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					                                   GADGETS


                     THE GEOFFREY KAYE ORATION 2004

     “OUR PROFESSIONALISM AND OUR VULNERABILITIES……..”


The Geoffrey Kaye Oration is delivered biennially by the retiring President of the
Society.

It was my pleasure and privilege to present the 2004 Oration at the Darling Harbour
Convention Centre on 21 September 2004. An abridged version of this paper was
published in the April 2004 ASA Newsletter.

Geoffrey Kaye was this Society’s first and longest serving secretary and he has been
honoured since his death by this Oration. My predecessors have studied Kaye and his
works and have addressed certain aspects of his character as themes of these orations.
Much is known about him and much has been said. Gwen Wilson’s work “50 Years”
is the source of much of what I will say.

Kaye was born in 1903, graduated in Medicine from University of Melbourne in
1926, attained an MD (Melbourne) in 1929, DA (Eng) in 1939, Fellowship of the
English Faculty in 1949, Foundation Fellowship of the Australasian Faculty in 1952,
and Life Membership of the ASA in 1964.

As a “resident anaesthetist” at the Alfred in 1927, Kaye was already handling private
anaesthesia cases a year after graduating “to earn pocket money” whilst working for
his MD. He aspired to an MRCP and to be a physician which he felt was a “dignified
calling, but perhaps…….(sic) a somewhat futile one”.

His thoughts turned to anaesthetics. He was impressed by the technical aspects of
practice (unsurprisingly, as was his wont), and also by “the doyens of the day” noting
them to be “self trained specialists” …where (sic) conditions of Australian medicine
at that time, especially in rural areas, required that they be resourceful. Fine qualities,
he felt.

We have heard in previous Orations of “Kaye the communicator”, “Kaye the
visionary” and “Kaye the organiser”, but not specifically I believe of “Kaye who was
impressed by technical aspects” (or “Kaye the gadget man”, as I suggest he might
subsequently have been called).

There was no doubt that Kaye was a gadget man. One of his great passions was
anaesthetic apparatus. Engineering techniques fascinated Kaye and he maintained
from that time an engineering workshop in his home. This was the basis of the
collection now housed within the College in Melbourne, and it had began with a visit
to the USA in 1930 and an association with McKesson. Kaye though had a fascination
with the contemporary – worth remembering in the context of the “historical
collection” at Ulimaroa.
Kaye the gadget man was though what I believe John Ashton, in the 1990 Geoffrey
Kaye Oration, would describe as a “gauge watcher” and a “dial fiddler”.

Kay was also known for his martinis – no doubt an interest acquired during his
American visit - and later for his military career, and there was no doubt he was an
internationalist. Any of these might well be themes for future Geoffrey Kaye
Orations.

Our professionalism………………

Our specialty has enjoyed wonderful times over the last seventy years. I say seventy,
because to me, Anaesthesia became a specialty in this country in 1934 with the
establishment of the Society, spawning a Faculty, a College and two subdisciplines
(Intensive Care and Pain Medicine) along the way. We, as anaesthetists, are all proud
professionals – and we use that term to describe what we do and who we think we are
as medical practitioners expert in anaesthesia.

“Specialists” and “resourceful”, and “technical”……………these words impressed
Kaye, and no doubt to him connoted professionalism.

The dictionaries are consistent: the professional person is typified as skilled,
proficient, expert, masterly, experienced, trained, qualified and paid.

John Hains (President from (1992 - 1994), writing in “Anaesthesia and Intensive
Care” in 1987, described the development of the Society’s current symbol, or more
correctly, badge. In heraldry, a badge is a “distinctive symbol”. In replacing the
Society’s former badge, which contained a kangaroo jumping over a stylised Australia
(certainly itself a “distinctive symbol”), certain features were felt to be important.
These included elements of the original design (some history), the need for a
reference to some element of anaesthesia (our science), a linking of the identity of the
(then) Faculty and the Society (collegiality), and “uniqueness” (lending perhaps some
special authority?) Various designs were proposed, some including the serpent seen
so often in the “caduceus”, which was in one design “embowed” such that the serpent
appeared to be eating its tail. This circular serpent lead ultimately to our circular
symbol. The colours selected were black and gold: these were the colours used in the
Faculty (and now College) gown (providing for the linking of identities), with the pot
and wavy lines indicating vapour (the element of anaesthesia), and the hand (used in
the UNESCO badge) suggesting “compassion sought and given by the touch of a
hand”. The final product, our current badge, was felt to be “a distinctive symbol, clear
and bold, which depicts the ideals of the care, control, compassion and skill inherent
in the practice of anaesthesia”.

Combine all these – can we define anaesthesia professionalism?: care, control,
compassion and (technical) skill. “Specialists”, and “resourceful”!

But is this definition enough in contemporary times ?

William Sullivan (a prominent American medical sociologist whose writings feature
prominently in the recent literature addressing professionalism) gives an expanded
view:
 “the professions have been granted a monopoly over the use of a body of
knowledge…… as well as considerable autonomy, prestige, and financial
rewards……on the understanding that they will guarantee competence………provide
altruistic service……conduct their affairs with morality and integrity”.

Sylvia Cruess (a Canadian medical sociologist) whose writings also are well known in
this area also addresses broader attributes of professionals, in a recent paper in the
MJA (Med J Aust 2002; 177: 208-211):

“core element is work……based on the mastery of a complex body of knowledge and
skills………a vocation founded on knowledge of science or learning…… the practice
is used in the service of others……a commitment to competence, integrity, morality,
altruism and the promotion of the public good within their domain…… these
commitments form the basis of a social contract between a profession and
society………society in return grants the profession autonomy in practice and the
privilege of self-regulation............professions and their members are accountable to
those served and to society”.

Other commentators such as Irvine (an Englishman) have had similar things to say.

And there are other definitions of professionalism which others (be they patients,
colleagues or others in the broader community) use to describe how they understand
who we are and what we do.

………… and our vulnerabilities?

I do see an increasing challenge to “our professionalism” as we understand it. We are
I believe vulnerable, and this is the theme of this oration.

Our professionalism is being challenged in a number of ways:

Firstly, there is a challenge to us as medical practitioners, and secondly, a challenge
to us as medical practitioner anaesthetists. There are a number of challengers, all of
whom have different concepts of what “our professionalism” is.

Our professionalism (as medical practitioners) has been under challenge for certainly
a decade, perhaps two or three, popularly with the rise of complementary and
alternative medicine and the expression of a belief that orthodox medicine is not the
sole possessor of knowledge in health care, and more philosophically, by
postmodernism and post structuralism. This recent challenge is not a feature of third
world countries, where health resources are short and health outcomes as we expect
them uncommon. It is though a phenomenon that is well observed in western society,
where “consumer” and “green” movements are well established. Other professions
have also of course been subjected to similar scrutiny, and the rise of secularism
continues unabated.

I will address this first challenge initially. Our professionalism as medical practitioner
anaesthetists is under challenge for different reasons and I will come back to this
later.
In many ways, these challenges (as we would view them) to “our professionalism”
remain hard to understand, but I would advocate that we do indeed need to try to
understand them – and the modern sociological theories that underwrite them - if we
wish to maintain control of “our professionalism”.

the Sociologists’ view………

Firstly, Sociologists – and medical sociologists – now emphasize a “contract between
professions and society”.

The “contract” gives rise to their preferred definition of professionalism.

Sullivan (writing with particular reference to Canada and the United States) states that
the “contract” is…… relatively simple: the contract is the social basis of the
extraordinary grant of occupational authority and independence to professionalized
occupations [such as medicine and law]…. a social contract between the profession
and the public.

Professionalism is (then) the moral understanding among professionals that gives
concrete reality to this social contract.

He adds:

“Professionalism is based on mutual trust………in exchange for a grant of authority
to control key aspects of their market and working conditions through licensing and
credentialling, professionals are expected to maintain high standards of competence
and moral responsibility………the work of the traditional learned professions has
long been understood to require a significant domain of discretion in individual
practice………it has therefore been thought to require a stronger sense of moral
dedication than most occupations……… a professional is not required to ignore
material considerations but is expected to subordinate financial gain to the higher
values of responsibility to clients and to the public interest”.

He continues:

“the root of the public's trust is the confidence that physicians will put patients'
welfare ahead of all other considerations, even the patients' momentary wishes or the
physicians' monetary gain”.

The three Sociological theories of “professionalisation

Secondly, Sullivan has proposed three divergent theories of professionalisation - that
is, the processes leading to professionalism – that have held sway throughout the
twentieth century:
1)
     the “collective mobility” theory of professionalisation emphasises the
     economically strategic side of professionalism - the use of claims of superior
     knowledge and special moral integrity as devices which secure some control over
     the economic market for services [i.e. a struggle between economic interests]
   The economic dimensions of professionalisation within “the liberal capitalist
   order” are stressed, noting important variations in other parts of the world viz. the
   USA was perhaps quite ‘laissez fare’ is this context, the “British world” much less
   so.

   I would call this the “robber baron” theory.

   [The potential for conflict is apparent. In this construct, a rise of “managed care”
   would be seen as a loss of guild monopoly in the face of more powerful market
   players (especially insurers and providers) (legitimated as an advance of consumer
   sovereignty). This would be the interpretation in the USA with insurers and
   providers aggressively engaging “suppliers” and patients. (In Australia, if you
   have a public appointment, you could read “State Health Departments” , DVA
   and Workcover insurers for “more powerful market players”)].

2) The “rationalisation” theory of professionalisation emphasises cultural and social
   authority arguing that the “market success” of medicine has been the consequence
   of an ability to exercise authority over a specific area of scientific and technical
   expertise [i.e. an agent of the spread of scientific and technological
   rationalisation].

   These interpretations of professionalisation emphasize the role that expert
   knowledge (especially scientific knowledge)       has  played in establishing
   professional autonomy in work and prestige in society.

   I believe this is best called the “traditional theory of medical professionalism”,
   and it is I contend the prevailing view within the profession in this country.

   [Again, conflict could arise from the advent of “managed care” which from the
   point of view of this theory would represent a serious loss of legitimacy from a
   scientific elite to an economic elite. This I suggest would be the view taken by
   Australian medical professionals].

3) The “cultural and political development” theory of professionalisation, by
   focusing on the professionalisers' social criticisms and their formulation of new
   social goals, sees the emergence of professionalism as an ideology of social
   reform.

   Professionalisation is thus a cultural and political development which could infuse
   social responsibility into what had been perhaps a more industrial context, rather
   than a struggle among economic interests or as an agent of the spread of scientific
   and technological rationalisation.

   From this viewpoint, professionalisation is seen as an expression of occupational
   self-interest and a movement with broader appeal to the middle classes, and the
   catalyst for a distinctive "social ideal" that has been crucial to (relatively recent)
   developments like “the welfare state”.

   I would call this “the social reformist” theory.
   [Conflict could again arise where proponents of this theory promote their
   particular interests].

   The scene is set for the proponents of all three theories to come into conflict as we
   will now see!

The challenges to us as medical practitioners …………………

       from “the social reformists”…………………

I believe that the traditional relationship between the doctor and the individual patient
underwrites the traditional definition of medical professionalism. I believe that our
profession itself has always codified this relationship through oaths and codes which
are in more legal parlance forms of “contract” and that these continually evolve. The
preamble to the current AMA Code notes that changes in society, science and the law
constantly raise new ethical issues and may challenge existing ethical perspectives.
However, the AMA Code says first: Consider first the well-being of your patient and
secondly: Approach health care as a collaboration between doctor and patient; treat
your patient with compassion and respect.

The 2004 version of the Code in “the Doctor and Society” asks: “Endeavour to
improve the standards and quality of, and access to, medical services in the
community. Accept a share of the profession’s responsibility to society in matters
relating to the health and safety of the public, health education and legislation
affecting the health of the community. Make available your special knowledge and
skills to assist those responsible for allocating healthcare resources. Use your special
knowledge and skills to minimise wastage of resources, but remember that your
primary duty is to provide your patient with the best available care (my italics)”.

Duty then to “Society” is only a part of the AMA Code of Ethics, with the
overwhelming emphasis given to the contract with the patient.

It is within what I see as this difference in emphasis (between the traditional view of
the medical profession, and the view of sociologists who may be devotees of the
social reformist script for professionalism) that I see some of the vulnerability of “our
professionalism”. The scene is set for a second contract: what Society requires of
medical professionalism. I believe we can consider many of the conflicts we perceive
in our practice as medical practitioners and as “medical practitioners in anaesthesia”
in terms of friction between the proponents of the three theories, and I will explore
further examples of this friction later before offering some possible strategies that
might assist the preservation of “our” professionalism .

From the USA, a NEJM article has noted “.. ..considerable interest in reinvigorating
medical professionalism….. reflects a profound unease with the seeming primacy of
economic factors among those currently affecting medical practice…….. general
agreement that patients' interests must take precedence over physicians' financial self-
interest …… professionalism also entails service to vulnerable populations and civic
engagement.
This is US based, and more a challenge to the “collective mobility” theory though
again introduces a duty to “Society”.

From the UK, the Lancet reported “the new professionalism evolving in UK medicine
is fundamentally different from the past……..an explicit statement of professional
duties, responsibilities, values, and standards for doctors, developed and agreed on by
the public and the profession…………..compliance is being secured by linking it
directly with medical registration…… doctors will have their abilities assessed
regularly by peers and by members of the public………… to ensure that they remain
up-to-date and fit to practise……disciplinary action will follow if they are not”.

This challenges the “traditional theory of medical professionalism” and introduces
“assessment…by the public”.

The “Medical Professionalism Project” has become the trans-Atlantic and major flag
carrier for these sentiments. It is “internist” driven. It asserts ownership of the
“professionalism” highground. Its “Charter” was published simultaneously in “the
Lancet” and “Annals of Internal Medicine” in early 2002. The “Project” arose out of
“concerns” that changes in “Healthcare Delivery Systems” in North America and
Europe were threatening “the very nature and values of medical professionalism”.
Theory ‘3’ issues a challenge!

The Charter was published in the Medical Journal of Australia in late 2002 and keenly
promoted by its Editor, Martin van der Weyden. Cruess and Irvine themselves,
writing on “Medical Professionalism”, have been recent contributors to the pages of
the MJA.

The Charter is to support the efforts of practitioners to ensure that both physicians and
healthcare systems are committed to patient welfare and to social justice and that this
commitment would be applicable to different cultures and political systems. It was
said that ninety professional associations, Colleges, Societies and certifying boards
had endorsed the Charter by the middle of 2003,. These included the American Board
of Anesthesiology, the American Board of Medical Specialties, The American Society
of Anesthesiologists and the Royal Australasian College of Physicians and Surgeons
(sic).

Practitioners are exhorted to commit to “the three fundamental principles” with the
(professional) responsibility for doing so laid “squarely on our shoulders”.

The “three fundamental principles of the Charter” are the primacy of patient welfare
(“self apparent, central to the trust at the heart of the physician–patient relationship,
not be compromised by external factors”), the autonomy of patients (“must be
respected”) and the promotion (sic) of ‘justice’ in the healthcare system by the
profession.

Accompanying the principles was the suite of professional responsibilities: these are
commitments to professional competence, honesty with patients, confidentiality, the
maintenance of appropriate relationships with patients, continuous improvement in
quality of care, improving of access to care, facilitation of a just distribution of finite
resources, the upholding and promoting of scientific knowledge and research,
limitation of conflicts of interest, and the respect of additional responsibilities which
include education, standards, regulation and discipline.

The Project is now to review the impact of the Charter and “within that context,
explore the opportunity to define the health rights and responsibilities of patients,
physicians, and society”.

Two of “the three fundamental principles” with most of the (professional)
responsibilities are of course recognisable from most Codes of Ethics (including that
of the AMA) and indeed from Hippocrates. What is novel is the improving of access
to care, facilitation of a just distribution of finite resources, and the limitation of
conflicts of interest. These are new concepts which have been introduced by
sociologists and their allies, and not necessarily ones that the profession would not
support.

I am delighted to say that my Presidential predecessors had mentioned
“professionalism” before the Charter was published, though everyone is talking about
it now, and orations dealing with professionalism are hardly novel.

I would though ask: to what extent are the “principles” threatened in this country, and
to what extent might we be committed to all the “responsibilities”? Further, where
might our innate professional values (i.e. our ethics) have failed our patients or our
society to the extent that we – as an Australian profession or specialty - should also
commit to the Charter and its principles and responsibilities, as have the ninety bodies
alluded to above? Does theory ‘2’ yield to theory ‘3’?

Australia has a unique healthcare delivery system that has evolved over half a century,
that probably by now well reflects its political and societal values. There have been
watershed changes and there has been gradualism. But it is only in the last few years
that we have seen the beginning of a real debate about healthcare and its costs and
proposals for a reappraisal of the distribution of resources (the “principal of social
justice”).

       from the Ethicists……

“The internists” have been active even more recently with the “Medicine as a
Profession Managed Care Ethics Working Group”, established by a number of
“concerned organisations” including once more the American College of Physicians.
The “working group of stakeholders” included patients, medical practitioners,
“managed care representatives” and ethicists. The language of the document includes
“health plans” and “purchasers”. These terms are largely unfamiliar to Australians and
are not easily translated: it refers to the common American practice of employers
providing (private) healthcare as an employee right, and deals with some of the
concerning aspects of “managed care”. This is I think theory ‘3’ confronting theory
‘1’. And we do have “managed care” in Australia already, and it does not (as yet)
involve private health insurance funds. It involves State Governments! The Medicare
agreements, through the funding arrangements between Commonwealth and State
Governments, provide for the “purchase” of healthcare on behalf of Australians who
obtain their healthcare in “public hospitals”. It is here that the profession and the
specialty can take heed of the principals espoused by this group: “that the delivery of
health services should be characterised by respect, truthfulness, consistency, fairness
and compassion……(with) a shared responsibility for the appropriate stewardship of
healthcare resources…….all parties should foster an ethical environment for the
delivery of effective and efficient quality healthcare”.

This is the language that we would hear if there is a change of Federal Government at
the end of 2004, with the establishment of a Commission that would see PBS and
NBS expenditures “cashed out” and extended to the lower levels of the health system.
This has been canvassed last year through the national health summit, espoused by the
national health reform allowance.

       from regional political forces……………………

Most of us are now familiar with New Zealand’s Health Practitioners Competence
Assurance Act (the HPCA Act). Trisha Briscoe, then President of the NZMA, has
recently published a superb critique of this legislation and it is seminal reading.
The stated purpose of the Act was “to protect the health and safety of members of the
public by providing for mechanisms to ensure that health practitioners are competent
and fit to practice their professions”. The Act was initially widely supported. It was to
be “an omnibus piece of legislation” designed to bring a large number of health
practitioner groups regulated by numerous statutes into line with the registration,
competency and discipline provisions of the Medical Practitioners Act, which was felt
to be a modern, effective piece of legislation. She noted that this whilst laudable was
ambitious and conceptually flawed.
During its gestation, that the initial concept became “lost under the onslaught of
multiple competing agendas” resulting in a complicated piece of legislation which
“undermines professional functioning……its effect may be exactly the opposite of its
intention”.
Briscoe also reports “a political perception that more political and external controls on
the professions are what Society wants”. Theory ‘3’ in action! This though is said to
be counter to “the growing body of international opinion that competence, quality and
safety are better assured through models structured on professionalism rather than
State control”.

The Act as passed also provides for additional and great ministerial powers over the
“scopes of practice” of all health practitioners. Theory ‘3’ again. Sixteen health
practitioner groups now also have the ability to define their own “scopes of practice”.
This may see the New Zealand Nursing Council determine that nurses would practice
independent anaesthesia. Theory ‘3’ confronts theory ‘2’!

Briscoe’s summary was that health legislation can actively promote professionalism
or it can discourage it. The NZMA believes that the HPCA Act is a backward step for
the promotion of professionalism in medicine. She finishes by quoting Sullivan
“neither economic concepts nor technology nor administrative control has proved an
effective surrogate for the commitment to integrity evoked in the ideal of
professionalism”. Theory ‘2’ rules!
Should Australian anaesthetists be concerned with the HPCA? For a number of
reasons, I believe “yes”. Firstly, the geographic and cultural proximity of our two
countries is obvious, and almost close enough for osmosis. Secondly, and more
specifically, the New Zealand Health Minister meets with the Federal and State
Ministers of this country on a regular basis. The HPCA Act is in my view a
prototypical example of the clashing of theories of professionalism, and their
respective supporters. We are unlikely to change the mind of the zealots, be they other
professionals, sociological supporters of theory ‘3’ or politicians with an electorate to
play to.

       through the “Quality          debate”       and    “the   medical    indemnity
        crisis”…………

Further challenges to our professionalism as medical practitioners have been
observed at “close range”: that is, in Australia.

These I believe have been the “quality and safety in healthcare” movement which in
its initial delivery (almost ten years ago) directly affronted our professionalism and
was unashamedly misused by a devotee of theory ‘3’, and the “medical indemnity
crisis” (which in its genesis was I believe influenced by the former). It also was
perceived as an assault on our professionalism.

The message of the “Quality Study” was so sensational that the study’s deficiencies
were largely missed. Certainly, retrospective chart review is in my mind no way to
define standards of national practice, though no one else has produced an alternative
study. The authors of this work certainly though had a demonstrated commitment to
the primacy of patient welfare (one of the principles of the Charter) and a
commitment to the improving of quality of care. Measures have been progressively
adopted by the specialty in Australia and New Zealand and this shows in my view
how our professionalism enables us to react rapidly. More ponderously, other bodies
in and outside the specialty, aided by substantial Federal and State monies, are also
pursuing safety and quality initiatives though in some cases with the measured zeal of
the “social reformers”.

With the “medical indemnity crisis”, an adventurous interpretation of the common
law by judges and its exploitation by lawyers (all “social change” agents) encouraged
claims which were quite often of little or modest virtue. Negligence was infrequently
central to the action. We witnessed the largest medical professional indemnifier in
Australia taken to the point of bankruptcy (though it was not entirely blameless).

Doctors were concerned that their livelihood and assets would not survive this assault.
It seems that we have had a reprieve, perhaps (optimistically) a victory, but the
medium and long-term outcome remains quite uncertain. The plaintiff lawyers
continue to take every opportunity to remind the public that the profession practises
negligently. The feeling that this continuous farrago has engendered in us is indeed an
affront and a challenge to our professionalism.

We have had to learn how to practise in an era of increasing regulation and overview
by traditional and new “players” – not just Federal and State Governments through
the DHA, the HIC, State Health Departments and Medical Registration Boards, but
also AMC, AHMAC, AMWAC, ACSQHC and Standards Australia, not to mention
APRA, ACECC, the NCC and probably now the medical indemnity organisations.
We debate MOPS and “CDC / CPD”, and have seen what may become a new national
CPD paradigm. There is the threat of “new trainers”.

The actions of all of these other parties should be viewed within the context of the
divergent theories of professionalisation.

The challenges to us as “medical practitioner anaesthetists”……………………

A number of the challenges and issues mentioned above have strong connections with
and implications for anaesthesia and for how we practice it.

What gallery do we play to? To our patients, to our colleagues (medical and nursing),
to “the public” (including “government”). “Task substitution” is an expression we’ve
heard. Apropos our specialty, we’re told “task substitution” may be necessary because
of workforce shortages.

We are affronted daily by what seem challenges to our professionalism at worst: the
achieving of “proper” consent, “DOSA”, “IFC”, “Gapcover”, “production pressure”,
all of which impinge the “doctor - patient relationship”.

These again are manifestations of the divergent theories of professionalisation in
action.

       “Gauge watchers”, “dial fiddlers” and “numbers men”

John Ashton [ASA President, 1988-1990] had much to say in his Geoffrey Kaye
Oration in 1990 about professionalism in its older context, as have some other
Presidents at other times, for example, Peter Brine at the NSC in Perth in 2000. John
noted that the ASA had realized (in the 1940’s) that “the same high standards for
qualification” as for physicians and surgeons would be needed: this was seen with the
inauguration of the Faculty. John, in 1990, was though more concerned with the
relationship between the surgeon and the anaesthetist.

He was concerned with an (over)emphasis on technology and he foresaw what I feel
has become a “trap”: if we were to become “gauge watchers”, “dial fiddlers” and
“numbers men”, “we will surely be relegated to the status of technicians”. His
concerns were with having us seen….. as “good doctors”.

       “we will surely be relegated to the status of
        technicians……………………”

A perception that we are practitioners of a technical specialty with a first class safety
record presents particular problems. Anaesthesia seems in many ways to be a “mature
speciality” with a perception that much of the “hard work” in research has already
been done. Certainly, the firm establishment of the scientific basis of the speciality
was seen in the 60’s and 70’s, with dramatic improvements in our application of new
knowledge and physiology and pharmacology leading to a dramatic reduction in
certainly mortality, and probably also morbidity. The scientific ‘action’ in our part of
medicine is now more in Intensive Care and Pain Medicine.
Could ‘anaesthesia’ be seen now as “too easy”?

Could perhaps our efforts, both intended and unintended, be our undoing as medical
practitioner anaesthetists?

Perhaps our Mortality Reports and our claims of “world’s safest anaesthesia” make
our specialty look safer than it really might be.

Sullivan queries whether “a profession (can) secure public recognition of its claims to
traditional professional prerogatives on the basis of its technical skills alone…”.

In a purely Australasian context, and using mainly hindsight, the excision of the two
subdisciplines (Intensive Care and Pain Medicine) could be seen as having been a
degrading of our core professional body of knowledge and expertise. With the “time
pressures” of contemporary practice confining us to operating theatres, we might
perhaps be seen by some others as perhaps technicians tied to machines and monitors,
not doctors who get out into wards and consulting rooms to consult. What would we
think of surgeons or other proceduralists who operated on patients with whom it
seemed they had not had consultations? These others may be tempted to think that
they too can dispense our drugs – and perhaps they can - but of course [we would
assert] without what we know is our professionalism. Herein lies a particular
component of our vulnerability as “medical practitioners in anaesthesia”.

Answers……………..?

What do I think we should do to address our concerns about professionalism,
………… and our vulnerabilities?

Is it worth fighting for?

In an Australian and very local context, Southon [as a Social Scientist, writing from
the School of Health Services Management at UNSW (Soc Sci Med. 1998
Jan;46(1):23-8)] observed that:

“increasingly questions are being raised about the ability of……current health
reforms to address the challenges……… facing health systems. We investigate this
situation by exploring the role of professionalism in the delivery of health services.
In contrast to the dominant approach of considering professionalism as a social
phenomenon, professionalism is considered as primarily a task-related phenomenon”
– that is, theory ‘2’ perhaps, but not theory ‘3’.

       the characteristics of the task are high levels of uncertainty and complexity.
       high levels of uncertainty and complexity lead naturally to the key social
        features that typify professionalism.

“However, health reforms threaten professionalism”:

       health reforms have been based on ……dissatisfaction with the performance
        of professionals……….[theory ‘3’]
      the reforms have been developed without…..consideration of the…..role that
       professionalism has played.
      the reformers have adopted a simplified view of the task.
      this simplification is (sic) inconsistent with the realities and complexities of
       health service provision.
      the centrality of professionalism has thus intrinsically been downgraded.
      the downgrading …. is…. unwarranted.
      this……..generates many of the conflicts and contradictions being reported.

In sum, “the future of health service reform depends on an effective understanding of
the nature of the task, recognition of the central role of professionalism and the
development of professional and organisational structures that support each other”.

A sociologist gives heart to theory ‘2’!

I hope that you now know that “others” have differing expectations of “our
professionalism” and what they think it should be offering them and society.

Cruess says we “must understand the origins and nature of professional status, and the
obligations necessary to sustain it…… Professionalism must be taught explicitly”. I
agree. But we need to be quite clear about the parameters of the debate.

The Charter is said to help in this regard, but is it so different from the Codes – with
the exception of social justice concepts? I think is a diversion!

[Our Society and College both espouse the principles of the primacy of patient
welfare and patient autonomy. Further, the commitments to professional competence
and honesty with patients, quality of care, scientific knowledge and “professional
responsibilities” hardly need to be restated].

Should we address the fair distribution of resources and possible discrimination in
healthcare? How well do we do in this area, and how well might we do? Commitment
to improving access to care and to the distribution of finite resources is complex. We
are beginning to see the start of a wider community debate in these areas.

A commitment to maintaining trust by managing conflicts of interest that might
compromise professional responsibility through the pursuit of private gain or personal
advantage exists. We back this up through our IFC Position Statement. The Charter
says that “physicians have an obligation to recognize, disclose …. and deal with
conflicts of interest”, and in this country, we have lawyers and courts to back it up!

The Charter notes that the profession is “confronted by an explosion of technology,
changing market forces, problems in healthcare delivery, [bio-terrorism] and
globalization”. It does not mention government! We are familiar with expression
“managed care”, and believe that this connotes problems in the appropriate delivery
of patient care to the patient’s detriment, particularly when financial resources are
finite and allocation is difficult. State Governments practise “managed care” in this
country!
How should NZ anaesthetists deal with the HPCA? How would we view others who
might aspire to our professional activity? Further, how could we rest with
governmental control of professional ethical standards? The HPCA is as mentioned
above a prime example of the clashing of theories of professionalism and their
supporters.

Cruess says that Medicine's professional associations must be extremely wise in how
they negotiate for their members. “Any hint that the public good is being ignored
during …… negotiations can be damaging to the credibility of the profession and
result in loss of the trust, which is so essential to the healing process”.

The privilege of self-regulation outlined in “the contract” entails an absolute
obligation to guarantee the competence of members. The setting and maintenance of
standards is of overriding importance, and issues such as recertification and
revalidation are, without question, now regarded as professional obligations. The
disciplining of unethical or incompetent practitioners must be rigorous, open, and
have the support of every practising physician. A heavy price has already been paid
for failures in this domain. eg Bristol, perhaps Camden and Campbelltown.

Even if the medical profession itself carries out the above actions, it is unlikely that
the values cherished by physicians for centuries can be preserved unless their
preservation is encouraged and supported by society through the structure of the
healthcare system. Healthcare systems can actively promote desirable behaviour or
they can encourage physicians to place their own interest first. If undue competition
among physicians is promoted by the system, one should not be surprised if
competitive physician-entrepreneurs emerge. If medical manpower policies coupled
with payment methods actively encourage physicians to see large numbers of patients
to maintain an adequate income, they will do so. Physicians will maintain professional
values, but not at any price. Thus, the support of policy makers in preserving a value-
based healthcare system becomes critical. For this to occur, the issue must be
considered to be important by those negotiating on behalf of the profession.

In this country, anaesthesia is represented by two organisations which have distinct
areas of particular interest and responsibility, but also areas where their interests
overlap. We accept that the ASA represents the professional, economic and industrial
interests of anaesthetists. ANZCA is responsible for the training and examination of
anaesthetists, the associated aspects of teaching hospital purview, and professional
standards. Both bodies address continuing education and welfare. The observation of
this dichotomy has been a mantra of this Council. It has been a feature of GKO’s that
the Society / College relationship is addressed. In my view, this dichotomy is
beneficial to both organisations, though it is counter to a view expressed by a number
of my predecessors in the early 90’s. The prestige of our College as an independent
training and examining body is I believe underwritten by the dichotomy.

We are seeing encroachment on the traditional independence of the profession, in
particular I believe through engagement of the Colleges over trainee selection and
OTD matters, in a way that I believe could ultimately risk their independence. I
believe that the maintenance of Collegiate independence requires the support of
strong member based organisations like the AMA and ASA. This is ultimately
essential for the future vitality of our profession and the maintenance of our
professionalism.

We need to work on our professionalism.

We must as anaesthetists get out of the operating theatres more often – and in a shirt
and tie or equivalent. Most of our patients will appreciate it. We need to ‘look
professional’!

We need to be seen to care for our patients. They will appreciate it – more so when
awake then when comatose. Whose idea was it to let others do our preoperative
consultations? John Ashton was in my view rightly concerned with what he saw as an
overemphasis on technology. His concern was in having us seen as good doctors – not
just good technicians. This safeguards our professionalism.

The promotion, protection and support of our craft; and the maintenance of our
professional status, interests and independence are key objectives of the ASA.

These further objectives are central to the preservation of our professionalism in a
time of challenge.

I think Geoffrey Kaye would approve of this approach even if professionalism in his
time was best expressed as a facility with gauges, dials and numbers.

Dr J P Bradley
Immediate Past President
20 February 2005




Gadget
From Wikipedia, the free encyclopedia

For other uses, see Gadget (disambiguation). For Wikipedia Gadgets, see Wikipedia:Gadget.

A gadget is a small[1] tool such as a machine that has a particular function, but is often thought of
as a novelty. [edit]History

The origins of the word "gadget" trace back to the 19th century. According to the Oxford English
Dictionary, there is anecdotal evidence for the use of "gadget" as a placeholder name for a
technical item whose precise name one can't remember since the 1850s; with Robert Brown's
1886 book Spunyarn and Spindrift, A sailor boy’s log of a voyage out and home in a China tea-
clipper containing the earliest known usage in print.[2] The etymology of the word is disputed. A
widely circulated story holds that the word gadget was "invented" when Gaget, Gauthier & Cie, the
company behind the repoussé construction of the Statue of Liberty (1886), made a small-scale
version of the monument and named it after their firm; however this contradicts the evidence that
the word was already used before in nautical circles, and the fact that it did not become popular, at
least in the USA, until after World War I.[2] Other sources cite a derivation from the
French gâchette which has been applied to various pieces of a firing mechanism, or the
French gagée, a small tool or accessory.[2]

The October 1918 issue of Notes and Queries contains a multi-article entry on the word "gadget"
(12 S. iv. 187). H. Tapley-Soper of The City Library, Exeter, writes:

A discussion arose at the Plymouth meeting of the Devonshire Association in 1916 when it was
suggested that this word should be recorded in the list of local verbal provincialisms. Several
members dissented from its inclusion on the ground that it is in common use throughout the
country; and a naval officer who was present said that it has for years been a popular expression
in the service for a tool or implement, the exact name of which is unknown or has for the moment
been forgotten. I have also frequently heard it applied by motor-cycle friends to the collection of
fitments to be seen on motor cycles. 'His handle-bars are smothered in gadgets' refers to such
things as speedometers, mirrors, levers, badges, mascots, &c., attached to the steering handles.
The 'jigger' or short-rest used in billiards is also often called a 'gadget'; and the name has been
applied by local platelayers to the 'gauge' used to test the accuracy of their work. In fact, to borrow
from present-day Army slang, 'gadget' is applied to 'any old thing.'[3]

The usage of the term in military parlance extended beyond the navy. In the book "Above the
Battle" by Vivian Drake, published in 1918 by D. Appleton & Co., of New York and London, being
the memoirs of a pilot in the British Royal Flying Corps, there is the following passage: "Our ennui
was occasionally relieved by new gadgets -- "gadget" is the Flying Corps slang for invention! Some
gadgets were good, some comic and some extraordinary."[4]

By the second half of the twentieth century, the term "gadget" had taken on the connotations of
compactness and mobility. In the 1965 essay "The Great Gizmo" (a term used interchangeably
with "gadget" throughout the essay), the architectural and design critic Reyner Banham defines the
item as:

A characteristic class of US products––perhaps the most characteristic––is a small self-contained
unit of high performance in relation to its size and cost, whose function is to transform some
undifferentiated set of circumstances to a condition nearer human desires. The minimum of skills is
required in its installation and use, and it is independent of any physical or social infrastructure
beyond that by which it may be ordered from catalogue and delivered to its prospective user. A
class of servants to human needs, these clip-on devices, these portable gadgets, have coloured
American thought and action far more deeply––I suspect––than is commonly understood.[5]

[edit]Other   uses

The first atomic bomb was nicknamed the gadget by the scientists of the Manhattan Project, tested
at the Trinity site.
[edit]Application     gadgets

In the software industry, "Gadget" refers to computer programs that provide services without
needing an independent application to be launched for each one, but instead run in an
environment that manages multiple gadgets. There are several implementations based on existing
software development techniques, like JavaScript, form input, and various image formats.

          Further information: Google Desktop, Google Gadgets, Microsoft
          Gadgets, and Dashboard software Apple Widgets

     The earliest[citation needed] documented use of the term gadget in context of software
     engineering was in 1985 by the developers of AmigaOS, the operating system of
     the Amiga computers (intuition.library and also later gadtools.library). It denotes what other
     technological traditions call GUI widget—a control element in graphical user interface.
     This naming convention remains in continuing use (as of 2008) since then.

     It is not known whether other software companies are explicitly drawing on that inspiration
     when featuring the word in names of their technologies or simply referring to the generic
     meaning. The word widget is older in this context. In the movie "Back to School" from 1986 by
     Alan Metter, there is a scene where an economics professor Dr. Barbay, wants to start for
     educational purposes a fictional company that produces "widgets: It's a fictional product."
Further information: Workbench (AmigaOS) Premise
Inspector Gadget is a famous cyborg policeman with a seemingly endless amount of gadgets he can summon by
saying "Go-Go-Gadget" then the gadget's name. The word "Gadget" is actually part of the name, as hinted in some
episodes. Although he has all this equipment, Gadget is ultimately incompetent and clueless (in a manner similar to
the Inspector Clouseau character of the Pink Panther series), and overcomes obstacles and survives perilous
situations by sheer good luck, with help from his faithful niece Penny, who is a genius, and intelligent dog Brain who
both must secretly help him solve each case. Even his gadgets often malfunction, which Gadget often deals with by
exclaiming that he needs to get them fixed.

Almost every episode of the first season follows a detailed and set formula, with little variation (though many of these
elements were tinkered with in season 2). A disguised Chief Quimby interrupts a normal family activity between
Gadget, Penny and Brain to give him a mission to stop the latest plot by Dr. Claw and M.A.D, via an exploding
message, which then, through Gadgets actions, blows Quimby up. The episode usually takes Gadget to some exotic
locale and somehow Penny and Brain find a way to accompany him. Brain keeps Gadget out of trouble from M.A.D.
agents (who Gadget usually mistakes for friendly locals; ironically, Gadget often mistakes Brain in disguise for a MAD
agent), while Penny solves the case. With the help of Penny and Brain, Gadget inadvertently saves the day, Dr. Claw
escapes and Chief Quimby arrives to congratulate Gadget on a job well done.

Each episode ends (as many cartoons did in the 1980s) with Gadget (and usually Penny and Brain also) giving
a public service announcement - in direct contrast with his dangerous job and risk-taking behavior in the show, with
most of the tips having a connection with problems Gadget had experienced during the episode. For example in one
episode, Gadget tries to hitchhike saying he hopes the approaching motorist doesn't mind him doing so, with the
ending PSA making very clear how dangerous hitchhiking can be.

[edit]Characters


    Inspector Gadget is the main protagonist of the series and movies. He dresses like Inspector Clouseau, drives
     a Matra Murena car and acts like Maxwell Smart, who was portrayed by Gadget's voice actor Don Adams. The
     clueless Gadget frequently bungles during his cases and gets into danger, but he always gets out of trouble
     through either his trusty gadgets, Penny or Brain's unseen assistance, or pure luck. One of his most famous
     catch-phrases in the series is"Wowsers!" While he would never succeed in completing a mission by himself
     without Penny and Brain, they usually would not succeed in completing a mission themselves without Inspector
     Gadget as his gadgets unintentionally foiling the MAD agents' plans.


    Penny is Gadget's precocious niece. Always down for the cause, she is a master of investigation and
     technology who is the one truly responsible for foiling M.A.D.'s schemes, a fact only Brain knows. Using a
     computer disguised as a book and a utility wristwatch, she monitors her "Uncle Gadget's" activities,
     communicates with Brain and foils M.A.D.'s plots. Penny very often gets captured by M.A.D. agents before
     calling Brain for help or escaping by herself.


    Brain the Dog is Inspector Gadget's and Penny's faithful pet dog and companion. He is bipedal, just as
     intelligent as a human and assists Penny in keeping Gadget out of danger and solving the crime. Brain uses a
     variety of disguises, which Gadget never sees through, and is often mistaken for a M.A.D. agent by Gadget.
     Brain's collar is outfitted with a retractable video communications system linked to a computer wristwatch Penny
     wears that allows her to relay information on Gadget's activity, or warn Brain as to the whereabouts of M.A.D.
     agents. Brain can communicate with humans, through a gruff, Scooby-Doo-like "dog" voice or pantomime and
     physical gestures to communicate effectively.


    Doctor Claw (his real name is never revealed) is the main antagonist of the series and leader of the evil M.A.D.
     organization. Throughout the entire series, Dr. Claw is an unseen character. Only his arms and gloved hands
     are visible, leaving the viewer to guess as to his face and body. However, his face is fully revealed on the video
     game as well as on the action figure. He is usually at a computer terminal where he monitors his various
     schemes, often in a creepy old castle. Although he is aware of Gadget's idiocy, he believes the Inspector to be
     his greatest enemy, never fully realizing that it is actually Penny and Brain who foil his plots in each episode
     (although he or his M.A.D. agents have captured Penny and sometimes Brain a number of times). Dr. Claw's
     preferred mode of transportation/escape is the M.A.D. Car, a black and red vehicle that can transform into a jet
     or a submarine. He is always seen with his fat pet cat M.A.D. Cat, who reaps the benefits of his brief victories
     and bears the brunt of his defeats. Dr. Claw's catch-phrase is "I'll get you next time, Gadget! NEXT time!" It is
     heard at the end of every episode, during the credits, and is followed by a loud "Mraow" from M.A.D. Cat.


    Chief Quimby is Inspector Gadget's short-tempered boss and the chief of Metro City. He has a moustache and
     is usually seen with a pipe in his mouth. He appears disguised at the beginning of each episode with his own
     theme music to deliver Gadget his mission only to be blown up by the self-destructing message (a parody of
     the Mission: Impossible messages) because of Gadget's obliviousness; he appears again at the end of most
     episodes to congratulate Gadget on a job well done, but he never realizes that it is Penny who is truly the one
     responsible for foiling Doctor Claw's plots.


    Corporal Capeman, voiced by Townsend Coleman, is a recurring character introduced in the second season
     as Inspector Gadget’s sidekick. Capeman is a self-proclaimed superhero who acts in the manner of a
     stereotypical crime fighter, but he is equally as inept as Inspector Gadget. Capeman is obsessed with learning
     to fly and often mistakenly believes he has miraculously acquired the power of flight while in the midst of dire
     circumstances.
[edit]Running     gags
Like many animated television series, Inspector Gadget contains a few running gags – events that occur in almost
every episode. At the start of each episode, Chief Quimby stealthily presents Inspector Gadget with a note containing
his next mission, the final line of each stating that, "This message will self destruct." This process is similar to mission
briefings in the Mission Impossible series. As Gadget casually tosses the note away, it explodes near Chief Quimby,
leaving him the only one injured. As the series evolves, Quimby, knowing what will be coming next, often attempts to
protect himself as he sees the note being tossed, always to no avail.

Another gag involves the inspector's built-in gadgets. While usually faithful in responding to his commands under
normal circumstances, often while in desperate need for a specific tool (for instance, something to slow his descent
or brace from impact after falling from a building), a different, often useless tool such as a flower from his hat will
appear instead. This misfortune is overcome by luck or Brain's quick thinking, saving him from injury.
[edit]Conception

The show was created by Andy Heyward, Jean Chalopin and Bruno Bianchi. The initial idea for Inspector
Gadget came from Heyward, who also wrote the pilot episode with the help of Jean Chalopin in 1982 (Winter
Olympics, often syndicated as episode #65, Gadget in Winterland). Chalopin, who at the time owned the DIC
Audiovisual studio, helped develop the format and concept for the rest of the episodes together with Bruno Bianchi,
who also designed the final versions of the main characters and served as supervising director.

According to the DVD bonus film "Wowsers", a retrospective featurette with co-creators Andy Heyward and Mike
Maliani on the four-disc DVD set Inspector Gadget: The Original Series, Gadget went through approximately 150
sketches before reaching his final design.


        This section

        requires expansion.(October

        2011)

[edit]Production

[edit]Writers

Nelvana writer Peter Sauder was the head writer for Season One, which was co-produced by DiC and the Canadian
Studio Nelvana (exactly which/how many writers the first season had is unknown). In Season Two, as Nelvana was
no longer part of the production, the show was written by the D.I.C studio's employees Eleanor Burian-Mohr, Mike O'
Mahoney, Glen Egbert and Jack Hanrahan (a former Get Smart writer, among much else). Hanrahan and Burian-
Mohr would later write the Christmas special Inspector Gadget Saves Christmas as well as many episodes of
the Gadget Boy spinoff series; and Burian-Mohr additionally wrote dialogue for the educational show Inspector
Gadget's Field Trip.

[edit]Animation

The first sixty-five 22½-minute episodes were written, designed, storyboarded and voice-recorded
in Canada at Nelvana Animation Studio (which co-produced the series under DiC's supervision), with creative
supervision by Jean Chalopin. Bruno Bianchi was the Supervising Director. Most of these episodes were animated
in Tokyo, Japan by Tokyo Movie Shinsha, the studio that animated most DiC cartoons of the 1980s, while a few
episodes were animated in Taiwan by Cuckoo's Nest Studio and Wang Film Productions, before being finished in
post production by DiC and Nelvana. The pilot episode, "Winter Olympics", was animated by Telecom Animation Film
and had a slightly higher budget than the rest of the episodes.

In the second season, the animation increasingly began to resemble a typical 1980s Japanese anime cartoon, most
likely because it was animated by DiC's own then-new Japanese-based animation facilities (many first-season
episodes that were animated by TMS Entertainment often mimicked typical American animation, akin to their work
on Tiny Toon Adventures). It was not uncommon for Gadget to briefly freeze in an "anime" pose when shocked, or
slower frame rates when characters would move.

[edit]Voicing

The role of Gadget went through three different voice artists during and after production of the pilot episode. The first
was Gary Owens, who voiced Inspector Gadget in a deep-toned, British-sounding way.Jesse White sounded closer
to the voice of Maxwell Smart (Don Adams) of Get Smart, one of the series' inspirations. Eventually, producers
decided to hire Don Adams himself to get the full effect, and found that he fit the role perfectly. Adams' first episode
was the first of the regular series, "Monster Lake".

Gadget's nemesis Doctor Claw - as well as his pet cat M.A.D. Cat and Gadget's loyal dog Brain were voiced by Frank
Welker. Penny was originally voiced by Mona Marshall in the original pilot and was subsequently portrayed by Cree
Summer for the rest of the first season in her first voice acting role; and her father Don Francks wound up playing
Doctor Claw in a few episodes where Welker was unavailable for recording.

When production of Inspector Gadget moved from Nelvana in Canada to DiC's headquarters in Los Angeles for the
second season, several of the voice artists were replaced, including Cree Summer, who was replaced with Holly
Berger as the voice of Penny.
[edit]Music

The theme music was inspired by Edvard Grieg's movement "In the Hall of the Mountain King" and was composed
by Shuki Levy.[5] For many years, Levy had a partnership with his friend Haim Saban, with Levy composing the music
and Saban running the business. Their records company, Saban Records, (now Saban Music Group) has provided
music for many DiC cartoons and children’s shows in the 1980s and 1990s, and is still running today. [2]

Many of the background music cues were some sort of variation of the Gadget melody. Even at festivals or dances in
the cartoon, the Gadget theme was often played. Occasionally during an episode, such as in Launch Time and Ghost
Catchers, Inspector Gadget would hum his theme. Levy also had a range of other musical cues for each character,
as well as cues for the various moods of the scenes. Penny and Brain each had several different versions of their
respective musical themes.

The theme song was sampled in the song "I'll Be Your Everything," performed by Youngstown, which served as the
theme song for the live-action Inspector Gadget film starring Matthew Broderick as both Inspector John Brown-
Gadget and a robotic impostor of him whom Dr. Claw creates. It was also sampled in "The Show" by Doug E.
Fresh and Slick Rick.

[edit]History

See also: List of Inspector Gadget episodes
[edit]Season 1

The pilot episode featured a slightly different opening and closing credits and a mustachioed Gadget. In a later
version of the pilot, dialogue by Penny and Gadget was re-dubbed explaining Gadget's mustache as a disguise for
the holiday.

Since DiC was a French company looking to expand its operations to the US, the show was produced for release in
both France and the USA. It was broadcast in the North America in September 1983. A month or so later, the series
premiered in France, whose version also featured a theme song with French lyrics and the French title Inspecteur
Gadget appearing in front of the episode.

The first season was aired from September to December 1983, comprising sixty-five 22½-minute long episodes. After
the first season, the show was a worldwide hit.

In the first season, nearly every episode saw the introduction of some new supervillain who had come to be
employed by Dr. Claw to commit a crime suited to their special skills. They are typically arrested at the end of the
episode, and do not appear again in the series.

[edit]Season     2
The first season episodes were repeated during the 1984 – 1985 season, with 21 new episodes premiering for the
second and last season of Inspector Gadget from September 1985 to February 1986 making 86 in all. Several
changes were made to the established formula.

The format of the show changed significantly. In the second season, the episodes would feature three episodes in a
row sharing the same general theme and often the same villains, who usually were not arrested at the end of the 3rd
and final episode. Many of the episodes simply revolved around M.A.D. trying to get rid of Gadget, rather than Dr.
Claw's spectacular crimes and plots to dominate the world from the first season.

New characters and settings were introduced. Gadget, Penny and Brain moved into a high-tech house filled with
many gadgets, where a few of the episodes were actually located. Penny spent much less screen time solving
M.A.D.'s crimes. In the season's fourth episode, Corporal Capeman was introduced as Gadget's sidekick. The
Catillac Cats from another DiC cartoon, Heathcliff and the Catillac Cats,made a few cameo appearances in the
second season, just as Gadget had cameos in their show.

[edit]Merchandise


HDMI (High Definition Multimedia Interface) allows users to connect their laptop, DVD player, Blu-ray player, cable box, and

gaming consoles to their HDTV or 3D TV. It also connects with Home Theater Receivers delivering theater quality sound,

and is great for streaming movies, video, and music, all from the internet and viewable on your TV through your selected
device. HDMI is also good for data sharing and networking between devices. A lot of users enjoy every aspect that HDMI has

to offer, especially gamers and movie junkies.


With gamers, the standard A/V cable (you know the one with the red, white, and yellow connectors) just doesn't give them

that in-game depth that they seek while playing. With sport games, using HDMI, the user can see every drop of sweat, the

grass flying up on the football field, the nets move on the basketball hoop after a monster dunk, the blood wound from

shooting your nemesis on you favorite FPS, and the list goes on. As for movies, the clarity is second to none. I rented Jet Li's

"The ONE" on Blu-ray, and was so overwhelmed by how different it looked when I saw it without the HDMI cable, I had to go

out and buy it for my collection. HDMI was originally classified by versions. Recently HDMI Licensing, LLC changed this

because the versions were not intended for consumers, but for manufactures. By changing this, it will cut down on the

confusion between different HDMI cables and their intended use. There are five HDMI types. HDMI Standard, HDMI

Standard with Ethernet, HDMI Standard Automotive, HDMI High Speed, and HDMI High Speed with Ethernet.


      HDMI Standard is the basic HDMI cable for home entertainment. It can transmit video resolutions of 1080i or 720p, as

       well as surround sound.

      HDMI Standard with Ethernet does the same as HDMI Standard, but allows Internet connection for sharing and

       networking between devices.

      HDMI Automotive is designed especially for vehicles with HD compatible devices installed, such as navigation, DVD

       player, gaming system, etc. The chord is built to withstand the conditions of being installed inside a vehicle.

      HDMI High Speed is made to display higher video resolutions than HDMI Standard, such as 3D and 4k, while still

       supporting the surround sound.

      HDMI High Speed with Ethernet does the same as HDMI High Speed, but allows Internet connection for sharing and

       networking between devices.

Ensure that both devices you are connecting with the HDMI chord displays the same video resolution as the chord you

selected.


Ranson T. Evans invites you to shop for the right HDMI for you here. You can also find more HDMI fun facts here. Happy

Readings.




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December 1941


GUS KEEPS 'EM ROLLING
  by Martin Bunn
   "I dunno what we're going to do," Joe Clark gloomed to his Model Garage partner,
Gus Wilson. "It was tough to lose Harry to the Army. Now he's gone and got himself
into that officers' training school, so he'll stay in the service a long time, and when he
comes out it isn't likely that he'll be willing to come back to work as a grease monkey.
   Ever since he left, every half-way-decent mechanic we've managed to get hold
of has either enlisted or been blown away by the draft or has quit us to go to
work in some defense industry.
  "Oh, I ain't kicking - I'm just as patriotic as the next fellow. But how are we
going to keep this business running? That's what I'd like to know! Since folks
have realized that they're likely to have to make their cars do for a long time
we're getting more business than we've ever had before. We need two good
mechanics right this minute - we could use three. And what can we get?
Nothing but kids fresh out of high school. What the heck are we going to do,
Gus?"
   Gus looked up from the complicated gadget he had on his workbench - it's an
idea that he's working out experimentally before he sends it to the National
Inventors' Council down in Washington with what we all think is the well-
founded hope that it will be a help in the good work of making Hitler less of a
nuisance than he is now. "What are we going to do?" Gus repeated seriously.
"We're going to do the only thing we can do - keep right on trying our darndest
to keep our customers' cars rolling. That's our job, Joe, and it's an important
job. We'll just have to do the best we can with whatever sort of help we can get.
Quit your worrying and hire one of those kids you've been interviewing. It
might happen that I could turn him into something useful."
  "O.K.," Joe agreed, without enthusiasm.
  "And I'll tell you something else I'm going to do. I'm going to hire a girl to do
most of the work in the office, and I'm coming out here in the shop. Lord knows
that I don't pretend to be a mechanic, but there must be some things I could do."
  Gus looked downright scared. Joe's few attempts at mechanical work have
been far from successful. "That's a swell idea, Joe," he said soothingly, "but for
the time being it would be a lot more sensible for you to keep on running this
outfit from the front office. That's your job. If the time comes that I need you
out there, I'll tell you so. That sounds like Doc Foley's horn."
   It was, and a moment later Dr. Foley came in with a worried look on his usually
cheerful face. "There's something seriously wrong with my car," he announced. "I
think it must be the fuel pump."
  "What are the symptoms, Doc?" Gus wanted to know.
  "Yesterday afternoon," Dr. Foley told him. "I was doing about forty when I came to
that steep hill four or five miles up the road. Half way up it my motor began to labor,
and although I stepped on the gas hard it went dead before I got to the top.
   From the way it died I thought I was out of gas, but the gauge showed that the tank
was three quarters full. I took a look under the hood, and so far as I could tell
everything was all right - not that I know much about motors. Anyhow, when I got back
in the car and stepped on the starter, away she went as nice as you please!
   "I was on my way to see the Dawsons' little girl - she's got the measles. Dawson is a
fellow who enjoys fussing with his car, so I told him what had happened. After he had
done some checking on my motor, and found that it was running perfectly, he said that
probably a speck of dirt had clogged one of the carburetor jets and then worked its way
out again, and that I wouldn't have any more trouble.
   "I forgot all about it until the same thing happened again today. In fact, it happened
three times while I was on my rounds. I know it's after your working hours, but I have
a lot of calls to make now that young Dr. Smyth has gone in the Navy and I've taken
over his practice, and I just can't afford to be driving a car that I can't depend on."
  "Drive her right in, Doc," Gus invited.
  "Working hours are whenever I'm here. That goes for the duration!"
   By the time Gus had locked his gadget in the office safe Dr. Foley had driven his car
into the shop.
   Gus looked at its speedometer. "Thirty-six thousand four hundred," he read. "How
long have you had this fuel pump, Doc?"
  "Why, it's the one that came on the car," Dr. Foley told him. "Anything wrong about
that?"
   "Maybe not, and maybe there is," Gus said. "Seems to me that it's a good idea to
install a new pump every 20,000 miles or so - just to be on the safe side. There's nothing
that makes a man feel more helpless than to have his fuel pump go bad when he's ten
miles from nowhere in the middle of the night, and leave him with no way of getting
gasoline from his tank to his carburetor. But maybe your trouble isn't in the fuel pump
at all. I'll have to do little checking."
  He cleaned a small amount of sediment out of the pump bowl. Then he replaced the
bowl, opened the gas line from the pump to the carburetor, and stepped on the starter.
Gasoline spurted out of the pump.
   "Your fuel pump is O.K.," he told Dr. Foley, "but I still think that it would be a good
idea to put in a new one, considering the mileage. The chances are that the trouble is in
the carburetor."
  He cleaned out the short line from the pump to the carburetor. Then he took the
carburetor apart and blew its jets clean with compressed air. Then he reassembled
carburetor, and again stepped on the starter.
  The engine took off promptly and ran smoothly.
  "It seems all right now," Gus said. "But it seemed all right a couple of times before,
and then went dead on you. Got time for me to take her out for a little road test, Doc?"
  "Sure, go ahead," Dr. Foley told him.
  Gus was gone for the better part of a half hour. "How was she? All right?"
  The doctor asked when he drove back into the shop.
  "Nope - she's still all wrong." Gus said. "Did the same thing with me that she did
with you. The engine drifted to a stop on a hill, but took off fine again when I stepped
on the starter. You'll have to let me do some more checking this evening, Doc. Right
now I've got to hustle down to the Park House to get my dinner, or the dining room will
be closed. I'll drop you off at your house on my way, and I'll bring your car around to
you on my way home tonight. If you should get a hurry call before I've got it fixed,
phone me and I'll bring my bus around for you to use, O.K.?"
   When Gus got back to the Model Garage after he'd eaten a hurried dinner he found
the lights burning in the office and Joe Clark busy over his ledgers, and the lights
burning in the shop and Ez Zacharias, his postman's cap on the back of his shaggy head,
chewing tobacco industriously and gloomily contemplating his mud-plastered R.F.D.
sedan. "Joe said you'd be back," Ez explained. "Say, Gus, I'm right behind the eight
ball. My ol' bus sounds like all her connecting-rod bearings was burned out. Take a
look at the ol' girl, will you?"
  "I will if you want to wait until I've found out what's the matter with Doc Foley's car,
and fixed it up," Gus told him. "His job's ahead of yours, and I promised it to him for
tonight."
  "I got lots of time," Ez assented comfortably. "The P.O. Department ain't got us
R.F.D. fellers deliverin' mail at night - not yet, anyhow. I'm a-takin' this here World
War Two easy-like - they danged near wore me down over there in France in the first
one. Course if them Nazis ever came over here I'd feel different. I'd get me a machine
gun and show some of those kids who're swaggerin' around in uniforms how we used to
-"
  He went on sounding off while Gus, paying mighty little attention to him, rechecked
the fuel pump and carburetor of Dr. Foley's car. Again he could find nothing wrong
with either.
  Finally Ez interrupted his monologue.
  "What's the matter with that crate?" he demanded. Gus described the difficulty.
  "Huh!" Ez grunted. "Bet it's the carburetor. Carburetors are the cause of about
three quarters of the trouble you have with automobiles. They're like kids' stomachs
and hosses' bellies!
  Hey, look here! When you took the cover off that carburetor I seed that the float
bowl was near empty. That ain't natcheral. What's the cause of it, hey?"
  Gus stared at him. Then he stared at the float bowl. "You're right by gum!" he said.
  "I never thought of that. You are of some use, after all, Ez! Let's see, now."
  He examined the float bowl carefully.
    Then he laughed. "That's one on me," he acknowledged. "See what's wrong, Ez?
The float needle is worn to a wedge fit. It sticks so tight when the float bowl is emptied
that it doesn't open when the float arm pressure is removed. Then the engine stops
because it isn't getting any gas - and then when you step on the starter the carburetor
gets a little jar which loosens the float needle, the gas flows again, and the engine starts.
I'll just lap out the valve seat a little with some very fine valve-lapping compound, and
Doc won't have any more trouble with it. First time I've ever run into that one. You're
some trouble-shooter, Ez!"
   Highly pleased with himself, Ez chewed his tobacco placidly and amused himself by
scoring an occasional bull's-eye on the waste box while Gus put the valve into workable
condition. Then he went into the office and telephoned Dr. Foley. "Your car's O.K.
now," he told him. "It wasn't the fuel pump, after all, but it would be good business to
put a new one in just the same. How about it?"
  "Whatever you say," the doctor told him.
  Gus came back into the shop and installed a new fuel pump. Then he turned to Ez.
  "Now for that wreck of yours," he said.
  "What did you say is the matter with it this time - a burned out connecting-rod
bearing? Let's hear your sad story."
  "She's sad, all right," Ez said, grinning.
   "This morning on my route I had to tramp on the gas pretty hard to make a steep
hill, and there was a rap somewheres in the car's innards. Every hill I went up after
that the rap got louder. It sounded to me like a connecting-rod bearing gone flooey.
   Gus raised the hood. "Start her up, will you?" he said. Ez climbed into his car and
started the engine. Gus listened intently for half a minute.
   "There's a rap, all right," he decided, "but I can't tell where the noise is coming
from."
   He went over to his workbench and came back with a three-foot length of iron pipe.
"Speed her up a little," he told Ez. Keeping one ear close to the upper end of the pipe,
he held its lower end in contact with various parts of the engine. After a few minutes he
raised his hand. "Switch her off," he told Ez. "There's nothing the matter with your
bearings. That rap is coming from - or from somewhere near - your fuel pump. Ever
had any trouble with it?"

				
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