domain:parrhesia.substack.com?page=0?page=0?page=2
MaiqTheTrue
Renrijra Krin
5m ago
I’m not sure that’s all bad. For the most part, medicine on a family practice level is pretty simple. It’s routine physicals, vaccinations, and common diseases about 80% of the time. The issue is less a NP or PA can’t handle that kind of workload than he or she is not handing off edge cases to doctors. If they were properly handling cases where patients had more complex symptoms or were complaining of serious pain with no known cause, there wouldn’t be much of an issue. Furthermore, wasting the talents of a full fledged doctor on walking into a room where a kid has a fever and runny nose and telling him he has the flu is a waste of the patient’s money and the doctor’s time. Doing routine vaccinations and physicals is likewise a waste of a doctor’s time and a patient’s money. And I don’t think at that point adding a bunch of doctors fixes the issue. You could do what happens in a dentist office in medical offices with no loss of care. The nurse does all the routine work and the doctors look over the data and only talk to the patients if there’s something more complicated than basic medical care needed.
Gleba was by far the hardest planet for me, I got brain-burnt enough that I had to take a break for a couple of days. Works ok now though. Aquilo was somewhat simpler, and much less frantic.
orthoxerox
If you can read this, you're using a custom theme
14m ago
It's not just age. It's the answer to "how likely would the person be able to have the same experience by asking his wife/GF or hooking up" that determines the cringeworthiness. So it can be age, kink, difference in attractiveness, etc.
Felagund
18m ago
I find it interesting that you put flat earth in a different category than a fusion-powered sun.
Anyway, I think there are clearly at least some voluntary components to religions, which are plainly choices. Religious people do also talk about having struggling with doubts.
But yeah, Christians do literally think that God died and was resurrected 2000 years ago. Doesn't mean that that's always going to be fully internalized, of course, but we do think that. If you asked a Christian "Was there someone 2000 years ago named Jesus, who was crucified?" "Did Jesus rise from the dead?" "Was Jesus God?" I think you'll generally get some pretty sincere yeses, especially if you ask the questions in that order.
MaiqTheTrue
Renrijra Krin
18m ago
It’s not just financial means. Nobody really wants to live in a downtown area of a city, because of homeless people, drugs, crime etc. unless you happen to be rich enough to afford one of the very expensive and exclusive areas of the city, you basically live with crime as an everyday reality of your life. Leaving the door of your car unlocked so thieves don’t smash it. Women carrying at least mace (because guns are illegal) and often being consigned to their homes after sunset. Using the buddy system or proactively telling people everything you’re doing so someone knows where to start looking if something happens. I can’t imagine any woman tolerating the idea of having a baby in the city if they have the means to flee somewhere safer.
Incanto
18m ago
Have played this game several times and quite enjoyed it. Feels like the different components of worker placement, deck building and (very) light combat work together nicely to create tension.
The situation in the UK is as bad, indeed worse because of immigration as you say. The native (and 2nd/3rd generation immigrant) doctors who run the BMA and the colleges limit places because they know that almost all senior jobs in hospital trusts and places in elite surgical specialties will go to British-trained doctors because of networking and because they interview better than ESLs, and want to limit their number, forcing the NHS (as you say) to hire incompetents from abroad.
Felagund
36m ago
Presumably some teachers think wearing Goth clothing leads to some things they disapprove of (Satan worship, depression, arson, whatever) but they would still be rightly reprimanded if they called home about these things.
I guess I don't really see a problem with informing parents of that either.
If parents want to impose some special conditions under which their students are watched, that's something for private and not public school, which should cater to the general public as decided by the government's education department.
I imagine the relevant component to you isn't the government's education department? That is, if they decided that the guideline was that parents should be informed, it seems like you'd be disappointed, not happy that they're catering to the will of the general public.
Felagund
41m ago
What would a "relatively neutral" presentation look like to you? How positive would things be posed as?
IGI-111
God was a dream of good government.
41m ago
Prioritise the safety of whoever is in more danger.
This is just slave morality.
IGI-111
God was a dream of good government.
56m ago
the mere fact of that objection doesn't seem to be why he was sacked
Given Google settled the lawsuit and the declarations made by both parties at the time, I think this is clearly wrong. He was sacked precisely for objecting in the way recommended internally. He didn't even leak his own memo.
You can't fire people for their opinion and claim they aren't "asked to celebrate anything". His was a political punishment.
Terracotta
1hr ago
That AMA link gives such a laughably biased summary of the actual study, though. The paper itself suggests a far more nuanced picture than your metaphor about Juan the day laborer-- and that's a study led by an MD who presumably has his own professional axe to grind. (I'd be much more interested in seeing some adversarial MD-DNP research collaborations in this area.)
Notably,
- The study focused almost entirely on costs in an ED setting; on a skim, I can't find that it examined detailed health outcomes at all beyond 30-day mortality and "preventable hospitalization," the latter of which seems difficult to define in terms of patient welfare. They say NPs and MDs had no significant differences in 30-day patient mortality.
- The study did find that treatment by NPs cost the system more than treatment by MDs, owing to NPs calling for longer hospital stays and more tests. But the difference in costs diminished with more experienced NPs.
- The cost difference also diminished to a relatively trivial level for less complex cases, and the authors themselves suggest that this means NPs could be valuable substitutes for physicians in primary care.
- They found almost as much variability in productivity from clinician to clinician *within* professions as there was *across* professions. Money sentence from the abstract: "Importantly, even larger productivity variation exists within each profession, leading to substantial overlap between the productivity distributions of the two professions; NPs perform better than physicians in 38 percent of random pairs."
Crowstep
1hr ago
My only experience with a NP was getting misdiagnosed with asthma when I had whooping cough. The actual doctor (which I did see her) diagnosed me correctly in about a second. Prior to that I didn't really know what a nurse practitioner was.
I certainly agree that the doctors' cartel (the British Medical Association) are a gang of scoundrels though. The UK has a chronic shortage of doctors and a chronic oversupply of students who want to be, and are smart enough to be doctors. But the BMA artificially limits places at medical schools to keep their wages up, leaving the UK reliant on imported doctors who are objectively worse (with no disrespect to @selfmadehuman, I'm sure you're great).
jimm
1hr ago
He works on training a chatgpt instance to provide gender affirming care
Yeah, he's already gone wrong there. That's not a problem with therapy though so much as this person's attempt to blow smoke up his own ass and call it therapy.
The opposite doesn't really work either though. If a human therapist says "Tim, I think you're delusional", the most likely result is broken rapport and Tim shopping for a new more gender affirming therapist. Even if the therapist managed to get enough buy in that Tim doesn't walk, he's still left with "Okay, I'm delusional. Now what? I still feel like shit." rather than "Okay thanks, all better!".
You really have to come at things without a pre-prescribed ending point in mind. Like, "I feel really shitty every time I look in the mirror and see a man. I feel like I am a woman, and that doesn't match what I see. What do we do about this?", and finding out what to do about it as you seek to understand the issue together. I guess it's pretty non-obvious how to do this effectively, now that I write it out.
roche
1hr ago
This part is interesting because it's new to me. I suppose it's related to predictive processing?
Yep. Here's the initiation ceremony for Saiva Tantrikas, for example.
I struggle a bit with numbness
Try holotropic breathing. Like meditation or psychedelics it gets stronger across consecutive days.
Also, what would you need in order for spiritual practices to be "real"? You can experience a state of mind in which everything feels profound, but that doesn't mean that the profound connections you see have real depth. Are you fine with the experience, or are you looking for more scientific results which influence the outside world and not just the mind?
Non-dual perspectives are fine, but we need to draw a distinction between metaphysical truths on the one hand, and perceptive shifts on the other. You can make yourself believe in any religion you'd like, it's easy, happens all the time.
The power of placebo is quite strong, so most of the things you're trying to do are probably possible through imagining that they occur
The brain is trying to maintain homeostasis at all times, and part of that homeostasis is a consistent world-view, which is why a huge fraction of the pain when something horrific happens isn't just the pain, but the fact it wasn't supposed to be this way! yet it is. There's basically a high floor of cognitive dissonance that you, I, and everyone else are operating on at all times where we assume that certain very bad things in this world simply won't happen to us. Other people get ball cancer, but me...? Nah. You rejoinder Oh that would be a waste of mental energy, duh, we're just being practical! but the point is we don't have a plan for when things go really south, which is why most cases of psychosis happen precisely because our mental models are exploded, and it's why the zenith of LSD experience is the whole universe aligning to a single purpose, while the nadir of LSD is a total fracture of your world view, like "Oh shit I was a chair rotting in an abandoned factory for 20 years and my previous life was a lie!". We're the only species that has psychosis, and the only one that has "world views". Your body will do some truly impressive shit to maintain homeostasis, which is the premise behind meditation, and this thread. Including the placebo effect. This is an area that's not being explored.
The "energy scale" is basically true
Wanna try an experiment? Do some heavy thinking during sex, and pay attention to your thoughts during orgasm. There should be a brief, brief period of ecstasy where your thoughts connect and everything naturally clicks into place. It's very neat.
If you just want small superpowers by modifying or training your perception, then I suggest psychonetics
Curious, I'll look it over.
You can get the best relaxation ever if you just kind of give up for about 30 minutes. Set an alarm as you shouldn't even keep track of time. Don't worry about any sounds you hear. Yes, this means that your house could catch on fire without you noticing, that's how determined you have to be to just forget everything completely. When I did this, it felt like I had gotten 5 hours of solid sleep, it was amazing.
I mentioned Krishnamurti downthread; this is probably how he achieved his "calamity". For any worries about going insane, I'd like to suggest the likelihood of going insane from any altered state of consciousness correlates with the amount of thinking you do during the state. Doing heavy thinking while deep in meditation is essentially screwing with the wiring of your perception, you are almost definitely in over your head, while Zen-style "no-thoughts-head-empty" is harmless if you have the discipline to do it properly.
I know very little about this, but it seems to be about turning off all defense mechanisms which separates people, and then indulging in pleasure?
Tantra and Tibetan practices are the most confusing side of Buddhism, and I've yet to find a good resource on it. So yeah, sorry. I really need to get back into looking around.
roche
2hr ago
Thanks! Glad to hear you stayed safe. That quote seems to ring a bell, but I can't find the original post/thread now so the context is lost. I'll try to respond regardless.
See my conclusion was that enlightenment is functionally identical to insanity. You can not attain it until you let go of everything - including the ability to understand and be understood.
You may be interested in Schopenhauer's definition of insanity: The thread of memory is severed. In our scientific epoch, knowing the material and efficient causes of any phenomenon is considered absolute knowledge, in other words, "There are those who think they know the bird having seen the egg it crawled out of". So for the insane man who has lost access to this mode of knowledge, he must instead observe the phenomenon directly and consider its qualities per se for knowledge. For Schopenhauer, this was the only way to obtain true knowledge of anything, and there's a good chance Plato held a similar view; both lend to the shamanistic/mystic side of philosophy, and shamanism itself is nothing other than reading into the forms, which is why an insane person could do it.
Personally, I'm skeptical of it. You should look into P.G. Krishnamurti's view. It's fascinating, and it would be healthier than idolizing literal schizophrenia too, lol.
Where did Kavanaugh leave written receipts of any wrongdoing exactly? Afaik there is no evidence for him doing anything untoward, only hearsay.
Our man would still be AG in waiting if all there was was hearsay.
I understand closing the ranks is a sound tactic, but if you can't recognize picking competent leaders is too I can't do anything for you.
Throwaway05
2hr ago
I mean a physical therapist is the appropriate medical professional for the issue you had. You went to the "am I dying" doctor and they said "shit I don't know, you aren't dying," if you were dying they would be able to help you. They have limited training in diagnosing MSK issues because that's not what they are for.
Routine issues and urgent care level emergencies are supposed to be managed through your primary care doctor who would say "this seems like an MSK problem, here's as prescription to go see a PT for that, as they are the experts in this area and can spend an hour with you twice a week and I can't do that without it being cost prohibitive."
We see this all the time, people go to the ED for non-emergent issues and get frustrated when they get what seems like poor quality care and it takes forever.
Furthermore patients don't like hearing this so you get some half-assed attempts at managing these issues in those settings instead of the correct response which is "no go see your PCP."
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.
I think this is true for many professions with a deep moat around them, regardless of that is educational credentials or some level of career success. This doesn't have to be very highly compensated professions mind you.
In situations where you're "safe" once you're in many people check out mentally and this affects not only job performance.
Being a "midwit" is only partially an effect of intelligence but also of practiced intellectual rigour, often requiring a competitive environment, which typically means work. It's like if people who were professional athletes when they were young thought they're still competitive when they haven't really exercised in over a decade. Disconnect from competition and practice allows for personal preference rule uninhibited by reality.
Yes, this is another major thing and one we’ve discussed before.
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