spare me the "you've never been there, man!! You just don't know!" rant.
Everyone's been stuck in dead-end jobs. Many people have been broke, had to live on noodles, had to move out of their place and in with friends to save on precious, dwindling cash reserves... There's jobs out there if you're willing to swallow a little pride. It may not be what you want, but it's only temporary. It may grate on his I'm-the-computer-elite ethos, but he could even do in-home tech support... hell, advertise in the upscale neighborhoods and fleece those despised computer-dumb yuppies for a fortune... that'd surely assuage his member-of-the-proletariat angst. Even if he stripped his resume and got a job as a tech-support monkey, his vast computer knowledge should shine through in about five minutes... and if he made sure the right people noticed it, he might find himself running the show in no time. It helps to be willing to dial back your expectations in order to get your foot in the door.
He may have to sell his house on the lake and get a cheaper place, which sucks, but is a reasonable thing to do when your income drops. Lots of people's fortunes go up and down... the key is to be able to adapt.
I'm not saying the original poster is a bad person... my comment had more to do with his psychology. I think he's depressed, looking for someone to blame, and generally feeling helpless... and yet, he's the ONLY ONE with the power to change his situation. Admitting that, however, would take away his "I'm a victim" ego defense, and force him to take responsibility for alleviating his own plight. His situation is very common... and so is his reaction to it. He seems like an insightful enough chap, so I expect he'll snap back.
Sometimes holding up a mirror to someone is the best thing you can do.
Sheesh... a few of flashes of insight in there, but it's mostly bitter, sarcastic, angst-ridden despair... quite depressing read, actually.
Notice how he blames it on everyone else, as if some puppetmaster controls his destiny? (evil corporations, GW Bush, supervisors and managers). Sheesh, guy... I hate to sound like your dad, but that's life. Lots of people have been screwed out of jobs before, and lots of peolpe have had jobs that frankly sucked, but there's always work out there if you are willing to swallow some pride, and make some sacrifices. Go back to school for god's sake.
I wish I hadn't read that depressing little piece... I'd say it was a lot higher on the despair scale than the humor scale.
While in the military. A bunch of us were overseas for the war in Afghanistan, and were really hungry for some unfiltered internet access. We had mil access, but the military access rules were a bit too restrictive for our tastes, and everything was constantly monitored. (the thought of some E-1 laughing his ass off and showing my sweet sappy emails to my wife around to all his buddies bothered me... call me crazy). To be fair, however, it could have been worse... in the early portion of the war, we were under total communications blackout... no cell phones (or regular phones, for that matter), no computers... no fun.
We looked into some satellite internet access for ourselves (one guy in our group was a satellite 'net installer), but couldn't find a provider. We could have smuggled the hardware into the country, and even set it up, but we couldn't find a satellite to hit. We had the Innmarsat in our comm gear, but the guy in the article is right... it's extremely expensive to run, and the bandwidth sux0rs.
I have all the respect in the world for these guys... programming methods or no, what they did and are doing is priceless.
I was in New York on Sept 11... flown in on a C-141 as part of the rescue/relief effort (the rest of my Urban Search and Rescue team had to drive... I beat them there by a number of hours). That was the most unique flight I've ever been on, since by then the entire civilian air fleet had been grounded... between us and the f-15s, we were basically the only things flying....
Closure is important, and these guys are providing it... I'd like to shake their collective hand and buy them a nice cold beer.
And your point is what? Doctors already have the power to kill undetectably; permitting them to assist in suicides doesn't make a big difference there
Really? Making it easier for physicians to kill and giving them legal avenues to do so doesn't increase the potential for abuse? For a man with such a dark view of medicine, you certainly have great faith... but only in your own brand of practitioner.
I believe that the state has no right to kill people, for any reason
A curious stance, particularly in light of this little discussion.
But I tire of this.
You are so paranoid about your legal issues that you seem to think everything is about you
I'm going to offer you a debate pointer, and then end this thread. In the future, if you wish to engage someone in a sincere discussion, refrain from insulting them, accusing them of crimes, or wildly attributing malicious motives or pathological mental states. Such behavior is likely to annoy your conversational foil, and result in a prematurely truncated debate, as it has done here.
Good luck... I sincerely hope you never need the services of the kind of doctor you seek to create.
I'm full of rhetoric and slogans... yet your contribution is that "it's a matter of paying your fair share." Yes... indeed. This makes my point perfectly.
"Fair" is a word laden with moral and ethical implication... a child may utter "that's not fair!" much the same way a politician does (and with about the same amount of thought behind it). "Fair" is code for "soak that rich guy, he didn't earn it/doesn't deserve it/can afford it/won't miss it/stole it/inherited it/made it off the backs of others." Ever said any of those things?
I pay about 50% of my income in taxes already. But even before I take home a penny, I end up donating somewhere in the neighborhood of 30+% of my professional medical services. That's about a third of my total work (and often my most-difficult cases) for which I receive nothing. That percentage sounds bad, but it's better than I used to do... I've previously worked in inner-city ERs where it was closer to 50%. Are those percentages quantitative enough for you? I'm not bitter about it... it's part of my professional, ethical, and legal duty; I rarely give it a second thought, even at tax time. Not only do I render a valuable service to society, but I also directly care for the very poor and indigent the leftists claim to lionize. I don't consume a greater proportion of society's benefits... I AM THOSE BENEFITS.
Please understand, I'm not attacking you for your point, I'm simply pointing why I totally reject the "you haven't given your fair share" argument. I try to make the most of the pennies-on-the-dollar I do manage to take home, and when I look at the numbers, I have a very hard time accepting the premise that I'm some kind of drone, or that what I've given represents a net drain on society in any way, shape, or form.
A few more drones like me and this economic downturn would disappear.
Well, I'd have to disagree with that one. I can only drink so much water, use so much electricity, and drive so many miles in a day (all of which I pay for, either directly, or indirectly). I'd also say that my vote doesn't count for any more than joe the garbage collector's vote.
Why ought the rich to pay a greater percentage? Because they are bad people? Because they stole it? Because they don't deserve it? Because they perspire more than other people? Why? I've yet to have any higher-tax-rate proponent explain that to my satisfaction. A flat tax that kicks in at a certain income level is the epitome of fairness... everyone above a certain income level pays the same cut. They pay different amounts, of course, but the percentage is the same.
I didn't steal my wealth from anyone... I worked hard for it, and I continue to do so. I won't be told that I somehow don't deserve to enjoy it, or that I'm wrong to be well-off.
The progressive taxation argument is simple class warfare, and plays on the baser emotions of jealousy and envy, nothing more. As I listen to the lefitsts of the world, I wonder if I somehow missed something, I wonder if I'm going to wake up tomorrow and find out that I'm an armed robber instead of a healthcare professional... listening to some democrats, you'd think that's how I made my money.
I refuse to accept the moral aspersions that are thrown in my direction, simply because I make a good income... as if we are all idle rich who inherited it, and lay around all day putting on airs and abusing the "less fortunate." I utterly reject the implied lack of moral fitness that some want to tie to wealth.
I actually think doctors are not the best persons to assist in patient suicides
Bravo. You have touched on a very important point. Doctors are not the ideal people to perform this function; active killing of patients is extremely dystonic to a profession focused on the preservation of life. Many physicians, including myself, view euthanasia as counter to our traditions and oaths. Perhaps an executioner-type profession, similar to what already exists in Saudi Arabia, is closer to what you had in mind.
It may come as a surprise to you, but I'm not confident in my ability to rightly choose who lives and who dies. I don't want that power, I don't want that responsibility, and I won't be forced into shouldering it. I am a fallible human man, and the prospect of choosing incorrectly or being the agent of such a choice, when the consequences are so final, gives me great pause. What if the patient who approaches me was pressured by his family, either because they didn't want to spend the money to cure his disease, or they threatened him with institutionalization? What if he's doing it for life insurance money? How about conflicts of interest? End-of-life care is too important, and I fear that issue could get lost if we focus too much on euthanasia, instead of on pain relief and death with dignity.
I would remind you that I have only defended my ethical position... whereas you have assailed me from the beginning, accusing me of malpractice and assault. You even went so far as to suggest that I prolonged the suffering of terminally-ill patients in order to maximize the financial return from the patient's insurance company. Which of us has a problem with the opinions of others? There are physicians out there who feel as you do, but I am not one of them. Surveys of Oncologists have found that a significant percentage have "assisted" patients in their demise. If they are comfortable doing that, bully for them. I may not agree with them, but neither would I hunt them down outside their clinics.
You have seen cases where doctors performed unnecessary procedures for financial gain... how many patients could an unethical physician kill? It's already happened: nurses and physicians have been convicted of murder for motives including financial, love triangles, and "mercy." It's too much power to put in the hands of one person, particularly when there is such terrible potential for abuse. Also, my reference to Nazi germany was not to the ovens and Zyklon-B showers; I was referring to the euthanasia of the mentally ill and the mentally incompetent. Psychiatrists did this willingly, and thought they were showing mercy whilst purifying the gene pool... What a horrific erosion of anything even resembling morality... truly chilling. How many "Doctor Deaths" or Josef Mengeles would it take for you to consider the other side?
These issues are not necessarily clear-cut, and the physician is sometimes caught between competing priorities. That is when you must fall back on your own moral foundations, and the recommended and legally-sanctioned "best practices" of your profession. Sometimes it's simply a matter of choosing what shade of grey you can life with. I have encountered these issues and situations more times than I can count, and I know what manner of handling them gives me peace, and a clear conscience. I will always relieve suffering, and I will always try to honor patient wishes... but I will NOT pull the trigger, and I will NOT choose the manner and hour of their demise. That power is not mine to wield. I cannot create life; how can I see myself fit to arbitrarily end it? I'm not going to act, in the absence of mortal danger, deliberately and actively take the life of another, and definitely not under the guise of my medical practice.
is typically used to refer to "mercy killing" of sick or ill individuals, whether by an act of commission, or ommission. I object to performing an act that will directly result in the death of another person. You seem to have a serious problem with that stand, even accusing me of "unethical" behavior in that situation. I can't be ethical in my stand, but you can? "Think a bit further" indeed...
I have considered these issues, both in ethical discussions with my colleagues, and various bio-ethicists. I have a personal ethical bent against killing other persons with my art of medicine... I took the Hippocratic Oath in its original form, and as stated in the oath, I "will give no deadly medicine, if asked, nor suggest any such counsel."
I asked your background to ascertain your level of experience with end-of-life issues. I don't know if you have ever stood by and watched a person die, or personally turned off their ventilator and inotropic drugs and watched them slowly expire... I have. It's difficult, to say the least. I'm simply trying to gauge how much credence to give your statements, since some of them seem to have been made in an experential vacuum. Experience and knowledge DO count... and to some extent this discussion is based on them. After all, information is the basis of consent, without knowledge, there can be no choice.
I certainly don't object to your personal opinion. I strongly object to your condemnation of my medical practice, and impugning of my ethics, particularly when you haven't experience or bioethical credentials to lend support to such an indictment. I am a non-programmer, thus I make no judgements about program flow or design... I could read a few books, and then attack your programming technique, but I would be manifestly arrogant to do so, since I would lack the credentials and experience to lend my judgement any weight. You will, of couse, understand if I ignore your condemnation.
You would have me participate and actively cause death amongst the patients I'm sworn to aid, and condemn me should I refuse. I will not do as you ask. Where, pray tell, is my right to self-determination? My right to a principled ethical stand? I hardly have a monopoly on the means to suicide... there are dozens of ways to die in the aisles of any department store, some of them quite painless, and books have been published on that very topic. I am not blowing in the wind with this latest ethical shift; I base my practice on a judeo-christian set of ethics, bound by hundreds of years of tradition, following in the footsteps of my predecessors. If you wish to overturn such a long-established ethical standard, seting aside the weight of history, expert opinion, and real-world experience, then the burden of proof is on YOU... YOU must prove your case. Even if we, as a society, decided that euthanasia was acceptable (it was practiced in Nazi germany, and the horrors that resulted are well-documented), I would still not personally participate in the active killing of patients.
Ah, yes, there is the "proper" way to die, the medically and legally approved one, the one based on "sensitivity and compassion". It doesn't seem to occur to you that different people have different preferences.
The irony of your exhorting me to consider the "different preferences" of others while simultaneously attacking my preference is not lost on me. Are physicians not entitled to their ethical stands and preferences if they differ from yours?
I practice within my ethical and professional bounds and within the standard of care, because I happen to agree with those standards, and because to do otherwise would cause patient harm, and sanction/loss of my ability to practice. At that point, I couldn't help anyone, and there are too many other patients out there who need me. Philosophical debates are fine, but legal issues are real, and physicians MUST consider them. It's not simply a matter of establishing suicide as an individual choice. Physicians largely pra
Do not project your angst about the US healtcare system on me, my good man. I know of what I speak, because it's my business to know, and because I deal with these issues on a daily basis. Where do you think people go when they are dying? Unfortunately, they sometimes come to the ER, where time, patient load, and acuity sometimes interfere with their care. I'd much rather see patients pass away quietly at home, without pain, surrounded by family and friends... not sandwiched between a schizophrenic and a withdrawing heroin addict. I'm curious what you do for a living, particularly when you attempt to speak with experience and authority on an issue you do not seem to fully grasp.
My statement about the person who slits their own wrists has to do with their mental state. It is my professional, ethical, and legal obligation to prevent persons, ostensibly not in their right mind, from harming themselves or others.
You make wild, unfounded accusations about my practice of medicine, and then dare to take umbrage when I outline the legal difficulties behind your ravings? I might point out that you flat-out accused me of malpractice, necessitating my schooling you on the issues involved. Those issues are part and parcel of the practice of modern medicine, whether it is malpractice, wrongful death, end-of-life care, or medical care of prisoners/detainees. That you are unaware of that particular reality of medical practice makes me wonder about your knowledge base.
It's the other people, the people you resuscitate against their wishes, who are usually so ill and have such short life expectancies that they are not in a position to sue you for their pain and suffering afterwards.
Are you having trouble reading my earlier posts? I specifically stated that I will not, and do not, resuscitate a competent terminally ill patient against their wishes.
You seem to be focused on the loss of control... my patients are always in control of their care, as long as they are competent to make medical decisions. If a patient wants to assure their wishes are followed in the event of their incapacitation, THAT is what advance directives and living wills are designed to do, hence my encouragement to have one drawn up. Now, I have my own set of ethics, and I will not help them kill themselves, if that is their wish... I am NOT Dr. Kevorkian. I will perform no direct action to deliberately kill someone... I am a healer, not a murderer. I will not assist a patient if he wants to committ suicide... I will allow nature to take its course, and assure the patient's comfort if that patient is terminally ill and suffering, but I do not kill patients. If I have a patient who wants that kind of "service," they need a hitman, not a doctor... I cannot/will not help them.
I have a suggestion for you, totally without prejudice. I'd like you to volunteer at your local Hospice, and see how end-of-life care is properly rendered. I have both personal and professional experience with Hospice, and have never been anything but impressed with their sensitivity and compassion.
You seem quite passionate about this issue... you should really turn that energy to the service of others.
Have you had any recent experience with an ER in the United States?
Every state where I have ever practiced has a DNR law, and as I stated earlier, I generally honor patient wishes. If a person has a DNR bracelet and the appropriate paperwork, and there are no question marks, I don't resuscitate them... period. They might have terminal cancer, they might simply be deathly afraid of ventilators, or they might have a religious preference... whatever. If they state their intentions that clearly, then I can literally be arrested and charged with assault if I go against those wishes. Besides, who the hell am I to foist myself on another person who made an objective, conscious, and well-educated decision about so important an issue?
If a person tells me they want to walk out of the hospital, and quietly die from their illness in their car in the parking lot, I cannot stop them, so long as they are of sound mind and understand the risks/benefits. If they are actively suicidal, drunk, or otherwise not in their right mind, then that is a very different story. If I smell a rat (ie. they have DNR home-made tattoed on their chest, look otherwise healthy, and have slit their own wrists), or there is otherwise doubt that the situation is as-advertised, I'll err on the side of resuscitation. Death is irreversible, so in case of doubt, I err on the side of safety... not to be flippant, but they can always live to die another day. Something else to consider: plenty of people have been taken to court for wrongful death... but I'm not aware of a single successful suit brought for wrongful life.
In the setting of chronic illness, cancer, etc, and the abscence of mental impairment, DNR means DNR... I would not so violate another person against their expressed wishes. I've got too many other patients take care of, and I can't take care of them from a jail cell.
I'm only replying to this because you had the courtesy to post under your actual account
The fact that you, as a physician, often choose to ignore people's explicit wishes and do not assist their suicide is just an expression of your arrogance
Horseshit... do NOT insult me, sir. End-of-life issues are extremely important... Even as an emergency physician, I refer patients to hospice for care, and ALWAYS honor patient wishes, even if their family does not. Self-determination is a fundamental individual right, and one I honor scrupulously.
As for your assertion that health insurance plays a role in how long I let someone live... again, do NOT insult me. Insurance plays NO role in my resuscitation of a critical patient... in most patients, I don't even look at it. I look at that information ONLY if trying to work within a patient's means (I will not prescibe a heinously expensive outpatient treatment to a patient with no insurance and no money... they won't be able to comply; other avenues must be considered, including public assistance and cheaper alternatives).
Please try to contribute something to the discussion, instead of posting such outrageous flamebait. Thanks.
Are you implying that I spammed this discussion?;-)
When you work in the healthcare field, and witness the sequela of various medical conditions, it takes a real case of denial to allow yourself to indulge in them... I see way too many withered elderly folks on oxygen tanks to even consider smoking, for example.
Honestly, I think it makes you appreciate your own good health (it certainly does me). When you see how quickly life can change, and what kind of tragedy can happen in the blink of an eye... it reminds me every day to be thankful for what I've been given. Few things are more valuable than your good health.
how much "living" are you really going to be accomplishing after 80, and based on what standard would you define it?
I've met some pretty spry 70-80yo folks... if you take care of yourself your whole life, you really can extend it in a quality way... I truly believe that.
However, you will not be living the same way you are now. Simple age will intervene at some point; virtually everyone develops medical problems if they live long enough. Even if you didn't work at a nuclear plant, you receive enough background radiation during your life that cancer is always a possibility... genetic damage accumulates. Osteoarthritis will set in eventually, it's a wear-and-tear phenomenon that will get you if you live long enough. Your bowels may not function like they once did (never underestimate the value of a properly functioning GI tract). Your prostate will gradually enlarge (eventually necessitating a procedure to open it up). Your eyesight and hearing may start to decline. You may outlive many of your friends (this can be real problem for the octogenarian+ group, and contributes to isolation, depression, etc). You may develop a heart attack or stroke (much of the body's cholesterol level is genetic, and only partially affected by drugs and diet).
Simply put, living may not be as fun when you are 80+ years of age. This sounds cliche`, but moderation may simply be the key to the whole game. Enjoy yourself, but don't go nuts... that way you'll live a long time (barring genetic defects and accidents), and you'll have plenty of stories about your adventures to bore your grandkids.
on your willpower... would that more people had the same drive to stay fit.
However, instead of willpower, people are going the bariatric surgery route... I've seen more TV news magazine reports recently about this trend than I've ever seen before. Danger, Will Robinson.
Apart from the obvious complications of surgery (bleeding, wound dehissence, infection, obstruction, etc, etc), stomach stapling changes your lifestyle permanently. Some of these things would be real burden for slashdotters... for instance:
You become nable to drink during meals (your stomach is so small after the surgery, it cannot hold both food AND drink)
Carbonated beverages are to be avoided (same reason as above... no Mountain Dew, no Jolt, no Bawls.)
No alcohol (beer will stretch your now-tiny stomach as much as regular carbonated beverages). Also, about half of consumed alcohol is broken down in the stomach via alcohol dehydrogenase... theoretically, you could find that your whiskey sours pack about double the punch as before (not necessarily a good thing).
You are also not necessarily done with surgery after your stapling. Ever see a person who has lost 150lbs or so? They have skin folds just hanging off of them... plastic surgery is required to get rid of the redundant skin. The potential also exists for nutritional deficiencies, like B-12. To be fair, the liver stores a fair quantity of B-12, so this might only show up 10-15 years down the road. Bottom line: The true long-term effects of this operation are not known.
I don't even know what to say to the people who purposely make themselves fatter so they can qualify for the surgery... it's madness.
That brings up another issue... when does life stop being worth living?
This is the question that the euthanasia folks would dearly love society to answer... but they can't; it's an individual decision. This is part of the drive behind people getting living wills, durable powers of attorney for healthcare, and advance directive, etc.
I'm not quite to mid-life, without a single health problem. I run, work out, don't smoke, or drink to excess... and I have a living will, AND advance directives. Why? Because, as a physician, I have SEEN life that's not worth living (at least it wouldn't be for me), and I would never want to get to that point. I encourage people, even healthy ones, to think about a living will... and to have the necessary conversations with their loved ones and significant others. Once you're critically ill/vegitative, unable to make that choice for yourself, and others are trying to deal with the emotional trauma of your incapacitation... that is NOT the time to attempt an objective conversation about it.
Yes, you can diet, and deprive yourself of all the "good things" in life, but is that really a life worth living, particularly if it only buys you a small, arbitrary gain? Again, it's an individual decision.
If you wash your hands between patients (and especially before going to see someone who's immune system has taken a hit... chemo, HIV, SCID, etc, etc), you'll cut down dramatically on the spread of disease.
The nosocomial, or hospital-acquired infections are the worst actors... multiply-resistant, and prevelant in the one location where sick and vulnerable people are gathered in one place.
This doesn't leave out healthcare workers. Your own commensal organisms that live on your skin and in your gut tend to be wild-type, and less-resistant than nosocomials.... until you wipe them out by doing something dumb, like taking antibiotics for an infection that's viral, or would clear up on its own given a little time (mild sinusitis, for example). This is why I advocate avoiding antibiotics unless clearly indicated... this includes taking antibiotics for infections that would get better with good wound care alone... like boils and smaller cutaneous abscesses. If you work in a health care facility, your normal bacterial population is the only thing protecting you from mass colonization with resistant bugs, particularly if you work with critically-ill patients. You don't want to get really sick with something, then find out there's nothing that can treat your infection... I've seen it happen to too many patients.
So yes, wash your hands... and don't take antibiotics unless you damned well NEED them... If I personally get sick, and all the antibiotics are going to do is shorten my disease course by a day or two, I'll skip them... I'm not sacrificing my precious normal flora for such a minimal gain.
Plague of painful sores Seas, rivers, and springs turn to blood Plague of darkness Plague of Locusts Great Earthquake The four Horsemen Gates embraces Linux
Depends on what kind of aerial you're talking about... if you mean 2meter, 440, etc, then yes... a tall tower (typically for a repeater, and that might not survive the hurricaine) facilitates communications, since these bands tend to be line-of-sight.
However, if you read the article, you'll notice they are using the 80-meter band, which is NOT line-of-sight. Tall antennas are not as critical... you can rig up a dipole with some wire after the storm passes, and get passable reception.
aerials, schmaerials... a true ham is a master at jury-rigging stuff, including antennas.
And this is different from the civilian world in what way exactly?
Ah, I see. It's OK because the civilian world does it too? C'mon... I'm all for promoting people with their shit together, but the fact that the current system encourages bullshit artists is wrong. Results should get you promoted, not flash-and-dance.
I should point out that rank and promotion are utterly unimportant to me, unlike most of the military... let me explain.
I'm a physician, residency-trained and board-certified. I take care of patients... that's what I do, and there is no greater responsibility. There's nowhere to go educationally speaking (I already have a terminal degree, and specialty post-doctoral training), unless you want to go to school just for fun. Why would I want to climb the ladder as a physician? So I can become an admin type and trade my hard-won skills and experience for some kind of paper-shuffling gig? That would be advancement how? My feeling on this issue differs from yours, but our positions are totally different. Going into a management position was a step UP for you... whereas for me it would actually be a step BACK.
One of the big things that drove me crazy about the military medical corps was that they won't let doctors be doctors. If you want to get to full-bird colonel, you generally won't get there by being a good doctor. Low complication rates? Big deal. High patient satisfaction? So what. Able to "move the meat" in the clinic? Bah. You get to full-bird by pushing your clinical responsibilities off onto your colleagues, and becoming the "go to" guy for every senior officer's pet project... you get there by making yourself highly-visible in the command for admin stuff... NOT for patient care. I personally couldn't care less if I'm a captain, or a colonel... I'm doing the same job, regardless of my rank, and nobody orders me to take care of a patient in a way I find improper... rank be damned. I've had colleagues "ordered" by senior ranking physicians to do things they found medically objectionable... "Hello? IG's office?" That's one of the problems with military medicine... you serve two masters: your medical/ethical/professional obligation to the patient, and the military rank structure, and they don't always want the same things.
The only reason promotion even exists for physicians (and the only reason most even care about it) is because they tie your pay to your rank. Personally, I'd change that, and simply tie it to years of service, regardless of rank... but I'm not in charge.
I was active duty for 4 years. Airborne Infantry. I received seven(7) Army Achievement Medals in that time. First choice of school slots. All my promotions were after minimum time in grade. You think I got that by being humble and quiet? No. I got that by accomplishing the mission no matter what it took and making sure the right people knew it.
Good for you. If you were a competent and effective soldier, I would expect you to get promoted. Accomplishing the mission no matter what is a given... if you can't do that, leave the military. Making sure that people "knew it" is a FAR CRY from the kind of blather that goes on OPRs/EPRs... and you know exactly what I'm talking about (either that or you haven't read very many). You can have a guy who pushes a button for a living, and if you read his EPR, it'll make it sound like he's the only thing standing between freedom and the communist hordes, in addition to personally saving half the defense budget. I'd personally like to see a person's EPR/OPR actually reflect what they do... having to cut through all the bullshit is a waste of time, and dilutes the accomplishments of the true "AJ squared away" types. It's the military version of "grade inflation," and it's just as bogus.
Slashdot Mirror
spare me the "you've never been there, man!! You just don't know!" rant.
Everyone's been stuck in dead-end jobs. Many people have been broke, had to live on noodles, had to move out of their place and in with friends to save on precious, dwindling cash reserves... There's jobs out there if you're willing to swallow a little pride. It may not be what you want, but it's only temporary. It may grate on his I'm-the-computer-elite ethos, but he could even do in-home tech support... hell, advertise in the upscale neighborhoods and fleece those despised computer-dumb yuppies for a fortune... that'd surely assuage his member-of-the-proletariat angst. Even if he stripped his resume and got a job as a tech-support monkey, his vast computer knowledge should shine through in about five minutes... and if he made sure the right people noticed it, he might find himself running the show in no time. It helps to be willing to dial back your expectations in order to get your foot in the door.
He may have to sell his house on the lake and get a cheaper place, which sucks, but is a reasonable thing to do when your income drops. Lots of people's fortunes go up and down... the key is to be able to adapt.
I'm not saying the original poster is a bad person... my comment had more to do with his psychology. I think he's depressed, looking for someone to blame, and generally feeling helpless... and yet, he's the ONLY ONE with the power to change his situation. Admitting that, however, would take away his "I'm a victim" ego defense, and force him to take responsibility for alleviating his own plight. His situation is very common... and so is his reaction to it. He seems like an insightful enough chap, so I expect he'll snap back.
Sometimes holding up a mirror to someone is the best thing you can do.
Sheesh... a few of flashes of insight in there, but it's mostly bitter, sarcastic, angst-ridden despair... quite depressing read, actually.
Notice how he blames it on everyone else, as if some puppetmaster controls his destiny? (evil corporations, GW Bush, supervisors and managers). Sheesh, guy... I hate to sound like your dad, but that's life. Lots of people have been screwed out of jobs before, and lots of peolpe have had jobs that frankly sucked, but there's always work out there if you are willing to swallow some pride, and make some sacrifices. Go back to school for god's sake.
I wish I hadn't read that depressing little piece... I'd say it was a lot higher on the despair scale than the humor scale.
While in the military. A bunch of us were overseas for the war in Afghanistan, and were really hungry for some unfiltered internet access. We had mil access, but the military access rules were a bit too restrictive for our tastes, and everything was constantly monitored. (the thought of some E-1 laughing his ass off and showing my sweet sappy emails to my wife around to all his buddies bothered me... call me crazy). To be fair, however, it could have been worse... in the early portion of the war, we were under total communications blackout... no cell phones (or regular phones, for that matter), no computers... no fun.
We looked into some satellite internet access for ourselves (one guy in our group was a satellite 'net installer), but couldn't find a provider. We could have smuggled the hardware into the country, and even set it up, but we couldn't find a satellite to hit. We had the Innmarsat in our comm gear, but the guy in the article is right... it's extremely expensive to run, and the bandwidth sux0rs.
I wish we'd have known about this guy's deal.
but I must say my geek hat is off to you, sir... I would have never come up with that one.
Kudos.
It sounds to me like he's got his finger on the pulse of the geek community (or at least the /. community).
I, for one, give him +1 insightful.
those tags on your mattress that say "do not remove under penalty of law!"
Yep... the mattress police... fear them.
So it can go back to the old-school days of EFNET?
:-P~
D00000D! Wassssup!!
RU single???
B0st0n R0X0r5!!
ROFLLMAOPIMP!
Ah well. I was planning on moving to DALNET anyway...
I have all the respect in the world for these guys... programming methods or no, what they did and are doing is priceless.
.
I was in New York on Sept 11... flown in on a C-141 as part of the rescue/relief effort (the rest of my Urban Search and Rescue team had to drive... I beat them there by a number of hours). That was the most unique flight I've ever been on, since by then the entire civilian air fleet had been grounded... between us and the f-15s, we were basically the only things flying...
Closure is important, and these guys are providing it... I'd like to shake their collective hand and buy them a nice cold beer.
And your point is what? Doctors already have the power to kill undetectably; permitting them to assist in suicides doesn't make a big difference there
Really? Making it easier for physicians to kill and giving them legal avenues to do so doesn't increase the potential for abuse? For a man with such a dark view of medicine, you certainly have great faith... but only in your own brand of practitioner.
I believe that the state has no right to kill people, for any reason
A curious stance, particularly in light of this little discussion.
But I tire of this.
You are so paranoid about your legal issues that you seem to think everything is about you
I'm going to offer you a debate pointer, and then end this thread. In the future, if you wish to engage someone in a sincere discussion, refrain from insulting them, accusing them of crimes, or wildly attributing malicious motives or pathological mental states. Such behavior is likely to annoy your conversational foil, and result in a prematurely truncated debate, as it has done here.
Good luck... I sincerely hope you never need the services of the kind of doctor you seek to create.
I'm full of rhetoric and slogans... yet your contribution is that "it's a matter of paying your fair share." Yes... indeed. This makes my point perfectly.
"Fair" is a word laden with moral and ethical implication... a child may utter "that's not fair!" much the same way a politician does (and with about the same amount of thought behind it). "Fair" is code for "soak that rich guy, he didn't earn it/doesn't deserve it/can afford it/won't miss it/stole it/inherited it/made it off the backs of others." Ever said any of those things?
I pay about 50% of my income in taxes already. But even before I take home a penny, I end up donating somewhere in the neighborhood of 30+% of my professional medical services. That's about a third of my total work (and often my most-difficult cases) for which I receive nothing. That percentage sounds bad, but it's better than I used to do... I've previously worked in inner-city ERs where it was closer to 50%. Are those percentages quantitative enough for you? I'm not bitter about it... it's part of my professional, ethical, and legal duty; I rarely give it a second thought, even at tax time. Not only do I render a valuable service to society, but I also directly care for the very poor and indigent the leftists claim to lionize. I don't consume a greater proportion of society's benefits... I AM THOSE BENEFITS.
Please understand, I'm not attacking you for your point, I'm simply pointing why I totally reject the "you haven't given your fair share" argument. I try to make the most of the pennies-on-the-dollar I do manage to take home, and when I look at the numbers, I have a very hard time accepting the premise that I'm some kind of drone, or that what I've given represents a net drain on society in any way, shape, or form.
A few more drones like me and this economic downturn would disappear.
Well, I'd have to disagree with that one. I can only drink so much water, use so much electricity, and drive so many miles in a day (all of which I pay for, either directly, or indirectly). I'd also say that my vote doesn't count for any more than joe the garbage collector's vote.
Why ought the rich to pay a greater percentage? Because they are bad people? Because they stole it? Because they don't deserve it? Because they perspire more than other people? Why? I've yet to have any higher-tax-rate proponent explain that to my satisfaction. A flat tax that kicks in at a certain income level is the epitome of fairness... everyone above a certain income level pays the same cut. They pay different amounts, of course, but the percentage is the same.
I didn't steal my wealth from anyone... I worked hard for it, and I continue to do so. I won't be told that I somehow don't deserve to enjoy it, or that I'm wrong to be well-off.
The progressive taxation argument is simple class warfare, and plays on the baser emotions of jealousy and envy, nothing more. As I listen to the lefitsts of the world, I wonder if I somehow missed something, I wonder if I'm going to wake up tomorrow and find out that I'm an armed robber instead of a healthcare professional... listening to some democrats, you'd think that's how I made my money.
I refuse to accept the moral aspersions that are thrown in my direction, simply because I make a good income... as if we are all idle rich who inherited it, and lay around all day putting on airs and abusing the "less fortunate." I utterly reject the implied lack of moral fitness that some want to tie to wealth.
I actually think doctors are not the best persons to assist in patient suicides
Bravo. You have touched on a very important point. Doctors are not the ideal people to perform this function; active killing of patients is extremely dystonic to a profession focused on the preservation of life. Many physicians, including myself, view euthanasia as counter to our traditions and oaths. Perhaps an executioner-type profession, similar to what already exists in Saudi Arabia, is closer to what you had in mind.
It may come as a surprise to you, but I'm not confident in my ability to rightly choose who lives and who dies. I don't want that power, I don't want that responsibility, and I won't be forced into shouldering it. I am a fallible human man, and the prospect of choosing incorrectly or being the agent of such a choice, when the consequences are so final, gives me great pause. What if the patient who approaches me was pressured by his family, either because they didn't want to spend the money to cure his disease, or they threatened him with institutionalization? What if he's doing it for life insurance money? How about conflicts of interest? End-of-life care is too important, and I fear that issue could get lost if we focus too much on euthanasia, instead of on pain relief and death with dignity.
I would remind you that I have only defended my ethical position... whereas you have assailed me from the beginning, accusing me of malpractice and assault. You even went so far as to suggest that I prolonged the suffering of terminally-ill patients in order to maximize the financial return from the patient's insurance company. Which of us has a problem with the opinions of others? There are physicians out there who feel as you do, but I am not one of them. Surveys of Oncologists have found that a significant percentage have "assisted" patients in their demise. If they are comfortable doing that, bully for them. I may not agree with them, but neither would I hunt them down outside their clinics.
You have seen cases where doctors performed unnecessary procedures for financial gain... how many patients could an unethical physician kill? It's already happened: nurses and physicians have been convicted of murder for motives including financial, love triangles, and "mercy." It's too much power to put in the hands of one person, particularly when there is such terrible potential for abuse. Also, my reference to Nazi germany was not to the ovens and Zyklon-B showers; I was referring to the euthanasia of the mentally ill and the mentally incompetent. Psychiatrists did this willingly, and thought they were showing mercy whilst purifying the gene pool... What a horrific erosion of anything even resembling morality... truly chilling. How many "Doctor Deaths" or Josef Mengeles would it take for you to consider the other side?
These issues are not necessarily clear-cut, and the physician is sometimes caught between competing priorities. That is when you must fall back on your own moral foundations, and the recommended and legally-sanctioned "best practices" of your profession. Sometimes it's simply a matter of choosing what shade of grey you can life with. I have encountered these issues and situations more times than I can count, and I know what manner of handling them gives me peace, and a clear conscience. I will always relieve suffering, and I will always try to honor patient wishes... but I will NOT pull the trigger, and I will NOT choose the manner and hour of their demise. That power is not mine to wield. I cannot create life; how can I see myself fit to arbitrarily end it? I'm not going to act, in the absence of mortal danger, deliberately and actively take the life of another, and definitely not under the guise of my medical practice.
Unethical? No... I sleep very well at night.
is typically used to refer to "mercy killing" of sick or ill individuals, whether by an act of commission, or ommission. I object to performing an act that will directly result in the death of another person. You seem to have a serious problem with that stand, even accusing me of "unethical" behavior in that situation. I can't be ethical in my stand, but you can? "Think a bit further" indeed...
I have considered these issues, both in ethical discussions with my colleagues, and various bio-ethicists. I have a personal ethical bent against killing other persons with my art of medicine... I took the Hippocratic Oath in its original form, and as stated in the oath, I "will give no deadly medicine, if asked, nor suggest any such counsel."
I asked your background to ascertain your level of experience with end-of-life issues. I don't know if you have ever stood by and watched a person die, or personally turned off their ventilator and inotropic drugs and watched them slowly expire... I have. It's difficult, to say the least. I'm simply trying to gauge how much credence to give your statements, since some of them seem to have been made in an experential vacuum. Experience and knowledge DO count... and to some extent this discussion is based on them. After all, information is the basis of consent, without knowledge, there can be no choice.
I certainly don't object to your personal opinion. I strongly object to your condemnation of my medical practice, and impugning of my ethics, particularly when you haven't experience or bioethical credentials to lend support to such an indictment. I am a non-programmer, thus I make no judgements about program flow or design... I could read a few books, and then attack your programming technique, but I would be manifestly arrogant to do so, since I would lack the credentials and experience to lend my judgement any weight. You will, of couse, understand if I ignore your condemnation.
You would have me participate and actively cause death amongst the patients I'm sworn to aid, and condemn me should I refuse. I will not do as you ask. Where, pray tell, is my right to self-determination? My right to a principled ethical stand? I hardly have a monopoly on the means to suicide... there are dozens of ways to die in the aisles of any department store, some of them quite painless, and books have been published on that very topic. I am not blowing in the wind with this latest ethical shift; I base my practice on a judeo-christian set of ethics, bound by hundreds of years of tradition, following in the footsteps of my predecessors. If you wish to overturn such a long-established ethical standard, seting aside the weight of history, expert opinion, and real-world experience, then the burden of proof is on YOU... YOU must prove your case. Even if we, as a society, decided that euthanasia was acceptable (it was practiced in Nazi germany, and the horrors that resulted are well-documented), I would still not personally participate in the active killing of patients.
Ah, yes, there is the "proper" way to die, the medically and legally approved one, the one based on "sensitivity and compassion". It doesn't seem to occur to you that different people have different preferences.
The irony of your exhorting me to consider the "different preferences" of others while simultaneously attacking my preference is not lost on me. Are physicians not entitled to their ethical stands and preferences if they differ from yours?
I practice within my ethical and professional bounds and within the standard of care, because I happen to agree with those standards, and because to do otherwise would cause patient harm, and sanction/loss of my ability to practice. At that point, I couldn't help anyone, and there are too many other patients out there who need me. Philosophical debates are fine, but legal issues are real, and physicians MUST consider them. It's not simply a matter of establishing suicide as an individual choice. Physicians largely pra
Do not project your angst about the US healtcare system on me, my good man. I know of what I speak, because it's my business to know, and because I deal with these issues on a daily basis. Where do you think people go when they are dying? Unfortunately, they sometimes come to the ER, where time, patient load, and acuity sometimes interfere with their care. I'd much rather see patients pass away quietly at home, without pain, surrounded by family and friends... not sandwiched between a schizophrenic and a withdrawing heroin addict. I'm curious what you do for a living, particularly when you attempt to speak with experience and authority on an issue you do not seem to fully grasp.
My statement about the person who slits their own wrists has to do with their mental state. It is my professional, ethical, and legal obligation to prevent persons, ostensibly not in their right mind, from harming themselves or others.
You make wild, unfounded accusations about my practice of medicine, and then dare to take umbrage when I outline the legal difficulties behind your ravings? I might point out that you flat-out accused me of malpractice, necessitating my schooling you on the issues involved. Those issues are part and parcel of the practice of modern medicine, whether it is malpractice, wrongful death, end-of-life care, or medical care of prisoners/detainees. That you are unaware of that particular reality of medical practice makes me wonder about your knowledge base.
It's the other people, the people you resuscitate against their wishes, who are usually so ill and have such short life expectancies that they are not in a position to sue you for their pain and suffering afterwards.
Are you having trouble reading my earlier posts? I specifically stated that I will not, and do not, resuscitate a competent terminally ill patient against their wishes.
You seem to be focused on the loss of control... my patients are always in control of their care, as long as they are competent to make medical decisions. If a patient wants to assure their wishes are followed in the event of their incapacitation, THAT is what advance directives and living wills are designed to do, hence my encouragement to have one drawn up. Now, I have my own set of ethics, and I will not help them kill themselves, if that is their wish... I am NOT Dr. Kevorkian. I will perform no direct action to deliberately kill someone... I am a healer, not a murderer. I will not assist a patient if he wants to committ suicide... I will allow nature to take its course, and assure the patient's comfort if that patient is terminally ill and suffering, but I do not kill patients. If I have a patient who wants that kind of "service," they need a hitman, not a doctor... I cannot/will not help them.
I have a suggestion for you, totally without prejudice. I'd like you to volunteer at your local Hospice, and see how end-of-life care is properly rendered. I have both personal and professional experience with Hospice, and have never been anything but impressed with their sensitivity and compassion.
You seem quite passionate about this issue... you should really turn that energy to the service of others.
but you do not know what you are talking about.
Have you had any recent experience with an ER in the United States?
Every state where I have ever practiced has a DNR law, and as I stated earlier, I generally honor patient wishes. If a person has a DNR bracelet and the appropriate paperwork, and there are no question marks, I don't resuscitate them... period. They might have terminal cancer, they might simply be deathly afraid of ventilators, or they might have a religious preference... whatever. If they state their intentions that clearly, then I can literally be arrested and charged with assault if I go against those wishes. Besides, who the hell am I to foist myself on another person who made an objective, conscious, and well-educated decision about so important an issue?
If a person tells me they want to walk out of the hospital, and quietly die from their illness in their car in the parking lot, I cannot stop them, so long as they are of sound mind and understand the risks/benefits. If they are actively suicidal, drunk, or otherwise not in their right mind, then that is a very different story. If I smell a rat (ie. they have DNR home-made tattoed on their chest, look otherwise healthy, and have slit their own wrists), or there is otherwise doubt that the situation is as-advertised, I'll err on the side of resuscitation. Death is irreversible, so in case of doubt, I err on the side of safety... not to be flippant, but they can always live to die another day. Something else to consider: plenty of people have been taken to court for wrongful death... but I'm not aware of a single successful suit brought for wrongful life.
In the setting of chronic illness, cancer, etc, and the abscence of mental impairment, DNR means DNR... I would not so violate another person against their expressed wishes. I've got too many other patients take care of, and I can't take care of them from a jail cell.
I'm only replying to this because you had the courtesy to post under your actual account
The fact that you, as a physician, often choose to ignore people's explicit wishes and do not assist their suicide is just an expression of your arrogance
Horseshit... do NOT insult me, sir. End-of-life issues are extremely important... Even as an emergency physician, I refer patients to hospice for care, and ALWAYS honor patient wishes, even if their family does not. Self-determination is a fundamental individual right, and one I honor scrupulously.
As for your assertion that health insurance plays a role in how long I let someone live... again, do NOT insult me. Insurance plays NO role in my resuscitation of a critical patient... in most patients, I don't even look at it. I look at that information ONLY if trying to work within a patient's means (I will not prescibe a heinously expensive outpatient treatment to a patient with no insurance and no money... they won't be able to comply; other avenues must be considered, including public assistance and cheaper alternatives).
Please try to contribute something to the discussion, instead of posting such outrageous flamebait. Thanks.
Are you implying that I spammed this discussion? ;-)
When you work in the healthcare field, and witness the sequela of various medical conditions, it takes a real case of denial to allow yourself to indulge in them... I see way too many withered elderly folks on oxygen tanks to even consider smoking, for example.
Honestly, I think it makes you appreciate your own good health (it certainly does me). When you see how quickly life can change, and what kind of tragedy can happen in the blink of an eye... it reminds me every day to be thankful for what I've been given. Few things are more valuable than your good health.
how much "living" are you really going to be accomplishing after 80, and based on what standard would you define it?
I've met some pretty spry 70-80yo folks... if you take care of yourself your whole life, you really can extend it in a quality way... I truly believe that.
However, you will not be living the same way you are now. Simple age will intervene at some point; virtually everyone develops medical problems if they live long enough. Even if you didn't work at a nuclear plant, you receive enough background radiation during your life that cancer is always a possibility... genetic damage accumulates. Osteoarthritis will set in eventually, it's a wear-and-tear phenomenon that will get you if you live long enough. Your bowels may not function like they once did (never underestimate the value of a properly functioning GI tract). Your prostate will gradually enlarge (eventually necessitating a procedure to open it up). Your eyesight and hearing may start to decline. You may outlive many of your friends (this can be real problem for the octogenarian+ group, and contributes to isolation, depression, etc). You may develop a heart attack or stroke (much of the body's cholesterol level is genetic, and only partially affected by drugs and diet).
Simply put, living may not be as fun when you are 80+ years of age. This sounds cliche`, but moderation may simply be the key to the whole game. Enjoy yourself, but don't go nuts... that way you'll live a long time (barring genetic defects and accidents), and you'll have plenty of stories about your adventures to bore your grandkids.
on your willpower... would that more people had the same drive to stay fit.
However, instead of willpower, people are going the bariatric surgery route... I've seen more TV news magazine reports recently about this trend than I've ever seen before. Danger, Will Robinson.
Apart from the obvious complications of surgery (bleeding, wound dehissence, infection, obstruction, etc, etc), stomach stapling changes your lifestyle permanently. Some of these things would be real burden for slashdotters... for instance:
You become nable to drink during meals (your stomach is so small after the surgery, it cannot hold both food AND drink)
Carbonated beverages are to be avoided (same reason as above... no Mountain Dew, no Jolt, no Bawls.)
No alcohol (beer will stretch your now-tiny stomach as much as regular carbonated beverages). Also, about half of consumed alcohol is broken down in the stomach via alcohol dehydrogenase... theoretically, you could find that your whiskey sours pack about double the punch as before (not necessarily a good thing).
You are also not necessarily done with surgery after your stapling. Ever see a person who has lost 150lbs or so? They have skin folds just hanging off of them... plastic surgery is required to get rid of the redundant skin. The potential also exists for nutritional deficiencies, like B-12. To be fair, the liver stores a fair quantity of B-12, so this might only show up 10-15 years down the road. Bottom line: The true long-term effects of this operation are not known.
I don't even know what to say to the people who purposely make themselves fatter so they can qualify for the surgery... it's madness.
That brings up another issue... when does life stop being worth living?
This is the question that the euthanasia folks would dearly love society to answer... but they can't; it's an individual decision. This is part of the drive behind people getting living wills, durable powers of attorney for healthcare, and advance directive, etc.
I'm not quite to mid-life, without a single health problem. I run, work out, don't smoke, or drink to excess... and I have a living will, AND advance directives. Why? Because, as a physician, I have SEEN life that's not worth living (at least it wouldn't be for me), and I would never want to get to that point. I encourage people, even healthy ones, to think about a living will... and to have the necessary conversations with their loved ones and significant others. Once you're critically ill/vegitative, unable to make that choice for yourself, and others are trying to deal with the emotional trauma of your incapacitation... that is NOT the time to attempt an objective conversation about it.
Yes, you can diet, and deprive yourself of all the "good things" in life, but is that really a life worth living, particularly if it only buys you a small, arbitrary gain? Again, it's an individual decision.
I think I'll keep eating my cheeseburgers.
It really comes down to hand-washing.
If you wash your hands between patients (and especially before going to see someone who's immune system has taken a hit... chemo, HIV, SCID, etc, etc), you'll cut down dramatically on the spread of disease.
The nosocomial, or hospital-acquired infections are the worst actors... multiply-resistant, and prevelant in the one location where sick and vulnerable people are gathered in one place.
This doesn't leave out healthcare workers. Your own commensal organisms that live on your skin and in your gut tend to be wild-type, and less-resistant than nosocomials.... until you wipe them out by doing something dumb, like taking antibiotics for an infection that's viral, or would clear up on its own given a little time (mild sinusitis, for example). This is why I advocate avoiding antibiotics unless clearly indicated... this includes taking antibiotics for infections that would get better with good wound care alone... like boils and smaller cutaneous abscesses. If you work in a health care facility, your normal bacterial population is the only thing protecting you from mass colonization with resistant bugs, particularly if you work with critically-ill patients. You don't want to get really sick with something, then find out there's nothing that can treat your infection... I've seen it happen to too many patients.
So yes, wash your hands... and don't take antibiotics unless you damned well NEED them... If I personally get sick, and all the antibiotics are going to do is shorten my disease course by a day or two, I'll skip them... I'm not sacrificing my precious normal flora for such a minimal gain.
Let's see here...
Plague of painful sores
Seas, rivers, and springs turn to blood
Plague of darkness
Plague of Locusts
Great Earthquake
The four Horsemen
Gates embraces Linux
Depends on what kind of aerial you're talking about... if you mean 2meter, 440, etc, then yes... a tall tower (typically for a repeater, and that might not survive the hurricaine) facilitates communications, since these bands tend to be line-of-sight.
However, if you read the article, you'll notice they are using the 80-meter band, which is NOT line-of-sight. Tall antennas are not as critical... you can rig up a dipole with some wire after the storm passes, and get passable reception.
aerials, schmaerials... a true ham is a master at jury-rigging stuff, including antennas.
That's Sierra-Hotel to you, rookie.
Always use the phonetic alphabet... it makes you more 1337.
And this is different from the civilian world in what way exactly?
Ah, I see. It's OK because the civilian world does it too? C'mon... I'm all for promoting people with their shit together, but the fact that the current system encourages bullshit artists is wrong. Results should get you promoted, not flash-and-dance.
I should point out that rank and promotion are utterly unimportant to me, unlike most of the military... let me explain.
I'm a physician, residency-trained and board-certified. I take care of patients... that's what I do, and there is no greater responsibility. There's nowhere to go educationally speaking (I already have a terminal degree, and specialty post-doctoral training), unless you want to go to school just for fun. Why would I want to climb the ladder as a physician? So I can become an admin type and trade my hard-won skills and experience for some kind of paper-shuffling gig? That would be advancement how? My feeling on this issue differs from yours, but our positions are totally different. Going into a management position was a step UP for you... whereas for me it would actually be a step BACK.
One of the big things that drove me crazy about the military medical corps was that they won't let doctors be doctors. If you want to get to full-bird colonel, you generally won't get there by being a good doctor. Low complication rates? Big deal. High patient satisfaction? So what. Able to "move the meat" in the clinic? Bah. You get to full-bird by pushing your clinical responsibilities off onto your colleagues, and becoming the "go to" guy for every senior officer's pet project... you get there by making yourself highly-visible in the command for admin stuff... NOT for patient care. I personally couldn't care less if I'm a captain, or a colonel... I'm doing the same job, regardless of my rank, and nobody orders me to take care of a patient in a way I find improper... rank be damned. I've had colleagues "ordered" by senior ranking physicians to do things they found medically objectionable... "Hello? IG's office?" That's one of the problems with military medicine... you serve two masters: your medical/ethical/professional obligation to the patient, and the military rank structure, and they don't always want the same things.
The only reason promotion even exists for physicians (and the only reason most even care about it) is because they tie your pay to your rank. Personally, I'd change that, and simply tie it to years of service, regardless of rank... but I'm not in charge.
I was active duty for 4 years. Airborne Infantry. I received seven(7) Army Achievement Medals in that time. First choice of school slots. All my promotions were after minimum time in grade. You think I got that by being humble and quiet? No. I got that by accomplishing the mission no matter what it took and making sure the right people knew it.
Good for you. If you were a competent and effective soldier, I would expect you to get promoted. Accomplishing the mission no matter what is a given... if you can't do that, leave the military. Making sure that people "knew it" is a FAR CRY from the kind of blather that goes on OPRs/EPRs... and you know exactly what I'm talking about (either that or you haven't read very many). You can have a guy who pushes a button for a living, and if you read his EPR, it'll make it sound like he's the only thing standing between freedom and the communist hordes, in addition to personally saving half the defense budget. I'd personally like to see a person's EPR/OPR actually reflect what they do... having to cut through all the bullshit is a waste of time, and dilutes the accomplishments of the true "AJ squared away" types. It's the military version of "grade inflation," and it's just as bogus.