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    #26
    Originally posted by Patrick Thistle View Post
    Moving off the space thread, yesterday I learned about "airgraphs" which were used during the second world war. A person bought a form to write a letter / draw a picture, which was then photographed along with lots of others (1600 letters per roll of film), the film was transported overseas, where the airgraphs were printed and given to the serviceman who could send an airgraph back if they wanted. 65 million letters were sent this way from 1942-46.
    This is fascinating.

    Do you know about the big arrows on the ground across the US that were used as navigational aids by Air Mail pilots on their coast to coast runs?

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      #27

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        #28
        Originally posted by caja-dglh View Post
        Today I learned that some colleagues spend their time doing whatever they like so they cannot commit resources to things that need done.

        Crossover with workplace annoyance there.
        You've missed a famous bit of Hamlet there.

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          #29
          https://twitter.com/RaphaelCormack/status/1518164766073753601?t=zDBoE_xSA1ZOZIHDAUKqrw&s=19

          This thread on the interwar Opium trade is very interesting. Properly the milieu of Eric Ambler novels

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            #30
            Today I discovered what a US OB/GYN does and I am frankly baffled by the entire concept as it is so different from the system in the UK.

            So, I've known vaguely for a while from various media, films, books, that women in the USA are always visiting their family gynaecologist and found it faintly mysterious but never bothered to investigate. Today it somehow came up in conversation again and I decided to actually research it. I certainly don't have, and have never had, a family gynaecologist and had no idea what the role might involve.

            So, it seems that the concept is to have one doctor who specialises in "everything female" who you see for all your "female needs" right through from puberty to post-menopause. This means one doctor learns how to do everything from smears / pap tests, to sonograms, dispensing of contraception, overseeing of natural births, actual surgery for caesareans, advice on HRT, fertility treatment, etc. I find this to be an astonishing and very surprising lack of specialisation.

            For comparison in the UK, this is how it works.

            If I have a health query, I go to my GP / general practitioner, in exactly the same way as a man would. I am then referred to a specialist as and when necessary.

            If I need a cervical exam / smear / pap test, it is usually carried out by a nurse at a GP surgery (clinic). I am sent a letter in the post inviting me to attend one.

            I can access contraception advice from a GP or go to a specialised family planning clinic. Many contraception options are available over the counter at pharmacies. If I choose a longer-term contraception option like a coil I get referred to a sexual health clinic to have it fitted. Sexual health clinics also provide tests for STDs. You can either get a referral from a GP or go to them directly.

            When pregnant, a GP will conduct a pregnancy test to confirm it and then you will be referred to various specialists. You will be sent to see sonographers for sonograms, usually at a hospital or specialist facility. You will have blood taken for testing by phlebotomists. You will be seen regularly by midwives who specialise in pregnancy care for checkups throughout the pregnancy becoming more frequent as you approach your due date. Depending on your assessed level of risk, you may also see an obstetrician during the pregnancy.

            For childbirth you have a few options depending on your assessed level of risk. If you are low risk you can choose a home birth in which case a midwife will come to your house once you go into labour to oversee it. If you choose a hospital birth and are assessed as low risk you will be directed to the "home-from-home" centre which is midwife-led and aims to result in a natural birth. This centre has access to and can administer gas and air (a mix of nitrous oxide and oxygen) and epidurals if necessary. If you are higher risk, are opting for an elective caesarean, or there are complications during labour you will be redirected to the consultant-led birth centre where there are obstetricians and surgeons who can help with any needed interventions such as caesareans. At the hospitals where I gave birth the home-from-home centre and the consultant-led ward were down the corridor from each other but in some areas they are in different buildings and may require transport between them via an ambulance.

            Once a baby has been born, during any necessary stay in hospital you will be attended to by nurses. There are separate specialists of the baby needs any specialist care. Some of the nurses are trained to give breastfeeding advice and support.

            If you have fertility problems, you speak first to your GP and are then referred to a specialist fertility clinic.

            For mammograms, you get invited to an appointment and then go to a specialist location for that (often a travelling mammogram trailer that can go from town to town).

            I don't know a huge amount about menopause treatment yet, but I suspect you also go to your GP first and then get referred to a specialist of necessary.

            It's worth noting that when I go and see "my GP" I don't always see the same person. And for minor ailments, like a thrush infection, I would generally be seen by a nurse instead. Also, during my pregnancy and during labour I was seen by multiple different midwives and doctors. Over the course of my lifetime I have probably seen over a hundred different people for all the things that one OB/GYN is supposed to do.

            In some ways I can see that the US system might be nice. Not having to start from scratch explaining your medical history each time. If you have a competent OB/GYN maybe they can tailor care better to your individual circumstances. But what if you have an incompetent OB/GYN? Or worse, an abusive one? Where do you get a second opinion from? And I still don't really get the concept of a "family gynaecologist". Do you and your mother and your sister all go to the same one? I find that faintly horrifying.

            But by far, the very weirdest thing that I have found from this entire research process is on websites describing what to expect from your first OB/GYN appointment. Apparently you go when you're aged 13-15, not because you have any specific issues, but just because it's "what you do". The OB/GYN will ask you about your sexual activity (at 13???) and will "examine your vulva". Why??? Nobody examined my vulva when I was 13. I can't see why they would need to. The idea of subjecting my daughter to that unnecessary invasion of privacy is bizarre. Sure, if you have some sort of pain or discomfort that needs to be assessed, but just for a doctor to have a look? What do they say? Yep, looks like a vulva to me.

            ​​​​​​​The first time any medical profession "examined my vulva" was when I was over 21 and invited for a smear test for the first time. Most smears these days are carried out by female nurses. You can specifically request a female nurse and can ask to be accompanied if you want. Historically, most OB/GYNs in the US seem to have been men. So 13 year old girls were routinely sent for a middle-aged man to examine their vulva? How utterly creepy.



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              #31
              Yup.

              And a significant number of them were assaulted.

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                #32
                According to Germaine Greer gynaecologists are/were (don't know where/when her data was from) predominately male. And as a group had the lowest marks in medical school.

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                  #33
                  I recall being shocked by the first of those as soon as I figured out what they did (all of my mother's gynecologists were male).

                  And the second strikes me as being very plausible. The whole existence of the "specialty" was grounded in misogyny.

                  ms ursus has never had a male OB/GYN in the 40+ years that I have known her, and my sense is that the profession as a whole is significantly more female than it was a generation ago. As an aside, her current OB/GYN became a family friend and is one of the most intelligent people I know.

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                    #34
                    My wife doesn't have an ob/gyn. It didn't even occur to me that this might be unusual until seeing Balders's post. But then, I had no idea what one was or did until I read Balders's post (and reading Balders's post makes me a bit shocked that such a thing exists, a lady-doc for lady-things, so serious medical people don't have to worry about such things). It was just a term that used in US TV, like someone would talk about their oncologist or their lawyer or their therapist, as if everyone has one of those, too.

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                      #35
                      I didn't know pineapples eat people whilst people are eating them

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                        #36
                        The data I could find shows that women now account for 59% of OB-GYNs, up from 7% in 1970.
                        And men now account for just 17% of OB-GYN residents, so it will be more than 80% female in a generation.

                        But what if you have an incompetent OB/GYN? Or worse, an abusive one? Where do you get a second opinion from? And I still don't really get the concept of a "family gynaecologist". Do you and your mother and your sister all go to the same one? I find that faintly horrifying.
                        Then you find a different one.

                        Unless you live in a very small town and can't travel, you'll have some choice on doctors, especially for common things like OB/GYN. That's one of the only redeeming features of our "system."

                        You also have to find one that will take your insurance, but even with that restriction, most people would have choices for something like OB/GYN. Not so much for more specific specialities. In those cases, you either just get what you get or you have to travel further than you want to, or both. That's why big tertiary care centers often have hotels nearby or on site.

                        The way most specialties work is that, even if you know what specialty you need to eventually see, you first talk to your primary care provider (PCP), which is sort of like a GP, which is sometimes known as the "gatekeeper." And you can usually switch PCPs if you want to.

                        You might not even talk to them specifically, but maybe one of their physician assistants or nurses and, increasingly, you don't have to actually go to the physical office. They'll then refer you to the specialist and, if there's some choice, can help you figure out which one is available and will take your insurance. Often, the simplest way to do it is to just find somebody else in that same healthcare system. Then the billing and referrals and lab testing and all of that is all in the same computer system.

                        In most geographies, there only are two or three systems that own everything and employ most of the physicians, so that's convenient, if nothing else.

                        Once you're on the books with that specialist, you don't usually have to go back through gatekeeper to keep seeing that specialist.

                        I'm not really sure how OB/GYN stuff works, but I assume it's pretty simple to get an appointment with one of them without spending much, or any, time dealing with a separate PCP. You might not even need a referral at all to see one for the basic stuff. And some OB/GYN's are also set up to also be PCPs so that's handy.

                        If you find yourself having to fill out the same health history forms and telling the same story over and over to different people each time you get referred to a new specialist, then there may something wrong with how their EHR system is working and/or they'd rather here you explain it all again than read the chart. It's also a problem that everyone involved is aware of.

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                          #37
                          France also has 'family' gynaecologists (uniquely in Europe I think?) that you're supposed to first see as a teen and then go for yearly check-ups like at the dentist's. I never went and never understood why it was a thing when men and boys are not expected to go to a shlong inspector once a year. Filed it as one those French medical quirks/population-level delusions, like homeopathy being a legitimate branch of medicine, vaccines being full of aluminium that give you Parkinson's or 'heavy legs' being a recognised medical condition

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                            #38
                            That again raises the complication Balders noted an which was not at all unfamiliar among teenage women of my cohort, who were understandably appalled at the spectre of having to use the same gynecologist as their mothers.
                            Last edited by ursus arctos; 22-06-2022, 20:34.

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                              #39
                              I suppose this thread is home to the 'fascinating fact' I mentioned the other day, asking if there was a home for them on here. And that fact is this:

                              The day that Michael Jackson burnt his hair while filming that Pepsi commercial was the exact halfway point in his life. It was the same number of days after his birth as it was until his death.

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                                #40
                                Originally posted by ursus arctos View Post
                                That again raises the complication Balders noted an which was not at all unfamiliar among teenage women of my cohort, who were understandably appalled at the spectre of having to use the same gynecologist as their mothers.
                                I don't understand why that's appalling, but I'll take their word for it.

                                There are lots of issues around what parents can demand to know from their kids doctors, but whether or not the parent is also that doctor's patient has nothing to do with it.

                                "Family" attached to the name of a doctor or medical practice just means that the practice overall serves people of all ages. Somewhere along the line, some marketing people realized that was a succinct and appealing way to get that across. It doesn't mean they expect the same doctor to see everyone in a given family although it might end up that way in some cases.

                                On the other hand, "Family Entertainment" just means it's supposedly ok for kids. It cannot promise that parents will actually like it. And, as often as not, the only thing that makes it "family friendly" is that it doesn't have swears, sex or gratuitous violence.

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                                  #41
                                  It was appalling at the time because the doctors in question were notoriously indiscreet.

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                                    #42
                                    It's also just the idea, which may be rather prudish, I don't know, that one person would have seen both your and your mother's genitalia and would be able to make comparisons, even if only in their own head. Or that they would know about both your sex lives. Somehow an intrinsically uncomfortable concept.

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                                      #43
                                      What's an EHR chart?

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                                        #44
                                        Electronic Health Record

                                        It can be hard for us sometimes to realize that the rest of the developed world doesn't do things this way.

                                        Not unlike not using the metric system.

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                                          #45
                                          EHR is very useful. Much better than keeping all that info in boxes and having patients fill out the same forms repeatedly

                                          However, doctors complain that the systems are designed around the needs of billing and insurance rather than the primary users.

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                                            #46
                                            Well, the hospitals and insurance companies consider themselves to be the primary users.

                                            It is a fundamental problem with time keeping and billing systems in any industry I am familiar with.

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                                              #47
                                              The NHS uses electronic records as well, with varying degrees of efficacy. But they always seem to want the patient to start by recounting their medical history themselves verbally.

                                              I've become very adept at giving a short potted history of my bipolar episodes as a result.

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                                                #48
                                                Something else I find odd about the US OB/GYN system. Prospective parents in films seem to spend a lot of time and effort trying to find the right OB/GYN who promises to be there for the birth and then inevitably is on holiday when it actually happens leaving the parents panicking.

                                                But how does anyone expect that to work anyway? You get given a due date, but a standard length pregnancy can be up to three weeks before that date and up to two weeks after it and still be considered full-term / a non-complicated pregnancy length. Then of course many people give birth prematurely, or remain pregnant beyond 42 weeks and end up being induced due to safety concerns. So, the OB/GYN is expected to be available 24 hours a day at zero notice over the course of six weeks or longer for each individual patient? How ridiculous.

                                                Also, there is the sheer length of labour to consider. I was in labour for 22 hours with my daughter before finally needing a caesarean due to concerns for her safety. There is no way that I would have wanted one person to be present with me for the entire 22 hours and then be the person wielding the knife for the surgery. It's surely very obvious that that's not safe? And many labours last a lot longer than that. Three days is not at all unusual. It's bad enough that the woman has to stay awake that entire time. You definitely don't want your medical support team doing the same.

                                                All very odd.

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                                                  #49
                                                  While having dinner last night with family and two 26-year-olds from Philadelphia (but now residing in Colorado) I discovered that they (and most other USA citizens?) had never heard of the slang term "gee gees" for horses.

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                                                    #50
                                                    Coming from where I do, I've obviously heard the slang-term of "Gee-Gees", but have no idea where it comes from.

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