Joseph ⭐⭐ @pepemac27 Twitter profile | Pikagi

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Joseph ⭐⭐

@pepemac27

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Dad | Husband | Jew | Gastro Paediatrician | Cancer survivor | #ChelseaFC ST holder | ADC SoMe Editor Views/grammar don't represent employer/human race

London

https://t.co/D5clfSsEUF

Joined April 2011

Don't wanna be here? Send us removal request.

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@pepemac27

Joseph ⭐⭐

3 years

What a week last week was. Started off watching my club win the champions League, again #KTBFFH Got published Taught my daughter to ride her bike 🚴🏾‍♀️ (My wife did the groundwork) Had my final neonatal shift yesterday, which was INTENSE. 🚴🏾‍♀️⚕️

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Iron-deficiency anaemia: the perils of excessive milk-drinking

Iron-deficiency anaemia is a widespread and largely preventable problem in the paediatric population, with numerous potential sequelae. We describe the case of a 2-year-old girl presenting with...

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@pepemac27

Joseph ⭐⭐

3 years

Me: father to two thriving kids, paediatric registrar, often the most senior paediatrician in the hospital at nights, regularly manages life and death situations. Also me:

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Joseph ⭐⭐

29 days

This little VGA to HDMI adapter represents so much of what disappoints me working in the NHS. A thread: 1/

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Joseph ⭐⭐

29 days

How many are working at 120% capacity in a system so starved and stretched it only results in 60% output (charitable estimate)? How many metaphorical VGA to HDMI cables are we all buying with our own money all the time? What's the cumulative cost of it all? Rant over. 9/9

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Joseph ⭐⭐

29 days

But it got me thinking. How many seemingly tiny costs are being absorbed by NHS staff every day? Not the £3.50 cables, but the other less tangible forms of inefficiency and intransigence? How much do we absorb extra time, energy, and opportunity costs to keep it all going? 8/

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Joseph ⭐⭐

3 years

We realised that our amazing F1, Grace, never had a med school graduation. So today we held her own one as graduation from med school and from her first paeds job. There were speeches, tears, a reading of the Hippocratic oath, and even robes! #paedsrocks #choosepaediatrics

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Joseph ⭐⭐

11 months

My favourite of all the responses are the angry "I'M TAKING BACK MY CLAPS" as if I've been using them to pay my mortgage for the last 3 years and they weren't a totally worthless gesture in the first place.

@SkyNews

Sky News

11 months

BREAKING: NHS consultants vote to strike for two days next month

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Joseph ⭐⭐

2 years

Good morning to everyone except the @TfL bus driver who, on hearing I'm a doctor who's bike just broke on the way to work, informed me that yes it is up to him whether to let me and the bike on, but then gave me a nice smarmy smirk, closed the doors, and drove off anyway.

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Joseph ⭐⭐

4 years

This evening (19:45) I went to the hospital canteen on the way in to work, and I was served by the same woman who served me and my colleagues breakfast during our night shift at 06:00 this morning. Love to her & other unsung heroes of the #NHS , working 14h shifts feeding us all.

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Joseph ⭐⭐

2 years

I'm just a mid-30s father of two Standing in front of my family Asking them to turn the lights off in parts of the house they're not using

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Joseph ⭐⭐

3 years

The most rewarding part of being an NHS staff member is when a manager tells you you can't take any form of carer leave to look after your kid after a major operation because it isn't enough of an emergency. Love that.

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Joseph ⭐⭐

2 years

Remember how worried everyone got about Zika? I had family members who wouldn't fly to even Zika-adjacent areas because they were a woman of childbearing age, not pregnant. Now we have covid placentitis, double risk of stillbirth, and everyone's just "heigh ho let's carry on"

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Joseph ⭐⭐

2 years

This week in NICU I noticed a baby's mother was born in 1994 and my immediate thought was "bloody hell she's a bit young, only about 17 years old" before getting a much more accurate realisation of "bloody hell I'm a bit old".

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Joseph ⭐⭐

2 years

I'm at my daughter's school sports day today and - no exaggeration - one of the mums has brought with a pair of spikes for the parents' race. Spikes. For the parents' race. On sports day.

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Joseph ⭐⭐

2 years

Today I celebrate D-day - diagnosis day. The 20th December marks 18 years since my diagnosis with cancer, aged 15, when I was found to have stage 4 Burkitt Lymphoma. Here's a little story for you... 1/ #Cancer

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Joseph ⭐⭐

2 years

This is my favourite NHS sign, in our toilet at work. 1. Double threatening from the human who put it up and the Rook itself 2. A quick ornithology lesson

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Joseph ⭐⭐

3 years

It's finally happened. My sordid past has caught up with me. On NICU today, welcoming the new med students. One goes to me: "I'm so sorry to ask you this, it's going to sound really weird, but... Do you have a ring doorbell and did you once leave your handbrake off?"

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Joseph ⭐⭐

9 months

URGENT request for recommendations for marriage counsellors/mediation specialists. I have just discovered that instead of putting the dishwasher tab in the little compartment (image), my wife just throws them into the machine (video). This is chaos, right? Please confirm.

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Joseph ⭐⭐

3 years

STOP GIVING SALBUTAMOL TO THREE MONTH OLD BABIES WITH BRONCHIOLITIS, PLEASE.

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Joseph ⭐⭐

4 years

I've seen so much of @RealDeniseWelch telling doctors how to do their jobs I'm starting to think she might be an Imperial med student

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Joseph ⭐⭐

3 years

Wtf is the sheer jobsworthy-ness of some NHS employees? I finish nights just now and my ID card has stopped giving me access to NICU etc. I go to the ID card office, there's a sign that they do ID cards between 10am-2pm. Fair enough, but I'm gonna try anyway, otherwise ...

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Joseph ⭐⭐

2 years

NO NO NO NO NO NO NO. NO. FFS NO.

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Joseph ⭐⭐

3 years

Also, so many people have been so incredibly kind in the replies. Thankfully, I am fine. The car is fine. The wall is fine. Thank you to all of those who have wished me and my NHS colleagues well. We are here for you if you need us - please stay safe.

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Joseph ⭐⭐

29 days

I go online to find an example, and find they're actually only £3.50. I did not know that. I thought they were like £20. So whatever. I buy it myself. £3.50 delivered next day to the Amazon locker in the hospital. It isn't worth the NHS headache or my ward manager's time. 7/

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Joseph ⭐⭐

2 years

And don't @ me for trying to use being a doctor to get on the bus. Yes. I begged, I used it as a sob story - which is true, I don't care. I have night shift colleagues and sick children waiting.

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Joseph ⭐⭐

29 days

In my ward Dr office (broom cupboard) there are two computers. For the last two years there has been an unused spare monitor on a shelf in there. I'm weirdly into having two screens. I find it really helps me with productivity, so this week I tried to set it up. 2/

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Joseph ⭐⭐

3 years

So glad my folly has made so many people laugh! I don't have a SoundCloud, but I used to write a blog in my bio. So many charities I want to plug, including @TeenageCancer @DuchenneRF @MakeAWishUK Mostly though, stay home, wash your hands, wear a mask, reach out to the lonely.

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Joseph ⭐⭐

29 days

No discussions without a ticket on the IT service desk portal. May I use a computer there to log one? No. Ok so I went back to my ward. Logged request. "No, we don't have those adapters. It'll need to be requested by someone with a cost code." 4/

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Joseph ⭐⭐

29 days

Because a second screen is about £100 on our catalogue. So here's me with a second screen that works, a cable to connect it, and a working computer. All I lack is an adapter. Our ward manager nurse is sensible and pragmatic and so is just like yeah let's request it. 6/

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Joseph ⭐⭐

2 years

Oh God. Oh God Oh God. I have accidentally just replied all to an email with about a thousand recipients. Please pray for me.

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Joseph ⭐⭐

2 years

This week has convinced me that lateral flow tests are one of the worst things to happen in this pandemic. The false sense of security the government have created in laypeople with no understanding of sensitivity and specificity has contributed to crazy levels of spread.

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Joseph ⭐⭐

2 years

When the CSF red cell count is 0. I knew keeping an emergency bottle of champagne in my locker at work would come in handy some day! Very proud of my SHO. #ifyouknowyouknow #paedsrocks #choosepaediatrics

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Joseph ⭐⭐

3 years

Why are people like this? What is this "computer says no" attitude? Before anyone jumps in with a #BeKind , please don't. They knew it was a quick fix. They understood that not doing it would impede clinicians working at night. They just didn't care until they were accountable.

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Joseph ⭐⭐

29 days

This is fair enough and I'm sure exists as a safeguard against rogue employees etc. Cool. ➡️ Barrier 2 But actually it's an old screen, so they say it's unlikely to get granted. Better to request a new second screen. But there will need to be proper justification for this. 5/

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Joseph ⭐⭐

29 days

Only issue is it's an old monitor so needs a VGA cable. Our computers are luckily quite new, so utilise HDMI sockets. So I did what anyone would do, and went down to IT to ask if they had a VGA to HDMI adapter I could use. ➡️ Barrier 1 3/

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Joseph ⭐⭐

3 years

I spent all day in paeds ED dressed like this. Am I happy I felt cool all day? Yes. Am I slightly annoyed nobody confronted me to say it's not in the dress code so I could smugly ask them to show me that part of the dress code and be right? Also yes.

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Joseph ⭐⭐

3 years

When you know, you know. #NHS

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Joseph ⭐⭐

3 years

Kudos to the night team for this excellent April fools joke. I *did* question the name during handover when they kept slipping Gaga songs into the history (we poked her face, she was born this way etc) but they were adamant and kept totally straight faces! #AprilFoolsDay

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Joseph ⭐⭐

3 years

If it's like this for doctors who are embedded and relatively knowledgeable re. the system it must be bloody awful for patients having to navigate this level of inflexibility during times of uncertainty and fear.

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Joseph ⭐⭐

2 years

STOP. GIVING. TODDLERS. WITH. SNOTTY. NOSES. ANTIBIOTICS.

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Joseph ⭐⭐

4 years

How it started: How it's going:

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Joseph ⭐⭐

2 years

Can anyone explain why we can't do electronic prescriptions to local pharmacies from ED? If we don't have the meds in stock, the options are either get parents to schlep back the next day or ask the GP to Rx it, which is unfair and more work for everyone. What's the barrier?

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Joseph ⭐⭐

2 years

My 6yo just said "daddy, I'm not sure if Bluey is Jewish or not Jewish. They eat shrimps which aren't kosher but they also eat spring rolls so maybe they are actually Jewish?" Oh God. Our Chinese food consumption level is so high my kids think it's a religious practice.

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Joseph ⭐⭐

2 years

Just met a med student who told me that in 3rd year (during COVID) instead of placement they were just put on an HCA rota and expected to work 35h/week without pay or medical degree teaching. I felt so bad for them.

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Joseph ⭐⭐

2 years

Note the titling and untitling of these two doctors in the first photo.

@ANDYL0CKEY

Prof Andy Lockey

2 years

20 years as consultants in Emergency Medicine at @CHFTNHS . Started April Fools Day 2002 and the time has whizzed by. A lot has changed (monitor size, hair styles!), but still the same amazing department. @EDCHFT1

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Joseph ⭐⭐

3 years

"Yeah but I don't do the cards until 10am" I explained the crash bleep situation. They were unmoved, until I had to calmly pull out the ridiculous nuclear option of "ok do you mind if I take your name please?" "OK I'll do it" It took - no exaggeration - less than two minutes...

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Joseph ⭐⭐

2 years

My brother in law's wife just had a baby, so now I have to muster every ounce of willpower and restraint in my body when I hear every family member say "he's holding my finger!" to *not* reply "it's a reflex"

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Joseph ⭐⭐

2 years

Colleague just told me her navy boyf has a study budget he can use towards "any course that improves him as a person". Not even relevant to his job. This guy just did a cocktail making course. He didn't even have to lay out, they just pay for it. #MedTwitter could you imagine???

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Joseph ⭐⭐

2 years

Happy UK Arrest Call Day everyone #2222

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Joseph ⭐⭐

2 years

Today in clinic one of my consultants (and role models) invited me to his scope list tomorrow. I replied "yeah, I really need to get my scoping skills down". His reply? "What you really need is to make sure your work/life balance is right. The scoping will come." My heart.

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Joseph ⭐⭐

2 years

1. Hero status for missing trains, staying late, ruining your personal situation for the service. 2. Vilifying people who set boundaries as doing the "bare minimum" because they leave on time. 3. Onus on individuals to make a system work with extra toil. No. Don't do this.

@genievanny

genevieve 💙

2 years

Just reflecting on tonight's OOH service. There are people who would give above and beyond to make the system work, and there are those who would do the bare minimum and leave promptly on time. Admin guy today missed his train, and still patiently sorted his paperwork first.

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Joseph ⭐⭐

3 years

I'm sure you have done already but could anyone who knows the real @drphiliplee1 please let him know about the outpouring of solidarity and support he's getting. We love him.

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Joseph ⭐⭐

2 years

On Thursday my awesome grandfather, Benny "Guy" Moses passed away. We are sad, a little angry, but also relieved he is no longer suffering. My grandpa was quite the legend and this thread is a bit about him and his life. 1/

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Joseph ⭐⭐

6 years

Why a wear this eye-mask every morning on the tube home from night shifts: my [first] thread: 1/

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Joseph ⭐⭐

3 months

Tale as old as time #paediatrics

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Joseph ⭐⭐

1 year

The year is 2073. We live in a post-internet world since AI took over. 05:30am. I am awoken by an abrupt knock at the door. It's the postman. Silently, he stares through me, and delivers a handwritten note on a single piece of paper: PROD WORKFLOW MAILER: REGISTRATION EXPIRY

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Joseph ⭐⭐

1 month

Wife and I going through finances this PM, household budget etc She asked me to justify stuff GMC £44/m RCPCH £35/m It is such a massive bloody scam that we are forced to absorb these costs. I had to explain that as a trainee *I* am forced to pay for my mandatory eportfolio 1/

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Joseph ⭐⭐

2 years

I've had similar convos w consultants at old jobs. "It's not about the money, you're letting down the team, you have a duty to the patients". It is my time, I'll decide if it's about money. The "team" I'd let down working for peanuts is my wife and kids. My duty is to my family.

@EmergencyMedDr

FY20 🩺

@EmergencyMedDr

2 years

Despicable. Medicine is NOT a vocation. It’s a career doctors work tirelessly at, to the detriment of their personal lives. Drs must stop being abused for their good nature. Great example of what NOT to say if you want drs to fill gaps on top of full time antisocial hrs 🙄

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Joseph ⭐⭐

2 months

A mate has just told me there are not any (ZERO) training places for geriatric medicine (whatever it's called now) in London/Kent, Surrey, Sussex this year. What on earth are they doing? This is madness.

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Joseph ⭐⭐

2 years

Just walked into the neonatal unit to find this and crapped my pants. Training dolls in dangerous positions will never not give me a shock. #Paediatrics

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Joseph ⭐⭐

3 years

Just remembered a posh girl in my first year PBL group at uni. Her mum was a GP and she was a proper know it all. One session she kept calling diclofenac DIE-CLO-fenac instead of DICK-lofenac. It annoyed me then and it annoys me now.

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Joseph ⭐⭐

5 months

This reminds me of when I was an F1 and the hepatology F1s (incl. My good friend) were LOCKED IN A ROOM by the consultant and not allowed out until someone agreed to work the unfilled long day shift that day that was vacant due to sickness. Nothing happened to the consultant obv.

@Dr_Done_

Dr Done

5 months

⚠️ WHAT is going on in the NHS? Doctors - you have the right so say ‘F*** Off’ in these scenarios Whist these Consultants exist, medicine will be further degraded In any other workplace this would be an investigated for harassment/subhuman working conditions @ImperialNHS

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Joseph ⭐⭐

1 year

Imagine having 23 registrars from anywhere in any UK ED

@rahttled_doc

Rattled Doc

1 year

A snapshot of UK doctor numbers in a single department, in a single hospital, in Australia. As of today our ED has : 26 UK trained Resident Medical Officers 23 UK trained Registrars 10 UK trained Consultants Pay your staff what they're worth @SteveBarclay or lose them

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Joseph ⭐⭐

2 years

Two years after it all started it's finally got me. Very coryzal and positive on lateral flow. I logged my lat flow on the gov website today, and an hour later my GP called to check up on me. That is amazing service if you ask me! #gp #NHS

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Joseph ⭐⭐

3 years

Did it

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Joseph ⭐⭐

3 years

Last night I referred to a paeds surgeon at another hospital, and they were simply amazing. In 3am conversations they were approachable, kind, dynamic, enthusiastic. Amazing energy. Is it weird to call tomorrow to find out their consultant's details to give +ve feedback?

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Joseph ⭐⭐

2 years

But I'll continue to celebrate what I have been able to take and embrace from a horrific situation. I couldn't have had that mindset without the mother and sister I have and the support and strength they gave and continue to give me. I'm one of the lucky ones. Happy D-day. 30/30

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Joseph ⭐⭐

2 years

There's a beautiful quote in Dave Grohl's book, Storyteller. "You're only ever as happy as your unhappiest child". Never is this more apparent than on a paeds ward with a child sick or in pain. It's something we need to keep in mind when interacting with "difficult parents".

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Joseph ⭐⭐

6 years

@DocMcShorty @amirreyahi Tomorrow night I'll be the doctor on call on the paediatric oncology ward where I was treated for my own cancer 14 years ago. Now that's magical.

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Joseph ⭐⭐

3 years

This weekend in Paeds ED was frankly a total nightmare. HUGE numbers of kids coming in. Most worried well, but quite a few sickies too. Winter has already arrived. Feels like this is what it was like for the adults last year, except nobody is coming to help. It's unsustainable.

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Joseph ⭐⭐

3 years

I have a 3500 word grid job application word to perfect - due in two weeks - in order to achieve my longstanding career aspirations to be a paediatric gastroenterologist. It's also my son's 3rd birthday, so naturally I spent 5 hours today making this cake. #bluey #baking

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Joseph ⭐⭐

5 months

Live scenes of me fighting every urge in my body to just tag the consultant who did it (who is on twitter) and turn off notifications for the day.

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Joseph ⭐⭐

5 months

This reminds me of when I was an F1 and the hepatology F1s (incl. My good friend) were LOCKED IN A ROOM by the consultant and not allowed out until someone agreed to work the unfilled long day shift that day that was vacant due to sickness. Nothing happened to the consultant obv.

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Joseph ⭐⭐

2 years

Does anyone else get MASSIVE ick when they see a discharge summary has a final line saying: "We wish them well" I can't put my finger on why but it makes me so annoyed.

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Joseph ⭐⭐

2 years

*SCREAMS IN PAEDIATRICIAN*

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Joseph ⭐⭐

3 years

Every once in a while as a paediatrician parent I have one of those shifts which make me want to immediately sprint home, grab my kids, hold them close to me, and never let them go. The night from which I've just got home was one of those shifts.

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Joseph ⭐⭐

3 years

My SHO just tidied up the doctors' office and threw away the two thirds of a roast chicken leftovers I had brought in from home to eat tonight. I am heartbroken.

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Joseph ⭐⭐

2 years

I propose a new rule for educational supervision meetings whereby unless the supervisor has a past career as a typist, it's mandatory that the trainee does all the typing of whatever the supervisor wants to put in the form. I should add that I love my supervisor and he is great.

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Joseph ⭐⭐

8 months

Live scenes of me, a paediatrician, when I get to question 10 of the mandatory Dementia training assessment, I've already got two wrong, I need 80% to pass and if I don't I've gotta click through the entire training again

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Joseph ⭐⭐

3 years

Premature Anaesthetists babies 🤝 Needing caffeine in order to breathe

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Joseph ⭐⭐

1 year

@Aidan_Baron @Qantas I once helped someone on a flight from SYD to BKK, and we landed in Adelaide so they could be taken off the flight by medics. @British_Airways put me and fiancée in first for the rest of the trip back to London and sent me a free flight voucher for Club Europe. Was really lovely.

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Joseph ⭐⭐

2 years

I believe this platform should be about sharing failures as well as successes, so here I am. Gutted I didn't get a paeds gastro grid post this round. My shortlisting/interview scores were good but with only one post in London it was always going to be super competitive. 1/2

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Joseph ⭐⭐

2 years

The cognitive and emotional difference between doing a run of 3 nights vs. a run of 4 nights is absolutely incredible. It's only 25% less night shift but it feels disproportionately better to do. #teamnightshift #MedTwitter

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Joseph ⭐⭐

1 year

Absolutely ecstatic to say I've accepted a paeds gastro grid subspecialty training post in London for the next two years of my PGHAN journey. Absolutely can't wait to continue training in this awesome deanery. #Gastro #PGHAN

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Joseph ⭐⭐

3 years

Yes this is just a rant and shouting into the void you don't have to ask me what the point of the tweets are

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Joseph ⭐⭐

5 months

Merry Christmas from the paediatrics ward Santa @ChelwestFT

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Joseph ⭐⭐

3 years

You know when they advertise cars with 0-60mph in however many seconds? I don't care about that. Get rid of it. What I want to know is how many bloody minutes it's gonna take to de-ice and de-mist the windscreen at 7am on a midwinter Monday morning. #cold

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Joseph ⭐⭐

2 years

@RadhikaThakrar Someone will inevitably enter this thread to tell you to be more understanding because that person was having a bad day/under stress/[insert irrelevant excuse here]. I disagree with them. Most of us have busy and stressful jobs, it's never an excuse to be mean or rude.

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Joseph ⭐⭐

3 years

Got my first dose of the vaccine today. How it started: How it's going:

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Joseph ⭐⭐

2 years

Hey Twitter, I did a #poetry Where are you really from?

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Joseph ⭐⭐

2 years

@jasaunders90 Would you refer to me, a paeds reg, as a lesser qualified professional if I was working in the GP role without supervision? I would. I am not qualified as a GP.

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Joseph ⭐⭐

2 years

I hate bagels. There. I said it. Bagels are crap. They're tough as old rope, the work of chewing you need to do to get through them gives me a jaw ache, and if you have any decent thickness of stuffing inside it all gets squeezed out when you bite down. They're awful bread.

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Joseph ⭐⭐

1 month

The clocks may have gone forward last week but I feel like I've gone back to the 1950s. Recently I've seen diseases that could + should have been consigned to the dustbin of history. Multiple kids with measles. Haemophilus. Pertussis. Meningococcal sepsis. It's genuinely scary.

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Joseph ⭐⭐

3 years

Why do all recipes online start with someone's life story? Please just get to the ingredients, friend.

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Joseph ⭐⭐

3 years

Tonight I realised our NICU documentation ( @BadgerNetUK ) isn't the most same-sex couple friendly. We have no way of changing the preset mother + father headings in admission/discharge summaries to mother+mother etc. Not all families look the same. It's time we adapted to that.

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Joseph ⭐⭐

10 months

I don't think non medics appreciate this level of NHS HR cruelty. They disregard contract clauses (through either malice or incompetence) in order to underpay junior doctors not savvy with finer details of our contract, then won't pay when called out on it. Disgusting.

@dominicarr

Dom Carr

10 months

Another London NHS Trust underpaying doctors for 3 years+. Initially acknowledged, only to mysteriously change its mind🤨(NB it actually affected all departments) The 2nd email was 2 months ago. Still no update. Doctors still being underpaid @BMA_JuniorDocs @TheBMA @Doctors_Vote

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Joseph ⭐⭐

2 years

The rate I'm offered in London as a paeds ST6 is £44. I do not take the shifts.

@BronwynW00dburn

Bronwyn Woodburn

@BronwynW00dburn

2 years

@_Amy_Li_ I think our going rate across the NE is £40 F1 and £45 F2. But most places have been paying enhanced rates of an extra £10/hr for a while

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Joseph ⭐⭐

2 years

Got home the other day. Took off my trousers. Found this gaping rip on the arse of them. I had been wearing them at work since 0830am. Cool cool cool cool cool cool. Cool.

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Joseph ⭐⭐

2 years

By far one of the worst things about working nights is waking up with the urge to piss when you're only 3 hours into the day sleep and the impossibility of getting back to sleep once you've done it. Brutal.

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Joseph ⭐⭐

3 years

My Ayre. Head of science. Refused to help the hospital teachers for me to do my GCSE science coursework in hospital. I had cancer. The next year I expressed my ambition to study medicine. "I will do everything in my power to stop you becoming a doctor" Well that didn't go well.

@i_Lean

Eileen Mary O’Connell

3 years

Who’s a teacher that wronged you and you’re STILLL mad about it! NAME NAMES AND NAME THE INCIDENT!

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Joseph ⭐⭐

3 years

I just wanna say I knew from the start that fella wasn't a real doctor. His comportment was totally off. #MedTwitter

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Joseph ⭐⭐

3 years

... I'll be screwed at 8pm tonight. The ID card person answers. I explain the situation. I politely beg for them to update my card. They literally knocked on the sign and said "no, we only do cards between 10 and 2. Come back then" "But I am on nights. I need to go sleep"...

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Joseph ⭐⭐

2 years

@andrewmeyerson Congratulations on getting your 15 minutes on screen, I think you actually did decently in the circumstances. However, please don't do this. We have a union got a reason. You don't get random train drivers going on the BBC when they're balloting for IA, and it's for good reason.

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