Throwaway05
1hr ago
It's a combination of resource stewardship and modern day politics, as everything is.
A few things make this vaguely feasible though - the criminal underclass is the criminal underclass, these people are out there "safely" being repeat offenders without causing significant issues, we just notice the fraction that do cause problem and not the 9 others who don't. Likewise a large fraction of people causing trouble are mentally ill or behaving in a way that gets them in front of the healthcare system, if you decarcerate you hope they head over to medicine and get managed that way.
Throwaway05
2hr ago
The flu vaccine certainly doesn't work as well as some of the other vaccines, but it is very clearly a vaccine, I don't know what the other poster is on about on that front.
The flu vaccine is one of the odder and more complicated vaccines we have - we have to guess for the yearly formulation some years we guess better than others (based off of the expectation of what this years flu will look like). It also is not good at preventing you from getting an infection, what it is good at is preventing you from dying. People will often say "oh I have the flu" no, usually they have the common cold - the flu is ass.
As for if it makes sense? Young unvaccinated people die from the flu every year, not a lot of them but they do. Vaccinated people have a much better time - all cause mortality reduction in 65+ is 20%. If you are the kind of person who doesn't wear a seat belt maybe skip the vaccine, but if you wear a seat belt then this is up there with the most impactful things you can do to prevent random risk of death.
The COVID vaccine gave me flu symptoms, flu vaccine never did - which is the case for most people. If you do that's certainly a better reason to skip it, but when my non medical (male) friends ask me about it I ask them if they are a pussy.
You can go to bed a few hours earlier in order to prevent death in you and your family/friends.
Throwaway05
17hr ago
Notoriously, it wasn’t called the flu vaccine but flu shot.
Do you have a citation for this?
Here's a paper from the 90s referring to it as vaccine.
Throwaway05
21hr ago
That's never been true though?
Measles is something like 3% post vaccine, and mumps is something like 12% per a quick google.
Flu is a bit more obvious - the idea behind the flu vaccine is to make the flu uncomfortable but not require hospitalization and result in death, it's never really been entirely preventative.
Throwaway05
1d ago
What do you mean by this?
Throwaway05
2d ago
90% for me. Honestly thought the last part in particular was incredibly difficult, I'm shocked 80% is the average given how hard it seems to be.
Throwaway05
2d ago
I've seen a bunch of mainstream media coverage pretty explicitly surmising that the Democratic establishment doesn't find anything he is up to is objectionable but they are trying to get rid of him before the deadlines for the general because they expect the Republicans to be sitting on bigger bombshells and they figure someone else would be more electable.
Nothing fancy about the Jews or a sea change in sentiment here.
Throwaway05
2d ago
As a rule I don't trust reporting of medical issues (which important vein? that matters a lot and who knows if that is even accurate!), and the UK has a lot less experience with penetrating trauma of all kinds. We can also do miracles if you managed to get stabbed in an operating theater with shit ready to go.*
None of that changes that this happened out in the field with help far away and that any 8cm stab wound into thoracic cavity is going to require a million things going right to be survivable.
*Like given how long it took him to decline I can't imagine that he wouldn't have survived if he was immediately put on ECMO but that is not a reasonable expectation by any means (given their description ECMO could have been impossible but how the fuck did he take so long to die then wasn't it like a half hour?).
Throwaway05
3d ago
More dressy options are out there but I'm not your huckleberry for recommendations on those. I know others have preferences though.
Insoles, orthotics and other nonsense are all entirely internal and viable options.
As for the pain being somatic. I mean yeah. You are a psychiatrist - you know that doesn't mean it is unconnected from everything else. Minimize negative inputs and you'll get a better result.
Additionally if you feel helpless or apathetic about improving your experience, keep in mind how depression might be a contributor.
Lastly, Jesus Christ who still wears ties? The fomite risk alone! But for psychiatry the strangling!
Throwaway05
3d ago
This is a point of serious Opinion because of our retarded amount of hours worked over here, and while it dials down after residency for most specialities it can be a real deal career limitation factor for surgeons. Foot, leg, and back pain are all connected.
This gets to the point where people are straight up recommending Yoga to Ortho-bros or you have Vascular reading "Becoming a Supple Leopard."
The specific recommendations for footwear are pretty body type, mechanics, and use-case related (I love my clogs but only when I'm doing more standing around than walking, I've seen plenty of residents break their ankles hurrying to a code).
Dig into the shoe discussion on the medicine or residency subreddits you'll see a lot of recommendations. Hoka is a common viable option. Basic orthotics can make a big difference.
Some attention to your footwear and stretching routine can absolutely radically improve your day to day experience.
Throwaway05
3d ago
I really think people underestimate how much being drowned in these "trainings" for years and years impacts you. I'm pretty damn not-pozzed but I have to do trainings multiple times a year* and it makes it hard not to unconsciously buy their frame on things.
The "anti-racist" training is incredibly racist and it works and it results in stuff like this...
*One employer took us off clinical duties for a full week yearly to indoctrinate us in social justice. And it's one you've heard of.
Throwaway05
4d ago
I remember seeing a video, I want to say it was in Germany? of a non-white person engaging in a mass stabbing act of terrorism, the police arrived on scene and assisted him because they assumed he was being attack by the native white Germans (and got injured in the process).
This is a pattern.
Throwaway05
4d ago
Despite all the aches and the pain and the desire to drag my sorry ass home to rot in peace.
You have appropriate hospital shoes, right??????
Throwaway05
11d ago
Huh, TIL - that makes a lot more sense anyway.
Throwaway05
11d ago
uilt by the navy, which did enlist the best men it could find.
What about press-ganging? Wasn't that just wandering around stealing random people?
Throwaway05
12d ago
I mean medically that's definitely a thing - but it's variable and diffuse and complicated and 100% should not have legal ramifications.
Throwaway05
21d ago
Sure other countries are different, the US is notorious - they should still be doing 24s at least though, no?
Throwaway05
22d ago
Medschool isn't difficult, neither is studying finance. Barely anyone wash out of either and testing with bringing in less talented people show that it doesn't affect graduation rates much at all.
I don't think this is true at all.
With respect to pure academic difficulty Medicine may not be the most difficult, but it does have pretty much the highest volume of content. Keeping up with years of punishing pace (often while doing multiple other things) is incredibly difficult. Once clinical years roll around you are doing things like rotations that could be over 80 hours a week while studying for an academic test, working weekends, pulling 24s and all kinds of other hellacious things.
That bit aside - the selection pressure for Med School is intense. The average MCAT score in an accepted individual corresponds to an 86th percentile. That's a phenomenal amount of filtering out. Once you get to school the drop out rate is pretty low - somewhere in the 3-5 percent range. That is with the intense selection pressures however.
Additionally a dirty secret is that schools will drag you to the finish line (maybe requiring extra years) knowing that doing so will leave you unable to match. Completion without advancement isn't really that, but it is part of the stat juking and realistically residency completion is a much better reflection of "washing out" or not. Advancing through to get your MD and then independent practice is a really different number, if you start with possibly the best reflection: "intention to be a doctor" to "finishing the path" then the completion percentage is probably under 20% or something else obscene.
Throwaway05
22d ago
All granny with a UTI needs is Prozac and Zyprexa!
Throwaway05
22d ago
Oh that would make sense - I just googled and saw born in Germany and the irony/appropriateness took me.
German heritage is a pretty good pick for generic American at this point so it would have made sense.
Throwaway05
23d ago
Apparently he is German. I do not think this invalidates him being American in any way though lol.
Throwaway05
23d ago
I mean lifestyle interventions are always the first recommendation for everything - lose weight and your BP improves. Socialize and exercise more and your depression improves. People don't do these things so we hit the second line interventions of actual medicine that are a band-aid not a solution.
In the case of SSRIs, if one doesn't work....you just switch to the next thing. Psych has more viable first and second line agents than most disciplines. Even if hit rates are lower it isn't a big deal.
Additionally, depression is more of a syndrome than a disease - shit life syndrome, major depression due to a cardiac problems, classic melancholic depression, all of these things manifest slightly differently but more or less the same and zero percent chance we have a full understanding of the underlying pathophysiology. Shit life syndrome likely responds poorly to medication, but how are you going to define that and separate it for the purposes of research?
Throwaway05
23d ago
Do physicians generally “know” or feel with a high degree of confidence when they’ve correctly zeroed in on what the problem is?
It depends on the thing, but it is important to keep in mind that for many problems diagnosis is not important (especially in psychiatry). Fixing a problem is important, but a clear diagnosis? Nah. In psychiatry most problems are fixed by an SSRI or an antipsychotic - who cares if they have schizophrenia, schizoaffective, or bipolar disorder if the solution is the same. Who cares what the cause of the hypertension is? Rule out some important things to rule out, and then move on.
Also because the level of specificity - sick, infection, bacterial infection, anaerobic bacterial infection, a specific organism, the specific genetic profile of the specific strain of that organism, all of these are accurate diagnosis, but you can stop early and often should.
So it's hard to answer some of these questions without being reductive or ponderous.
Prions
Our tools aren't magic - for a long time the start of the art for identifying bacteria was dumping dye on it. Identifying something as weird as your own bits during slightly weird shit is hard as hell.
Throwaway05
23d ago
Now this is my shit right here. How do psychiatrists gauge whether they’re more or less on path to following a proper diagnosis?
Oh boy. This is a long and tough topic. So Medicine is hard. Some people get that some people don't but it needs to be carefully examined.
Some questions are harder than you think, and we don't realize it because we take so much for granted.
So like what is a disease anyway? What is sepsis?
The later is a question still under investigation even though treating sepsis is a core hospital task.
What about a run of the mill bacteria infection? Well turns out usually we are just pattern matching or guessing based off of what died to the antibiotic. An actual culture is useless or impossible most of the time. Spirochetes took forever to identify because splashing shit with these colors we usually use didn't work (yes that's what we do! Random dye!).
A lot of stuff might be an infection and we just don't know yet because who knows what caused it. It's a miracle we figure out prions existed for instance.
So sewing and cutting and surgery is great and all but the noodly thinking bits are an important and interesting part of medicine. Cue nosology.
But you asked about psychiatry though.
That's a further complicated question. The brain is like the most complicated thing in existence, and mental health is the most complicated and multifactorial aspect of medicine.
The specifics become specific, it is why doctors have jobs after all. Some diseases have neuro-chemical markers, brain imaging findings, genetic components and other "hard stuff." This is evolving and of unclear clinical significance.
Sometimes we go off what facilitates communication - depression is hard to define. If everyone including the patients agrees what depression is then you've found it. Sometimes this becomes a cultural negotiation.
Sometimes clinical response is king - if it looks like a duck and quacks like a duck and gets slaughtered by medication like a duck then you got it.
To TLDR it - explaining the specifics of a diagnosis in a thorough way is easy to convey to people in the field who have a shared assumption base, but to people outside of it a lot will be lost in translation and it can look like some stupid questionnaire defines everything.
The rigor isn't what we want but it's more than you fear.
I mean I don't think it's possible to be an ethical billionaire in the same it's not possible to be ethical in general - someone is always going to be upset. Superficially Gaben looks like a good answer, but then you find out how many people in the development and publishing space hate him for steam being "freeloaders." Consumer hate is rarer but still comes up with respect to some decisions they make.
So if we reframe the question as "who are the most ethical" billionaires I'm sure you can find some, it's just usually not people the man on the street knows about.
Consider the Duff brothers from Mississippi - they made their money running a tire company.
Or Judy Faulker in the healthcare space, Epic gets a lot of flack but most of that is actually regulatory burden or angry competitors.
Plenty of people make a billion in generally unethical spaces (real estate, investing) while being no more unethical than everyone else in that space, sometimes even more ethical (just very good or lucky).
More options
Context Copy link