Silversea Water Cooler: Part 3, Welcome!

[Tothesunset]

...Don't get me started about the sorry state of medical education these days...

But the quality of the product seems to be ripe for further training. My department was a validated training dept for oral and maxillo-facial surgery and the trainees (and me too, for that matter) held the equivalent of DDS and MD (that is BDS and MBBS over here) - so they had been in the system for 9 years before stepping on the first rung of the ladder to consultant (or Board Certified I think you'd call it). I never found the candidates' abilities wanting but never shook off the feeling that they were over-educated and under-practised - in other words they might know all about procedure xxx but lacked experience in the hands-on.

 

I was also lucky enough to be an examiner for the Royal College of Surgeons of England for those training in my specialty and I must confess that I could often feel humbled by the intellectual acuity of the candidates. BUT the one thing that constantly struck me, and I do think this needs addressing, was the lack of good written English - yes, their case reports etc were properly structured but dusted with unusual spellings, convoluted syntax and often only a passing acquaintanceship with punctuation.

 

In sum I think the guys and girls coming through are at least the equal of my generation in ability, a little less practised (largely due to legal restrictions on working hours) and no less well-equipped for the future. I feel sanguine about the future of medicine.

[UKCruiseJeff]

Extremely elegant JP!

 

All it needs now is a pizza oven. :D

[Lois R]

I have been out all day....met my girlfriend for breakfast.......then ran some errands......shopping both clothing and

grocery store:D

 

Oh I didn't know it is Jeff's birthday........HAPPY BIRTHDAY:)

[Lois R]

Tell us more, Lois. My memory gets a little rusty!! As you consider places to visit in Europe, what most interests and motivates you? Is it history, culture, shopping, architecture, urban environments, nature, music, art, wildlife, nightlife, food, scenic countrysides, wine, etc.?? Are you mostly for being more "aggressive" in doing and seeing as much as possible? Or, seeking a more relaxed and laid-back experience? Are more just of a "float on a boat" person where the ship is the prime "destination"?

 

THANKS! Enjoy! Terry in Ohio

 

Super loved Dubrovnik!!! See more details and lots of great visual samples/examples at this link. Have had over 38,583 views on this posting and appreciate those who have tuned-in and dropped by.

http://boards.cruisecritic.com/showthread.php?t=1439227

 

Hi Terry, I love food:D LOL...........wildlife? like a zoo? ok.......lol.........museums, depending on which........I enjoy that

too..........and yes, I enjoy learning the history of places as well.

 

Actually, the girlfriend I met for breakfast loves Paris and she has been there at least 1/2 dozen times over the years

and there is a possibility we may. go together........I will keep you posted on that one........so there is a chance

we may visit for a week in March........so I am putting the land trip and river cruise on hold for the time being.

Edited September 16, 2017 by Lois R

[UKCruiseJeff]

Good Morning Coolers,

 

Some reading from today's Sunday Times for Lois ........

 

Paris

 

https://www.thetimes.co.uk/article/the-best-things-to-do-and-where-to-shop-in-paris-2017-d2tp6drws?shareToken=3dabf1b8fd6567b6324d2b552c684c0e

[mysty]

Greetings Coolers!

Apropos of nothing.....beautiful story of a British war bride and a Canadian soldier who celebrated their 75th wedding anniversary on August 22nd of this year and died hours apart on Friday.

 

http://ottawacitizen.com/news/local-news/this-defies-any-sort-of-logic-war-bride-and-groom-die-within-hours-of-each-other

 

Have a great day all!

[UKCruiseJeff]

Hope your watching the F1 GP today M, ...... I expect it to be really worthwhile. Singapore plus a wet track plus that starting grid .......

 

I'll read the article after the race ..... I promise ........:)

[mysty]

Enjoy the race J! That story lasted this long.....it is not going away soon. :)

[UKCruiseJeff]

 

 

 

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[spinnaker2]

Happiest of birthdays Jeff et famille.

[UKCruiseJeff]

Thanks Spins ... I hope everything this week goes according to your wishes and that the home challenges are all under control.

 

Today's birthday prosciutto on toasted Pugliese durum bread and some Buganay and some fresh fruit salad.

 

 

 

 

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[spinnaker2]

Yum and thanks Jeff.

Pictures of your food are both comforting and grounding.

 

Clean up here continues.

City dump truck came through for first wave of debris, multiple times.

Now more storm lashing detritus is at edges of our properties looking like so many fences made of denuded branches.

Many people are complaining of feeling discombobulated...

Edited September 17, 2017 by spinnaker2

[Camillus112]

Spins, warm (but maybe I should wish cool) feelings for you and your neighbors on dealing with the aftermath. I'm sure the cruise will be restful and will lift your spirits.

 

Tropical storm María is expected to become a hurricane and pass through Puerto Rico as a level 3. The infrastructure was so much damaged by Irma's brush that I hardly think it will withstand a direct hit. After so many days, there are still around 100,000 houses and businesses without power. I do hope Florida will be spared this time around.

[Lois R]

Good morning:)...........Jeff, thanks for the article:)

[Camillus112]

Very nice breakfast for our Birthday Boy! Jeff, I enjoyed your article on Paris. We have not been there since 1985... Somehow, it just hasn't happened. A plan to develop for the future.

[UKCruiseJeff]

Hi,

 

I read travel articles whenever I see them and a suprising number are very clearly armchair journalism and are completed by lazy journalists not visiting but googling. They often get extremely basic facts wrong because they have landed on an out of date google page. This lady genuinely knows Paris.

 

Lunch not breakfast I'm afraid Camels. We seem to eat so much less these days so I'm adjusting to take account of it. I have found lately that I'm less interested in the meat I cook, but more interested in simplicity ie a piece of crusty bread, some nice cheese and some nice tomatoes and a glass of rustic modest peasant wine. Except for rose.

[jpalbny]

But the quality of the product seems to be ripe for further training. My department was a validated training dept for oral and maxillo-facial surgery and the trainees (and me too, for that matter) held the equivalent of DDS and MD (that is BDS and MBBS over here) - so they had been in the system for 9 years before stepping on the first rung of the ladder to consultant (or Board Certified I think you'd call it). I never found the candidates' abilities wanting but never shook off the feeling that they were over-educated and under-practised - in other words they might know all about procedure xxx but lacked experience in the hands-on.

 

I was also lucky enough to be an examiner for the Royal College of Surgeons of England for those training in my specialty and I must confess that I could often feel humbled by the intellectual acuity of the candidates. BUT the one thing that constantly struck me, and I do think this needs addressing, was the lack of good written English - yes, their case reports etc were properly structured but dusted with unusual spellings, convoluted syntax and often only a passing acquaintanceship with punctuation.

 

In sum I think the guys and girls coming through are at least the equal of my generation in ability, a little less practised (largely due to legal restrictions on working hours) and no less well-equipped for the future. I feel sanguine about the future of medicine.

 

I have days when I do feel OK about the future of medicine, and other days when I most definitely do not. The raw talent of the students is quite impressive, I agree. The potential is there. And medicine is getting more complicated; just the number of new drugs which have come out since I left school is astounding.

 

The kids seem very focused on what will be on the test, and not very focused on what will give them the experience (and expertise) necessary to be complete physicians. Yes, the intellectual ability of the students is quite impressive...but the intellectual curiosity needed to become lifelong learners is too often lacking. They also don't seem to want to examine patients, or take the time to listen to them. They spend lots of time at the computers, looking at lab results and radiology reports. We call that the phenomenon of the iPatients, at times.

 

As an internist you can take the easy way out (identify the problem at a rudimentary level and call the appropriate specialist to solve it for you), or you can dig deeper and figure it out yourself. I much prefer the latter. It is a real chore to convince most of my residents that they can and should be doing that. It gets discouraging after a while. They seem amazed that I can figure out what is wrong with their patients before they give me the CT scan results, but they don't want to put in the effort to do that themselves.

 

There is way too much emphasis on high-tech imaging scans, accompanied by a very literal interpretation of the written radiology report - which is taken as Gospel. There is no real clinical correlation with the history and physical exam, which seems to be a dying art. My approach to a patient with a respiratory complaint is to talk to them and do a physical exam before I decide what tests to order, if any. Their approach is to stop after they figure out it's a respiratory complaint, do a standard battery of tests, and order a CT scan whether it's needed or not. The tests and CT are a standard approach, regardless of the diagnosis.

 

Such a waste of testing, and often the CT shows something that's irrelevant and sends them in the wrong direction, chasing something that is clinically insignificant. And they don't know any better, because they didn't take the time to talk to the patient and do an exam!

 

Documentation is terrible; I agree with you. Progress notes are full of cut-and-paste templated superfluous garbage, which is there solely for billing purposes, but obscures the important parts of the note. Sometimes you can read the note and still not know what is actually wrong with the patient! And the "RICHMAN" approach to inpatient notes is a disaster. Every patient has "Respiratory, ID, Cardio, Hem/Onc, Metabolic, Alimentary (GI), and Neuro" problems in their progress note, whether the system is malfunctioning, or normal. These notes especially drive me bonkers. I wish that the kids would use their intellect to write down what is actually wrong with the patient - as a specific disease, not a set of organ systems which may or may not be relevant to what is actually wrong. I can communicate better in just a few paragraphs than they can in a few pages.

 

Anyway...if I go on any longer we will drive the rest of the cooler to drink. Will that be a metabolic problem, or an alimentary one? Time for me to finish the bottle of Sauvignon Blanc that we started last night. Cheers!

[MissSophia]

Evening All.....

 

Lovely lunch out at the river pub...we had a table in the conservatory which gave us the most beautiful views down river where the trees are starting to turn colour....we shared the delicious charcuterie board to start followed by their roast....sorry Jeffers, l chose pork today!! Furry baby got a good doggie bag!

 

Just two days to go until l leave for Athens so much to do before my 6.30am departure on Wednesday......hoping to see Spins on the pool deck for some fizz.....

 

😊

[Tothesunset]

Bit of a shock this morning when UPS delivered our Silver Box for our Wind TA on 10 Nov - there's still 53 days until sailing. Not that I'm complaining, mind, it just seems a lot more in advance than usual.

[UKCruiseJeff]

Good afternoon Coolers,

 

Soapy ... so pleased you didn't have rib of beef ..... and feeling the excitement. Hope your travels to Athens go smoothly.

 

TTS, hope you have a great cruise ..... and looking forward to hearing about it. Today was burgers in panini and fries.

 

 

 

 

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[TLCOhio]

I have days when I do feel OK about the future of medicine, and other days when I most definitely do not. The raw talent of the students is quite impressive, I agree. The potential is there. And medicine is getting more complicated; just the number of new drugs which have come out since I left school is astounding.

 

Really found fascinating and appreciate the insights, comments and this follow-up by J.P. as to the future and details on medicine. Having just gone through my first (and hopefully last) kidney stone challenge in May, there are many plus and minus factors involve with health care. And then there is that little (but huge) question as to who pays and how much? Excellent background by both Tothesunset and J.P. Can you guys figure out that financial challenge? Or, is that too much Mission Impossible?

 

Also, here in America, PBS (Public Broadcasting) started last night an 18-hour, ten-part series by famed documentary producer Ken Burns. It is all about Vietnam!! The initial part started with the history of the French colonial period, plus the Japan occupation during WWII, then the pushing out of the French, the division of country between the north versus the south, etc. All of this first part leads towards what we call the "Vietnam War". In that country, however, they call it the "American War". In just four months, late January 2018, we will be doing our first visit to Southeast Asia, for Hong Kong, Bangkok, Vietnam and Cambodia, including, seven days sailing on the Mekong River, visiting Angkor Wat, Ho Chi Minh City, Hanoi, Ha Long Bay and Hue/Danang. Any others have Vietnam experience to share???

 

Then there is this CNN headline this morning: "Hurricane Maria: 'Significant' strengthening likely as storm nears land". Here is their quick summary: "Hurricane Maria is forecast to rapidly strengthen over the next two days as it takes aim at Caribbean islands devastated by Hurricane Irma just days ago. Maria has prompted a hurricane warning for Martinique, Guadeloupe, Dominica, St. Kitts, Nevis and Montserrat."

 

Full story at:

http://www.cnn.com/2017/09/18/americas/atlantic-storms-maria-jose-lee/index.html

 

THANKS! Enjoy! Terry in Ohio

 

Panama Canal? Completed Feb. 28-Mar. 15, 2017, Fort Lauderdale to San Francisco adventure through the Panama Canal with our first stops in Colombia, Central America and Mexico, plus added time in the great Golden Gate City. Lots of fun, interesting pictures!! Those visuals start on the second page, post #26. See more at:

http://boards.cruisecritic.com/showthread.php?t=2465580

 

Here is the CNN graphic this morning for the direction of Hurricane Maria as it heads to the Caribbean.:

(Open your screen/viewer wider to see these pictures larger!)

[TLCOhio]

Bit of a shock this morning when UPS delivered our Silver Box for our Wind TA on 10 Nov - there's still 53 days until sailing. Not that I'm complaining, mind, it just seems a lot more in advance than usual.

 

Good to know that Silversea is being efficient in getting that Silver Box sent to you so far ahead of your Nov. 10 Silver Wind sailing. Lots of interesting stops on this Barcelona to Barbardos trans-Atlantic sailing. Hopefully, you will do some posts as you are doing this "adventure". I am especially interested in a couple of your stops in Morocco.

 

Be watching today for the responses to various CC Board questions to SS Managing Director Mark Conroy. Lots of good questions were raised. It will be interesting what this experience cruise veteran has to share.

 

THANKS! Enjoy! Terry in Ohio

 

Venice: Loving It & Why??!! Is one of your future desires or past favorites? See these many visual samples for its great history and architecture. This posting is now at 69,811 views.

http://boards.cruisecritic.com/showthread.php?t=1278226

[Camillus112]

Terry, a double whammy to the devastated islands! Although I feel proud to say that Puerto Rico has taken over 2,000 refugees from the smaller islands battered by Irma, these people will again suffer as María's eye is forecast to ram through Puerto Rico. Puerto Rico's infrastructure basically collapsed under Irma, and will not be able to stand up to María. All are being warned to prepare for not having power nor water for a long, long time. Praying for the best!!

[Tothesunset]

Good to know that Silversea is being efficient in getting that Silver Box sent to you so far ahead of your Nov. 10 Silver Wind sailing. Lots of interesting stops on this Barcelona to Barbardos trans-Atlantic sailing. Hopefully, you will do some posts as you are doing this "adventure". I am especially interested in a couple of your stops in Morocco.

Thanks, Terry. We are indeed looking forward to the stops in Spain and Morocco, although, for us, the ship is the destination and the ports just added extras.

 

Each time we go away I fully intend to post a daily diary of the trip but never get around to it. Some of the voyage journals posted on here are really detailed and interesting and I'd like to think I could do the same. The trouble is that we get so into the rhythm of the cruise that we rarely find time to check emails never mind post reports. I know, I'm a disappointment (in so may ways!) but shall try to do better in future.

[mysty]

Greetings Coolers!

 

Our PM Justin Trudeau is meeting with the the British PM Teresa May here in Ottawa later this morning. One topic on the agenda is a trade dispute by U.S. aerospace company Boeing against Montreal-based Bombardier. Boeing alleges government subsidies to Bombardier led to a deal to sell 75 jets to Delta Airlines for a lower price. Bombardier is both a major Canadian company and a significant employer in Northern Ireland, with 5,000 workers in Belfast making up about 10 per cent of the area's manufacturing jobs.

 

Trudeau's office said last week the two leaders will discuss innovation, climate change and gender equality.

 

 

http://www.cbc.ca/news/politics/justin-trudeau-theresa-may-meeting-1.4294515

 

 

Another unseasonably warm day today! I think we are finally having summer! :)

 

 

Have a great day all!