self_made_human
Kai su, teknon?
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!
User ID: 454
self_made_human
Kai su, teknon?
29d ago
Tolerance is a well known issue, but I'm not a daily user. When I'm cramming for exams, I average anywhere from 20mg to 50mg max, and that's about daily usage for 2 to 6 months.
That's interspersed with long periods of minimal or no use. My ADHD is mild, I don't need to take Ritalin to make it through a working day, and in fact, doing so is actively unpleasant. I may not be the most hardworking and zealous doctor around, but I certainly do more than the bare minimum needed to avoid malpractice litigation, heh.
So I take it so I can study, acquire knowledge, pass exams, then use said acquired knowledge in my day job. The job itself doesn't need it, and I doubt I'd take it through residency. My internship was terrible in terms of workload and what it did to my mental health, and UK Residencies, while still a slog, really can't compare. If I take my meds as a resident, it'll be if I'm expected to keep studying particular topics, or for exams like the MRCPsych. Besides, Psych isn't nearly as high intensity as something like surgery or critical care.
You can't tell I have ADHD in normal conversation, or in my work. It's only when the textbooks come out that my eyes glaze over, and my usual coping mechanism that worked through high school of forcing myself to study through a combination of personal tutoring, extreme stress and lethal doses of caffeine all failed hard when the books became both big enough to kill a calf and too long to cover in a few days of cramming.
So I've been taking Ritalin for about 5 years now, and I can't say I notice a tolerance. At most, after 3 or 4 months of continuous daily use, I'll end up needing 30-40 mg, and that's impossible for me to disentangle from just needing more of it so I can study longer.
And if said tolerance does develop, well, the UK is a more enlightened nation in that regard and I can cycle through the better alternatives that aren't available here. It's not something I'm worried about.
Assume the plan is to pass all your residency/training/etc then coast in the NHS, but I’m curious.
I'm doubtful that most doctors will be employed after the 7 years it would take me to finish my training, leaving aside most humans, so after a certain point it becomes rather moot. I just don't currently have a better alternative than to act as if that's not going to happen, just in case it doesn't.
self_made_human
Kai su, teknon?
29d ago
I reckon it would be hard to evacuate the key Taiwanese workers in time, would you leave your family behind as hostages? What kind of message does that send to the lowly infantryman if the elites are fleeing before the war begins? The machinery would be wrecked but a lot of the brainpower might fall into Chinese hands. Furthermore, Taiwan is useful for submarine bases (the Yellow Sea is quite shallow) and it controls the sea routes leading to South Korea and Japan.
I think that if it possible to perform an evacuation, it'll be done. That's leaving aside unlikely scenarios like chinese commandos storming the parliament or a container ship spilling out drones like a clown car. I expect that many Taiwanese politicians certainly hope to not have to stick around when the CCP invades, and skilled fab workers are much more valuable.
And it doesn't necessarily have to be public. Tragic, the fab caught fire, and half the employees are missing in the midst of a war, who can say who's responsible? I don't expect the US to salt the earth unless they feel compelled to, as in it's obvious China will win. Either way, the fabs won't survive.
Furthermore, Taiwan is useful for submarine bases (the Yellow Sea is quite shallow) and it controls the sea routes leading to South Korea and Japan.
That's rather minor isn't it? After all, there's a reason they're concerned about their neighbors only a few dozen kilometers away across the Formosan Strait. Knocking out Taiwan eliminates an adversary, but if China wants to mess with SK and Japan they don't need Taiwan to do so.
While more relevant to @Throwaway05, @Pigeon and any other doctors lurking here, I have a funny story from work. For context, if you don't know me, I'm a doctor from India, who, having passed one heap of British medical exams, while still recuperating (and losing sleep from the residency matching process) for another, happens to be working at one of the more prestigious hospitals back at home. In India, almost all of our own exams, including from med school, involve actual bona fide sick people, even the more fancy ones.
I turned up, as usual, only to find my ward crammed with dozens of obviously senior doctors and not a patient in sight. And I didn't sign up for any medical conferences, I only attend them if there's a buffet table and booze.
Turns out the MRCP PACES exam, which, as the acronym would suggest, provides membership to the Royal College of Physicians in the UK (basically internists, but sounds cooler), was being conducted there. It involves somewhat more involved cases and more tricky diagnoses than what I had to endure in my own British OSCEs. And which I hope to never have to give myself, since I just want to be a fucking shrink, I don't care to palpate your liver, no, not even if I'm seeing you after a paracetamol overdose. Palpating the fake prosthetic tiddies on a grinning male actor while doing my best to look in the eyes (up there, a bit to the left) the actress who supposedly had a breast lump somewhere in there takes most of the fun out of it.
And nobody had told me. Cue me gingerly creeping to the doctor's room, which kept getting invaded my yet more cute postgrad trainees/residents. I'm not one to complain about that, but I really wanted some fucking sleep.
Eventually, I spotted a girl feverishly reading MRCP station notes, and I enquired politely about them only to be told she wasn't giving the exam herself.
Huh?
Like, I'm not the most passionate doctor around, but it's pretty rare to study for an exam you're not fucking giving.
Turns out that in lieu of highly trained professional actors fluent in English, as is the case in the UK, at least as far as I can recall my friends telling me, or by googling it myself, they just recruit the medicine residents in India.
Well, it must be fun to be on the other end of the poking and prodding. I recall them chatting about how one poor bastard had to endure some particularly painful tests, and had to do his absolute best from wincing as his abdomen was molested in an effort to find something wrong with his perfectly normal kidneys. Why? Because the test wasn't supposed to be painful, and if he did show his pain, that would be interpreted as an intentional clinical sign by the examinees, who not having access to the script, would then promptly jump to the wrong diagnosis and thus immediately fail the station.
Funnier still were the ophthalmological exams, since a few of the over-qualified patients had visual issues of their own, and the imaginary platonic ideal of a patient they were supposed to embody didn't. One of them found out he had a heart murmur the hard way, which has to suck, but I heard that the examiners did end up agreeing to pass the people who noticed that particular divergence from fiction.
Well, I guess it beats seriously ill patients being subjected to the same, it's a bit awkward when they die on you or have to shifted to the ICU mid exam, really wreaks havoc on the grading. Well, I've no intention of giving the MRCP, but it was sure funny to just sit there and munch popcorn as the bacon was made, until someone guilt-tripped me into admitting my lack of productive work to my boss and I was reassigned to another ward for the week. Eh, it was good while it lasted. If I do ever give it for the lols, I'll hope the 'patient' takes pity on me or wants respite from my fumbling, and just whispers the diagnosis to me instead. They'd probably know better.
self_made_human
Kai su, teknon?
29d ago
I can't drive, well, not legally, so I'm safe for now. At least you'll find out when you need more than reading glasses quickly!
self_made_human
Kai su, teknon?
29d ago
Nothing at all, I'd hope.
This is a different resident, he's asymptomatic, but does in fact have early heart disease, since from the overheard description it wasn't an innocent murmur. But I had work elsewhere and no shortage of other patients with cardiac issues, so my curiosity was sated.
self_made_human
Kai su, teknon?
29d ago
Hey, I genuinely appreciate you remembering to get back to me!
It's as I feared, but that's fine, I was ready to deal with this outcome. I'll do my best to handle things from this end, and given that immigration lawyers are unlikely to help with the USMLE as you've said, it's a good thing I don't have to pay for them just yet.
Thank you, you did keep up your promise, and I hope I can find a solution on my lonesome or with the help of people in the same boat.
self_made_human
Kai su, teknon?
29d ago
Kidney palpation is difficult, you have to really dig into it, and there can be spurious confounders, like someone being bruised (maybe they were after a dozen people had done it), too fat, and so on. I've never had much luck with it myself, and you have to go hard to even expect to feel it.
There are certainly clinical exams which are useful and done in reality, but I sincerely hope nobody is making serious decisions off of one, in the absence of other tests. I presume that's what the medical resident knows better than I did, and hence why they took pity on the people desperate to find any hint towards a diagnosis, after all, he was healthy, as an actor he was expected to make shit up and feign pain and discomfort where it's expected, even if he didn't actually feel it.
self_made_human
Kai su, teknon?
29d ago
Thank you, and I'll keep at it from my end! If it does seem to end up at a point where I could use a lawyer, I'll be sure to ask.
self_made_human
Kai su, teknon?
29d ago
Thanks for tracking them down, I could have gone to one of the archival sites where I last saw them, but I really was drunk and dreading work the next day.
self_made_human
Kai su, teknon?
29d ago
I'm pretty sure that neither Sri Lanka or the Maldives have or had lions (well, maybe the former has some zoos), but I guess the branding works lol.
Not as bad as Singapore, which was named that way because a myopic Indian prince thought he spotted a lion, which definitely wasn't, at best it could have been a tiger unusually fond of swimming.
self_made_human
Kai su, teknon?
27d ago
Not particularly. I saw a pretty famous psychiatrist, and he largely took me at my word since I was a med student and read up on it, I was already taking modafinil, and he ended up agreeing that I should try Ritalin.
I recently spoke to another doctor with ADHD from the other side of India, and she said she has issues with the doctors there being much more leery about prescribing it, which is retarded IMO. It obviously has abuse potential, but I think the benefits of giving the millions of underdiagnosed people with the disease here their meds outweighs the small risk that some of them will abuse it.
I would say most psychiatrists aren't particularly gatekeepy about it, and worst case you can shop around. I know my diagnosis was legitimate, I'd have failed many of my exams in med school if I wasn't able to take it to study, and thankfully that never happened.
self_made_human
Kai su, teknon?
26d ago
My condolences, but it could be even worse. For example, while ADHD is known to be an actual disease in Japan, all stimulants worth a shit are banned, so I guess I know which country I never intend to do more than visit.
Do you have the option of telemedicine and getting it delivered from a country more understanding? Or just driving/traveling over in person?
Huh. I'm just as confused as @netstack. Surely there must be some cases where an expression of discomfort is expected, as it would be IRL?
If there's a gentle way to palpate a kidney, I haven't heard of it. As far I know, it's usually not possible to even feel them in normal patients, unless you go hard. But I never said I was a good internist or interested in it, so I could well be wrong.
I MADE IT
FUCK THE HATERS
Ahem. Sorry. Got a bit too hyped up, but I've gotta be my own hype man, it's 11 pm at the hospital.
@Throwaway05, @TheDag, @AhhhTheFrench, @faul_sname, @whoeveritmayfuckingconcern (there's a lot of people who've egged me on over the years, I'll get to you all):
I got a match offer in psychiatry! While Scotland might be a little bit on the dreary side, well, endless exams are even drearier.
I was in an awkward position. If I'd done a lot better, I'd be confident in an offer. If I'd done way worse, I could have washed my hands of it and resolved to grit my teeth to prep yet another year of my short life. But I did well, but not so good that I wasn't on tenterhooks.
Most British doctors don't match on their first try, barring the least craved options like GP.
But psychiatry went from having a competition ratio lower than 1, to 9:1.
The exam got ten times harder since I began planning for it. Doubled in the span of a year. Yet I beat it. Beat all the bastards.
No more wannabe psychiatrist, upgraded to shrink-in-training. Then, barring an act of Satan, a bona fide shrink and not a LARPer
I might hold the current offer in the (mildly vain) hope that I get an upgrade to somewhere less rural, but I'll still take it. (Hmm, it seems that the hold window is already over, it seems to be take it or leave it, but I'll still ask around)
Fuck yeah. Gonna drink a lot of scotch and fuck a lot of bitches. I'm getting out.
Now, it's shame I've got 9 hours left at work, and while its going to be a slow night, I'd rather not lose my Indian license by drinking on duty. That can wait till the morning.
self_made_human
Kai su, teknon?
26d ago
Thanks g. If anyone wants controlled drugs from a shady psychiatrist, get your orders in.
(For legal reasons, that's not me)
self_made_human
Kai su, teknon?
26d ago
Appreciate it, I just hope I don't shrivel up from the lack of sunlight, then again, it's not like I leave air-conditioned, closed climate controlled spaces all that much here.
self_made_human
Kai su, teknon?
26d ago
Well, there's a reason everyone in that country is supposed to be on Vitamin D supplements. Even the gingers.
They probably won't give me time, but I likely have the option of working less than full time if I wish, without discrimination, especially since I can make a convincing case with my ADHD. That would however involve a small paycut and longer training, but I'll worry about that when I'm there. At that point, maybe I can summer (winter?) in warmer climates.
I'll keep working on the USMLE thing in the background. Assuming in the 3 years it takes for my Core Psychiatry Training to end, it'll be worth the headache. I recently spoke to another Indian doctor in the same boat, and it took the ECFMG about 3 years to finish the process when he got the ball rolling, yet another reason not to sit around.
At least I don't have to give the NEET PG, fucking cursed exam, like a quarter is bullshit histopathology on top of that, and while I did learn ECGs eventually, those bastards are still pink blobs to me haha.
I appreciate you listening to me at my lowest, and I'm sure you're glad that me burning my mental health from both ends did pay off!
And yeah, I checked the rough geographic location, since in the UK training is rotational over rather large areas, and it doesn't seem to be an utter backwater. Close enough to Edinburgh that it's a short weekend drive I'd say, country roads allowing.
Fuck. I need to get a drivers license already.
self_made_human
Kai su, teknon?
26d ago
Honestly, my approach is, fuck it, why not?
Well, there are actually reasons why not, such as the hope we can find a less ghoulish cure, things like mirror therapy for phantom limb (well, that one's already gone, its just that maybe there's an equivalent), or the fact that they might go on disability.
But if someone who is otherwise healthy and financially sound wants to chop off pretty much anything for any reason, my opinion as a psychiatrist-about-to-start-training is a shrug, presuming I was convinced that nothing else we could do would help.
Surgeons aren't that gung-ho in my opinion, maybe it's because I worked too long in Onco Surgery, but I've seen more cases turned down as non-resectable or not worth it than those that were done knowing it was futile. Surgeons usually want what's best for the patient too, even if it's in conflict with their wallets. They're rich enough that's not the biggest deal.
Chop off a mole, a limb, a dick, anything at all. As long as you make sure you're not a burden on the rest of us, it's not my business, unless you ask me for my advice.
self_made_human
Kai su, teknon?
26d ago
I only hope your upcoming boy comes out with an intact soul 🧐✝️
If not, there's always hair dye and sunscreen haha.
Thank you, I appreciate it. I suppose Scottish chicks are kinda cute, not that I'm particularly picky about ethnicity if they're hot haha.
self_made_human
Kai su, teknon?
26d ago
Eh, that's not really my experience with them. What exactly do you think psychiatrists get up to? Leaving aside the gender-affirming types.
self_made_human
Kai su, teknon?
26d ago
All well and good, might as well condemn biologists for Lysenkoism at this point.
None of those are really a knock against the field as it exists today. I'm here to dish out drugs, that's why I'm a psychiatrist and not a psychologist.
And most practising psychiatrists, unless they're still seeing patients at 80, have nothing to with any of them really.
self_made_human
Kai su, teknon?
26d ago
That's still a headache for the future, but you can bet it's one I'll gladly accept if I'm given the chance. And that I'll pick your brains about it whether you like it or not haha.
self_made_human
Kai su, teknon?
26d ago
In that case, make sure you stock up. I understand it's a pain, made all the worse because of the extra headache you're experiencing as someone with ADHD. Absolutely the last diagnosis worth gatekeeping, if you're making people jump through this many hoops, well, you're probably selecting out a lot of people who need the meds the most.
Well, it's certainly an AAQC for me, even if I'm going to quibble on a few key points:
I don't think involution is the right call for the US. Rules-based international order (or globalism) seems to have been a massive benefit to the States, even as it helped the rest of the world flourish through the currently disrupted Pax Americana, though this obviously helped competitors like China as well.
If the US wants to maintain its wealth, it will inevitably need to continue securing supply chains across the globe, including maintaining its deterrent capabilities, for issues like Ukraine where nobody (perhaps barring France) particularly wants things to go nuclear.
After all, China is investing so heavily in coal, both in terms of power plants, production, and land-based alternative routes to producers like Russia, because they're fundamentally afraid of what might happen if the US cut them off, for many things, but primarily oil, be it at the Strait of Malacca, near Japan and so on. Of course, they're also building naval power both in case they want to fight over Taiwan (pure nationalistic stupidity, there'll be little of value left, especially in terms of chip fabs, if the conflict goes hot. The US would likely prefer to evacuate Taiwanese researchers and workers and destroy the fabs rather than having them be captured, especially since the CHIPS act has been rather underwhelming).
An actual war with China, should it happen in the near-term before we have ASI (and once again, despite the stupidity involved in the implementation of CHIPS, the US still leads by a country mile when it comes to actual AI research, even if it's corporate), will almost certainly be global, regardless of whether it earns the moniker of WW3. So a US focused on industrialization (especially with full automation approaching), should aim to both to defend its shores and allies, while also producing enough raw military materiél to fight in less friendly shores).
Whatever takeoff we have till ASI, it's still in the slow phase, and while it's impossible to outright declare a victor, my money is on the US winning the race, be it through universal eudaimonia or getting us all paperclipped. Right now, China is only capable of picking a fight over Taiwan and that seems to me like a pure waste of time, and will likely be that way for the foreseeable future.
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