Throwaway05
1hr ago
Yes please. This is not meant to be bait and I am happy to take the discussion into DM if it helps me improve my mental model of those with these priorities.
Throwaway05
2hr ago
because he knew what the word game was that they were playing with him.
To dial in on this bit, one thing I learned working in a forensic setting is that bad people and those who don't really care don't really understand what they did was wrong. That's obvious right? But they know that certain words causes problems, you don't use the words and describe the behaviors....no problem right?
This sounds a bit obvious and definitely applies more to low intellect/education types, but everyone can probably identify someone in their life who is say, against "beating their wife" but has no problem with "showing her who is the boss."
Once you start looking for this...omg it's everywhere.
Throwaway05
2hr ago
My guy, can you tell me what it is about the Jews?
I've never been able to figure this out. Take the mask off a bit and tell me why them.
You had me nodding along and then it is abruptly about Jews and I check out.
Yes Jews are in the pile that is causing these problems but they are a rounding error in comparison with say, HR dog moms, or X actual ethnic/racial demographic that supports the spoils system instead.
Did a Jew bully you in school, get your dad fired, close your favorite restaurant?
I don't know where this stuff comes from and I earnestly want to.
White anti-black racism has a straight line from perceived degradation of communities to the feeling, accurate or not.
I don't know where anti-semitism comes from.
Throwaway05
1d ago
Some causes (usually it is one or more of these):
-You are older and your body sucks now (and did not before).
-You are dehydrated.
-You don't move your body enough.
-Your diet doesn't have enough fiber.
-You are fat.
-Your bowel habits suck in some other way that is catching up with you (like holding things in too long, you might need a squatty potty, etc.).
-Weirder stuff like psychiatric stuff, hormones.
-Serious medical conditions (may be worth getting stuff checked).
-Other substances that impact bowels. Too much or too little caffeine (or withdrawal from the same).
Usually common sense adjustments for these things will help. See a doctor. Only after that is it worth something like PEG, Senna, etc.
Usual high fiber stuff like Metamucil, Prunes, Fiber soda whatever.... all of this is sustainable.
Also important to get this addressed early to rule out serious conditions, and perhaps to prevent things like hemorrhoids, fissures, diverticulitis.
Throwaway05
3d ago
I'd suggest caution with this, the rules vary state by state and hospital by hospital. Some almost always go "eh" when people don't pay. Some will fuck you.
Throwaway05
3d ago
Sorry, I had heard at work that more stuff came out but I misunderstood and it's just the house vote.
Some mainstream media coverage in the last few days has been attempting to figure out when people are going to jump in front of stuff, with Summers seemingly being one of the first (ineffectively, apparently).
I'd consider Trump approving the release evidence that nothing serious is in the files, but of course he could be relying on the justice department to stone wall.
Dershowitz has publicly speculated that any true bombshells would be hidden in FBI files that wouldn't be impacted by any of the political nonsense.
And of course Trump has explicitly noted that no matter what he releases people won't be satisfied and will assume there is more. I don't think he is wrong.
Throwaway05
3d ago
Interesting. Anything actually in the emails about him? I know Warren was saying he should fuck off prior to the recent release so I'm curious if it's because she had more information or if because he was getting pressure from her (and thus others).
Throwaway05
5d ago
The impression I've gotten from writings of Cim and others is that Epstein was clearly a sex addict who mostly got up to stuff in his personal life and that's it.
And at the same time there's a small amount of information out to suggest that he did get up to some shady business with a few people.
You'll see a few credible people in the political and news class who have claimed to see specific lists of people but they won't go on record because they are 100% sure they'd get sued to death (Mark Halperin has talked about this for example).
Likely a large piece of this is that the information available isn't smoking guns but is instead lists and manifests that don't give enough proof to separate from the dinner parties and other social events Epstein famously held quite often.
But to give an example - that would include for instance, Bill Gates. You can see some actual news coverage on how this might be related to his divorce but I also know some people who don't have first hand knowledge but are in the same social class who think that's real.
Circling back to your original question you can expect that as soon as something gives them actual cover you'll see a punch of journalists punch out with already planned and researched stories. Since we haven't seen anything......doubt it, just the Trump bullshit.
Throwaway05
6d ago
Maybe we have the capacity to do a more laissez-faire model based on reputation? It’s more plausible now than in the Yellow Pages era.
I don't think it is, even within the field with expert level knowledge it's hard for me to know if a doctor I'm seeing is good before I go, and depending on my knowledge of the speciality it's also hard afterwards.
Patient surveying and other mechanisms of assessing doctor quality tend to zero in on customer service which is important but is often the opposite of what you need for an actual quality doctor.
In smaller tighter knit communities you were more likely to get to "he was gruff but I think he caught things others wouldn't."
I have a friend in primary care who picked up most of the local population of a specific ethnic group. He's a good doctor but they don't know that, he was just nice to them and understood their culture so they all came.
They don't know that he's not making mistakes other PCPs would make.
Throwaway05
8d ago
Then there are the stupid questions:
I feel like I have stepped into the role of nagging elder relative at this point buttttttttttttt.
Medical board exam questions usually come in two flavors: 1. "We are required by weight of history and other requirements to put this in here" (which usually involves historically important acknowledge of ye old white men and deprecated theories, as well as political drivel), and 2. "No really I need to know you know this for practice" (at times especially because people aren't actually doing it).
Vitals monitoring is common for a ton of meds some of which isn't really that important some of which really really is (like say venlafaxine). In the times of Telehealth reminding doctors they actually should be doing this is kinda important. Depending on clinical specifics cardiac monitoring is also not unreasonable for ADHD meds. Granted the necessity of this is probably a bit reduced in a less.....um, lawsuit laden? environment but that doesn't mean that on paper you shouldn't be doing these things.
Perhaps most importantly they told you that none wasn't an answer so that tells you that there is something you misunderstood, didn't know, or that they were hiding behind "most likely." It's not worth fighting them about in your own head, especially because you were able to figure out the trick.
Likewise yes yes we don't really know how anti-depressants work, but you can just say the receptor of interest and move on with your life lol.
Anyway bitching like this is usually a sign that you passed, and these exams are mostly designed to make you feel like "wtf" walking out after them.
Throwaway05
9d ago
Yet they can't do long division which only requires repeating four simple steps.
Holy crap, I just realized I don't know how to do long division anymore.
I'm not sure how I feel about this.
Throwaway05
9d ago
"All of the above" should be the default answer for any medical multiple choice questions, It Is Known.
Throwaway05
13d ago
I walk past a middle school in a major blue city on the way to work now and I am constantly seeing kids smoking and selling pot and other shit right in front of the school. It's ridiculous.
Throwaway05
19d ago
I had a friend from Medical School. Beautiful Korean girl, super introverted, super quiet. People would just talk to her, explain things about their life. You'd figure they'd hit on her, but no, instead she got unsolicited information. I told her she'd be a good psychiatrist, guess what she ended up doing?
And at the same time, seeing her years later..... she looks more like a psychiatrist now.
I think it's a little bit of natural temperament and a certain kind of charisma that does something very specific, and at the same time the training and practice takes any innate character and accentuates it.
To some extent I figure this applies to all physicians - once you get used to people telling you about their anal leakage that changes how you interact with others in a big way.
Throwaway05
21d ago
While I do agree that ADHD in children is probably over diagnosed, it's worse in adults because of people motivated by the diagnosis.
This also applies to children to some extent - parents looking for an easy answer, medications, etc.
They can then shop around until they get the answer they want.
Throwaway05
25d ago
I'm not sure what you mean, but an excess in consults is driving people out of practice, raising costs, lowering quality and all kinds of other shit. It's a mess.
Throwaway05
26d ago
Midlevels are ass and have no organized educational standards. They also appear to objectively hastening the demise of US healthcare through over utilization of referrals and unnecessary testing.
They also literally do not have the same practice and malpractice standards, which is just so so absurd.
Throwaway05
26d ago
A very large chunk of US healthcare expenditure is on end of life care that other countries more strictly ration.
EMTALA is also very expensive.
Throwaway05
26d ago
I think some of these people feel they will survive his mayoral term and then what whatever comes next will be perfect for them for years.
This probably isn't wise, Mamdani is a damn smart operator.
Throwaway05
26d ago
I think it's somewhat confused because some of the very wealthy donor class are actually (passively) all for him winning - they think he's going to be such a fuck up that it sets back socialism for awhile.
Not sure this is wise but I know for sure that some are thinking that way.
No.... I think you are taking away the opposite from what I'm trying to impart?
Pharmacists are not the appropriate choice they have limited training in clinical medicine and diagnosis. Their job is to explain medication, mechanisms, and interactions not know when to prescribe or not to prescribe.
Throwaway05
26d ago
"You had a fever for a week, you tested negative for the few viral things they tested for, and they didn't want to explore it further at all or put you on an antibiotic as a precaution?"
As presented (which it may not be! One of the things we get paid for is to know what information is important) um, to put it gently they need to reconsider what they are doing or if they are specialists they should refresh on general medicine. Antibiotics target a specific organism, random antibiotics is effectively never a good idea in an outpatient setting. Empirical supportive care is fine for a variety of things. Things like an extended viral panel would be low value but critical for having an informed opinion. Knowing your Centor score (which a Telehealth doc can't do either) would be important.
To be charitable maybe they haven't been following practice guidelines. Or maybe I haven't been following practice guideline updates since I'm not in primary care, but viral illness is the primary cause of sore throat and with rare exceptions we don't have any way to treat viral illness.
Any kind of fever of unknown origin work up is a bonk straight to idiot jail with your timeline.
In any case, as I've mentioned before, we don't get paid to manage stuff like this - usually go home and relax is the treatment. We get paid to manage your aunt who is on 8 medications for chronic conditions including hypertension, diabetes, heart failure and s/p hysterectomy for 3a cancer who we see every 4-6 weeks instead of once a year.
Most of the job is not the kind of thing that relatively young and healthy people are seeing us for.
Outpatient administrative burden is usually because of regulation and actually has value (at least in my experience). You won't catch many (if any) physicians supporting the existence of the assistant infection control nurse for the 15th-20th floor but I'm zeroing in on the implied attack on physicians bit.
Throwaway05
26d ago
While that's something of an edge case, again watchful waiting is the treatment for most human illness by the numbers. That's appropriate, but annoying. Most doctors are used to doing something because patients demand it but that doesn't mean it's a good idea, just that they don't want complaints/bad reviews/lawsuits/etc.
So; just more ridiculous inefficiency in the inefficient healthcare system.
What about this was inefficient?
You want doctors to order expense interventions that are not risk free just because you demand them?
You want to do what most countries do instead which is provide significant care rationing and shortages?
You got to rapidly see several providers, in most countries you'd just be waiting for days to weeks or even months and then they would tell you they weren't going to do anything most of the time.
Maybe you want to be able to decide your own care. A few countries allow that but they are never countries remotely like the U.S. - usually some combination of much poorer (so few people can afford to dictate their own care), much healthier (and critically with less comorbidity so stupid decisions are less risky) and perhaps most critically: anti-intervention. I've heard from Indian doctors that their patients refuse to take medication most of the time. Americans overuse. It just wouldn't work here for a million reasons.
Lastly, who would they sue when things went wrong? Can the government sue you for fucking things up? Can we order your death because you chose to do something stupid and destroyed your kidneys for no reason?
Fundamentally most people can't be trusted to manage anything technical - if you poll people on a plane that's being delayed for deicing a good chunk would want it to take off and get themselves killed. Even most doctors can't be trusted to sensibly manage their own care because they are too close to it. People off the street? Jesus.
Recently experiencing mild inconvenience is not a good reason to advocate for disastrously stupid policy.
Throwaway05
26d ago
Ah, earlier than I thought - don't worry more good shit is coming.
Not Asian but I suspect it's because of Hot Pot culture.
It's a whole social thing that replaces drinking or goes in addition to drinking for some Asian communities.
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