Throwaway05
1d ago
Arguing that your side surrender because conflict result in unacceptable outcomes is not good game theory when being attacked by an aggressor.
Throwaway05
1d ago
We know that one of the attack vectors used by our geopolitical rivals is to specifically emphasize these points to cause political strife, withdrawal from conflict, and to destabilize the US.
Regardless of underlying virtue associated with these conversations, we should be much more careful and diligent in doing what our enemies want us to do.
I seldom see that happening.
Throwaway05
1d ago
It's woke to complain whenever the U.S. fails to be absolutely perfect and not complain at all when Russia/Islamic Regimes deliberately murder civilians with specific intention.
I do not see Dase equally criticizing Russian, Iranian, and Palestinian attacks on civilian populations.
In short, isolated demands for rigor on political grounds is a classic woke manifestation.
Throwaway05
1d ago
I figured the UK had a culture of ethical handwringing but that you might be spared it due to location.
Like I said not criticizing you for your post however we see one of the Common Points which is that even without identifiable information patients can read it that way, and it does generate consternation and distrust at times. Not necessarily a reason to not do it.
With respect to the bus problem - don't report so that the guy feels comfortable opening up and can get treatment and harm mitigation is often selected as the answer.
Throwaway05
1d ago
It's a very good question, and one that has generated a lot of discussion over the years. Self_made's milieu (sorry I'm too boomer-core to actually tag you but I imagine you'll see this) is likely less intellectually masturbatory than mine, part of that is training locations, part of that is also just how things are with the way healthcare and the world has changed.
As physicianing becomes just a job, and the role is more maligned than deified, the idea of those special obligations (and privileges) we used to have goes away. This may be a bad thing, but it is.
Some thoughts.
Hypocratic Oath - It's dead. Many schools have gotten rid of it in general or replaced it with woke screeds. While ethics is taught, it's often head cudgeling "professionalism" ethics. Thinking abstractly about moral pulchritude is gone. I usually blame everything on wokeness, and will do so here.
Official ethical guidelines are often shockingly self constructed or not actually enforceable. The Goldwater rule is pretty famous on this front. This is further complicated by the fact that much of practical ethical behavior is locked into a complex web of federal and state laws that are generally not actually explored by the legal system and can be mutually incompatible (ex: mandatory report this is one jurisdiction but CAN NOT in another jurisdiction, but what happens if care crosses state lines?).
A classic question like "do I report the alcoholic school bus driver" is fraught as hell and younger generations have basically been taught not to engage with the question and to report to risk management.
Basically ethics has been beaten out of the curriculum.
Engaging with your specific question -
Oliver Sacks famous wrote about specific patients. Ish. He also famously made a bunch of stuff up. Conveying the meaning without the details (and with a mild to moderate to sometimes excessive level of alteration and fabrication) is one way to tell the story. Hat was written in 1985 - it's an old argument.
I am unsure how much Theodore Dalrumple fuzzed his patient stories, but he is considered politically unpopular because he illustrated reality as it is. Life at the Bottom is important because it's real, regardless of the reality of the specific patients, but if they are real specific people the value still makes it worth sharing.
For me - when I've written my patients stories here and on our predecessors with my old handle, I generally tried to write about patients whose stories are common or obscured enough detail that many docs would say "did this happen to me?"
This isn't to say I'm judging self_made. Writing to process training is a time honored and important way to not fucking go crazy and become a bad physician, especially for someone whose story has taken them to a place where the other ways of processing are less available.
Throwaway05
2d ago
Have you seen Shrinking? I think it proves Ford can act when he wants to, he just doesn't usually bother.
Throwaway05
3d ago
All levels in the US are able to move up and down more than you see in say, Europe.
Class not really being a thing here is part of that.
Rich kid at a rich school with rich friends doing fancy things and then ends up with a boring office job while all their friends end up in NYC finance is a thing that happens, for instance.
Throwaway05
3d ago
I wonder how much of this is driven by the fact that the U.S. has a lot of up/down mobility in the way many countries do not.
Although it's also sort of a meme in Japan that High School is the best time of your life, which informs much of anime, gaming.
Throwaway05
3d ago
I've met people who work in intelligence work and I've met apex businessmen - guess who is usually more persuasive?
Career progression in government work is sometimes based around success but is often just based around politics and staying. Meanwhile business rewards skill, and many fields like production in real estate finance, represent one of the few ways to end up with million dollar pay checks without equity.
The best salesmen work in sales, because if you are truly good at sales you can become absolutely filthy rich and retire at 50 and spend the rest of your days at golf clubs nobody has heard of.
Throwaway05
4d ago
It seems that even the attack on that girls' school was deliberate,
This is an EXTREMELY inflammatory claim not supported by your article. Do you have any evidence for this?
Throwaway05
4d ago
Being opposed to the war is not treason.
I feel like my point was missed by the majority of posters (which could easily be my fault).
The problem is not opposing the war, it's serving as opposition to the war effort, which some people are clearly doing.
You have a difference between not wanting to spend American lives in Vietnam and giving aid to the VC, or even just hoping that the VC win.
Throwaway05
5d ago
You don't think this measurably increases the chance of a proactive nuclear attack? (terrorist or otherwise).
I imagine the more religious end of Iranian politics would push hard for it.
Throwaway05
5d ago
But I have no confidence in Trump's vision or plan. I expect we'll bomb them for a while, Trump will declare victory and stop, and Iran will still be Iran, just shaken, somewhat weakened, and still hankering for revenge.
This is exactly my concern. An Afghanistan style solution does not seem likely to be helpful, Israel and the US Military (but perhaps, not Trump) may have a plan that could work - but if the propaganda apparatus is efficacious enough Trump will bail and we'll be stuck with a hankering for revenge outcome.
That's worse for everybody.
Throwaway05
5d ago
This is why I drove a distinction between (T)reason and (t)reason in my post.
Throwaway05
5d ago
It sounds like you disagree with what is happening. The point is that people are turning that disagreement into making things worse for everyone or attempting to do so.
So don't do that.
Throwaway05
5d ago
Okay we hold back and don't use the big scary T word, which is fair, the legislature needs to be able to express itself even if it's a terrible idea.
But again, what happens if we just stop now? Everyone is worse off - Americans and everyone else will likely die.
Doesn't that make the actions un-American? Irresponsible?
Being mad that we are here doesn't seem unreasonable. Trying to make everything worse in the frustration doesn't seem wise.
Throwaway05
5d ago
When does "criticism" of the current military action in Iran (and by criticism I mean a variety of behaviors from our political leadership to randoms on the internet) become "treason" (both in the firm prosecutable sort and the "historically your neighbors would have stopped talking to you or maybe chased you out of town" sort)?
I get it, people are mad at Trump, Republicans, America, the Jews, Israel, whatever.
I get it.
Many people would rather have had us not get here. But we are here. The ship has sailed.
If everyone returns to their corners now at the very least we have billions of dollars in economic dysfunction, realistically we have tremendous destabilization in the region which is going cause the biggest problems we've seen in decades. In truth, we call it all off now, Iran will probably finish arming themselves and nuke a civilian population, likely Israel. Even the most anti-semitic person who ever lived should be able to understand how bad doing that could go. It would likely be the worst thing that's ever happened just from the resulting chaos.
So we are stuck.
But you see a lot of people with an agenda trying to defang the war effort or get it cancelled or whatever. Many probably don't expect it to happen, they are just trying to set up Trump looking bad. An example of this is probably the war powers resolutions.
But at that point you have overt politicking putting American, Israeli, Middle Eastern lives (and maybe everyone else?) at risk because you want to slightly increase the chance you can spend two years repeatedly impeaching Trump.
I think that's kind of treasonous? Maybe not the executing kind, but definitely the "holy shit what are you doing kind."
Like the war. Hate the war. It's happened. Criticizing how we got here is understandable, but I think we need to be careful.
Make the PR bad enough and we stop with the job half done and everyone loses.
Throwaway05
7d ago
Tyrant Philosophers
It's coming up in my reading backlog, can you elevator pitch it so I can building anticipation?
Throwaway05
8d ago
I've updated my opinion of Elon considerably downward over the past few years. This isn't motivated reasoning or tribal updating, I think his early work genuinely represented some of the most impressive entrepreneurial achievement of the century, and I weighted that heavily for a long time. It's just that the account has been drawn down pretty substantially at this point.
It does credibly seem like he's become the victim of (wealth induced) substance abuse generated personality change.
That's a hard thing to deal with.
Throwaway05
8d ago
People who used to just die are now morbidly obese with access to cheap entertainment and drugs.
If you get sick we treat you regardless of ability to pay instead of just throwing you onto the street.
This is the society that the billionaires built!
Being poor in America or Western Europe is probably the best now that it has ever been.
Throwaway05
9d ago
From what I can tell these days most male doctors come into med school already attached, meet another doctor in school, or end up getting scooped randomly on the apps (if they don't suck) or flounder on the apps (if they do suck).
People avoid the work drama of the past because of woke stuff, although the mid to late career physicians still get up to that sometimes.
Female doctors seem to hold out for someone on the apps of ultra high quality and succeed or fail, with some going for much lower social class/success boy toys.
Throwaway05
10d ago
I understand many people haven't interacted with much of the Iranian diaspora, like always that's a self selecting group but they resemble Asians or Jews in many ways - strong family ties, a focus on education, and lots of involvement in successful industries and business. This is world class elite human capital with a lot of national pride who would be willing to go back, should the situation change.
Throwaway05
11d ago
Absolutely, we have a millions reasons why getting involved is a bad idea.
This isn't one of them - but it has gotten some of the most play on social media.
It's a shallow emotional appeal that makes no logical sense, but that is where the population is at right now. It's embarrassing.
Throwaway05
11d ago
People die in war and conflict. Iran is a country actively engaged in killing its own people and those abroad (civilian and otherwise). People are arguing about the alleged death of some school children as if this event means that Iran should be allowed to go back to killing whoever they want.
That is stupid.
I don't know about elsewhere but Med influencers are widely mocked and attacked, one guy at Mayo just had his career tanked. Some of this is probably jealously but with the exception of saint Glaucomflecken most medfluencers are trash.
Also I believe Scott lost his job and had to start his own business because of his writing.
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