self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
I'm a transhumanist doctor. In a better world, I wouldn't need to add that as a qualifier to plain old "doctor". It would be taken as granted for someone in the profession of saving lives.
At any rate, I intend to live forever or die trying. See you at Heat Death!
Friends:
A friend to everyone is a friend to no one.
User ID: 454
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
9hr ago
Yup. If it's an old injury, and there are no glaringly obvious signs of ongoing inflammation/disease, physio would be the first port of call. I imagine it's easier to go to a physio and then a doctor if they so advise, instead of the other way around.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
12hr ago
Yeah, it really shouldn't taste like fried rice, in the same sense that fried rice shouldn't taste like risotto.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
12hr ago
It's a bit late to be praying that that's the case, but I'm not going to risk it again.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
12hr ago
Not at all. You can spend your entire career as a psychiatrist without ever having to worry about whether you need to use ANOVA instead of MANOVA. I dare say most psychiatrists don't need to know any of this, I've never seen a senior of mine sit down and calculate PPVs or positive LRs while working with a real clinical case. If they ever knew, they've probably forgotten, and it doesn't seem to hurt them.
In theory, this information might come in handy if we need to do critical appraisals of a new paper or engage in research. That's the theory anyway, the practical aspects of it were already iffy, and these days? Everyone is going to check ChatGPT. There are zero clinical scenarios involving a real patient where this specific question matters.
Or, putting it in another way, if I learned psychiatrists are being taught and examined on wrong statistics, how scared should I be?
Don't lose sleep over it. That's my job. I'd rather be unemployed.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
13hr ago
I'm not sure, it didn't taste raw at the time, though I can't that I've eaten raw chicken on purpose to take notes. I threw it in a microwave at maximum heat for 3 minutes before consumption, it came out hot, and didn't taste awful. That's the main reason I even came back looking for it.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
13hr ago
Yes. It's even something I order it to do in my user prompt, though it's pretty good about doing it my default.
I tell people to always ask for citations or double check the work when doing anything mission-critical with LLMs, and my professional trajectory counts. I usually ask both ChatGPT and Claude at the same time, to reduce the risk of error/hallucination being correlated, and if they disagree, I dig into it (assuming I haven't reviewed their sources and confirmed things to my own satisfaction). Of course, for less important topics, I don't go that far.
Here, SPMM is remarkably wrong. They're so wrong that they disagree with the original authors of the paper they've used for the question. In fact, every single fucking time I've asked, it's SPMM that's wrong and the LLMs correct (when they do disagree, my bullshit detector isn't perfect either).
So I'm studying for the MRCPsych again, and the standard resource everyone uses for this is called SPMM. SPMM costs money. If you pay extra money, you get mocks. If you feel desperate, you can pay even more money, for a "stats crash course,".
The MRCPsych Paper B is heavy on statistics. Most of my colleagues find this difficult because most of my colleagues went to medical school, where the stats curriculum is approximately "p < 0.05 means good." I find it less difficult, which is not the same thing as enjoyable.
The problem is that SPMM's stats teaching is bad. I read a passage, frown, screenshot it, send it to ChatGPT or Claude, and ChatGPT says "yeah, this is wrong." This has happened enough times that it has stopped being surprising and started being a sort of recurring bit. The remaining percentage of the time, the notes are oversimplified to a degree that would make an actual statistician put their head in their hands, which I'll grudgingly accept as the cost of doing exam prep.
Now, I present the question that broke me today.
There's a study, presumably real, looking at childhood trauma and hallucinations in adulthood. There's a graph. The y-axis is the probability that someone has childhood trauma somewhere in their history. The x-axis is "number of hallucinatory modalities," running from 0 through 5, because apparently the authors decided five was enough senses and shipped it. Sure, I guess we can skip proprioception, vestibular positioning, and the other minor crap.
The question: "The predictor that emerged as the statistically significant variable is most likely to be..."
I pick ratio variable.
Let's examine my reasoning. The variable is a count. Counts have a true zero, where zero modalities is a meaningful and non-arbitrary absence rather than an arbitrary point on some scale. The intervals between values are equal: going from 1 to 2 modalities is the same conceptual distance as going from 3 to 4. And the ratios mean things, in that a patient hallucinating across four modalities is doing so across literally twice as many modalities as someone hallucinating across two. This is the textbook definition of a ratio variable. Stevens 1946. Every introductory stats book ever written.
SPMM informs me that the correct answer is "ordinal." I wanted to die.
I tried to be charitable. Maybe SPMM is operating from some idiosyncratic but defensible framework I'm not seeing. Maybe there's a niche position that count variables with low cardinality should be treated as ordinal because of how they behave in small-sample inference. Maybe somebody, somewhere, has a real argument.
I went to ChatGPT and laid out my case. ChatGPT said my logic was textbook, my answer was correct, and SPMM was wrong, but I should still pick whatever SPMM said in the actual exam because the exam doesn't care about being right, it cares about agreeing with whoever wrote the answer key. This is very sound career advice and also makes me want to lie down on the floor.
I pushed back. I said no, I have standards, I want to know whether there is some technical sense in which SPMM could be right and I am wrong. ChatGPT politely declined to manufacture one. After some pushing, it concedes, and says that I should go with my original answer if this specific question comes up in the actual exam. I screamed internally, because screaming externally would wake my neighbours.
The really insulting part is the upsell.
SPMM, having taught me statistics with the precision and care of a man hammering a nail with a banana, also offers a paid crash course in statistics. I will let you guess how I feel about paying them additional money to clear up confusions they themselves introduced.
There are two hypotheses.
Hypothesis A: SPMM is teaching stats badly on purpose, so that you have to buy the crash course to fix what they broke. This is the version I want to be true, because at least it would mean someone, somewhere, is in charge.
Hypothesis B: at some point, an underpaid registrar was handed a brief that said "write 500 stats questions, here's £500, you have a weekend". They paid peanuts, and the monkey just offered me a banana.
Hypothesis B is overwhelmingly more likely. It is also worse, because at least under Hypothesis A there's a coherent villain. Under Hypothesis B there's just a pipeline of tired people producing slightly wrong content for other tired people, who then sit in their flats at midnight wondering whether they're losing their minds or whether the material is in fact wrong, and there is no one to be angry at, because everyone in the chain was doing their best with too little time and not enough money, and the result is diffuse ambient wrongness that lives in PDFs forever, gaslighting trainees into doubting whether ratios still mean what they used to mean.
Anyway. Number of hallucinatory modalities is a ratio variable. It will continue to be a ratio variable on the day of the exam, and if it doesn't, the number of homicide victims in a future study will remain a ratio variable.
Edit:
The study is "Association between childhood trauma and multimodal early-onset hallucinations" in the BJPsych. The authors ran a hierarchical binomial logistic regression with childhood trauma as the binary outcome and number of hallucinatory modalities as a numeric predictor, reporting OR = 2.24 (95% CI 1.16 to 4.33) per additional modality. You can't meaningfully report a per-unit OR for an ordinal predictor. Reporting that OR is exactly what you do for a count variable on a ratio scale. The original authors treated it as ratio. SPMM has marked me wrong for agreeing with the people who wrote the study.
Last week, I bought fried chicken from an M&S nestled inside my hospital, before heating it in a microwave and then joining the other doctors for lunch. Thought it was pretty solid, and this week, I nipped in to see if I could get another helping.
I found the same dish, read the label more closely and was... less than happy to discover that it said "cook before consumption" on the front, alongside "guidance for handling raw meat". The rear only confirmed my mounting horror. I dare say I felt outright queasy. Oh well, ignorance was bliss, and it's been long enough that if I was going to get salmonella, I'd know by now. I'd rather be a victim of deceptive advertising than food poisoning.
("Southern Fried Chicken", and you expect me to think it hasn't been fried already? Fuck.)
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
15hr ago
For the sake of my mental health, I'll assume that you've just had really bad luck. If I moved to the States and never managed to find decent biryani? I'd self-deport.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
16hr ago
I think you have a point. English snobbery is something I've only looked at second-hand, and I hope it stays that way.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
16hr ago
I'll give myself a pass mark, not because I physically went to the gym (I didn't), but because I've been doing non-zero amounts of exercise at home and bought a set of dumbbells (which I did use! I'm not using the mere act of purchase as an excuse).
The next few weeks are going to be hectic. I've got an important exam coming up, and while that's not entire incompatible with working out regularly, it makes it hard.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
1d ago
You sir, are a gentleman, a scholar, and possibly a gourmet too.
Yeah. British mushy peas can stay in the dishes where they belong.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
1d ago
While I appreciate the effort, they don't call it the Land of the Free for nothing. I'm sure the lowest ranked state would spank the entirety of the UK.
And I suspect that the climate map is slightly misleading in terms of presentation, if you don't carefully compare across seasons, you'll miss the dramatic temperature shifts seen in some parts.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
1d ago
And now you're cooking with gas brother. In fact, you've made me incredibly hungry just looking at that, but I will resist the urge by thinking of England (and whatever passes for biryani in the wider UK).
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
1d ago
Plan? More like aspire. If the problem with my med school (they've been lazy about specific American accreditation, and the accreditors just as lazy) gets resolved within the next 3-4 years, it's quite likely I'll give the USMLE. If the problem solves itself later (and I'm a senior psychiatrist) then it's theoretically possible for me to seek to transfer my credentials without the USMLE and another bloody residency program.
At the end of the day, I don't have much control over the timeline. I'm also already in training, I have a good enough shot of progressing further in my career elsewhere, and the thought of sitting down and grinding for yet more competitive exams when I might have a wife and kids does not feel great. Even worse, AI is nipping at my heels, so it might become an entirely moot proposition by then.
But if I have the luxury of choice? Then California, baby. Or Texas. Or most of the US, really, probably excluding Alaska. Scotland is cold enough for me.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
2d ago
Sorry dude, I'm the one who is very sleep deprived. Not your fault, and looking at it with a coffee in me, I understand the riff.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
2d ago
It looks absolutely delicious, but I must complain about portion sizes. That's the quantity I'd feed a teenage girl, a real man needs twice as much, especially after all that work haha.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
2d ago
- The site blocks the UK for
- Using a VPN, I seem to see that the link is down.
Oh well, I can only imagine the masterful quality of your biryani, while settling for bastardized versions to be found in Anglo lands.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
2d ago
You must have had bad biryani. This is understandable, since the best stuff is only truly available in India.
Even in the UK, I've struggled to find anything as good as what I was used to at home. The best I've found is acceptable, it's biryani-shaped and roughly tastes like biryani. And then the "Indian" restaurant I ordered from yesterday served it with peas.
Fucking peas. I haven't been as flabbergasted since I tried lasagna with peas in it. Why not just piss in my mouth instead? I'd probably enjoy that more, in all honesty.
Of course, there's regional variation. Pakistani biryani is different, so is the Afghan kind. There's like half a dozen other variants from India. The one I'm most fond of can't be found anywhere nearby, for love or money.
I believe @DirtyWaterHotDog mentioned finding actually appetizing biryani in the States, he might be able to guide you better.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
2d ago
To be fair, it could both do nothing for you and also be very effective for the average person.
And that is precisely what I said, so I'm not sure what your point is. I'd rather have had bog-standard uncool depression instead.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
2d ago
Good post, even if I studiously ignore most of the lifestyle advice for myself. For what it's worth, the antidepressant effects of exercise are significant (g of - 0.63 when walking briskly, which compares favorably to both CBT and most antidepressant drugs). Even better, you can capture the majority of the benefit with about 2.5 hours of brisk walking a week. I knew that living so far from the bus stop was doing something for me, that isn't just wearing out my shoes.*
*I don't think it did anything for me, but defer to RCTs over the anecdotes of a very lazy man
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
2d ago
I'd be hesitant to blame Woke for this, really, though I've already plead general ignorance on trends on the ground (I'm not physically there, and I don't interact with the Indian diaspora on an intentional basis). Sure, identity politics was enthusiastically adopted by a specific clade of diasporans, but there are fewer true believers than you might think. People will do anything to improve their odds on college admissions screens, and this is hardly unique to Indians. In fact, they're in a particularly awkward spot.
I think @Testing is more likely to be right here, though that's a low confidence claim. Then there's reaction-formation: if anti-Indian sentiment is on the rise in the States, the natural thing is to band together. My impression is that the worst of it is mostly restricted to X and other social media cesspools, the average Indian on the ground in the US hasn't really noticed active discrimination. In the UK? We're still very much model minorities, the usual vitriol is reserved mostly for other (sometimes visually indistinguishable) South Asians.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
2d ago
Thank you. Whenever I feel the need to go tut at Count (more often than I wish or like), the usual culprit is that he's sneering at the locals and asking for them to be replaced. I can't even imagine doing something along those lines, my right to reside in a Western country is clearly a privilege, and I refuse to bite the hand that feeds. I don't think the West is perfect, but it has my loyalties not just because it offers me a higher standard of living (in some ways).
In the ending of The Camp of the Saints, I'd like to imagine you'd be like the character Hamadura, a westernized Indian taking a last stand against the destruction of western civilization together with the Frenchies (or in your case, the Brits).
Unfortunately, the phone call was always coming from inside the house.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
2d ago
Moving to Germany or the UK would be easier for the typical professional Indian looking to emigrate, but my strong impression is that the US remains the first choice. Not just because of the pay, though you're correct that it's a major component. It's just far from trivial to achieve, even for those not bottlenecked or gate-kept by professional licensing like I am.
Whatever you do, don't come to Scotland. I'm fine with nail polish, in general, but the nail extensions you can see in the trashier parts of the country are so long and garish they should probably count as edged weaponry.
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