#tpsa

(I'm working on book two but it's slow going... Zero draft finished and I have start the rewrite.)

Snippet from chapter two Braiths POV

“Why would we be the threat? You are the newcomer here.” Morana stated. She tilted her head with a smirk before replying, “Why not? Everyone can be a threat darlin’.” “You're right about that.” Morana purred back before adding, “but we don't stab people in the back, we prefer to look them in the eye when we twist the knife.”

The look in her eyes, a warning that she just couldn't resist poking at. Braith laughed and warned, “Some people won't give you that chance before they have a blade to your throat,” she threw one of the many mini-daggers that lined her belt, it hit the x on the map next to the shaman's head with a loud thud and she winked before stating, “you never truly know who it is your dealing with or their skill level, sometimes a knife in the back is much more efficient.” “Your aim is impressive but your bite is lacking.” Morana said with unveiled amusement.

Tagging my tag list and a few mutuals in hopes of seeing some fun writing shares but no pressure

Morana is a shaman aboard the pirate ship who hasn't really been raised amongst her own, so to speak. She is definitely a bit of a wolf, but she randomly adopts people into her pack...but ahh don't threaten them.

Braith is an ex assassin who was aboard another pirate crew's ship until her queen ordered her to be an emissary. She is also rather cold, but in comparison to Morana she may come across as the Saner of the two...but only if you can excuse the murder, mayham and her incurable boredom... Which leads to her poking at nearly everything and everyone for reactions. 🤦

They meet at a pirate council meeting on Faélánd...they didn't really interact at first beyond backing their respective captains. Then from their the Captains chat and things start happening that makes an emissary necessary on the ship and Braith is selected...due to her loyalty...ain't no one questioning that.

Anyway Morana shows her around the ship and they both can see something is hidden within the other...so it'll be interesting to see how it moves forward even to me.

Thanks for the ask

I would say nearly any adventure with them is a little crazy...I'm not sure which would win the title as I'm not that far into the first draft.

The most questionable would probably be when Braith goes out and hunts down someone that made Morana cry and drags them back to the ship...for an apology 😅 (tentative planning stages for it ATM)

The most violent would be the masquerade I have planned..it kinda goes to hell for a while as all plans do when met with the execution of said plan.

My blog post a few days ago on the upcoming vote on the tentative physicians services agreement has definitely stirred up emotions on both sides of the argument of whether or not to support the agreement.  Those in the “NO” side have accused me of being naive, not knowing the true nature of how negotiations work, having outdated thinking, being a socialist and of course all of this shouted out IN CAPS in case I missed their point. 

Specifically the idea from the last line of the blog where I suggest that we act/vote so that we can  “get down to the urgent work at hand - for our patients.” has drawn out a lot of emotion.

In my opinion, supporting the tentative physician services agreement is in the best interests of our patients.  This is a risk that a rejection of the agreement could lead to further unilateral cuts to the system.  I think people may argue about the level of that risk. But can one really dispute that this risk of further unilateral cuts (voting NO) is not greater than if we shifted our stance from an adversarial to a partner position with the government (voting YES).  Cuts to the system, will impact our patients resulting in longer wait times and decreased access and delaying the opportunity to improve the system.

I don’t think any physician can argue that acting in the best interests of our patients is our primary responsibility - we all pledged to honour the oath we undertook in med school. 

Was it just platitudes then or have we lost some of that love of why we are doing this work in the first place?  I would argue that the vast majority of us are in the latter category - overwhelmed with the day to day challenges of caring for our patients, dealing with the “system” (ie working for the “MAN”) and getting our kids to soccer practice.

As many of you are aware, we are having a  binding referendum on Aug 14th at the Allstream Centre to decide whether or not to ratify the tPSA.   My personal opinion from talking to colleagues and reading the social media chatter is that we are pretty divided on whether to approve or reject the agreement.  It is unclear what direction the members will vote on Aug 14th.

Some of you may have read the article in the globe by Andre Picard on his thoughts of the infighting between doctors and the way some physicians have been opposing the tentative agreement.  He has referred to this as “Trumpism” - the idea of blaming and attacking everyone (fire the negotiators, OMA council resign, MOH lying etc) as a strategy to persuade the general membership of the righteousness of their position to reject any agreement.

I believe Mr. Picard has made a valid observation - which has earned him the ire of the many physicians who resent being lumped in with Mr. Trump.  I too have alluded to the similarities between the resistance by some physicians to the agreement and the movement to have the UK leave the EU (Brexit).

The root cause I think is a widespread populist anger by physicians…. against who they perceive are “elites” in “positions of power” making unwise decisions about healthcare.  

But why are physicians so angry?

In spite of a modest raise in their incomes over the past 15 years, many physicians feel burned out, many are extremely stressed with the volumes of patients, administrative work, and new responsibilities being downloaded to them.  Couple this with a health care system that is falling apart at the seams, struggling to maintain the same quality of care that Ontarians are used to.  The healthcare budget is growing fast (approx 3.1% per year) faster than the provincial budget.    And with an aging population, there doesn’t appear to be any respite in sight.   On top of this, physicians are being asked to shoulder (through shared decision making) some of that added system responsibility of using resources wisely and efficiently.  No wonder many are angry and upset!

What is the choice?

Physicians can continue to direct their anger towards the MOH and the OMA hoping for a magic fix to the structural issues that are stressing our society.   A rejection of today’s tentative agreement will result in “business as usual” with more unilateral cuts as the government struggles to keep the budget intact.  Some physicians will hope that it will force the government to come back to the bargaining table with more money (raises with no hard cap).  How realistic is this goal based on the reality of today?  It will only delay the inevitable conversation that is urgently needed to overhaul the system to ensure it becomes sustainable for our children.  

OR

Physicians can take up the challenge and vote to accept the agreement (however imperfect it is), and begin in earnest the conversation, ask the difficult questions and listen to our patients about what they want - a health system that works now and in the future.

I for one am hoping we choose YES on Aug 14th and get down to the urgent work at hand - for our patients.

Sanjeev Goel

Family Physician

Wise Elephant Family Health Team