Throwaway05
2d ago
Absolutely not, they think it's because conservatives are "___" (insert attack here).
Same level of blindness as media people who can't see why movies are failing etc.
Throwaway05
2d ago
obviously a Martian
This is goblin erasure.
Throwaway05
2d ago
Replied elsewhere but in sum, the politics is spot on.
The actual events is umm more condensed (a single day isn't usually that interesting, but a whole month?). Obviously later season events are a bit different.
The competence level is higher than average, especially for the students but it is not out of the realm of possibility for a good group at a high end institution. Independence is a bit much though.
Some inaccuracies but kinda not a lot (and importantly on Meddit you'd see some arguing on "inaccuracies").
The most important part is the vibe and the personalities which....phew. Oh my god it is spot on.
At times really rewarding and people feel seen, at other times...tough.
We'd play a game where we try and see which doctor we most represent and most people have a strong connection to one of the archetypes.
Throwaway05
2d ago
Best example I can think of is Game of Throne's "we aren't sure if they are bastards or not" .......are they half Black? If so.... Recasting debacle.
Throwaway05
1d ago
Well played.
Throwaway05
5d ago
Hospitals with a bad mix of patients (aka medicare and medicaid) have been dying at high rates for awhile now (this includes rural but also urban hospitals with a shit mix), it has been getting worse lately but that is perhaps more because these things can take decades to finish happening and because of growing regulatory burden.
It is possible that Trump is hastening the deaths but they were absolutely going to happen anyway.
Throwaway05
8d ago
A common pathway for something like this is:
-you nearly bleed out
-medical attention arrives
-in the meantime multiple organs are not getting enough blood and therefor oxygen
-this may include the brain
-you are taken to the hospital which keeps you alive
-but you are already dead OR
-while in the hospital swelling, tissue death, infection from all of the damaged areas causes problems leading to formal death later
tons of stuff like this can happen.
Throwaway05
13d ago
They are better than the USA, which is the key benchmark. Canada is much more similar than Western Europe and also has historically out-performed the USA, although our healthcare system is getting fucked on pretty hard right now so idk how the stats match up post-COVID.
Don't fall for the propaganda here, the U.S. has worse outcomes on many metrics but a population that is more unhealthy and those worse metrics are driven by a social goal (you have the freedom to accept lifestyle diseases). When you get sick you are better off here than everywhere else in every way except the pay check. You'll get faster care if it's outpatient, and better across the board. You might have worse outcomes because you eat too many Big Macs but that is a public health and cultural problem instead of a medical care one. The expense is higher is really the only problem.
(And note well: those lifestyle disease worsen outcomes on everything, example diabetes fucks with wound healing and metabolic process of all kinds, obesity makes surgery impossible, etc.)
I'm torn on this, if the USA also captures most of the world's pharma profits than this is a net gain no? No idea how the math works out there though.
I don't know either but good thinking.
This is true but hilarious. Americans are violently against "taxes to pay for healthcare" but are completely fine with "employer subsidized insurance premiums that mean they get less cash in hand in exchange for access to healthcare" which is functionally just taxes but with more middlemen??!!?! And poor people I guess get less services versus single-payer, but then everyone subsidizes them anyway via higher medical bills to offset all the non-payments from the aforementioned poor people.
This manifests in all kinds of ways. Don't want to take vaccines and want to accept the bad outcomes? American individualism. Clearly dying grandma with 95% 30 day mortality rate? Spend EVERYTHING. Etc.
Are death panels real anywhere? I also feel like prices/medical bankruptcy (66% of all USA bankruptcy filings) are kind of analogous? If you can't afford chemo you sell everything you have until you run out of money to pay for it and die. Also you absolutely do have rationing, it's just in the form of prices versus bureaucratic limits. It can be debated which type of rationing is better, but the human demand for healthcare is infinite, supply never will be.
The usual way this shows up in real life is in other countries under spending on end of life care (which is super expensive and with where I am in my life now.....yes I'd want that for me) and delay of care. Canada is notorious for this. I need major hip or knee surgery in the US and I can get it within the week, but Canada though? Months. People also die from cancer and other diseases or have worse morbidity because it takes awhile to be seen and treated.
U.S. has a lot of profit motive and well payed people so they get to both care about patients and actually hustle when it's necessary and the system allows it because $$$.
Also, since I don't really get to talk about my favorite medical topic here but now is a perfect time - Trauma!
No better place in the world to get fucking shot (at least in a civilian context)!
Throwaway05
13d ago
Their are two problems with this line of thinking:
- Are those systems actually that good?
- Can we make that happen here?
The U.S. is fundamentally a different place than Western Europe - we spend a lot of money on illegal immigrants, have a maximal amount of cost disease, we are more unhealthy (and importantly as other countries catch up they look more like us), we subsidize the rest of the world's medical research (maybe not fair, but we are the wealthiest country and nobody else will pick up the slack if we go away), we are more independently minded (people don't want to be forced onto insurance or into making certain decisions), medical malpractice is a huge drain, we don't have death panels and rationing, you can get care fast if you can afford it, etc. etc.
Fundamentally our healthcare system doesn't resemble anyone else's in both bad and good ways (don't believe the reddit left - the best care is in the USA).
Even putting aside those things good luck changing our system to resemble other's once reality comes into play (for instance forcing people onto plans).
Throwaway05
13d ago
The whole situation is a mess, I like to think of healthcare economics like communism - yes you can absolutely up end the system and make it way better than what we have now, but when has that ever happened successfully?
The thing that probably gets the most complaints over in doctor land is that changes to the current medicaid structure is likely going to result in a further decline in safety net and rural hospitals. This trend has been ongoing for some time but loss of medicaid dollars will probably accelerate it greatly and people are expecting to see that with the current wave of budget cuts.
Two specific things off the top of my head that you'd have to watch for:
-It is very easy for the hospital to help you by signing you up for medicaid. Private insurance would likely find ways to block this. Hospitals rely heavily on this.
-Medicare and Medicaid are much lower overhead on the clinical side of things and less paperwork. Private insurance is a lot more work (although Medicare is trying to change that! Yay). Don't expect a reduction in medicaid to reduce bureaucratic costs and middleman costs.
Throwaway05
24d ago
Thank you for sharing this!
I enjoyed that in a large part he seems to be sunk by the fact that he can't name his blood pressure medication.
This is vindicating to me, given the number of times I have asked a patient what life saving medicine they are on and gotten the response of "dunno."
Throwaway05
27d ago
All of this below is somewhat moot in the sense that I'm not convinced that Ellison had Bipolar.
Disturbances in cognition exist on a spectrum from "this is not recognized pathology and is just my personality structure" (like a preference for scrambled eggs, a love of baseball, or being an asshole to your girlfriend because you are insecure about your small dick) to "this is purely something with an organic cause and blaming the person for their behavior is asinine" (a classic example benign example is a granny who is violent in the hospital because she's delirious and thinks she's is in a Nazi camp because of a UTI, a classic scarier example is someone who engages in a mass shooting because they have a golf ball sized tumor pressing on a few key structures in their brain).
Cases of the former are much more legitimate to blame (whatever that means) if love of eggs cause problems. Realistically insecurity about the small dick requires some sort of sex therapy or something if the person wants to stop hurting others and have a bit better of an experience of life.
Murder granny gets put in restraints and we treat her UTI and then everyone goes about their business and forgives her afterwards.
When it comes to things in the middle of those two extremes (that is, classic mental illness) we have a similar range. On one end you have personality disorders, like borderline personality disorder. These are in truth diseases of personality construction and really tease at what a "disease" is. It's easy to not feel bad for them (although I encourage you to) and this is true to the point where people don't want to give the diagnosis because of stigma (they give bipolar instead, relevance to Ellison?).
At the other end is one of: schizophrenia, schizoaffective disorder, and bipolar disorder. You could debate which one and they are certainly interesting and have interesting impacts on how much sympathy and guilt we should feel (what do you mean a symptom of the disease is that he doesn't think he has a disease and that's why he doesn't take medication and then ends up hurting people?),
True Bipolar 1 with psychotic features is the most stark here. Again I doubt Ellison had this but this the most sympathy you can have. This is a person with a monster inside them that comes up abruptly and severely because they run a 5k and their metabolism of their lithium changes.
They go from total normal nice person to a violent felon who doesn't sleep, spends their entire family's money and does X,Y, and Z ends up in jail with HIV and then gets started on medication and then goes completely back to normal.
Some people do things that put them at higher rate of an episode, but many people commit no mistakes and still lose.
Living with that should increase sympathy, no?
Most people aren't as stark as the straw patient above, but that is what it can be like.
Throwaway05
1mo ago
I have to imagine that the Dems have gotten very good at knifing each other for perceived thought crimes and insufficient demographic achievement. Only those who have been around long enough manage to avoid this through the accumulation of political power manage to survive in this environment.
Too much eating their own.
I do know a lot of young dems who in other times would be stepping up, but they seem to be too white and/or male and therefore stick with the think tanks or party strategist roles (and lead the elders into unpopular decisions).
Throwaway05
3mo ago
So, I can often be found posting on here complaining about bias in medicine (although I disagree about some of the kinds of bias with quite a few posters here).
We do have something of an update to a long running story that’s worth sharing.
Meddit link for more discussion and detail: https://old.reddit.com/r/medicine/comments/1jotpzz/follow_up_on_the_study_showing_discrepancies_in/
Basically, awhile back there was a headline about how black babies received worse outcomes when care for by white doctors. Apparently, this went so far as to get cited in the supreme court.
Sometime later someone on Meddit (which is still quite pro-woke) noticed that they forgot to control for birth weight, which would likely completely kill the effect size (explanation: white physicians have more training and take care of sicker babies who have worse outcomes). At the time there was a significant amount of speculation essentially going “how do you miss this? That would be the first you would control for.”
Well, it turns out that someone filed a FOIA request and well, to quote Reddit:
“A reporter filed a FOIA request for correspondence between authors and reviewers of the article and found that the study did see a survival benefit with racial concordance between physician and patient, however it was only with white infants and physicians. They removed lines in the paper *stating that it does not fit the narrative that they sought to publish with the study.” *
While I often criticize medicine for being political, I’m often found here telling people to trust the experts when it comes to (certain aspects) of COVID or whatever, and well this kinda stuff makes it very very hard.
The initial findings were passed around very uncritically and sent up all the way to the supreme court.
How can people trust with this level of malfeasance? How do we get the trust back? How do we stop people from doing this kind of thing? I just don’t know.
Throwaway05
13d ago
Yeah you can absolutely get some things done faster by heading over to the U.S. but keep in mind that the times where it's really useful (ex: cancer workup, need a new knee) it will become cost prohibitive and unreliable very quickly.
I assume the reality of the situation is Canada is not as bad as some of the stories would make it seem but those stories are still quite alarming.
It's also worth noting that while US care is expensive EMTALA and others things ensure you will get care for most types of maladies even if you become bankrupt afterwards. Many countries don't ensure this this outside the affluent west.
Throwaway05
1mo ago
This post was beautiful and uncomfortable and made me need to forcibly reboot my brain in order to go about my day in the way that the best Old-Scott posts did.
Well done and also screw you for dredging up those feelings from that time in such a rich way.
Throwaway05
1mo ago
As others have stated the bad behavior by ill behaving cyclists is just so so bad.
The other day I watched a guy on a bike run a red light in a LARGE busy intersection and nearly get hit by a car no less than three times while doing so.
How this person remained so unfazed (and also alive) is a mystery to me.
Brainless degenerates seem to be a minority of people behind the wheel of a car, but a common occurrence on bikes (probably driven by things like delivery drivers who do an outsized amount of cycling but are more dangerous than most).
Throwaway05
24d ago
Reading between the lines (and using some experience with the interaction between medicine and the legal system) my suspicion is that the court and multiple involved parties are aware of this and are more or less working together to block this guy in a paternalistic but likely ultimately wise way.
Throwaway05
3mo ago
Sometimes I look at this stuff and wonder if this what it was like to be pro Civil-Rights back in the day. Just watching all of these pillars of society being told "don't be racist" and hearing "no" in response while much of the influential nod their heads along like it's a good thing.
It is a chilling feeling.
Throwaway05
23d ago
I understand that drug names are not necessarily intuitive and while they have some tricks those will be impenetrable to patients.
That said, you need to know what you take, when, how, and why - otherwise you are at significant risk of increased bad outcome (although this obviously depends on what conditions you have).
What we usually recommend the elderly do is have a sheet with that information written out and store it in your wallet so it becomes easier to read out, can be retrieved if you are not arousable and so on.
This advice is good for anybody however.
With respect to this specific patient - we see a class of older men who have a large number of medical problems and put no effort into understanding what those are for, what they are doing about them, how to avoid making them worse and so on. While some of these people are stubborn or anti-medication most just have very low conscientiousness. Not ideal for a first time gun buyer at 80 something.
Throwaway05
22d ago
The way states usually handle this is that the person has to have some thing happen like a: has a psychiatric illness b. is a credible threat to themselves or someone else.
The presence of criteria for a psychiatric illness is important here and does most the political protection.
A really common teaching interaction is something like "haha, yeah man this patient is delusional because he is Trump supporter and thinks Obama isn't a citizen" attending puts on a very serious face "no, absolutely not. Political beliefs are not delusional unless they are totally culturally dystonic and fixed, the fact that he won the election is proof that is isn't delusion blah blah...."
Psychiatry is in general a pretty pozzed specialty but they don't fuck around when it comes to that kind of stuff.
You will absolutely see patients get discharged who are odious, violent, domestic abusers, substance users and all kinds of other crap because they don't actually meet commitment criteria and aren't psychiatric.
Now you are more like to see something like "this patient does meet commitment criteria yet we'd usually let him go because it's probably safe to do so however he was using racial slurs towards the staff so in he goes." This is unprofessional but still unfortunately legit.
Throwaway05
1mo ago
As for additional driving scissor statements, I prefer to back into a parking spot, or pull through a double spot to be facing out. Some people call it “getaway parking,” others deride it as “ghetto.”
I also do this, I had no idea anyone would deride it.
Throwaway05
1mo ago
Catastrophically bad and regular bad are not the same thing.
You can't compare a half assed stop at a stop sign in a car to blowing through a stop sign or red light at full speed on a bike.
Yeah the former is common for cars, but the latter is common for bikes and not cars.
Throwaway05
1mo ago
Any time I walk in a city I see a cyclist do something brain dead and dangerous. Every time I see a cyclist I see someone running a red light or stop sign. I do not see someone do something brain dead and dangerous every time I drive a car. I do not see someone running a red light or stop sign every time I drive a car.
I am aware of the existence of catastrophically bad drivers, I've seen videos online. I've never seen one in real life.
I've seen catastrophically bad cyclists many times.
I am a doctor and an extremely anti-woke consumer of media (although if it's good...it's good).
The Pitt didn't bother me.
The reason is that most woke stuff kills verisimilitude (think fantasy filled with black people in clearly Northern Europe).
However in this case this stuff is adding verisimilitude because that's how the field is. Especially at a teaching hospital and especially the trainees are crazy far left (because it's part of the admission package and curriculum) or are just good at pretending so they don't get ostracized.
A small sample is the TV in the surgical lounge - we abuse trainees all the time (unfortunately), if you fuck up suturing? You will go home crying. Put a subjective finding in the objective section of your two minute patient presentation at 4am? Crying.
In this sort of environment the trainees still feel comfortable changing the TV from Fox (its always that) to MSNBC and then breaking it/hiding the remote/locking it/whatever.
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