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PaperclipPerfector  2mo ago (text post)   1637 thread views

Wellness Wednesday for February 14, 2024

The Wednesday Wellness threads are meant to encourage users to ask for and provide advice and motivation to improve their lives. It isn't intended as a 'containment thread' and any content which could go here could instead be posted in its own thread. You could post:

  • Requests for advice and / or encouragement. On basically any topic and for any scale of problem.

  • Updates to let us know how you are doing. This provides valuable feedback on past advice / encouragement and will hopefully make people feel a little more motivated to follow through. If you want to be reminded to post your update, see the post titled 'update reminders', below.

  • Advice. This can be in response to a request for advice or just something that you think could be generally useful for many people here.

  • Encouragement. Probably best directed at specific users, but if you feel like just encouraging people in general I don't think anyone is going to object. I don't think I really need to say this, but just to be clear; encouragement should have a generally positive tone and not shame people (if people feel that shame might be an effective tool for motivating people, please discuss this so we can form a group consensus on how to use it rather than just trying it).

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I have been having back and leg pain for the last few months. It comes and goes (although seems to be triggered by running, which is a shame because I love to run) and can be extremely painful at times (on the order of not being able to walk). It’s always on the same side and the pain is severe enough that I think I must have a pinched nerve or something (I’m sure I haven’t sprained or torn a muscle).

I want to see someone about this and I’m not sure what sort of doctor I should start with. Is there any reason to goto a chiropractor, or should I just start with an orthopedic surgeon? I’m hoping this is an issue that is solveable with physical therapy.

Maybe the healthcare system where you are is different, but why not a physiotherapist? In my experience, the biggest benefits you will get from a chiropractor are temporary or coincide with physio techniques. Do a bit of research and find a physiotherapist who deals with athletics (maybe running specifically). Back pain is weird. Unless there was an injury that sparked the pain, it sounds like an issue with form and overcompensation. Usually that means taking break from aggravating activities, doing strengthening exercises, and mobility work. There often isn't a dramatic one time fix.

Have any of you noticed the "Lookism" trend gaining in prominence? Motte is likely mid 20s at youngest, but apparently an insane emphasis on looks for both men and women is now standard among Late Gen-Z. Terms like "canthal tilt" and maxillo-squillo-I-don't-fucking-know have flown out of 19th century physiognomy handbooks and into TikTok feeds. High schoolers apparently use words like mogging and looksmaxxing now on a regular basis. The youth are approaching S. Korea-levels of fixation on bone placement, skin quality, eye-squintiness and height.

Two thoughts:

(1) Getting older is weird. Seeing tiny little currents that flowed beneath the surface in your own adolescence blow up to become tidal waves years later. It's like how the beatniks presaged the hippies, or like how the late-80s Seattle scene probably felt when grunge blew up. Another current example is the increased popularity of specific anime like Nichijou, Lucky Star, and S.E. Lain among late Gen-Z. These shows always had an audience, but the fact they're so popular now seems to mean something. Baton-passing is guaranteed with any popular-enough media, but increased popularity for an old thing tells you something about the new generation. Maybe it's trite and mundane, but it will always tells you something.

(2) This is awful. Morality aside, you could pick any trait of yours from a hat, and it would be more open to modification than your looks. By that same token, even attractive people aren't happy with their looks. It's all fun and games up until around 25, then it's a real fight to preserve what you have -- new exercise routines, new clothing, new cosmetics. You spend years cultivating your outward self and neglecting your inward self, so when you "hit the wall" it's a double tragedy because you have little else to offer the world. Many beautiful women struggle through this process and have their ego shattered, but come out the other side as excellent people as Ben Franklin points out. If guys are getting in on this too, I honestly see it as a generation-wide tragedy. This is a giant arrow pointing away from what actually matters in life, it only benefits 20% of people, it's long-term untenable for 100% of people, and it's happened before. Perhaps genetic engineering should take us in the other direction instead -- so that no one is too attractive, and instead of mewing and bone-smashing we'd be cultivating virtue and writing proofs. Or we can stop acting like jackasses and realize looks are a small part of life. That works too.

I take everything from Gen Z with a grain of salt. I'm sure there are some people that believe these things but I really think it's all just irony and post-irony all the way down. Just replace sarcastic with ironic here: https://youtube.com/watch?v=udJw-CzX7sA

This is awful. Morality aside, you could pick any trait of yours from a hat, and it would be more open to modification than your looks.

?

You can modify your looks, with everything from trivial ease to great expense. Make up. A proper haircut and shave. Rhinoplasty. Buccal fat removal. Ozempic.

Intelligence, for example, another nigh unalloyed good, is nigh impossible to modify. Stimulants don't make you smarter, just harder working/dedicated/conscientious. Even the most well studied options like ashwagandha for memory show minor effects.

Perhaps genetic engineering should take us in the other direction instead -- so that no one is too attractive, and instead of mewing and bone-smashing we'd be cultivating virtue and writing proofs.

I'm at a loss for words. I suppose making a taller bucket helps some of the crabs.

Good looks, at least in the form of clear skin, facial symmetry and hair, is a sign of good overall health. It correlates with intelligence too. It might be be more zero-sum, but it is not entirely so, so I fail to see any reason why something as questionable as enforcing "looks restrictions" on genetic engineering is remotely a good idea.

Once everyone is on the Pareto Frontier when it comes to attractiveness, we'll find something else to compete on, though I doubt your suggestion of "cultivating virtue" and proof writing will get any take up.

I thought the sarcasm was obvious enough. Oh well

My bad. I didn't think it was that Ben Franklin quote, which I can see after I bothered to open it.

Don't mind me, just dying of my 8th bout of COVID here.

I got into a fight with my wife the other night. Which is extremely rare for us. I'm genuinely...confused at the mix of emotions I'm feelings. I'm wondering how people who get into fights with their spouses all the time live like this. I can't manage to focus on anything for being annoyed. It's so weird. How do I move back towards normality with her, when part of me feels like I have no intention to until she apologizes.

Mind my asking what it was about? Or DM me if you don't feel comfortable saying it for an audience.

It's a little hard to explain as a satisfying narrative. It's something like: we rescheduled Valentine's to be not on Wednesday because that's stupid. Last Saturday we went out for dinner and then to the Symphony as "Valentine's Day." Then, Wednesday, I thought I would have time to make a nice dinner and suggested that, then work got crazy and I texted her saying "Hey, is it ok if maybe we do that tomorrow, time crunch." She said ok, but apparently was upset. She likes Valentine's day significantly more than I do. When I got off work, I ran for flowers and to pick up a nice present that she wanted. When I got home, she was in a bad mood, and I did not get the reaction I thought I would get. I felt I A) already had done Valentine's Day and "had it in the bank" and that B) anything I did Wednesday was extra credit and therefore un-failable and that therefore C) her reaction was inappropriate and demeaning. I probably overreacted, but I had this distinct feeling of being demeaned, I had already submitted by doing Valentine's day to begin with. She felt that I had promised something and then reneged, and that Valentine's Day is her favorite holiday, and that I had half-assed it and not made it a priority.

We've since gotten over it. I was just stunned at the weirdness of feeling that way with her. I told her Thursday, hey I'm still feeling annoyed, I don't like feeling this way, I need you to do something extra nice for me so I can then make a nice romantic dinner without feeling like a doormat for giving in. She made protein muffins and treated me well, I made steak tartare with a baguette, she likes the earrings. We're all better.

I think you're in the right. You pre-discussed valentine's day and 'did it' on the Saturday. Then she wanted it again on the Wednesday in spite of your earlier agreement and got upset when you didn't do it twice. You're somehow in the wrong because you should have known that any deals about valentines day are completely void because of how important it is to her. I don't know how taking her to dinner and a symphony of all things is half assing it.

I applaud you for talking it out and fixing it, but I think your wife has been immature and this sort of thing is likely to happen again unless she works on herself. I kind of get it because my long time girlfriend will negotiate doing something for her birthday on the weekend before it happens because we have more free time. Then she will 'spontaneously' want to do something on her weekday birthday evening even though I'm tired from work. Then she will try triple dipping and ask to do something on the Friday night post birthday because we couldn't do 'enough' on her birthday. I was lucky that when I calmly talked her through what had happened and said 'its enough, we've already done all this stuff so you can't have a "Birthday Week" where I'm at your beck and call' she pulled her head in. I think this is because she knows I'm not a doormat and that I'm willing to weather emotional storms. Ironically because I'm willing to endure fights, they don't happen and we manage to talk things out before they ever get that far.

Its this last part that's important. While its ideal to 'never go to bed angry' and resolve fights on the day they happen, I think its more important to show your partner that you can set proper boundaries when you are actually in the right. If she can't help feeling upset and self regulate, well that's something you need to learn to tolerate until she finally gets over it. Be willing to extend an olive branch, but don't apologize. If you can't self regulate and push through when your wife is unhappy with you (even though she is in the wrong), well I'd say try to work on that.

The trouble is:

  1. You can’t actually move a holiday, so for someone who cares about them it feels empty even if you did something on another day.
  2. Your loved ones want to be your first priority. If you’re rescheduling for a work crunch or for a more convenient date, you’re making it implicitly clear they aren’t. In this case the ‘correct’ thing to do would probably be to take the afternoon off on Valentine’s Day. The signal has value precisely because it’s obviously costly to you.

Life circumstances (not everyone can take afternoons off) and reciprocity permitting, this seems reasonable. I still think it should be able to be discussed before the event and if there are issues they should be raised then.

Oh, sure. I’m just describing what I consider to be the emotional narrative underlying the apparently irrational behaviour.

I applaud you and your wife’s resolution to the argument, very mature and thoughtful.

Valentines Days is an interesting and tricky day. Most men (including myself) do not give a shit about Valentines Day. It is a capitalistic holiday that society has tricked women into thinking their man should spend money and time on them to prove the strength of their love and relationship. And if the man doesn’t live up to their expectations, then perhaps he doesn’t actually care about her and the entire relationship may be doomed.

Valentines Day has become especially pernicious in the social media age. With every woman posting the surprise gift/dinner/experience/proposal on Instagram, there is so much comparison and expectation and letdown. I’m not, and never will be, a big Valentines Day celebrator. I will buy my partner roses, a card, and either cook her a nice dinner or take her out somewhere nice. I think that is more than enough.

Just now seeing this and as a fellow non-fighter, I know exactly what you mean about being unable to grasp how people just live with constant fighting. I had girlfriends where we had perpetual stupid acrimony, and it really was miserable. I am apparently not good at all with living with these sorts of things, because my wife and I almost never have any real arguments and I would strongly prefer to keep it that way. I do wonder if the people that fight constantly are just not experiencing the same thing I am or whether they're just miserable pricks for the vast majority of their days on Earth.

Even the few "arguments" we have are more like what you describe, where we both felt like the other person did something hurtful, we don't see eye-to-eye, and it takes a bit to move beyond. The only thing that really works for me is just trying to really hard to extend empathy to try to understand why she's feeling how she is. Even if I still think she's just plain wrong, that at least drops the animosity level to some tolerable range where I can make the effort to make up. This is also only like once every couple years or so, so having about a thousand good days to one bad day ratio makes it easier.

If it isn't something serious I'd just apologise for the fight and if she has any shame she'll do the same. If she doesn't then you might have a problem but if you haven't fought before it's probably worth just taking the L and moving on, regardless of who's right.

How do I move back towards normality with her, when part of me feels like I have no intention to until she apologizes.

I know this feeling. What I suggest is that you examine your own behaviour carefully, check if there is anything that on reflection you feel you did wrong, then apologise for that and only that. Maybe it sets the ball rolling, maybe it doesn't. But you'll have got right with yourself and the rest is her problem; I find it's easier to calm down when I'm okay with my side of things.

least relative to cultures like that in the Philippines.

Solution: Marry a Filipina, apparently.

Continuing my saga of trying to solve my chronic joint pain…

Got a ton of lab work done, including an ultrasound, pancreatic enzymes, H27BLA, stool test—all normal except extremely low pancreatic elastase in stool (32). Ultrasound was normal, but pancreas appeared heterogenous (non specific finding, suppose it could be gas or something). Stool test was weird because fat content was low/normal and protein was normal high but elastase was low regardless. Normal blood sugar but higher fasting insulin than I would like (7.9).

Doctor has me on oregano oil and allicin assuming SIBO and has ordered an MRI to rule out pancreatic etiology. These supplements are kicking my ass and causing not only a lot of bloating, but upper right abdominal pain I’ve had on and off the last 10 years of my life.

Needless to say, I’m struggling. The physical discomfort from the SIBO treatment is a huge anxiety trigger. I’ve started wondering whether I’m looking at something life changing like pancreatic cancer and I’m increasing feeling like I’m staring over this void. I’m trying to manage the anxiety through meditation and therapy but a physical trigger is extremely hard to ignore.

I’m 32 male, no family history of pancreas issues. I’m really struggling with all of this, I’m attempting to just keep moving forward but it’s really hard.

AI Video Gen just leapt forwards

Ay yo just look at this shit. Shame it's an OAI product and thus utterly neutered by the time it makes it to us plebs.

Increasingly clear that (at least in the first world) the future of human civilization, (barring collapse / elysium / manna scenarios) is living the lifestyles currently enjoyed by aimless funemployed rich kids. As someone who knows many, it’s not a bad life, but it is often an unfulfilling one.

I suppose CGI animators are next in line for the chopping block, we’re only a year of two from full Pixar movies being created with (AI-assisted) prompt engineering by one to two people.

Don’t you think it’s more likely that for the jobs that AI appears to be capable of automating right now (a lot of things, but basically any job where you sit at a computer all day) we’ll increasingly just turn our jobs into makework? Email and excel have already made us 100x more productive at white collar work, but that’s only created more of it, and people often point out that there are tons of e-mail jobs where nobody is really sure exactly what these people are doing, right now. I don’t see why that trend won’t continue, we’ll create project managers who oversee the AI’s work output, we’ll need people to interpret what’s needed and figure out how to ask the AI for it. We’ll have AI audits and compliance. We’ll create professional licenses to use certain AIs. We’ll have companies employing a bunch of people to have meetings all day about nothing. I think you work in high finance?, if so you’d be well aware there are boomer MDs who don’t know how to use excel and dick around on phone calls all day making million dollar salaries. There are people who work from home for 5 hours a week making 200k in tech. Theres millions of people in low level admin roles making $50k who do approximately nothing all day.

Until we see really impressive AI robotics which automate manual labor (it’s fair to extrapolate capabilities, but we’re not there yet), I don’t think it will fundamentally alter our economy that much. There will be various disruptions, but ultimately I think there is way too much status and people’s self worth tied up in their jobs to fully do away with them. The market is competitive and in theory incentivizes companies to automate away as many employees as possible, but we’ve all seen with our own eyes that lots of companies are very bad at this and employ thousands of people who don’t help the business at all (see Elon firings at Twitter). Plus already a substantial number of white collar employees work for government or non-profits.

we’re only a year of two from full Pixar movies being created with (AI-assisted) prompt engineering by one to two people.

Gosh, I hope so. But I must admit I'm skeptical. Stable Diffusion was released to the public in August 2022, about 1.5 years ago, and though the progress in those roughly 18 months have been amazing, it's still nowhere near the level of being able to create an image equivalent of a Pixar movie (I dunno, maybe a 30 page comic book with coherent characters and a plot that loosely follows the 3-act structure?) just with prompt engineering. I do think we'll see even faster progression in the next 2 years, but going from even the impressive stuff we have now to a full coherent 90-minute film seems sufficiently difficult that it would still need a lot of actual industry experts making edits and putting them together.

My prediction in 2 years would be that an amateur studio with 1/10-1/100 (but probably not a smaller fraction?) the manpower and resources that Pixar has today could make the equivalent of a Pixar film. Highly speculative, of course. But I really do hope you're right, and we enter a world where a couple of professionals could just use prompts to generate Pixar-equivalent films - and ideally this would imply that amateur individuals with little expertise could generate 10-20-minute videos with professional, if not necessarily Pixar-level, production values (though in the realm of AI, the way "production values" manifest themselves will be different, since AI is really good at some things that CGI has trouble with, and vice versa).

In addition to us developing new techniques to prepare for deployment, we’re leveraging the existing safety methods that we built for our products that use DALL·E 3, which are applicable to Sora as well.

Yep, that's DoA, DALL-E's built-in filter is infamously hair-trigger even for non-risque things, besides the model itself having a semi-poisoned dataset for certain things like anime artstyles. I predict Sora's capacity to generate people being even worse than that of current models, there's a reason they mostly showcase heckin cute puppers and shit.

On a related note, it's getting very tiresome how my excitement for new advances in AI tech ("holy shit this is insanely cool wtffffff") is near-immediately soured by the reality of its applications ("I can scarcely begin to fathom how cucked the pleb-facing version will be"). This is more or less a me problem but I can't be alone in thinking this, it's not even so much that I personally feel cucked by not being able to gen e.g cute girls doing cute things, it's more like here is this insanely creative technology, it's pretty cool right, let us proceed to do absolutely fucking nothing with it because letting plebs have fun is too problematic in the current year, your superiors know what's better for you, no fun allowed, get back to your wage cage you fucking rube. We live in a society, etc.

I know I sound like a curmudgeon and say nothing constructive, technically they can do whatever they want with what they themselves developed, but I am drunk, sorry incredibly tired of this safetyism mindset, even after getting thoroughly desensitized to non-kosher uses of generative AI after a year in the company of /g/entlemen (whose existence technically proves it's not as bad as I paint it, but still).

On a lighter note, experts say.

I'm not thinking as much about inevitable filters as I'm thinking of how there's gonna be maybe 2-3 months of fun you get out of it and then social media just gets flooded with samey-samey videos with the "smell of AI" on them, like with images.

On that note, I'm honestly impressed and partly relieved by how quickly people develop a "sense" for AI-generated things - image, text, and soon likely video. It also reinforces my belief that whatever the eventual AGI/ASI may be, it will not be a master persuader with infinite charisma like some people seem to believe, we'll already be reasonably hardened by years of psyops before it comes into play.

What worries me is the possibility that people will sour on 'pretty' AI-generated art/text/video the way they soured on realism in the 20th century. The 'real art is shocking' brigade are too powerful already.

It looks close to as good as it can get. Everything beyond this, a model needs more than just information from videos and more instruction than a text prompt to increase in usefulness. I can't believe temporal consistency was solved this soon, I thought it would take another year minimum. But I guess that's because other companies video generation is just so bad. Googles whiff on Gemini and now this really cements that OpenAI is easily more than a year ahead of the competition.

Dunno how to feel about this. On the one hand, I might be able to tell some stories I want to tell with short movies.

On the other hand, it really seems to be over for artcels. :/

...this is a link to a three-year-old boston dynamics robot video. Is that intentional?

I finished Intro to Python and then some Data Structures so I can't really comment on your position, but it certainly strikes me as analogous to medicine.

What is the human body but a bunch of asynchronous microservices, with doctors forced to interpret tea leaves poor proxies for what's actually going on.

Error Code: Patient turned yellow

But I did get over most of my imposter syndrome, though to be fair my clinical knowledge was severely lacking compared to my peers because I was depressed and phoning it in through med school. But I did get better, and can even plausibly claim to be above average (in my peer group), despite, like you, having no innate love for the subject. It took a lot of grinding and periods of utter despair, but eventually some of the shit sticks.

I second the other suggestions to look for jobs where you don't have to bash your head at a wall doing something you hate. It might be a bad time to be a programmer looking for a job, but from what I know, it's an innately cyclical industry and the odds of you being unemployed and uncomfortable are low. Maybe brush up your LinkedIn and open up to recruiters?

Why not try to find an employer that doesn’t have a spaghetti microservices mess?

  1. Do you have colleagues doing the same work that you can benchmark yourself against? Not all feelings of inadequacy are in your head, but some are, and it helps to have a point of comparison. Especially if you're working with inscrutable legacy code where a slow pace is kind of inevitable.
  2. If you do have an actual skills / enthusiasm problem, who can you ask for help to improve? It may be that there are tools you could be using but aren't, or scripts that people have put together for debugging, or textbooks that dig into the theoretical side of what you do* in a way that you generally neglect. If your manager cares about results he/she may well be happy to help you develop rather than put the time and effort and money into finding somebody new and bringing them up to speed on weird legacy code. Likewise it's a rare colleague who doesn't enjoy explaining what they do and they may well be happy that you're putting in effort to hold up your end better.

*Building Microservices by Sam Newman has a good reputation.

and halfway depressed when I'm supposed to figure out why a given customer's X isn't doing what it's supposed in a tangle of a million interconnected asynchronous programs

Without even getting into the "decade of legacy being heaped upon legacy" bit, boy, do I know how you feel! I tend to be insecure, and so I keep second-guessing myself, but there came I point where I wanted to slap anyone who uttered the word "microserives", still if the idea caught on to such an extent, it felt like I'm wrong / being arrogant. Then recently I saw a Twitter Space from around the time of Elon's takeover, where some hotshot hacker that briefly worked for Elon was tearing the Twitter architecture a new one, and one of his throwaway lines was "usually when you call something a microservice it's supposed to mean a 100 lines of code, not 10 000". Oooooh, suddenly it all makes sense. Maybe I'm not insane, and neither is the person who came up with the idea of microservices. Maybe if you have so many asynchronous jobs you can't trace where the bit of data that interests you came from without wanting to claw your eyes out, it's the architect that needs to be given a gentle push down a flight of stairs.

Another experience I had semi-recently was when I was asked to quickly build a proof of concept for something. I dug out a framework I haven't worked with in ages, but remembered fondly, and... what is this feeling? I can work without having an aneurysm? If I don't know something, finding it in the documentation is maybe 5 minutes? Madness.

I don't know your situation, but maybe you're not as bad as you think, it's just that your circumstances suck.

So this post is mostly just a reminder to myself: Losing one's job is not the end of the world. Life goes on. You'll find another one, old boy, and it can hardly be more boring than the old one.

My advice would be to try and get ahead of it. Maybe you'll find something more enjoyable, but in any case, it takes off the stress of "when is the hammer gonna drop?" The job search will probably also be a easier to handle.

People with social anxiety, how have you managed to cope or manage it? I've had it since 12 years old, I'm 25 now. The biggest impact for me has come from consistent sleep and exercise. Went from having hard time calling customer support and going to public places with a lot of people to having a slightly increased heartbeat when talking to people I'm not familiar with. I've also tried meditation, but couldn't stay consistent with it. I know some people swear by CBT, thinking of trying it out next.

Testosterone replacement therapy helped me a lot, but mine was actually pretty low for my age group. It likely won’t do anything if yours is in range (and commits you to giving yourself weekly injections the rest of your life), so isn’t something to just jump right into

Have you tried intentionally progressing your exposure therapy methods? I keep a list of progressive exercises:

Go out in a public place

Go out in a popular, crowded public place (bar, club, restaurant, sports game)

Make eye contact with a person

Smile at a person

Ring the bell on a bicycle to get through (source)

Ask a person what time it is

Comment on a post in a large online forum

Comment on a post in a small online forum

Call the waiter in a crowded restaurant (source)

Call a close family member

Call a close friend

Call a distant family member

Call a distant friend

Disagree with a person

Leave and re-enter a movie theater during the movie while seated in the middle of a row (source)

Call a business to ask a question or place an order

Ask a question during a work meeting (source)

Cold email someone

Publish a standalone post on a large online forum

Publish a standalone post on a small online forum

Delegate a task to a person

Cold call someone

Admit being wrong in private

Admit being wrong in public

Present at work (source)

Ask for abnormal accommodations at a business (keeping a large water bottle at the table for self-refills, etc)

Ask what tipping customs are when in a foreign country

Send food back because it wasn't correct or is very poor quality

Ask for things (cigarettes, lighter, money, borrow a phone)

Sing in public (karaoke, on the street, etc)

Dance in public

Go to a foreign country without speaking the language well

Compliment a person

Walk backwards slowly in a crowded street for three minutes (source)

Cold approach a person

Ask a person playing music out loud or having a conversation on speaker to put headphones in or turn off speaker

Ask multiple people in a specific and obvious location (e.g., right outside XXX Park, or a T stop) where to find that location (“Excuse me, I am looking for XXX Park”) (source)

Wear a shirt backward and inside out and buttoned incorrectly in a crowded store (source)

Dance or sing in the street or subway wearing attention-grabbing clothing (source)

Recite “Twas the Night Before Christmas” in the subway platform (source)

Approach group of people at bar or restaurant and ask if you can practice a best man’s toast (source)

Tell someone at bookstore that you don’t know how to read and ask them if they can read the back cover to you (source)

Ask a staff member in bookstore for their opinion about whether to buy the Kama Sutra or the Joy of Sex, have a long conversation about this, buy the books and then return them immediately (source)

Enter a food establishment and interrupt people asking if they own a silver Camry because their car is being towed (source)

Go to every table in a crowded restaurant asking for Joe Smith (source)

Go to a fast food restaurant and only order water, then spill the water, clean it up, and stay in the restaurant (source)

Go to a hotel. Have the patient conduct a long conversation with the concierge about romantic vacation packages (asking about in-room massages, arranging horse-drawn carriage ride, etc.), book a package, and then cancel for no reason except changing their mind (source)

Pay for an embarrassing item with change, and then state that you don’t have enough and leave the store (source)

Initiate conversations with/tell jokes to strangers in bookstore while wearing hair in a side ponytail with bandages on face (source)

Attend a multi-level marketing pitch and saying no

Cold approach and flirt with a person

Cold approach and flirt with a person with the intention of getting their contact information

Go to a random person's house and ask if you can cook them dinner in their house

Go to a foreign country without speaking the language at all

Perform stand-up comedy

Have you tried intentionally progressing your exposure therapy methods?

See, making it intentional would add an extra source of anxiety for me. While I've probably done ~80% of the things you've listed, I've never intentionally went out to perform these tasks. In general, I just try to catch my anxious thoughts and reflect on how they affect my decision making in the moment. E.g. If I don't know how to get to X place, my brain instantly starts looking for solutions that avoids social contact, I catch that thought and instantly force myself to do the opposite and ask a random person for directions. That way my brain doesn't have time to react and get anxious. With things like public speaking, I've noticed that I'm most anxious right before the event rather during it. It's kind of ironic, I think someone spontaneously putting me on the spot to make a speech would be less triggering than being told 3 days in advance to prepare a speech.

I would keep pushing yourself within the bounds of your tolerance.

I used to be like you until I took an arrow in the knee eventually became less socially anxious over the course of about 5 years. I spent a lot of time deliberately going out for social interaction though. Now I help host my friend's meetup when I'm there helping others who are shy to fit in with the group.

There isn't really a shortcut to getting over social anxiety. The fast chemical route is a crutch (even though I used A LOT of alcohol over the years to tolerate uncomfortable environments). All the training in the world won't help with introversion though. I can't make myself want to stay in high stimulation environments to this day.

I wish I had an answer to this. I still have not figured this out.

Alcohol. It's a pretty sweet social lubricant.

I won't say I'm the most anxious person around, but I lean towards the introvert end, and I'm a different, cooler version of me with a beer.

Hardly a sustainable solution outside the odd party on weekends, but exposure therapy as someone advocated should help.

the problem with alcohol is doing/saying things you regret, and also feeling like crap later if you consume too much.

2 things: The first was realizing that I was approaching the world with the mindset that everybody hated me and thought I was a loser. I decided to pretend instead that everybody was my friend, and surprise surprise, people respond to that and I started to believe it myself. I flipped that switch when I was 17, and it still serves me well.

The second is less inspiring - an SSRI. I started taking if for panic and found it did wonders for my social anxiety also.

The first was realizing that I was approaching the world with the mindset that everybody hated me and thought I was a loser. I decided to pretend instead that everybody was my friend, and surprise surprise, people respond to that and I started to believe it myself.

Oh trust me, I've had similar realization long time ago too. I think it did help me a bit, but my current problems come from physical social anxiety symptoms. I can come into a social situation with confident mental, but my physical symptoms still present themselves and it turns into a positive feedback loop. Increased heartbeat --> sweating & shaking --> 'oh my god, i hope they don't notice i'm a fucking wreck' --> more sweating & shaking. That's why I think sleep and exercise has made such a big difference for me, my physical symptoms have reduced significantly.

The second is less inspiring - an SSRI.

Meds will be my last resort. Really don't want to be hooked on something for the rest of my life

Oh yeah, the physical stuff is the worst. I blush at the drop of the hat, and when I was a teenager I would just start shaking when people talked to me. That's where the meds really helped.

Exposure therapy, lots of it. Public speaking in my case.

And lots of meditation. Including a guided style of meditation called Ideal Parent Figure. It can help you emotionally reconsolidate the difficult memories of episodes/life situations that contributed to your developing the anxiety.

Exposure therapy, lots of it. Public speaking in my case.

Yeah I do plenty of that in my daily life, but I think I need to do something more out of the ordinary, maybe take an improv class.

And lots of meditation. Including a guided style of meditation called Ideal Parent Figure. It can help you emotionally reconsolidate the difficult memories of episodes/life situations that contributed to your developing the anxiety.

That sounds interesting, thanks. Especially considering I attribute my social anxiety issues to one of the parents being extremely neurotic in my youth...

Check out https://www.attachmentrepair.com

He's a good teacher of IPF (calls it "perfect nurturer" though due to some copyright issue).

Hey, just want to say big thank you for mentioning Ideal Parent Figure. As I was researching it, I stumbled upon EMDR (Eye movement desensitization and reprocessing therapy) and tried a virtual session last night. It's most likely a placebo effect, but I've had 0 social anxiety symptoms today. It was probably my first time feeling like this in my whole adult life. Will continue with it and see how it goes.

Oh wow, that's wonderful. :)

I did some EMDR too, and it was helpful. I should have mentioned it. But I'm glad you found it anyway!

Btw, what I've found is that some stress can be tied up in more general "concept situations" and not just specific episodic memories. What I mean is, the pattern can be something like "this will be a big challenge in my life" or "this happens around lunch time" rather than the very specific like "holding x presentation at work".

I'm one of the unlucky newbs that had his entire account wiped last night. Anyway, I'll open with a mystery for you biologically-minded guys

For about ~10 years now, I've had this issue where I'm generally healthy, but some chemicals don't seem to be flowing right, and so I've lived in a state of sorta-permanent emotional numbness and pleasure deficiency. I've seen many doctors and psychs and none figured out what's going on. Well, I myself had no idea until last year when a few amazing discoveries happened, and I made some theories. I did an experiment where I'd go out, do some intense cardio for an hour, then go back inside, drink tons of coffee and eat sugary snacks, and relax with a fan. Within a few hours some of the symptoms subsided -- symptoms which no antidepressant or antipsychotic could touch. So I took this discovery online and the response was predictable: Everyone agreed that it was the cardio. To me though this was dubious. I had done lots of cardio before and it had no effect, so why now? I believed the fan played a crucial role, but also understood that was odd. Why would a fan improve these symptoms?

Well, several months later I have the answer. It wasn't the fan that improved the symptoms, but the way I positioned my body when I used the fan! After working out, I would slink down my chair out of exhaustion so that my torso was almost parallel with the floor, with my head against the back of the chair, and then use the fan. After exercising, or drinking coffee, or eating sugary snacks or a carb-heavy meal, if I recline like that, before long my symptoms magically start to fade. I regain the ability to smell, my skin is more sensitive, colors are brighter, etc. This would be a miracle, but there's one problem: insomnia. After just one day of doing this, my sleep is worse. By night 3, sleep is near impossible.

Also, depending on the routine I used, different symptoms would improve. On my cardio-heavy routine, I regained the ability to enjoy music, whereas if I sit in my room and chug a lot of coffee, bodily sensitivity (like sense of smell) increases instead. Further, there seems to be no limit on what I can regain from these methods. The cardio method began with increased music enjoyment, but spread to other forms of pleasure after a couple days. When I stopped all methods, all gains also disappeared.

So that's the mystery. I'm no scientist, but my first guess is something blood or circulation related. Lying supine decreases the effect of gravity which apparently helps blood return to the heart. Gut microbes play a major role in producing both neurotransmitters and our sense of smell. But why would gravity affect this process? And why insomnia? It's all really mysterious. So yeah, ideas welcome! I'm afraid until I discover the mechanism at work here, progress is impossible

If I become a psychiatrist, I pray I don't get you as a patient. I prefer the ones who just get better with pills and CBT (not the one involving roosters).

As for my modestly uninformed opinion, I have no fucking clue, but if it works it works, and psychiatry is a practically pre-paradigmatic field so I wouldn't sniff at it.

If the pills don't work, you're kinda S.O.L. There were actually two meds I saw mild results on -- Nortriptyline and Tranylcypromine. I told this to my psych, but rather than perking up she frowned and said "I can put you back on the NTP but the parnate's too dangerous". It has to be a downer when your patient finally responds to a drug, but all you can say is, "Didn't work well enough, onto the next one". And maybe that's the best option. I've seen psychs try to write smartly-designed protocols online, but they still boil down to "This pill is effective for a lot of people and we don't know why", with directions on how to safely use it, but you're doing the same thing as all other psychs. c'est la vie

This reminds me of this person with Myalgic Encephalomyelitis. He received a Halo to hold his head up and went from bedridden to energetic rather quickly.

Having a rare problem definitely changes how you see the medical world. Not in a pessimistic way though. More like, it's amazing our protocols work as well as they do. If you have a toothache, any doctor can give you a painkiller + antibiotic and the problem will just vanish. That guy's story kinda paints ordinary doctors in a bad light, but if there is no protocol for solving your problem, then doctors aren't really prepared to help. This criticism gets levied against psychiatrists a lot, but doctors operate the same way -- they just appear better because doctor protocols are much more advanced. Medical consensus has taught our doctors everything they know, so when it comes to fringe issues like ME which aren't acknowledged by the medical world, it only seems right to defer to consensus and ignore it too rather than go out on a limb & explore.

Rather than blaming ordinary doctors for doing their job, I think we need a better pipeline established between rare-disease-sufferers and genuine medical researchers. The problem is that for every person with a genuinely rare problem, there's probably 10+ people who fit neatly into a pre-established disease category, who constantly badger medical workers that they're different. That's why the doctors in that guy's story are so dismissive, they deal with this shit non-stop. Right now there's no simple way to prove you're a genuine outlier. Maybe there is and I missed it.

While I think your initiative is extremely laudable, just know that the path ahead of you is fraught. You may have a serious medical issue which forums could exacerbate. But keep documenting things, trying new things, and taking the initiative. I'd recommend a heavy bias towards experts who can see you in person, even if you have to shop around for the ones that work for you. Cautionary note: cascades of care, and incidentalomas.

Lastly, this reads like you're looking for a simple fix that has a clear mechanistic explanation. Generally speaking, I would not expect such specificity, but keep trying to make things better.

So, here is a layman speculation (without knowing your age, weight:height, mood, stability, aerobic capacity etc).

sorta-permanent emotional numbness and pleasure deficiency.

This sounds like anhedonia. It could be hormones (testosterone, free-T, T:E ratio, various thyroid hormones, medications you are taking, cortisol, micro or macro nutrient deficiency). These can all be looked at in one blood panel. I'd start with a full workup from a GP. (and the results will give us amateurs more to (possibly dangerously) speculate about!)

It may be a neurotransmitter imbalance. This can be an appealing thought, as it seems to promise a clear mechanistic solution. IME, it isn't nearly so cut and dry. If you can get through your day without chaos, I'd investigate this last.

For now:

Consider cutting caffeine. It isolates one variable and should improve sleep. I won't sugar coat this, this is awful for a week or two. However, you'll get back good data quickly. Sleep is a miracle drug.

Consider following a balanced diet of whole foods with a tiny caloric surplus. Whole foods and sufficient calories are the goal.

Supplements: vit-D+k, zinc, and magnesium are the most common deficiencies. Might want to wait until after the blood panel. Creatine 5g per day because almost no harm, many potential benefits. L-citrulline (malate is fine). May improve blood flow at 10g per day. Glycine for sleep. NAC works for some to clear brain fog. Can also allegedly cause anhedonia (did neither for me). Prob some others but the supplement world is waaaay overhyped imo.

One-crazy-thing: Carnivore diet. Never tried it. Seems insane. The good: It's simple (but not easy) to adhere to. It's an elimination diet so fewer variables. Its radically not the same, perhaps resulting in different outcomes. Wide anecdotal support. The bad: most support is anecdotal. Its wild. Diarrhea for a week.

Again: have a bias towards experts in person, but keep the initiative. Its your life you're free to experiment and deviate. Best of luck.

I've had this problem for a full decade now, so I've tried all the things you mentioned. Did carnivore, ingested a weird chemical powder from China, got blood work, etc. If none of that works, you're left alone to theorycraft some possible cause. Hence the post

Oooof. That's rough. Yeah, I'd say you're at the theorycraft stage. Add some info to your post. I'm still unsure exactly what your symptoms are, how they present, your clinical history, and current status.

I'm stumped, and this is way beyond my pay grade anyhow. I perused the "The Mechanical Basis of ME/CFS" post. Interesting stuff from deep down a rabbit hole. And from your other comments its seems like you know how things work. Best of luck!

One thing that can be helpful in situations like these is something which programmers call "rubber duck debugging". The method is to put a rubber duck (real or figurative) on your desk and then explain your problem to the duck. Quite often, the solution to your problem becomes obvious.

I think you've completed the first step by writing down your problem here.

Now, what does the duck say back?

What would you say if someone else told you this exact story?

I'd suggest they go find a doctor or a bored med student, but it's hard getting an audience with those guys, so we're forced to solve weird medical puzzles ourselves.

Mf just ignoring me right here, with all the solicited and unsolicited medical advice I dish out for free.

That's it, I'm going to get Zorba to implement micropayments and a blockchain so I can bill you all.

(But as I said above, I'm not touching this one, psychiatry is built on One Weird Trick like talking to people and making them feel better, resetting their brains with electrical currents, supplementing neurotransmitters when we know there isn't actually a deficiency, fucking ketamine yada yada. But those are Weird Tricks that scale, and I'm betting this doesn't)

The caffeine would contribute to the insomnia, especially if consumed after noon. Can you try the same routine with less/none, or earlier in the day?

Sure. When I'm not experimenting with some routine, it seems that caffeine has a negligible impact on my sleep. But really, in my "normal state" the effects of most drugs are far weaker -- it takes me a lot of alcohol to get drunk -- so maybe one of the improvements was increased drug sensitivity, and I received the full impact of the caffeine which caused insomnia. That's a good suggestion, I'll give it a try. Thanks

I just got back my results for the exam I just gave to enter Psychiatry training in the UK, and I am extremely whelmed.

Back when I first decided to go down the route to becoming a doctor in the UK, the competition ratio was <1, basically there were more open vacancies than people to fill them. And now, it's about 4 something, so you need to scrabble your ass off to make it. So the one thing I desperately desired got about four times harder since I began the long, tedious and expensive process for questionable payoff.

Anyway, I did well. A score, which if I did the maths right, is about 64th percentile. Why do I have to calculate this myself? Because the company contracted by the NHS, Pearson and by extension, their website, Oriel, is trash, and managed to bungle the onerous task of ranking people in a CSV file/Excel spreadsheet.

So, I am officially better than the average British doctor in the mad scramble for positions. Yay me. Unfortunately, that may or may not be good enough for a seat, given that 3500 people are fighting for maybe 400-600 of them.

The silver lining is that since this exam is the sole gatekeeper for Psychiatry, but also a requisite for other subjects like ACCS and Anaesthesiology, there are plenty of people who apply to psych and GP alongside because they have nothing to lose (other than a few hours of filling up horrid forms). If they're significantly better than me, well they're likely to match into their desired subjects and leave their nominal psychiatry slot vacant, and I might get in. This means a good fraction of the 1300/3500 either get something they desire more or would turn down a seat in psych even if they were accepted, whereas all I want is to do that one blasted subject.

Unfortunately, it seems that Manchester is unlikely to be an option given my score, and I never aspired for London in the first place. Too expensive, for one. I can only hope that I end up qualifying for a place that isn't in bumfuck nowhere, where the primary presenting complaint happens to be BAA (beastiality-associated anxiety), a significantly overlooked concern in Wales and Scotland.

For fuck's sake, I would appreciate some clarity as to whether or not I'm in or out. Now, I have to wait for an official score and then the weeks or months of preferencing, matching, reserving, upgrading, and all the other rubbish that follows. That takes long enough that I might end up studying for Round 2, in September, which I would have to anyway if it becomes clear it's a lost cause.

But it isn't clear. Not yet. Now I stew and fret, and wonder if I should consider studying for the even more abominable version that is the Indian residency exams. 4:1 competition? Nah fam, more like 40.

I did decent. About as I expected really. It ought to be a confidence booster, but I am also incredibly fed up of it all, especially the enormous amounts of time it takes. The curriculum is vague, half the exam is pure guesswork and ass pulls, I did much better in the actual Clinical Dilemmas section than the SJT (turns out advocating for Dr. Stephen Hawking MBBS to roll himself off a cliff instead of bothering me wasn't the correct answer). The study resources have only vague similarities to the actual exam, and nobody knows what the fuck is going on.

At any rate, I have to thank @Throwaway05 for bearing with me when I was badgering him in the DMs, but some gratitude is owed to everyone listening to my meandering descent into insanity.

As usual the UK is different than the US so I don't know enough about what's going on here but some things likely hold true:

-Above average for a physician, on any type of assessment or metric.....is impressive as hell. These people are study psychopaths and you have your neurodivergence etc. Good. Fucking. Work.

-Have some caution with respect to specialty trends, these can turn on a dime and if you don't have a good source of intel you can miss out on wild swings in competitiveness (for instance in the US Psych went from not competitive at all to tough as hell to average, all in the span in 3-4 years. Advisors mostly missed this and left people high and dry). Sometimes it's better to swing the bat and not worry (shit, does that also work for Cricket?*).

-Ruralness. This one I can definitely comment on(ish). There are a handful of cities in the US most Residents want to be in, and approximately 10,000 places they don't want to be. Thanks giant ass continent. Normally when I'm advising students I'll tell them to rate location higher than they think. Not wanting to shoot yourself because you have fun things to do during your limited fun time is more important than higher salary or academic prestige. However higher than you think doesn't mean it's the whole list. Training is short, career is long, and the UK is small. As long as you have flexibility after you are done then you can live with wherever they put you and then leverage yourself into a better position later.

The reason I tell people to be in a big city is that you don't have too much time during training so you want to have access to easy fun. The flip side is that if you are in a shit location you don't have a lot of time to regret being in a shit location, and when you have vacation you can just travel where've you need to go (again, uk smol).

You might be concerned about training quality in a rural area and this is real, but psych isn't surgery. You don't need physical practice doing a Whipple, you can catch up on knowledge gaps through training and studying resources pretty easily. You also likely get to avoid the truly annoying patient populations (like malingering homeless) that a big city will be flush with, and rare shit like autoimmune encephalitis is still rare enough that you wouldn't see it in London or wherever. You will need to eventually learn how to deal with bread and butter homeless malingerers and decompensated psychosis but because they are common in a city setting you'll figure it out quick when you move to one.

At least I think, for all the above there. I don't know the UK well but I imagine some of the trends are similar to how it is here for that sort of stuff.

-I meant to reply to a post but didn't, so I'll ask here....how do you deal with all the hackers in Tarkov?

*apologies for blatant stereotyping.

Above average for a physician, on any type of assessment or metric.....is impressive as hell. These people are study psychopaths and you have your neurodivergence etc. Good. Fucking. Work.

❤️

(It's 64th percentile for all the MSRA applicants too, not just Psych, which is heartening. These are proper lads and lasses with GMC registration)

I did study my ass off, if it wasn't obvious I was on the verge of absolute burnout haha. What makes me even more pissed is that most of that work was utterly irrelevant, you'd think the examiners were taking the piss if you saw the questions I encountered, and not just the SJT part which I've complained about enough.

For example, NICE guidelines recommend urgent referral for malignant hypertension with papilloedema to prevent further end organ damage, and in the question where I had such a patient, the options included "admit" and "refer to _ specialist".

Mf, is that supposed to be an urgent referral? Is it implied that we're going to admit them first to get the hypertension in check before bleeping someone?

So many questions like this, with vague options. The majority of questions were maybe 2 or 3 sentences long, whereas all the MCQ banks give you whopping multiple paragraph cases with little tidbits and clues inside. I would like to say that the additional difficulty and challenge helped me prepare, but as far as I can tell, it didn't, that particular question was the only one where the megabyte of guidelines I memorized was relevant, and even then the answer wasn't clear.

5 questions in a group where I'm pretty sure the answers were all bacterial vaginosis (though maybe one could be a misplaced tampon, not that I'm quite sure how you can lose one of those in there, but I opted for BV).

It all makes one despair, what on earth can I study to improve on that? And the SJT is.. I won't repeat myself.

So I fervently hope I manage to land a place this go, as I am frankly unsure how it's even possible to improve further. Maybe read more neuro, which I skimped on, but that's about it. No childhood rashes, no paediatric milestones, none of the supposedly high yield topics except gyne, and even then it was just BV.

Have some caution with respect to specialty trends, these can turn on a dime and if you don't have a good source of intel you can miss out on wild swings in competitiveness (for instance in the US Psych went from not competitive at all to tough as hell to average, all in the span in 3-4 years. Advisors mostly missed this and left people high and dry). Sometimes it's better to swing the bat and not worry (shit, does that also work for Cricket?*)

For what it's worth, the sudden ramp up in difficulty seemed to come as a surprise to even the UK locals. I will work on the assumption it'll only get more difficult, if I am cursed to have another go. Besides, I haven't found anything else I like :(

I haven't swung a bat in ages, I find both cricket and baseball to be remarkably boring sports, at least in the former the spectators get more cardio than like all but 3 of the players.

Ruralness. This one I can definitely comment on(ish). There are a handful of cities in the US most Residents want to be in, and approximately 10,000 places they don't want to be. Thanks giant ass continent. Normally when I'm advising students I'll tell them to rate location higher than they think. Not wanting to shoot yourself because you have fun things to do during your limited fun time is more important than higher salary or academic prestige. However higher than you think doesn't mean it's the whole list. Training is short, career is long, and the UK is small. As long as you have flexibility after you are done then you can live with wherever they put you and then leverage yourself into a better position later.

I think both my training and my career are going to be short, for the usual reasons we discussed heh. I suppose that disagreement can only be resolved with time, not that I wouldn't be exceedingly happy if I manage to be a Real Consultant™ 7 years down the line.

You might be concerned about training quality in a rural area and this is real, but psych isn't surgery. You don't need physical practice doing a Whipple, you can catch up on knowledge gaps through training and studying resources pretty easily. You also likely get to avoid the truly annoying patient populations (like malingering homeless) that a big city will be flush with, and rare shit like autoimmune encephalitis is still rare enough that you wouldn't see it in London or wherever. You will need to eventually learn how to deal with bread and butter homeless malingerers and decompensated psychosis but because they are common in a city setting you'll figure it out quick when you move to one.

That's what I suspected and it's good to have some confirmation! I'm not worried overly much about the quality of the training, just QOL in general, but psych is still supposed to be chill, and the fewer hobos going for a needle the better.

The UK is small enough that I don't have to worry particularly much about getting about, though geographic proximity would certainly help maintain the one relationship I've got going. And there's family in the bigger cities, not particularly close, but better than nothing. It's not too big a deal, I am sick enough of studying the 3 odd years since I finished my MBBS that I'll take any training post with the word psychiatry in it (though not in India).

If my USMLE woes are resolved, then I'll phone it in at work with LTFT, going from 80% hours to as low as they'll let me before they realize I'm not showing up at work at all, and if I do manage to pass it and match I'm going to firebomb the GMC building and catch the first flight out. But that's not a given, and so to that particular damp island I go, for now.

Thank you, as always, for the excellent advice, it's too early to celebrate quite yet, but if I'm being honest I think my odds of matching are >50%, and worst case it's another 6 to 8 months gone.

It may not be satisfying per se but some of the oddities of medical examinations come from a very well-defined place (well if it’s like the USMLE anyway).

-Specific pieces of data one specialty wants to convey to another. “No ortho you really do need to know this about the ‘beetus.”

-Making things harder in a way that assess actual knowledge and understanding instead of fact recall.

Those are two of the biggest. Also repeat questions are often stemming from the whole “experimental questions” aspect of the exam.

Making things vague, removing buzzwords. This means you have to actually UNDERSTAND the stuff instead of just memorize facts or guidelines. You need to know the why and what of currant jelly stool instead of just recognizing it in a stem and slamming down on the answer.

I swear to you with time and space you’ll find that some of the stuff is more reasonable than your experience of it felt like.

Except the SJT, fuck that toxic horseshit.

Put another away:

Ideally at some point you’ll be doing a boards question or some other assessment and you’ll have this experience of “I don’t know the answer to this question but my knowledge is sufficient to understand what the answer should be based off of other things I do know.” I’m not quite sure I made that come across the way I wanted to but hopefully you’ll have the ah-hah moment at some point.

Thing is, it's not like the USMLE, I attribute the oddities of this exam to incompetence rather than malice attempts at making questions that get at in depth understanding of medical matters. The SJT alone should be sufficient evidence to back up that claim.

The questions were easy, at least in terms of diagnosis, and I understand scenarios where one has to use limited information to make a snap judgement come up regularly, and vagueness is not necessarily inaccurate to real life, it was the fact that they designed questions that ranged from "why did I even study for this" to "choose between two plausible options with insufficient information to decide between them". Admit? Admit and do what? Refer? Urgently or not? That's critical, and without it the question becomes a matter of guessing, especially when a lot of it hinges on the particulars of where you see the presentation. It matters a great deal whether your nominal location is in a GP practise, or they're showing up at the ER, and in some cases that information was both relevant and absent.

I can't say I know much about the USMLE (given that it would be an entirely academic curiosity for me, right now), but the PLAB exam was significantly better in that regard. Clear curriculum, an understanding of core competencies to cover, better written questions. I can't even say the MSRA by itself was harder, both had the typical pattern matching red currant stuff too, but this exam made me feel like I went to get a driving test and then ended up forklift certified. The difficulty comes solely from the fact it's competitive for limited seats, whereas that's far less of a factor for the PLAB. I'd rather have a hard exam where I know how to prepare than an "easy" one where I'm at just as much at a loss as anyone else.

Ideally at some point you’ll be doing a boards question or some other assessment and you’ll have this experience of “I don’t know the answer to this question but my knowledge is sufficient to understand what the answer should be based off of other things I do know.” I’m not quite sure I made that come across the way I wanted to but hopefully you’ll have the ah-hah moment at some point.

The missile doctor knows what the right answer is by knowing what it isn't eh?

PS: Tarkov cheaters. You learn to live with them. And don't go Labs, if you can help it. I play on Singapore and occasionally Chinese servers, so I'd imagine I have the worst of it, but avoiding Labs and Lighthouse (except for quests) will keep you mostly safe. And eventually you'll be rich enough that dying to a cheater every dozen raids or so is the cost of doing business.

Given the general state of the U.K. I am entirely amenable to the idea that the exam is just absolutely fucking retarded, but I do want emphasize that it's probably just a tinge more likely that they are doing something on purpose, potentially with a heaping dose of "I don't like this."

Sometimes it's straight up "this seems like a stupid question but it seems to correlate with exam performance so..."

I don't know if this exercise is viable for India, but one exercise I have students do towards the tail end of clinical is look back at their first year exams, you'll see clinical correlate questions mixed in with basic sciences questions and at the time they are enormously frustrating "why the fuck did they ask about that" is a common refrain, but if you come back at the end of clinical you'll see that it's common, or a necessary concept to reinforce and so on.

The SJT for instance is stupid, but it's placed there with quite a degree of deliberation, just the two of us hate it.

Congrats on the solid score. I don't think I've ever replied to one of your posts on test prep because I don't really have anything to add, but I'm happy for you nonetheless. Good luck on the next steps!

Not as solid as I'd like, but it's still respectable, especially for a first attempt at an utterly fucked exam haha. There's a decent chance I'll get in somewhere, even if it's not perfect, and after 4 years I'll have the opportunity to sit yet more exams (depressed party horn) and then sub specialize, which could entail upward mobility. And worst case, I could still take that CCT degree and head to the Middle East for better money, if that becomes a crisis.

Thank you, it means a lot to me that there are people quietly rooting in the back.

It seems to me that a smaller town would be a good thing for a doctor from a poor country, no?

Salary will largely be the same (or possibly even higher) and living expenses will be as low as possible. You seem like a guy that's mostly either at work or at home anyway so if you want to do something in the city you can always travel there.

It seems like a pretty good deal when you're starting out.

London sucks the life blood out of the rest of the country. The only other cities I'd call respectable would be Manchester and Edinburgh, not that I've exhaustively traveled the country.

I'm unabashedly a city boy, and not so poor that I consider the lower COL to be a driving factor. London would be tight, but I am best described as the poor son of comfortably well off parents (at least by Indian standards).

However, posts in bigger cities have advantages too. Looks good on your CV. More opportunities for locum work, which pays market rates and is thus often double to quadruple the paltry standard NHS wage.

And while I am a homebody, it's not like I don't leave the house at all, and a bigger city = more and interesting friends to drag me out of my shell.

Sadly the working conditions of NHS doctors makes taking regular trips to the big city a luxury at best, but I plan to work 80% hours if possible, which gives me a free day off during the week (to fuck about or to locum for actual money).

That might prolong the period of my training, but the salary cut is not nearly 20% because it draws from a higher tax bracket.

Not that it's the end of the world, just potentially mildly unpleasant, and you're right that I'll be too busy to really notice or care.

Right, and large parts of provincial Britain are so poor that the town doctor is one of the richest people there, which isn’t necessarily a terrible place to be if one doesn’t care about the amenities of the big city.

What is the recommended dose of vitamin D supplements? I've seen cited doses between 50 and 600 IU but I've read that this are actually severely underestimated.

As for buying supplements, can I just buy some random brand on amazon?

Just to add to the others - since I've gone from 0 to 2000 to 4000 and then 10000 IU/d, I've seen increasing benefits. I'm a lot more awake even with less sleep, for one. I want to say "more energetic", but that's a low bar for me. I also haven't gotten a cold since, but it hasn't been that long.

I am having the strongest sense of deja vu..

Look, start at 5000 IU daily. Recommended daily intake is 7000 IU but that includes dietary sources and the 🌞.

I can't be arsed to hunt down the citations I provided last time, before the site was Thanos snapped, but 600 IU is, to put it bluntly, fucking useless. 50 IU? Does it come in homeopathic packaging? It ought to, ya know.

Go big or go home. Or better yet, we all go touch grass, it needs sunlight to survive so there should be some out there.

I am having the strongest sense of deja vu..

I read the comments of the previous week but then the Great Disappearing happened😂

...but 600 IU is, to put it bluntly, fucking useless.

Dosing confusion is frustratingly common. Do you know how hard it is to cut a 5 mg melatonin pill into 16ths so you get the right amount?

This is the real shit.

After a certain point it gets easier to crush and dissolve tablets in water and then pour it out. I don't know if that works for melatonin, but you could use a grinder and make a slurry in the worst case.

But melatonin dosing is god awful for the opposite reason as Vitamin D, as you seem to be aware.

It’s hilarious that we as a society take far too much melatonin and far too little vitamin D, seeing as they both regulate sleep. I’ve found myself sleeping like a morning person (not tired for three hours if I wake at 7am) since starting on D before work. (I don’t take melatonin at all, and drop off within five minutes of bedding down.)

At what point do you have to worry about taking too much? I was under the impression that vitamin D is fat-soluble rather than water-soluble, and so it takes longer for your body to get rid of any excess.

From my comment vanished into the ether, the typical recorded cases of excess Vitamin D supplementation (manifesting as hypercalcemia) involved 60k IU daily for several months.

You need to mistake them for gummy bears and have a real sweet tooth to end up going that far. I have never heard of such a case, all the seniors I asked have never seen one in recorded history.

It's an exceptionally unfussy medication, that's not going to happen naturally, the only issue is with people being prescribed uselessly low doses, which is sadly far too common.

It's an exceptionally unfussy medication, that's not going to happen naturally

Which somehow doesn't prevent The Establishment here in Finland treating it like something where going even slightly over the official recommended (ridiculously low) dose causes immediate and strong side effects.

It's the same thing with protein supplements. It's always about how "So and so many grams of protein is all you could possibly need or benefit from. Remember that there is no reason whatsoever to ever get more."

Wow. So the 10k IU (250 mcg) D3 I take daily is almost certainly no big deal? Maybe skip a day or two each week?

It is about as safe as it gets when it comes to something you can ingest.

If you want, you can get a blood test every few months to see if you're within the normal range and adjust accordingly, but I would not worry about it.

Yes, you convinced me last time. Interestingly it seems hard to find good estimates for the IU you get by spending time in the sun. One estimate says that with near full body exposure (so a bathing suit) you get 10-20,000 IU from the midday summer sun in 30-60 minutes. But obviously that isn’t the default. How much do you get if it’s just your face being exposed? How about the winter sun? Online evidence is pretty vague. I’ve increased my daily supplement dosage in winter to 6,000 IU for now.

You're asking the wrong person, I spend an entire day in a closed window climate controlled hospital and have blackout curtains at home. I haven't seen the nuclear fusion reactor in the sky for a good while yet.

Besides, it's also affected by things like skin tone and sunscreen use, getting firm figures is difficult, and the advise for supplementation is universal, at least in the UK. I would expect it to be a factor largely irrelevant when it comes to dosing.

I would also like to know the answer to this. I just started taking 5000 IU personally. Since many people take 10,000 IU for years without issues that seems to be a safe amount. A white person would get at least that much (and possibly much more) from a pre-modern amount of sun exposure.

High levels of Vitamin D in the blood are correlated with all sorts of positive health outcomes, but so far data on the value of supplementation has been mixed. It's quite possible that these studies are using too-low levels of supplementation. 400 IU?! What is that - a supplement for ants?!

Another possibility is that sunlight might produce a higher level of bioavailable Vitamin D or that sunlight has other unknown benefits which are correlated with Vitamin D but not caused by Vitamin D. For that reason, I deliberately tan during the summer months, taking care not to burn or to get sun on my face and neck.

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