Throwaway05
31m ago
I'm playing on PC and it looks great, but I've heard mixed things about base PS5, a lot of FUD though it seems, waiting for legit reviews seems like a good plan.
Throwaway05
1hr ago
Anybody playing Crimson Desert?
Throwaway05
1hr ago
I mean if everybody's fucked everybody is fucked.
I'm not saying we are immune to getting fucked, we'll just be along with everyone else.
That should be a comfort!
Throwaway05
5hr ago
Sure self-driving cars are getting there, but they aren't fully in use yet, and the legal tests aren't all the way there yet.
AI may in fact replace everyone at some point, doctors have more physical work, patient interaction work, need to be a liability sponge, and so on than most other white collar work.
Yes the financial pressure to replace us is higher, but by the time they come for us in a serious way everyone else is gone too. Especially in psychiatry - you should have some safety there. More likely is an intractable increase in volume due to AI assistance.
In any case, even the finance people who love this shit are starting to push back against the way our economy is overweighted.
LLMs might just end up getting dropped as a boondoggle before they apply to too many use cases.
Throwaway05
5hr ago
Seems like that glove fits you best.
"Please investigate the situation." "I refuse."
Throwaway05
6hr ago
Have you made any effort to determine any of the facts? Have we increased the number of medical schools? Is the number of medical school the problem?
Is there a cartel? Who is the cartel made out of? If you identify a cartel, then what is it doing, who does it represent?
Do doctors agree that we need to make changes? Are we making changes?
Make some effort to understand that is happening, what has been changed, what is going to be different in the future, how we got here.
I understand that people who are just mad and toss out slogans exist but I can't for the life of my understand how they would end up here.
Throwaway05
6hr ago
What are you mad about? COVID? That was public health, not doctors. Plenty of doctors got fired for criticizing the official stance on the thing. Bills? Doctors aren't in charge of billing in most cases these days.
Either way it sounds like you have an anger with a specific part of the system.
People do that.
That does not mean it is any way reasonable to just take a hammer to random things without figuring out if that is doing anything useful.
Throwaway05
7hr ago
They may mis-state, misinterpret or lie about their symptoms.
Yes this is going to be a hard problem, and self_made does give a counter argument, but you'll also see downstream problems that cause angst.
For instance, ADHD evaluations. Most people will say the right things and at the same time note really have adult onset ADHD. A psychiatrist gets to do this weird dance and figure out how often to bend. The LLM is either going to be confused and offer everyone stimulants or be rebelled against after it refuses anyone.
Anyone else with motivation issues will have the same problem - testosterone? Inappropriate antibiotics?
People who want conservative or aggressive management for something will rapidly figure out how to do so, and all kinds of other bullshit.
People have response variety and can make a variety of judgements.
As could true AI if we get that, but we dont have it.
Throwaway05
7hr ago
No I get they can do fancy things, but translating those in a real environment is HARD. We will get there eventually, but we can't get self-driving cars approved because of the liability and failures - medicine has just has much cost pressure to do so but as much contrary pressures (if not more because of people's demand for a person).
We also have a side game where LLMs are killing skills and knowledge development by outsourcing thinking (ex: in note writing). That will be a separate problem.
Throwaway05
7hr ago
Sure! Some people go to Rogan so that they get to have the "access," if that's not for you well that's that clips are for.
A lot of podcasts have variable model where some people watch the whole thing, some people watch the sound bytes, some watch clips that vary in size from a few minutes to big ass chunks.
In order to get all of those you need the base thing though.
Throwaway05
7hr ago
Ah! Great example. Do you blame the IRS accountant for you being forced to pay taxes? He's not in charge of the tax rates.
Throwaway05
9hr ago
I don't think you can get those nuggets of value without the meandering.
Rogan needs to create an environment where the person is drawn in, talks about a bunch of off topic stuff, gets relaxed, and gets to to share some of their "texture."
If he had a 15-20 interview the person would just stay on message and do the press junket thing.
Throwaway05
9hr ago
With respect to AI, I'm sure it will get it done eventually, and I am sure it has tremendous pressure to do the job.
AI can do simple fact recall, it struggles much more to deal with a patient who tells you he fell and can't move his leg at all when really it's he won't move his leg due to pain. The AI will probably assume a neurologic deficit and trigger a work-up for that. A physician will poke the patient and see him move and assume traumatic injury. Someone needs to get clean data to give to the AI for outsourcing to work (for now).
And yes some states are doing alternative paths to practice, this is exploding in popularity and it's a solution to the allocation problem. It may even be a good one, it seems ineffective so far though because people can't get malpractice coverage or privileges without actual training - the liability risk is too high.
Throwaway05
10hr ago
I think it's important to keep in mind (and this applies to the AI side of things also) that the U.S. is a weird country and that weirdness has benefits and costs.
One of the things that pops up is that the number of demands on U.S. physicians extends beyond beyond academic medical knowledge, this is one of the reasons that individuals with perfectly excellent medical knowledge sometimes don't survive the retraining process.
Doctors here have to survive the vagaries of our legal system, malpractice environment, U.S. patients (who are...different) and other factors. This requires both higher standards of behavior and other standards of behavior.
Much of this I would happily get rid of, but that's not usually the targets complainers want to go for. Tort reform would solve a lot of problems.
With respect to the physician shortage, it mostly isn't real.* If you live in a reasonably sized area you can get a PCP. You may need to look around, and you may have to establish care before you get sick. But the problem is that U.S. patients are demanding and don't want to think ahead and want instant gratification. If you live outside of a major area you may not be able to find a doctor but that's because of the allocation problem. Midlevels don't fix the allocation problem because they also don't want to move to those areas and then don't.
For specialists the situation is more complicated, some of them can't be replaced by midlevels, cant really increase training amounts, others have had shortages get worsened by midlevels (like cardiologists getting over consulted, same for neurology and some others). Others like psychiatry have a situation where people just stopped taking insurance and do cash pay because its more lucrative leading to a phantom shortage.
*Strong disconnect between the feel people have about this and the actual numbers.
Throwaway05
10hr ago
Like people make no attempt to investigate the facts of the situation and repeat outdated or incorrect information?
Yes.
Throwaway05
21hr ago
Leaving me hanging bro!
(no its okay I know you disagree with me on some of this, especially AI)
Throwaway05
21hr ago
Unrelated bit first - great user name.
So the issue is that the triage is the work for a lot of medicine. That's basically a vast majority of what emergency medicine is for.
For a simple example (in the sense that triage nursing programs and AI can handle this one):
Someone comes in with chest pain. Do you give them some tums or give them a hundred plus thousand dollar cardiac work-up? Do they get better in three seconds or die.
Knowing to ask things like "hey did you just have a 3 pounds of spaghetti with red sauce?" lets you figure it out.
A more complicated question might be something like "this person fell, do you scan their head before sending them home?" which has a lot of research, debate, and need for asking patients (who may be unreliable) very specific questions.
Once you've triaged and diagnosed them things get simpler, but at that point to a large extent the work is already done.
Also - Americans need someone to sue.
Throwaway05
21hr ago
Private practices are dead for most specialties, killed by hospital lobbying and regulatory burden. The vast majority of types of physicians are "employed" now (also - this is why we aren't responsible for whatever thing is annoying you, we aren't in charge anymore).
Physician compensation is unusual, the starting salary for an attending is usually pretty much the same as the salary for an attending who has been working for 30 years. So yes your friend's are getting offers around 500k which is about the median for Radiology.
Radiology is one of the better compensated specialties, and used to be considered one of the "best" for high compensation better work-life balance ("ROAD") in recent years compensation per work done has declined sharply and the radiologists have kept up by increasing work load to the point where it's becoming a bit undesirable.
Last time I checked allergist salaries that was close to what they were making period, so that's a good gig (granted my knowledge on that one may be out of date).
Again 7 figures is basically impossible without being Neuro/Spine/Cash Plastics or something else like fraud (it happens), another revenue stream (owning a patent, executive work), or working 80-120 hours a week (people absolutely do this).
Basically as with any career with ownership or sufficient hustle and skill you can make bank, but the top 1 percent doesn't say too much about ten pop (and the salary data I've seen matches that).
Throwaway05
21hr ago
Most of the time I am just requesting people investigate how the system functions and malfunctions. Is that an unacceptably high bar?
Throwaway05
23hr ago
I apologize for sounding harsh, but that is a bad justification. More so on a forum that prides itself in identifying collective incompetence and blind-spots in elite circles. This is the common excuse of Bureaucrats & careerists who love abstractions more than action.
The point is that most people who have an opinion on this wildly misunderstand the reality of the situation with respect to the role of the AMA, where the shortages are, how much physicians get paid (millions a year??? see down thread), how much of US healthcare spending is on doctors and so on.
Having an opinion does not mean one has a realistic understanding of what is happening and how to fix it.
To me this is a classic Gell-Mann amnesia issue. I see how firm and misinformed most people who post on this topic here are and it makes me trust the experts vs. posters here on topics I am not knowledgeable on.
Throwaway05
23hr ago
Notably Australia is also one of the few countries with US comparable salaries.
Throwaway05
23hr ago
FFS anything to avoid talking to an actual expert.
Throwaway05
1d ago
Let me add a little bit -
The constraint is fundamentally ensuring adequate training quality, you'll see people here saying that isn't necessary and maybe they believe it but shit that doesn't seem wise.
People with more knowledge than anyone here (including me) have been working this problem for a long time, the approach is two fold - yes they have been increasing the number of medical schools and residency slots, maybe not as much as required but they are trying. Every year a large tranche of students doesn't advance to the next level of training. We have room to optimize this and interest in doing so.
The other piece has been an explosions in mid-levels, they suck frankly, and have expanded beyond the intended use case while in some ways making the issue worst by overusing specialists. If a US doc wants to retrain to cardiology they need like 2-5 years training. A midlevel needs zero. Guess who makes a better cardiologist?
In most cases the issues are things like allocation problems (which mid levels don't fix, they don't want Gainesville either), a decline in work done by physicians (increasing administration burden, malpractice, and decline in compensation and people work less), a decrease in years worked (turns out women drop out more and faster) and other complicated things like that.
Stealing doctors from other countries is a popular solution and it has some ethical and practical problems (prior to recent political changes everyone wanted to come here, we cant steal from everybody! Additionally if you import enough to depress the wages the reason for coming dies off). However they do seriously need retraining, I don't have access to the private stats but best I can tell the two most common causes of residency termination are intractable substance use and terminal inability to survey the mandatory retraining.
With respect to AI, you can't rubber stamp every case needs actual review to make sure you aren't missing something or you'll be using the doctor as a liability sponge.
AI will come eventually but it isn't ready yet.
AI can't solve procedural work (that's robotics), inpatient work is as much coordination and other soft skills as medical knowledge, and outpatient work has a lot of social components (including the usual things, but also stuff like realizing what the patient means and says are different things).
AI is not ready for that level of ambiguity. It also can't be sued, which the American patient demands.
Throwaway05
1d ago
I have spent literally years here replying every time explaining that this is not how the doctor shortage works and this is not how the AMA works and that this information is easily discoverable. At this point it's embarrassing.
I guess I will now also have to explain that that is also not how AI in medicine will work and not how medicine works.
Yep, it seems simultaneously better than I could have imagined (yes you really do have that much shit to do and options for things) and worse than hoped (Korean slop writing).
It's been a great "watch low effort video content" while playing game so far, but I can understand if that's enough to justify the price.
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