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Throwaway05


				

				

				

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joined 2023 January 02 15:05:53 UTC
				

				

				

				

				

				

					
				

				

				
				
				

				
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Throwaway05


								

								

								
								
								

								
							
					
 
				


				

				
				
				

				

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					joined 2023 January 02 15:05:53 UTC
				


				
					

					
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User ID: 2034


					
					
					
				

			


					

						
					



		

	

 











			
			

			
			

			




	


		

			
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				Small-Scale Question Sunday for March 15, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Dang must have had 'em mixed up with someone else - point remains about it being a first language vs. not a first language expectations thing.


Always going to be harder coming in.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Chesterton's Pill
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Don't mind me I'm just walking uphill both ways to work (in the snow).


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of March 16, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
All experiences are relative to their cultures, just saying that I think lots of people stroke out on the spot if they saw my local equivalents.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Chesterton's Pill
			
		

	

	

	

		
			

			

				

			

		

			


				

					


Ah. So this is universal, speaking from experience in the UK and India. I've heard even other postgrad trainees (in the UK) make the same complaint.




alarms blare


You've activated my attending trap card. Basic intern year scut work (both inside surgery and outside of it) isn't actually wasted. You learn valuable tools like "writing that fucking note quickly" and "nurse management" and "sick vs. not sick."


Certainly the modality has some yield issues at times, but the gain in fluency and skillset is real, with variable spaced repetition of more traditional surgical skills.


Also is what separates us from midlevels.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Chesterton's Pill
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Basically the issue is that the required case volume to become proficient in modern surgical modalities is a lot more than with classic open cases. Decent surgical residencies can theoretically get you enough cases for bread and butter procedures but for less common things it gets harder. Consider how much harder it is to orient and to appreciate anatomy through a lap, and with a lap to ably use your technical skills (less of a problem with robots).


Surgical residency is already long and miserable enough, adding more years just isn't feasible.


Additionally things don't go wrong enough, which is good, but you need experience with things going wrong in a controlled environment to be able to provide quality care when you are on your own.


This means that many junior attendings aren't really fit for purpose and need hand holding, academic work, or enhanced engagement from their partners. None of which is good and it isn't really a solvable problem, especially with the push to condense training.


Also, usually the intern year for surgery is wasted on floor monkeying only pretty much.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of March 16, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					


is the potential hypersexuality,




Hold up, is teenage hyper sexuality in India kissing boys and watching porn? These people's heads would explode if they were exposed to dysfunctional American ER visitors.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Chesterton's Pill
			
		

	

	

	

		
			

			

				

			

		

			


				

					


Hey, don't be so harsh. You do have an audience for that diatribe, even if it might just be me. Let it all out, I have a father who I cannot accuse of lacking surgical skills even if his expertise is in laparoscopic surgery (and he is world-class at it, if I say so myself). This is a safe space.




It's a travesty! Junior attendings lack effective experience! Nobody has experience with disaster cases! Open conversions are always in the worst circumstances! Hundreds to thousands of hours of extra training time!


Ultimately the switch is a good thing but it causes some skills deficits which are especially problematic in the US with the way our training works.




Strabismus




My favorite for this is autoimmune encephalitis, seldom seen, often missed, never fails to make the psychiatrist feel like the smartest person in the world and everyone else feel like a dumbass.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Chesterton's Pill
			
		

	

	

	

		
			

			

				

			

		

			


				

					


Maybe @Throwaway05 even if his OPSEC is so strong and his knowledge base so broad that he could be in anything from IMT to psychiatry to an ER specialist to a dermatologist.




Listen nobody here wants me to bitch about the decline in surgical skills training driven by laparoscopic and robotic surgery. It is poorly received every time! Every time!


So we talk about this psych bullshit instead because it is interesting and has more relevance to the average person.


For you-


I'm 110% not a child psychiatric and I did not examine this patient but weird behavioral stuff is usually Autism or ID in the U.S. The need to rule out some medical pathology is of course important (and obviously needs to be done with any patient with a presumed psychiatric diagnosis). That said this is a distant ass culture from mine and I'd have questions about how these things do and don't manifest in those culture. India strikes me as a place that would have a ton of variety and not variety in cultural presentation that would require a steady hand and clear eye to notice and distinguish with the other pressures (ex: time, resources) in play.


For OP-


You are hitting on one of those questions that is super valid and at the same time once you have training you forget it is valid. No shit "don't pathologize the normal human experience" is wise lol. It's very much baked into how the DSM thinks about things but beyond that too - being six foot four is more or less normal being seven foot four will have tremendous impact on your health, life expectancy, and experience of existence. But sometimes we forget this is an actual thing people worry about


Also, things like ODD exist to be like the pornography of psychiatry - give some labels and descriptions to "I know it when I see it" stuff.


Kids being difficult is normal. Some kids are "holy shit."


One of the ways to tackle this is by focusing on appearance in a number of environments. Kid acts like a bored little shit in church and school? Yeah fair. You leave em to their own devices at home and they also can't function? More likely to be pathology.


The real world does get in the way sometimes with overly dictatorial parents, attempts to get school accommodations, teens and adults relying on TikTok for stuff - but there is a real phenomena being targeted here.


Additionally, psychiatry is a bit looser than medicine - ADHD symptoms can be best explained by Anxiety, Depression, latent Bipolar disorder, medical illness, permanent brain damage, resolvable brain damage upon further development, substances, specific environmental factors, disordered personality.


Try sorting this shit out in a 15 minute appointment with a patient or family who already "knows" what the diagnosis is. Giving the diagnosis triggers further resources (including medicine) but doesn't always mean an understanding of the underlying mechanisms.


In the U.S. we shuttle things from Psychiatry to Neurology once we understand them (schizophrenia used to be early onset dementia, then we figured out what dementia was and punted it over). If something is still a psychiatric problem it means it is quite a bit more tenuous and complicated than a nevus or blood pressure evaluation.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Small-Scale Question Sunday for March 15, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
You are Indian right? It's worth noting that the a core part of "English" education in America has been reading the classics, so we do get more practice with the more archaic style. This serves to expand vocabularies, recognize more styles of English communication, and to understand where some words and cultural references come from (I'm looking at you Billy S).


If your primary experience with English is dryer teaching English or technical writing some literature will absolutely be a bit challenging to read, but much of it was more or less lowbrow at the time and it is expected that an "educated" person in the U.S. be able to read these with an excess of assistance.


Separately, many English speaking people will have a fluency with Victorian social norms that will puzzling to people from outside milieus.


Probably your struggle is as much vocabulary as it is missing cultural context.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Small-Scale Question Sunday for March 15, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Credible Defense on reddit has a lot of knowledgeable posters and high discourse standards, you'll high quality answers to questions like this and links to more formal presentations of the same.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Small-Scale Question Sunday for March 15, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
My understanding is that the supplement industry is not regulated in the same way drugs are so reputability of manufacturer is critically important since they aren't required to have the content or purity as advertised. See: lead in fiber supplements.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of March 9, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
As I made clear down thread, I'm perfectly willing to engage with criticism of Jews, Israel, and this war. I find plenty of people capable of rational discussion about this topic including people I deeply disagree with.


However some of the posters here are clearly just angry, hateful, and blinded by some sort of intense and specific dislike that will never make sense to me and is clearly objectively irrational despite being historically common.


What's the value in discussion with someone who is going to blame the Jews every time? You already know they are going to blame the Jews. They aren't going to say anything novel. They might even be right occasionally but you won't be able to tell because they say the same thing every time.


I've never had any significant interaction with anti-semites in person or in real life prior to this conflict and I now get while growing up the Jewish people I know just automatically assumed anyone who was anti-Israel was anti-semitic.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of March 9, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
I mean it's a tough situation, I'd prefer to not be rude and both options are rude.


I think many people here have something interesting to say for or against this conflict but at this point I've started to find the anti-jew posters aggressively one note on anything that can be blamed on jews. On reddit I'd tag people with RES so I could keep track of things like this, but I don't know how to do that here and I wasn't 100% if he was one of those...and well he made it clear.*


If you are more irked by my lack of response to you, well I watched mainstream media on the recent events, personally heard the talking points in real time, felt convinced I understand the public justification and aims, then watched the dem talking heads land on a narrative of "not clear" and people download that.* I am happy to explore how valid my thought process is on this with a curious party like OP, but your stance suggests a fixed position and willingness to use disingenuous talking point to affirm your stance.


Ex: At this point Trump has been in the public sphere long enough that unwillingness or inability to adjust to his administrations communication style is the fault of the interlocutor. The lack of professionalism is a reason to critsizie them for lack of professionalism, it is not a reason to fail to appropriately engage with their communication.


*Plenty of reasons to dislike Israel and its recent actions, but if what you are saying tries to make Israel seem worse than or equivalent to Iran+terrorists than the complaints just aren't credible and I think discussion is unlikely to be fruitful.


*Seen many times in recent high quality political discussion like with Mark Halperin going "here are the aims! They said that in this speech! Stop pretending it wasn't clear" and talking heads just not engaging.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of March 9, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
My guy, I implore you to consider the ramifications of our interaction going like this: "I'm worried you make everything about Israel" "of course Israel made you say that."


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of March 9, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
I appreciate your response but I won't be engaging with you on this. I've personally found the anti-Israel/anti-Jewish posters to be too laser focused on that end of the conflict to the point where it makes the conclusions questionable and discussion unrewarding.


My apologies if I have you pegged incorrectly on the Jewish front.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of March 9, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Why?


Look what Iran is doing - shutting down the global economy, launching missiles at and deliberately attacking civilian infrastructure and the economy (oil, travel, etc etc) of its neighbors. They've always been interested in doing this in all likelihood, but didn't think they could get away with it. They also had their civilian terror networks temporarily defanged.


What happens if they get the bomb? What happens if they rebuild the missile capacity and expand the drone capacity?


What if two years from now they wanted to close Hormuz and were a nuclear state? We'd have to just accept it or much riskier things.


The U.S. and Israel absolutely have classified timelines on missile production, they may have timelines on the nuclear stuff.


Iran can't be allowed to do what it wants to do, because it would do this. We know this, we can see now exactly why that is.


It just happened Trump was sitting in the chair instead of a cowardly president who might end up just waiting and praying.


Why now, specifically?


Trump made his threats and it was clear something was going to happen eventually, it appears to have gone off a bit half cocked but I imagine that's because the Iranians foolishly put enough of the government in one room together.


Why don't people understand this?


The government has been very explicit with stated public war aims and reasons, and has a number of private elements that are easily guessable. The media has landed on a meme to criticize this conflict as "they weren't clear" so people think it isn't clear when it is.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of March 9, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
You guys are dropping a lot of words right here and I am smooth brained right now because I'm doing a caffeine hiatus, so either of you may have teased this out, but usually we try and dodge most of the definition of a delusion problems by noting things like - fixed and false, and not shared by others in the culture (which knocks of religion, Epstein conspiracies, and so on). Importantly falsehood can be tough to evaluated but fixation is pretty easy "is it at all possible this could be wrong" "what would happen if I showed you evidence to the contrary?"


Outside of heat in political arguments you can get people to say something like "well if that's true Trump/Biden is an idiot, but it isn't true" contrast with "no, all Republicans are robots and if you see one bleed that's a lie they don't bleed because they are robots."


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Chesterton's Pill
			
		

	

	

	

		
			

			

				

			

		

			


				

					


I think, on a empirical basis, that this effect is insignificant. Med influencers make significant amounts of money and acquire fame by attracting patients using case reviews, and I don't think Scott has ever suffered for it.




I don't know about elsewhere but Med influencers are widely mocked and attacked, one guy at Mayo just had his career tanked. Some of this is probably jealously but with the exception of saint Glaucomflecken most medfluencers are trash.


Also I believe Scott lost his job and had to start his own business because of his writing.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of March 9, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Arguing that your side surrender because conflict result in unacceptable outcomes is not good game theory when being attacked by an aggressor.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of March 9, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
We know that one of the attack vectors used by our geopolitical rivals is to specifically emphasize these points to cause political strife, withdrawal from conflict, and to destabilize the US.


Regardless of underlying virtue associated with these conversations, we should be much more careful and diligent in doing what our enemies want us to do.


I seldom see that happening.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Culture War Roundup for the week of March 9, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
It's woke to complain whenever the U.S. fails to be absolutely perfect and not complain at all when Russia/Islamic Regimes deliberately murder civilians with specific intention.


I do not see Dase equally criticizing Russian, Iranian, and Palestinian attacks on civilian populations.


In short, isolated demands for rigor on political grounds is a classic woke manifestation.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Chesterton's Pill
			
		

	

	

	

		
			

			

				

			

		

			


				

					
I figured the UK had a culture of ethical handwringing but that you might be spared it due to location.


Like I said not criticizing you for your post however we see one of the Common Points which is that even without identifiable information patients can read it that way, and it does generate consternation and distrust at times. Not necessarily a reason to not do it.


With respect to the bus problem - don't report so that the guy feels comfortable opening up and can get treatment and harm mitigation is often selected as the answer.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Chesterton's Pill
			
		

	

	

	

		
			

			

				

			

		

			


				

					
It's a very good question, and one that has generated a lot of discussion over the years. Self_made's milieu (sorry I'm too boomer-core to actually tag you but I imagine you'll see this) is likely less intellectually masturbatory than mine, part of that is training locations, part of that is also just how things are with the way healthcare and the world has changed.


As physicianing becomes just a job, and the role is more maligned than deified, the idea of those special obligations (and privileges) we used to have goes away. This may be a bad thing, but it is.


Some thoughts.


Hypocratic Oath - It's dead. Many schools have gotten rid of it in general or replaced it with woke screeds. While ethics is taught, it's often head cudgeling "professionalism" ethics. Thinking abstractly about moral pulchritude is gone. I usually blame everything on wokeness, and will do so here.


Official ethical guidelines are often shockingly self constructed or not actually enforceable. The Goldwater rule is pretty famous on this front. This is further complicated by the fact that much of practical ethical behavior is locked into a complex web of federal and state laws that are generally not actually explored by the legal system and can be mutually incompatible (ex: mandatory report this is one jurisdiction but CAN NOT in another jurisdiction, but what happens if care crosses state lines?).


A classic question like "do I report the alcoholic school bus driver" is fraught as hell and younger generations have basically been taught not to engage with the question and to report to risk management.


Basically ethics has been beaten out of the curriculum.


Engaging with your specific question -


Oliver Sacks famous wrote about specific patients. Ish. He also famously made a bunch of stuff up. Conveying the meaning without the details (and with a mild to moderate to sometimes excessive level of alteration and fabrication) is one way to tell the story. Hat was written in 1985 - it's an old argument.


I am unsure how much Theodore Dalrumple fuzzed his patient stories, but he is considered politically unpopular because he illustrated reality as it is. Life at the Bottom is important because it's real, regardless of the reality of the specific patients, but if they are real specific people the value still makes it worth sharing.


For me - when I've written my patients stories here and on our predecessors with my old handle, I generally tried to write about patients whose stories are common or obscured enough detail that many docs would say "did this happen to me?"


This isn't to say I'm judging self_made. Writing to process training is a time honored and important way to not fucking go crazy and become a bad physician, especially for someone whose story has taken them to a place where the other ways of processing are less available.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Friday Fun Thread for March 6, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
Have you seen Shrinking? I think it proves Ford can act when he wants to, he just doesn't usually bother.


				

				

						

							

								
							

						


						
					

				
			


			

	


			
			
				

			
		

	






		

			
			
				Small-Scale Question Sunday for March 8, 2026
			
		

	

	

	

		
			

			

				

			

		

			


				

					
All levels in the US are able to move up and down more than you see in say, Europe.


Class not really being a thing here is part of that.


Rich kid at a rich school with rich friends doing fancy things and then ends up with a boring office job while all their friends end up in NYC finance is a thing that happens, for instance.