Throwaway05
1mo ago
Jayce is somewhat hispanic coded and his voice actor is hispanic.
The main characters are (per wikipedia cast list): white woman (LGTBQ, voice actor is not white supposedly and she identifies as multi-racial), white woman, hispanic man, asian woman (LGBTQ), black woman.
Major supporting cast is: white male (but not human character, is orange?), white male (villain), white male (villain), white male (diesish, sorta villain), black male, black female, black female, white male villain.
Definitely Netflix casted.
Throwaway05
1mo ago
While I think OP is overstating the case I find that the majority of people underestimate how bad the weed crisis is, it's not that the majority of people have a bad outcome but culturally it has no immune system, many many people abuse it to an absurd extent and some of the problems (like addiction, hyper-emesis, psychosis) are super under estimated.
The people in society who we are always complaining about are all abusing weed. it might not be the cause of the problems but it is contributory.
Throwaway05
1mo ago
For Season 1 purposes:
Throwaway05
1mo ago
I feel like the best leaders don't need to think about being leaders at all.
That said - thinking about how to be a good leader gets you above so many bad leaders and basically all of those people you see complaints about on social media and reddit.
My father spent the back half of his career in an extremely high profile leadership role and I think every time I've seen him in the last few decades he's had the latest book nearby.
I don't know if any of them were particularly good but it seems like their is a million ways to go about it and a million opinions and the people who are any good invest a lot of training and time. Not really shocking but easy to forget and people tend to focus on technical skills and such a lot of the time.
Throwaway05
1mo ago
"Anti-capitalism" + lots of LGBTQ* themes and relationships + girl bossing + "diverse casting" up the wazoo.
Also, how many white men can you name in the cast who aren't villains or being set up to be villains?
Throwaway05
1mo ago
Mmm fair. You can find good Mexican food in the NE but it sucks except for random places. Pretty much only in Texas/SW/Cali tho.
Indian wise that's an interesting point. Maybe blame Edison?
Throwaway05
1mo ago
My delta is NYC actually sucks at some food
Out of curiosity which ones? Unless it's all
plays. It's astonishing how bad a lot of places are but they're still viable just because they are in a lucrative location. You have to worry about this a lot more in NYC, IMO.
Throwaway05
1mo ago
The liberty bell is basically a tourist trap.
I don't disagree but I feel like this is most America history items.
I think we might have different tastes, especially once you had the context...The Barnes is just an exquisite museum.
Throwaway05
1mo ago
Yeah it's frightening. Suddenly people take what you say seriously. How you feel about something is important to people. Offhand suggestions quickly become reality. Sometimes I wonder if it is what being a beautiful woman is like haha.
The more management work I do the more I realize that it is one of the hardest skills, mostly orthogonal to other skills, not something we bother to train...and almost everyone sucks at it.
Throwaway05
1mo ago
Some interesting things related to this:
Obviously it doesn't happen very often, thank god.
It's also more of a problem for therapists/psychologists/psychiatrists who do therapy (rarer) - consider that for many people talking to someone for an hour a week is more than they talk with most people in their life and family. Med management doesn't create that level of intimacy.
Also most men are not experienced with being hit on at length, especially by someone seductive (and with borderline the pleasing aspect is quite possibly why the pathology exists given its association with trauma).
For this reason old school docs would suggest to their trainees that they hire prostitutes if they weren't getting enough gratification in personal life.
Amusingly back in the day it was actually considered treatment for borderline women. It actually worked???* Obviously terrible from an ethical perspective however.
Malpractice has gone back and forth if it should be covered. Obviously it's a completely avoidable mistake that should end in the psychiatrists professional evisceration, but if malpractice covers it the victim can get more money.
Professional boundary rules are incredible strict for psychiatry. In other specialties you can eventually date patients if common sense steps are taking in most jurisdictions. In psychiatry never ever ever. This makes sense but is taken to an extreme - one guy lost his license because of a woman that he had a patient encounter with decades prior to them meeting again that neither remembered.
*Basically having someone who you can't push away successfully helps with developing appropriate personal relationships and coping skills. These days a boyfriend who don't peace out substitutes.
Throwaway05
1mo ago
Food-wise that's fair unless you specifically want a Cheesesteak or something like that.
Independence Hall, Liberty Bell and so on are solid.
The Philadelphia Art Museum and The Barnes are both A++++++
I think I heard once that Philly has the second largest collection of impressionist art in the world that's something.
Throwaway05
1mo ago
I could name names, but I think everyone has at least one example that comes to mind.
I want to nominate Andor and Arcane (season 1 only for both, haven't seen the rest yet) as cases of very progressive seeming stuff that comes across as both true art and not annoying.
I'd appreciate other recommendations if people have them (and Deltarune/Undertale are good choices!).
Throwaway05
1mo ago
So a few years ago I ran into a cover of "A Cruel Angel's Thesis" with Frank Sinatra on vocals (AI obviously).*
I remember this kind of thing having a brief moment, getting knocked off of the internet....but might now be back given everything that has happened since.
Anyone have any recommendations along those lines?
Or really any stellar mashup/remix I'm a sucker for those.
General recommendation: The White Panda.
*https://youtube.com/watch?v=FLmt6dQmMTU&list=RDFLmt6dQmMTU&start_radio=1
Throwaway05
1mo ago
us stuff
Not taking a stance (although I have one), just suggesting some deliberation and care and thinking - it will serve you well with deciding where to put the boundaries.
rizz
Haha it's less about dating in the workplace and more about "ooooh I can fuck this girl in the closet" type trouble. Increasing puritanism and declining doctor respect have thankfully hampered this, but its not uncommon for young male doctors to get into trouble just by following along with flirting - but it's a small unit and now its awkward because you made a (mutual) pass at 1/4 the nurses.
An additional but somewhat unrelated element is this - if you have personal presence, competence, and authority you will start running into other kinds of trouble - people will listen to you because you are the boss.
This is a lesson for anyone in manager roles, but when you are in charge and people respect you....your offhand opinions, tastes, and requests become reality.
Say: "I think this pathology is annoying" and it becomes gospel. Get frustrated with a patient and let it out verbally during a meeting? Now a good chunk of people are going to think of and maybe even treat the patient worse.
"Will no one rid me of this turbulent priest?" can be an accident with sufficient poise and authority and those are things we often try and cultivate because they improve care quality.
Throwaway05
1mo ago
Wait until he finds out what they do with crayons.
You know I think you see war less in media these days and OIF/OEF were "small" in many ways. The military is pushed out of our culture in a way that's kinda new given the World Wars and Vietnam have defined American identity for a long time.
I'm wondering if you see vets in political office less now?
Throwaway05
1mo ago
One of the first things I encourage students to do is to look at the people around them and pillage them for things that they like and things that they don't. I still remember the names of the physicians who make up who I am.
You should also do the same for the environments you've experienced.
People don't like to admit it but the standards for care and for professionalism in the U.S. are higher than anywhere else.
Is this one of those times? Is being more strict here part of why? Or is it irrelevant. I don't know.
You could make an argument that investment compromises objectivity. You could argue it's sensible in India where knowledge and passion are much less evenly distributed. You could argue that investment trumps anything else. I don't know what the answer is - but you should actively think about it and make choices instead of falling into family involvement as your "this is water" where in the UK it may be more malpractice. Being deliberate will bleed into your professional skills in a positive way*.
I don't think one particular decision is correct, but it is one you want to actively consider.
Two additional points - it's much easier to be involved with family medical care in "medical" care. Psychiatry is inherently trickier for a multitude of reasons. It's also worth noting that it becomes easier to avoid boundary violations if you avoid boundary crossings. Some old school doctors will insist everyone refer to them as doctor so and so not because they are stuffy but because they find it helps with boundaries. Nobody talks back during a code with those guys...and of course there are costs for that.
I'd also note that based off of some of your other writings I suspect you have or will develop the "rizz" as the kids say. Many a young male doctor has gotten into trouble because of that (don't worry outside of work or with staff lol). Caution.
Haven't fallen into that trap, and I don't intend to! The GMC had me remove "Grippy socks, grippy box" from my flair, on pain of death. Goddamit, are there any perks left in the profession?
On a more prurient note, unironically disagree - lability is liquidity after all.
Throwaway05
1mo ago
Bruh the place has some pretty great food, for the history buffs it's one of if not the best choices in the U.S. and for men of culture it's got one of the most exquisite art collections in the world. Not a bad spot. Now Philadelphians......
Throwaway05
1mo ago
This deserves a long response for you but I have a busy day today.
The good news: you are in good company, all of us need to figure this out.
The bad news: your family will ask for medical advice. Your friend's partner will complain about her vaginal discharge. Your barber will start telling you about their suicide attempt in the 8th grade.
Since you are a psychiatrist you will probably work on polishing your presentation and bedside manner and unless you run into demographic issues or somewhat you will have insane interactions with the general public. The same response to you will be useful professionally.
Figuring this out is hard. In psychiatry it will be a core topic at least, which will help.
Also with respect to psychiatry - don't sleep with your patients. It sounds stupid advice but it isn't.
Throwaway05
1mo ago
-If you haven't been before do some of the touristy stuff. Much of it is overrated but it is still worth doing once (ex: Time Square).
-NYC is arguably the greatest city in the world. With the most selection in the world. This means shopping (for a partner maybe?). You ever wanted incredible Indian food but don't have it in your usual area? What about something more specific like Cambodian? Pull up some lists of stuff and go to town.
-You'll be there for a minute, depending on what your situation is it may be worth doing something like taking Amtrak to Philly for a day trip. If you are coming in from say Toronto or otherwise have limited access to the east coast you'd be surprised at how much you can do nearby. You'll never run out of things in NYC but it can be overwhelming and adding extra stuff can be paradoxically helpful.
-I've never been to an IRL Motte/SSC diaspora meet up but I've always figured you'd have a chance at getting some of the paranoid opsec types with an open invite to some location instead of a direct "lets meet up." Food for thought?
Throwaway05
1mo ago
Many of the possible organic causes are horrible.
Many of them aren't though! And some if treated may remit.
With respect to timing .....not really brief, but things can get better spontaneously shockingly far out. The human brain gonna do what it do.
The increasing paranoia is concerning but not as unilaterally bad as you might expect, while getting worse is obviously not a good outcome, it can sometimes lead to treatment that makes things better in the long run!
Try and recruit as much support as you can. :/
Throwaway05
1mo ago
First things first: "Secure the scene first," "at a cardiac arrest, the first procedure is to take your own pulse," "self-care bro."
However you frame it - this is going to be tough make sure you are getting support. Likely you did not do anything wrong. Try not to blame yourself. Try not to blame yourself for blaming yourself.
Caveats: I deliberately only skimmed so everything is general and pretend it's general if I didn't do a good job making it general (I am not your or her doctor and am not asking the questions required to provide specific or informed advice.
Second: These things are more common than you think and go in all kinds of directions. Be aware that catastrophic decline is on the table, but so is total remission and so is things like backbreaking medical causes. Try not to get locked into a particular hope or despair without more understanding, information, and crucially - time.
Third: You are going to get a lot of shitty medical and psychiatric advice. Your therapist may accidentally be right but already this doesn't seem like a true delusion (insufficiently fixed?) is inconsistent with borderline personality persistence and doesn't really exhibit evidence for bipolar. Could be prodrome however. Don't worry what any of that means that isn't your job. Could be you don't have the language to relay the behavior you are seeing (that's not your fault! You aren't a trained healthcare professional). Most of the geographic area of the country has poor access to psychiatric care (NPs/PAs have some uses in medicine but never in psychiatric care, I've never met a psychiatrist who was willing to privately say something good about an NP except those who were getting a significant financial benefit. With unusual patients they are significantly worse than useless), and while it's out there it is hard to find a FM/IM/ED doc who is sharp on psychiatry which is important because-
Four: In order to meet the criteria for a DSM diagnosis the symptoms have to not be better explained by a medical condition or substance use. Usually the work up for this is inadequate in most settings. The ED will usually get a head scan if the patient has a first episode of psychosis in atypical age range, but they don't always.... Other basic lab work like an RPR usually needs to be done, but they might not have done it. Someone who knows what autoimmune encephalitis is needs to think about it for three seconds. Realistically it isn't any of the rare stuff, but those things do happen. For drugs a UDS is grossly inadequate if she's doing anything weird, which she may be. Patient's get access to a benzo with the wrong metabolite, use some local herb, or buy some weird designer drug. Shit happens and in the case of something like caffeine nobody may ask the right question when it totally explains the psychosis.
With someone who is uncooperative it will be hard, but taking her to a competent PCP under the basis of "hey I'm worried about you its not your fault lets see if anything medical is happening" can sometimes gain traction.
This is difficult however because people who aren't truly mentally ill don't think they have anything wrong with them and are correct and people who are truly mentally ill often have refusal to acknowledge that they are as a symptom.
Medical/substance/environmental/lifestyle causes of psychosis and/or mood disturbance are not as common as simple causes but they aren't rare. If you wish get access to the medical records and google things and make sure the right crap has been done.
Five: Some facts about potentially relevant DSM conditions. -Women get schizophrenia later than men, especially a bump is seen around menopause. -The DSM has a diagnosis of "Brief Psychotic Disorder." Some people have true psychotic symptoms that remit spontaneously (and never come back). -Adequate care can get someone back to normal. It can also get someone normal enough. -The DSM has a diagnosis of "Delusional Disorder" which means someone is otherwise normal but has delusions about a specific thing. -If someone has schizophrenia you will see some combination of other things in addition to delusions. People act weird. Usually the family can pick up on this (but not always). Same is true for other conditions. Take stock of what you noted. Point it out to medical professionals. -Depression can manifest with psychotic features or other significantly concerning behaviors.
Six: Not every behavioral problem is a DSM disorder (they have a cheat option for "unspecified" or whatever but that's not really the same).
This moves out of medicine to the reality of people doing weird shit and having weird beliefs. I think social justice people are crazy! But they aren't DSM relevant. Some problematic behaviors respond well to therapy some don't but you will find people in the population who have something like midlife satisfaction issues, political freak outs and so on.
You can peck around the edges but if this is the case the medical and legal systems (including medication) will be of limited assistance.
This leaves some room for "maybe two years from now she'll be like....that was dumb" but the lack of options isn't really comforting right now.
You should be prepared for the possibility of this being a true medical/psychiatric issue and also for the possibility of it being a "she's changed." Both will be tough to deal with but in different ways.
I'm sorry.
Throwaway05
1mo ago
For a few reasons, one is that the hospital is not in charge of the patient's bill, they are in charge of the bill that the patient's insurance gets. They don't have access to or control over that information, what the hospital can provide is something else.
Another is that anything more sophisticated than "the average patient in the ED generates X dollars in charges, here are the error bars" requires significant clinical time to develop. Do you deliver the patient only ICD codes? CPT codes? One primary code vs all encounters with comorbidity? Who is "like me" for expected billing purposes is NOT an easy question.
Another is that this information is materially valuable to the hospital's "enemies" yes that means competing hospitals but also the insurance company who if they have more complete information can leverage that. Famously - hospitals go bankrupt if they only get paid in Medicare and Medicaid (which is less than cost often), extracting the most money from commercial insurance is the only way to stay afloat without significant financial subsidy from the government, with Hahnemann being the most infamous example of how that isn't usually enough. Also see the recent issues with rural hospital failure.
The last reason is that the information is beyond the average person's ability to use and can significant problems. Someone with good insurance might go to the hospital with chest pain, generate 300,000 dollars in charges for their insurance and then be on the hook for a 150 copay. If you get a piece of paper that says "1 percent of ED visits generate charges more than 250,000 dollars" then the average person will sprint away before they can be told that their insurance is never going to charge them that.
You might maintain that you will use this information sensibly and that may be true but the average person is not you and you are unlikely to be you if you are in a moment of medical extremity. The graph isn't that useful and will literally cost lives even if they aren't lives you particularly care about.
Nobody who has complained about this in this discussion or last time has really given me an example of a clinical situation where they would put this information to use. I imagine it's not running away from the hospital when they have a ruptured appendix. It's probably for trying to figure out which colonoscopy is cheaper and shit like that. That's a much more fair use case but hospitals are disincentivized from providing these numbers for multiple financial and liability reasons and it's extremely hard to legislate this given things like the difficulty in defining care settings (What's ASC? You are telling me the ED and Obs are not the hospital even though they are in the hospital and your are on a hospital floor? Oh they are for some things but not others.....blah blah).
Hospital spending is the largest single category of healthcare spending.
Throwaway05
1mo ago
My apologies but I don't really feel like we are going to have a productive conversation and we should call it here.
Throwaway05
1mo ago
Providers have to decide if they want to give a unified price to all their customers, or if they can predict which type of customer is associated with which kind of cost, and offer different prices based on that.
No?
Nobody is really calling for this and if given a list of priorities (like overall expensive, waiting room times) people will put price transparency at the bottom.
Additionally health system do not decide how much patients pay. Insurance companies do. If you would like more price transparency in how much people pay ask the people in charge of how much patients pay.
Turned this on and instantly knew I'm going to have a fun time with the rest of these.
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