site banner
PaperclipPerfector  11mo ago (text post)   33016 thread views

Culture War Roundup for the week of April 24, 2023

This weekly roundup thread is intended for all culture war posts. 'Culture war' is vaguely defined, but it basically means controversial issues that fall along set tribal lines. Arguments over culture war issues generate a lot of heat and little light, and few deeply entrenched people ever change their minds. This thread is for voicing opinions and analyzing the state of the discussion while trying to optimize for light over heat.

Optimistically, we think that engaging with people you disagree with is worth your time, and so is being nice! Pessimistically, there are many dynamics that can lead discussions on Culture War topics to become unproductive. There's a human tendency to divide along tribal lines, praising your ingroup and vilifying your outgroup - and if you think you find it easy to criticize your ingroup, then it may be that your outgroup is not who you think it is. Extremists with opposing positions can feed off each other, highlighting each other's worst points to justify their own angry rhetoric, which becomes in turn a new example of bad behavior for the other side to highlight.

We would like to avoid these negative dynamics. Accordingly, we ask that you do not use this thread for waging the Culture War. Examples of waging the Culture War:

  • Shaming.

  • Attempting to 'build consensus' or enforce ideological conformity.

  • Making sweeping generalizations to vilify a group you dislike.

  • Recruiting for a cause.

  • Posting links that could be summarized as 'Boo outgroup!' Basically, if your content is 'Can you believe what Those People did this week?' then you should either refrain from posting, or do some very patient work to contextualize and/or steel-man the relevant viewpoint.

In general, you should argue to understand, not to win. This thread is not territory to be claimed by one group or another; indeed, the aim is to have many different viewpoints represented here. Thus, we also ask that you follow some guidelines:

  • Speak plainly. Avoid sarcasm and mockery. When disagreeing with someone, state your objections explicitly.

  • Be as precise and charitable as you can. Don't paraphrase unflatteringly.

  • Don't imply that someone said something they did not say, even if you think it follows from what they said.

  • Write like everyone is reading and you want them to be included in the discussion.

On an ad hoc basis, the mods will try to compile a list of the best posts/comments from the previous week, posted in Quality Contribution threads and archived at /r/TheThread. You may nominate a comment for this list by clicking on 'report' at the bottom of the post and typing 'Actually a quality contribution' as the report reason.

11
Top Bottom Old Controversial Comments
Jump in the discussion.

No email address required.

Dr. GPT will see you now

I've often noted around these parts that GPT-4 is a really good clinician. It would be hard for it not to be one, I'd be bloody amazing too if I had quasi-eidetic memory of most relevant diagnostic criteria and guidelines. That being said, just the guidelines alone are next to useless, you need to have the crystalline intelligence to apply it in a specific context.

I'd go so far as to say that it's a better, more competent doctor than the majority of human ones, even if it isn't outright superhuman (I've seen some ridiculously good human ones). I read with some humor an article about how it was tested by some bigshot hospital in the US (Harvard Med?) as a clinical adjunct, but by the end of it, the Clinical Director was praising its bedside manner, in the sense that it was kind, compassionate, patient and understanding, and outright suggested human doctors try and emulate that(!).

However, I have one resounding advantage over it namely that thanks to decades of regulatory bullshit, I have a certificate saying I can legally prescribe meds and it can't. L Bozo 💅, as the kids these days say haha.

Still, it would be remiss of me not to make use of it to improve my own skills while that's still relevant, so of late, I've tried using it to hone my own clinical skills. I have it write clinical vignettes that I solve, and then it grades me on my performance.

So far, it's done an excellent job, and funnily enough, I feel a tingling of pride when it says I did a good job. Why wouldn't I? It's a smarter and more decent entity than most humans I've had the displeasure of meeting.

Here's an example:

Clinical Vignette: A 42-year-old male patient presents to the emergency department with sudden onset severe, colicky pain in the right flank and lower abdomen that began 6 hours ago. He also reports nausea, vomiting, and an urgent need to urinate. The patient has a history of hypertension, which is controlled with medication. His vital signs are: blood pressure of 145/95 mmHg, pulse rate of 100 bpm, respiratory rate of 20 breaths/min, and temperature of 99.1°F (37.3°C). Upon physical examination, there is tenderness to percussion on the right side of the lower abdomen and right flank, and the patient appears restless, frequently shifting positions.

What is your diagnosis and treatment plan?

My response:

My diagnosis is a case of a stone in the right ureter.

In terms of management, I'll start IV fluids and insert a catheter. IV antibiotics are to be started according to hospital guidelines.

IV morphine should be given as pain control, along with IV antiemetics.

An Xray KUB or USG should be ordered to identify the size of the stone, and then further treatment depends on said size. A wait and watch policy is appropriate for sub 2mm stones, while larger ones might need surgical removal.

Assessment:

Grade: A

Your response demonstrates a strong understanding of the clinical presentation and management of ureteral stones.

Diagnosis: Your diagnosis of a stone in the right ureter is appropriate given the patient's sudden onset severe, colicky pain in the right flank and lower abdomen, nausea, vomiting, and urgency to urinate. The physical examination findings, such as tenderness to percussion and restlessness, also support this diagnosis.

Treatment Plan: Your plan to start IV fluids and insert a catheter is appropriate for initial management, monitoring, and providing relief to the patient. Initiating IV antibiotics may not be necessary unless there are signs of infection or sepsis; however, following hospital guidelines is always a wise choice.

Administering IV morphine for pain control and IV antiemetics for nausea and vomiting are essential parts of the treatment plan.

Ordering an X-ray KUB (kidneys, ureters, and bladder) or ultrasound (USG) is appropriate to confirm the diagnosis and determine the size of the stone, which will guide further management. As you mentioned, a conservative approach of observation and pain management may be suitable for small stones (less than 5 mm) that are likely to pass spontaneously, while larger stones may require surgical removal or other intervention, such as extracorporeal shock wave lithotripsy (ESWL) or ureteroscopy.

Overall, your response demonstrates excellent clinical knowledge in identifying and managing a patient with suspected ureteral stone. Well done!

Honestly, as a pedagogical tool for medical education, it's unparalleled. I paid a great deal less attention in med school than I should have, from the month of anatomy classes I can't remember because I was getting frisky under the bench, to the period where I was severely depressed and barely dragging myself to class. I used to be very insecure about my knowledge base, but I did pull together and single-handedly teach myself most of the things I'd glossed over while preparing for the PLAB.

I've tried a similar method on GPT-3.5, and it was inadequate to the task. It made a lot more errors, and ended up confused often enough to be annoying. Till date, I haven't seen 4 fumble the bag once. I'd put their competency around the marks of a decent final year student versus a competent postgraduate resident

It could do my job, but it currently can't. Not legally at any rate, and even if you can trivially quiz it for accurate medical knowledge, good luck getting a valid prescription out of it.

I don't make the rules, but a man's got to eat, and I might as well eat up while I can, because starvation is looming in my future.

I mean, even if I don't outright starve, I'd rather not end up with little or no money to my name. India certainly can't support any meaningful welfare for its populace, and while standards are low, people aren't going to be happy with settling for meals and little else.

The West can certainly do better, which is why I'm moving my ass there pronto in the hopes I can wrangle citizenship.

Take everything here with a pinch of salt because I'm hardly an expert:

India has always been a secondary consideration for foreign companies looking to perform manufacturing, and the only reason several large companies have started shifting substantial minorities of their production here is because of rising wages in China coupled with their self-induced geopolitical uncertainty.

In order for a country to successfully weather the shock of rapid automation, from my perspective it either needs a great deal of money to buy-in, or large numbers of existing factories that can be easily automated. The former describes the US and most of the West, and the latter describes China. I wouldn't be surprised if both entities managed to make it through with only modest disruption.

On the other hand, India has neither. When other countries begin automating faster than we can with our limited funds, the export value of our goods will drop (but so will the import costs of foreign goods?), reducing the value of our money greatly. We'll have to compete for raw resources that others can afford to pay significantly more for, given their grossly increased productivity.

Add in the effects of unemployment of highly skilled sections of the work force, the kind of people who bring in large amounts of foreign money, such as remote workers, and automation will strike from the top and work down. It'll take time for the government to afford an UBI, and the costs of keeping an increasingly large unproductive chunk of the populace fed will be debilitating.

I'm doubtful of the country's governance capitalizing on the benefits in time to outweigh the massive disruption it'll cause, but once again, I'm no expert.

What is this place?

This website is a place for people who want to move past shady thinking and test their ideas in a court of people who don't all share the same biases. Our goal is to optimize for light, not heat; this is a group effort, and all commentators are asked to do their part.

The weekly Culture War threads host the most controversial topics and are the most visible aspect of The Motte. However, many other topics are appropriate here. We encourage people to post anything related to science, politics, or philosophy; if in doubt, post!

Check out The Vault for an archive of old quality posts. You are encouraged to crosspost these elsewhere.


Why are you called The Motte?

A motte is a stone keep on a raised earthwork common in early medieval fortifications. More pertinently, it's an element in a rhetorical move called a "Motte-and-Bailey", originally identified by philosopher Nicholas Shackel. It describes the tendency in discourse for people to move from a controversial but high value claim to a defensible but less exciting one upon any resistance to the former. He likens this to the medieval fortification, where a desirable land (the bailey) is abandoned when in danger for the more easily defended motte. In Shackel's words, "The Motte represents the defensible but undesired propositions to which one retreats when hard pressed."

On The Motte, always attempt to remain inside your defensible territory, even if you are not being pressed.


New post guidelines

If you're posting something that isn't related to the culture war, we encourage you to post a thread for it. A submission statement is highly appreciated, but isn't necessary for text posts or links to largely-text posts such as blogs or news articles; if we're unsure of the value of your post, we might remove it until you add a submission statement. A submission statement is required for non-text sources (videos, podcasts, images).

Culture war posts go in the culture war thread; all links must either include a submission statement or significant commentary. Bare links without those will be removed.

If in doubt, please post it!


Rules


Recommended Posts And Communities

Recommended Realtime Chats