Come on, this should be easy for you.

The BMA doesn't want third parties rating their performance any more than CBA or LSUC does. Imagine if this was being proposed for the legal profession. Consumers being able to rate the barristers and solicitors they hire will inevitably send some bad lawyers siwrling down the toilet. And then prompt questions about why the self-regulating professional associations haven't done more to, you know, flush the bad apples long before anybody else knew they were around.

I'm not surprised the BMA thinks it stinks. No self-regulating professional body will ever be in favour of something like this.

Just because things are easy for you doesn't mean they are easy for me. I hate when you make fun of me. I suppose the point is this: when does this sort of response seem outdated? I frankly thought it would just be something you can't say this plainly anymore.

But, just to let you know, the idea that a lawyer is not open to public assessment doesn't hold water if you have ever spent time in family law and criminal court. Having the public including newspaper reporters and cops watch as a judge tells you that you suck (again) makes you aware that you are open to independent valuation from day one.

I did not mean to make fun of you, I apologise unreservedly. I know you are a good egg. =)

One hopes that most professions would welcome the opportunity to not only be more demonstrably accountable, but to weed out the elements that give the profession a bad name in the eyes of the public.

The public being present in court does present one to some independent valuation, but how well does that information flow through the public sphere when some other person many years down the road is considering hiring a family/real estate/whatever lawyer? My guess is, not very well. A lot of people rely on word of mouth, or whoever's office is closest to work/home etc. There is no easy way to look at a snapshot of someone's recent work and evaluate it for yourself. You would have to go poring through court records (or land registry office records, etc) to see how well somebody has been doing their job. And the answer is not altogether obvious.

I am just having fun but too sick to remember to use the ;-) when expressing my deeply hurt feelings... ;-)

I agree with your assessment of the difficulty the public faces but if I heard a law society respond like this medical society I would think it even odder given that lawyers do not operate in the same sort of bubble

You get sick every couple of weeks. Don't you have vitamin C in that house? =)

There is a lot of oddity coming out of Britain these days that confounds the senses.

This has been a bad winter for school-borne bugs.

Having a few family members employed in the medical system at a level that is dealing with patients directly, I can tell you that I can understand the BMA's concerns. In the last 15 years, people have become more and more of the complaining type and it is not always due to a long wait.

A psychologist I know summed it up by telling me that it is a combination of a number of factors. First, people with less money and less education get sick more. People in general have a perception of less control over their lives, especially those who are less educated and earn less money (and are, see first point, more likely to be sick). These people, having a sense of mild futility in many aspects of their lives lash out and demand control when they can, such as in line at a store when the cashier makes a mistake, at a bar when someone bumps into them or at a place of service where they feel they are not being treated as well as they would like.

All in all, people in general are more likely to take everything personally when it comes to level of service, are more likely to complain and given the ease of use of the internet, more likelyto do so given the opportunity.

I am sure in many cases that is true, Sean, but it's often not that simple.

Generally when I get health care I am pretty easygoing; that said though I usually research everything thoroughly before I go, so that I have some idea of what the doc is talking about. I also ask a lot of questions (not aggressively, just in a "what does that neat thing do?" sort of way). When I'm dealing with someone else's health, though, I'm not always so easygoing. After all, it's not my life to gamble.

What I have seen is that the system is willing to splurge a little if you're on the near side of, say, fifty. On the other side of the hill, the cost factor becomes more and more important because they evaluate you as being nearer and nearer death's doorstep. Even if you are in very good health, when you hit 70 or so your care becomes basically palliative in nature, even if you live another ten or twenty years. If you're lucky you may get a major procedure, but don't count on it. In the eyes of the system you're headed for death and their resources are better allocated to younger patients.

My 74-year-old grandfather died of dehydration/starvation because he was having problems taking food after his surgery, and the hospital declined to give him even a basic saline IV after we warned them repeatedly that he was drying out and constantly thirsty. He survived for four weeks on a couple of small dixie cups of water a day. The icing on the cake was that the coroner's report listed heart failure as the cause of death. I'm sure that's accurate in the same way that a guy who bleeds out through a slashed artery also, ultimately, dies of heart failure. It doesn't say much about what brought him to that point.

This is the part of socialised medicine that sucks. Even if you wanted to pay for heroic measures at an elderly age, you can't. Unless you are one of the lucky few who can afford to unplug from the system entirely and all of your care becomes private.

Having now spent a fair bit of time on the "other side", I can say - quite categorically - that your impression of "palliative care only" past age 70 is drastically wrong. I've seen numerous elderly patients who've received bypasses, pacemaker/ICD implantation, among other things. In fact, a very sizable proportion of hospital in-patients are 70+.

I don't want to dispute your anecdote in any way, but "heart failure" is a very specific term referring to end-stage cardiac muscle dysfunction/insufficiency, essentially when it fails to pump enough blood to satisfy the body's metabolic requirements. It's not a generic term as a cause of death by any stretch (you might be thinking of "cardiac arrest"). Also, "heroic measures" refer primarily to CPR not to major procedures in general. On those occasions when surgery, for example, is not indicated for elderly patients, it's generally because the risks outweight the benefits - prostatectomy for a 75 year old man with cancer, for example, is often not indicated since such tumours often grow so slowly that the likelihood of death from some other cause exceeds the risk of "watchful waiting" for the cancer.

While I think it is skating on thin ice not accepting an honest and serious example like Chris's, I do have the experience in my family of a man in his 70s who has had cancer surgery, chemo, a quad bypass and a pass maker.

But each case is different and in a real sense processes like bypasses are quick standardized. The hospital where this one took place did six at at time over and over and over. I would worry if the ailment were rarer. Frankly, I would also take advantage of proximity to US hospitals for at least a second opinion if that was a reasonable recourse in a rare case, though I realize that might just lead to knowing what you could not afford.

I wonder if you can get US health care insurance if you are not a US resident.

I'm going on a recollection of a 12-year-old coroner's report and I'm afraid I let my Medicinæ Doctor lapse between rounds on the golf course, so forgive me for using the wrong nomenclature. Say, Josh, while you're at it, why don't you scan the the coroner's report on your desk and tell me what else I missed?

I guess those bedsores on my grandfather were present from being turned too often, and it wasn't us who turned him, it was the interns doing what they were paid to do. We didn't have to keep a family member posted at the hospital to change his sheets, try and get water into him, or do any of the routine duties that the interns and nurses normally look after. How silly of me.

Obviously our experiences with my 74-year-old grandfather, 85-year old paternal great-aunt, 86-year old maternal great-aunt, and 95-year-old grandmother are all strict anomalies in the health care system. It has nothing to do with, say, them being in a major metro area with high demand for services—where my own doctor has something like 25,000 other patients besides me—as opposed to a university town with a fraction of the population.

And that's the whole skating on thin ice thing I was thinking of. Nothing will overcome the reality of a specific case and no amount of statistical reports will capture the reality of different levels of care practically available in different locations. To pontificate otherwise is to risk real offense not to mention looking like a doofus.

I probably mentioned this before but I made sure the person in my family moved to my new town as in our old province of residence, PEI, too many men in their 70s and younger died on the road to St. John NB where they were to get their bypass. In fact my dentist, my parents' doctor as well as the man in his 50s who rebuilt their house all died that way. They may as well have been living on Ice Station 17.

In fact, locality has likely more say in the level of health care that you will receive and that does not mean urban over rural so much as teaching university centre over not univserity centre. Halifax as well as London Ontario are likely in the same situation as Kingston.

Once again, I am not commenting on the specifics of the situation(s), but on what I have observed in terms of patient care at the major tertiary care and referral centre for the Maritimes - hardly a sleepy "university town" institution. Of course, Nova Scotia health care never reached the insanity in Ontario of firing thousands of nurses and subsequently replacing them with ones on contract. By all means, I agree with you that nursing care is often overlooked and, at various times, has been sorely deficient. It is still NOT the case that care is "mainly palliative" after age 70 - indeed, if proper palliative care were on offer, your personal experiences would probably have been much better.

Finally, your comment about "heroic measures" was problematic simply because said measures are more likely to be ineffective than anything else. What exactly would you be trying to pay for that's denied?

You are looking like Mr. Can't Take A Hint, Josh.