Throwaway05
17hr ago
Why shouldn't an owner be able to buy a failing restaurant, sell the real estate, and then let the restaurant fail?
Sounds fine, until your area loses its hospital because PE came in and did something similar (it's a growing problem in healthcare). Lots of organizations you wouldn't want to lose are sitting on valuable real estate and operating with razor thin margins or other similar sins.
Throwaway05
2d ago
Hey man, like what about justice man?
I do mean this seriously however. Don't underestimate how many people on both sides are incensed due to their understanding of the facts on the ground and feel like the situation is untenable. In the case of the pro-Israel side you'll find people from all over the word who interpret events as "I have no particular interest in or affection for jews, but I see Hamas as terrorists and terrorism can't be allowed to flourish, out of either a sense of justice, or out of fear for what may later happen to me and mine if people find this valid."
Throwaway05
2d ago
It's worth noting that while some of the impetus for anorexia may come from social and cultural expectations and so on, it is very, very much a mental illness and has dysmorphic components. You can't easily reason your way out of it especially if people "feel" fat (while objectively being thin, it's somewhat of a psychotic process). "Yeah yeah if I was really skinny you might be right but I just have to shed these last few pounds to be normal" is a bizarre sounding but reasonable in their own mind response.
Throwaway05
2d ago
I wouldn't call it "don't allow." VBAC's can be very dangerous, they can also be safe, the relevant care team will likely try to assess the risks and summarize for the patient. OB is pretty notorious for being a bit more heavy handed with consent than some specialties, but that's ultimately not that unreasonable when many women are interested in fucking off and having a "natural" birth at home even when it's high risk to the baby and mom (and notoriously, will see the doctor even when it's a consequence of their own shitty decision).
This over focus on outcomes and liability potential is also why you shouldn't trust those stories from mothers. Yes it probably happens at times, and certainly used to be more common back in the days when OB was >85% male instead of >85% female, but OBs are way too worried about getting sued and making sure the baby is okay to do that for the most part.*
And hospitals are very likely to have a dedicated laborist these days anyway.
*"Force" mom to have a C-Section and something goes wrong because you wanted to go play golf? That's a multi-million dollar liability judgement. Everyone knows that isn't worth it.
Throwaway05
23d ago
-
Never, ever, EVER, sleep with someone you can diagnose with BPD easily. You're welcome. cries
-
Excuse me what the fuck with that head bleed.
-
Social media autism.
-
All these people are probably borderline.
-
Once you have training to look for mental illness you'll see it everywhere, especially on the apps.
-
Tell them Tylenol is the absolutely worst way to die and to use Melatonin instead.
Throwaway05
15d ago
To conclude, is therapy helpful when administered by someone who knows what the fuck they're doing? Yes.
This point is the whole thing. I notice here that a lot of people seem to have complaints about "endless therapy" and "never getting better," but reputable, well trained therapy involves a constant progression towards "being done" (well typically anyway).
I suspect this is equal parts misunderstanding and a surplus of shitty therapists, which makes sense since it's far harder to regulate, train, and assess than "traditional" medicine.
Small amounts of therapy that anyone with diligence and training can do (like motivational interviewing) can radical improve care for any specialty.
Shit is good when done well. And even more fluffy and "less evidence based" therapy modalities like psychodynamic therapy work great when done by someone who cares and knows what they are doing (and are shocking similar to CBT anyway).
Throwaway05
1mo ago
Dr. House doesn't really exist, the equivalent in real life is something like a specialty tumor board at a premier research institution, which is a group of knowledgeable specialists "discussing" the specific approach to a known problem (and rarely trying to figure out what the problem is or arguing over what it is).
Your situation is different in that you know what the problem is, and it's a basic diagnosis, but you can't seem to get it treated. It's not unreasonable to be like "okay what's up we need more options, more heroic measures."
However, my suspicion is that you need to go back to basics.
Basically - you need therapy. Medication may not help in the way you want it to help.
This doesn't mean you should give up on medications, you can always try more/different SSRIs etc. to find something that hits for you, but at a basic level you have to keep in mind that some things are more responsive to medication than others and this includes in psychiatry.
The classic example non-psychiatric example is insomnia (well some consider this psych). We have meds. We have a lot of meds. We have really expensive meds. We have really dangerous meds you should never use but people demand anyway and have really bad outcomes. What works for insomnia? Behavioral modification and therapy. Works (maybe an exaggeration, maybe not, I'd have to review the data) orders of magnitude better than meds.
In psych - for people with certain types of depression (terminal cancer? live in an active war zone and your family all got blown up?) medications aren't going to work for a lot of people. Therapy is generally going to do more.
Back to anxiety.
Anxiety often requires higher doses of medications (sometimes to the point where the side effects outweigh the value), but best practice is essentially to have medications lighten the load enough for therapy to be useful and helpful.
You don't need a genius psychiatrist, you need an excellent therapist (can be a psychiatrist), which is not the same thing and is something you can absolutely pay for if you wish in most metro areas (and a cheap, serviceable therapist may do). It is possible that a slightly more clever psychiatrist would throw something on that would solve the problem but that should be a secondary goal.
Now I don't know what your relationship with therapy is but you might be skeptical about it and might be asking why that would suddenly be a thing you would need now later in life after medication worked for so long. Additionally, if you are posting here you are probably intelligent, high resource, and rational - and thinking because of all that therapy shouldn't be needed. Unfortunately that's not how this work.
For example: a lot of anxiety related behaviors and experiences are basically just good old Pavlov fucking with your nervous system. Don't matter if you are mucho smart, if the bell goes off you'll salivate.
I wonder if a process like that happened here - you went off the med and expected something to happen or something happened, you felt like the safety net was gone, you had experiences, they rapidly reinforced themselves now you are in an anxiety spiral..... one you'll be able to get out of with time and space maybe, but faster and more effectively with some skills training, CBT, whatever - all with medication as a supportive factor. The meds are often a crutch, and therapy skills can be more definitive treatment (one of the reasons why you may want to avoid meds for anxiety).
Keep in mind that other conditions often work very differently.
It may also be reasonable to see your PCP to rule out any medical problems (not that they are likely) and assuage any health anxiety.
Throwaway05
14d ago
I am sure that some people exist who feel this way, but all of the therapists I know (which is bounded by these people being mostly physicians, or PHD/PsyD psychologists), think that shit is nuts (and have much displeasure with the popular presentation of therapy, mental illness and so on).
Throwaway05
1mo ago
Pretty much everything you've said about the doctor side of things is wrong and much of it borders on malpractice. Frustratingly, I've corrected you on some of the clear matters of fact in the past and you've refused to update, so I guess this is more for the benefit of others who may be looking.
-Physician salaries are not responsible for high healthcare costs. They are a low percentage of healthcare costs. 8.6%. Half physician salaries (which nobody is suggesting and would collapse the system anyway) and you would barely make a dent in cost. Data: Stanford (SIEPR).
-Anesthesiologists do not make 700K a year. The average salary of a gas attending in the northeast is 380k. Data: MGMA survey (granted the one I have is a few years out of date).
--Can a gas attending make that much? Probably not in a desirable geographic area but if they want to work 2x full time or take a lot of weekend/holiday call they can get close. Maybe in L.A. if they do celebrity work, pain management or something like that? The ones I know who crack that level make the money off of owning something, patents, or something else of that nature, not working.
--On a more editorial note, why does gas make $$$? Gas is like being a pilot, most of the time it doesn't look like you are doing something outside of take off or landing but you get paid for the hopefully rare emergencies. Additionally procedural work reimburses well in the U.S. for historical reasons. Fix that problem if you want.
-The average physician salary is 350,000 in 2023. Not far off from Cim's range. Data: 2023 Mescape reports.
-Over half of doctors are in the "low paying" specialties where it's not uncommon for your salary to be under 200k (IM, FM, Peds, Psych). Depending on where you work and what you do you may be able to go over 500k but that's pretty much 95% percentile and involves shady cash only practice or working exclusively night shifts in Arkansas.
-No specialty makes over 800k without it being "fair." What do I mean by that? To make that much you are doing something like cash practice plastic surgery for wealthy people in LA, own and run a business (unrelated or related), have patents/high level consulting work, work 350 days a year (yeah people do do this), or are a neurosurgeon (egregiously long training, work hours, stress, and competency requirements).
-Doctors. Do. Not. Make. Millions. A. Year.
-The federal government is in charge of residency spots. However, state governments and private companies can and do make their own residency spots. We've had a bunch of recent scandals about this as the residents have been critically undereducated and frequently unhireable outside the system that trained them (specifically: HCA in Florida). Turns out medical education is complicated and you cannot just increase spots this is most true in surgical specialities which have small number of highly trained doctors, but also represent most of the specialties making the most money.
-The AMA is not a cartel. Most physicians hate the AMA and have for decades, as they've been lobbying for depressed physician salaries in the form of increased midlevel involvement (which is to the benefit of end career physicians at the expense of everyone else).
Their's a lot more to say here on things like "docs in Europe get paid less because their training is shorter and they don't have hundreds of thousands of dollars in debt" or "training quality if much higher outside the U.S., even in wealthy western countries" but this has gone on long enough.
Cim you have to reevaluate your level of knowledge on this topic because (among other things) you said "doctors should be paid $120-300k a year at the cap, with the high figure for the most elite surgeons in tough specialties" is very close to the system we already got.
Additionally doctor's wages in real terms have been decreasing for over 30 years while costs (including med school tuition) have been skyrocketing. It's driving a lot of people you want in medicine out of medicine. Just 68% of medical school graduates at Stanford went on to residency (with the majority of the rest going into tech or business instead). And that stat was in 2011, can't imagine how much worse it is now.
Throwaway05
22d ago
Mild symptoms complicate both diagnosis and treatment - much of what DBT is designed to help is for moderate functioning people (can be great) and low functioning people (where it isn't likely to).
Your diagnosis could be wrong, but I'd guess what's happening is that you are well enough, and the underlying biological reality of a borderline brain gets in the way sometimes.
However also possible you are what you are and don't meet criteria for anything.
Throwaway05
2mo ago
To what extent should we protect patients from themselves? Two things happened this week that had me considering this again.
One, some discussion on medical reddit popped up about how to handle people (chiefly young women) requesting sterilization at a young age especially prior to having children. This has obvious implications for regret and forcing people to be locked in to insufficiently considered choices.
Two I was talking to a friend who was complaining about a side effect of laser eye surgery and she said she was not told about the possibility. In talking to her she was very clearly told about the possibility of this side effect but simply didn't get it.
This is not uncommon. Either surgeons half ass the consent process, or patients just completely fail to understand and fully grok what we tell them. Generally both.
A different example - I've had the conversation "X problem is gone because of your medication, if you stop your medication X problem will come back" "okay doc I'm here to complain about X problem, I stopped my medication" a million times. Including with smart and highly educated people. People often don't understand what is told to them and that can include things like life altering surgery.
What do we do with this? Do we let people make mistakes? Where do we draw the line?
This topic comes up very frequently in medicine but the discussion quality is generally very poor "protect them from themselves unless they want such and such political topic in which case sterilize them at their request with no counseling etc etc." I think this community may have something more interesting to say.
I especially don't know how to handle this given the tendency to strongly protect autonomy in some areas but not others.
More general CW implications include the usual trans problem, but also "protecting people from themselves instead of the more specific patients.
Throwaway05
23d ago
Funnily enough, no AVM found on multiple kinds of imaging, including an MR angiogram. No kidney disease either. As far as anyone could tell, it was just bad luck.
Fuck.
Also OB/GYN is traumagenic. Complicates the psychiatric formulation.
On a more serious note it's worth thinking about the way autism has become a catch all for poor socialization, that isn't to say that these people don't have some form of autism spectrum, just that it's worth being a bit more cautious with it since it's becoming an over diagnosed thing (at least in the U.S., thanks TikTok!).
Throwaway05
22d ago
Yeah don't date one, but you gotta keep in mind that if you are seeing them (at this phase in your training) it's either so bad they are on an inpatient psych unit or in the ED, or they are in the hospital for other reasons and they are such a pain in the ass that the diagnosis makes itself clear.
In training you'll get the skills to pick up more mild cases in the community, and presumably also see more mild cases in therapy clinic.
This also is true for things like depression and anxiety (early in training you'll only see total shit shows, but more mild cases exist they just don't need you).
This is also, also true for things like hypertensive emergency vs. generally outpatient family medicine seeing mostly controlled shit.
Throwaway05
22d ago
Borderline is better conceptualized as more like depression or anxiety than schizophrenia when it comes to severity. Many people with depression or depressive thought process never present for care, nor do they need it. Some of these people kill themselves.
The same is true with Borderline. At state hospitals in the U.S. you often see a mix of psychosis and severe borderlines who won't stop hurting themselves. It can be very bad. You also have borderlines where the symptoms are so rare or mild that you'd have to have a long relationship with a therapist to catch it.
Don't underestimate how "harmless" it can be.
When it comes to treatment it is treatable. Certain kinds of therapy work (chiefly DBT). Patients accumulate coping skills and calm down just by aging. Medications don't work great but can be helpful for symptomatic management.
Throwaway05
23d ago
Lots of weird shit causes orgasms, and IIRC people have used hypnosis as a replacement for anesthesia. Dissociation is powerful.
If you are saying hypnosis can make your boobs grow then I'm going to call you a crank unless you have some damn good evidence.
Throwaway05
2mo ago
It's pretty common to give print outs like medication information sheets, or something called an "after visit summary." Frequently what happens is that it gets comically enormous and useless as various stakeholders fill it with random bullshit.
Anything more personalized/off the cuff becomes extremely difficult, especially as corporate control of medicine pushes doctors to see more patients faster. Really hard to do when your visits are 15 minutes max and that's supposed to include your charting time.
Throwaway05
25d ago
Hypnosis is actually not fake, it just doesn't work the way people think it does. It's used in modern (Western) medicine it just doesn't really work well and the real version isn't mega useful so you don't hear about it a lot.
Throwaway05
3mo ago
Two additional things to consider:
-
"They" did in fact "interfere" with the election, and publicly admitted to it (see: "fortifying" type claims). This may not count legally as election tampering or whatever but may feel that way to the right and disgruntled moderates.
-
Many voters know someone who hates Trump enough to do this and feel justified doing so. I have several family members and friends involved in government, some of whom I straight up asked "if you had the ability to stop Trump from being elected would you do it?" to which the answer is "yes absolutely, he's literally Hitler." It doesn't take much to believe that some people in the position to do something had the same thoughts.
I earnestly believe that anyone who doesn't get why people have concerns is being obtuse.
Throwaway05
1mo ago
That attitude leads to things like the opioid crisis where the rest of society is left cleaning up the mess left behind by people making questionable decisions.
A huge chunk of healthcare costs these days are associated with lifestyle related problems. That's going to get worse if you have 100k people fuck up their kidneys and need dialysis.
Negative externalities are a thing.
Throwaway05
2mo ago
You may find it fruitful to read some of the work done by non-woke Psychologists and Psychiatrists (ex: Life at the Bottom by Theodore Dalrymple), if for no other reason than to go "my god other people have noticed this!"
Everybody who deals with these people has experienced this stuff but having the tools to diagnose and label what these people do is helpful (and may at times give you some insight in how to work them for your needs).
Throwaway05
2mo ago
You have summoned a crankier doctor than the one I think you are looking for but I'm sure he will chime in at some point.
Some thoughts:
-It's generally standard of care to recommend that patients on psychiatric medication (or just cross through that and make it just meds in general) abstain from alcohol use. This is for a variety of reasons, chronic and acute alcohol use both have impacts on certain kinds of drug metabolism. Some medications have specific interactions with alcohol (ex: Benzos). Alcohol and Marijuana appear to have a problematic effect on underlying conditions (no shit booze is a downer). This also applies to non-psych things. We are going to suggest you stop drinking.
-Just because it's standard of care doesn't mean it's mandatory, but again if we are speaking in official capacity we are going to tell you not to do it.
-SSRIs are (with some exceptions) pretty fucking safe. Older antidepressants have some issues. We have mostly switched for a reason.
-Alcohol is a poison with a very variable effect on the human body. Sick? Tired? Just worked out? Empty or full stomach? Haven't drank in a while? Random luck of the draw nonsense? You'll have a bad time. Easy to blame on the social boogieman if you do two doubles on an empty stomach.
-Personal anecdote: I've run into a "date rape" drug level alcohol response in settings where I know nobodies shit is tampered with, so I'm certain this class of thing exists, including one time where it was me and my own bottle of rum (and I later connected the dots that I recently had diarrhea and that may have been responsible for my bad time...).
-People are variable (duh) and have variable responses to things AND also variable awareness. There are a lot of people in this world who struggle to realize they are drunk until they are absolutely obliterated. You can easily see how those types (or other adjacent groups) might feel they were drugged if they got really drunk secondary to some other non-sketchy circumstance.
-Mixing uppers and downers is a huge problem and a lot of young people don't take the combination of stimulants (including all that Starbucks) and alcohol seriously. That combo can cause severe reactions and more people abuse those things now.
Throwaway05
22d ago
Dawg I haven't changed my goal posts at all you just jumped down my throat reaallllll harrrrrdddd.
Throwaway05
23d ago
I am supportive of hypnosis as a modality but it has limited utility and that utility is further hampered by susceptibility to hypnosis seemingly being more of an innate trait. Some people it works for and they want it to work for and you can do some great things with it but for the majority it is useless.
However overstating its value in the way you seem to do patterns matches to ....a lack of scientific rigor, and I'm saying this as someone who came into the conversation correction someone to let them know hypnosis is actually a thing.
Throwaway05
23d ago
Since you are asking this question I'm sure there is a paper from 50 years ago with terrible research methods that suggests this is a thing, but that doesn't make it not absolute nonsense.
To more directly answer your question, I predict the literature that is the body of scientific knowledge suggests that this is not a thing and does not take it credibly. The existence of crank papers to the contrary does not mitigate this.
Especially since it is now known that many strange papers at the time represented intelligence work.
I see a much bigger rise in prevalence in women and assume the usual causes, for instance I've had a number of female friends and family members asked me if they should get a tattoo, if they'll be judged for it, will men hate it etc. I say nothing. Which is the same approach I assume most people use. The judgement for tattoos is still there, but saying anything that can be interpreted as critical to a woman is such a bad idea that people say nothing and the gap in preferences goes unchallenged.
More options
Context Copy link