Throwaway05
10mo ago
Time to kill some of my opsec. I have personally argued with Deb Koss at a conference in D.C. telling her to cut this shit out.
I won't say much about it but she (and others like her are) exactly as you'd expect.
It's not as worrying in the disciplines like Psych (hers), ID, and Peds where people are overwhelmingly left leaning but these advocacy people are still DEMANDING trainees participate in advocacy and politics (and it's always one specific kind of advocacy). Trainees who can't say no without negatively impacting their careers. It's gross and deeply unethical.
Furthermore these idiots seem fundamentally incapable of understanding how damaging this is to the long term health of the profession.
It's no different than any woke ideological capture but with a very damaging set up levers (ensuring incoming medical students are very left leaning, brainwashing them during vulnerable periods like residency, and mandating leftist political advocacy as part of educational curricula).
I hate it.
Throwaway05
7mo ago
I'm shocked that you thought even for a second that Bluesky would be better than Twitter - it's purpose is to be a new home for people who are upset that moderates and conservatives are being given a voice, any early adoption is going to be centered around that. Yes some of the media are trying to take mostly apolitical stuff over (like football) but its purpose is still "fuck Musk for platforming people we hate."
Throwaway05
4mo ago
Actual quote from my last time talking to a patient in the ED:
"A shelter, why the fuck would I go to a shelter doc? It's fucking filled with homeless people, besides they won't let me get high on crack!"
In order to fix the problem you need to be willing to violate some people's rights and to discriminate, the former is something that you do sometimes see flexibility on in the left but the later...
Throwaway05
4mo ago
Two case studies in government waste:
As you can likely imagine right now a lot of people in medicine are sharing tales and taking sides in the great DOGE debate. Two that popped up on my radar and stuck out to me:
- One of my medical school classmates is a psychiatrist at redacted city hospital. He has been informed that the state Medicaid will no longer pay for psychiatric emergency room visits if the patients do not go to their aftercare appointments within 30 days. They have been informed that they could lose their government funding if enough patients fail to do this.
Some problems: -As an emergency room most of their patients have no insurance or Medicare or Medicaid, meaning the facility often get paid less than cost. They only stay open at all because of their state grants.
-Many of the patients are drug addicts or malingering (because of homelessness for example). Every day you’ll hear something like “you’ve been here every day for the last three weeks” or “have you considered stopping using PCP? You always seem to fight with the police when you do” and “here’s your follow-up appointment, will you go? No? Fuck me? Okay thank you have a nice day.”
-Many of the patients who do actually have mental illness are in denial about it, or have some sort of limitation that prevents them from attending aftercare appointments.
-The “best” solution is probably to violate patient rights and involuntarily commit them to make someone else be on the hook for making sure they go to their aftercare.
-In the meantime, the hospital has hired several additional staff to manage some of the administrative complexities associated with this change (for example hammer calling the patients to remind them to come to the appointment). They have also hired night staff whose job is to sit in an office overnight purely to schedule appointments with an outpatient program (otherwise no patient could be discharged overnight because they wouldn’t have an appointment to go to…).
- One of the residents I mentor is about to do a rotation at the VA. This is pretty common for residents. His rotation starts in a few weeks. A few months ago, he got an email that included the instructions “it is imperative that you start your onboarding process for the VA right now otherwise your onboarding may not be finished by the time of your rotation” and “it is important that you not start your onboarding right now as it is too early to start onboarding and your onboarding may not be valid if you complete it too early.” This is not a joke or an exaggeration.
Anyway, he dutifully completed his requirements in a timely fashion (which were all pointless! Ex: what is the motto of the VA???). So, months later his rotation is starting soon. He begins the process of emailing the education team once every 2-4 business days. You have to email them multiple times before they respond. The conversation goes something like this over the course of multiple weeks, “I think I’ve completed my onboarding do I have to do anything else?” “no” “okay is my onboarding done” “no” “okay when can I pick up my ID card” “when your onboarding is done” “I thought my onboarding was done” “yes” “okay what I am waiting on” “nothing.” I have seen the emails; it really looks like this.
At this point his program tells him to CC the chief of medicine at the VA hospital, at which point the person responds with “okay we put in a ticket for this a month ago, your training is complete but your training is marked as incomplete.” A screenshot has been attached that shows the request and an automatic response that says something about high ticket volume and that they will get to it at some point. The chief of medicine replies “….does the trainee need to do anything?” (we are here).
The resident will be able to rotate but will not be able to do any work without computer access.
It’s worth noting that the VA is paying for this resident to be there, despite the fact he will in fact not be able to do anything. At his last VA rotation (yes they go through this for every resident every time) he was six weeks into an eight week rotation before he got access.
Throwaway05
8mo ago
Trump's interview with Joe Rogan is out. I think it should be mandatory viewing, as someone who has read a lot about both of them but never heard either speak at length I had some interesting surprises.
I spotted a few major pieces of culture war fodder.
-
Joe apparently didn't want to do this because he was worried it would end up being fluff or making Trump look good.
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I do think it makes Trump look good. It's the beer test, implemented, and for all to see. Many people have the instant opposite visceral opinion. As with everything about this, that's interesting.
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Most here have concerns about legacy media, I think this adroitly makes the case against legacy media - as does Joe himself explicitly multiple times during the interview.
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I've polled some Kamala supporters and they all think she'd have done just as well, but I highly doubt that.
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Trump gets asked about election stealing...and some of his answer kinda matches some of the "best" answers we see here (complaining about procedural changes and so on).
At time of this posting it's at 18 million views in the same number of hours.
Throwaway05
2mo 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
8mo ago
He knows exactly what he's doing.
As a point of fascination with Trump I'm not really sure if he knows exactly what he's doing or he's just an entity who has gone through enough selection pressure to emerge as a thing that naturally does this kinda stuff.
Throwaway05
10mo ago
They do still exist but changes to the pre-matriculation "requirements" have decreased their numbers, and being "outed" as conservative or woke-questioning will kill your social life so they tend to be super locked down.
Add on the requirements to publicly go through the motions during times of profound stress and exhaustion.... you get people who legitimately convert or experience permanent changes.
Remember that medical school clinicals and residency is not far off from outright torture in a lot of ways and people get 1984'ed while going through this.
Salary and taxes walk some people over a few decades but it is less than it used to be.
Throwaway05
10mo ago
A lot of things are going on here, some of which are a bit more complicated to get the full picture on like the historical issues with hierarchy and abuse.
Two simpler bits:
-You don't decide where you work and learn during training and if you leave, quit, or get fired you are done. Sometimes with upwards of 500k in debt. Programs know this and will mistreat trainees knowing they can't vote with their feet and their lives are pretty close to over if they don't suck it up. Suicides and deaths from things like sleep deprived car accidents aren't common per se but are frequent enough that we all know multiple people who went out those ways.
-Unlike most high education/high skill labor you need a lot of 24/7 coverage and physicians are very expensive and in high complexity specialties like surgery you have to do a FUCKING LOT of stuff to become independently proficient in a reasonable number of years. The solution is typically to rely on trainees and long hours. On paper Residents aren't allowed to work more than 80 hours a week, must get at least 4 days off in a month, and aren't allowed to work more than 24+4 hours in a row. On paper. Very common for people to violate one or more of those in an easy specialty at an easy program. In something harder like procedural specialties? You might work 80-100 hours a week with an average of four days off a month.
For 5 years.
Shockingly!!! Substance abuse, mental illness, and medically measurable premature aging (fun study that one) are rampant.
This breaks people down and I think could be reasonably considered torture.
Add on the fact that you can't leave, and many other aspects of the training can be considered abusive (said things that are a bit harder to explain)...
Throwaway05
1yr ago
Obviously, most are highly interested in the president’s mental status right now so I figured I’d outline some related medical content.
Caveat- I’m not a geriatrician because fuck that (sorry if you are), so if anyone wants to throw out more specific domain knowledge feel free.
As is usual for medicine, terms are both highly specific and something that specialties don’t necessarily agree on, I’ll skip most of this to avoid blathering about the difference between a mild vs. major neurocognitive disorder vs. dementia as much as possible, but is it worth noting that the word dementia in a colloquial sense can end up being used to refer to normal or above normal age related cognitive decline and changes (which is likely what is happening to the president), or it can be used to refer to one of several highly specific disease process that may result in things like fast or slow progression, or extremely worrying symptoms like hallucinations.
A lot of people have commented “well my grandpa had looked like that” type comments and that’s not necessarily bad data but specific diagnosis of this stuff is surprisingly complicated and unsatisfying since a lot of it requires looking at the overall “clinical” picture and going “yeah probably” (including waiting years to see if progressive decline is happening) with confirmation being only available post-mortem if at all. One of the reasons for this is that the wheels falling off your brain results in some weird shit, some people get behavioral changes years before they get memory problems which leads to them getting diagnosed with something completely different, or something that is not even a “dementia” at all. It’s a huge pain in the ass.
As an aside, I think we may good evidence that the Biden administration is aware of and lying about his neurologic health, which I think many suspect but something that we can point to as evidence is helpful.
Readers may be aware that for a number of years Biden has been publishing his health assessments due to questions about his medical health and fitness. I have used these as a teaching tool because they are exceptionally well written notes and learners can get quite a bit from them. They can be found via google, however: https://www.whitehouse.gov/wp-content/uploads/2024/02/Health-Summary-2.28.pdf. Caveat – I don’t have specific knowledge on presidential notes, it may be standard of care to neglect to mention the specific stuff I’m going to talk about. But I question that.
If you read his note, you’ll observe he had a very extensive neurologic exam (as every president probably does and everyone probably should but doesn’t), but he actually has notable neurologic findings. These are ultimately unexciting and not related to the problem at hand, but it means his neurologic exam was performed and reported. Problem: a neuro exam includes assessment of cognition, sensorium, etc. It’s not all reflex hammers and muscle tone (for shits and giggles here’s a citation PMID: 32491521). Sidebar: this note does seem to rule out most pathology with notable physical component like Parkinson’s or cerebellar problems. Since specific deficits are present and commented on, I actually believe that.
However, I do believe his mental status exam is not being reported on, or was declined. Every patient who sees a doctor is having their mental status assessed. Most of this is invisible and often it’s not commented on in documentation. For a primary care provider role, you don’t need to comment on thought process and affect, but you will eyeball the person and if something looks off chase it.
Your doctor is paying attention to what you are saying and how you are saying, but mostly this is on autopilot. Standard of care is to assess orientation “who are you” “where are you right now” “what’s the date and time.” You might not get these questions every time because if you are having a complicated conversation with the doctor, they’ll assume you are oriented (rightly so) and then spare you the stupid questions. Asking them is however the standard of care, and you bet Biden is getting asked those questions and other basic mental status exam questions, which typically include things like some basic math and read back of three objects at five minutes.
Example MSE: https://meded.ucsd.edu/clinicalmed/mental.html
Now with someone in Biden’s age range, gaffes, stress levels, and observed behavior I’d want to do a more exhaustive test. Again, my feeling of what represents standard of care is that he needs a higher level of screening tool, which I do not see reported. Likely declined or deliberately skipped by his physician.
So, what are these? Two standard ones you can look are the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). You can google these yourself and these are what inspired me to write this. For the most part there isn’t fancy brain imaging or lab tests, we ask you to name a lion on a sheet of paper and you can’t and you get a “dementia” diagnosis.
The fact that nobody gave him an MMSE, reported that he got full points (which he should if he’s the fucking president) and has pointed to that as positive evidence….that’s concerning.
These instruments can be performed by anyone, I want to see Trump chase Biden around with a MoCA sheet, shouting “do you have a moment to talk about your mental status???” The tougher part is ruling out medical causes of illness, which they did as normal.
TLDR: Typically, if you come in for a neuro-cognitive assessment you’ll get labs and imaging, but the doctor will know the level of impairment from history taking (including with family) and from the physical exam. The history taking requires some art, but the exam portion comes on a sheet of paper and can be performed by basically anybody in under 20 minutes. It’s not asking the president to sit in an MRI for a couple hours. This has concerning implications.
Throwaway05
3mo ago
Die
Very funny Worf, eat any good books lately?
Throwaway05
10mo ago
For a few decades Medicine has felt angsty about claims of bad bedside manner in practicing physicians (never mind that this is as much about inherent pressures in the field and foreign trained doctors as it is about individual physician temperaments). The solution was to deemphasize grades, MCAT, and other traditional measures of academic success (and also research prowess). As we've pushed into the woke era this has turned more into looking for students to be engaged in specific types of volunteering and political advocacy. About ten years ago the MCAT was heavily updated to include woke content (although obviously this was pre "woke" era).
Additionally affirmative action* has gotten more and more egregious - troublesome given drop out rates and early retirement/exit from the field in some of those demos. On a less official note you'll schools pushing for "does this student match our mission" behind closed doors in admissions committee meeting. Of course this primarily impacts people from less affluent backgrounds and less prominent schools, since people with good backgrounds manage to slide in as usual.
Between affluent American children naturally becoming more woke and deliberate fingers on the scale with respect to who gets admitted theirs been less complaints about explicitly woke curriculums (sometimes removing traditional educational content and replacing those content hours on more trans health or whatever) some of which gets to the point where even the supporters are like...eesh man that's a lot.
The first part of the medical boards (Step 1) was also made pass/fail, which was sold as a way to increase diversity since minorities didn't do well on it, but was basically a move by top tier medical schools to make the bottom of their class look better, which absolutely worked leaving talented people from mid and low tier medical schools unable to differentiate themselves and move up a tier for residency. Anti-meritocratic bullshit.
*I'm going to throw women in here even though they are better candidates by most metrics but the problem is that they have a tendency to eat a training slot and then get pregnant a year or two into their career and then never return to the work force or work reduced hours, which is a huge issue with doctor allocation and shortage problems.
Throwaway05
2mo ago
Your story about "Daily Kos grandmas" who literally don't remember what they used to believe in is of course nonsense (just like all those Never Trumpers who are now MAGAs do, in fact, remember what they used to believe in). People remember, they just rationalize it or else they develop coping mechanisms for the cognitive dissonance.
I'm not sure this is the case. The one that sticks out to me the most is the initial response to COVID. So many people don't remember the early days where believing in COVID was racist and bad. They just swapped back and if you try and remind them now you'll get a lot of "holy shit I forgot about that" or "no way!!!!!!"
Throwaway05
2mo ago
The Great Books program is specifically supposed to be a replacement for a traditional college curriculum in which you learn things from primary sources in and see Western Civilization being shown off.
Much of what you ask for is contra to the mission - if you made the changes you are suggesting it would be something else.
It's like getting annoyed at Western Canon lists for not having Eastern material.
The following is loosely based on true events:
Imagine you are a trauma surgeon.
You work in a small trauma center; you show up to your shift. There’s more shouting than normal in the ED, so you head to the trauma bay first.
24 hours to go.
The first thing you see is a headless body in one of the bays. “What the fuck is that Jim” you say to your colleague, who is currently administering chest compressions to a clearly very temporarily alive patient, and only such because someone is basically rhythmically punching her in the heart.
“Oh yeah, EMS didn’t want to call it so they left that there. Paperwork, you know? No idea where the head is.” He pauses. “Car accident, we think, didn’t get a great report before they ran off.” He then grunts and someone else takes over chest compressions, he walks over to lab print outs and stares at some numbers, willing them to change. They don’t. The patient gurgles for a second, everyone’s breath pauses as they hope, but then nothing else happens. You look back at the patient being coded, her chest looks like it has the consistency of spaghetti and meatballs.
You take in the scene and then ask the dreaded question “how long?” “we don’t know, she was down in the field and we’ve been doing compressions for…30 minutes?” One of the nurses’ interrupts “43.” You stare. He stares back. He then points to the pediatric trauma bay. The curtain is closed. “I didn’t want all three, you know?” You nod, then walk over to the headless body. “Time of death, whenever the fuck now is. I’ll chart later.” Someone reads off the time, someone else writes it on a post it note and puts the name of the patient on it, and then slaps it to the computer you usually use.
You briefly consider how aggravated this would make the hospital legal team when a nurse walks in from the main ED, exposing the headless body to a bunch of civilians waiting for treatment of their mild respiratory infections. She says “umm doctor, the one patient wanted to talk to you about their pain medicine. Thanks!” She then runs away before you can ask follow up questions, and you hear her saying to another nurse “OMG it’s just sitting their headless.” A patient looks ill hearing this.
“Fucking nurses” you say. “Fucking nurses” the nurses in the trauma bay reply back.
Anesthesia sighs.
The phone rings, you pick it up. It’s the OR. “Dr. Fuckmylife, how can I help you?” “We’ve got a hot gallbladder down here, and then you have emergency cases for the next 12 hours. Jim’s got the bay, can you come scrub?
You sigh.
23 hours and 45 minutes to go.
Early training is not going to help with the above shitshow.
Throwaway05
1yr ago
A friend of mine recently went to a specialty conference, she described a lecture she saw that was talking about the difficulty in giving feedback to students these days, a student at the end asked "wait is that why all of my friends and I are told we are doing great the whole rotation and then get a 3/5 on our evaluation at the end?" Everyone just nodded.
Good teaching requires being able to safely give feedback and that just isn't possible anymore. The problem isn't limited to minority students.
Okay fine this a bit of an exaggeration but still.
Throwaway05
3mo ago
terrifying precedent
I was terrified when the democrats stopped listening to the court system (ex: gun control), ignored violent protests (BLM) and engaged in unprecedented law fare against individual politicians and an entire voting block (ex: anti-BLM, J6).
This is just more of the same or better than all that.
Throwaway05
3mo ago
Personally, I've never seen one.
I've seen a few of these in my life (both personally and as a treating physician) and have a few coworkers who meet this description. The classic example is boys who are a little too male for our current teaching paradigms. Think poor behavioral regulation or ADHD. If they have a supportive home environment and intellectual reserve it is very possible they'll stay out of just enough trouble/troubling behavioral patterns for their frontal lobe to develop and adequate coping skills/treatment to come into play.
Then they end up being productive members of society.
The American problem is the lack of sufficient home support for this to gracefully happen, then they fall out of society. School alone is pretty ineffective at covering that but you do need both.
Throwaway05
4mo ago
If you are asking this question you are likely not from the U.S., so some details:
The VA is the U.S.'s primary "socialized" medicine - health care for veterans.
It's been criticized for having amazingly poor care (what's the difference between a VA nurse and a bullet? A bullet can only kill one person), being more of a job program than a health system, at the same time some people love it (everyone involved understands the veteran experience).
It's a huge system with a ton of rot that is essentially a preview of what would happen with single payor in the U.S.
Throwaway05
8mo ago
On this note, I have a large number of friends who live in a Blue state, and have a tenuous connection to a swing state (for instance their parents live there) and they are just registering and voting in the swing state via absentee ballot.
Anyone who can swing it.
Throwaway05
6mo ago
I wish there was an Angi for health services.
Their is. Sort of - and they fucking suck.
The industry has essentially landed on patient reviews as the mechanism to do this and you can find all kinds of websites that track this, and certain forms of reimbursement may be partially contingent on patient satisfaction metrics.
The first layer of problems is the usual review issue - most people don't bother to leave a review if they had average care, a small fraction of people who receive great care leave a review, and a lot of people who are mad leave angry reviews, this creates a lack of realistic balance in the reported experience.
The other piece is that what makes for good care isn't usually legible to patients. NPs like to brag about studies where they have higher levels of patient satisfaction and it's often tied to not appropriately saying no to patients or things like unnecessary testing and treatment. People don't like being told "no" or "I don't know" doctors are better at doing that but it pretty uniformly pisses people off. The classic example is telling a patient no when they ask for antibiotics for a viral infection. This is good healthcare but obviously decreases patient satisfaction, and that's not bringing up things like angry patients seeking drugs of abuse and review bombing, or psychiatric patients who are angry because they have poor insight and received good care.
Outside of outpatient clinic medicine things get even trickier. The best hospitalist in the hospital is spending his time not in the room with you running down to pathology and radiology, calling insurance companies or social workers for dispo, teaching students, etc. The worst is sitting in his office playing Sudoko. Both only spend five minutes with you a day, you'll have no way to tell if they are good or not unless you have an avoided near miss or something like that.
I was hospitalized a little while back at my own hospital and was the victim of a pretty severe and unacceptable/easily avoidable medical error. I don't think a non-doctor would have even noticed.
Some other examples - anesthesia.....you'll wake up either way, the horribly wrong outcomes aren't generally the doctor's fault. With good gas you'll have an easier emergence, or if you know exactly what to look for on your anesthesia record you could see you were getting good care. How many people get enough surgeries or have the training to read those tea leaves?
For surgery... a lot of aspects of outcomes are patient and not surgeon dependent (like overall health status, engagement with PT), you don't know if your insides are an avoidable mess afterwards or not. The good surgeon might make your next surgery much much easier but you are unlikely to ever know. Patients will also often jump at the chance to get surgery not realizing when NO surgery is the better outcome. You might be a better doctor for saying no...and get worse reviews.
Exceedingly hard to manage this.
There have been attempts to look at more formal outcomes and this rapidly runs into pretty severe juking stats and perverse incentives.
A classic example is transplant surgeons forcibly keeping patients "alive" to get them to die outside of various thresholds (since that gets reported).
Surgeons will sometimes refuse to operate on risky cases because of the morbidity and mortality outcomes. Some of the best surgeons have the worst outcomes because they'll swing on cases that others won't. Some of the worst surgeons too - they'll swing on cases that they shouldn't.
It's a mess.
I do get asked "how do I find a good doctor then." I don't have good advice for this. In my specialty and my area? I already know who is shit and who isn't and hoard that knowledge like gold. Some related specialties? My specialty further away than I don't know them personally? Sometimes I can guess, but mostly I just have to know someone in that specialty in that region who has the wisdom to be able to determine which of their colleagues are ass.
That is not generalizable.
Throwaway05
1yr 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
11mo ago
I don't think I agree with this characterization (but in a way that makes the whole situation worse lol).
As part of my job I spend a good amount of time explaining complicated topics to "stupid" people and those who have some permanent or temporarily form of cognitive impairment. If you sit down and explain things calmly, slowly, and carefully you can explain most things to people. But they have to be interested, which is the first problem. Frustration with complicated systems is up and attention spans are down. You also need to have the time, energy, and wisdom to simplify the complicated thing, some combination of those is usually lacking.
Some of this is the fault of parents, school, and society not taking a breath to say for instance "insurance does this, it's not a magic button, it might not make sense to use the insurance, for instance if you have a small amount of body damage to your car......"
Cherry picked examples of people being freaked out and disappointment or angry misses that those people may be in shock about what happened, lying, or engaged in motivated reasoning as an ego defense.
The other big piece is that people involved don't understand these things. Many physicians don't really have a good understanding of insurance as a consumer, and as it results to their roles either. The former is generally a problem interest/time/frustration instead of intellectual horsepower or education. The latter is because of games insurance companies play to not pay. We have dedicated staff whose job it is to deal with insurance, and they don't have any clue most of the time either they just bang their heads against the insurance company until it does what we need.
I've seen people arrive at a DMV in an expensive Italian suit and have to leave because they misread something and they could only come on Tuesday's or need another proof of ID because this proof of ID valid in their old state isn't valid in the new state.
I've seen a professor walk out of a building at an Ivy League school and start to get on the wrong train on public transit because the signage was terrible.
Yes being stupid at baseline, having a poor attention span etc. can make problems more likely to happen but intellect and education aren't protective enough, you need to be attentive and practiced with these symptoms and that's hard to ask.
Some of our systems for the most indigent actually work better (for some definitions of better) than for the upper or middle class. Medicaid sucks and is a pain in the ass but a lot of places have staff whose job it is to navigate those things for the patient, and the specific way the suck happens sometimes makes it simple at least.
I don't know, I guess what I'm saying is that all the systems fucking suck and being stupid makes them worse but they fuck over plenty of smart people and can easily seem like a nightmare for them also.
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.
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.
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