% less than their male counterparts.

This could be put down to historical factors - ie, men currently dominate the upper echelons of the profession because there were more male than female medical students when they did their training. However, the pay gap has actually widened since 2004 when male doctors earned 21% more than female doctors. 

Of course, part time working and maternity leave play their part in lowering women's pay but Sally Davies, president of the Medical Women's Federation, told BMJ Careers: "What's interesting .... Even with women who have worked full time, have never had any time off and haven't had children because of their careers, there's still this unexplained gap." 

Another story highlights what my seven-year-old daughter loves to tell me from her classroom experience - boys are naughtier than girls. A study paublished in BMJ Open found that of the 2697 doctors on the General Medical Council's list of registered medical practitioners who had received sanctions just 19% were women. And women make up 40% of the medical register. 

Sanctions are imposed when a doctor's fitness to practise has been found to be imparied due to misconduct, poor professional practice, physical or mental ill health or criminal conviction. 

So, what's going on? 

 

Why do female doctors earn less than their male counterparts?

Posted in General at Thu, 18 Sep 2014 11:42:08

sken

Posts: 733
Joined: 13 Oct 2009

There are a few of interesting stories in BMJ Careers at the moment looking at gender differences in medicine. 

The first story looks at the pay gap between men and women and shows that women earn 29% less than their male counterparts. And, in fact, the pay gap is widening - in 2004 women earned 21% less than men.

The president of the Medical Women's Federation, Sally Davies, says that even among women who have never taken time off for maternity leave or to look after child there is still a pay gap. 

The other story confirms what my seven-year-old daughter loves to tell me - that boys are naughtier than girls. A study published in BMJ Open shows that women are less likely to receive regulatory sanctions than men. An analysis of the 2697 doctors who had a sanction against their name on the medical register showed that 19% were women, despite the fact that 40% of doctors on the medical register are women.

Doctors receive a sanction when their fitness to practise is impaired - through misconduct, poor professional practice, mental or physical impairment or a criminal conviction. 

And finally, there are comments from Clare Gerada, former chair of the Royal College of General Practitioners and now medical director of the Practitioner Health Programme who spoke, anecdotally, of the rise in the number of female doctors presenting with eating disorders. 

"We have seen a massive increase in eating disorders, and I think that's because it's endemic in medical students, and I think it's endemic in girls' schools," she said. 

So, what's going on? 

 

Are you a perfectionist?

Posted in General at Wed, 17 Sep 2014 20:18:05

Odysseus

Posts: 4221
Joined: 24 Feb 2009

A conference being held at the British Medical Association today, in conjunction with the American and Canadian medical associations, is addressing doctors' health.

There are many strands to the conference but one is looking at whether doctors tend to be perfectionists and, if so, that is driving high levels of stress. 

Do you think doctors tend to be perfectionists? Is this bad for your mental health? 

British Medical Association's manifesto: what do you think?

Posted in News & media at Wed, 17 Sep 2014 09:48:34

AnneG

Posts: 435
Joined: 18 Mar 2014

The British Medical Association has published a manifesto for the nation's health and the NHS ahead of next year's General Election.

The manifesto is in four parts and it's the public health element which will probably excite the most interest. The call for the sale of cigarettes to be banned to anyone born after the year 2000 is in there (that was agreed at the BMA's annual representative meeting this year). It also urges the next government to reduce the affordability and availability of alcohol and restrict its promotion. It says a minimum unit price of no less than 50p should be introduced.

You can view the manifesto here: http://bma.org.uk/working-for-change/policy-and-lobbying/general-election-2015

What do you think of it?

 

Is there any space for religious beliefs for patients and doctors?

Posted in Medical ethics at Wed, 17 Sep 2014 17:52:38

Arousa

Posts: 6
Joined: 05 Feb 2013

As medical students, we've all come across the ethical scenario of a jehovah's witness refusing blood transfusion and it is still debated as to what a doctor should do, especially in the case of a child - best interest vs autonomy.

I was wondering about the doctor's religious belief's however. Is it ever right for the doctor to make the patient aware of their religious beliefs? 

When it comes to health decisions how much importance should we be giving religious beliefs - doctors' or patients'?

After-hours care for Patients

Posted in Quality & Safety at Wed, 17 Sep 2014 02:56:58

tokdoc

Posts: 2
Joined: 17 Sep 2014

If you use any after hours service currently, what do you use and have you had any concerns about your patients care quality & saftey using the service?

Vijay

TokDoc - Simplifying after hours support - Looking for beta users

Posted in General at Wed, 17 Sep 2014 02:30:19

tokdoc

Posts: 2
Joined: 17 Sep 2014

I hope this posting is appropriate here. My aim with TokDoc is to improve the provider/patient relationship outside of the doctors office. I just recently launched tokdoc.com, and am looking for feedback on improvements.

If you are interested in trying this out, please contact me and I can provide you with some free credits.

Vijay

https://www.tokdoc.com

Another reason why we are the Naked Ape?

Posted in General at Thu, 18 Sep 2014 08:15:18

AnneG

Posts: 435
Joined: 18 Mar 2014

Here at D.Towers, we are in the midst of a flea infestation.  Cat fleas, I hasten to add, and we are tackling it.   But the little varmints have got into the carpets, and jump onto our legs and ankles.  They don't bite me, but they do Mrs.D, so they are truely irritans, even if they are Ctenocephalides felis.

But offering myself as bait, I sit, let them jump on and then pick them off my legs .  It's easy!  They show up as little, moving black spots against my white skin,  and I catch them between finger and thumb and, shall we say, dispose of them.    There have been other theories about our nakedness, that it's easier to lose heat in a warm climate for a species that chases down its prey by endurance, and the Aquatic Ape theory.  But what if we lost our fur to enable bug hunts?

Our faithful cousins, the chimps and gorillas (as my alter ego knows well) have made grooming the fur a time consuming but socially enhancing activity.   Did humans lose their fur and learn other ways to bind the tribe together; speech, even?

Hang on, there's another little !*&!!!$%!

JOhn

 

question : lung cancer

Posted in General clinical at Thu, 18 Sep 2014 08:09:40

AnneG

Posts: 435
Joined: 18 Mar 2014
My mom has initial stage lung cancer. She has difficulty in eating. Please suggest any feed options and treatment course.

What makes a good boss?

Posted in General at Thu, 18 Sep 2014 13:02:37

AnneG

Posts: 435
Joined: 18 Mar 2014

I write quite a few obituaries for the BMJ and am currently writing about someone who was described by one of his junior colleagues as being ambitious: not only for himself but for his staff too. 

He would introduce his junior staff to people who would be able to help them in their careers and get them invited to relevant scientific meetings. After they had given a successful talk he would write them notes congratulating them.

That struck me as wonderful attribute for a boss: to be ambitious for your junior staff as well as for yourself.

What do you think makes a good boss? And do you have examples of good (and bad) bosses? Obviously my managers here at the BMJ are the embodiment of good management practice...! 

Why can't a doctor be more like a vet...?

Posted in General clinical at Thu, 18 Sep 2014 13:30:47

AnneG

Posts: 435
Joined: 18 Mar 2014

There's a lovely BMJ blog by David Oliver about his cat, Tilly, who nearly died from acute kidney injury. The miserable moggy was brought back to life by a fantastic out-of-hours vet who displayed a care and professionalism all doctors would be proud of, but at a hefty price tag of course.

Could the NHS learn from this experience Oliver asks?

He writes: "My final reflection is that in the NHS patients and the public have great confidence in the one place where the lights are on 24/7 —the local emergency department—which they can use free of charge. Yet we react by penalising these departments and adjacent acute medical units: creating tariffs aimed to keep people away, and which lose hospitals income on acute activity driven by the public’s confidence in the services.

By contrast, in the land of small animal veterinary surgery, they can trade their way into tidy profits by offering acute services when all others have closed. And, of course, when we get the usual calls by working professionals, to see their GP at 8 or 9 pm on a weekday evening, we should remember that no other profession is expected to provide routine services at unsocial hours. Try getting your conveyancing or your tax accounts done at 9 pm, and see how far you get."

Terrorism: is it the worst Disease of the modern World?

Posted in General at Thu, 18 Sep 2014 15:59:36

DuaneF

Posts: 1467
Joined: 09 Dec 2011

http://www.foxnews.com/world/2014/09/18/australia-terror-raid-prompted-by-isis-plans-for-public-killing-pm-says/

 

This headline about ISIS attempt to Behead Australians should make clear to anyone with a brain, that Terrorism would appear to be the true Scourge of the modern world.  No amount of counseling, negotiating, or calmness will change this, Swift Military Force will however interrupt the pattern.

DuaneF