domain:novum.substack.com?page=4?page=0?page=0?page=2
Templexious
2m ago
The Instagram algorithm and general Zucksphere of platforms don't really appeal. The ideal platform is one which enables and promotes complexity. Either by promoting thinkers and posters of complexity or simply bruteforcing complexity by making the feed truly ideologically-diverse.
An intractable problem, but I'd at the very least like to avoid platforms that cave to foreign interests
jeroboam
11m ago
We can't necessarily trust the BLS statistics to give us an accurate picture of wages in certain professions (notably waiting tables, bartending, some trades, and doctors).
While your average salaried internal medicine doc at the local hospital might only pull down 200k, that's barely scratching the surface of what a doctor can make.
Being a physician opens the pathway to starting your own practice, which can easily lead to a 7 figure annual income. Presumably, this does not get reported as wages to the BLS.
Tophattingson
11m ago
Muslims are definitely not fargroup in the UK yet this pattern still holds.
daguerrean
12m ago
Maybe Danny Casolaro? I don't have an opinion on his case but it's kind of the 'classic' of this genre imo
daguerrean
18m ago
I generally believe in consumables theory, that you really can't go wrong with them and they will almost always be used. For the past few years I've often fallen back on a gift box of pastrami and pickles and such from Katz Deli. It is the kind of thing most people would never buy themselves but every man I have given it to greatly enjoyed it.
MotteAnon12345
18m ago
No. They'll get their information from their insurers and from the legal departments at the hospitals where they're employed, and I guarantee you that the attorneys involved aren't basing their advice on Pro Publica articles.
Fair enough.
The court addressed this specifically in IV.A. Specifically, on page 22, they state:
The Center argues that such a standard means that doctors are susceptible to a battle of the experts when not every doctor might reach the same medical judgment in each case. We rejected such an interpretation in In re State. “Reasonable medical judgment,” we held, “does not mean that every doctor would reach the same conclusion.” Rather, in an enforcement action under the Human Life Protection Act, the burden is the State’s to prove that no reasonable physician would have concluded that the mother had a life-threatening physical condition that placed her at risk of death or of substantial impairment of a major bodily function unless the abortion was performed.
(Footnotes elided.)
The opinion has more exposition on this (and I assume the case they refer to has even more). It does not seem to be as unreasonable a standard as you seem to imply.
Urgent Cares exist because people these days refuse to use the system how its designed (and it's because of incentives, I get it and have committed this crime also) but they aren't really designed for the care people ask of them.
Sounds like a design problem.
This has a number of important effects one of which is: most of the shit that annoys you most about doctors is not their fault, they are required to do it because they aren't in charge anymore (most people in most specialties are employed now and not in independent private practice).
Sounds like a design problem.
Doctors no longer work for themselves and are now required by law and by their employer to do things that annoy the hell out of patients and we hate it but its not our fault please dont blame us thank you.
Sounds like a design problem. I'm not blaming them, definitely not individual doctors.
But doctors are theoretically in the best suited to raise the issue and demand or impart adjustments. Seems like there's a large... incentive problem, who profits from keeping things as they are, and why don't they suffer consequences for failure?
Another Eliezer Yudkowsky tweet that lives rent free in my head on top of the other one is his almost certainly correct argument that completely removing all regulations currently effecting the healthcare industry would create immediate improvements compared to the status quo.
So, hope that Trump takes a chainsaw to the healthcare regs?
He also has interesting ideas on addressing the status quo.
cjet79
25m ago
We managed to get to the victory screen this week. It came sooner than expected. We were sort of expecting to unlock some new secret technologies instead of the victory screen. We still have yet to do anything with promethean science packs.
I think in order to really do end game stuff I'm going to need to need to focus heavily on quality builds for a new ship. Or retrofit my existing massive ship. The sheer volume of asteroids in the outer system was overwhelming a blue belts ability to transport missiles. The flat front of the ship also had some vulnerability to asteroids clipping the sides.
But in order for the sheer quantity of stuff I'd want for quality builds, I'm gonna need to clear up more of the production on other planets.
Including plastic on Gleba, which is becoming a real limiter in getting enough quality red circuits. @No_one was brave in being the one to start our Gleba builds. But I think I need to make some of my own attempts, because I've seen the Gleba builds clogg up enough, and I have my own ideas about how to build a Gleba mega factory and it's different than his approach.
I think I want to build self contained mini factories. They take in the raw inputs, make their own necessary intermediate products and output final products. The benefit of this approach over sharing around intermediate products is that the intermediates tend to spoil the fastest of everything, and they tend to require the most in terms of bulk, so they fill up belts and then quickly spoil on those belts. The other benefit of this approach is I can just shut the whole mini factory down if there is enough end product on the logistics network. Rather than sending in a constant set of inputs that proceed to spoil and clogg up once the end storage or spoilage handlers are full.
MotteAnon12345
30m ago
Really? I could believe e.g. that some fundamentalist voters (a small minority) believe that the non-viable fetus is still a living creature and therefore deserves protection. I could also believe that Ken Paxton is an attack dog who will go after suffering mothers because it's in his political interest. But the median voter? If you brought a case of a late term miscarriage, would the median voter really insist doctors wait for weeks before offering medical care?
Admittedly, I don't have great evidence for my view. I haven't looked at voter surveys on this question for example (are there any?). I do have some evidence: the Tx legislature clarified the law in HB 3058. But what evidence do you have?
And if the median voter doesn't have such a hardline view, we're back to my original question. Why would the Texas Legislature impose such a blunt guideline instead of a more nuanced one?
iprayiam3
43m ago
No see this is the issue. If conservatives have been ‘pearl clutching’ about sexual morality for this long maybe it’s not performative… and further why are you surprised?
Your entire reaction (if not performative) thus rests on the conclusion that conservatives don’t earnestly find anything wrong with soliciting teenage prostitutes.
If you don’t find anything wrong with it, again- ok. But to assume anyone who does is pearl clutching is an extremely warped worldview
Folamh3
51m ago
A reference to https://youtube.com/watch?v=nCuf_O2xaw8&ab_channel=NT?
NewCharlesInCharge
55m ago
Bloodletting was ahead of its time?
Throwaway05
55m ago
PCPs have sick visits, you establish with a PCP and they'll schedule you urgently if something needs to be managed urgently, if you have an established relationship with a PCP they'll know how reliably you are and will do somethings over the phone. This is how it is supposed to work, Urgent Cares exist because people these days refuse to use the system how its designed (and it's because of incentives, I get it and have committed this crime also) but they aren't really designed for the care people ask of them.
Additionally, physician pay has decreased year after year for longer than the majority of the people in this forum have been alive. This has a number of important effects one of which is: most of the shit that annoys you most about doctors is not their fault, they are required to do it because they aren't in charge anymore (most people in most specialties are employed now and not in independent private practice).
-Can't do something simple over the phone has to be an appointment? It's because that doctor's employer requires it so they can bill.
-Appointment short and unrewarding? It's because that is how the employer wants appointments scheduled.
-Doctor pays mostly attention to the computer? It's because there is no admin time and if he wants to go home before 8pm he's gotta start charting in the room.
-Doctor asks you annoying repetitive questions? Someone has mandated they ask them in order to bill or satisfy regulatory requirements or some other annoying thing. Or some incompetent front desk staff person said you were a smoker or a drinker or are missing your appendix and it requires forms in triplicate to remove from your chart.
Doctors no longer work for themselves and are now required by law and by their employer to do things that annoy the hell out of patients and we hate it but its not our fault please dont blame us thank you.
Gaashk
56m ago
I think this happens anyway. If you need a complex surgery in New Mexico, they will send you to Phoenix or Texas, even if it’s fairly urgent.
2rafa
57m ago
There is no such thing as a private emergency department / A&E in the UK, there are a couple of hospitals like the Princess Grace and St John and Liz that have urgent care (mostly only from 9am to 7pm and not usually on holidays) but it’s only for ‘non life threatening’ stuff and if you rock up and it’s bad they’ll immediately call an ambulance to take you to an NHS A&E.
That said if you need inpatient treatment you can get out on the private wing of an NHS hospital as soon as you’re out of intensive care (if necessary) which is much nicer.
MotteAnon12345
58m ago
Page three of the opinion:
A physician who tells a patient, “Your life is threatened by a complication that has arisen during your pregnancy, and you may die, or there is a serious risk you will suffer substantial physical impairment unless an abortion is performed,” and in the same breath states “but the law won’t allow me to provide an abortion in these circumstances” is simply wrong in that legal assessment.
Similar wording shows up repeatedly.
2rafa
1hr ago
That’s fine. Let’s double the number of physicians and surgical specialties, leading hospitals, top medical schools will all still have their own prestige and standards. But there will be enough doctors for everyone.
Folamh3
1hr ago
The percentage of people who believe that... Shakespeare is mandatory reading off the top of their heads is also likely in a small minority
On the contrary: more than half of Americans still believe Shakespeare was "one of" the greatest playwrights of all time. That's not exactly the same question as "do you think Shakespeare should be taught in schools?" but I find it hard to imagine that only a small minority of Americans would answer "yes". Open to correction though, if you have a source.
faceh
1hr ago
Yep, we discussed that a bit not long ago, so I can't say I'm donating entirely out of altruism.
I don't know if they filter out the microplastics from the blood somehow (probably not) or if they just get passed along to become the next guy's problem.
Throwaway05
1hr ago
I mean you are always going to run into study design limitations. In this case most of the money in medicine wants NPs to look good so there isn't good funding for this. The VA (generally) has pretty much the worst healthcare in the country and the quality of care in the ED is also pretty much the worst in the hospital (because of how it gets misused). This is likely to flatten the curve a little bit - good doctors almost never work at the VA.
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. In general hospital medicine nurses line up each other and that includes NPs but in most mental health care settings nurses will say they think the NPs are shit.
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.
Now you could argue that you don't really care about those problems and if its not obvious their is a skill difference in outcomes lets save money, who cares if people have the wrong medication or diagnosis. But that goes back to the ED stuff - you have a difference in mortality and morbidity, it may be small but most Americans value "the best possible" not "good enough."
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.
Well conveniently I explained what happened with my primary care physician elsewhere in this thread.
i.e., he's been 99% useless to me compared to the time and money cost, so urgent care is simply the better option.
Ultimately if you say, go to your lawyer and ask for accounting help, they may charge you for it and try and help but they aren't an accountant.
Ackshully, as a practicing lawyer, I can say that that may very well be malpractice, and its for this exact reason I keep a number of trusted accountant and financial advisors in my rolodex to send clients to rather than even risk that issue.
MotteAnon12345
1hr ago
If NATO directly entered the war with large numbers of its own combat forces, it would defeat Russia's military and drive it out of Ukraine.
That was my assumption as well back in 2022. But then the Russia sanctions did nothing, Ukraine made some good advances and then got bogged down, and the West started running out of ammo. That last part is what got me. Because that's how the West won WWII against Germany (& Japan) and then the Cold War against Russia. We outproduced them until they couldn't afford it anymore.
Right now, the situation is reversed. It's Russia that enjoys a comfortable margin in artillery, tanks, and men. The West is giving Ukraine everything that isn't nailed down and it still isn't enough. Maybe the problem is a bloated inefficient military sector? Maybe the problem is political will? Maybe the problem is that we don't care enough about Ukraine? But those are all structural factors that are unlikely to change anytime soon. My current thinking is that the West can't challenge Russia in most of Europe and Russia can't challenge us in America proper. Africa is up for grabs and China will get the rest.
The Ukraine war has proven NATO to be a paper tiger.
anon_
1hr ago
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, doctors have focused on limiting entry, reserving their title for themselves and therefore turning away many decent candidates.
This will lead to the same problem -- just in different terms.
The issue isn't the title -- it's the nature of the jobs. Bringing them all under the umbrella of "physician" just moves the status problem to intra-physician jockeying.
Throwaway05
1hr ago
In order to learn the U.S. standard of care you must learn with a U.S. level of resources and training. Much of Europe can meet that standard but the third world cannot. This is magnified by the fact that the U.S. population is more challenging due to obesity and other factors.
Putting aside that general point, with surgery in specific we are talking about modern surgical modalities - I don't know how many da Vinci's are in the entire continent on Africa but I doubt it's more than a handful.
Vulcanus will always be somewhat limited with launch capacity. The gravity is higher on the planet, so more rocket parts are needed (4x if I remember right). Then two of the launch components require oil products, which you have to get through coal liquefaction. And you'll be amazed at how much coal you can go through for liquefaction.
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