domain:freddiedeboer.substack.com?page=3?page=3?page=0?page=2
urquan
11m ago
I'm sure there have been some converts, but I don't doubt that there have been enough progressive young tech workers joining the field to more than balance them.
There are not official gradations of lawyers, but it's widely understood that there are (specialties aside) bad, okay, good and fantastic lawyers, and the public has a good idea where specific levels of quality are found. They know that is all you can get is a mall lawyer, your chances are much lower (for the same quality of case) than if you could hire a prestigious law firm. Doctors associations cling to the idea that (specialties aside) doctors are essentially fungible, and this is even more explicit in countries where a public system assigns doctors to the public. Of course, this is preposterous to the public, you don't have to be a doctor yourself to spot when one is particularly good or not. Anyone with a bit of life experience has seen lazy doctors, doctors who don't listen to them and give them an obviously bad diagnosis because of it, and on the other side doctors who spotted something from hard to read symptoms. My wife recently got assigned by our healthcare system to a shifty clinic in a bad neighborhood where the clinic also advertises "natural remedy treatments" alongside having actual licensed doctors, and to our system that's good enough: to them she needed to be assigned to a clinic, any clinic, they're all as good as one another, and if she wants to switch she gets shoved to the back of the line and likely will be without an assigned clinic for 5 years. And on the opposite side, an optometrist going above and beyond speculating about the reason for me having an uveitis led to me having an auto-immune disease diagnosed and my quality of life improved dramatically.
Throwaway05
25m ago
For anyone wondering
Laparoscopic surgery is the other main issue on this front, but you'll have more of that available in Africa.
EdgeCityRed
27m ago
Precisely. That's a tomorrow problem when you're in that state.
Lizzardspawn
36m ago
New media isn't conventionally left or right, but the most popular versions tend to lean republican.
The more you tighten your grip, Tarkin, the more star systems will slip through your fingers
The total media dominance in print, tv and web news and the monoculture turned everyone even mildly dissenting to alternative pastures. And there was demand for right wing content and the market delivered.
George_E_Hale
insufferable blowhard
36m ago
A Da Vinci is a robotic surgical setup meant to be less invasive. I had thought they were relatively new but that Wiki link says they were introduced in 2000.
Loquat
38m ago
My immediate neighborhood had very few signs, but there were absolutely places within a 15-20 minute drive where loads of houses had signs for one or the other. Roughly speaking, the places with quaint, walkable mini-downtown shopping area had mostly Harris signs, the people who seemed like they frequently used their pickup trucks to actually haul stuff had mostly Trump signs, and nice suburban houses with big lawns could go either way. (Location: Pennsylvania)
hydroacetylene
41m ago
Know what you want to do, and figure out an actionable plan to get there.
Now is the beginning of the rest of your life whether you want it to be or not. Make use of it.
Quantumfreakonomics
43m ago
Youtube comments sections have gotten signifigantly further right over the last 3 years. That's basically social media.
hydroacetylene
45m ago
Umm, are dual culture kids consistently WEIRD?
hydroacetylene
47m ago
I'm not middle aged or a woman and I think carrying on a purely sexual relationship with a high schooler while a man in his thirties is pretty cringe.
Jiro
52m ago
New media isn't conventionally left or right, but the most popular versions tend to lean republican.
They do? Social media, except X, is all on the left too.
Certainly themotte didn't leave Reddit because Reddit was censoring Democrats.
EdenicFaithful
Dark Wizard of Ravenclaw
53m ago
So, what are you reading?
Still on Future Shock, 12 Commandments, Crystallizing Public Opinion and Galactic Patrol.
One in 200 is probably how unique I think my intelligence really is. I'm quite conscientious and like learning about basically everything so I think I present as smarter than I really am because I can talk decently about a lot of things.
I think the real humbling thing is realising that being 1/200 or 1/1000 is nothing, there tons of us and most are doing very normal things.
Terracotta
59m ago
However the bad outcomes are mostly increased lifetime mortality and risk of side effects 20 years down the line when the patient is seeing someone else. This becomes effectively impossible to study so we don't... Psychiatry is a better example - psychiatric interviews and pharmacology are the most complicated in medicine. Mental health care NPs are terrible at both of these things, give people unnecessary medications and incorrect diagnoses and are legible experienced as lower quality by patients and staff with some regularity.
I should emphasize that I have a lot of respect for psychiatrists, who seem to hurl themselves into the breach of various social ills in a way I certainly wouldn't want to do. But if we're searching for a test field where rigorous evidence makes it very legible which are the "necessary medications" and "correct diagnoses," so that MDs' highly effective healing practice contrasts clearly with NPs' useless flailing, then I'm not sure psychiatry is the obvious pick. We're talking about the same psychiatry that regularly diagnoses from subjective surveys and patient self-reports, correct? Where almost none of the biological mechanisms are thoroughly understood, either for the ailments being treated or the medications that treat them? Where exercise, healthy diet and getting plenty of sun/fresh air seem to work as well as the best drugs a lot of the time? Where official medical conditions pop in and out of the DSM with every passing political wind?
Would you say that psychiatry does a good job of monitoring its physicians' contribution to patients' lifetime mortality and/or risk of third-order side effects 20 years out, either across different levels of physician talent/conscientiousness, or versus not receiving psychiatric care at all?
Also, since this is why people normally bring it up - if you magically paid all doctors NPs salaries and didn't really change anything else......healthcare costs wouldn't go down at all in any substantive way.
I don't quite get the reasoning here. Is the idea that receiving NP salaries would cause physicians to practice as badly as you believe NPs practice, because all the competent MDs would decamp for higher-paid professions (notwithstanding the additional benefits of prestige, flexibility, autonomy and meaning in medicine)? Doctors in Canada, the UK and Germany earn about 1/3 to 1/2 what they earn in the US; is the contention that they must practice incompetently and waste a ton of money doing so?
hydroacetylene
1hr ago
I think people receiving blood transfusions have bigger problems than microplastics, so I wouldn't worry too much about it.
hydroacetylene
1hr ago
We have left-wing musings that the failure to reach low-propensity voters comes from a “lack” of a left-wing media ecosystem, which makes me scratch my head somewhat, given the disproportionate skew of media to the left. There doesn’t appear to be any introspection or soul-searching here. The issue might not be a lack of left-wing media, but a lack of trust in that media; becoming more online creates a healthy level of skepticism about what we consume, especially as AI becomes more prevalent.
Legacy media is left wing. New media isn't conventionally left or right, but the most popular versions tend to lean republican.
Now make no mistake, Rogan and Trump are allies of convenience. But they are allies nonetheless and arguing with him about dragons just makes democrats look shrill and out of touch(Rogan's audience, like most normies, answers esoteric paranoid schizophrenia with 'interesting, so, uh, did you see the game last night? How about that weather we're having, huh?).
doglatine
1hr ago
I've been getting VERY interesting in egregores and eldritch analogies lately, and I'll probably do an effortpost on them at some point, but in the meantime I'm trying to track down a brilliant rationalist-adjacent blog that did long-form essays about a bit of different egregores, some of which had Lovecraftian or Biblical names. My Google Fu is failing me - anyone have any idea what I'm talking about?
lagrangian
1hr ago
My dad's theory of gifts has long been that the best gifts are something you'd want, but would never buy for yourself because you wouldn't spend the money.
I take a similar approach: buy a nicer version of something than they would buy, or even have already bought. E.g. they may have a couple $10 knives - buy a $100 knife.
Quantumfreakonomics
1hr ago
I saw very few yard signs at all this cycle. I thought everyone simultaneously realized they were cringe.
JarJarJedi
1hr ago
"Governing" here is a very murky term. Sure, they are the biggest and the meanest of the gangs, but so what? Among any set of gangs, there would be one that is the biggest and the meanest. They didn't have any process that resembles free election even remotely - they had a gang war with FATAH in which they emerged victorious, and slaughtered or exiled anybody who was affiliated with the competing gang. Being the strongest gang counts for something, sure, but that something shouldn't earn them any legitimacy in the eyes of people who should know better.
ABigGuy4U
1hr ago
-Ron Brown the Secretary of Commerce who was killed in a plane crash in Croatia. The medical examiner found a execution-style bullet hole in his head that was explained away as a flying rivet.
-Mark Middleton, who hung himself from a tree, and then after that shot himself with a shotgun.
The real suspicious thing is just the sheer volume. How many politicians have a double digit number of associates die violently or commit suicide?
It's called the art and science of medicine for a reason, in psych it can be pretty evident to the lay man, in other specialties it's less but still present. This means experience, heuristics, gestalts, they lead doctors astray yes, but for a lot of things we don't have good guidelines or understanding.
Importantly, doctors can be sued - this causes all kinds of problems but it does serve as a feedback mechanism that assess for problems and gives patients recourse.
Let me give a specific example of how this happens, sticking with psych because it's more interesting than me mumbling about open vs lap vs conservative appendix management.
Most people are aware of Bipolar disorder, at least superficially. Lots of people say "I have mood swings" and tell that to healthcare workers with less training, these people dutifully write down Bipolar in the chart. Or they say "you ever like have mood swings and be unable to sleep?" Gets the diagnosis. Someone who actually has Bipolar 1 with a manic episode barely sleeps for a week of more, does illegal things, or spends ALL of their money in the bank account and all kinds of other stuff. The diagnosis is serious and life limiting without treatment. The medications are also serious - most patients get antipsychotics these days which increase all cause mortality. They are worth it if you actually have the disease. Put undertrained staff give the dx to people who don't have it and then suddenly...
NPs also do things like mix benzos and stimulants, put people with depression or anxiety on antipsychotics which will result in an early death....just all kinds of ridiculous stuff.
The skill ceiling in psych (and medicine) is very high, but if you don't work in healthcare you'll (hopefully) never see it come into play. Most medical work isn't your quick annual physical with your doctor but for many patients (especially young ones) that's all you see.
As for the second point, no the issue is that physician salaries are less than 10 percent of healthcare spending, and it's been decreasing every year. Cutting doctor salaries does not solve the problem and introduces all kinds of new problems.
Likewise NPs don't save money because they do more unnecessary testing and over consult, which drains the specialists and slows down care.
More options
Context Copy link