Yep, I get tons of folk coming in asking for miracles. "How do I stop getting older?" sums up a lot of them. They want an (unavailable) miracle, but they use up my time. Should I not charge them?

My car mechanic, has worked on several of my kids cars. Sometimes he says, "this car is stuffed". I pay him for his time to work that out.

As a GP, folk pay for my time. I mostly can help in some way, but not always. If someone comes with a crazy stupid request, like can you regrow my lost leg, should I forfeit any payment when I spend half an hour saying why I cant do it? Basically, if you use my time, why shouldnâ(TM)t you pay for it.

The commonest disabilities in the western world are heart disease, stroke, diabetes, and multiple arthritis from being too heavy for your poor bones to handle.

I'm a GP doctor; as folk walk in the door, it is usually obvious who is going to be at risk for future problems. They are fat, overflowing my poor abused seats, they groan as they stand up, they are obviously unfit. As a added bonus, I can often smell the cigarettes on their breath.

Does knowing who is at risk help? Sadly, all too often it doesnt.

Lazy fat slobs will on average die considerably younger of way too many diseases, and I have not even mentioned chronic crappy disabilities like back pain, hip pain, knee pain. I pride myself that I turn a few of these folks to the bright side of eating a bit better, exercising a tad more, and thus living longer and actually enjoying those healthy extra years.

You don't need an algorithm to work out who is at risk of future disease, it is bloody obvious (can I have my $3M now?). The problem is getting these fat, unfit folk to realise there is more to exercise than driving to buy their next greasy pizza.

Oh! they deliver now as well...

In Australia, the last time I looked, around 90% of the lifetime medical expenses is spent on the last year of life. This has been true for decades.

You think you are doing good stuff, but all too many suffer and die. As a GP, my role is to keep folk alive. If I was a complete rationalist, I would work out some way of stopping useless treatments, but unfortunately that is usually only obvious in retrospect.

I counsel folk on the pros & cons of cancer treatments.

Sometimes it is obvious you are flogging a dead horse, and really they should pull out and enjoy their last days in comparative health, without the misery of chemotherapy et al, with the horrible side effects, and before you recover, the cancer catches up to you & you die in continued misery. I kept one of my mates out of lung cancer chemotherapy (in this case there really was no chance), and he enjoyed his last few good months without being stuffed by chemo. His family still thank me years later.

Then there are the less obvious cases, where the therapy may help, but usually just adds to life's burden of misery, worst just before they die.

Then there are the successes. They are wonderful, but not that common.

Sure, some guys making chemo drugs make a lot of dollars, but what drives most medicos is that we care, and we are not very good at pulling back when things are hopeless, because sometimes we succeed.

I speak as a general practitioner of many decades, and I've been playing with computers since the early 70's. The main reason medical records software is not accepted is that it sucks.

My 24" screen holds far less information than a bunch of scribbled A4 pages. Time is what I lack, and scrolling through pages & sections on a screen is just not very efficient.

Yes, there are some great aspects in most of the software I have used over the last decade, but as far as being a place to store info that I want to easily access & collate later, all too often it is too bloody slow & awkward.

Except for one feature of electronic records, I would go back to pencil & paper.

The only really successful feature was the first; writing scripts & recording the fact that a script was written. In the 'old' days, you would write a script, then the phone would ring, on hanging up, you forgot to record what you had just prescribed, leading to problems down the track. Software to prescribe & automatically store a record of that transaction has been fantastically useful for both myself & the patient.

I have sat here for some 10 minutes, and the only other feature I like is that my notes are more legible to me down the track. As a computer nerd, I want to love these systems, but so far they are not very good.

Try Debian Linux. There are 3 main flavours.

1) unstable - pretty much the latest software, has bugs, can crash.

2) testing - lasted in 'unstable' for awhile & survived. is pretty good for most desktops, rare crashes, but fairly up to date.

3) stable - tried and tested. stable, but usually an older version. use it when your system MUST work.

You can pick your own trade off between stability & the latest software. Personally, most of my system is 'testing', with a few favored applications from 'unstable' for the latest features. If they crash, you can always go back to the less feature full, but more stable option.