domain:apollomindset.substack.com
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!
TequilaMockingbird
2hr ago
Because that would defeat the purpose of having taken the hostages in the first place, of course this is also why the Isrealis have made the return of the hostages a prerequisite for any negotiation, so as to eliminate any incentive to take hostages in the future.
How did you think Californias current "ruling class" came to be?
I think they "came to be" by rejecting both our nation's founding principles, and the "low-key barstool populism of men like Nixon and Reagan" in favor of the rhetoric of people like you. People who care more about the color of a man's skin than they do their behavior/content of thier character.
Can you place the parasites and social dysfunction in a box
Yes you can. Specifically by tackling the behavior directly. The cucked liberal identitarian whinges about "disparate impacts" and "social capital" the based conservative declares "looters will be shot" and allows the cards to fall where they may.
The social dysfunction that has followed the largest non-white group of 'Americans...
Im going stop you right there. When I look at the US today (or anytime in the last 40 years or so) the most socially dysfunctional states are almost never the states that are the most black or brown, its the states that are the most blue.
Throwaway05
3hr ago
That being said, there are lots of reasons why people don't take their medication
Putting side effects and related problems aside (and they are severe, antipsychotics increase all cause mortality for example), many patients don't think they have a problem.
https://en.wikipedia.org/wiki/Anosognosia
It's a core symptom for many with psychotic illnesses and but many mood disorders or personality disorders involve people thinking nothing is wrong or blaming unrelated things.
Many of those with awareness of illness want to be free anyway, even if it means being miserable. Sometimes it is so they can do drugs. Sometimes it's because inpatient facilities suck.
Valuing autonomy is good but it leads to some grossness at times.
Magusoflight
3hr ago
The provocation is designed to rally more women to the democrats
sulla
3hr ago
So Nate Silver's problem is that his method is junk. He takes some averages and models them out. The problem is that a lot of the data he relies on is bad.
I’m more sympathetic to the pollsters than I am to Nate. The pollster’s job is to poll people using a reasonable methodology and report the data, not to make predictions. They can’t just arbitrarily add Trump +3 to their sample because they think they didn’t capture enough Trump voters in their samples.
Nate’s job is explicitly to build a model that predicts things. He can legitimately adjust for things like industry polling bias. He doesn’t because he’s bad at his job.
Muninn
3hr 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.
rmtodd
3hr ago
Well, they already handed a Peace Prize out to Obama while the country he ran was simultaneously fighting wars in Iraq, Afghanistan, and Syria, so it seems that actively being involved in one or more wars is not considered a disqualification for the Peace Prize.
astrolabia
3hr ago
I agree with most of this, but I feel like some male shit-talking and joking, at least in a group setting, also has an element of faux-combat. Constantly challenging each other is a form of play-fighting, but it's also a test - someone who regularly can't come up with a comeback or simply shuts down will eventually lose status and become more likely to be simply dominated by the others.
LiberalRetvrn
3hr ago
Nick’s audience is separate from the groups that actually successfully control women’s bodies
Is it? Nick has said he supports the Taliban's gender policies. I think he probably has a significant Muslim fanbase nowadays.
urquan
4hr ago
That's an intense history. I have a lot of sympathy for all the roles you've had to fill simply as part of IT administration. It was hard to follow certain elements of what your daily tasks were, but from what I could gather, it seems crazy how much access to protected health information you seem to have had. I would expect that HIPPA information would have been plugged into opaque databases a long time ago -- guess I have a lot to learn about healthcare bureaucracy!
The reluctance of clinical personnel to work with the systems was also somewhat surprising, particularly how many decided to quit rather than adapt. Do you think this was because they were nearing retirement, the systems were non-standard for the industry and so they decided to leave for greener pastures, or because working at a community mental health clinic was a tough position and the change in systems was the straw that broke the camel's back in pushing them to get a better job?
For all of their limitations, side effects, and potentially inflated prices, drugs are absolutely, positively the best bang for the buck treatment of mental illness at the community and society level. They provide relief from pervasive states of consciousness and a stability that clients simply cannot achieve without them. Unfortunately, I believe any greater outcome for any given individual would require that magical "willingness to change" that is, all too often, limited to nonexistent.
And this is why I don't agree with the legal reasoning in O'Connor. When we're talking about mental illnesses that make people unable to discern reality or care for themselves, we're talking about a population that, to put it bluntly, needs to be made to take their medication. Chronic moderate harm, not simply imminent bodily harm, to the individual and to society is far more damaging than we give it credit for. Every time I see the homeless beggar on the corner who can't control his movements, I feel that we've done a great deal of wrong to him and to all of us by letting him live on the street like an ancient leper and not putting him in an institution that can guarantee him a warm bed and a set of pills.
That being said, there are lots of reasons why people don't take their medication, the most sympathetic being that many antipsychotics come with all sorts of uncomfortable side effects, as you might expect for a class of drugs that mucks around with the dopaminergic system. Tardive dyskinesia seems horrible. But we can solve this problem with better drugs, and in the meantime the tough situation is that it's better for the patient and for everyone else if we keep them in touch with reality.
spring
safe, legal torment nexuses
4hr ago
Putin ready to end Ukraine war
This implies that Putin's terms for ending the conflict/war goals have changed since Trump became president elect. In June this year Putin stated terms were Ukrainian recognition of Russia's annexation of the four oblasts and abandoning any plan of joining NATO and that still seems to be the case.
TequilaMockingbird
4hr ago
There's nothing nasty about making fun of the people who practice murdering their children so they can continue having careless sex with no consequences.
Yes there is. Nasty is as nasty does.
Loquat
4hr ago
Yes, it would be nice if reporters interviewing anti-flouride activists would ask about this. Genuine, hard-hitting reporting is a rare and valuable thing in all sorts of fields, alas.
I do continue to wonder, though, whether your scenario of a town official deliberately adding unnecessary extra fluoride in exchange for kickbacks from the fluoride company has ever actually happened anywhere, and if it did happen how the situation was handled once it became public knowledge.
the claim that we "add" fluoride to the water supply is a lie.
And this is an extraordinarily bad idea. Any time you take a statement which is clearly true in vernacular speech, and try to tell normies it's false because Science(tm) has assigned a different definition to one or more of the component words, you are lowering the general public's respect for science and scientists.
MadMonzer
Temporarily embarrassed liberal elite
4hr ago
The election wasn't a 50/50 or a dice-roll. It was one way or another.
Before it happened, it wasn't. Even if you had universal legilmency and knew the political views of every voter as well as the voter knew themselves, the result could differ from the legilmency-poll because of differential turnout (which can be affected by unpollable things like the weather on polling day) or late swing (some voters actually change their minds in the 3-4 days between the field work being done for the eve-of-poll polls and the actual election).
If the exit polls are correct, the Brexit referendum was decided by people who made their mind up day-of.
RandomRanger
Just build nuclear plants!
4hr ago
China wants to work peacefully with us
They've been saying that for ages, they have this holier-than-thou attitude where they go 'unlike the US, we think the world is big enough for America and China to be big powers - also stop making provocations in the South China Sea and encouraging separatism, you're stirring up trouble and spreading a Cold War mindset'.
The Chinese version of 'working peacefully with us' is just the same as the US version of 'being held accountable to the international community', it's a polite way of saying 'we are the good guys, we set the fundamental rules on what's acceptable, you can retain some sovereignty but not where it crosses our red lines'.
I'm not convinced that there is anything "to get" in this case. Its a simple expression of "boo outgroup" where Fuentes' "outgroup" is women in general and liberal women in particular. Make of that what you will.
Contrast this with the classical form of the Your Momma or Dead Baby joke where the target of the joke is invited to respond and then recieves a subversive rejoinder in the form of the punchline.
lollol
4hr ago
For years now (since at least 2018), whenever my parents ask me "who's going to win?", I point them to Nate Silver and says I trust whatever he says. And I don't think I have been proven wrong yet. For this election, my gut was telling me Harris was gonna win, I won't deny that I was only reading stories and news from very left-leaning-space, but I have very incredibly high stakes in this election but no responsibility (still on work visa) and venturing into right-leaning-space meant more mental energy than I could bear. Even on election night, while scrolling through fivethirtyeight's prediction thread, I keep telling myself "how can these guys think Trump is gonna win?". The only voice of reason in my head was Nate Silver (and on some level Ezra Klein and that Astead/Run Up podcast from the NYT). Silve himself said "Don't trust your gut" a week or two before the election and look at that, my gut was wrong. This election has proven to me once again that polling works, and that data doesn't lie, it's the people that read the data that lies to themselves and others.
Tractatus
4hr ago
Because absolutely no last-minute polls existed that justified his sudden shift the day prior to Election Day 2016. Nate knew something was wrong with the polling, and put his thumb on the scale to make Trump look better than his model said.
SteveKirk
4hr ago
Yes, I honestly can't blame them given how hard we've leaned into menacing banjo music intensifies to goad this exact sort of ovaryaction
honeypuppy
5hr ago
Selzer deserves to be knocked down a peg (although I think "totally ignored" as some want it seems excessive). But that's mainly because she was incredibly far off on the final result. The equivalent for Nate would be if he were predicting a Harris +7 PV win or similar.
With hindsight, given that Trump has been underestimated three times in a row now, it seems reasonable to think that polls have likely systematically underestimated Trump. But before we got the results, it was only twice in a row, and so a lot more likely to be a coincidence. Nate has written extensively on how hard is to predict the direction of a polling error, and many have been burnt assuming that one or two polling errors in a row necessarily predict a polling error in the same direction in the next election. And with Trump off the ballot in 2028, we'll be back to square one.
Tractatus
5hr ago
"Selzer was also an oracle up until random number dialing in Iowa stopped working." I certainly did...back in 2004, when she confidently predicted a Kerry win in Iowa.
Anyne looking at Selzer's methodology should be discounting her on that basis alone.
"...the reality is that polling methods haven't adjusted for Trump and the response bias issue with his supporters..."
sulla
5hr ago
I get so triggered by this logic because it’s so wrong. Elections are not a football game. They are not actually a random variable. On November 4th the result was already set in stone, unless one of the candidates died or something. You could replay November 5th 1000 times and Trump would win 1000 times. It wasn’t 50/50. It can never be 50/50. It is always 100/0.
Epistemic uncertain is a feature of the model and its inputs, not some inherent feature of the real world. There was enough data to conclude with relatively high certainty that Trump was on pace to win. Nate’s model didn’t pick up on this because it sucks. It has high epidemic uncertainty because it’s a bad model with bad inputs.
There have certainly been elections which were decided by tiny margins. They might well decided by the contrast in weather between the red and the blue part of the state. Now, you can say that Nate's model sucks because it does not sufficiently predict the weather months in advance.
We can score predictors against each other. A predictor who gives you a 50/50 on anything, like 'the sun will rise tomorrow' or 'Angela Merkel will be elected US president' will score rather poorly. ACX had a whole article on predictor scoring. If there is someone who outperforms Nate over sufficiently many elections, then we might listen to them instead. "I bet the farm on Trump, Biden, Trump and doubled my net worth each time" might be a good starting point, especially if their local election prediction results are as impressive.
Unfortunately, I have not encountered a lot of these people.
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