domain:freddiedeboer.substack.com?page=3?page=0?page=0
faceh
11m ago
The fact that I was able to get an issue solved by a Physical Therapist with an investment of about $50 and 30 minutes of time seems to suggest that the medical industry is overcharging for certain services.
Not sure what you'd suggest I do when I'm experiencing ongoing immense pain but no immediate danger and it'd take weeks or possibly more to get in with a specialist.
If the urgent care folks had said "oh, we aren't really geared for this, go see a physiatrist" then I'd give them credit.
That ain't what happened.
Fruck
Lacks all conviction
16m ago
Hey, I don't know if you remember me, I hung out around here six months ago and then flounced off after a poorly received post (in my defence at the time I was disassociating hard due to the election, and what I saw at the time as insane behaviour from my (blue tribe) circle of friends and family but I'll own up to it, I handled it poorly.) At the time you gave me advice that I took to heart, it was a great post I thought on a lot, to the point where for a few weeks my personal mantra was 'all the best teachers are dead'. I really can't thank you enough for that post, it sent me down multiple rabbit holes which I have found hugely helpful and I do believe if I hadn't read it I would be incarcerated in some fashion by now.
If all I wanted to do was thank you I would have just pmed you, but I always pay attention when I notice synchronicity, so when I read this post (I've been lurking since just before the election) I knew I had to log in and say something. Because while I loved Juvenal and Gracian, the author whose insight helped me the most wasn't one you listed - it was none other than Siddhartha Gautama. I have been devouring books on Buddhism for the past six months, it utterly blows my mind how smart and insightful the Dhammapada is. Like you I have no interest in Buddhist dogma, and in reality I've spent most of my time trying to jam sutras into my default pseudo-Christian perspective (they actually go together quite well in my opinion but I understand why Buddhists and Christians don't like hearing that), but it has had a huge influence on my outlook.
I ended up reaching a similar conclusion to you, although I think I picked a different resolution. See my conclusion was that enlightenment is functionally identical to insanity. You can not attain it until you let go of everything - including the ability to understand and be understood. That is the most difficult thing in the world to give up, because you can't do it deliberately - just the act of trying itself is failing. And the idea of going insane isn't particularly appealing to most people either. Once it happens you realise you were making a big deal about very little, but it's like virginity, once it's gone you can never really get it back.
ActuallyATleilaxuGhola
Axolotl Tank Class of '21
24m ago
But the performative surprise that others might is disingenuous.
Uncharitable and frankly surprising since your posts are usually pretty high quality. I'm not performing anything. "Performative " describes people who act outraged when a 42 year old bangs a 17 year old but don't care when a 43 year old bangs an 18 year old.
It’s not some made up woke shit.
Conservatives were performatively butthurt about this stuff way before the Woke. "Won't someone think of the children!" is an ancient meme. I never said it was "made up woke shit." Conservatives have a way longer history of disingenuous pearl clutching, that's why I brought up Lewinsky. I'm saying that I think both wokies and self-righteous moral majority types who express offense at this are inconsistent and ridiculous.
stolen_brawnze
I am the way Sia says "batteries" in that one song.
25m ago
Ex-pats' children, then.
TitaniumButterfly
1hr ago
My church is putting together a big fund for sending Haitian children to school and privately I thought, what's the point of educating Haitians?
Still not sure what to make of it.
campfireSmoresEaten
1hr ago
I played a boardgame called Dune: Imperium for the first time recently. It's a worker placement game. And it vastly surpassed my expectations. I could see myself getting obsessed with it and sinking a lot of time into it.
The_Nybbler
Does not have a yacht
1hr ago
and hundreds of thousands more people would probably fly
But the FAA wouldn't know how to handle that. So they made it impossible.
stolen_brawnze
I am the way Sia says "batteries" in that one song.
1hr ago
I don't understand your confusion. She says it right in the part you quoted. Instead of allowing physicians to have varying levels of competence to go with their shared license/title (like other professions do!), they overregulate quality by strangling supply of practitioners.
That there are no official gradations of "licensed lawyer" is her point. MDs don't need different licenses; just allow more variability among the licensed.
We should encourage understanding; that is, a rational understanding of the physical and social causes that make people think as they think and do as they do. But such understanding is distinct from empathy and compassion as emotional affects.
Compassion isn't a social affect: it's an act of the will.
When I suggested to you that compassion is better than understanding, my point was not that you need to get all teary-eyed and emotional about everyone's problems, though I won't knock that. My point is that it's far greater and more important to earnestly will and desire the best for everyone. That doesn't mean being emotional about it, and it certainly doesn't mean affirming the desires of every single person, especially when they go against their best interests. It can often mean telling people to their face that the path they're on ends up in disaster and they need to stop, now. "Admonishing the sinner" is considered a work of mercy very much for that reason.
But it certainly means caring about what happens to people, even if only abstractly. It means seeing the bad places and needless suffering that people end up in, and earnestly wishing that it were not so. It even includes taking steps to prevent bad outcomes, if only in a very small way.
Understanding can help, insofar as it can help you see where people have ended up with the needs that they have. But it's more important simply to wish for the best, even if you don't fully understand what that looks like, even if the only thing you can muster is the earnest desire that all should end well.
If I understand @dovetailing and @SubstantialFrivolity correctly when they talk about empathy and compassion, I think this is what they're saying. The antonym isn't emotional impassivity, but malice. Dovetailing is arguing that what people often feel towards trans people is malice: "the cruelty is the point."
anti_dan
1hr ago
This is plausible. But the real world data is that P is very high compared to R. So Rs are being subsidized with not-Rs in the post-R environment. All indicia point to X>C
Throwaway05
1hr ago
I mean we (being doctors) mostly hate NPs and PAs unless we are benefiting from them financially.
They have very limited training (in the case of NPs excruciatingly limited) and yet think they have the same level of knowledge and expertise.
All of us have lost patients are seen catastrophic avoidable outcomes.
And they can't be sued in the way we can.
Throwaway05
1hr ago
Ugh I bring this up every time and it gets ignored every time by people with axes to grind.
To further explain - common surgeries still happen (duh) but you have things like:
-Needing to experience complications, which happen less because we are better at stuff now.
-Stuff that used to be always or often a surgery being managed more conservatively leading to less cases.
-Changes to how surgeries work to be less invasive but more complicated to learn. Might take 100 open cases to be proficient and a 1000 robot cases or whatever.
-Duty hour restrictions. We used to work 100% of the fucking time. Now we get to sleep, but that means stuff happens without us.
This is pretty surgery specific but a number of other types of specialities have similar issues where you can't maintain training quality with increased residents.
Throwaway05
1hr ago
I know this is an immensely frustrating experience as a patient but it is important to understand that this is not what urgent care is for.
If you saw a physiatrist (which is the specialty that handles this kind of problem) and they get it wrong....that person's license should maybe go away. A good PCP should get this right but these days we don't do nearly as much MSK work and hospital demands mean we aren't as good at this kind of thing as we used to, you may have PT be the replacement for managing it since it isn't really a medication issue.
But it's effectively out of scope of practice for Urgent Care and ED.
Patients go to UC and ED because it's more convenient than getting a PCP, but ED physicians don't handle these kinds of issues, their job is to triage and manage emergencies, which would likely involving turfing this back to a PCP or PM&R doctor for outpatient management.
There's all kinds of reasons why patients use UC and I get it, but ultimately it results in a lot of disastifiaction because it's generally not the right doctor for the problem.
Throwaway05
1hr ago
preferably actual studies
This is an area of ongoing research, for a long time there was a bunch of non-inferiority type studies published by the nursing lobby which were apples to oranges comparison. Ex: NPs with simple cases and MDs with hard cases had similar outcomes.
Now that the NPs have made such a mess of things you have more research such as this: https://www.ama-assn.org/practice-management/scope-practice/3-year-study-nps-ed-worse-outcomes-higher-costs#:~:text=The%20study%20found%20the%20physician,complexity%20of%20the%20patient's%20condition.
It's important to keep in mind that NPs get effectively no training. Even if you think medicine is grossly simple (which....sigh), you should have some training.
I think people really struggle to understand how big the gap is no matter how often it's pointed out. You wouldn't trust Juan the day laborer working construction with designing a skyscraper, but that's a reasonably apt comparison in training differences and amounts.
NPs don't save the healthcare economy because while they do get paid less they do more unnecessary testing, it's just a wealth transfer from MDs to hospitals. They also stress the system more with unnecessary consults and admissions which only makes the doctor shortage issues worse.
Jiro
1hr ago
I don't understand how you justify a different name and different clothing being a step towards a medical process (justifying parents being given third party info) on the one hand but being completely innocuous on the other hand when it comes to Goth/alt culture.
"A different name and clothing is a step towards a medical process" is an observation about how humans behave in the real world, not a conclusion which needs to be justified. Humans don't behave that way with respect to Goth culture. If they did, then teachers should have to tell parents about that too, but they don't.
The teachers don't have any special knowledge about what students are going to do in the future.
They don't have 100% certain knowledge. But they do have knowledge about what sort of things are likely and what sort of things aren't, which is enough.
SubstantialFrivolity
I'm not even supposed to be here today
2hr ago
I definitely agree that people don't, as a rule, look down on PAs/RNs/NPs. I seem to recall @2rafa lives in the UK, maybe this is a British thing? British people do have a reputation for being incredible snobs.
I don't sit in some sad fucking cubicle or worse, some trendy-looking open office. I have a private office—an actual private one, not one of those manager offices with the window or frosted glass door that's expected to be open unless you're on the phone or discussing something sensitive...
I am genuinely envious. Once upon a time such a thing was able to be found in the tech industry, but sadly those days are long gone. The only private office I'll ever have is when full time WFH.
Some 10%ers will be doing supermarket work of course, they might be perfectly fine, honest and upright people. Others will abuse welfare or spend their entire lives heading in and out of prison.
But on a global level, we see whole countries of the bottom 10% where nothing works: the bureaucracy is a complete shambles and infrastructure is a mess. The characteristic of the bottom 10% as a group is that they erode civilization, they're not merely pawns that do menial tasks.
Scott Alexander memorably pointed out that they do not have alphabetical organization in Haiti - this rather impedes efficient administration. They still have not managed to repair the National Palace where the President lives since the earthquake in 2010.
https://en.wikipedia.org/wiki/Haitian_crisis_(2018%E2%80%93present)
Or from another angle, someone actually wrote this as a story and published it. A real adult thought other people would like to read this. It's pretty bad: https://www.webnovel.com/book/30212039405390805/81118027365538549
I believe that the difference between me and von Neumann is less than the gap between me and this guy. Not in our work capacity but in our general faculties and comprehension.
crushedoranges
3hr ago
I would attribute that to the population getting older in general. City life, and its progressive paeans, are more attractive to the young who seek opportunity and change. They are willing to tolerate things like noisy neighbors and the homeless because they are willing to bear that burden, even if it annoys them privately. The old and those with families wish for the reverse and move away to where they can get away from that within their financial means.
It very well may be that the blues diminish because their societal bedrocks self-select and become redder in the bargain.
FD4280
3hr ago
The tenth percentile of the general population is living off some combination of government aid and crime. They’re certainly not cashiers; even restricting to college students, the tenth percentile will not have the work ethic or the numeracy for this.
Sitting on kompromat against Trump to use when it's needed didn't work the last ten times they tried it, and it may well have cost them the election (Trump was able to stall his criminal cases for 18 months, but I doubt he would have been able to stall them for 40 months, especially if he couldn't point to ongoing elections as political cover).
I got the sense from some Democrat lawmakers that they were personally afraid of a Gaetz DOJ. This interview is a masterclass. People in the comments say it's sarcasm, but it's deeper than that. Everything the congressman says is literally true. Even the subtext is straightforward. It is only the emotional valence assigned to the facts laid out that differs between Republicans and Democrats.
100ProofTollBooth
Dumber than a man, but faster than a dog.
4hr ago
In the book Where's my Flying Car?! The author does a great breakdown of how, because of over-regulation, general aviation died by the 1960s. If it hadn't, he lays out a good case that a pilot's license would be roughly equivalent of (good) driver's education for the same cost, and hundreds of thousands more people would probably fly. It would reshape highway systems and transportation in general.
Regulation doesn't just slow existing business / industry, it aborts new ones from forming and developing before they ever have a chance (emotive metaphor definitely used on purpose)
100ProofTollBooth
Dumber than a man, but faster than a dog.
4hr ago
What's the long term upside of being a PA/NP? Are their managerial and executive equivalent roles for PAs/NPs? Beacuse while making $130k is great out of school and pretty good for a full career (inflation adjusted, of course) ... junior state department officials can build careers that end in Congress, advising /consulting F500 corporations, or just good old fashioned Sinecures at Think Tanks that can push them past $500k / yr. Sure, definitely not all of them will get there, but there's at least the possibility and the pre-established career path.
I'd argue that this is one of the defining features of the PMC approved career paths - that they all have the possibility of creating eye-watering levels of income (bonus points, however, if they have some way for you to pretend you're doing it out of genuine passion and not just for the money. This is why politics is so PMC attractive).
hydroacetylene
4hr ago
Pilot training is so expensive that it probably evens out here(planes, man).
HaroldWilson
4hr ago
Do I really care about rainbow flags everywhere and trans activists in the workplace sending out multiple emails every month about the importance of PRIDE!!!! and allyship and diversity?
Maybe I just can't see the forest from the trees because I myself am very left-liberal and agree with the implied politics of 'pride', but this description is pretty alien to the workplaces/institutions I've been in, but as I say perhaps I just don't notice it.
"Why do we need yet another Pride event? Nobody is harassing you here, of all places. (And why do we need entire full-time positions just to support and affirm you?)"
I think this would meet with a negative reaction partly because people who rock the boat in this way are perceived, rightly or wrongly, as tiresome and trouble-making, in a way that doesn't really have anything to do with LGBT issues specifically. People don't like people who won't go along to get along. I appreciate it's easier to say this when what I'm going along with aligns with my politics anyway, but the politics of workplace pride is usually pretty banal. 'Unnecessary' is one thing, but I don't think a rainbow lanyard implies support for a particular regime of gender identity law, more just an interpersonal respect thing.
I think a good analogy would be some scheme or event or whatever for veterans. A lot of Western workplaces (esp. the US federal government) do have some such schemes, which I have nothing against, but even if you are virulently isolationist/anti-Western in your foreign policy views, anyone who objected to such schemes would probably find themselves written off as a tiresome bore, not because anyone cares that much about veterans but because it would make that person seem self-righteous and self-important. Such pontification implies you think other people care what you think, which probably isn't the case.
like say, a James Damore
I think this illustrates the point - Damore really wasn't being personally imposed upon in any meaningful way. His objections were to firm-level hiring practices in relation to diversity. Obviously he's entitled to think they're unfair or whatever (and the mere fact of that objection doesn't seem to be why he was sacked), but on a personal level there was nothing he himself was being asked to do that might have run contrary to his beliefs. Not to say I agreed with all the backlash, much of which was a bit hysterical, but he certainly wasn't being asked to 'celebrate' anything.
"Why yet another Pride event?"
All of which it to say, I don't think saying this occasions objection or even outrage just because of the literal message of the words but because one wonders why you would bother to say something like that. The social rule you'd break wouldn't be anything to do with progressive orthodoxy, but rather the general rule of 'if you have nothing nice to say, say nothing'. Clearly some people like it and find it meaningful/valuable, so good for them and anyone who doesn't can ignore it and move on with their lives. Don't people have better things to do than complain?
Before I reply to this comment, let me first write this: Enlightenment is real. It changes how you experience things, the only question is how much it changes and how great this experience is.
"Letting your guard down" makes you more receptive, but I don't think it starts the feedback loop. Otherwise, the same feeling would appear every time, but instead I think it's the feeling you start with which gets amplified.
Common advice related to meditation techniques contradicts itself. It's sold as a way of removing attachment, but also as a way of experiencing the moment. As a way of finding yourself, but also of destroying your sense of self. I don't want to experiment more with meditation before somebody can tell me if it results in dissociation or if it helps one get rid of it, for I've had "experts" tell me both. This is a shame, as I would otherwise have much more data for you. "Mindfulness" is good though, at least people who practice it have stronger ASMR responses according to research.
This part is interesting because it's new to me. I suppose it's related to predictive processing? I struggle a bit with numbness, and one of my solutions is mentally removing the constraints on future states by telling myself that every situation is new and that I don't know what may happen.
This sounds different. I meant the location of the "I" inside the head. Thoughts being hard to reach does resonate with me, but I think that's a side-effect of exhaustion or low dopamine. An energy drink fixes it, at least until the energy drink wears off. On second thought, maybe you meant that you felt further away from yourself than usual. Your other experiences are very interesting, but I haven't tried anything like them myself.
Training yourself to hold your focus fully on something (emotion, feeling, an area of your body or your sense of self) and creating a feedback-loop would allow you to test out like 7 different practices all at once. By the way, it seems like you're losing faith in these teachings because you think they should be more popular if they actually worked? But many of them were intentionally kept hidden, and it wasn't uncommon to believe that these things couldn't be communicated. An attitude of "He who knows, does not speak. He who speaks, does not know" probably held back the popularity of much of this.
Also, what would you need in order for spiritual practices to be "real"? You can experience a state of mind in which everything feels profound, but that doesn't mean that the profound connections you see have real depth. Are you fine with the experience, or are you looking for more scientific results which influence the outside world and not just the mind?
I can tell you that these are true at least: 1: Visualization generally works. This relates to "praying" and "desiring", which tunes your brain towards getting or experiencing specific things using the same system which makes you able to wake up at exactly 7am if you wish (most people have experienced this, right?). A quote from The Alchemist goes "When you want something, the whole universe conspires in order for you to achieve it". I'm still not sure if the subconsciousness is stronger than we think, or if human consciousness can influence the probability of things (my visualization sometimes affect the behaviour of other people) 2: You can feel really great just by having strong beliefs. You get that feeling of certaincy which is not much unlike confidence. It feels a bit like being in the flow state or like everything is within your control. If you do something with enough confidence, other people are unlikely to question you, so in the personal and social realm, this is quite powerful. It can just fall apart when you engage with more objective things. 3: The first jhana is real at the minimum, this suggests that other methods of focusing are likely to work. 4: If you escape the state of constantly distracting yourself, and pay attention to the bigger picture, you will often experience enough coincidences that it's just a little bit weird. This adds a lot of meaning and depth to life, so I don't even want to try to disillusion myself about it. 5: Changing ones body temperature and heartbeat by will is possible. The power of placebo is quite strong, so most of the things you're trying to do are probably possible through imagining that they occur (What I think happening when you do drugs in dreams, and likely similar to how hypnosis works) 6: The "energy scale" is basically true: https://www.actualized.org/forum/uploads/monthly_2022_11/636af7340097d_LevelsofEnergy.png.41f9c93fecfbb701a3ec558364120c5d.png
When I reached the highest state a few years back, I experienced some strange things. The environment around me felt smaller, more familiar and like it was my own. (When I'm depressed, the environment feels bigger and hostile/foreign). At some point I thought about my girlfriend leaving for somebody better than me, and the idea made me happy on her behalf. It's the abundancy mindset taken to the limit. At one point I waited on a friend for more than an hour after we had agreed to meet up, and not only did I feel fantastic the entire time, I also did not get bored, and I wasn't in a hurry to do anything.
If you just want small superpowers by modifying or training your perception, then I suggest psychonetics: https://web.archive.org/web/20211015001108/https://deconcentration-of-attention.com/psychonetics.html (I don't recommend doing any of the exercises which requires you to strain your eyes, though)
And if you're just looking for happiness, bliss, peace of mind, or immunity to stress, then just ask, I will try to explain how to achieve these. They are quite easy, they're just dangerous as they can result in complacency, or in guilt (when a loved one dies and your mood somehow doesn't seem too affected)
By the way, I once walked outside with my brother, and suddenly got a really bad feeling. We stopped walking at the same time, looked at eachother, and said something like "we need to get out of here" at the same time. A sudden, shared sense of impending doom. We also once got a strong dejavu at the exact same moment. We just froze and then started talking about it at the same time. Two minor experiences I have had were: Feeling a sudden sense of familiarity with a place I had only been a few times before (it felt as if I had been there for many years), and for a moment before falling asleep, having my entire perception overwritten by an image of an eye and a strong feeling of being observed for like half a second. These experiences were more extreme, but they're much easier to dismiss since they happened to just one person. By the way, unlike people on the subreddit you linked, I've never touched psychedelics. I will be experimenting more with bodily sensations, but I always have a million small projects going on at once, so I may get distracted before I have anything fun to report.
I know very little about this, but it seems to be about turning off all defense mechanisms which separates people, and then indulging in pleasure? I haven't done the sex part, but I've removed these defense mechanisms which separated me from other people before, and it allows me to meet a week of social needs in just a few hours, it's really great. I only allow myself to do this around unvulgar people, though. I could be one with my environment or nature as well if I trusted it, but at the moment thoughts of germs, bugs and other danger/uncleanliness causes me to separate myself from my environment. I can't even enjoy my soft bed unless I'm really tired. If I removed these negative associations, I could become like a cat just chilling on a whim. So what I gather from a quick Google search is that Tantra is like the physical version of enlightenment/acceptance/non-duality/lack of separation. Being on friendly terms with everything.
I need to read more about this as well. Is this the practices you're refering to? https://en.wikipedia.org/wiki/Tibetan_tantric_practice
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