Throwaway05
1d ago
In short, my lack of success is due to being banned from Hinge (the best dating app I have ever used)
I'm going to write taking the rest of what you said at face value (by which I mean that you are a very well educated, successful and therefore likely hardworking and intelligent individual).
The above quote is a loser attitude. I don't mean you are a loser, far from it. You are demoralized because you aren't getting lucky and luck is required because that's what you need with the way you aren't embracing every opportunity.
If someone was trying to break into your field (7 figs in early thirties???) would you tell them to just passively apply to jobs or take low end jobs and not excel? Fuck no.
You gotta hustle. And we have reason to believe you can hustle in other domains in your life - you gotta apply those lessons here. Dating is going to involve a lot of discomfort, it's easy to justify avoiding discomfort but that is what it is and what you gotta overcome. Some of the other posters here complaining about dating have bigger concerns - but you, your fundamentals are extremely "attractive" and you are living in a place with a shit ton of women meeting your needs.
That means you are probably doing something wrong or you aren't doing enough. That is good news! It means you can do something different, and/or do more. It's going to be uncomfortable but dealing with that is a core skill in dating and in business.
Okay an example - you got banned from match apps. Why? Someone probably reported you or something, likely multiple someones (does that mean you did anything wrong? no, women on the apps be crazy). Is there a way to appeal this ban normally? No. Do you likely know someone on LinkedIn who knows someone who works there? Given your background very possible. You can cold message someone and be like "hey I work in NYC and I'm interested in whaling on this shit but I'm banned for no apparent reason..." Is this likely to work? Maybe not. Could it work? Yes absolutely. I was having a serious redacted issued with major tech company and I contacted person I knew for redacted reason and they got someone to fix it. If you have the professional network you can use it. Even if you don't have a connection you can leverage if you have a built up LI you can probably just cold message a few people. If you don't have a built up LinkedIn you are probably not networking enough, that will help you at work but those networking skills can also be leveraged to pick up women, especially if you are looking for a specific type (meet a guy who hangs out with ABGs? ....become friends with him and you'll meet ABGs IRL).
Likewise make a CMB. Now. Do not stall, if you stall that stall will last a long time. Make it and start using it now, maybe you don't find anyone with the qualities you want but dating is a skill and like any skill it has to be practiced, it is also a numbers game so you gotta get on it if you want it to work.
I don’t have that many opportunities to meet single women IRL: my hobbies and social circles are pretty male-dominated and the attractive women in them are already taken; plus work keeps me pretty busy.
More discomfort - pick up some new hobbies that have women. Depending on how male-dominated your current hobbies are that could end up being great for you for reasons other than dating, but if what you are doing right now isn't working (and it clearly isn't) you gotta start doing something else!
This, I think, is especially true when it comes to women who are my type (well-educated Asian-Americans), as they tend not to just hang out in bars or whatever waiting for guys to approach them; if they’re in the dating scene at all, it’s through apps.
I think you also have to be careful with how dialed into your type you are. That's instantly going to make things more challenging for you, but if that's still the only thing you want I think you are missing out on some of the stereotypes - FOBs might be not hanging out in bars, but ABGs are big into the clubbing and rave scene, are all over certain kinds of bars, you can approach while they are doing some dumbass trendy thing in K-town etc.
Throwaway05
1d ago
Yes absolutely depending on what you are doing.
In America diet/obesity is the more likely cause, but if you are deadlifting like crazy or something else which fucks with your abdominal pressure yeah could easily happen.
Throwaway05
1d ago
Am doctor but not eye doctor. Not a fan of LASIK especially in your age range. Carefully research the risks first, you won't get a good objective assessment from an ophthalmologist because if at all possible they'll recommend the procedure (because surgeons want to cut).
Does your ban extend to Coffee Meets Bagel? It's very popular in the Northeast and Asians are over represented. Recommend Asian adjacent real life activities if that's your mojo. Ex: EDC (or whatever local concerts there are).
Find a place to meet residents (physicians), easy way to pick up intelligent professional women.
Don't know how to find a dating coach but do recommend that.
I think Raya has gone out of fashion now but you might be able to find its replacement or try signing up for its corpse.
With your salary a good personal trainer is super affordable and is good for your overall health and mood and also for making you more superficially attractive.
If you have good insight- figure out why you aren't successful. If you are moderately attractive you should be drowning in women at that wealth level. Are you fatter than you want to admit? Fashion style not making it obvious you are bringing in money? No rizz?
Figure out what it is and then you can address. This ties back to matchmaking - if the issue is your profile was shit they'll fix it. Don't want to pay someone? Run it by women in your life if you don't want to pay. (assuming you can get on CMB)
Throwaway05
1d ago
If your hemorrhoids are caused by your diet, adjust your diet. Likewise do what you can to reduce straining. Fiber intake. Fluid intake. Exercise. A squatty potty (no really they work!).
Here's google AI's list of risk factors. Modify what you can. If it is caused by most of these (ex: excess straining), any treatment is going to not matter much because of the likelihood of recurrence.
Straining during bowel movements
Sitting on the toilet for long periods of time
Chronic constipation or diarrhea
A low-fiber diet
Weakening of the supporting tissues in the anus and rectum, which can happen with aging and pregnancy
Frequently lifting heavy objects
Being obese
Anal intercourse
Certain diseases, such as cirrhosis
Family history of hemorrhoids
Throwaway05
3d ago
Here's a two minute video explaining PBMs in a humorous fashion by a Doctor/Comedian influencer.
https://youtube.com/watch?v=_khH6pZnHCM
TLDW: United IS its own PBM.
Throwaway05
4d ago
ASCs in the U.S. will sometimes do cash pay for low risk things, so it is possible in the US but keep in mind that due to greater access to expensive technology, salary costs (nurses get paid more in the US than doctors do in the UK right?), and lack of rationing mean that the price of care can be much much more expensive.
By a lot.
California alone has more ECMO centers than the entire UK.
Throwaway05
5d ago
I'm not sure it is possible in the sense that I believe the USMLE scores become invalid after a certain period of time (somewhere in the 5-10 year range?). Would need to investigate that and potentially move quickly.
I don't know if you can take them again if they've expired but it would be extremely hard most likely (on just the studying level if nothing else).
If they are still valid though - NYC almost always has a bunch of unmatched FM and IM spots. That's probably the best place to look. EM has been off and on grossly uncompetitive in the last five years but it hasn't been consistent. Psych used to be a place people looked but it doesn't really work anymore. Peds may have more spots open now.
HCA and other for-profit places have started offering program slots and they aren't popular with US grads but could be a good spot for FMG/IMGs
Throwaway05
5d ago
The benefits are all theoretical.
I don't really care about DST but it is worth noting that there's supposedly an association between time zone changes and medical and psychiatric health issues. Healthy people can change their sleep easily but medically ill people get more heart attacks, people with bipolar are more likely to have an episode etc.
I say supposedly because doing a lit review right now the evidence base isn't aggressive, but it is often passed around as medical fact.
Throwaway05
5d ago
Hahaha I guess that counts as fitting though?
Throwaway05
5d ago
______>
Throwaway05
6d ago
I don't think I disagree with any individual thing you said there - downvotes aren't representative and shouldn't be over analyzed, the job and pay are worth it (but less so than the past), people are meaner and angrier in person (to say nothing of online) these days, and so on.
That said - the excess of disagreeableness and decline of respect for institutions and expertise is real (everywhere and sometimes deserved). It's extremely noticeable in our jobs though, because most of life and health takes place outside of the hospital so we can easily see when people don't listen (and come back or die) or make a mess during their stay/visit.
Our oldest can tell us how different it was in Ye Olden Days, or if we work in settings with radically different populations we can see the gap (Vets).
These days we see more and more patients doing things like walking away from treatable cancer to ending up terminal on homeopathic arsenic from someone who is legit licensed in Oregon because that's a thing they do. While I'm not immune to slinging mud at times...people yelling at me on the internet scratches the fundamental same itch writ small.
What bothers me a little more is when people don't realize the decline, especially when it is the respectable types, because of course that hurts more.
Yes I want to be respected (who doesn't?) but it's so intrinsic to the job for us. Yeah its kinda funny when I whinge about it being harder to pick up women as a doctor, but patients shooting their doctors (real but rare), people demanding things that are dangerous to themselves and others like antibiotics for a virus (common as all hell and a problem but individually small potatoes) to the expansion of midlevels because people don't realize how much worse they are (metastasizing everywhere and I'm tired of seeing my patients and friends end up with bad outcomes from it)...these things are real and bringing my end of things closer to collapse.
Like much of everyone's current ills I don't know what the solution is, but I will get on the soapbox and mumble a bit.
And on traditional and all together saltier note, since I was a young intern on call at one point in the distant past: yes nurses get it worse from patients but they totally deserve it.
Throwaway05
6d ago
The complicating factor is that many presentations of illness look very similar - does your young person with chest pain have heartburn, an honest to god heart attack b/c of something like genetic disease, anxiety, costochondritis, or something else?
The triage process tries to prioritize people and then once questions are answered (okay the EKG is reassuring, anxious Karen can wait for six hours) readjust how to prioritize people. If you send someone back out to the waiting room and they die because you missed something or had an atypical presentation.....massive lawsuit.
How you get prioritized and triaged usually happens in the background without you knowing about it (for the obvious reasons).
One approach that a lot of places uses kinda zigs a bit from your idea. EDs will have a "fast track" area (will likely have a euphemistic name to make it harder for patients to know) for simpler chief complaints. Work that is expected to be more brainless and less acute (what constitutes this is not necessarily obvious, someone with a diverticulitis flare up or a broken arm is in crippling pain and need some specific intervention but it doesn't require a lot of cognitive resources to figure out the plan) and it's staffed with generally less experienced or competent staff. They can then churn through the simpler cases while people spend an extended period of time in the main idea waiting on labs, images, consults, a hospital bed, someone to figure what the fuck is going on).
You might note the name is kind of the opposite of what you are saying - fast track, so it doesn't disincentivize the over utilization behavior, but ultimately getting people out of beds or the waiting room takes priority, and a lot of regulatory/bonus/compliance structure involves reducing wait times anyway.
Throwaway05
6d ago
There's a good discussion on EMTALA today on Meddit:
https://old.reddit.com/r/medicine/comments/1hdpuq6/seeking_advice_on_emtala_violation_allegation/
Throwaway05
6d ago
Doctors (and myself) certainly exaggerate sometimes but the amount of good (and bad) shit that happens and sounds fake is nuts.
I'm assuming quite a few of the downvoters on my latest posting spree are assuming that the 24 hour shifts aren't real or are a gross exaggeration.
Nope.
Throwaway05
6d ago
My primary care dr told me he gets way more time with patients at the VA then when he was at the local privaye clinic. Unfortunately he left to do research. Now I have a Nurse Practitioner whom I haven't seen yet.
Thank you for sharing.
Yeah slow pace does have some benefits - you carry less patients you spend more time with patients, which is mostly what we want. It has the costs though.
I'm not going to say the VA is a guaranteed death sentence and depending on what you need the quality of care can be higher (I'd say that psych is probably better in the VA because you see people with more time and specialized knowledge and time and that helps a lot in psych), but the VA is usually the butt of the joke in general medicine.
Throwaway05
6d ago
Gas is a lot like being a pilot and flight attendant in that you receive a lot of training for things that aren't often happening and that the average person doesn't see or notice. Job looks easy when things are going smooth. Every time you do something you do a lot of preparation and planning that seems to happen automagically to outsiders.
Unlike aviation, the plane tries to crash repeatedly and active actual plane crashes happen a few times a week. Fundamentally you are fighting to keep the patient alive while the surgeon tries to kill the patient. Think about things like open heart surgery. Even something as simple as an open gallbladder involves radically changing the patient's physiology. Bad outcomes get blamed on you and are your fault.
Surgery isn't everything gas does though.
Imagine you are working a 24 hour shift overnight, it's 4am and you are sitting in a break room watching jeopardy reruns and eating shitty chips from a bag, your pager goes off. You have 90 seconds to get to the trauma bay, where you find a patient has got hit in the face with a sledgehammer. His anatomy looks a cheeseburger put in a food processor and pulsed. You have to keep the guy alive long enough to put a tube down this throat, get fluids and blood running, and get the guy to the OR where another doc and the surgical team repairs the guy's face in an 16 hour surgery.
Ten minutes later you are back to eating chips and watching jeopardy.
OB, psych, and gas have serious tempo issues which more resemble the military and police and are not for everyone.
Throwaway05
6d ago
and they have incredible status to boot
I don't think this is true anymore. Anti-doctor viewpoints are super common right now. The left and the right hate us. Corporate media blames us for cost overruns. We aren't independent anymore. Patients murder us and it doesn't make the news. We get threatened all the time at work and the police and the hospital both shrug, even in places where there are specific laws against that.
Look at the tone here. Sure I'm not a perfect communicator but every time I try and refute lies about the AMA I get buried in downvotes, the "doctor bad" and "doctor is the problem" memes are rampant, and that extends to general society.
Not saying it isn't true, just saying that people absolutely feel that way.
For a practical example - you used to be able to get laid or find a partner b/c you were a doctor. Doesn't really work any more.
Throwaway05
6d ago
That's the high end of the range, here's what google AI bullshit says on the matter:
"Obstetric malpractice rates are high, with OB/GYNs having one of the highest malpractice rates of any medical profession: Malpractice claims: More than 62% of OB/GYNs are sued during their career. Malpractice insurance: OB/GYNs have some of the highest malpractice insurance rates. Costly claims: Obstetric malpractice claims are among the most expensive medical malpractice claims. Birth injuries: Birth injury claims are the most expensive obstetric malpractice claims."
And from an article: "As a result, an OB in Chicago typically pays about $140,000 a year for med mal insurance, while the median premium for other specialties is $30,000 to $40,000."
Some key bits - OB gets sued a lot, OB patients are pretty much by definition healthier than most patients so that means bad outcomes are more expensive (compare 75 year old with kidney failure with 30 year old mother of two with no past medical history). If you injure a kid literally while they are being born you are like on the hook for everything that ever happens to them...
I think it's probably more of a practice environment issue than mistake issue, on average they get sued (62%) and there are states that are known to be hell holes for this (example: NJ).
Don't know for sure though.
Throwaway05
6d ago
We've been trying to figure this out at work and we have a few theories.
Sidebar: social media presence rarely paints an accurate picture of a person for a variety of reasons. This is also a huge part of why social media is so damaging for young people.
None of this is a diagnosis. I know fuck all about actually clinical relevant information for this guy, media sucks and speculation is rampant. Mostly writing this as a thought experiment to see if I can come up with any good questions for you to ask if you get another chance.
In no particular order.
-
Mostly depression/pain and he decided to make a political statement instead of just toping himself. Sample evidence for: back pain problems? has caused murder before in others. The supposed withdrawal from family. What could you ask your friend: probably not a lot given the timeline. Usual "depressed y/n" questions would work if someone saw him more recently. Caveat: more to depression than just the stereotype most people know. Against: Doesn't really look the type in the photos and such we have now, but that's shitty quality data.
-
Pure politics/radicalization (I'm including drug/psychedelic induced scrambled brain in here). For: superficially that looks to be what happened, easily fits the data we have now. Drugs. Ask: need someone close enough to him to know how he actually thinks about things (we are all familiar with hiding our power levels), behavioral and thought patterns suggestive of tendency towards radical politics. Looks like you spotted some of those. How'd he feel about Trump, COVID? How evangelic and aggressive was he about those? Did have radical political swings in response to popular stuff? Think about the stuff you see that predicts someone becoming a "woke crazy" type. Same underlying thought patterns and behaviors can cause radicalization in all kinds of different directions, even in the rational and intelligent. May not even be "wrong" see: US founding fathers. If your friend is intelligent, thoughtful, and aware of this stuff you can just ask him if he looks like someone who could easily be radicalized with the right setup. Against: some of the other explanations work better with the limited information we have right now.
-
Personality disorder. (What is this? Think antisocial personality disorder, narcissism. The latter is hypothetically where most school shooting type events come from, which is a surprise to some). For: makes it easy to decide to kill people. Is normally what causes similar events. Ask: Check out the DSM criteria for ASPD and NPD. The former is easier to ask about "does he like, not fucking care about other people's rights at all?" The latter is going to be hard to elicit from a layman if it's not obvious unfortunately. Many people pick up the vibe on these people though so your friend might go "oh yeah." These are essentially life long so would have been present when your friend interacted with the guy. Against: Doesn't smell right (ASPD especially) and doesn't really match with the online profile so far in my opinion. If he ends up being more incel seeming with more data NPD could end up being a good explanation though.
Probably the most interesting:
- Prodrome. (What is this? The guy is catching schizophrenia or something else and is starting to go weird but it is still early). For: Guy is organized, intelligent and had a good plan but it went off the rails in a strange way that doesn't match the rest of the story. Substance use. Manifesto stuff. Some things are off. Withdrawal from family. People with good intellect, education, and resources hold it together, often for some time and then it starts to fall apart but not usually in this rough of a fashion. Ask: Any family history of mental illness, especially serious mental illness (your friend probably doesn't know but this would be huge). Did his behavior change in any way while your friend knew him? Weird beliefs, social withdrawal, "looking like" a different person (seems like the interaction wasn't longitudinal to likely catch this)? Was he weird? some weird people have a predisposition towards mental illness of this kind and develop it (or don't). You'll notice the person is off. Poor social skills. Not as emotive. Strange beliefs. Doesn't seem to move through social situations as well. Oddly confrontational about strange things. Limited functioning in some ways (if they have partners the partners are more like them). Can't emotionally connect with others. I'm sure an expert in first episode psychosis would have a better way of conveying this but there's a vibe most people are able to notice once it has been pointed out to them. I know you said your friend stated the guy is weird but we are looking for a specific weird here. Against: Little old for this to be common (usually starts more like late teens early 20s, but his resources may have impacted course). Doesn't seem overly psychotic right now (but again this is more prodrome than full blown illness)
Throwaway05
6d ago
The Canadian system absolutely has problems with insufficient resources, long wait times, and rationing, however that kind of wait time in the ED specifically can happen in the US pretty easily.
I imagine this exact case would have gone differently but it is pretty common to sit in the ED for a very, very extended time with nothing visibly happening to you. Here the primary driver is over utilization (people refusing to go their PCP instead or not having a PCP).
A bit different but the most alarming example is behavioral health, especially for kids (although this bit is shortage related). It's not uncommon for an ER to have one kid who has been boarded in the ED for weeks to a month waiting for a bed at a psychiatric facility. For adults it's often days to weeks.
Throwaway05
6d ago
Fair point, my only personal VA experience is with hospital and residential programs.
A common problem whenever healthcare discussions come up is that patients view the outpatient experience as the majority of healthcare but for us it's the opposite. Most of the training, complexity, fun stuff, whatever is all hospital based. Ideally as a patient you do that the absolute fucking minimum and mostly interact outpatient.
The more general problem with the VA is that standards are very different from the rest of American healthcare except for things like Prison/Indian Health Services.
Malpractice standards, rationing, staff competence and speed and quality of care, documentation standards. VA staff work less hard and get to skip some very frustrating types of administrative work (like having a lower documentation burden), VA patients are some of the most fun to treat because they are often pleasant and friendly. This leads to happier staff and therefore pretty high patient satisfaction.
Unless you fall afoul of some rationing or speed based need I doubt it makes a huge difference in an outpatient setting, but I get very, very nervous every time one of my relatives or friends ends up in a VA hospital.
All the horror stories (mostly undiagnosed conditions) I've heard were in the private systems.
I'd love to hear more about this. Outside some scummy for-profit systems like HCA this is totally alien to me.
Throwaway05
6d ago
Yeah I don't think there really is a way to make this change. A common suggestion medical people have is to reduce the cost of medical school tuition to international norms which would then decrease the laser focus on higher paying specialties.
I don't think that really matters because of my thesis - MD salaries aren't the problem. Fixing supply, reorienting where people are going, etc. All distractors.
Throwaway05
6d ago
Let me first reiterate that I don't think this is super rational.
Keep in mind that like 55-60 of percent of grads are women, and ultra woke ones at that. A good chunk of the guys are gay. 45% are non-white (mostly Asian and Indian).
The politics these days are super far left (downstream of admission requirements and other factors).
That alone makes these people disproportionately want to live in the biggest most blue areas or "one of the good ones" in a red state.
If my mom was here she would tell me to shut the fuck up about making this too much about politics so I'll point out other things like - you didn't do anything at all for fun (exaggeration but gets the point across) in your 20s or early 30s. You want to live in a place where you can go and make up for that, and not feel 30 years older than everyone else. That means SF, LA, NYC, Chicago, etc.
A college town has amenities but most of the people using them are younger and don't look soul crushed and it makes you feel worse.
This got rambley.
Atlanta/Houston/DFW are fine at attracting people but where the need is a two drive away from each of them. That's fine for a weekend trip but when you are trying to make up for lost time it isn't viable, you want to be able to catch a show after work, go to a hip new bar or restaurant.
An alternative way to think about this is that a lot of people graduate from college, spend a few years downtown somewhere partying and having fun, then calm down and move to a suburb or further out than that. Physicians are 10-15 years behind their peers on that process.
And then kids get involved and you want a good education because it is pretty much impossible to get through training without valuing education and unsurprisingly that extents to your kids. Not finding that in most rural areas or most places in general.
Throwaway05
6d ago
What I REALLY want to see is the percentage of drugs that make it to FDA testing and THEN fail.
Really good thought.
If you don't already know about it you should read up on the story of what happened with Aduhelm (summary not provided in order to avoid being biased).
You should go tell your doctor what is happening. Could be you are just learning something about yourself for the first time, could be a sign of something mild, could be a sign of something serious. Best to figure it out.
If you'd like to subject yourself to hell you can look at some stuff on the cascade.
For your sanity don't.
https://en.wikipedia.org/wiki/Coagulation
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