Throwaway05
10hr ago
This is going to be my life for the next 5 months, no relief from the pain.
Rotations get better. By the end you'll look back at your level of knowledge and efficiency and be horrified. Remember this part.
Also - I think you said you are on consults, consults in any specialty are highly variable. Some seasons, weeks, months are harder than others. Sometimes jack shit will happen because the hospital is stuffed and another specialty is suffering. The tide goes in an and out, but it does GO.
When I was in residency I had a senior who made the claim that people are fast or slow, and that that never changes. I've learned that's true, but only for some personalities. You do not have that personality.
You can get faster and more efficient if you want to. So want to. And figure out how to do that.
Throwaway05
17hr ago
https://thelastpsychiatrist.com/2011/03/bad_at_math.html
Tis a shrink tradition.
Throwaway05
22hr ago
psychotics on public transit,
Who said anything about the mentally ill? Threats of murder are how Americans say hello.
Throwaway05
22hr ago
If I ever stop posting it is because I relayed this idea to the missus.
Throwaway05
23hr ago
I have literally already had a patient threaten to shoot me today!
...and that's not counting the nonsense on my commute.
Throwaway05
1d ago
gym I'm going to for the next week and change is for the mind
Time to plug my favorite cultivation novel!
https://www.royalroad.com/fiction/41330/virtuous-sons-a-greco-roman-xianxia
Throwaway05
1d ago
Is Hantavirus that much of a big deal?
No.
Among other things it has a much smaller window of H2H transmission.
Throwaway05
3d ago
I don't think that's true - I think the USA and Israel are both intensely concerned with PR and constrain themselves accordingly, at the same time they have massive structural disadvantages that make losing the PR battle inevitable. This tension is part of the at times incoherent strategy we see.
For example: the Trump administration clearly wants the Iranian people to rise up (and they likely do want to rise up) so their hands are tied with respect to certain kinds of action that would reduce that possibility. They won't be given any media credit for these decisions, and that media credit is part of what is supposed to circle back to create interest in rebellion in the country.
I really do think that anti-Trump and anti-semitic media bias is worsening and prolonging the conflict.
Circling back to OP's comment - the black out isn't total. I'll be vague for OPSEC reasons (not because it's actually necessary but because the Iranian's involved are intensely paranoid about their government and I will respect that) - certain people in certain industries that aren't really personally or professionally regime aligned are still given access to the outside internet. This allows them consumption of foreign propaganda and communication with members of the diaspora abroad. Some of the those with access are absolutely the kinds of people you might suspect as being aligned with resistance elements.
You'd also have to imagine the U.S. government is taking advantage of this.
So no, shutting off the internet does have downsides, even if some of the benefits are not materializing.
Throwaway05
3d ago
From my understanding (which is not based off of exhaustive review) the outbreak is effectively over (come laugh at me later if it is not).
People are sensitive because of the great trauma which....sure.
I can't imagine how much of a freakout the 2014 Ebola outbreak would have caused these days.
Throwaway05
3d ago
Media looking for something to sell is absolutely part of it, the bigger part is a poor information environment -
- Hantavirus is very bad.
- Yes H2H transmission appears present.
- No this is not actually novel for Hantavirus.
- Other aspects of the disease makes it a poor pandemic agent.
On Meddit everyone seems aware of all the pieces and therefore concern is low, however elsewhere (including here) people seem to be missing or misunderstanding one or more of these pieces.
That can easily breed fear. For instance some people in gen pop think this is a possible pandemic. No not really. Some people here think this could plausibly be a bioweapon no not really.
But if you are concerned about either of those things panic and discussion seem reasonable enough.
Throwaway05
4d ago
Last I heard this was not yet confirmed but it's suspected to be a known and normal variant that does human to human transmission reasonably well.
The disease lacks several factors that would make it pandemic-able however.
Medical community is mostly non concerned.
Throwaway05
5d ago
When using LG make sure you are using the latest TLD - it's still up as of this posting.
Throwaway05
5d ago
godspeed my guy
Throwaway05
5d ago
Don't they give you dx and med questions???
Throwaway05
6d ago
What you provided was evidence of nearly every stake holder involved saying "this is a bad idea" including PTs themselves.
That is not evidence that the AMA is indirectly or directly responsible for this, it may be evidence that the AMA had a stance, but that doesn't make the AMA the villain here, or the decider.
It also does not establish that cutting physicians out is a good idea, indeed PTs don't seem to think it is a good idea as per your source.
And again, the restrictions seem to be reasonable and common sense, again as per your source.
Things like "if you try for awhile and it doesn't work you need to escalate the level of care providing therapy that appears to be ineffective."
That's common sense!
And why are you focusing on blaming the AMA when seemingly everyone opposed the change??
Throwaway05
6d ago
Your citation is from 1991 - even with an atypical forum such as this one....most of our posters didn't exist at that time.
This is one of the central problems of complaints like yours, the lobbying activity of the AMA that people get frustrated about was something that occurred in their parents time, or their parent's parents.
That system is dead. Private practice is dead in most specialties. Physicians don't bill, the people who own the work of the physicians bill and make decisions.
You are misattributing blame.
Speaking of which, from your own citation -
"Opposing forces varied from state to state and included hospital and medical associations, physicians, chiropractors, and physical therapists."
If the AMA is the villain can you explain why doctors, physical therapists, and even fucking chiropractors were on the same side of the lobbying?
Throwaway05
6d ago
Weird, could have sworn I double checked and didn't see anything about the timelessness in your original post. shrug
That doesn't address the substance of my complaint, however.
Throwaway05
6d ago
So I stand by what I said - in many states it is illegal to see a PT indefinitely without seeing a doctor.
That's extremely different from what you said before - seeing a PT for initial evaluation and treatment is not the same as seeing a PT indefinitely without further evaluation (such as things like imaging).
One of the purposes of that sort of restriction is to prevent scams where a PT just bills insurance without doing anything.
One of the reasons I can be reliably summoned this way is because the complaint is essentially baseless slander that does not acknowledge the possibility of other sensible explanations or the reality that the situation has changed in healthcare has changed. I am therefore (reasonably I think?) frustrated.
Conspiratorial posts about the AMA have low predictive value and create uncertainty for legitimately information seeking third parties like OP.
Throwaway05
7d ago
As per your link the restrictions include things like:
"A therapist who has more than one year of experience supervises any therapists licensed for less than one year."
And:
"The therapist thinks the care is within his or her scope. If a therapist thinks the care is outside of his or her scope, he or she must refer the patient to an appropriate healthcare provider."
How are these unreasonable?
Insurance is more likely to prove a barrier.
Throwaway05
7d ago
My usual recommendation for this kind of thing is to look for stuff you can pirate that US grads are using. Most US speciality boards have at least on killer app or test prep book. Easy to nab on Libgen or whatever.
Obviously might end up with different areas of focus but overall should get the job done?
Throwaway05
7d ago
Yes this is always my plan - straight to PT. Obviously I have more information which makes things a bit easier for me.
In the U.S. you do need to ensure your insurance will allow this, but a local PT can usually help walk you through that.
Throwaway05
7d ago
it really shouldn't taste like fried rice
You mean like....good?
Throwaway05
7d ago
I think I'm just expecting it to taste like fried rice and it doesn't. Might be an expectation thing.
Throwaway05
8d ago
.... I think I'm just a heathen, I've been to the few places in the US with legit stuff and still meh
It's impossible to have a good version of this talk in this setting, but I will try - usually (but not always, I'm not there, I don't know what you are struggling with) the problem for early phase trainees is excess cognitive load associated with stuff that should be "free." Writing notes shouldn't usually require thinking, it should only require time. Basic interviews will be effortless. Physical exam (oh wait psych lol)...
Later the difficulty will be true medical decision making in complicated cases, advanced level exam and interview, and leadership and administrative tasks. These have higher ceilings.
For now you are probably finding it painful to do basic things. I mean yeah, that is what training is for. Most of the work is those basic things though, and as you do them more often you will find them easier, they will be automatic. Even sitting at your desk working is less exhausting if dictating or typing your note is automatic and not an onerous process as you remember how to accurately describe such and such thing.
Example - as you start getting more experience you'll notice how remembering everything for the patient encounter gets easier. This is not because you are gaining memory kung-fu, it is because your brain is automatically knowing what is important and pertinent and what is default.
This process will happen as time goes on, but with some mindfulness you can accelerate it - or if that's hard you can just ride the wave and know it will happen.
It's happened before for every trainee and it will happen to you.
One of my favorite processes in medical education is watching textbook driven people go "you aren't teaching me" and then gradually realizing that the work is the teaching and that they learned the textbook without needing to sit down and do that bullshit.
It comes. It's hard and you have to do it, but the knowledge and skills come.
Then things get easier.
*Above advice not valid for procedural skills.
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