Garmin Nuvi 2595LMT GPS

I bought my Garmin Nuvi 2595 LMT GPS at Best Buy for approximated $250.  I'm a sailor and have been depending on Garmin for decades without fault. I've also a backwoods garmin for wilderness camping and hunting.  I was glad they made these portable ones for the car which could be attached to the dashboard with a suction cup. I've a Mazda Miata and Ford F350 truck so liked that I'd be able to transfer my gps from one vehicle to another.
The car gps is way superior to the other gps for it's function.  The display is visible with very little distraction from driving.  In addition there is a voice feature. A comedian did a very humorous sketch of his love for his gps lady.  She sounds like a school teacher.  When I plot in my route by declaring my destination she tells me where to turn and prompts me about upcoming turns.  A little vehicle on the screen shows me driving along the grid with names of roads displayed.
Richmond BC is a blackhole bermuda triangle.  It's been one of the areas of largest growth in the Vancouver Canada region because the realtors have ensured there is no signage on the streets that can take you back to 99 south.  Once you leave the highway you enter a vortex Maze. Most people give up and just buy property and live there.  This has been especially true for Chinese people who come to Richmond to visit family and can never return.  I've made it in and out on several occasions with only hours of loss of life and heart felt prayer.  I can say today that the Garmin Nuvi guided me out of this place where dragons be on  the shortest but wholly counter intuitive route.  This was especially appreciated  as the Hitchcock  birds had eaten  the bread crumbs I'd strewn behind the car as I entered Richmond.
On the I5 the Garmin guided me across 4 lanes near Everett and took me off the freeway on the most convoluted exit to get me to the Best Western Navigator late at night.
There are accessories too. Blue tooth for adding your phone.  An interesting audio book feature which comes loaded with a Bill Bryson sample. Great choice.  There's several other apps including calculator and currency exchange which I don't need but are added features.  It came loaded with maps for US and Canada and more can be loaded.  Further I can get these updated as part of the Best Buy Garmin package for free. Warranty for a year.
In the convertible the volume for my older ears could be better but it's adequate. With the roof up it works just fine.  The limitation is the audio books with the roof down. So I'd like a little more audio boost if I could.  It finds a variety of commerical places so far the best being gas stations. Lost in Richmond needing gas I used this feature and it took me to the nearest gas station. Now that's a treat!. It's weakness was in just navigating to another city.  I kept entering Seatle and it wanted a specific location in Seatle.  So I'd personally like a less specific search criteria for plotting. Maybe it's in the garmin but so far it's been so idiot proof I haven't had to read the instructions.  I might read them to find out how I can do this without knowing a specific place in the town. That's just how I travel across country town to town.  However I have a list of restaurants in the Garmin.  We inputted Best Western Navigator in Everett and that got us here.  We'd been to Best Western Navigator and liked it. I'd have liked a hotel app feature rather than restaurants.  But I just have to input the hotel chain and town so it's pretty simple. In addition to finding gas stations it finds other things of every day living like laundry.
Having used a Garmin gps fish finder I know I can input into the memory favourite places myself. I just haven't figured how to do this and again may actually have to read the instructions. When I was trying to read the instructions and input the garmin on the dashboards with both hands while driving Laura grabbed hold of her door handle. I have noticed that that's her indication to me that she's panicked.  I later read in the instructions specific notice  to avoid just what I was trying to do.  It's recommended that one pull over to the side of road and put in the text instruction for the destination while the vehicle is stopped. This naturally takes all the risk and fun out of driving with a gps but likely contributes to getting one to ones destination too.

Turning Point Recovery Society Gala Fundraiser

Last night Laura and I so enjoyed another annual Turning Point Gala.  This was our 5th one since they began and this one celebrated 30 years since Turning Point began. In 1982 Jim Ross and some fellow addicts and alcoholics banded together to have a house where they could live sober while putting back their lives after the devastation of years of the disease of addiction. With the  security and spirituality of Turning Point homes hundreds of sick people have found they way back from the abyss returning to health, employment, family and citizenship.  The spiritual message is simply that there is clearly more than death on the street that a human is meant for.  At Turning Point men and women leave the shame of addiction and gain a life of dignity in recovery.
Actor Rob Lowe humorously shared his ideas and feelings about real living, his 20 year loving marriage, his adored sons, his work as an actor doing the best he can be with the people he most cherishes.  His talk was spiced with anecdotes of childhood friends like Charlie Sheen and even stories of time with Wayne Goreski.  The room was packed full and he received a standing ovation.  A lovely soul and fine human.  His memoirs, Stories I only Tell My Friends, is naturally a best seller.
The very beautiful and chic Randene Neil from Global BC news team hosted the night marvellously  for the fourth time.  Fred Lee from CBC brought his immense enthusiasm and good will with an extra helping of hilarity to his role as Auctioneer.  The much loved Turning Point Recovery Society Executive Director, Brenda Plant spoke of the year's accomplishments, the difficulties of stigma facing those with addiction but the success of opening a new  woman's only home in Richmond. The hope is to open another home this year on the north shore.  Her heartfelt thanks went out to  all.  Randene read lists of dignitaries from Vancouver and Richmond present to the applause of all.  Again this year Finance Minister Falcon was there in great form.  The Fred Lee and Kevin Falcon combo was high wit at its finest.
Westjet tickets to anywhere and back were auctioned. Terrific weekend getaway packages  to Spinnakers in Victoria with whale watching, Tofino's Pacific Sands Beach Resort with Coastal Hotspring Tour, and Whistler Pan Pacific with River Rafting and Ziptreking.  In the silent auction there was a wealth of jewelry, dinners, lunches,  paintings, Canucks Tickets, spa packages, RCMP bomber jackets, all manner of  perfumes and lotion packages and even Canadian Tire contribution of patio sets.  Laura was really pleased that I was able to beat the pack and get her the Mary Kay and Bumble and Bumble Hair Products I knew the girlie girl in her would enjoy.
The Four Seasons meal and service was exquisite.  I loved the fine threads, the ladies most elegant in gowns while the men in suits cleaned up well indeed. I enjoyed the best of company at our Rosemary adorned table, Laura and I sitting with our friends Ganesh, Anita and Darren while tonight I was delighted to make a new friend of globetrotting Jason.  As always I loved to see my friend Malcolm, Bill  and colleague Peter.
This Turning Point Recovery Society  Gala event of the year was spectacular in every way.  

Paranoia

Wikipedia defines Paranoid as a "thought proces believed to be heavily influenced by anxiety or fear, often to the point of irrationality."
It's as good a definition as any.  Freud stated though that a "man who does not lose his reason over certain things can have no reason to lose" (Freud 1895).
Paranoia is therefore considered a useful developmental 'defence' or 'stage'.  Fear of alieness is self protective. Discrimination is healthy and beneficial to individuals and the species.  Immunology is essentially the biological science of the 'same' and the 'other'.
In psychoanalytic psychiatry Rycroft 1968 describes paranoia as " a functional psychosis characterized by delusions of grandeur and persecution, but without intellectual deterioration. In classic cases of paranoia, the delusions are organized into a coherent internally consistent delusional system on which the patient is prepared to act."
Paranoia is seen in several modern DSMIV-tr diagnosis.
Paranoid Disorder is a specific persecutory delusional state that is relatively fixed.  Patients will say that they believe they are being followed.  They believe people are talking about them. They believe that people are watching them.  What's significant in the grandiosity involved.  A standard question is 'why would they be watching you."  Tied into the paranoia is an inferiority complex with egomania for sure. I remember a cleaning lady who believed the RCMP had invested millions of dollars in watching her, surveillance being a very costly affair.  Addressing this she expressed a sense of wonder but wasn't rational about the obvious discrepancy about her mundane life and the belief that it warranted dozens of men in uniform following her every day.
Paranoid disorders aren't usually associated with hallucinations.  If these are present we consider the diagnosis of Paranoid Schizophrenia instead.
In Paranoid Disorder there's a often a believable thead despite the over the top character of the concern.  A person might have a specific conspiracy theory. In one case a man believed his boss was persecuting him despite his leaving the firm a year before.  Another woman believed her ex husand was spying on her in the bathroom.  A tragic man who had been in a concentration camp believed the nazis were still watching him.
Mostly these people are highly functional and capable unless their paranoid delusional state was addressed. The son of the man who'd survived the concentration camp said his father was fine so long as no one mentioned Nazi's or the news didn't focus on Germany.  If something triggered his delusional state he was convinced the neighbours were spying otherwise he was able to go about work and care of family without much evidence of this very disturbed 'corner' or 'compartment' of his mind.
Paranoid Schizophrenia is more commonly more dispersed and often coupled with hallucinations. Whereas paranoid disorders often remain constant with often poor response to medication, paranoid schizophrenia can respond well to antipsychotics such that the patient will realize and have insight into their previous pre medication insaniety.  With paranoid disorders medications have modified the level of concern but mostly the patients have felt their ideas were true but that perhaps they'd 'reacted poorly'.  'Still it's true what I said.'
Paranoid Personality Disorders are persons who don't have frank delusions or hallucinations but persist in maintaining the idea that they are the subject of persecution.  They see the world in black and white, us against them.  They do well in oppositional parties, cults and marginal church organizations.  These institutions can give them a place to 'associate'. Any group association can generally help to modify these people.  Alone they tend to maximize their bizarre ideas.   More often than not they are loners. These people insist that Jews are controlling the world. If not the Jews it's the Conservative Government of Canada, the Democrats, or the Republcians in the States. Sometimes the identified enemy is anyone that will help maintain the person's paranoid position of one downmanship. The secondary gain in paranoid personality disorders is evidenced in the power that individuals and groups who function as paranoid can bring to their cause.  Indeed media these days is often seen as promoting paranoid personality disorders.  Once drug dealers ravaged America with marijuana smokers and jazz muscians seeking the daughters of the wealthy today it's just terrorists in general.  There's always an element of truth in paranoia and the more discrete the more alluring.
One interesting paranoid disorder is 'pathological jealousy'.  This is the situation where a person will believe everyone is out to get their mate and that their mate is out to betray them with everyone else.   Again there's a combination of inferiority complex and egomania.  There's narcissism and entitlement and often some reason for the concern.
Medications are highly beneficial with paranoid schizophrenia. The original meds for this condition were Chlorpromazine and haldol.  While these medications are still used especially in institutions newer major tranquillizers have been developed with less side effects and greater specificity for the neurochemical deficit.  Dopamine channels are thought to have been overworked, defficient or imparied and the medications restore the brain chemistry to the appropriate balance. Modern research shows that different areas of the brain are 'overfiring' and the inhibitory channels aren't working appropriately.  Untreated modern scans show that the brains of paranoid schizophrenics increasingly lose matter with late stage subjects showing enlarged ventricles and decreased frontal lobe functioning.  Early psychosis units are now the mainstay of treatment with recommendations for early intervention.
A brief psychotic episode lasts weeks to months.  Schizophrenia is definitely diagnosed when a person has a year of delusional thinking especially if this persists despite medication and therapy.
Paranoid disorder is ameliorated with medication.  The newer medications for treatment of paranoia in general are much better tolerated with little or no side effects in the low dosages which are usually most beneficial.  These medications include rispiridone,olanzepine,  seroquel (quitiapine), abilify (aripiprazole) and ziprasidone.  Sometimes patients will need just the least amount of medication whereas others need a much higher dosage. Medication is titrated against an identifiable sympton.  A person who won't go out of the house because they're sure that the devil is going to get them this day may well return to work and activities and church without the extremely persecution on any of the above medications. It's as amazing to see the restoration of function of people tragically brought down by mental illness.  Medications in this sense are like insulin and digitalis in terms of the break throughs and advances they have provided individuals.
Interestingly there is a depressive disorder which is associated with paranoia.  In the above cases paranoid disorders and paranoid schizophrenia and delusional jealousy don't respond to traditional antidepressant medications.  Paranoia as noted is neurochemically seen as related to dopamine receptors whereas depression is most associated with serotonin and noradrenaline receptors.  However in psychotic depression, the particular form of depression associated with paranoia a person can indeed have essentially two overlapping disorders. The treatment is first to treat the depression but to modify depression treatment with the combination of the medications already noted. Abilify works well in this regard but if insomnia is a problem seroquel commonly is coupled with the antidepressant medications for benefit.
Paranoid personality disorders don't respond to medications generally. If they do it's usually the lowest dose of one of the atypical antipsychotics.
I've mentioned medications first because paranoia, even more severe intransigent monosymptomatic delusional disorder where the paranoia is highly specific and highly resistant to change, can respond to medication.  Medications in these group of patients often are the first step in treatment and can often allow a person to overcome their paranoia to enter into some form of therapeutic alliance.
Sadly today given the litiginous society we live in , paranoids are often the prey of unethical lawyers.  Police often have a 'frequent flyer' list of paranoids in the community who commonly call the police for help when they experience delusions.  One of my patients, well known to the police. often wakes in the night convinced that some famous actor has raped her.  She herself is very beautiful and it was a concern initially because she falsely accused a star who indeed was in town making a movie. There was no association and no consequence, the star being a mensch of the first order despite the threat and potential damage.  Shortly thereafter it was recognised that the patient was being raped by men who were clearly not in town and often not on the continet. A classic paranoid disorder medication had a limitted benefit but if she was under stress for any other reason this delusion might resurface despite the medication.  I was thankful that my treatment years back reduced her phone calls to the police from weekly to only a couple of times a year.  As a truly lovely and sophisticated lady she was deeply perplexed by these decreasing episodes and definitely remorseful about her causing trouble.  As a result she was highly compliant with medication and had a very good result last I heard.
Psychotherapies have not been particularly beneficial for paranoid disorders.  I've treated a few with one on one psychoanalytic therapy or cognitive behaviour therapy with the principle concern being, not allowing one to get caught up in the person's delusional system.  Normally the junior doctors do just this.  With paranoids you're the greatest friend as long as you thoroughly agree with them that the Conservative Party of Canada or the CIA or Catholics are malevolent and likely to be out to get this poor persecuted individual.  However once you challenge this premise you are rejected and seen to be part of the conspiracy and in fact more confirm the diagnosis.  Given this many psychopharmacologists limit therapy to focus on the brain disease with far greater benefit than inexperienced therapists who think that by exploring the person's past they will 'solve' the paranoia.  There is often 'trauma' but just addressing the trauma doesn't necessarily resolve paranoid disorders as it might resolve a ptsd or depressive disorder.  R.D. Laing who worked with schizophrenia wrote a book called 'knots'.  It was mostly poetry but the metaphor as it applied to paranoia and for him paranoid schizophrenia is that the knot is very good and very tight.
There is an attempt today with dialectic therapy, a new form of psychotherapy based broadly on the philosophical ideas of Marxism and showing some benefit in the treatment of paranoia. I confess I find this not a bit ironic since Marxism - Lennonism has been seen to be one of the greatest paranoid structures wholly reliant on the evil 'capitalist' . McCarthyism was a similar competing paranoid system.
Group therapy has been beneficial but only in the traditional low level 'supportive' way.  There is alot of 'rage hidden in the paranoia and commonly it is a a person with a quiet form of paranoid disorder that one day goes 'postal'.
My own exposure to an excessive amount of paranoid spectrum disorders is because I work in addictions.  All of the chemical addictions increase paranoid tendencies. The alcoholics are forever persecuted by usually the wife, boyfriend, government or boss or parents.  "If you were married to my wife, you'd drink like me."  There's tremendous self pity and grandiosity as every alcoholic is described as a 'legend in their mind', their depression being the greatest, their suffering monumental.  Alcoholism results in regression of defensive and coping mechanisms to an adolesecent stage with clear cut splitting of 'good guys - those who let me drink, and 'bad guys; , those who interfere with my drinking. All the pathological jealousy I've seen has been associated with alcoholism.  This might well explain the success of soap operas given the plops so often reflect the behaviour of alcoholics.  This indeed made Two and a Half Men a tremendous parody until Charlie Sheen's had his Purple Rose of Cairo meltdown.
Drug abuse is an even more associated with paranoia.  Most often this is directed at authority and specifically the police. A quote attributed to Keith Richards was "I don't have a drug problem, I have a police problem".  So again there's those who are for me and those who are agin me the early adolescent dilemna when the child is first leaving home, rejected parents for friends and struggling to resolve in group and out group association.  Marijuana smokers are especially prone to conspiracy theories.  Ask any marijuana smoker about 9-11 and it's sure to be an adventure in some mix of fantasy and reality.
Cocaine seems more specifically paranoia associated with money.  The 'harder' the drug the more of the frontal lobe or humanity of an indivdual is lost. Cocaine addiction and psychopathy go hand in hand with sex and  money the 'pac man' pursuit of the addict.
In all these cases treating the addiction is the answer.  For most people removing the substance for a year or two allows the persons brain to restore especially if there is a process of mental "decontamination' removing them from the cult paranoid thinking that helps to perpetuate addiction. 12 step communities and religious and ethnic communities and families can counteract the paranoid gang like thinking that goes hand in had with the addiciton.  Dr. Rabbi Twerki's book Addictive Thinking is a marvellous treatise on the negative effects of addiction on thought.  Insight therapies have traditionally proved very unsuccessful with addicts and the development of group therapy and motivational therapy and 12 step faciltation therapies often coupled with spiritual psychiatry approaches is now considered the treatment of choice psychotherapeutically.
Given that addictions are anxiety avoidance techniques and addicts collectively have by nature an underlying anxiety disorder most of the insight therapies and essentially therapies that result in eureka and dynamic realization and change as a consequence of new learning don't work with addicts because change causes anxiety and promotes relapse.  Supportive therapies usually are beneficail in the first three months of therapy when a patient abstinent is detoxing. Anxiety provoking therapies, psychoanalytic, relationship etc are used carefully because of the learning impairment implicit with addiction.  Addicts have rarely been able to grasp quantum changes but can learn more of the same old same old in a clever way.  Historically they were once using therapists consciously or unconsciously like psychopaths do, to improve their game with no real intention of changing.  Therapists who aren't trained in addiction more commonly are 'enablers' and on the street are called the 'addict's bitch'.   Meanwhile the therapist is either feeling warm and fuzzy or thinking of how much money they are making.
Antipsychotic medications are beneficial in the first year of treatment of addicts.
Commonly therapeutically I may agree in part but not in whole with a paranoid so that I don't so easily become caught in their black and white reality.  For example I might say 'The CIA can be concerning" in response to the patient telling me he believes the CIA have planted a chip in his tooth. I certainly wouldn't disagree with him without proof.  I watch NCIS and Insecurity on television so I know what spy agencies are capable. I will focus my attention however on 'why you'.  And what can you do to effectively not be overwhelmed by this fear.
Finally I like to remember, especially when I have my own paranoid moments, that Jesus said, "Do not be afraid."  My minister psychiatrist friend and colleague likes to say, "That wasn't a suggestion. That's a command."

Gratitude

I am thankful for this day.  It began with Angel the cat crawling over my head and then Gilbert the dog licking my face.  I am thankful for such furry cozy loving alarm clocks.  I am thankful that Angel lead me to her food and takes such great delight in manipulating her human. I am really thankful that I am her human.  Gilbert meanwhile went back to sleep, his job of assisting his sister done, and now he would wait for the leash.  I am so thankful that I have these two curious companions.   I am thankful for my friend Laura who was in the bath while I was making coffee and enjoying immensely the aroma and taste of that first cup of coffee. I am thankful for the yoghurt and banana too.  Then I looked at my iphone which I am really thankful for and the friends who post on facebook and twitter and email me.  So I have this moment drinking coffee seeing what my local world of known friends is interested in.  I'm annoyed by the Facebook pigs and worry about missing family posts given the limits of display.  But really I'm very thankful for this communication and the BBC on line which gives me an reasonable headsup to world affairs. Meanwhile Laura is listening to CBC locally. So by the time I'm in the washroom thankful that everything is working we have got the scoop locally, nationally and internationally and learned we really have no excuse not to get dressed.  After a shower I am immensely grateful,  functioning bowel and bladder, and shower are right up there as number ones, well I'm ready to get dressed. This week I'm especially pleased that I got the laundry done and can find clean clothes relatively easily.  Gilbert has his Canucks jersey on. I say he must wear it for luck so the Canucks will win tonight.
Now with Gilbert I go outside and am really thankful for the clean air. I don't much like the rain right now or chill but the air is great. So are the colourful flowers. I'm especially thankful that I can get by with a simple leather jacket and don't have to wear a parka.  And I'm overwhelmingly thankful for my new car. I love the Mazda MX5 sportscar and after putting Gilbert in get on my side and get the top down. Then I'm really thankful for Blue Collar Comedy on Sirius Satellite Radio. I'm thankful for hearing and breathing and heart beating and feeling and the motion in my body and that the pain level is tolerable.  I'm thankful that beautiful Laura joins me and we head off to her work.  I'm grateful to have such a lovely friend.
then I'm really grateful for the parking space and the second cup of coffee. I'm grateful for the work too. I'm grateful for the staff. I'm grateful that I'm able to get through the hundreds of email daily and the calls in addition to the countless demands that make up the work and that I've recorded everything as best I could though I know there are those far removed in ivory towers and Monday morning armchairs who would never think that my recording is good enough. My hand writing is not neat enough and my typing is not all encompassing. And I'm overwhelmed to answer the myriad of in depth questions in so little time.  There is never enough time and I feel like I'm squeezed in a chute going down a dark tunnel with a whole chorus of people shouting at me from every side saying remember me, I'm first, me first, me first, and all the time I'm trying to focus on the person in front of me who sometimes in the past has carried guns and knives and told me that they were going to kill me or have tried to kill themselves.  Complete strangers have walked in off the street making threats. Anonymous phone callers have phoned making threats.  I am afraid of the interactions of these new compounds. I'm hastily looking up and cross references and citing texts and talking. I used ot only listen but the change was so limitted. Now I talk more and people change positively more.  There's a sweet spot between talking and not talking and yet more and more as the medical model is demanded again I'm back to the general practice 'teaching' model and my brain is okay but yours is not. I miss the days when our minds were all that mattered but the economists don't know meaning. We're deluged with self important technicians.  I'm thankful for the lack of surprise today and that I was of use I hope to many. I'm glad I could be a cog in a great wheel. i am thankful for doing my part in the busyness of the multidimensional glass beed game that today's psychiatry is. At times I even felt like I was playing three dimensional chess again but I must restrict myself to unidimensional chess. My colleague who retired writes of resurrecting people and we know how dangerous that is.  I'm thankful for the anonymity.  I'm thankful for the mystery. I'm thankful for the colleagues. I'm thankful for the internet and wikipedia and the books in my office and the programs and all the learning that I've been so blessed to be apart of. I'm deeply thankful for my teachers, those ones who gave me such positive lessons and those one whose lesson was to teach me what not to do.
I'm thankful for my fingers.
I'm thankful for the close of day. I'm thankful for my dog. I'm thankful for driving home in a new car. I'm thankful I'm not on the motorcycle in this rain. I'm thankful that parking was so easy when I stopped at the store. I'm thankful for the delis in grocery stores. I'm thankful tonight for IGA. I'm thankful for the cellphone so that I could notify Laura that' I'd pick up dinner for us.  I'm thankfu for the great meal and the joy and fun of sharing barbecued chilcken with two cats and a dog, all of us nibbling togehter.  I'm thankful for the chicken tradition and the pets.  I'm thankful for my family. I've thought of them fondly through the day, cousins, nephews, brother, in laws, dad.  I'm thankful the Canucks won. I'm thankful for televison. I'm thankful for Cherry Garcia ice cream.  I'm thankful for this routine day, this relatively uneventful day.  I'm thankful for tradition and routine and the novel and amusing.
I'm thankful for this bed . I'm thankful for sleep and dreams.  I dreamed last night I was shooting a monstrous bear that was attacking me. I was using the small guage 30 30 that I crushed under the flipping ATV. I guess I probably incorporated the time the bear did attack me and I was shooting it repeatedly in the back as it came to within inches and feet of me but veered off to go up the tree where my last shot killed it.  When I skinned and butchered it I found my bullets had gone through the heart , both lungs and liver, guts and spleen and one hip.  It had fallen from the tree when I'd severed its spine.  It'd put a clip into it at close range and changed out the clip to shoot the final shots at it up the tree.  My 3006 rifle was touching fur in the final shots of the charge. A medium black bear.  In my dream the bear was monstrous and the 30 30 shells were having little effect yet I was backed up by afriend with a pistol and the bear didn't maul the person it was chasing who ran by me.  Odd dream.
It is bear season. This time last year I was climbing mountains and shooting over the heads of bear who lived to tell the day wary now of men with cockapoo dogs at their sides.
Iam thankful for the outdoors and nature, hunting and fishing, hiking and wilderness. I am thankful for this day. Thank you God for this day. Thank you.

Professionalism and Medical Social Engagement

Jack Coulehan, Peter C Williams, S. Van McCrary, and Catherine Belling in the Cambridge Quarterly of Healthcare Ethics, 2003 12 21-38,  article, "The Best Lack All Conviction: Biomedical Ethics, Professionalism and Social Responsibility" do a superb job of discussing "Professionalism and Social Engagement".  As a clinician I truly admire the way they summarize the issues clearly.
They begin by asking "Are altruism and social activism appropriate topics for medical education to address/"  While saying we 'admire' doctors who 'work in free clinics' or 'engage in public policy debates" but, "do these activities make them better doctors or simply better people?
I have had to reflect on this alot in my life because it's my personal experience that I have been penalized routinely for putting patients concerns first and "rocking the boat' or 'swimming upstream' against individual and institutional graft and corruption.
I was indeed told that my membership in Physicians for Social Responsibility and my days as a card carrying member of the Canadian Civil Liberties Association was considered a 'fault' in a psychiatrist.  While I was reading Jay Lifton, MD's books, including "Nazi Doctors',  my colleagues who went onto increased power and position were studying "business administration" and reading 'financial columns."
I began a dual speciality in Community Medicine and Psychiatry where at the time the furthest extremes of equation public and private were represented by both faculties. The Community Medicine faculty taught me public health concerns and I even wrote a paper on Psychiatry and Social Responsibility in the 80's in the Canadian journal, seeing it back paged. I wrote responses to medicare decisions in the provincial journals and was actively involved in medicine and politics.
In comparison one colleague saw roughly 50 patients for 30 years having a coffee clutch weekly with these loyal patients.  I saw thousands in comparison and worked on the toughest 'assignments'.  I am usually uttterly exhausted by the end of any clinical day.  I certainly haven't time left over for the constant beaurocratic in fighting and back scratching.
New patients are the greatest risk of complaint.  A 'stable' is never a threat.  My colleague who 'gives patients what they want' has a loyal following. Popularity is their calling.  Rate your doctor has their name as 5 star.  They cherry pick patients and had been seeing their friends only for decades.  They sat on committees and served in the main stream high profile positions.  They had energy for these functions where they ensured that the greatest funding and support went to doctors of like mind.  In the end they had 'position power'.  They never 'rocked the boat' and they never challenged the authorities.
Social responsibility is a precarious position.
I think back to a half dozen complaints I had to the College of Physicians and Surgeons and the most vociferously complaining patients on rate your doctor.  These complaints have been specifically to do with my diagnosis and addressing addictions. While in my psychiatric residency I worked in the Winnipeg Detox.  I fear I was the only psychiatrist who did that, certainly the only one I knew while I was there.  When I came to BC I just naturally continued to diagnose alcoholism and substance dependence according to DSMIV criteria, using AUDIT and CAGE screening tests when available.  Alcoholism and substance abuse disorders were simply rarely diagnosed. The standing joke in the 80's was that you didn't have an alcoholism problem unless you drank more than your doctor.
I have seen patients that other colleagues have 'colluded with' and said they did not have 'alcoholism'.  No clinician would question a list of DUI's and liver disease etc as evidenced based diagnosis but I would invariably be the first to make the "diagnosis" despite dozens of doctors seeing the patients. The patients would be outraged,
The consequences of my doing my 'job' of diagnosing 'alcohol dependence", "cocaine abuse' and other DSMIV Axis I diagnosis has been that my life has been threatened repeatedly, my windows shot out, beer bottles smashed against my windshield, cases of empties thrown at my house, my dog killed.  It would have been professional and socially responsible for my colleagues to have made the correct diagnosis but 'at what cost.'
The consequence of a diagnosis of 'addiction' was that people who were working in safety sensitive areas and were causing accidents in the work place would be 'required' to 'undergo' treatment for the addiction.However if they could get a psychaitrist to say that they were 'depressed' rather than having a 'concurrent diagnosis' they could avoid the  consequence of their actions.  Indeed if they could get a psychaitrist to tell them their mother's lack of breast feeding necessitated their drinking at the age of 50, even better.
The cost of doing the 'right thing' being the 'socially responsible' doctor, is that I have lost at least a quarter million dollars  in real money and time.  I've lost personal time to pursue my own research interests.  Instead of addressing issues of 2012 I'm mired in dealing with what was proven true and beneficial 20 years ago.  Indeed in general psychiatry circles I am surrounded by proponents of 'better living through chemistry' and considered too 'conservative' when it comes to addiction matters.  Social activism is only 'hip' if it's left wing and pro pot smoking.
The politics of medicine favour those who make the most money in the practice of medicine.  Making the most money is based on doing the old technologies and old standards of approach.  The reformer is an enemy of anyone who benefits from the status quo.
All my pro bono work in a variety of areas has in no way benefitted me in the 'hierarchy' of medicine.  Indeed I've heard colleagues contend that if I'm doing these things for free then they are without value.  When doctors have attempted to get paid for all their many hours of 'free' work people collectively become obscenely offended yet would never expect anyone else to work overtime, be on call, or work without pay.  The deeply shameful government year in and year out published the 'gross earnings' of doctors who routinely paid tens of thousands of dollars in training and started earning 10 to 15 years later and died routinely 10 years younger and worked on average 120 hours, the equivalent of 3 government jobs, yet were compensated at a penance of their worth.  When people complain of the 'nationalization' of mines and copywright theft and fixed housing income and interference in private business, I just reflect that I have worked my entire life with a ceiling, and supported government services up the ying yang through taxes and my doing the core clinical work which is what causes the overall health care services to be supported. There is no health care services without doctors but administrators and planners and beaurocrats galore ride on the shirt tails of the work of physicians, work that is commonly donated free. So every time I did 'motivational therapy' regarding quitting smoking going back
Now I'm at the end of my career and if the life expectancy of the doctors I started is anything to speak too, perhaps my life, due to stress and overwork and lack of resources or support.  So many of my colleagues I worked with in early years died in their 60's, and then there were those friends who died young from diseases the caught in their work.  Every doctor I know except some administrative government types and a few for profit only doctors generally does pro bono work.  Even in the 'bad' United States it was standard for doctors to donate their time to the indigent hospitals.  If I were paid in my office today for all the work that I do I'd be a millionaire many times over.  Looking at the fee schedules with a colleague recently we laughed at how the 'bean counters' have set it up so that hospital doctors with accounting departments can ensure that ever cent owed is collected whereas in community medicine and psychiatry bad debt in the name of the game.  I've lost 20$ of my income in uncollected fees in a bad year, 10% in a good year.  When I had a psychopathic staff person steal from me her criminal behaviour was never addressed by police or government.  The doctor is routinely treated as the 'bad' person with all those poor people who are suffering and yet it's so forgotten that doctors are patients too.
I don't get breaks financially.  I don't have people doing things for free for me.  Instead my life has been that people in business learn I'm a doctor and I am double charged even though a doctor saved their baby's life. There's a great lie in business that business people are 'big hearted' . They're not. The rich are rich by not losing money.  Yet we know the standard joke is to invest where doctors are not.  Because doctors collectively are giving it away.
So despite being reasonably re imbursed, not at all in the league of health care administrators when their time off, holidays, lunches, perks, coffees, pensions, plans and everything is truly factored in, we're still working for free alot for the sake of patients. We're covering the indigent. We're all doing our best for children and commonly women and the old.  We're staying late at bed sides and we're really caring.  But when doctors go on salary oddly they work like normal people and the whole system simply cannot afford salaried doctors here.  Salary commonly brings out the 'union' 'work to rule' ideation. Maybe it works elsewhere. Maybe it could work.  The difficulty in the field is that there are those who are communists and those who are capitalists. The socialists sit in between somewhere and mostly we thrive in a mixed economy.  My favourite cosmetic surgeon donated time to the burn clinic. He made his money on nips and tucks and could enjoy restoring children's faces after devastating burns.  The standard medical service payment couldn't pay anything near his fees and any businessman wouldn't work in the low end of the scale with the burn patients. Yet most plastic surgeons I know do just this.  Even the dermatologists, another high paying group who could all be rich overnight if they just stuck to botox instead serve in indigent communities.  It's normal to see this.

So this article definitely wet my whistle.  The AMA recommended 'each physician has an obligation to share in providing care to the indigent".


The authors of this article while raising the question and discussing it conclude
"In summary, it is fair to say that there is a long tradition of social responsibility in the medical profession."

Port Angeles

I was surprised at how big Port Angeles was.  I certainly wasn't expecting a half dozen car dealerships or the large Walmart.  I'd driven Laura and Gilbert down from Vancouver BC in my new Mazda Miata sportscar.  Northern Washington is just the best place to drive this time of year.  I love the road ways.  We'd already explored the winding back country roads on my Harley Electraglide motorcycle years gone by. Now were really enjoying them in the new sportscar.  Glorious sunshine after a winter of rain.
The ferry to Port Townsend from Whidby Island lasted less than half an hour but it's advised that one reserve.  We didn't either way and got on without difficulties but then it's early season.  We loved Port Townsend, Fort Worden and the Point Wilson Light House.
Port Angeles is only an hour drive west on the I20. Great road.  People drive up from Seattle and don't have to take the ferry. Which explained the numerous RV parks which looked really inviting. It's about 2 hours from Seattle.
I'd once come to Port Angeles in my 40 foot sailboat, SV GIRI,  some 20 years past. I couldn't recognise the town but immediately remembered the well sheltered port. Looking at the harbour I really wanted to sail back here again. We looked across Juan de Fuca Strait at Vancouver Island.    I think I could just see the city of Victoria in the distant haze.  I recollected all the sailing adventures I'd had starting or returning through the Juan de Fuca Strait.  North it becomes the Strait of Georgia and that's where my home sailing is. But Juan de Fuca has been the departure point for heading to Mexico or crossing the Pacific to Hawaii. I fondly remember returns from circumnavigating Vancouver Island or just travelling out to the exquisitely beautiful Barkley Sound and back.  There have been storms too and I believe it was to avoid one that I came into Port Angeles that time years ago.
Port Angeles is famous also for the week long month of May, "Esprit Gala". This is an annual cross dressers, transvestite, transgendered convention that has attracted hundreds. The very old and discrete Cornbury Society of Vancouver has been recommending Esprit for many years.  It's really quite the institution.  Shopping forays, lectures on make up, hair stylists, dinners and even a ball gown event, for those who wish to go formal, is hosted, according to advertisements. Again I'd never have thought of Port Angeles, ostensibly an outdoors coastal logging community,  as so sophisticated to host such a cosmopolitan event.    Monty Python had done a sketch about loggers in frocks but that was when Benny Hill and his gang were still in the closet.  We'd been laughing on the ride here listening to Izzie Edwards the cross dressing English comedian on Sirius Satellite Radio Blue Collar Comedy.
I was impressed looking at all the boutiques downtown.  Quite the range of restaurants, foods, ethnic choices, and quaint shops.  A couple of prominent lingerie shops too.  Two smoke shops which caught both Laura and my eye given the indeceny of tobacco these days.  The head shops seems less offensive these days when one considers the obscenity of lung cancer and cigarette addiction.
Looking in the brochures for the region it turned out both Port Townsend and Port Angeles are major centres for all manner of conventions. Both attract alot of eco tourism but a wide range of businesses choose these towns for their meetings. I'm not surprised. The towns have so much to offer and the surrounding environment is so inviting for all manner of outdoor activities.  Culture and logging. Who would have guessed. Yet that's surely what Port Angeles is about. Nightclubs and fishing boats too.  Everyone was friendly. Gilbert enjoyed the walks and pee breaks.
We didn't have time to stay. It was a destination for a drive. We had to be back in Vancouver that night.  I enjoyed the expresso drive through too.  The Miata was a joy too. Sirious Radio comedy channel, opera or symphony with just the occasional blue grass driving through the corridors of trees. Beautiful farms, great vistas of forest and water.  Cows, horses, sheep and apacas.  I loved the drive.  Gilbert loved the chances to run on the beach.  Laura enjoyed the sunshine and sightseeing.
Looking at the pictures I took. I have some of the spit and harbour.  It figures being a sailor.  But I've only a couple in the town. Tourism is about seeing what catches your own eye.  I happened to enjoy taking a picture of a bumblebee outside the native art pitstop where Gilbert piddled and we enjoy the native art.  Nearby there was  busy bustling casino. 

Point Wilson Coast Guard Light

Just outside Port Townsend is this marvellous old coast guard station. There are terrific RV and campgrounds near by and picnic areas. The attraction though is the wild and wonderful beaches that go for miles. Orcas pass in the channel. We saw them.  Eagles soar above. Black tail deer walk about in the nearby woods. it's a mystical place.  A place that makes me want to bring and easel rather than a camera.  it deserves a whole lot more.  But we had places to go and people to meet.