Throwaway05
10hr ago
I've never heard of this idea before but it grossly fails the sniff test - a lot of this stuff is pretty much known in medicine to almost always be untreated/diagnosed/refused diagnosis Cluster-B.
Some of the rest of it is known to have other different causes for instance (allergies).
Seems very likely to be bullshit, especially since the patients we see who fit into these buckets are um very un priestly.
Throwaway05
11hr ago
Now the secret is that I haven't actually reread it in nearly 20 years. But it was "sticky" (and formative given my age when I read it).
It's okay to love something and not be obsessed with it. It's also okay to keep bouncing off of it even if you love it - stop when you feel you've got enough.
That's maybe one of the lessons of the book haha.
My experience of the discourse of the book is course then out of date.
Throwaway05
11hr ago
What about Anki decks for your boards?
Yeah F codes are a little silly at times cough cough struck by orca but automated tools help make them less of a pain in the ass.
The DSM is great though for kludging a million random phenomena into something that can be actually communicated between humans.
Throwaway05
11hr ago
Honestly I've used the downvotes from my sometimes half-cocked healthcare economics rants as part of exposure therapy for fear of online censure.
Our people pleasing and neuroticism needs treatment!
My recollection of medical school was that almost all of the stellar students and smartest students were the same people. You did have a pot of smart bad students but usually they had something like ADHD and couldn't keep up with the study demand. Although I find that the smart people who didn't do well were better at retaining information years later than the not as smart but better students (this retention being in reference to things like other people's specialties).
However, "bad student" for medical school in the U.S. is a god outside of it - things like pre-exam crams and all nighters are flat out impossible. It isn't uncommon at the start of first year to be basically learning multiple undergrad classes worth of material in a week, every week. Almost all exams are incredibly high stakes and some are full days in length or more etc.
The material usually doesn't require much beyond an above average IQ to learn but the amount of it is vicious - the classic statement is "like drinking from a firehose" and then you do that for years.
No amount of pure horsepower can do it - you also need the effort.
That said an interesting part of how this has gone in the US is that the rote memorization component of medical education has become more or less solved, and since they need to do some candidate discrimination..... they've worked very hard to dial in on the "thinking" parts instead of pure memorization.
A question might be - patient with x disease has y side effect, which of the following medications most likely caused the side effect? And then all 6 meds cause that side effect - they want you to know that one of the medications is overwhelmingly likely to be prescribed because of a practice guideline, causes the side effect at a much higher rate, or something else like that.
15-20 years ago the standardized tests were hard because the way medical knowledge has exploded in recent years. Now they are actually fucking hard and require much more in depth understanding.
This may be a bit US specific though, as the population of students here is generally neurotic passionate about care people or money seekers looking for the best gig (which also requires high performance).
EDIT: An added layer of problem is that the exams have no constrained syllabus, the best you have is weights. The contents is usually "everything." Nephrology in Ortho boards? Sure. A modality that hasn't been used outside of Eastern Europe for 30 years? Sure. A drug that just cleared clinical trials five minutes ago? Yeah.
The secret is that all of the questions are fair or at least important (ex: new drug is actually the first in a new class of medications that they've been trying to get off the ground for decades), but as a student you don't know that until years later, so if you want to do well (and people do) you have to know absolutely EVERYTHING.
Throwaway05
12hr ago
It's my favorite book but it can be Work.
I am shocked at how it only seems to become more prescient as I age.*
*and disturbed.
Throwaway05
12hr ago
Ya'll don't have review books over there?
Dang.
Also medical classification systems are great. Fight me bro.
Throwaway05
2d ago
Uhhhhhh let's see. Lose weight, stay hydrated, have muscles. I believe staying warm and avoiding activity before hand also help.
Ultimately some people just be like that though.
If that's you I'd avoid blood donations - you know it's going to present a challenge and you know you'll have an increased risk of complications.
Unless you have a rare blood type I'd try and do some good by nagging someone else to go in your stead b/c it isn't super viable for you.
Throwaway05
2d ago
Who can actually draw blood with some skill is pretty variable, usually a hospital will have a formal or informal plan for how to do this ("call the ultrasound guided IV team" or "get Agnes") and hospital blood draw quality has worsened in recent years because of various healthcare problems. Most hospital staff also don't like working with police and will probably not put in an effort to be independent about fixing the issue in a case like this.
Of note one of the biggest factors impacting ease of blood draw is hydration - someone who used meth and passed out in a car is probably dehydrated and going to a hard stick.
Throwaway05
4d ago
No worries, I'm just here to be ornery on medicine topics periodically. >_>
Throwaway05
4d ago
Or even massage artists as compared to chiros as compared to orthopedic surgeons.
Hold up now. The primary role of an orthopedic surgeon is to provide medical and surgical management for orthopedic issues. A chiropractor is a physical therapist with less training, delusions of grandeur, and a notable fatality rate (dissections).
Everything that a chiropractor can do that is actual medicine is better served by a PT or PM&R doctor, and a lot of what they do is placebo bullshit at best, actively dangerous frighteningly often.
Throwaway05
5d ago
Hospitals are also extremely obsessed with not getting sued and with not accidentally doing something against policy - they'll eat the cost on a long stay instead of sending someone home to an unsafe discharge.
You'll see things like someone needing rehab, not being able to get placement because of whatever (like being illegal) and then just chilling in the hospital instead.
If someone lives up steps for instance they may not be able to go home.
Throwaway05
5d ago
My biggest fear is that people will notice this. It will become a Thing...and more will do it.
It may be better that he wasn't found.
Throwaway05
7d ago
They were hunting down and putting J6 people in jail YEARS later.
Meanwhile seems to have been no particular effort at all to hunt down BLM rioters except for some of the worst in a few states.
Absolutely crazy gap in effort.
Throwaway05
7d ago
I have some family and friends who work in DC as part of national Democrat political strategy.
They are comically far left, woke, and every extreme stereotype.
Outright caricatures who literally run out of the room if you push back against their political positions in the most mild way.
Throwaway05
13d ago
Yes "gun culture" is more American, but my point is that the access to guns is there in most countries should you wish. Most gun control advocates don't realize this though.
I'm aware that isn't you but might have been OP.
Throwaway05
13d ago
Most countries allow for hunting rifles and such, no?
Throwaway05
13d ago
I mean I'm even thinking street buys - by definition not responsible (more or less). Even those guys are going get the ick from someone decompensated like that.
Usually people like this have negative symptoms that an average person can clue onto even if they are not sure what it is and that's not counting anything directly weird the dude might say.
Throwaway05
13d ago
Keep in mind that the U.S. is not just LA, DC, and NYC - it is also Montana, Wyoming, and Idaho.
I'm pretty much most countries like the US have gun rights.
How much? Okay that can be a problem, but when social services are three hours away and wild animals are an actual threat....you have to.
Europe is not the US
Throwaway05
13d ago
I mean I'm aware it exists but I've never actually seen it which says something unfortunate.
Some places have "ACT/PACT/Whatever" teams that follow people in the community so they don't need to go to appointments but that requires sufficient patient engagement.
Usually that means lots of commitments and you get them with "you wanna stay out of the hospital bro?"
But we let a lot of people wander who dont want treatment and stay out of trouble.
Usually drugs is what gets people involved because it makes them erratic enough for the police to get involved.
Throwaway05
13d ago
Tough situation. It's good that you noticed this* - people like this (in terms of mental health AND criminality) are all over the place all the time. This is both scary and should be heartening - in many environments it's national news if something goes wrong.
It may also be helpful to know that their isn't too much you can do here, guy is unlikely to want help and is unlikely to meet the criteria in the US for involuntary help. Family resources if well applied and other things like that can convince someone to be help seeking, but that ain't going to be your bag.
The gradual burning off of these resources is generally just a part of how this disease goes.
That said - some of the story is certainly concerning but the guy seems to not have caused problems (otherwise the police would be picking him up more often) and made it into middle age which is a good sign, and he is also seemingly not anti-social which is a huge source of violence.
Even people with broken brains tend to have a predisposition to not do violence, in a big city you'll see people running around screaming and attacking trash cans and saying threatening shit but they won't actually hurt other people most of the time.
Incidentally this is what concerns me about recent political violence, it is teaching people with poor judgment that said stuff is a good idea. Not wise.
This guy would likely struggle to get a gun anyway - if it's obvious to you its obvious to someone selling a gun who sniffs crazy every day.
*Our system in the U.S. is very rights focused. That can be good, that can be mad. People who are pro-2a need to experience these people in order to be taking an informed stance.
Throwaway05
13d ago
I mean it depends on the where. Usually you can get someone to a psych ED through a wellness check, the police, etc (at least in a blue state). But then if it's a city this guy is absolutely going to get cut loose. So you need non-urban (save for the real acuity) or non-rural (not enough resources) for their to be any chance of really catching this guy and sending him to inpatient - which is what you'd have to do since he won't meet the criteria for involuntary outpatient and doesn't likely want treatment himself. Inpatient is not really appropriate either.
This is the system we have unfortunately (or fortunately - it's very rights forward which can be a good thing, but is pretty American).
Throwaway05
13d ago
Psychiatric medication having side effects was mentioned below and is true, although less of an impact for patients like this who may not be "with it" enough to notice the problems.
"Anosognosia" can also be a core symptom of some disease - if you realize you are delusional....well you aren't really delusional, now?
Additionally many regular people struggle to take their medication for seemingly "benign" things (like high blood pressure or diabetes) and up to really bad stuff like "my anti-rejection medications for my transplant."
Throwaway05
14d ago
Kirk wore a lot of hats, Erika is planning on taking over only one of them.
People with Autism and people with "Autism" are very different. There is a large community of people in the US who have a number of the conditions on this list by their own understanding but are really just someone with BPD.
"Yes I have depression, anxiety, PTSD, EDS, mast cell blah blah and 5 allergies as well as a non-typical gender presentation." That person is a borderline who refuses diagnosis or is not diagnosed.
This is so wildly off base.
Additionally most of these people are women. Women aren't really priests in the abrahamic tradition and the emotional instability associated with these people is not a good fit for priestliness.
Most of the listed disorders are incompatible with leadership and gravitas.
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