Friday 20 November 2009

Doctors: Know Your Place Shut Your Face

Many doctor bloggers are talking a lot of shite. They seem to see the degree nursing issue as a threat and are convinced that BSc nurses want to be doctors. What a load of horseshit.

In Witch's post it was mentioned that apprenticeship is going out the window. If anything it is growing and will continue to do so. Even now there is usually only one or two trained nurses on the ward and everyone else is an untrained apprentice getting on the job training only. They are not training to be nurses yet as that is years away. They are training to be health care assistants. Theyhave the option to go to uni later on and train as a nurse using credits from their apprenticeship. Nice people a lot of them but the lack of knowledge is scary. Most of them have no desire to actually become Nurses.  They don't want to deal with the stress, the drugs, doctors, emergencies, etc etc.

Their lack of knowledge is appaling. That is because apprenticeship style training only is crap. Most of them are very nice to the patients. But then they do something stupid like open an IV pump up and take the tubing out (so that they can change a patient's gown and weeve the IV line through the sleeve) without clamping it...when potassium is infusing.  They don't understand a thing about heart failure and tell patients on furosemide that the sure do wee a lot.  Stupid things like that.

Let's be honest: Doctors do not know anything about nursing, nursing issues etc etc. Nursing is a completely different science and profession from medicine. Please stick to diagnosing, prescribing, where to get the best cocaine and cheating on your wife. Leave the nursing issues to the RN's.

 Let us nurses talk about education levels for nurses,

Let 's get some facts straight.

Degree nurse does not equal nurse who doesn't believe in doing basic care herself. Quite the opposite.

My university  required us to be in the top 10% of our high school class and have two years of university level science and math with top grades to get into their nursing program. They had 50 applicants for every one place each year. We were taught by masters (and higher) degree nurses who taught us the importance of being good bedside nurses.
The university nurse training in England has as much on the job training as the old style training did.
When California instituted nurse patient ratio laws ensuring that each degree educated RN have no more than 6 patients in hospital (ensuring that the RN can nurse them properly and avoid malnutrition etc) the number of applicants to their nursing program that year rose dramatically. Something like 80,000 RN's came back to the workforce as well. To do bedside nursing. Yeah.

Anyway I responded over here with the following.

Degree trained nurses are not taught to be above basic care. They get plenty in the way of hands on placements. They are always on the wards for weeks and weeks at a time.

There is not such thing as "the modern nurse who thinks she is too posh to wash". That is a myth perpetuated by fuckheads who don't know better or cannot understand the situation. I am degree trained, have nursed for many many years, and have worked with many new grad nurses.

I have yet to meet any highly educated nurse or any RN who thinks that he is above basic care. Most just are not in a position to do it. So I am thinking that maybe you are just a liar, or a goofball repeating statements that you don't understand.  To posh to wash nurses must be out there someone, but they are rare. It's not something I run into as a bedside nurse among other bedside nurses.

I trained at a well respected nursing school in the northeast. I had to have two years of uni level science and math and top grades to even be considered for their nursing program. I was able to take it together and stay in if my grades were high enough.. And even then they had over 50 applicants for every one place.

Our nursing instructors had masters degrees in nursing, doctorates in nursing and PHDs.
They taught us to be bedside nurses. They hated the medical model of care.

They taught us that hospitals should not be using care assistants instead of RN's and that highly educated nurses should do all care. They taught us that if we didn't do basic care ourselves that are patients would not be assessed properly and that would lead to poor outcomes. They taught us that nursing was a completely different science to medicine and that we were nurses not junior doctors. They hated the whole diagnose and prescribe thing like the devil hates holy water. Their degrees were in nursing, not  medicine.

These same instructors, despite holding master degrees and higher still did shifts at the hospital as bedside nurses. They attended our placements with us, and needed to be up to date. Therefore they stayed in touch with basic care and reality.

Not every school of nursing is this good but they should all be. 

They taught us that if we were ever working in facility where we were taking on more than 6-8 patients at a time that we needed to get the hell out of there and find a new job. "If you are working for a hospital that makes you take 10+ patients you will have no choice but to triage and delegate all basic care to care assistants. THIS IS BAD. Never EVER work for such a hospital". These were nurses with masters degrees who were teaching us these things.

"such a hospital" is every fucking hospital in the NHS and most of Canada and the USA.

The new grad nurses are very well aware that people think that they are too posh to wash. When patients are having an acute atttack of CCF and are short of breath these new nurses are putting people on bedpans and handing out meals rather than notifying the on call and getting orders because they are so afraid of being labelled as "uncaring" by visitors, health care assistants, and guys like you.  How sick is that?

Remember you only have one nurse for a large group of patients. If she isn't getting the diuretic drug etc for the heart failure patient who is going south then NO ONE is.

You wouldn't believe the scare stories that are happening because many of these new grads are on a mission to prove that they are not to clever to care and all that. I have seen patients with an HB dropping faster than a hooker's knickers not get intervention nor their blood  transfusions etc for hours and hours because the lone RN was getting grief off of visitors and patients for not getting the bedpans out fast enough.

You people need to stop it with this bullshit (perpetuating the myth that degree nurses are not into basic care) because people are getting hurt

I don't like your link but agree about NOT using degree nurses as pseudo docs. Is that clear?

Forget about the practitioner thing. I never met one personally. Even though I know many highly educated nurses I don't know of ONE who wants to be a practitioner. Not one. Not one.  I know they are out there but I don't think that they are as common as you fear.
If they forced all of us degree nurses into the practitioner role the vast majority of us would get the hell out of healthcare. Most degree nurses have no desire for the  frat boy, medieval world of medicine. Let's be honest: Medicine is simply about you guys swinging your dicks around to see who has the biggest one. No thanks. If I want to make more money I can uproot the family and go abroad and work as a nurse. Registered Nurses in other industrialised nations make more money than junior doctors in the UK.

 Read here and scroll down if you want to see how ratio laws requring degree educated nurses at the bedside with a very small number of patients brings RN's into the workforce and back to the bedside. And when the article in this link uses the term "Nurse" they are referring to university educated RN's.I agree with the doctors when they say that we should all just stick to what we know professionally. I will blog about issues in nursing and you guys please stick with the medical stuff. Blog about what you doctors know. Things like cocaine, philandering, cocaine, philandering, cocaine, philandering.

Re-Edited on 10/1/10 because of the glaring errors that result from my inability to type as fast as I think.  Notice that I did not take out the stuff about frat boys, cocaine, and sex addiction.


Nurse Anne said...

Seriously, it's no big secret that one has to be strung out on cocaine and other uppers to get through medical school. ASk any drug dealer who their major client group is.

When I was at uni nursing students were on floor 2 of the dorms and med students were on the 3rd floor. They were forever smoking up and trying to sell it to us. They had so much coke up there that the place looked like a department store winter wonderland display.

So sorry if my generalizations are offensive but it's based on experience.

Jobbing Doctor said...

Interesting post, Anne, but a little rant-y, even for you.

Your last paragraph says it all: I blog on experience and make assumptions based on experience, just like you do.

However, you will struggle to find any anti-nurse stuff on my blog.

Nurse Anne said...

Ahh come on you know I love and respect doctors really.

Nikita said...

Angry, yet brilliant post!

the a&e charge nurse said...

Ranty, JD? - if it is, it is only because the supposedly clever doctors are STILL not getting the message.

Anne's anger is undoubtedly related to the perpetuation of several damaging MYTHS by certain medical bloggers (see all the bullshit about 'too posh to wash', 'micky mouse education', 'wanna-be-doctor syndrome', etc).

This misinformation has the same affects on us as Daily Mail report's (about greedy GPs, etc) on you.

Anne has already highlighted the philosophy of her educators in the States - personally I'm finding it very hard to disagree with any of their conclusions. Perhaps it's time some doctors stopped prescribing (on this matter) and started listening, at least those who are genuinely interested in trying to get a handle on some of these issues?

Actually, I've always found you to be one of the more balanced bloggers and I'm not accusing you (as far as I can remember) of knocking the changes imposed on nurses by the impact of technology, patient acuity, increase in bed occupancy (despite fewer beds) etc.

Hell, some docs are even blame nurses for high MRSA rates when research evidence shows time and time again that it is they (as a group) who are least likely to wash their hands, while some doctors have been taken to task over prescribing habits when it comes to use of antibiotics, etc.

My own view, for what it's worth, is some doctors think they understand nursing issues, but this is not the same as KNOWING about them - providing commentators can distinguish the difference then we can all get along.

Anne is absolutely right to raise these issues and her communication style has never been for the faint hearted.

Nurse Anne said...

But most of the nurses I know and love are British and they have completed 3 years of uni and they are certainly NOT to posh to wash. And even if they want to advance their education they most certainly do NOT want to play doctor.

Happy1 said...

I am a diploma nurse, working towards a degree. I don't see why it is thought that my 'basic care' skills will change based on this extra education. These doctors are just excitable about their themselves and their position. They are threatened by nurses gaining education.

Its silly really, cos they will always be what they are, and we will always be what we are. As you say Anne, education is not what moves nurses away from basic care, its poor staffing ratio's.

And if its thought to be the case that we should all be sticking to our traditional roles only, then you docs can come and put your own bloody cannula's in. Can't have it both ways.

Garth Marenghi said...

someone dust protest too much?

the point i have tried to make is that the balance between the apprenticeship and other teaching is being lost

too much either way obviously has its problems

certainly in medical training the educationalists have become far too obsessed with the politically correct, med students do not spend enough time with various medical firms anymore, they spend a lot of time learning about ethics and communications skills without getting enough hands on experience,

from chatting to a lot of senior staff nurses they think that nursing training has gone too far this way, there is a lot of pseudo-academic mumbo jumbo that helps no one, ie essays on the philosophy of nursing and various psychosocial bs

I am certainly not anti-nurse and would like to think i do not speak 'shite'

Some people do like to quote chunks out of context and spin my arguments into something they are not, if you read everything in context I am ust trying to make some simple logical points

the a&e charge nurse said...

"I am just trying to make some simple logical points".

Well, perhaps we should examine a bit of Ferret 'logic'- how about this little gem;
"Basic things such as feeding patients, washing patients and attending to bedpans are beneath some modern nurses".

Or, how about this;
"Nursing is no longer good enough for modern day nurses, a lot of them now go into nursing as an easy route to becoming a quasi-doctor or 'noctor'.

Yet, despite perpetuating such myths, Ferret then claims;
"I am certainly not anti-nurse and would like to think i do not speak 'shite'.

Disagree too often, no matter how much 'Crippenesque' spiel he churns out, and Ferret will simply delete any reasoned challenges that does not fit with his 'nursing has been wrecked by political correctness' mantra (rather than the reasons identified by Nurse Anne's educators).

Why is this such a hard concept for some doctors to grasp?

the a&e charge nurse said...

I'm even more flabbergasted after reading that claim second time round

Ferret seems to believe;
"a lot of them (nurses) now go into nursing as an easy route to becoming a quasi-doctor".

So, a 'lot' of newly enrolled nursing students have only signed up due to the mysterious siren call of 'the noctor'

Now what do you mean by a 'lot'?

Please tell us more, Ferret - as far as I know Anne does not delete comments if they happen to be in opposition to hers.

Nurse Anne said...

No I love comments that are in opposition to mine. This stuff needs to be hashed out.

My post was meant to be more funny than mean but I am regretting referring to ferret's and witchdoctor's posts as shite and horseshit as I am a big fan of their blogs. So sorry about that.

If you want to blog about how much you hate the idea of noctors that is fine. But you all need to knock it off with the too posh to wash to clever to care bullshit. It really is bullshit. It's giving people the wrong idea and patients are getting hurt.

the a&e charge nurse said...

Witchdoctor has produced a fantastic post - I whole heartedly agree with the sentiments it contains.

Matt said...

I am sick of this whole too posh to wash, too clever to care shit that the press and unfortunately some of our nursing colleagues spout every fucking time nurse education is in the press. I do not have a problem with washing patients or delivering personal care. I understand its importance and work as a HCA to help pay the bills around my course so please don't give me that shit that I am above delivering personal care. I have never seen a student refuse to deliver personal care on the basis that they are above it. Too many people are living in the past viewing nurses through rose tinted glasses thinking that all we do is wipe bums and feed people. I feel that the old guard a lot of whom have now retired and some medical colleagues are intimidated by the newer nurses being degree educated thus able to think for themselves rather that blindly folow orders.

Degree training for nurses is here for good, get over it, its not the end of the world and it will benefit patients in the long run.

Nurse Anne said...

Thank you Matt.

Happy1 said...

Matt hit the nail on the head with this

"some medical colleagues are intimidated by the newer nurses being degree educated thus able to think for themselves rather that blindly folow orders."

Old style nurse training produced very skilled nurses who knew what they were doing, but often without the depth of knowledge as to why. They then learned 'on the job' through experience, a great deal of further knowledge to compliment their skills. They also followed orders more willingly, as knowledge base came only with experience.

But newly qualified nurses are as accountable as any nurse. What the flip is wrong with having a bit of under-pinning knowledge?!

And I've never met a nurse / student who wishes to become anything other that a nurse, so the comments:

"..a lot of them (nurses) now go into nursing as an easy route to becoming a quasi-doctor".

..a 'lot' of newly enrolled nursing students have only signed up due to the mysterious siren call of 'the noctor'

are ridiculous in my mind.

Nurse Anne said...

"Old style nurse training produced very skilled nurses who knew what they were doing, but often without the depth of knowledge as to why. They then learned 'on the job' through experience, a great deal of further knowledge to compliment their skills. They also followed orders more willingly, as knowledge base came only with experience"

And then they got the blame when the order was bad. I once had a very new doctor tell me to give 40mmol of potassium IV push. Does anyone want to guess what would have happened if I had followed that order rather than going sobbing to a senior doctor?

I would be flipping burgers right now at burger king for a start.

Nurse Anne said...

He wanted me to push it in "very fast". No doc, YOU do it.

Happy1 said...

Thank god for nurses having a little bit of knowlege hey.

The Dobbing Doctor said...

Doctors v Nurses the neverending blog war. Across all domains this demon spans.

I am speaking from a position of relative naivety but I think this whole BSc Nursing requirement is a complete non-issue.

If its proven that degree trained nurses are better at keeping people alive, that's the kind of nurses we want. End of.

I don't care how you trained as long as you can do your job. Everyone knows a shit nurse, just like everyone knows a shit doctor and a shit car mechanic. Let's all pull in the same direction for a change.

p.s. I don't hookers and blow to get my rocks off :-)

Nurse Anne said...

Good points. Now I do believe that the nursing program should require a heck of a lot of higher education (even my initial diploma program required this) but that doesn't mean that I don't think that the current BSc program needs a fair bit of tweeking.

I think it needs less focus in some areas (sociology) and more focus in others (anatomy, chemistry and microbiology as applied/relevant to nursing, pharmacology, and physical assessment skills tied into all that.)

Less reflecting and more learning dammit!!

I also think that the course leaders/instructers need to do the occasional shift as an RN on the wards to get a grip with reality, as mine did.

Too many course leaders are on an entirely different planet.

Garth Marenghi said...

if no nurses want to become quasi-doctors then i find it strange that these posts are always easily filled while there arer numerous standard nursing posts left unfilled

maybe standard nursing should be rewarded better than it currently is, there are currently too many roles which are far better paid which suck the good experienced nurses away from what they have been trained to do

Nurse Anne said...

Gareth read my last comment over at ferret fancier.

I still stand by the fact that I don't know anyone who wants to be a quasi doctor. I know a couple of people who haven't had a choice but to go into those roles.

Ward nursing is so hellish it's amazing that there aren't MORE noctors running around.

Standard nursing posts???? Where??? Where??? Where??? Can't find any of those advertised around here.

My trust has NO posts advertised for ward registered nurses.

Anyway, everyone knows better than to go for the ward nursing jobs. It's nothing but hell and abuse, like being beaten over the head with a baseball bat for 14 hours.

RN's are looking at things like podiatry, becoming a nanny, child minding, school teaching,....all those things are easier than ward nursing as an RN and pay better, with better hours (that's according to nurse friends of mine who made the switch). That's where more of your ward nurses are going. Practice nursing is always an easy out but there are very few full time jobs advertised and lots of competition.

We need an out and quasi doctoring is not the way most of us are looking for.

My major at one time was in History and I am taking a few courses here and there, hoping to teach. And god how I wish I never ever went for nursing. Do you have a problem with me being a history teacher Gareth? Let me tell you, those courses at uni were MUCH easier than my nursing courses.

And again I will say that there is no ward structure for promotion etc. Only way to do better is to leave the wards.

I think I went into this on your comment section.

Nurse Anne said...

Hang on I am facebooking one of my friends overseas who is a teacher turned nurse back to teacher. She went for nursing because where she is they pay nurses more than teachers.

Nurse Anne said...
This comment has been removed by the author.
Brian said...

I'm not wholly convinced that nurses with degrees provide better care than nurses with diplomas. I'm sure the studies that Anne refers to could do with some forensic examination. Still, degrees are on their way, so we shall see.

The trouble is that what we'll see may not be what we want. I predict that whether or not trained nurses are, in fact, "too posh to wash," they will be FORCED into that position by health service managers. For example, when the roles of Modern Matron and Nurse Consultant were invented they were "sold" as high level, clinical roles yet Nurse Anne's posts suggest that Modern Matrons are often as detached from the reality of ward work as any middle or senior manager. Why? Because managers don't value clinical nursing and won't invest in improving it. (It's also possible, of course, that sisters/ charge nurses won't tolerate interference in their areas of clinical responsibility...)

No good idea survives the dead hand of NHS managers unscathed. I don't think they will be at all content to see all those expensively trained and demonstrably highly qualified individuals making people comfortable when they could be, oh I don't know, doing something really important like an audit or something.

I predict that, for the reason I've given above, the BSc/MSc qualified nurse of the future will not be ALLOWED to do much in the way of basic nursing. S/he will be EXPECTED to supervise the largely unqualified assistants who will do the actual nursing.

Moreover I predict that the unqualified assistants will become discontented with their lowly position, lack of recognition and will want professional recognition. A few patient care disasters will also have NHS managers and the public demanding more control over this workforce so naturally HCAs will have to be registered. They'll need their own register because registered nurses will want to protect their status. Which reminds me that the original title of the Enrolled Nurse was State Enrolled ASSISTANT Nurse...

Nurse Anne said...

You are right glam they are shooting themselves in the foot.

They don't realise that it would actually save them money to have RN's at the bedside with a small number of patients, rather than healthcare assistants.

The cost of complications, failure to rescue, and avoidable deaths is far more expensive than better RN staffing. States and provinces with nurse ratio laws have found this out firsthand.

Garth Marenghi said...

my trust is recruiting for new nurses in Ireland!

part of the problem is short sighted managers running too many beds with too few nurses and then filling the gaps with agency staff

the nhs should run with more slack in terms of capacity and use agency less given how expensive this is

Nurse Anne said...

They should be trying to retain but all they do is recruit a new crop just to burn them out and run them off from nursing.

But at least your trust is making an effort.

Matt said...

This whole too posh to wash thing is nonsense. As Anne has blogged on several times before, its not being above delivering personal care, its that RN's are having to delegate these tasks to others as they have other tasks that unregistered staff are unable to deal with. Its the same in any job.

Anonymous said...

Whilst I broadly agree with you Anne, there is no doubt that nurses are trying to fill roles that they are in no way trained for. Even as a lowly medical student, I have had many largely amusing and occasionally worrying experiences with various nurse practitioners and "specialist" nurses.

Some highlights of my first year on the wards full-time:

(1) Nurse in charge on resp ward insisting that salbutamol targets alpha-1 adrenoreceptors.

(2) Different nurse, different hospital, resp ward: "this patient should be taking aspirin for his cardiology problems, see the juniors (doctors) on this ward are useless, I know about these things because I used to work in cardiology for many years" - pt had presented with asthma.

(3) The stroke specialist nurse not realising that a specific set of symptoms meant that the damage was on the opposite side of the head.

I could go on, but I think the point is made. I have nothing but the greatest of respect for the vast majority ward-nurses I have worked with (for?) but its all the not-really-got-a-clue "specialists" that bother me.

All of those above had been assigned to teach us/taken it upon themselves to, yet as medical students we are using to lecturers being experts in their fields, not so completely ignorant that they are entirely unaware of it themselves.

I could write about about the wonderful nurses I have worked with (wound, urology) but there are even more woeful ones so I will end it there.

But I do enjoy your blog. ;)

uknurse said...

To Anonymous above,

Throughout your career you will come across many doctors who make the same silly, sometimes incredulous, mistakes. I recall an SHO prescribing an IV insulin bolus to a patient with HYPOglycaemia, another SHO ACTUALLY GIVING IV adrenaline to a patient with an allergic reaction (a very well patient who didn't even need it IM), and a doctor who prescribed amioderone for a bradycardia. If I wracked my brain I could come up with hundreds of worrying experiences with doctors. But we can all make errors, nurse, whoever, and with whatever training.

the a&e charge nurse said...

Indeed, uknurse - this doctor killed her patient with adrenaline

This doctor killed her patient with insulin

Both had been warned by nurses not to administer the medication - still, as long as they know the site of action of bronchodilators then we can all rest easy.

Nurse Anne said...

This blog isn't about promoting nurse practitioners or the dos and don't's of noctors.

It's about promoting well trained and educated caring nurses at the bedside with a manageable number of patients.

"3) The stroke specialist nurse not realising that a specific set of symptoms meant that the damage was on the opposite side of the head."

But LOL. That was so funny I just spit my tea out all over my keyboard. Christ. I thought most people understood that at the age of 10. LOL.

Anonymous said...

Normally a big fan of your blog, but this is probably the most ridiculous thing you've ever written and I'm sure I'm not the only doc that has lost a lot of respect for you both as a professional and as a blogger.

I would be just as mortified if a doctor had generalised about all nurses being chavy cheap slappers who chose to clean up shit in hospitals instead of Mc Donalds.

Nurse Anne said...

Oh come on anonymous where is your sense of humour? Think about all the things that were on netdoctors about nurses long before I even wrote this. And that stuff isn't meant to be funny.

Nurse Anne said...

I'm not finished yet Anonymous.

If doctors are offended it is tough shit really.

They have been socialised to abuse nurses and treat them with the utmost contempt. Patient care is suffering horribly as a result of this.

The number one reason for nurses leaving the bedside is doctor abuse. Everyone knows that bedside nursing feels like being hit over the head constantly and if you become a noctor or get out of nursing entirely it is like the beatings have suddenly stopped and you are painfree (and probably on a better wage with an easier workload and more respect).

Doctors take even a simple question that a nurse asks about a drug or treatment and commence a poisonous tirade accusing the nurse of trying to take over their jobs. Nurses cannot even ask a question about something that they do not understand without paranoid, angry abusive doctors feeling threatened and lashing out. It is pathetic.

You blame and abuse nurses for things that they have no control over. They are hit with such high patient loads in such a chaotic environment that they cannot do anything for anyone or keep on top of anything and instead of addressing this you attack the nurses as stupid.

You don't understand why the nurses have to phone you for this or that, you don't understand the codes and the rules they are governed by when it comes to informing you of things, yet you codemn and berate them and bitch about being pestered by bleep happy nurses.

You stick your noses into things that you don't understand AT ALL (like ward nursing and it's issues) and make ignorant comments slamming nurses. Yet you attack nurses for even thinking about sticking their noses into anything the doctor is doing. You perpetuate 19th century stereotypes in the media and amongst the public about nurses that inflate your ego and make the job of a bedside nurse even more intolerable and difficult. When hospitals are able to depict nurses as caring, thick, uneducated angels who only need compassion to do their jobs their hospitals can easily get away with cutting off the nurses from much needed supplies and resources. You dipshits are more responsible for this nightmare than anyone.

Really it's tough shit if doctors do not like the taste of their own medicine.

I'd bet a limb that NOTHING on this blog about doctors is as nasty or as hate fueled as the stuff on netdoctors about nurses. Funny that, considering that doctors know nothing about nurses.

Seriously, stick to your diagnosing and prescribing stuff.

Anonymous said...

dont be a goon nurse ann, everyone loved your blog on untill that ridiculous post. i'm sure more docs read your blog that nurses and we love it. it's usually insighful, intelligent,witty....

i was just disappointed thats all, as many docs are and i thought i'd comment.

most of the things you said just reflect your own insecurities. a great number of docs are inspired to go into medicine because they had parents who were/are nurses.

of course there is some conflict between the two professions, there always has been.

your post just shows that your completely ignorant of the reasons behind this conflict. but since the rest of your blog is so sensible I wont hold it against you.everyone's gotta have a chip on their shoulder.

i prefer to make more productive use of my rants, directing them at the real enemy *MANAGEMENT*

Nurse Anne said...

Seriously you guys have no sense of humour. Some medical students in canada a few years back wrote and performed a vaudeville show entitled "Nurse shut up and show us your tits". I think that line was the chorus of every song in it. Unfortunately they have taken it off of youtube or I would have posted it.

Now that is goonish. I can't believe that doctors cannot handle getting a taste of their own medicine on a meaningless little blog post. Pathetic. Seriously, let it go.

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