From: adam@address.invalid   
      
   TJ wrote:   
   > On 02/08/2013 06:32 PM, Adam wrote:   
   >> since the antibiotic didn't help, my neph/PCP is sending me   
   >> to an ENT and the first appointment available is a week from Monday, so   
   >> I expect to spend the next week and a half feeling medium-sick.   
   >>   
   > Ah, yes - the ol' medical runaround. Time was when your primary care   
   > doctor actually treated you, instead of sending you to an overbooked   
   > specialist for every hangnail.   
      
   I think some of that was back when there wasn't more knowledge available   
   than a G.P. would have.  In my case, my primary is already a specialist,   
   a nephrologist.  (Nephrology is a subspecialty of internal medicine and   
   he's board-certified in both.)   
      
   > The unfortunate thing about specialists,   
   > and I don't just mean medical specialists, is that they don't always pay   
   > enough attention to things that lead outside outside their specialties.   
      
   I learned a lot about that from a book about a surgeon doing his   
   residency back in the 1950s.  Even then, the specialists were very   
   protective of their areas, and falling afoul of that could result in no   
   referrals, meaning no work.   
      
   At the other extreme, too many things have gone wrong (and not just in   
   medicine) by people attempting things that they didn't realize were   
   beyond their competence.  (Example: Thiokol's final approval of   
   Challenger for launch that day being made by management, not engineering.)   
      
   > But I suppose that's unfair. Given your conditions, a specialist is the   
   > proper way to go. It's just that my experiences with specialists that   
   > didn't help, and one who didn't even want to try to help, and my parents   
   > is still too fresh in my mind.   
      
   I learned a lot about real-world medical practice (as of a few decades   
   ago, but I'm sure things haven't gotten better) by reading "The Making   
   of a Surgeon" and "A Surgeon's World" by William A. Nolen, M.D.  Nolen   
   was a practicing general surgeon and even covers a few things doctors   
   would rather not have mentioned.   
      
   > Accuweather.com sports a month-long forecast these days. Thing is, I've   
   > kept track, and anything beyond about five days is pure fiction.   
      
   But a month-long forecast has a certain "impress" value.  I agree; I   
   don't start worrying about weather unless it's predicted to happen   
   within the next three days or so.  This latest dumped about 12-13" here   
   which all the locals are used to and know how to handle.   
      
   > Funny thing about spell checkers, though. I can remember writing an   
   > email to somebody where my spell checker found the term "back yard" (as   
   > in "play in the back yard") completely acceptable, but "backyard" (as in   
   > "Let's have a backyard barbeque") wasn't.   
      
   Sometimes I have no idea where spell checkers get their basic list from.   
     I think some of them must be decades old.  I appreciate their flagging   
   things, but generally unless I've made a typo I trust my judgement more   
   than theirs.  Things I write with Open/LibreOffice tend to be more   
   formal, but my mail/news is much more colloquial and in particular uses   
   contractions that are understood by practically all but haven't made it   
   to some dictionaries yet, like else's, whatever's, and whoever's.  I've   
   even had to add "obvious" words like humidity, cancelled, okay, and women's.   
      
   Adam   
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