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Throwaway05
3hr 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
3hr 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
3hr 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
3hr 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
3hr 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
4hr 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
4hr 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.
5hr 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.
6hr 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
6hr ago
Pilot training is so expensive that it probably evens out here(planes, man).
HaroldWilson
6hr 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?
faceh
6hr ago
Far as I know it's just based on some eligibility criteria. Giving more often in theory means more blood available (for others) for emergencies. I like to think I'm banking some karma.
100ProofTollBooth
Dumber than a man, but faster than a dog.
6hr ago
Cool comment (seriously).
In your opinion what is the area of law that is at the optimization frontier for raw compensation and intellectual gratification? I have friends who do legal advisory work for the big banks, and they make crazy money, but they kind of hate everything. On the other hand, I know a guy from church who does small to medium local business law, fucking LOVES it, and makes more than enough money (though not Christmas-in-Aspen money). I have an older family friend who spent her whole career in family law and is now emotionally broken and sorta-kinda broke financially.
ulyssessword
6hr ago
I assume they're talking about blood donation, not blood tests. When you go to donate, they test a drop for iron, and after your donation they test for a bunch of other stuff.
grognard
Intel Pentium III 450 / Nvidia Riva TNT2 Ultra / Corsair 128MB PC133 / ABIT BH6
6hr ago
Do they have to be podcasts or can they also be visual? The Great Courses series is torrentable on 4chan’s /t/ board, just look for TTC:
100ProofTollBooth
Dumber than a man, but faster than a dog.
6hr ago
Licensing is one thing, but self-selection signaling is another.
If I graduate from the American Samoa school of Law (that's a Better Call Saul reference) I can handle wills and whatnot, but no real going business concern is going to hire me for complex corporate litigation. If I, this hypothetical business owner, enjoy spending my weekends enjoying recreational Columbia narcotics, I'm going to hire the lawyer who is ex-DA's office and knows all the judges, instead of the one man libertarian law firm who will passionately argue about decriminalizing all drugs.
Basically, we're talking about signaling-credentialism. If a Lawyer went to Yale Law and now works at Latham & Watkins, he or she is probably quite good. If a banker went to Harvard and is now at Goldman Sachs, likewise*. For doctors, we don't quite have the same gradations. If you're an attending in any major metro hospital, you're roughly interchangeable outside of specialties.
I think what OP is saying is he'd like to see more doctors, even those who are the equivalents of Saul Goodman - they can write a prescription for some antibiotics, but you're not going to them for your hip replacement. I could be wrong tho (not op)
- They're good in the way that matters for these specific professions (law, banking) - they know the right people in the right places. Many of them are probably good at, you know, lawyerin' and finance and whatnot, but 80% of these jobs boil down to "yeah, I know that guy."
bonsaii
6hr ago
I think the problem here is that you often don't know what you're dealing with until you're already knee deep.
If we're keeping with the baseball analogy, the specialist is the guy you call when you already know you're up against the absolute best knuckleballers. The generalists are still out there dealing with most pitchers, who aren't the best at it but do mix in knuckleballs among fasts and curves. I guess the analogy I should have used is:
"If I'm betting my life on a baseball team, I want most of their batters to have at least gone up against a lot of knuckleballs in their life instead of a bunch of guys who've mostly only hit against fasts/curves and are going to be out there winging it for the first time if it turns out the opponent team has many solid knuckleball pitchers." (Sorry if this is bad baseball, I don't actually follow baseball)
I've seen the point made that this could also be due simply to Islamists being more than willing to kill for insults to their faith, like the Charlie Hebdo incident. Christians, especially today, have a more "turn the other cheek" attitude, and aren't so willing even to criticize blasphemy, much less to kill for it.
If true, that's rather scary: it suggests that the only way to ensure tolerance of a belief system is to be uncompromising and violent in defense of it, because any weakness will be exploited even by people who consider themselves paragons of 'tolerance.'
I realize that sounds like a "Just Asking Questions" moment where I'm suggesting the opposite to justify something terrible, but I have a genuine fear that this is true and would consider it horrifying if it were. I would much rather we all get along, and I know the human being and fish can coexist peacefully.
grognard
Intel Pentium III 450 / Nvidia Riva TNT2 Ultra / Corsair 128MB PC133 / ABIT BH6
6hr ago
filled with toys I use on the weekends
Oh! Oh! What kind of toys?
grognard
Intel Pentium III 450 / Nvidia Riva TNT2 Ultra / Corsair 128MB PC133 / ABIT BH6
6hr ago
Why give blood every few months? Is that not excessive?
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.
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