domain:mattlakeman.org?page=4?page=0
Lol I think about the same thing from time to time.
Back when I moved to a new area and had to face the terrifying fear of finding a new doctor, dentists, etc. all on my own, I spent a couple hours of research to find a doctor who accepted my insurance, was located conveniently close to my home, and seemed sufficiently competent from the dubiously reliable reviews and ratings systems there are for doctors (this shouldn't be difficult? There should be some easy way to ascertain if they've ever fucked over a patient or not?). The appointment had to be made a month or so out. I saw him a grand total of twice. Each time I waited about 20 minutes to be seen. I think I spent a total of 15 minutes in his presence. The first time he asked me all the standard health screening questions, including Tobacco use. I truthfully said that I'd had a cigar earlier that year, which he marked down on my sheet and noted "that might make it harder for you to get life insurance." Sent me to go get the standard battery of tests one gets as part of a general physical exam.
Second time, X months later I came back so he could review lab test results with me. All seemed good (BMI a little high but I COULD HAVE TOLD YOU THAT), and I requested politely that he make it clear that I am not a tobacco user, and he was good enough to remove that from the sheet. Hours of research and waiting to talk to the guy for <15 minutes and be told I'm in great health, if a little heavy.
Never went back. Felt like the time investment was simply not worth the so-called 'preventative' benefits. What was the point of him and me being in the same room other than allowing him to show face and justify however much he was billing to my insurance co.? Every single measurement he took could have been done by a nurse, any information he needed to diagnose could be provided without me having to make the appointment and such. I can give blood, turn my head and cough, and get X-rays done somewhere else and send them to him for review without needing to coordinate our busy schedules to coincide.
That's how lab tests work! I go to a location that has plentiful availability, they do some tests and send the results to the Doc. Surely he could have looked them over and sent back some recommendations or concerns as needed. He can presumably do that from the comfort of his home, even!
If I feel something physically wrong with me and it doesn't go away, I go to urgent care and get attention on the spot. If I want to know about some given metric about my body I can usually purchase or borrow a tool that will give me acceptable measurements, then punch those into google (or, more recently, ChatGPT). As somebody with no chronic health issues I simply don't see the value-add of having a primary doctor that will just tell me things I already know, but with the authority of an M.D.
I give blood every few months and they do a mini-physical that allows me to have a small insight into my health going back for years, so its not like I'm just sticking my head in the sand!
Now, OTOH I kind of love my Dermatologist. Visits last <30 minutes, about 10 of those she's physically present, and the entire time she's actually doing examination of the relevant organ. I pay in cash, I get another appointment 1 year out, and that's that. If something out of the ordinary is noticed, she can write the scrip and I can usually physically see the improvement the treatments bring.
I wonder how much of the prestige for doctors is still driven by all the Primetime shows that portray doctors as various types of savants or at least dedicated, hard workers who are subject to insane pressures and generally rise to the occasion. It probably makes the layperson think its GOOD that we limit who can be a doctor. "Doctors have to be like top 10% for intelligence and capable of working insane hours, that's not something just anybody can do!!"
Nevermind that the shortage of doctors is the reason they get insane hours and plenty of people in the top 10% for intelligence would avoid the field BECAUSE of that.
hydroacetylene
6hr ago
I think the heavily hispanic areas swung towards Trump as a side effect of hispanics regarding themselves as having more in common with their white counterparts, leading them to vote with their coworkers and immediate bosses. This change has been more or less predictable for decades now even if most of the voices calling attention to it have done so prematurely.
hydroacetylene
6hr ago
I mean, scientologists are mostly white, and everyone thinks they're stupid and delusional.
AlexanderTurok
6hr ago
NYT had a good article about political sorting:
https://www.nytimes.com/interactive/2024/10/30/upshot/voters-moving-polarization.html
Rov_Scam
6hr ago
This is because being an NP/PA is considered a low-status job in PMC circles; not merely lower status than being a doctor, but lower status than being an engineer, a lawyer, a banker, a consultant, an accountant, a mid-level federal government employee, a hospital administrator, a B2B tech salesman etc, even if the pay is often similar. To become a PA as a native born member of the middle / upper middle class is to broadcast to the world, to every single person you meet, that you couldn’t become a doctor (this isn’t necessarily true, of course).
My sister-in-law is a PA, and I'm friends with several others. I have no idea what you mean from the suggestion that PA's have lower status than any of these other people. Maybe because some people confuse them with medical assistants, but people who don't know the difference aren't among those whose opinions I care about. A lot of them end up being PAs not because they couldn't cut it as doctors, but because doctors themselves warned them against med school. The option is going to school for 4 years after college, spend another 4 years working ridiculous hours for poverty wages, and finally get to be a real doctor some time in your 30s. At this point you're in so much debt that the higher salary only allows for the kind of lifestyle a normal college grad would have, not that it matters anyway, because you're still spending all your time at work.
And who is exactly looking down on PAs anyway? I'm a lawyer. I don't know what you do exactly, except that it's in finance, but unless you're in senior management I'm going to go ahead and pull rank here. 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—that's almost large enough to include a sofa and has sports memorabilia and custom photo prints on the walls and a large picture window with a view of a forest. I have my own secretary, and an army of paralegals will stop what they're doing if they're needed. If I need something printed I call someone else and have them bring it to me. I get printouts of most things because my work space cannot be limited to two screens. I have a bookshelf full of binders I prepare for each case (I'd have someone do this for me, but I don't trust them to not fuck it up). I have people send emails on my behalf, and people stop by my office with stuff for me to sign. I don't do anything that could be conceivably described as "real work". 90% of my job is drafting informal memos that aren't assigned by a superior or even directed to anyone in particular but are simply placed in the file for my own edification and so there's a record of my thoughts in case another attorney needs to look at the case. Most of my actual time is spent looking through documents and pacing my office thinking about things so I can make a decision. The only supervision I deal with is case assignments and who is covering depositions and court appearances, if there's a scheduling issue there. I don't deal with project managers assigning me work and emailing me every five minutes.
Beyond work, I live in a 3-bedroom house in an upscale area that's filled with toys I use on the weekends pursuing expensive hobbies. So please tell me who exactly I'm supposed to be looking down on. A guy who runs a crane in a steel mill? A video editor? The owner of a dog grooming business? A low-level financial analyst for a large company? A schoolteacher? A mechanical engineer? An audiologist? A registered nurse? A college professor? An accountant who does asset valuations? The guy you call before you dig? A middle manager for the IRS? The guy who works for a large bank who's described his job to me several times and I still don't know what he does? These are all friends of mine, and I could go on, but this gives you an idea of what my social circle looks like. There are no doctors or lawyers I regularly see socially, though my cousin is a Worker's Compensation attorney. I don't know anyone, even among lawyers, who engages in the kind of ostentatious spending that's meant to signal status. I know people who are really into things like craft beer, but that doesn't correlate with income. I personally drink High Life and Coors Banquet as my regular quash. I don't think PAs are below me. And I'm not one of those unrealistic egalitarians who think that I'm everyone's equal; I wouldn't date a girl who worked at McDonalds (or, realistically, one who didn't have a professional job), but that's about as far as it goes for most people. I don't ask what people do for a living before I decide if I'm going to be friends with them.
Instead of allowing (as engineers, bankers and lawyers do) a big gradation of physicians, all of whom can call themselves the prestige title doctor but who vary widely in terms of competence, pay and reputation in the profession...
There are no gradations of lawyers in the US. Once you pass the bar you're allowed to handle anything any client is willing to give you. You might not exactly be qualified to do so, but all the ethical canons say about that is that you have to familiarize yourself with the relevant law. Medicine, by contrast, has actual board certified specialties that require specific training.
OliveTapenade
6hr ago
Yes, with Islam specifically I think the implied belief is that 'Muslim' is basically an ethnicity or a race. This is silly, especially because Islam is very resolutely and explicitly non-racial and non-ethnic, but no one accused Western political discourse of making sense.
If you know anything about mixed martial arts, you'll know the name Conor McGregor. If you're not resident in Ireland, you may be unaware of what a generally scummy and loathsome person he is: the "Controversies" section on his Wikipedia page is nearly 500 words longer than the "Professional mixed martial arts career" section. He's also running for President next year. It need hardly be said that I'm having a hard time envisioning a worse brand ambassador for the Irish nation (I would sincerely prefer Barbie Kardashian, Gerry Adams, Dustin the Turkey or Jedward over him), and it infuriates me that in many cases he's literally the only thing non-Irish people know about our country.
After numerous criminal investigations for rape and/or sexual assault which were dropped for lack of evidence, one such complainant, Nikita Hand, sued him in a civil action. The jury has found in Hand's favour, and now that the trial is over, the injunction on the media has been lifted and they are permitted to disclose various details about the case, including the fact that Hand alleges that, after she filed the civil action, masked men broke into her home and stabbed her partner.
One reaction to the outcome of the trial I found particularly sharp was from Waterford Whispers News, a satire website which aspires to be sort of like the parochial Irish equivalent of the Onion. Between 2013-16, the website did not miss, and they'd have a wittingly biting take on virtually every major news story in Ireland. After that golden era the website kind of fell off and stopped seeing nearly as much traction on social media. Much like their main source of inspiration, they dropped all pretensions to neutrality and pretty much openly announced that their satire would only be a means to advance a socially progressive worldview, to the point that, earlier this year, they were literally selling merch with the dictionary definition of the word "woke", defined as "1. Alert to prejudice and injustice 2. Not a prick" - what is this, 2014? But occasionally they can still knock the ball out of the park, as with this post: "'Keep Women Safe': Hundreds of Far Right Nationalists Protest Outside Rapist Conor McGregor's House". The joke being, of course, that the kinds of working-class activists attending anti-immigration protests ostensibly in the name of protecting Irish women from predatory foreign men tend to be fervent admirers of Conor McGregor.
BurdensomeCount
Apparently "BIPOC" is a racial slur now.
6hr ago
(but, strangely, never the tier immediately above them)
I freely and openly admit that the people above me are much more exalted than I could ever hope to be. I recently interviewed a candidate at work who was applying for a quant job and he absolutely floored me with how intelligent he was, telling me things I hadn't realized about the mathematical question I ask people a few short tens of minutes after seeing the question for the first time. I came away from that interview thinking that I had just come into contact with someone blessed with true shape rotator greatness.
At least I am at the level where I could appreciate what I had just seen, unlike the average 95th percentile person who is so far removed from it that he wouldn't be able to tell the difference between me and this person had he been the one taking the interview instead.
bonsaii
6hr ago
Suppose surgery X is only needed by P patients per year per hospital, but surgical residents require C cases to reach competency. If residency is Y years long and you have R residency spots per hospital, then R is limited to C > Y P R.
BurdensomeCount
Apparently "BIPOC" is a racial slur now.
6hr ago
The 10th percentile are the ones breaking into bald men's heads looking for gold or deflowering virgins to cure their AIDS
I'd say those people are more like 2nd percentile. Either that or I have too high an opinion of the average human being (I find that hard to believe but am open to the possibility). I think 10th percentile is more like the people manning the tills at your supermarket rather than the dangerously stupid as in your comment. Would you not agree? If not then what percentile human being would you say is doing menial supermarket work?
I_Smell_Mendacious
6hr ago
you can't just go out and increase residency positions
This is the problem, but not for the reason you suggest, at least in the US. The issue is funding - training residents costs hospitals money, which is covered by CMS. Technically, I guess hospitals could fund residencies above and beyond their CMS allocations, but then they are spending money to train a future doctor that may or may not work for them. The financial incentives aren't there for hospitals to fund residencies themselves, so we end up with the number of residencies CMS is willing to fund. That number was mostly static for over 20 years, until Covid made stark how lacking in medical personnel the US is. So they've slowly been increasing the allocations over the last few years, but of course, at a much lower rate than general population growth.
You'd have to do this exercise for every type of surgery that a competent surgeon should know. Gallbladder is one of the most common (hence, one of the first to come off the top of my head), but you still need your local surgeon to be able to do the less known things as well. If I'm betting my life on a baseball player hitting a home run off a knuckleball pitcher, I want him to have at least gone up against a lot of knuckleballs in his life instead of a guy who's mostly only hit against fastball and curveballs and is going to be out there winging it for the first time.
jeroboam
6hr ago
Yeah, people tend to flatter themselves that there is a huge gulf in abilities between their own tier and the tier immediately below them (but, strangely, never the tier immediately above them).
It's why so much internet energy is spent talking about "midwits".
A simpler and more accurate model : intelligence matters a lot at every level with no high or low cutoff.
Celestial-body-NOS
🟦 All human beings are equal, **even when they aren't.**
6hr ago
I'm going to push back on the assumption that nurse practitioners, or even registered nurses, tend provide worse care than doctors for most patients. I want something more than an impression of anecdotes--preferably actual studies--because in my circle complaining about getting misdiagnosed made by doctors is a well-honed pastime.
I haven't been able to find it again, but I remember reading a story somewhere (possibly by Dave Barry, but I could be wrong) that went something along the lines of:
My tongue was swollen, and I went to my doctor. He did an examination, then diagnosed me with two Latin words, that when I looked them up later, turned out to mean 'swollen tongue', and told me to come back if it hadn't gone away in two weeks. I then asked a nurse, who told me to gargle with salt water; I did and the swelling was gone quickly. I'm hoping my dog's tongue becomes swollen; if the vet tells him to gargle with salt water, I'm taking all my medical problems to him.
(If anyone knows the source of this, please let us know.)
urquan
7hr ago
all the aspiring PMCs move as close to the blue enclave as they can manage
This is as much about economic opportunity as it is about cultural sorting.
In our country, we have red counties and blue cities. So someone with the talent, interest, and capability to do the sorts of high-skill jobs you need to do to get ahead in this day and age often end up having to move to a blue enclave, whether they like it or not.
There are certainly some strivers who pursue trades, or other skilled professions with more geographical flexibility. But in general, the money follows population, and the population is clustered around blue areas.
The brain drain is real. But describing it in terms of a desire to become Democratic simply doesn’t explain the cause by itself. People are just trying to provide the best livelihood they can to themselves and their families, and to do that they have to follow the money = population = density = Democratic correlation.
Celestial-body-NOS
🟦 All human beings are equal, **even when they aren't.**
7hr ago
· Edited 3hr ago
Laws which in practice aren't really enforced when a man is perceived to have gotten himself in over his head -- that's the point.
Yes, society still has a ways to go before it lives up to the ideal of being perfectly just.
Where $THING <> "force other people to pretend that you've changed your gender" I guess
I would describe it more as 'exist while presenting as the gender opposite that associated with your genitals at birth'.
resort to violence is not a part of the masculine story
There are times when it is perfectly justified to resort to violence; if Albert starts hitting Benjamin, I certainly do not think that Benjamin is obligated to stand there and let Albert continue. What is not justified is to impose an asymmetric standard of inter-personal respect on people smaller than yourself, or to de facto prohibit conduct which does not harm anyone, and which violates no applicable legal code.
to the extent that anything's actually changed
I don't know whether or how much it has changed, but if it hasn't, it needs to.
Who's this 'one'?
Anyone who is trying to move society in a direction in which Andrew being twice the size of Bill does not mean that the norms of society reflect Andrew's opinions more than Bill's, nor that Bill is obligated, under threat of bodily harm, to show any respect to Andrew that Andrew is not similarly obligated to reciprocate.
What does Tim Walz ... have to do with anything?
I was alluding to the speech in which Mr Walz said:
... we respect our neighbours and the personal choices they make, even if we wouldn't make the same choices for ourselves, because we know there's a Golden Rule: "Mind Your Own Damn Business.".
Even if one disagrees with the transgender ideology, a person, born with the genitals associated with one gender, choosing to exist in public while, via clothing choices/bodily alterations/whatever, presenting as the opposite gender is none of the business of the people standing next to them.
cartman
7hr ago
In your view, what are the most and least cringe age of prostitutes to hire, and for what prices?
RandomRanger
Just build nuclear plants!
7hr ago
I've said before that the 95th percentile human being has a lot more in common intellectually with a 10th percentile human being
Really? How many 10th percentile people do you meet?
The 10th percentile are the ones breaking into bald men's heads looking for gold or deflowering virgins to cure their AIDS. Or they star in the genre of youtube videos exposing how stupid and ignorant American university students are: https://youtube.com/watch?v=AkIUqH498PQ
The more cerebral of this cohort might subscribe to conspiracy theories about how the earth is flat, how everything is actually naval law and most countries are secretly enrolled as corporations in Delaware... They still cannot string a sentence together though, nor can they spell.
sarker
It isn't happening, and if it is, it's a bad thing
7hr ago
Quick Google search suggests that there's something like half a million gallbladder removals per year in the USA. I'll leave it as a simple exercise for the reader to estimate how many residents per year could be trained to do gallbladder surgeries at such a rare.
JarJarJedi
7hr ago
Nearly 100 trucks carrying food for Palestinians were looted in Gaza. Hamas security forces retaliated by killing over 20 gang members involved in the looting. Israel cited distribution challenges as the main obstacle in aiding Gaza.
Here I'd like to call out the fact that I don't see a reason why Hamas is any more entitled to have the food than the "gang members". Hamas is a gang like any other, maybe the largest and the most violent one, and maybe having the most success in controlling the food sent from abroad and thus maintaining its edge over other gangs - but I don't see why they would be allowed any more legitimacy than any other gang. The main obstacle is, indeed, that the food ends up in hands of violent gangs - either Hamas or other one - and the only way to get fed is to either associate with one of the gangs or to pay them for the food, and if you don't want to do either, you get no food. This is a huge problem but we shouldn't pretend Hamas is any different, and they have legitimate claim while "looters" do not.
cartman
7hr ago
The percentage of people who believe that ax2 + bx + c = 0 or that Shakespeare is mandatory reading off the top of their heads is also likely in a small minority, not to mention any more obscure things which are taught in school, but we don't change the curriculum to accomodate these beliefs if Shakespeare is stil genuinely the best way to teach English or we believe the quadratic equation is important math practica.
I really don't believe the distinction between factual and normative education is as bright a line as you think it is. 'every sentence must contain a subject, a verb and an object' is a normative statement, not a factual one. If you wanted to qualify with something like 'if you want to speak correct English as recognized by such and such body' then it would become factual, but as is there is clearly a normative element to this education where we are trying to get the kids to do things the way we want them to in the same way we dont want them hitting each other.
If you are claiming that educators are teaching kids en masse that "puberty blockers are completely reversible" then sure, we could agree that's likely not factual and a bad thing to teach. I don't think this is in the curriculum broadly. Just like sexual education which teaches kids about the existence of gay/lesbian people and how they differ from straight people is not the same as encouraging kids to be gay, I think there's a way to educate kids about transgender topics which you still might classify as 'gender ideology' that is relatively neutral.
This can’t be right. The number of doctors needed for any given discipline X should scale linearly with the number of cases in discipline X. If there are not enough cases to train doctors, then there is no doctor shortage.
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