The monsoons of the Indian subcontinent unleash a torrent of filth down the great rivers – all the unwanted rubbish and excreta of huge numbers of Homo sapiens living in sufficient prosperity to allow for a dense mass of people eating, sleeping, working, screwing, and dumping the rubbish of what they do not want.

Boors in the High Desert drive out “into the wilderness,” which for them, is about a quarter-mile down the dirt road and often someone’s driveway – and then unloading their crap and accumulati, inevitably including a brokeback couch, very often orange.  If not cleaned up by an irate homeowner whose property rights were impugned, it sits there, peacefully aging in the dry desert air that preserveth all.

Election time is in full swing.  The badwater of the American Political Machine and its detritus is barreling down the gulch after the rains, driving a few of us to queasy introspection.

We are in the Land of Narcissus.  The more mature of my narcissistic patients deal directly with me.  Corporate has given patients a private email account by which to communicate directly with their providers – all of the trappings of Direct Primary Care but none of the underpinnings.  One of my patients in particular averages three e-mails a day, often wishing to discuss the obscure reaches of her medical philosophy.  Corporate electronically collates and counts the number of “delays” in emails – meaning those which are left in the queue unanswered for over 48 hours, weekends included.  Even those nice replies that say “Thanks!” are held against us in our  performance ratings, if they are offered on Friday after closing time and we do not take them off until Monday.

ALL ’email correspondence’ goes into the CHART, of course.  All patient can read all parts of the chart, and the patient who pays in to the EMR upgrade can propose “corrections” to the chart.  I recall one patient who replied in umbrage to the suggestion that he was an alcoholic.  By God, he was a dope fiend, and heroin was okay, but hitting the booze was an indication of a lesser man.  Whatever.  The chart was ‘corrected.’

Corporate allows us to work from home, of course.  Accounting for such work time on a financial basis is, of course, impossible with the current EMR, so they can’t pay us for this effort; the pay is just to avoid punishment.  This was enough for a few Tribes to leave Egypt; human nature seems to have been unchanged since those days.

I have encouraged my frequent correspondents to change providers to one who is more energetically attendant to their needs – “needs” I write in the letter, not “whims.”  That suggestion inevitably spurs a complaint to Corporate, as well as fussiness directed towards me.

The less mature of my narcissistic patients do not contact me.  They appeal to Corporate for a switch of providers, often assertion that they cannot feel that I am caring enough for their problems.  Regarding some matter, I must confess that they are right.  MRI’s of the stable knee “just to look around” do not concern me.  Repeated courses of antibiotics just to “knock out” psoriasis – or what the dermatologist and I think is psoriasis but the patient does not – is uncaring, perhaps.  Biopsy-proven psoriasis is only an opinion, perhaps.

The Snitch’n’Bitch Culture endemic to our society presumes the presence of an Authority that will keep the complainer’s statement private, and deliver punishment upon the identified perpetrator.  Such Authorities thrive on the powers conveyed by snitching; they can lay down a mighty force on both the innocent and guilty alike, and entrap the voluntary squealers into an unpaid information network.  Bring us more problems to solve, comrade, or perhaps you will be the next problem!

There’s a legacy in the GeStaPo, the KGB and the StaSi, and every vile nest of “public information” that was ever set up by the psychopathic Eastern European machines.  What’s the point of encouraging it here?  It’s the nerve network of prison cultures.