Throwaway05
5mo ago
I apologize in advance because what I'm about to say isn't what you asked for but I think it's important to comment.
Independent of how good of an idea homeschooling was in the past, I think it is going to become a much worse idea in the future.
One of the joys of my job is that I get to see every single slice of the population and something I've noticed is that young people are nervous wrecks theses days (especially post-COVID)...this is known - but also that a lot of home schooled kids are a lot worse.
I suspect this is due to decreasing opportunities for independence and socialization and regular school is one of the last bastions of that. This trend will likely continue to worsen as people spend more time online and less time touching grass.
I'm sure the research will catch up at some point, as it has with social media and COVID pauses, but at that point some people's lives will still be fucked.
There are plenty of reasons to avoid traditional school (safety, poor quality, woke bullshit) but the benefit is probably worth it and if you are going to home school you'll need to dig out chances for your kid(s) to socialize adequately.
Throwaway05
5mo ago
violently ill
Norovirus?
Throwaway05
5mo ago
Do you have a source for that? I'm currently watching football and while I've seen a ton of drug ads none of them have any doctors in them. I suspect if an advertisement for a Derm product appeared it would have a doctor, but I have no idea to what extent any of these people are really doctors (as opposed to actors) or practicing clinical medicine instead of working in industry.
Additionally while all Pharma companies are interested in people buying their products, a fraction of a fraction of one percent of doctors show up in ads. Why mention them at all?
Throwaway05
5mo ago
Hold up, are you saying doctors want patients to spend more money on meds?
Throwaway05
5mo ago
Schizophrenia and other typical psychotic disorders most commonly manifest in young adulthood but can occur later randomly or because of some medical or substance induced insult - or acute stress.
True psychosis doesn't need to be the cause here - consider born again Christian or woke/anti-woke converts. Can have really really strongly held beliefs that others may feel are not reality based.
A veteran can also seek solace from their experiences and trauma and end up with odd or way too strongly anchored beliefs, even without something that meets formal diagnostic criteria.
Guy may have met criteria for major depression with psychotic features but based off the information available so far he doesn't really "look" like that.
Throwaway05
5mo ago
I've bitched about this enough IRL that I will refrain due to opsec.
A good example is NPO status though. Your surgeon says don't eat or drink anything. You are thirsty and hungry. Your nurse has mercy. Surgeons are very conservative with NPO, nurses want to be nice. Patients aren't going to know when "psst have some ice chips" is a good idea and when it isn't.
Throwaway05
5mo ago
Okay let's start with schizophrenia. Well known disease, somewhat understood etiology and biological mechanisms. Makes people believe weird shit, be psychotic. Relatively easy.
Then gets harder. Schizotypal personality disorder. Weird people....with magical thinking? Makes people believe weird shit. Maybe look kinda psychotic but not actually be psychotic? Might have schizophrenia as a complication. Okay that's kinda complicated. People in military have it? Well no probably not, it would be hard to get through basic but maybe?
What if it seems more personality driven - are SJWs psychotic? Religious people? Some people will say they are absolutely untethered from reality and psychotic and believing weird shit. Plenty people will say "no this is the state of the world."
Okay then so what if you are traumatized, you are looking for answers or your world view is knocked over. You try and fill it with something and find something online. Pizzagate, SJ, UAPs, whatever.
Maybe then you're kinda psychotic (well....a little delusional) but you don't have hallucinations or negative symptoms. Now other people think you have weird beliefs (but others don't!).
Or you end up with straight up schizophrenia or some other psychotic disorder because of stress/trauma or resulting substance abuse.
Throwaway05
5mo ago
I wish there was an Angi for health services.
Their is. Sort of - and they fucking suck.
The industry has essentially landed on patient reviews as the mechanism to do this and you can find all kinds of websites that track this, and certain forms of reimbursement may be partially contingent on patient satisfaction metrics.
The first layer of problems is the usual review issue - most people don't bother to leave a review if they had average care, a small fraction of people who receive great care leave a review, and a lot of people who are mad leave angry reviews, this creates a lack of realistic balance in the reported experience.
The other piece is that what makes for good care isn't usually legible to patients. NPs like to brag about studies where they have higher levels of patient satisfaction and it's often tied to not appropriately saying no to patients or things like unnecessary testing and treatment. People don't like being told "no" or "I don't know" doctors are better at doing that but it pretty uniformly pisses people off. The classic example is telling a patient no when they ask for antibiotics for a viral infection. This is good healthcare but obviously decreases patient satisfaction, and that's not bringing up things like angry patients seeking drugs of abuse and review bombing, or psychiatric patients who are angry because they have poor insight and received good care.
Outside of outpatient clinic medicine things get even trickier. The best hospitalist in the hospital is spending his time not in the room with you running down to pathology and radiology, calling insurance companies or social workers for dispo, teaching students, etc. The worst is sitting in his office playing Sudoko. Both only spend five minutes with you a day, you'll have no way to tell if they are good or not unless you have an avoided near miss or something like that.
I was hospitalized a little while back at my own hospital and was the victim of a pretty severe and unacceptable/easily avoidable medical error. I don't think a non-doctor would have even noticed.
Some other examples - anesthesia.....you'll wake up either way, the horribly wrong outcomes aren't generally the doctor's fault. With good gas you'll have an easier emergence, or if you know exactly what to look for on your anesthesia record you could see you were getting good care. How many people get enough surgeries or have the training to read those tea leaves?
For surgery... a lot of aspects of outcomes are patient and not surgeon dependent (like overall health status, engagement with PT), you don't know if your insides are an avoidable mess afterwards or not. The good surgeon might make your next surgery much much easier but you are unlikely to ever know. Patients will also often jump at the chance to get surgery not realizing when NO surgery is the better outcome. You might be a better doctor for saying no...and get worse reviews.
Exceedingly hard to manage this.
There have been attempts to look at more formal outcomes and this rapidly runs into pretty severe juking stats and perverse incentives.
A classic example is transplant surgeons forcibly keeping patients "alive" to get them to die outside of various thresholds (since that gets reported).
Surgeons will sometimes refuse to operate on risky cases because of the morbidity and mortality outcomes. Some of the best surgeons have the worst outcomes because they'll swing on cases that others won't. Some of the worst surgeons too - they'll swing on cases that they shouldn't.
It's a mess.
I do get asked "how do I find a good doctor then." I don't have good advice for this. In my specialty and my area? I already know who is shit and who isn't and hoard that knowledge like gold. Some related specialties? My specialty further away than I don't know them personally? Sometimes I can guess, but mostly I just have to know someone in that specialty in that region who has the wisdom to be able to determine which of their colleagues are ass.
That is not generalizable.
Throwaway05
5mo ago
Bombings generally are caused by the mentally ill or organized groups. The former is bad at using training, the latter doesn't need it (and has the government stuffed up their ass looking to make sure they don't accomplish anything).
A big risk is the social contagion aspect though, once the ill became aware of a modality (like a well published manifesto loudly stating I found X instruction in Y location) they become good at using it.
The tricky bit is that mentally ill doesn't just include schizophrenia and depression, indeed much of this likely comes from those with personality disorders, and these people may not legible parse as mentally ill to the general population.
And then you have all the stuff the government has done to limit access to supplies of various things.
Throwaway05
5mo ago
but not being a moron seems like an almost impossible bar to clear for terrorists
Most of these type of (seemingly) lone wolf events are more mental illness driven than anything else, which decreases the quality of the planning.
Throwaway05
5mo ago
Supposedly the guy was a radar operator and the special forces community is making a big deal about improving cross training and dropping a lot of memes as a result.
Also look up what the Green Berets actually do it is probably not what you think.
Throwaway05
5mo ago
Regrettably the commanders look like they are going to be good and more relevant for a few more years at minimum. Changes in the ownership structure and some high profile new players mean they'll have a few years of success.
Because they have been mostly pretty shit for a while and are in one of the most toxic division in American sports....people are going to be excited about it.
If you want to troll just start a conversation about the name of the team.
If you want to contribute something (which can be done without implying you know a lot about football if you just ask it as a question) you can comment that they must be the team winning the NFC East next year* (that'll get em going for awhile).
*The NFCE hasn't had the same winner (out of the four teams in it) for decades, so it's widely anticipated the Commanders will be the winner next year since the Eagles won this year. This is always good for some laughs and discussion.
Throwaway05
5mo ago
Yeah totally fair, I do worry some people don't really consider however. For those who do - go ahead!
Throwaway05
5mo ago
See response to Amadan.
Throwaway05
5mo ago
Context
Short version: If you go to an eye hospital ophthalmology department you'll note that nearly everyone is wearing glasses.
Long version: When I'm teaching medical students in surgery I say something along the lines of "roughly 25% of surgical residents drop out, nobody ever says they are going to be one of those..." People almost never think they are going to be in the pile of bad outcomes (unless they have a nervous disposition). LASIK risks are reasonably rare (but more common than you may think) and nobody ever thinks they are going to be one of the ones who gets them, but most people's primary means of interacting with the world with is through their vision. Losing that, or having it appreciably worsened with dry eye or tanked night vision...it's awful.
That said medical professional skepticism is driven by actually seeing the bad outcomes, that isn't necessarily appropriate if everything is weighted correctly. And lots of eye doctors avoid contacts for similar reasons. You do also see plenty of eye doctors that get it done, but I will always remember the time in med school I asked an ophthalmologist why he still had glasses and he said "why the fuck would I laser healthy tissue."
The other piece you want to keep in mind is that surgeons want to "cut" but LASIK makes the most sense in a relatively narrow age range and for a relatively narrow degree of eye defects. Outside of that it makes far much less sense, but you can still easily get it done.
Throwaway05
5mo ago
My understanding is that hypnotherapy does actually work, but its biggest flaw is that if it works or not is something of an unchanging and independent variable. The small fraction it works on? Pretty good. Doesn't work on you? Not going to work on you, ever.
Obviously it can't do any of the crazy Svengali shit.
No reason not to lean on CBT first either way.
Throwaway05
6mo ago
okay fine, a psychiatrist, so barely a doctor
What precisely makes a psychiatrist barely a doctor?
Throwaway05
6mo ago
You should go tell your doctor what is happening. Could be you are just learning something about yourself for the first time, could be a sign of something mild, could be a sign of something serious. Best to figure it out.
If you'd like to subject yourself to hell you can look at some stuff on the cascade.
For your sanity don't.
Throwaway05
6mo ago
In short, my lack of success is due to being banned from Hinge (the best dating app I have ever used)
I'm going to write taking the rest of what you said at face value (by which I mean that you are a very well educated, successful and therefore likely hardworking and intelligent individual).
The above quote is a loser attitude. I don't mean you are a loser, far from it. You are demoralized because you aren't getting lucky and luck is required because that's what you need with the way you aren't embracing every opportunity.
If someone was trying to break into your field (7 figs in early thirties???) would you tell them to just passively apply to jobs or take low end jobs and not excel? Fuck no.
You gotta hustle. And we have reason to believe you can hustle in other domains in your life - you gotta apply those lessons here. Dating is going to involve a lot of discomfort, it's easy to justify avoiding discomfort but that is what it is and what you gotta overcome. Some of the other posters here complaining about dating have bigger concerns - but you, your fundamentals are extremely "attractive" and you are living in a place with a shit ton of women meeting your needs.
That means you are probably doing something wrong or you aren't doing enough. That is good news! It means you can do something different, and/or do more. It's going to be uncomfortable but dealing with that is a core skill in dating and in business.
Okay an example - you got banned from match apps. Why? Someone probably reported you or something, likely multiple someones (does that mean you did anything wrong? no, women on the apps be crazy). Is there a way to appeal this ban normally? No. Do you likely know someone on LinkedIn who knows someone who works there? Given your background very possible. You can cold message someone and be like "hey I work in NYC and I'm interested in whaling on this shit but I'm banned for no apparent reason..." Is this likely to work? Maybe not. Could it work? Yes absolutely. I was having a serious redacted issued with major tech company and I contacted person I knew for redacted reason and they got someone to fix it. If you have the professional network you can use it. Even if you don't have a connection you can leverage if you have a built up LI you can probably just cold message a few people. If you don't have a built up LinkedIn you are probably not networking enough, that will help you at work but those networking skills can also be leveraged to pick up women, especially if you are looking for a specific type (meet a guy who hangs out with ABGs? ....become friends with him and you'll meet ABGs IRL).
Likewise make a CMB. Now. Do not stall, if you stall that stall will last a long time. Make it and start using it now, maybe you don't find anyone with the qualities you want but dating is a skill and like any skill it has to be practiced, it is also a numbers game so you gotta get on it if you want it to work.
I don’t have that many opportunities to meet single women IRL: my hobbies and social circles are pretty male-dominated and the attractive women in them are already taken; plus work keeps me pretty busy.
More discomfort - pick up some new hobbies that have women. Depending on how male-dominated your current hobbies are that could end up being great for you for reasons other than dating, but if what you are doing right now isn't working (and it clearly isn't) you gotta start doing something else!
This, I think, is especially true when it comes to women who are my type (well-educated Asian-Americans), as they tend not to just hang out in bars or whatever waiting for guys to approach them; if they’re in the dating scene at all, it’s through apps.
I think you also have to be careful with how dialed into your type you are. That's instantly going to make things more challenging for you, but if that's still the only thing you want I think you are missing out on some of the stereotypes - FOBs might be not hanging out in bars, but ABGs are big into the clubbing and rave scene, are all over certain kinds of bars, you can approach while they are doing some dumbass trendy thing in K-town etc.
Throwaway05
6mo ago
Yes absolutely depending on what you are doing.
In America diet/obesity is the more likely cause, but if you are deadlifting like crazy or something else which fucks with your abdominal pressure yeah could easily happen.
Throwaway05
6mo ago
Am doctor but not eye doctor. Not a fan of LASIK especially in your age range. Carefully research the risks first, you won't get a good objective assessment from an ophthalmologist because if at all possible they'll recommend the procedure (because surgeons want to cut).
Does your ban extend to Coffee Meets Bagel? It's very popular in the Northeast and Asians are over represented. Recommend Asian adjacent real life activities if that's your mojo. Ex: EDC (or whatever local concerts there are).
Find a place to meet residents (physicians), easy way to pick up intelligent professional women.
Don't know how to find a dating coach but do recommend that.
I think Raya has gone out of fashion now but you might be able to find its replacement or try signing up for its corpse.
With your salary a good personal trainer is super affordable and is good for your overall health and mood and also for making you more superficially attractive.
If you have good insight- figure out why you aren't successful. If you are moderately attractive you should be drowning in women at that wealth level. Are you fatter than you want to admit? Fashion style not making it obvious you are bringing in money? No rizz?
Figure out what it is and then you can address. This ties back to matchmaking - if the issue is your profile was shit they'll fix it. Don't want to pay someone? Run it by women in your life if you don't want to pay. (assuming you can get on CMB)
Throwaway05
6mo ago
If your hemorrhoids are caused by your diet, adjust your diet. Likewise do what you can to reduce straining. Fiber intake. Fluid intake. Exercise. A squatty potty (no really they work!).
Here's google AI's list of risk factors. Modify what you can. If it is caused by most of these (ex: excess straining), any treatment is going to not matter much because of the likelihood of recurrence.
Straining during bowel movements
Sitting on the toilet for long periods of time
Chronic constipation or diarrhea
A low-fiber diet
Weakening of the supporting tissues in the anus and rectum, which can happen with aging and pregnancy
Frequently lifting heavy objects
Being obese
Anal intercourse
Certain diseases, such as cirrhosis
Family history of hemorrhoids
Throwaway05
6mo ago
Here's a two minute video explaining PBMs in a humorous fashion by a Doctor/Comedian influencer.
https://youtube.com/watch?v=_khH6pZnHCM
TLDW: United IS its own PBM.
Throwaway05
6mo ago
ASCs in the U.S. will sometimes do cash pay for low risk things, so it is possible in the US but keep in mind that due to greater access to expensive technology, salary costs (nurses get paid more in the US than doctors do in the UK right?), and lack of rationing mean that the price of care can be much much more expensive.
By a lot.
California alone has more ECMO centers than the entire UK.
I agree it was always important but my fear is that it is going to be increasingly harder to do. :/
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