Throwaway05
59m ago
It's a real problem with research done on it - check out abx resistant in STDs (and by this I mean the details) MRSA vs. MSSA is a huge issue also.
We are in the growing warning stage with tons of money being pumped into avoiding the problem but as always man on the street won't notice until something boils over.
We have plenty of back up agents but often it means a switch to something less convenient, has worse side effects, or in the case with MRSA may result in increased sepsis fatality rates because of complicated things like time to static blood concentration, interaction with comorbid end organ dysfunction and other blah blah boring but important stuff.
Having an illness that goes from no big deal to no big deal but 1.2 out of 10k have a joint explode is not something the average person is going to notice but is an avoidable problem if idiots would stop pretending like they know everything and their doctors thousands of hours of education was meaningless.
Likewise you have stuff like some drug addict, illegal immigrant, or even just a regular person with the wrong insurance getting housed in the hospitals for 6 weeks because IV antibiotics is the only thing that works now instead of oral.
All these small things grow and contribute to the collapse of American healthcare.
In other countries rampant with problems (India, China) they just let people die a lot more. I'd like to keep our system.
Also hospital specific antibiotiograms are a thing.
Throwaway05
1hr ago
One of the most obvious examples if STDs, which is a known (and serious and growing) issue that's been magnified by homosexual sex norms (especially now that we have HIV medication).
Throwaway05
1hr ago
Historical research into PTSD and other conditions exists and has answers to some of these questions - life was better in some ways is something worth remembering (working with your hands, having nature around you, strong community). Also keep in mind that people with lots of conditions just tended to die or get killed if they weren't rich/powerful (ex: bipolar, schizophrenia).
Throwaway05
1hr ago
Plenty of people in my oil can't refer to him by name or refuse to reference him as the president, including some more moderate democrats. Could be a regional issue, but it is a real one.
Throwaway05
1hr ago
My understanding is Rubio is both in charge and has a detailed understanding of the region (and has been killing it down there). If I had to guess (based off of no particular special knowledge other) our move is in response to the oil dispute with Guyana.
Throwaway05
2hr ago
Structural but non-content spoilers, might do something though since I read on a chapter not book basis and I'm not 100% sure where you are:
It sounds like you spotted some of what made me raise an eyebrow tho.
Throwaway05
1d ago
Can we build a Golden Gate Bridge today? Can we still go to the Moon?
We have the money. We have the technology. In theory, we still have the know-how.
But we don't have the will. It's graft all the way down.
For sure cost disease and other considerations are problem, but on a positive note - when I-95 got shut down a few years ago near Philly it did get fixed real fucking fast.
I suspect if the need is there we can fix stuff quite ably, we just don't bother to or need to most of the time.
Throwaway05
1d ago
I feel like I usually see "he's perfect and would never do that to me" +/- "except for that one/fortieth time" in the early stages with later stages being even more awful than that.
Throwaway05
1d ago
I think it's truly the most banal of explanations - all those other riots, those didn't put them at risk. They saw the burning but the burning was for other people. But this one? Oh god that impacts me! Add a media class that identifies as part of the same DC elite that was terrified, and then you get the push.
Throwaway05
2d ago
I mean, I get why people take the Soma, but also it becomes a self-fulfilling prophecy.
Additionally most people don't have that insight into why they are doing it.
Throwaway05
3d ago
Ughhhh for medical work a deep dive involves citation which sounds like a lot of work. Maybe at some point, but for now some thoughts:
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Weed is a drug. Maybe more on the alcohol tier, but it's still a drug. If you talk to people who use many of them sound like addicts. It's not a mistake to notice this, they are. You can have withdrawal (although it's in many ways not as bad as some other withdrawals). People in denial of having a problem... Also, cannabis hyperemesis syndrome is a thing. You'll see patients come in multiple times a month with profuse vomiting and we know the exact cause and they have zero ability or willingness to calm down. Total addiction.
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It hampers human flourishing. For many people the primary problem is that it makes them feel okay with their life being ass. To some extent that's a good thing but I know plenty of people who didn't try to fix stuff as a result. That's bad.
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Plenty of people (as with alcohol) use a little bit and don't have any problems at all. Moderation is possible. This creates a context of false sense of security.
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The association with positive impact on the supposed indications is questionable. Anxiety and insomnia are best treated by addressing root issues. Use a drug is a crutch that prevents recovery. For many it actually worsens these things, and passing out does not mean "sleeping."
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Most importantly, like with alcohol a particular subset of the patient absolutely cannot. Psych patients. These people will go by even more unsafe street weed these days if they can't get it at dispensary (usually stepped on with a....variety) so hard to stop it, but it worsens all kinds of shit and can make recovery and tons of these people think its an adequate treatment.
Nearly every patient with a psychiatric diagnosis you see in the hospital - and I'm talking on medical floors too, has a massive weed addiction.
Some of these people also appear to have been created by weed.
Additionally, when I was young I remember people going "pshh they are overstating the risks, but risks exist?" with drugs. Lots of young people today are "this is perfectly healthy."
Throwaway05
4d ago
Personally I thought what you are talking about works fine, my concern is just pacing issues. The ideas are explored with the usual higher degree of competence than I would expect from random web author.
Throwaway05
4d ago
Don't worry I'm still loving it! This book just went in a very different (literal) direction.
Throwaway05
4d ago
I think we are slowly starting to establish the evidence base for the current schedule to maybe be appropriate.
For a long time "medical" use was just cover really, and for some of the proposed indications (anxiety, insomnia) it's at this point understood to be an actively bad idea. Chronic pain is a bit more debatable and for increasing appetite it actually works great.
The bigger problem is the growing damage to general human flourishing and the really significant negative impact on patients in the psychiatric population.
Throwaway05
4d ago
What did you think? I'm worried about the possibility of things going off the rails a bit.
Throwaway05
4d ago
Yeah all kinds of arrangements do exist, I'll note specifically that nurses tend to wear a much more limited number of hats and have less burden associated with "being on call" and if no patient is in the ED no work for the nurse. The PCP may be seeing clinic patients in between ED patients.
Throwaway05
4d ago
Some of it is a focus on hard blue tribe recruitment.
Getting through the undergrad and medical school filters requires a lot of woke interest and an aversion to red and rural areas.
Do some affirmative action or requirement focused on getting people who want to go to those areas and you'll have doctors who want to go as an adult, but for now a lot of people are straight up afraid of big cities in Florida because of dem Republicans.
Doesn't just need to be salary push.
Throwaway05
5d ago
I will say that the shortage in specific competitive subspecialties is a little more complicated - I can't say for sure that they are lobbying to reduce training volumes but it wouldn't be a stupid thing for them to do. That said for many things (especially surgery) getting requisite case volumes and educational quality is an important complicating factor, especially in the era of robotic surgery.
Most of the "shortage" is inadequate primary volume, but primary care doesn't actually pay that much and people want to be in big cities so it is an allocation and funding problem.
But since "pay the doctors more" is an unacceptable response...it doesn't go anywhere.
If you'd like to learn more about the noodly bits of the American system their is a YouTuber Sheriff of Sodium who does long form videos analyzing these things.
Throwaway05
5d ago
This is a meme passed around by anti-doctor idiots.
The government funds a good chunk to most of the residency spots, this number has been flat mostly due to US government dysfunction. Hospitals and States are welcome to fund their own spots and in recent years have increasingly done so (with mixed results since one of the biggest funders is a shitty for-profit health system).
Every year there are tons of unmatched residency spots (almost always in less desirable specialties). Places would rather not be fully matched than pull from the candidacy base.
When it comes to Medical Schools, the number of them has increased wildly in recent years. This has been questionably helpful because most of the new ones are bad and residencies won't take bad applicants, they'd rather try and SOAP or try again next year.
Additionally, because of the salaries the U.S. never has to deal with an applicant shortage - most of the world's best students will try and match here, even if the U.S. schools don't have enough graduates they don't need to worry (again they just won't take them because reasons).
Lastly it seems reasonable to assume that the AMA has some questionable lobbying on this subject in the past, I don't know about this for sure though - what I do know is that most of their lobbying has been spent on social causes and expansion of mid-level practice rights in the last few decades and they have rock bottom support from U.S. physicians at present. They are not an influential lobby either, which is why our salaries have been going down also for decades.
Throwaway05
5d ago
SMH already answered but at a busy city health system you have a level 1 trauma center, inpatient consults, outpatient clinics for everything, internal medicine teams with appropriate specialties etc etc.
At a rural hospital all of those things are Phil, the local family medicine doctor.
Obviously that's a bit of an exaggeration but true rural medicine involves the ability to do anything which is both empowering and terrifying.
Also you are always on call - the city hospital has a dedicated nocturnist and moonlighters for holidays.
Throwaway05
5d ago
I've heard anecdotally from the national media that the DC NG has made a huge difference.
Less reporting of it being helpful in other areas, the proposed explanation for that is that DC was somewhat open to the idea and coordinated areas for them to be present.
Even some dems have supported it, although usually quietly.
Throwaway05
5d ago
AMA limiting medical seats and residencies than it has to do
Sir!
I expect better from you, that's not how it works at all. ;_;
What have my rants been for!
Throwaway05
6d ago
Sounds like you are talking about outside the US - the US is usually different in medicine when it comes to a bunch of stuff. However it seems pretty similar on this issue. Yes male doctors are more "normal" now but you are still significantly more likely to find the population we want in men over women.
Doctors in the US also avoid rural areas but its a bit thornier because the US has a ton of them, the salaries involved can be eye popping in some places (like Alaska) and because a good chunk of the problem is downstream of politics. Since the student population is overwhelmingly leftist and feel like they are giving up good leftist opportunities by learning in Iowa City or Scranton, once given freedom they centralize on big blue cities much harder (especially since many are non-white and have racism fears in white places).
At this point we've spent decades farming poor and rich minorities and made no effort at all to grab people who are likely to return to Iowa after graduation. It's a problem.
Also it seems like night shifts in the U.S are increasingly done as part of part time money farming, poor resident staffing, and shit mid levels.
Throwaway05
6d ago
Yes female doctors hire nannies, and they are more likely to drop out of residency, have shorter careers, take more vacation, work less hours, and take on more administrative roles.
The absolutely huge gender disparity in medicine is a complete disaster because you need psycho hard working men for the whole thing to work.
God I wish I could get people IRL to think about this at all.
As usual I'm probably pissing into the wind here but this is so much more complicated than your over simplification. You aren't paying healthcare workers to answer simple questions, you are paying them to do things like know when something isn't actually simple - ex: your shoulder pain isn't your shoulder it's your gallbladder and you need surgery not pain killers for your arm.
Patients will always ask for antibiotics even if we know in advance the issue is viral and antibiotics won't do anything, and that's not counting the goal of abx stewardship, or just minimizing side effect burden. No medications are safe, if you give everyone in the country a full course of antibiotics people are going to lose their kidneys, have joins explode, or just flat out die.
All lab testing has sensitivity and specificity and someone needs to know when it should be ignored.
And so on and so forth.
And if you went to an urgent care you probably saw an NP/PA who doesn't know what they are doing but was put in place as a misguided cost saving and simplification mechanism.
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