Muninn
Burnt out, over the hill autistic IT nerd and longtime SSC lurker
User ID: 3219
Muninn
2hr ago
Yeah I don't mind the skimming at all, even though I had fun doing the repetition bit when I was writing the piece, it bloated it significantly. But this is the Motte, after all, and the one commenter who replied to me wanted the detail so I ended up going with it.
Can't think of anything that I could really tell you that you wouldn't have already encountered. I don't need to tell you how awful the healthcare bureaucracy is, right? Though maybe I will add that our most common doc issue is that they can't e-prescribe to the client because someone went and added a full address to the "address 2" field of the client profile, exceeding 40 characters and also obviously breaking address verification. That one ended up being thanks to an instruction from the clinical head who evidently was never taught Federal address standards...
If you're interested, our clinical side has largely been neglected in EHR land for the last 8 years as two different medical heads did not or did not want to get involved in that area. The next medical head pulled a Brave Sir Robin after trying her best to do that and still be a Psychiatrist for a year, and I can't blame her. I've been in a few meetings with the new head of medical, who is an old-timer, and have discovered that the institutional knowledge problem that I harp on is a big issue there as well, mostly because we could probably streamline some stuff out of the workflow for the docs (Meaningful Use has been over for a while, after all) but also because the nurses abandoned their actual note along the way and started using an outpatient note instead, leading to the loss of data and my employer getting its wrist slapped by the State. Definitely a LOL moment for me!
And thanks for the read, it had me sympathetically SMDH many times!
Muninn
2hr ago
Yeah, I apologize for the lack of clarity, my fingers are in so many different pies that it'd be hard to list them all. Off the top of my head, though, I'm still doing lots of data analyst and EHR admin as well as major pieces of the different data that we ship to our State for various departments and initiatives, Exchange admin, 365 admin, network admin, general server admin, help desk (we're all vulnerable to walk-ins, after all), some firewall/security stuff... in fact, I actually built an antispam server from open source wow, 21 years ago, and ran it until we modernized our network in 2011. That particular guy was one of my prouder accomplishments until I got into the guts of administering our current EHR platform. Anyway, the truth of the matter is that ever since that point and really earlier that on any given day I was putting out whatever fire was the biggest, if there was one, and if there wasn't then I was waiting for the inevitable.
On the whole HIPAA thing, yeah definitely not so much plugged into opaque databases. For all that the minimum necessary rule tries to restrict information, in the mental health world we do all kinds of wacky stuff that makes trying to even tamp down staff access difficult. When it comes to higher up stuff, most of the work we do is still wide open, though there are restricted clients that require an extra level of access, even to those that can generally access all clients with impunity. Fun fact: I actually had to go in and fix a family member's record not too long ago. They had been restricted because I worked there but still, someone made a mistake and there it was. I already knew said family member had gotten themselves TDO'ed so it just tickled my dark heart but if we had our act together and I was actually just doing IT proper stuff I'd never have to do that. And because I'm on the subject, I just can't even with all of the HIPAA breaches I've seen. Lots of them are genuine, "didn't get the memo/comprehend the training," type stuff like emailing documents with PHI in the wild, which our antispam gateway doesn't always catch, but there have been a few doozies, too. One of the saddest involved a staff who had somehow discovered that her boyfriend was also dating a client of ours, and said staff looked at the client's record and then proceeded to dig herself into a deeper hole trying to cover it up. Just a sad story and the only one I've seen prosecuted. Surprisingly, we've actually been forced to rehire staff that breached HIPAA and got terminated for it!
Anyway, I completely agree with you about needing a better standard than O'Connor and for me that's a real example of how my individualist ideals can lead to serious suffering in the real world. I can think of a few different "frequent flier" type clients that really would be better off institutionalized and that doesn't even touch clients that are homeless and suffering. And sadly, refusing medication for some of our most mentally ill clients goes hand in hand with being frequent fliers. I'm hopeful that we can find newer and better drugs for the folks that suffer from the terrible side effects (some folks do tend to think they're just fine without the meds) but then again, if you've ever read Scott's banger on esketamine, FDA approval is another thing on the long list of reasons that We Can't Have Nice Things.
Muninn
1d ago
I am enjoying Songs of a Lost World immensely thus far. The themes of aging, sadness, and loss speak directly to my experiences, even more so since 2024 has turned into another, "buckle up, buckaroos," kind of year of sweeping changes for me personally. I'm thrilled that The Cure has released an album this damn good in this day and age (and with multiple vinyl and cassette versions to boot!) and it's quite the poignant experience to listen to something that is so on point to my middle-aged self and that also makes my inner Goth Kid squee in delight.
Muninn
2d ago
I want my body to be cremated, I want the ashes to be transmitted in a metal Folger's can, and then I want them scattered at the edge of a cliff into the Pacific Ocean.
Muninn
11d ago
IRL, I used to work in the same building as a therapist and I used go to lunch with him. He told me it's fairly common in male victims of child rape to fetishize the behavior, that is, at least in the ones who are troubled enough to seek therapy. This didn't take place in a therapy-happy country mind you.
When I was a young man in a long distance relationship I would often end up listening to Loveline with Adam Corolla and Dr. Drew on my way back home Sunday evenings. One of those nights, they were discussing this in the more general context of the sexual experiences of children. Adam was talking about how while he was initially skeptical of the connection between adult sexual issues and childhood experiences, with enough time and repetition, he had come to believe that Drew was onto something when he always asked folks about their childhood when this sort of thing came up. He went on to liken a child's mind to wet cement that was slowly drying. Those childhood experiences would make an impression on the cement that ultimately cured into sexual expectations and preferences as an adult.
This made sense to me at the time and speaking as someone who works in the mental health field and is married to a therapist, I've heard more than enough stories like this myself to believe that this is the most likely explanation for all sorts of sexual preferences.
Muninn
12d ago
Haven't read Andromeda but completely agree on 12 Miles Below. I read the first one and ended up devouring the entire series several months back and I'm hoping there's more soon!
Muninn
14d ago
Thank you very much, that's excellent news! A cursory search has led me to an unofficial plug-in to support remote save; I'll give it a try and see if I like it better than Joplin.
Muninn
15d ago
Damn. Speaking as a Joplin user who had never heard of Obsidian before, I really like the look of Obsidian and would love to use its additional functionality (compared to Joplin) but at $4 a month for non-local storage that's a no-go for me. A big part of my use case is the ability to make notes to myself on whatever device I have handy that I can encrypt end-to-end and automatically sync via WebDAV.
Muninn
16d ago
"Intelligence Agencies create stories inside stories, each with its carefully constructed trail of evidence, in order to create false trails as diversions.”
Muninn
24d ago
I want to post an update on the status of my effortpost on the state of mental health care in my state. The first draft has weighed in at 8,202 words and, as trying to write the conclusion made clear to me, is heavy on legal and regulatory explanation. In fact, it is mostly a narrative of the impact of said legal and regulatory framework on our various clinics, seen through the lens of my own role in that, but light on outcomes, client stories and the like. While I can cram some of that into the conclusion, I'm planning on a rewrite that will try and flesh out how things have changed for our clients a little bit more than just the standard, "client care in these departments is suffering," and streamline the legal and narrative stuff, hopefully significantly. Or perhaps my perfectionism is getting the better of me. Either way, I'll find out as I get into the second draft. Stay tuned!
Muninn
1mo ago
Given that you're already curious, I'd definitely recommend it. The movie is what got me to read the book as well, and while I'd agree that the source material differs substantially from the movie, one of the things that I was able to better appreciate after reading the book is how well the movie does at both creating the strange atmosphere and conveying how deeply the MC (Keel) falls down the rabbit hole. I'm not a UFO/UAP buff or anything like that but my dad was so I'm familiar enough with the basics, but that book was my first exposure to the Esoteric explanation and I found it to be every bit as unnerving as the movie!
Muninn
1mo ago
Interesting, thanks for the recommendation! My first exposure to the Esoteric case for UFOs/UAPs was reading The Mothman Prophecies for the first time but I've never shaken it since. The publicly released videos from the Navy have seemed more Esoteric than Explorer to me as well, though to be fair that might well be because my bias had already been established at that point.
Muninn
1mo ago
Thanks for the feedback, everyone, you've convinced me to write the post. October is a busy month for me so it may not be ready anytime in the next week but still, coming soon!
@AvocadoPanic, when I used the word horrendous I was thinking in terms of money spent versus the quality of the outcomes, not necessarily any other state or country.
Muninn
1mo ago
How interested would you be in an effortpost about the (horrendous) state of public mental health care in one of the worst states in the USA as told from the perspective of someone with 25+ years of employment experience in the field? I love it whenever Scott (PBUH) posts on these things and I find that it just whets my appetite to talk about it more but maybe that's just my inner geek coming out and that wouldn't be as interesting to most Mottizens. Regardless, it seems like a promising thing to post about and if there's significant interest then I'd be happy to do it but fair warning: it wouldn't be pretty and there would be lots of references to Moloch and not being able to have Nice Things.
Muninn
1mo ago
I'll add my voice to the split keyboard users. In my case, I tried out the OG M$ ergonomic keyboard as an experiment because being left-handed, my index finger had a nasty habit of trying to type keys meant for my right index finger. All these years later, I just inadvertently killed my M$ Natural 4000 and am strongly considering picking up a used version to keep me going
Muninn
1mo ago
Erm, pardon me for quibbling, but my sense of the early internet was that it more consistently leaned libertarian, which is to say, pro-freedom, rather than straight left. The rise of social media in general and Facebook in particular is what made the move leftwards inevitable in my view, compounded by smartphones and the accompanying push notifications designed by the literal Devil himself.
Muninn
1mo ago
I'd like to add my voice to those encouraging you to write. You're an excellent storyteller, with an eye for bringing out the humor and more colorful elements of your experience, and I think that I'd enjoy reading whatever stories you committed to writing. Because you're specifically asking, I'm really interested in the stories about where you've been and why, as well as the mischief you got into, the romances, and the other fascinating characters (Cowboy comes to mind) that you've met along the way.
Muninn
1mo ago
Not at all, thanks for your reply. I'm happy to hear that your wife is actually on the hormonal IUD and I hope it works well for her! The side effects of all of the hormonal stuff are much better known and if my wife didn't have a seriously sensitive hormonal balance that was most definitely messed up whenever she tried hormone based BC, even the stuff specifically for women that had issues like hers, we wouldn't have gone down the copper IUD road to begin with.
Muninn
1mo ago
Erm, this is strictly an anecdote, but my wife experienced several downsides over time from the copper (paragard) IUD. The most immediate downside was longer periods which progressed to chronic bleeding and endometriosis. The second was more frequent to chronic yeast infections. None of these were official side effects but internet wisdom said that they were in fact side effects and when she finally had it removed after a couple of especially painful episodes of dysmenorrhea the doctor acknowledged these as side effects from the copper IUD and indeed, these issues disappeared afterwards. If your wife ever starts experiencing any of these symptoms, I'd strongly encourage her to have it removed as it can and does get worse over time.
Muninn
2mo ago
Hello again and thank you for sharing! Although my experience significantly differed in some key ways, (I was having an amazing trip on the best acid I'd ever had before things took a turn, for instance) I can really sympathize with what you went through. My sense at the time was essentially the blackest version of Hindu and Buddhist belief that I could contain; that existence itself is a deep, pervasive, and conscious lie that we believe, that our lives hold no greater meaning than what we personally instill them with, and that with said conscious belief in life we were actively participating in our own torture and suffering.
Yeah, I was a struggling, wangsty kid from the wrong side of the tracks coming to the end of his teen-aged years at the time. I'm happy to report that thanks to the actions of some friends and their families in key places at exactly the right time, I pulled out of it (probably narrowly avoiding inpatient mental hospitalization in the process) and got better! I'm grateful that your support network helped you out, too.
Muninn
2mo ago
Hi there, delurking to say thanks for your comment--there's lots here that I identify with myself!
So, umm, would you mind saying more about the black nihilistic episode that you experienced? If not I totally understand, it's just, well, I actually took the cosmic black pill myself (and managed to come out the other side) what seems like a lifetime ago and I'm intensely interested in learning more about what it was like for you and having a conversation about that if you're open to it.
I've only used Epic as a patient but from that perspective it's always seemed fine to me. My understanding is that on the other side of things, it's layers upon layers of complicated but then, so is the practice of medicine itself, so yeah.
AI is looking like we could probably feed it the bulk of our documentation and let it spit out nice notes for the majority of staff, but of course HIPAA. I don't use it much myself, personally, but then again I'm constantly context switching between our EHR side and our IT side and my personal goal is to pass on as much institutional knowledge as I can. I can remember when my old boss was jealous of me because I got to build fun things and learn while he had to ride herd on the clinical side. Now I'm doing what he did while the young IT Specialist is building fun things and learning new stuff. He did learn the hard way that anything he touches, he owns that way though!
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