Andrew Gunn – (we)blog therefore?

The Last Word on Wars

Australian Doctor 29 November, 2013 Dr Andrew Gunn
http://www.australiandoctor.com.au/opinions/the-last-word/the-highlight-of-a-conference-is-never-the-present

The highlight of a conference is never the presentations. It’s the networking — with taxi drivers.

An Afghan immigrant drove me to the airport a couple of weeks ago. He complained about the stupidity of toll roads and the governments that create them.

All roads no longer lead to Rome, but all taxi conversations still lead to politics. Cab fares cover discourse as well as distance. George Burns once said it was a pity that the only people who know how to run a country are busy driving taxis and cutting hair.

My driver enthused about a 2004 book called Imperial Hubris: Why the West is Losing the War on Terror. Thomas Hobbes was the 17th-century English philosopher who said that, without society, life is nasty, short and brutish (with society, it’s natty shorts and brewed tea). Hobbes believed that the greatest destroyer of peace is hubris.

I bought Imperial Hubris for myself this Remembrance Day. The book’s gist is that Western bombs, not Western culture, create Islamic extremists.

The cartoonist David Pope once expressed this by showing ground crew shouting to the pilot of a bomb-heavy American fighter plane: “And while you’re there, try to find out why they hate us so much!”

The game of thrones is now turning into the game of drones. Almost 10% of US Air Force pilots now fly drones.

My cabbie became distressed talking about drones. He said they are “men using PlayStations to kill people”.

We spoke about his family. He explained that Afghan families “are not a husband and wife, two children and a dog … tribal families can be thousands of people”. And if you kill one family member then it is custom that the others vow to kill you.

He frowned and said: “We all thought it was funny when Australia talked about ‘staying the course’ in Afghanistan … because when the Americans leave, you will be slaughtered … it’s crazy.”

He concluded, “Australians are nice people but their politicians are very bad.” I couldn’t disagree. For instance, an Afghan patient told me today: “You go to Afghanistan, you come back, you just want peace. You don’t want money or job, you just want peace.” Fly-in-fly-out politicians scoring a quick photo op with the troops never return with the same view.

My next taxi driver was Turkish. I talked with him about the Australian celebration of Gallipoli, hubristic pagan sacrifice of youth, and that kind of stuff.

He said: “Gallipoli is very serious for my people.” He lost one grandfather in World War I; the other was wounded.

I told him that one of my grandfathers was maimed at Gallipoli — he’d left Australia as a champion boxer and returned with a mangled arm and missing pieces of skull. His injuries deeply affected me as a child and might explain why I’m so aggro about being anti-violence.

My Turkish driver was relaxed about Australians visiting Gallipoli and harboured no ill will toward Anzacs. Instead, he heaped venom on Winston Churchill.

I actually have a soft spot for Churchill. I can’t detest a man who said democracy is the worst system of government apart from all the others. I also sometimes quote Churchill to patients: “If you’re going through hell, keep going.”

I hadn’t associated Churchill with Gallipoli, but the cabbie was right — Churchill was First Lord of the Admiralty during the invasion. He was then demoted for slaying too few of the cabbie’s relatives and too many of mine.

http://www.australiandoctor.com.au/opinions/the-last-word/the-last-word-on-fitness-to-drive

The Last Word: on fitness to drive

1 November, 2013 Dr Andrew Gunn

Frank Zappa was right – the world might not end in fire or ice. It could instead end in paperwork – like, say, The Apocalypse of Medical Assessments for Fitness to Drive.

I have zero inherent interest in decreeing whether elderly people should still be driving. Before a walking stick transforms into a walking frame, I generally give patients a choice: they can have, and probably fail, an expensive driving assessment with an occupational therapist; or they can let me clip their wings.

The angst starts when I cross out their motorbike and truck licences. Patients anxiously protest that these licences are still essential “for emergencies”.

I sadly explain that riding a motorbike at the age of 80 is more likely to create an emergency than resolve one. I also reassure them that the police will let them drive a truck if, say, a semi-trailer packed with singing nuns and orphans is being threatened by a hostile alien spacecraft. It’s a pity there’s no tick box on the form that covers that circumstance.

The tension then escalates at the hint of restricting their driving to within their local area and during the day.

I once reluctantly certified a patient as medically fit to drive after first checking with his psychiatrist and optometrist. Pleased as Punch (and more pleased than Judy), he drove straight to Queensland Transport’s offices. Staff watched him park through a window. This involved hitting a wall — twice — and ultimately parking slewed across two spaces.

The driving authorities twigged that things could get tricky and phoned me. My patient returned that afternoon with his version of events, insisting his car was undamaged. I showed him photographs emailed by transport officers that suggested otherwise. He angrily claimed they’d been doctored.

In an impressive but ultimately futile demonstration of functionality, he had his car repaired overnight and took it back to “those liars” at Queensland Transport. Regardless, I took his driving licence off him — so he took his medical file off me. I never saw him again although I did recently hear that he is now safely parked in the beyond.

Another elderly patient failed an occupational therapy driving assessment — but not too badly. He then attended a private driving school and obtained a letter attesting to his competency. I even talked to the driving instructor to check it was legit.

Initiative deserves reward, so I gave him temporary — but now revoked — medical clearance. He got another year or so of restricted driving without, as far as I know, hitting any singing nuns, orphans or Queensland Transport walls.

He’s still angry at the GP who sent him for the driving assessment and won’t see her again. Perhaps he won’t see me now either. Another GP phoned me this afternoon saying my (ex?) patient was asking for medical clearance to drive.

This is a stupid system, and one that destroys therapeutic relationships. I’d prefer everyone to sit practical driving tests every five years from age 70 (and yes, I’d also do revalidation to keep practising medicine).

Not that this would eliminate all problems. Another patient is an interesting guy but not the fullest stubby in the slab. It didn’t surprise me that he said he had two accidents while sitting his driving test. It did surprise me that he was passed.

I don’t know for sure if his story is true. I do know, however, that I dread Judgement Day — that’s the day he approaches me with fitness-to-drive paperwork.