Throwaway05
50m ago
I will absolutely complain about affirmative action in medicine but the problem is a bit more complicated - for instance we've decided to push away the autists in favor of socially minded types. This is both good and bad.
Throwaway05
51m ago
It's worth noting that PAs do get a somewhat condensed version of the physician curriculum, but NPs do not actually learn regular medicine.
That sounds ridiculous and it is. It should also stress you out and if it does, good.
Throwaway05
52m ago
This an outdated meme, wrote a bit more about it elsewhere in the thread.
Throwaway05
53m ago
Wrote a little about this in my general comment elsewhere in the thread.
Throwaway05
54m ago
I'm sure you know this but it's worth reemphasizing that the amount of stuff a doctor has to know has absolutely exploded in recent decades.
Compare the size of First Aid for Step 1 between now and 2004.
Related: the us training model worked much better when most of patient care was hopes and prayers.
Throwaway05
55m ago
Okay batching out my usual response to this:
-Most people don't have a good feel for what doctors actually do, your intuitions for your outpatient PCP are probably good, but outside of that something like The Pitt is more representative than general OP clinic life, and when you ARE in the hospital and you see your doctor for under five minutes it isn't because they are just chilling in an office somewhere doing nothing. This will be important for AI later.
-No the AMA is not conspiring to cause a doctor shortage. That's an outdated meme for the 70s and 80s. For the last few decades the AMA has been lobbying for an increase in supply via the production of midlevels (for senior doctors to supervise) and watching that genie get loose from the bottle. The AMA is also extremely unpopular with doctors, most doctors want more med schools and residencies, and we HAVE made more med schools and residencies. As it turns out what is actually happening with the shortage is (shocking!) highly complicated (ex: my rants about surgical modality changes making it so we can't really increase the number of surgical training slots anymore).
-The healthcare industry and government have been workshopping this problem for a long time. They've landed on midlevels as the solutions. As designed they work okay but they quickly metastasized beyond that and are a catastrophe. Putting aside the quality difference which yes is very real, they generate more shortages in some cases by over testing (which requires physician evaluation) and over consulting (ex: cardiologists are flooded with work that midlevels cant handle but is easily within PCP physician scope of practice).
-Decreasing training length by making undergrad medical school is a mixed bag. It works well in other countries with less economic opportunity and a less painful training period. In the U.S. you get lots of career changers into medicine (and you'd lose these) and drop out rates are reasonably high in med school/residency, this would worsen that problem. Think of all the Indian moms who would decide their 16 year old will be a doctor long before it becomes clear if that is reasonable. I don't know the drop out rates for BS/MD vs. traditional MD but I bet it's bad.
-AI is obviously coming but it's incredibly far from prime time. This is for a number of reasons. Risk: if we aren't allowed to have self-driving cars and it's taking forever but any accident is an unacceptable travesty...how much worse are people going to handle an AI getting things wrong? Lawsuits: people want to be able to see. You can't sue the computer. This is also one of the problems with midlevels, you cant sue them the way you can sue doctors. Hospitals like this. The actual work: most types of physician tasks aren't "I have x, y, z, how do I treat this?" Usually you are managing several comorbid conditions that overlap, trying to interrupt what the symptoms the patient tells you actually means "I am dizzy" means different things to every patient and will send you down different rabbit holes. Patient's who can't communicate well or have to be visually eyeballed and examined are a huge part of the work. That's not counting physician leadership roles (aka motivating the nurses) and so on. The types of ambiguities that exist in actual clinical practice are huge barriers to AI taking over. It will happen one day but by that point everyone has lost their jobs.
Throwaway05
18hr ago
It can be almost anything, but you'll certainly notice lots of trends and similarities. A man is a provider. A man is skilled at hard things. A man has a beautiful woman. A man is knowledgeable and intelligent. A man has a family. A man is powerful. A man is wealthy. A man has convictions. A man fights for a cause. A man appears effortlessly cool or funny. A man has a strong healthy body. A man is a good father.
Your comment reminded me of a quote-
“A human being should be able to change a diaper, plan an invasion, butcher a hog, conn a ship, design a building, write a sonnet, balance accounts, build a wall, set a bone, comfort the dying, take orders, give orders, cooperate, act alone, solve equations, analyze a new problem, pitch manure, program a computer, cook a tasty meal, fight efficiently, die gallantly. Specialization is for insects.”
― Robert A. Heinlein
Throwaway05
19hr ago
The individual human body + brain unit is usually very good at telling you how much to drink without much difficulty, but some stuff can throw this out of balance. Excess exercise absolutely can (this is what sports drinks were for!). Getting older can too, and for the elderly it starts to get to be a real problem.
An ego flattering example: getting tougher, makes it easier to ignore signals to drink (and then...problems).
Monitoring the color of your urine is a good way to outsource for most people.
Throwaway05
20hr ago
Sure, don't think that's a universal principle but it's true for some things.
Throwaway05
20hr ago
People and organizations follow incentives, Iran (and Hamas) have found some very powerful holes in Western incentives structures and are using them elegantly, the world will absolutely let them get away with some tactics (like grossly increased proxy activity) if the alternative is outright war with a nuclear armed state. That could be an existential risk to Israel, trade through Hormuz, and more. And as you note some of the ways around this (like rational trade deals or assassination) don't really seem on the table.
Ultimately the Western approach to Iran has been a bet - a bet that they will collapse before they do something too dangerous and cause something very very bad. It's a tough situation to manage, getting involved is likely going to cause all kinds of bad things and passive waiting is in many ways more "safe" yet it is equally more risky.
Everyone coming in right now to criticize is effectively betting on a game that is already over. We can explore the counterfactual of watchful waiting and what that might mean, but we can never actually know - and it makes intervention look the worse idea because the costs are actually happening.
However if we sat and did nothing......maybe Iran makes a nuke, uses it on Israel and then Israel destroys everything in the Middle East in a dying fit of pique. That's low likely, but it could have happened if we did nothing. We just don't know.
Throwaway05
21hr ago
Iran is significantly more likely to intentionally try and start a global nuclear than the other powers - they are a religious theocracy that acts on religious impulses and is engaged in low tempo warfare (through proxies if nothing else).
That's not the problem though.
Imagine Iran arms itself and then takes control of Hormuz and says "don't intervene" with a nuclear backstop, or attacks Israel (or anyone else in the region). Or does what it is doing right now, with a stark reduction in response options because they say they'll nuke Riyadh if displeased. Temperamentally the Iranian regime is far more likely to engage in is dysregulated instability inducing activity than most regimes because of historical and religious factors. Add nukes into the mix and things get way worse.
What if they finish going through economic instability, Balkanize, and then one of the successor states sells to the highest bidder or loses track of it?
Hell, what if they just give to a proxy group or some other terrorist organization.
You can't model Iran like other powers, a large portion of the state believes what they are saying on the religious front. North Korea is trying to semi-quietly maintain its own existence. India is a real country with real country interests. Pakistan is complicated, but looks nothing like Iran.
Throwaway05
22hr ago
Iran is an aggressor and has been for decades, they are very upfront and explicit about some aspects of it, and other aspects are very well understood by those paying attention (like cyberattacks, proxies).
This is not North Korea that utilizes some strategic ambiguity for face saving purposes.
Iran and its proxies have gotten very good at using gaps in Western cultural thinking to engage in violence without triggering an immune response.
Ultimately this is a defensive war and needs to be modeled as such - Iran is an attacker who is attacking now, was attacking previously, and stated they will attack again in the future.
Throwaway05
22hr ago
I think society would be better served with more people having a positive reaction to "we do this because it is hard and necessary, so that people in the future do not suffer."
We do not live in that society.
Throwaway05
1d ago
'If this goes badly, that makes it even more important to do it!' That's a Kafka trap.
These are talking points not fully fleshed out arguments, but I find the quality of discussion on this latest conflict to be far below what I usually see here.
Example: "Rubio said Israel dragged us into this war." No. Just no.
And as to this specific point, I should not need to write a full length essay in order for you to be able to connect the dots here. It's not a Kafka trap, it's an army sitting outside a castle building siege weapons shouting "when these are done are we'll kill you all with these weapons." You attack before they are done, and "wow that was fucking close."
I understand that a lot of people are using this conflict to funnel anti-Trump, American, and Jew feelings, but a lot of people are actively cheering for America to lose and to support Iran, a country that is recently accused of killing tens of thousands of its own population and actively, joyfully supports global terrorism.
Likewise the U.S. isn't an amazing hegemon, but people cheering for China or Russia to take over? Jesus Christ.
Throwaway05
1d ago
The usual reasons.
"We are doing this now because someone has to do it eventually and I'm left holding the bag and not a coward." Not inspiring.
"Personally, I hate watching civilians die." Not his vibe - and a huge leverage point with the school bombing.
"Complicated rambling about missile and drone production rates vs. interceptor costs" ...not going to work.
A different president might be able to convey the meaning without the specifics but Trump is not that guy, and critically the media and social environment is so relentlessly criticizing that he isn't incentivized in any way to try.
The vast majority of the military and the executive are not stupid, you see plenty of people saying "wow why did they do this when they don't have a plan for Hormuz" of course they have a plan. It's not a good one because there aren't any good plans, and doing nothing was a plan with risks of its own. The public does not tolerate those kinds of discussions though.
Throwaway05
1d ago
Yes some combination of those, to expand on a few reasons to go about this (not that I believe in all of them):
-The expression of the power of the United States has been inappropriately curtailed for too long, the most straightforward example of this is the Russian invasion of Ukraine which likely only happened because of the Biden administrations weakness. Showing off reaffirms the U.S.'s superpower status and likely prevents all kinds of bad outcomes. China's fans like to make claims but realistically every military in the world is shitting their pants looking at this and Venezuela. Later losing for political reasons will not change this. The whole world benefits from U.S. lead global stability and this affirms our capacity.
-Israel can probably be considered something of an albatross but it is a key ally, and was one when we needed it. We shouldn't abandon them. Additionally coordinating with Israel and the other countries in the area is more or less bringing everyone in the region into the U.S.'s sphere of influence. Unclear if this will be durable once Iran and proxies are gone, but it is a thing, and the world is probably better off if we transform the religious regimes into klepto-authoritarian ones. This also is a boon against China, as Venezuela was.
-Oil (long term stability, not short term obviously).
-Morals. The death of the protestors and general oppression is not good. Anyone who thinks they would stop the Nazis but isn't stopping Iran needs to be asking themselves hard questions. And - while it is deeply tied to his ego (b/c ignoring threats), people who know Trump will seriously and probably correctly point out that killing the protestors made him mad and is a big part of what made him pull the trigger. Lots of people treat Trump like a character and not an actual person, but he has been consistent in this, and he is of a generation that that was deeply impacted by the hostage crisis.
-We've been (essentially) at war with Iran for decades, to some extent increasingly. Asymmetric options like terrorism, cyberattacks, drones are only going to be increasing in danger. The country has threatened to kill our president. People with intelligence backgrounds I know have frequently emphasized Iran as one of the biggest threats, and people who played in the sandbox have a lot of problems with them. You don't let someone keep punching you indefinitely, especially if they are probing for the right spot for David to kill Goliath.
-Nukes. Absolutely fucking not. Regardless of how close they were in reality their response to being attacked makes it pretty clear that Iran actually getting nuclear weapons would represent an existential threat to global stability. People emphasize closeness but that isn't the right question, when can we actually stop them is the right question, how close is just political justification.
-Speaking of when is the right time, it's pretty likely now. The regime is going through a lot of political and economic turmoil and waiting might have panned out, but if they survive the clearly increasing missile and drone capacity pretty readily substitutes for Nukes in a MAD scenario (at least for the global economy). If our intervention ends out being bad, then that's evidence waiting while they get stronger would have been even worse.
Importantly how real the threat of the last two is is not going to be something people will actually be able to know unless a credible leak happens, and likely only in the affirmative.
Ultimately this is pretty likely to be a "bad idea" in the sense it is going to be a shit show, but that doesn't mean it isn't necessary to do the hard thing.
Throwaway05
1d ago
My state offers walk-ins, did it first thing at opening a few months ago. Was waiting for six hours.
Throwaway05
1d ago
I had a several year stint in NJ years ago, I tried to change my license like a good citizen, showed up with as much paperwork I could gather - after waiting months and driving an hour to the only DMV with appointments. They told me I didn't have the right stuff, despite me researching heavily beforehand.
I kept my old DL for the rest of that Jersey stay.
Throwaway05
1d ago
I mean support is still reasonably broad. I saw stats suggesting somewhere in the range of 80-85 percent of Republicans are down.
Most of the internet continues to have an anti-Trump/Republican bias that doesn't change. So you'd expect to have trouble with pro-war discourse.
Witch havens like here are stuffed with people with deeply unconventionally views (die hard anti-intervention folks and anti-jew posters for one) and are not representative of the general Republican field.
I'm personally for the war and found the experience supporting it here to be not very rewarding, I imagine plenty of others have similar thoughts.
Throwaway05
2d ago
I'm perfect willing to talk to someone who is anti-nazi, or anti-semitic, or anti-racism.
The problem is that quite a few people who these descriptions apply to are not worth talking to. I'd bet most people in Israeli leadership circles are very aware of how WWI created WWII, and therefore have awareness of the impact of what they do in Palestine has for the future. They'd be willing to discuss these tensions (at least previously).
Woke types? No. The Nazis are Satan if you try and argue that Cambodia or the USSR represent worse regimes you'll be labeled a Nazi or hear a bunch of talking points that are all soldiers or weak-men.
We've spent the last ten years getting used to how these people argue.
Anti-jew posters are often like them. For this specific poster - he recently had a conversation with one of our mods who handled it better and more eloquently than I could.
If you always blame the jews for everything in predictable ways, I'm just going to assume that's what you are going to do. You may eventually be right but that's not through predictive power it's through repetition.
Although - credit to SS for actually posting interesting things about other topics, although it took a bunch of redirection from the mods to get there.
Additionally if you disagree you typically get downvotes, personal attacks, and accusations of being a sheep. Everyone still here is sufficiently heterodox to make that an embarrassing accusation.
Throwaway05
2d ago
Major General William Neil McCasland is missing since 27th February.
This was brought up on some MSM I was listening to and IIRC he's been known to have some form of health issue (likely mental) and the government released some kind of notice.
Doesn't help the more conspiracy minded types but that's the explanation (and why you aren't seeing a lot of media coverage).
Throwaway05
2d ago
Context
Yeah def mixed him up with someone else.
Doesn't need to be literally Victorian or Regency for random English bullshit and Amero-English bullshit to be an appropriate description of context that is skipped off of.
And agree with the characterization of Austen being less popular than Shakespeare etc, but it remains pretty popular with women and girls who read which means the influence is there.
And the point remains: it's not pure highfalutin, and educated people will communicate in that way at times and American students are supposed to be presented the opportunity to develop understanding of those references. It's much harder for non-English speakers to get the exposure (especially in the formative years) to make this stuff easily understandable.
Throwaway05
2d ago
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.
Throwaway05
2d ago
Don't mind me I'm just walking uphill both ways to work (in the snow).
If you'd like to deep dive into the causes I recommend sheriff of sodium on YouTube.
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