What’s complicated about it? You should never let your children approach an unknown dog and the owner did exactly the right thing.
A dog, no matter how well behaved, can be provoked.
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Victim blaming is a thing
This
The noise they make with the bins. Dogs don’t like sharp noises.
Really useful listen for anyone talking to a person with dementia.
So pleased to hear more intelligent and humane approaches are current, rather than the rather stark reality orientation I was schooled in.
My O2 sats are currently in the 80s and low 90s. It’s a bit weird, feeling faint, woozy and occasionally even more confused than normal. And tingly.
It’s probably a side effect of a drug I’m on. Unfortunately (1) I really need this drug, and (2) the side effects can get a bit deathy. Ho hum.
Hmm, yes, it’s fuzzy world down at those sats.
Do you get O2 supplementation?
Nope, they would just pull the drug, which would land me in hospital. I’ll give them a call in a bit I think.
I hope you’ve stopped smoking.
Not had one all week, but it’s not related to lung function, it’s the drug twatting my red blood cells.
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Smoking reduces your O2 saturation.
Applies to a lot of dogs - terriers perhaps predominanatly.
As a child a Corgi bit me as I turned and walked away from it. Shithouse.
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Children should be kept on leads at all times - or preferably drowned at birth, along with the parents.
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In order to get a blood test at short notice, I have a chat with the nurses at Guy’s, they fax my doctor’s surgery, who ignore the fax. I go in to the surgery, they bleat that it’s not on their system (because they only input letters and faxes once a week or so), moan that they can’t do it now, get annoyed with me for standing there and quietly pointing out that I do actually need it today and that them pulling their fingers out of their arses and doing it is a whole load more efficient than me ending up in A&E. They then pull in more procrastinators and get into a big huddle, before finally printing out a form that is exactly the same as the form that they print out every few months for me. At the hospital, various reference number have to be written by hand on the bottles. In order to get the results, the nurses at Guy’s then have to phone up my surgery and get them faxed down.
I really can’t understand why there can’t be an electronic request by Guy’s and I just rock up to the hospital. I do know that the NHS programme for IT was a near Kafkaesque failure, but this is actually pretty simple stuff.
Then, just as annoyingly, there are 30 people ahead of me in the queue at the hospital.
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Why do I think that this will come down to whose budget the cost of the test is set against ?
My diabetes is managed entirely by a specialist team at the local diabetes/endocrinology/metabolism centre (and by me, of course). They decide what drugs I should be on but they won’t prescribe them, except sometimes a few days’ worth if they feel an urgent change is justified, which probably hasn’t happened for a decade. My drugs are prescribed by my GP and, I guess, paid for out of the CCG’s prescribing budget. So my specialists make the decisions but won’t and/or needn’t shoulder the cost.
VB
In Graeme’s case, yes when it comes down to prescribing I can guarantee this will come down to whose budget it comes out of - typically the majority of drug costs are paid for out of the practice ‘budget’ (really don’t get me started on this one!).
In Adam’s case its straightforward nonsense of a mish mash of paper vs electronic systems, potentially easily resolved, but a. its not anyone’s specific job or responsibility to sort this shit out, and b. the NHS can’t do IT without seeking to boil every bloody ocean on the planet in the process - so they don’t even bother.
It is though - the department for health should have an efficient system. It needs to be them that sort it out, as it will need interfaces between trusts, GPs and CCGs.
Interestingly my prescriptions are quite straightforward - I have 12 medications on repeat with my GP, and just click buttons and they turn up. But the consultants are always happy to prescribe as well, indeed they are surprised that I can get my GP to do so. Some of the drugs are fairly expensive as well - a private prescription for one cost almost three figures.
You’d think so but no. The DoH sees itself as a remote high level governance body with overall accountability for national strategy and little else. It has increasingly over the last ten years delegated all responsibility for performance and efficiency to the commissioning bodies it directly funds, in complete defiance of the fact that they cannot possibly implement this due to all manner of constraints, and the loggerheads that DH has created with two competing and diametrically opposed regulators.
Fast forward and you get the unofficial STP structures being snuck in by stealth, which its only a matter of circumstantial timing that they turn into statutory bodies. In theory these will span the GP/ provider/ commissioner dimensions and mange total funding and efficiency delivery. ACO’s are touted as the vehicle for this radical transformation.
Christ it’s absurd, I almost feel sorry for you working in it. Then I remember you’re a consultant.
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