self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
I'm a transhumanist doctor. In a better world, I wouldn't need to add that as a qualifier to plain old "doctor". It would be taken as granted for someone in the profession of saving lives.
At any rate, I intend to live forever or die trying. See you at Heat Death!
Friends:
A friend to everyone is a friend to no one.
User ID: 454
You're welcome! Don't worry, your dad could well be a narcissist, and if he's an asshat, you have the right not to contact him regardless of a formal or informal diagnosis.
It is entirely possible you do have ADHD. Based on what you've described, the clinical suspicion is at a degree that warrants formal assessment, and pursuing one is a move I would happily encourage.
That being said, I wince at anyone invoking "rejection sensitivity dysphoria," which in this context strikes me as a rather useless pseudo-diagnostic label that pathologizes being a Sensitive Young Man.
RSD appears in neither the DSM-5 nor the ICD-11, has no validated measurement instrument, and the term traces back mostly to one enthusiastic clinician in the 90s rather than any systematic research program. The construct it gestures at (emotional dysregulation in ADHD) is real enough, and the DSM-5-TR now acknowledges overreactive emotionality as an associated feature. That is very different from being a core feature, or being helpful in terms of narrowing down the differentials. Feeling terrible when a girl leaves you on delivered is not a neurological syndrome. Young man, that's the human condition, plus youth.
I used to be one, you know. Which is to say young. I'm still a man. In terms of sensitivity? Mostly I've just become increasingly willing to tell people to go fuck themselves, or more politely, to stand up for myself when I'm clearly in the right. There was a time when being left on read would have felt like the end of the world to me. These days I shrug and move on, or at worst wince slightly and forget about it by the next week. This will happen to you too, and it will manifest as external confidence. People can tell when you've got it, and they act accordingly. Time and reps, mostly. No pill need popping for that particular problem.
At best, marked rejection sensitivity might point toward a comorbid anxiety disorder, which is worth mentioning to whoever assesses you, since the comorbidity rates between ADHD and anxiety disorders run somewhere around 25-50% depending on the sample. But as a diagnostic marker for ADHD specifically, it offers little.
Now, I am a psychiatry trainee, and I do have ADHD. And my life has interesting parallels:
My dad, despite being a good doctor, was loathe to acknowledge that his son(s) have mental health issues. I'd blame it on him being from a different generation. When I was older and telling him about my problems again, he mentioned episodes around my age that sounded awfully like depression to me, except he hadn't had the vocabulary at the time, and more importantly, he had managed to push through and flourish anyway. In his eyes, a son who was clearly intelligent, academically and professionally successful, couldn't possibly be mentally ill, let alone chronically. He flinched away from the notion. In his cosmology, that's the realm of the insane and the delusional, and if you're objectively succeeding, everything must be fine upstairs.
I wish that were true.
On that note, I'd be careful bandying accusations of narcissism about. Not because you're necessarily wrong, but because I remember being around your age and being quite mad at my dad, and the heat of the moment is a poor time to hand out cluster B diagnoses to family members. Hold that belief lighter than currently feels natural. You can always revisit it when you're older and know better. That would the kind of statement that would have annoyed me when I was younger, but it's true nonetheless.
Pragmatically speaking: stimulants work on just about everyone. This has been known since we gave dextroamphetamine to entirely normal prepubertal boys in 1978 and watched their motor activity drop and cognitive performance improve, a finding replicated in normal adult men. That makes "I took Adderall and functioned better" a poor confirmation of the diagnosis, in the same sense that telling someone who perks up after a cup of coffee that they're "caffeine deficient" is a suboptimal diagnostic framework. Scott's essay on Adderall covers the gatekeeping problem well: attention is a normally distributed trait, the diagnostic cutoff is somewhat arbitrary, and most psychiatrists and possibly the majority of patients knows it.
Even more pragmatically:
ADHD is associated with a life expectancy reduction that is more alarming than I originally remembered. This paper found an apparent reduction of about 6.8 years for men and 8.6 for women, and Barkley's earlier estimates are thereabouts too. The mortality rate runs roughly double the general population's, pushed up by accidents, substance use, and the general downstream consequences of poor impulse control and executive dysfunction.
And treatment works! A Swedish registry study of around 150k patients found medication initiation associated with a 19% reduction in all-cause mortality over two years, concentrated in deaths from unnatural causes. The usual observational-study caveats about confounding apply, and the follow-up window is short, but the direction of the evidence is consistent across studies of injuries and hospitalizations too.
That's why I don't much care about gatekeeping this diagnosis as zealously as some do. The failure mode of slightly over-prescribing a well-tolerated medication with fifty years of safety data is considerably less bad than the failure mode of leaving a disorder with those base rates untreated because your dad is a dum-dum. I care about results uber alles, and I care even more about the fact my disease is comparatively mild. The medication changed my life for the better.
I have told him that, and I could tell he appreciated it.
I presume you missed the drama from last week. I particularly care about what my boss says for multiple reasons:
- He's my boss, and my career progression is gated behind his approval
- He's not lavish with compliments
- I can trust him to be a pretty fair dude
That's why his praise matters, and why his criticism stings. He'd been concerned about my performance earlier, while operating off what he personally acknowledged as outdated information. Instead of developing a martyr complex about it, I decided to go above and beyond, and I had the good fortune of being able to demonstrate it live.
He's the kind of guy who cares far more about action and results rather than getting into group cuddle and commiserate sessions. I spoke his language and, as I hoped for, he reacted very positively. We might not always see eye to eye, but I can have a productive professional relationship with him, and that's more important.
I was so stressed out I could barely get out of bed over the weekend. But I manned the fuck up and went to work, and ended up using my own judgment, arranging urgent scans and discovering an acute and extremely concerning pathology in a patient my seniors, including my supervisor, had been blase about. That is it's own reward, but it helps that I also was congratulated on this and also got assessments done. I also had my supervisor (the one I had a difficult meeting with) explicitly say I'd been doing a good job, and that he'd heard and seen excellent things about me. Go figure.
I have given up on the NHS, and am pursuing private psychiatry in earnest instead of just contemplating it while emailing around. That involves coughing up a significant amount of money for a re-assessment of my longstanding ADHD, but it's better than the alternative, and I'm getting what I half suspect is a collegial discount.
As I tell everyone, insight is necessary but not sufficient. I try to supplement this extremely novel observation with getting shit done and improving. I dare say I succeed.
I'd like to see a Tesla Model S redefined as an "electrical mobility vehicle". Particularly if it's in self-driving mode.
A lot of things are "normal" with aging. Like heart attacks, and cancer, unfortunately. You're going to lose lung capacity with age, but finding it more difficult to breathe through your nose? I'd find that worth at least a mirror and a light even if it was someone genuinely elderly reporting.
Please, do show me the rule violated. Preferably with quotes. I do have a blog.
Go to therapy. Touchy feely bullshit aside, just the opportunity to talk to someone who is good at listening and will be discreet about things is often worth the money. This also describes friends, but I'm not sure even I have a ton of friends who would listen to me vent about things along those lines for as long as it takes for catharsis.
Alternatively, I second the questions about whether you can switch to a less... visceral branch of law.
I just fucking know that if I had opted for law, I'd have turned to drink. Sorry you're going through this.
It's been a pleasure watching the fresh batch of baby doctors arrive on the ward, all wet behind the ears, lanyards tight around their throats. It makes me feel nostalgic, protective, and very old, all at once.
My colleagues before this lot were excellent, so the bar was set high. You can absolutely tell the new ones are new, but they compensate for the gaps with genuine diligence and a willingness to learn, which is all I can really ask.
Although "gaps in knowledge" is the wrong phrase. Talk to them for five minutes and the knowledge is plainly there, filed and indexed and ready to be recited. What makes an experienced clinician is the intuition about which parts of it apply to the person in front of you. Chess grandmasters famously don't calculate more moves than amateurs; they just see the board in chunks, and the bad moves never make it to conscious consideration in the first place. Medicine is like that, except the board is a 78-year-old with three comorbidities who has stopped taking one of her medications and hasn't mentioned which.
It's one thing to know the drugs and the diseases cold. It's another beast entirely to have a messy, inconvenient human in front of you, and that description covers the other doctors as fully as it covers the patients. Eventually, through sheer exposure, observation and practice, you just know. The relevant information stops requiring a search through your head, or a panicked Google in the loo (I am not above this). You build up what I can only describe as a mental cache, log(n) for the things that matter. Inconsistencies start to make you itch before you can articulate why.
Then there's the tacit stuff, none of which appears in any curriculum. How to refer to General Surgery without being swatted away. The exact words that make a busy Med Reg give a damn. Tactical phrasing that gets an urgent CT head done urgently rather than eventually. Presenting a patient so it parses for a doctor as exhausted as you are, who lacks the benefit of having spent the last four hours with them. Shortcuts through the hospital. Where to liberate your fair share of patient coffee, the single perk of the job. How to comfort the disturbed and disturb the comfortable, when clinically indicated. Which consultant will cheerfully field the silliest question, and which one will not suffer fools. The importance of booking annual leave early, so there is something to live for that isn't an ARCP. Getting along with your colleagues, because the NHS is a harsh mistress who will grind you down, and collegiality is a slow, reliable form of karma that they will be drawing on regularly. And, in due course, a tolerance for my worst puns.
I've been rather delighted by the FY1s and their impostor syndrome, which has a prevalence I estimate at 100%, give or take 0. They do their best to hide it, and you can always tell. I say that the shoe does fit, and eventually they'll stop noticing the blisters. They're fresh out of med school, and suddenly here is a human being who might die if you sneeze at them wrong.
Catch.
The most poignant case was the new core trainee. Lovely girl, fretting that she didn't know a thing. I told her, firmly, that if she knew everything already she'd be wildly overqualified, or at minimum a Senior Registrar. You're here to train, miss. It's in the name. You'll be fine.
On day one I told them that stupid questions do exist, and that I was issuing everyone a month of exemptions. The exemptions have been used. Expired ones remain welcome, because God knows I still ask colleagues, sotto voce, things I very much hope nobody senior overhears.
Sigh. I was there once, permanently braced for the moment someone worked out that I had no idea what I was doing. You pick up a few tricks, and hopefully avoid killing anyone en route. I think I've become the sort of senior I wanted when I started. Visibly stressed, clearly overworked, but always willing to make time for those need mine more than I do. I've certainly known worse.
As Black Wednesdays go, last week was far from the worst.
I recommend seeing a doctor. You might have a deviated nasal septum, could be inflamed sinuses or low grade allergies, you might have nasal polyps, it might actually be an issue further downstream. But short of someone actually taking a look inside, what do you really expect anyone to suggest?
Ungodly levels of stress, but better overall. Managed some exercise.
I've continued to get good feedback from work, and my relationship with my boss is back to cordial. I've got a presentation tomorrow, and I asked him for his input. He was very pleased with the choice of case, and said he'd defend me from any serious pimping if the other seniors had had their cereal shat in. What more can I ask for?
The floor has risen significantly. Even prior to Sonnet 5 (haven't fucked around with it it), the previous Sonnets were highly capable and treading into Opus territory at times.
I still think that for anything that isn't trivial/low-effort, the better models justify themselves very easily. I use the best that my plan allows unless I have a good reason to drop down (usage limits on a 5x plan are still annoying as hell).
I am genuinely taken aback by this take. I know you're being sincere, but I can't understand where you're coming from. It's easier to say what LLMs can't do for me. And I very clearly benefit from the additional intelligence the paid models provide. They're not eating white collar work for no reason, they can do a surprising proportion of the work that a regular human can do on a computer.
Mu. Alternatively, invalid type.
Honestly, I agree she had it coming. Use the belt.
If adherence to the requisite format was beyond your abilities, I'm sure there would have been room for an apology. I have just learned not to expect very much.
I understand that your day job involves coming into a situation where you had no original stake, or direct involvement, and then assuming an advisory position despite a clearly superficial understanding of the facts of the matter. I ask that you keep it there, I'm not paying you.
On a factual basis: no, I haven't presented myself as perfectly flawless on any day of my life, even I'm convincing women to let me sleep with them. Good grief. I, like a real human being, have made actual errors. And like a responsible trainee doctor, I've disclosed that to my boss. They're not material here, because the one specific issue he raised wasn't my fault.
Have you ever considered the possibility, in theory, that someone might actually be liked and good at their job? Or is that an entirely foreign prospect for you?
Beyond that? I hope your advice finds someone who needs it. If you want the fuller picture, I can ask my boss to sign up on themotte.org. I'm sure he has the time. God knows where I find it.
I think going into a moshpit as someone who wears glasses is remarkably inadvisable. Always wanted to try it, at some point, but then I remember that potential traumatic brain injuries are not going to improve anything.
You're a clinician, what does a person who always thinks they are the greatest, and is always correct about everything, and reacts aggressively when their ego is challenged sound like?
I know perfectly well what that person is. The problem is that I resent your implication that that's a fair description of me. You don't have to go digging very far to find examples of me admitting that I'm wrong about something, really. Here, I'll make it super easy for myself and kill two birds with one stone:
The recent shakeup at Google, with the departure of Jeff Dean, puts them out of the running as a frontier lab. I'm not saying they don't have a hope at all, I'm saying that regaining the lead is going to be even more of an uphill struggle. In other words, I was wrong.
Now, back to you, Coil:
Have you stopped beating your wife? Yes or no answers only, please. I'm too old for these games.
He'll either get humbled in a few more years and give what you said a second thought, or turn into one of those monsters in management who's "never wrong" and lashes out at people, destroying the institution from within.
I admire the confidence with which you present these as the only possible outcomes. I hope I do end up with that much epistemic humility.
I'm amazed at how many people don't cough up even the $20 required for the full-fat experience. At least OpenAI has recently announced that they're making unlimited usage of a newer model, 5.6 Luna, available to the masses for free. It is still several steps down from Sol, which continues to genuinely impress me.
Google's "free AI" is an incredibly imprecise term. It can mean Gemini 3.5 (Flash? Lite?) when used through the Gemini app. It can be the search-specific Gemini 1.5, IIRC, used if you just "Google" something. As you can imagine, not even Google can afford to use the best of the best when serving so many people at such scale, with the majority being trivial queries.
I would pay a great deal more than $20 for an AI plan, but luckily, I don't have to. I've got tons of Claude Max, because I decided to accept payment in that form instead of figuring out intercontinental financial transfers after my participation in Unslop.
I remember when a Dutch junior of mine was consulting another senior for advice when working on a meta-analysis meant for a big name journal. I could have clapped like a seal when the latter mentioned Claude, in addition to ChatGPT, for help with the stats scutwork. Then I asked, and confirmed, that she only had a free plan. I was so dismayed that I immediately offered to share my Max, and walk her through things. It didn't hurt that she's a pretty girl, and it would have provided an opportunity to go out with her (that ended up happening anyway), but I am beyond annoyed when other doctors use free-tier LLMs for clinical work. They still function adequately, but anyone who can afford better should use better. $20 is really not an onerous ask for a significant amount of intelligence on tap.
Hahahaha. I can't even be particularly mad, this loops right around into hilarious. When I worry I'm too self-aware for my own good, I can do with a reminder of what its absence looks like.
Aight buddy. I'm sure you've got a proper Big Boy job. I know a handful of Big 4 "consultants". Probably pays the bills well, doesn't it?
I do wonder just how common it would be for an error you've made while under stress to lead to someone dying. Do you have any idea what doctors do? Been to a hospital since you were (presumably) birthed in one?
My man, last time you skimmed this story you got the sex of every crying person in it wrong, then built a thesis about British civilizational decline on top of your own lacking literacy. Now you've skimmed again and built a theory of my employment. I'm starting to see what passes for your workflow: read 30% of the text, hallucinate the blanks, invoice for the full engagement. I wish I could get away with that, I seem to have to work for the money.
In other words: knock it off.
I am sure you have perspective to share. I sample plenty, and I've heard more informed opinions from the floridly psychotic.
Based on that experience, I suspect we’re only hearing one side of the story.
It's a first-person anecdote on a forum; of course you are. I presume Deloitte or PWC pays you for such cutting edge insight.
The difference is that my side comes with documents, and yours comes with hot takes about a profession you've never worked in a country you probably don't live in.
With all due respect (guess how much), the last man who guessed at my workplace from his armchair was you, one comment ago, and every checkable claim you made was wrong.
Let me see if bullet points help:
- I had repeatedly tried to obtain the assessments.
- The ward had been severely overloaded.
- My supervisor had been away and had not spoken to the people working alongside me.
- He cited supposed clinical errors without specifics.
- The one specific error he did cite was demonstrably committed by somebody else.
- He told me to obtain broader formal feedback.
- I did exactly that.
- The feedback, including from people outside my immediate peer group, has so far been uniformly good.
- He then actively facilitated me obtaining still more of it.
This is a strange way to “agitate with staff.” Apparently I have been so disruptive that nurses, pharmacists, ward administrators, junior doctors and senior doctors keep volunteering to say nice things about me when formally asked, and have said it before, without asking, and my boss's response to my campaign of terror has been to tell his colleagues to make time to assess me.
Perhaps the inevitable reckoning is merely taking the scenic route.
And to spell it out, my male peers, which includes the senior reg, and most of the consultants? They like me too.
A flattering type of audience to strive for, surely.
Not my target audience at all, unfortunately. They just form a substantial portion when you write on the open internet, without pay-walls. I do this, at present, for free. And that means I do not have a particularly strong reason to care.
Less charitably, my point is that contra your response to Bartender, you evidently don't see any objections as helpful; you are committed to not noticing the problem and dismissing nooticers, in whatever form - Bartender's clipped remark and my more detailed objection get the same dismissive response, in spirit if not in word count.
Completely factually incorrect. You want a citation?
https://old.reddit.com/r/slatestarcodex/s/5FyqfDLX2L
Please review that thread, which includes correspondence with Gwern.
I give as much heed to this feedback as I think it is due. Which is not nil, clearly, or I wouldn't bother to respond at all. I am merely pointing out that I am not open to not using LLMs simply because people ask me to. I have yet to take Prima's money, which would enforce a commitment to never touching them while on this platform. You are free to complain, I am just as free to say that I've read the complaint and don't intend to act on it. I would have been more likely to be polite if you had been polite, but let's have reasonable expectations here.
- Prev
- Next

I discovered that one of my new coworkers is ex-military before entering medicine, and is perfectly happy to nerd out over the fun toys.
I think we were discussing the relative strengths of offensive and defensive hand grenades when the new female trainee interrupted us for something, apologized, and said that she had absolutely no idea what we were talking about, but said she loved the passion nonetheless. I said that I'd lob a hand grenade at her for disturbing the peace.
More relevant is the fact that he's my neighbor, and has a gaming PC. I might actually have someone to play with, though I give only 25% odds we manage a match anytime soon. Maybe Helldivers, or Arma Reforger, since he owns both.
Otherwise, I've occasionally played Rimworld, and I've made it a point of booting up my pc and getting the game (with about 100x the original install size of mods) loaded. It takes 15 minutes (and that's with a ridiculously powerful pc), and minimizes the activation energy required to sit down and game. I've managed it some days this week, which is a sign that much of the anhedonia has lifted. I just don't have the time for anything more involved.
More options
Context Copy link