domain:asteriskmag.com
ebrso
8m ago
More research has shown pretty wide outcome disparity and things like a dramatic increase in costs from the NPs (due to unneeded referrals and excess testing, the later of which is often a direct harm to the patient).
Here's an example link: https://www.ama-assn.org/practice-management/scope-practice/3-year-study-nps-ed-worse-outcomes-higher-costs?utm_campaign=Advocacy
It's worth noticing that this source is from the AMA, which is an American physicians' group that lobbies to protect American physicians' class interests, including preventing mid-level health care professionals (NPs, PAs, etc.) from encroaching on practice areas seen as reserved for physicans. The url itself identifies this article as part of an advocacy campaign. The article highlights:
The AMA is advocating for you [American physicians] The AMA has achieved recent wins in 5 critical areas for physicians.
That doesn't necessarily make anything it says wrong, of course. But I'd expect the article published by the corresponding NPs' association to emphasize different observations and to reach different conclusions.
No_one
13m ago
Crime is still lower than it was in the 1970s-1990s pretty much everywhere in the 1st world
Not true. It's comparably low in the post-Soviet provinces, but quite a bit higher in places with a lot of immigrants. So the entirety of Western Europe, Scandinavia.
Don't be so parochial.
FiveHourMarathon
You can get anything here except red ink
14m ago
Reminds me of Jubal Harshaw
Now let me get something straight: you are not in my debt. You can't be. Impossible - because I never do anything I don't want to do. Nor does anyone, but in my case I am always aware of it. So please don't invent a debt that does not exist, or before you know it you will be trying to feel gratitude - and that is the treacherous first step downward to complete moral degradation.
Robert A. Heinlein, Stranger in a Strange Land
Skibboleth
22m ago
An enticing thesis in other contexts, but not here, as they are clearly speaking in reference to people who have American citizenship who feel they didn't deserve it and given the broader context of their conversation.
as in this week in DC and already elsewhere, voting
Also part of the ancient traditions of America
ebrso
22m ago
From the article
One professor said that a student in the operating room could not identify a major artery when asked, then berated the professor for putting her on the spot.
She knows literally less than a decent butcher.
The qualifier major is carrying a lot of weight here. There are thousands of named arteries in the human body, ranging from the aorta (which every medical student in clinical rotations really should be able to recognize, at least when it's exposed to plain view) to tiny branches that exhibit tremendous variation across individuals, and which even the absolute best students (and expert physicians) won't be able to reliably identify in cadaveric dissection (never mind in the operating theater). Viewing angle, anatomical posture, and similar (physical) factors can also make it much easier or harder to identify individual vessels.
So, even if we take this anonymous source's claim at face value (i.e., we assume that some incident occurred in which a medical trainee failed to identify a "major" artery on request, and then reacted badly), how should we understand the term "major," and why do we assume that there was a clear presentation? (And of course, one case, however egregious, doesn't establish a trend.)
WhiningCoil
44m ago
Well shit, then I guess learned helplessness is the only possible answer. Not using the eyes in your skull to perceive that the veggie tray is categorically different from the canned "Hearty Vegetable Stew" with 30 added grams of sugar, along with more unrecognizable ingredients than not. It's all processed! Nothing to be done about it.
The_Nybbler
Does not have a yacht
48m ago
You westerners have no idea how to deal with these culturally disruptive peoples and the rubber band will snap back soon.
The thing about rubber bands is that if you stretch them too much, they don't snap back; they break.
2D3D
51m ago
For all the talk about Biden and Obama keeping the border secure by performing border rejections and spinning up ICE, no one ever acknowledged that Biden was seen by migrants as the opening of the gates. Migrants are motivated to gp to the USA by promises made to migrants such as DREAM and sanctuary cities, migrants are drawn to europe by weakness and riches for the taking.
The irony of developmental economics is that as western aid becomes more efficient at making poor countries richers, it just gives them resources to make a trip to the promised land. Refugee laws were made when only neighbouring countries would flood your border, now you can get a trip on Air India to Canada or get coyotes to set up food and water and transport on your way to the promised land. The only thing that will stop migrants flooding borders is the rejection of any benefits to these people, including NGOs hiding them from police and illegal work. You westerners have no idea how to deal with these culturally disruptive peoples and the rubber band will snap back soon.
Highlandclearances
54m ago
My top questions are:
- what is the outlook for net migration? Are we likely to see a return to the high pre-pandemic level of ~600,000 per year
- is migration the “Irish question” of our times in that it will destroy the Conservative Party as the Irish question destroyed the Liberal Party?
- is the Conservative Party ideological or even conservative at all?
- what is are the long-run chances of the Reform party? It looks a lot like the Peoples Party of Canada which has basically collapsed as COVID ended.
Botond173
1hr ago
"Boyfriend back in their hometown" is a nonsensical category anyway. He's not your boyfriend, because in a practical sense you aren't together. If you actually had a boyfriend, you wouldn't be attending parties without him.
Botond173
1hr ago
"men I don't already know aren't allowed to speak to me"
It's just the usual shit. Women in general want fried ice (this is supposedly an old Arab proverb, although I have my doubts about that as they likely had no concept of ice.) They want to jettison the patriarchy because it's oppressive and whatnot while at the same time preserving aspects of it that benefit women. It doesn't work.
MaiqTheTrue
Zensunni Wanderer
1hr ago
I think in general for me, I want people here who generally want to contribute, are loyal to America over their home country, and aren’t net drains on resources. So I’d want people to learn English, get a job, and put down roots.
MaiqTheTrue
Zensunni Wanderer
1hr ago
Mostly the one weird trick stuff works on two pillars. One, it requires you to pay attention to what you eat. If you’re doing Paleo, you can’t just go buy something that sounds good, you need to read the label and evaluate the ingredients. That alone is a huge help. Second, because the market hasn’t yet caught onto the trend, there aren’t boxed versions of that diet’s foods available. If you were doing Paleo or Keto or Gluten Free when it first became a thing, you had to get the foods and cook them yourself. That eliminates most processed foods from your diet. In early Keto, before the food manufacturers started making hungry man keto foods, you had to get real fresh chicken or steak, real vegetables from the grocery store, and cook them yourself. So you’d end up making marginally better choices even if the new fad diet was based on unicorn farts.
2rafa
1hr ago
Processed foods are a meme. Washing and cutting up counts as processing for the FDA. It’s a ridiculous standard.
MaiqTheTrue
Zensunni Wanderer
1hr ago
We do. We’re rapidly approaching 50% obesity. We eat like crap and don’t exercise and that by itself I think lowers life expectancy by at least a decade. Add in stress and it’s like nobody should be shocked by the American life expectancy. It’s like asking why the car where you never change the oil needs more repairs than the one that gets regular maintenance.
2rafa
2hr ago
Residency is irrelevant. Even if you make the argument that US medical training and residency is vastly superior to Canada/UK/Germany/Australia etc, the US can and should simply skim off the top 20% of those countries’ trained doctors (who are surely at or above the American standard). They don’t because of the AMA cartel.
MaiqTheTrue
Zensunni Wanderer
2hr ago
I get that, and I’ve seen people do it in toxic ways. I just don’t see it as something that always and universally applies to everyone in all situations. Sometimes I think self-improvement ideas can overfit just because the techniques are developed for those settings are developed to rehabilitate the sick and don’t necessarily carry that baggage for those who are not sick. I want to learn formal logic and statistics because I think they’re useful tools for understanding the world. I want to write stories because it’s an interesting and fun hobby. Saying I should study in the context of self study to better myself, or I should work out so I don’t have a heart attack at 50, or I should finish my short story— these don’t necessarily have anything to do with other people.
What’s somewhat worse to me is that in some cases, that kind of assumption can end up being just as much of a guilt trip as the original “should” thought. If everything you tell yourself you should do is really about meeting other people’s expectations, then why do anything to improve yourself? Why exercise if you are only doing it to impress others? Okay, but then you will probably end up obese and are in poor heath. Why finish that story if you’re only trying to impress people? The alternative is another failed project that you started and didn’t finish and then you feel like a loser because you don’t actually do anything. Why learn? The alternative is that you live in Sagan’s demon haunted world where you can’t make good decisions because you have no idea how anything works and don’t have the tools to figure in out.
I think a lot of mental health advice ends up that way: designed to help people with severe problems, and works pretty well there, then gets applied to the general population and not only doesn’t help, but can create the problems that it was intended to prevent. Asking whether you’re doing something to people please is reasonable if you have a severe problem people pleasing. But for most people, shoulds are what gets them off the couch and into motion and doing things that they really should be doing. You should accomplish things. You should study and build a career. You should keep up your house or apartment. And on things like ruminating on your feelings, for normal healthy people, this can make them feel depressed because they focus on the negative feelings produced by events in their lives and over time talk themselves into anxiety and depression.
ControlsFreak
2hr ago
The crazy pill is that most medical interventions don't matter that much for lifestyle disorders, either, because for the most part, they can't undo the damage from our lifestyle diseases. I was just listening to this podcast with a couple MDs, and he was talking about chronic conditions generally, and a bit about obesity, specifically:
We don't really have the infrastructure to help with prevention, so you talked about how in medical school, we didn't have a single course on dying. We also didn't have a single course on nutrition or exercise or stress management or the psychology of eating and our relationship to food and how you can help patients make better choices with nutrition and things like that, so I don't buy the narrative that we have an obesity crisis just because people are fat, dumb, and lazy. I think that we live in a toxic food environment, and we don't have a healthcare system that's really geared to help people out of it, because frankly, physicians aren't compensated to do that. You just don't have the billable structure in which you can do these things, so instead, I think we focus on where our tools are, and our tools are drugs. Drugs become a good tool to use in a chronic condition setting.
Moreover, they often have patients who don't want to change their disordered lifestyle and wouldn't carry through with doing it even if the doctor had training and a billable way of doing it. So, they sort of default to, "When the chickens come home to roost, I guess we'll give you a drug to help manage your symptoms somewhat."
Walterodim
Only equals speak the truth, that’s my thought on’t
2hr ago
More or less, yes. Despite my position above that I don't think of there being much of a crisis of competence in medicine, that's precisely because there are standards that everyone has to meet. Some professions are basically fake in terms of actual technical knowledge and people can get by with a combination of improvisation and charisma; my impression is that people in these jobs sometimes mistakenly believe that all jobs work that way, and it just ain't so. Things like medicine and engineering have irreducible complexity, where you actually have to know each part of it and be able to use that understanding in practice. Physicians require more actual knowledge than marketing executives.
MaiqTheTrue
Zensunni Wanderer
2hr ago
You are what you actually do, not what you say you are going to do.
It’s a paraphrase of the Last Psychiatrist. The basic idea is that the modern world encourages people to adopt an identity and ideology. You might identify as an athlete or a thinker or a writer or an artist. But a lot of times, it’s about the aesthetics or about being seen to be like that because you see it as cool or interesting or something that other people will like about you. But the quick way to see if it’s actually true of you is to look at whether or not you’re taking action. Are you actually writing or drawing? Do you actually donate to those causes? Do you actively seek out knowledge? And very especially do you do it in ways that you aren’t being seen doing those things? Protesting doesn’t really count, nor does writing or drawing in public places — that can be done to show off. But if you’re doing those things alone with the door closed, then you might be that thing.
MaiqTheTrue
Zensunni Wanderer
2hr ago
Animals are in a sense easy mode. Animals generally don’t want anything beyond food and water and a nonabusive environment. They don’t really have demands beyond that. They don’t judge you or your life, they don’t complain, they don’t make demands, they don’t do things to annoy you or anything like that. People are the opposite. They aren’t happy with the bare minimum. A kid will turn up his nose at the dinner you made. A kid will complain about his cloth not being to his liking. A spouse will complain about the size or upkeep of the home. People judge you all the time. And they know just how to make you made.
I understand the sentiment of “if someone abuses animals, they’re bad news. I just see the cause a bit differently. Loving a being with no needs beyond the basics, one that doesn’t judge you or do things that annoy you, that holds no strong opinions you oppose — that’s easy mode. If you can’t be kind to a creature that exists to be a living teddy bear (which most modern pets are) then you probably have even worse behavior towards the people who do disagree with you and do judge you and do make demands and are annoying.
But I tend to almost give negative credit to people who brag about being kind to animals. It’s not really that hard.
MaiqTheTrue
Zensunni Wanderer
3hr ago
I’m hoping this isn’t a required thing. I can understand compassion for individual students struggling with this stuff, I can understand telling other kids to be nice to people who are LGBT+ and even explaining how that works (age-appropriate and mostly in high school sex ed courses) what they do. But I think it’s a completely different thing to have the school district hold essentially a protest in favor of a political issue. That’s not educational. Education should be about learning and seeking truth, not politics.
ArjinFerman
Tinfoil Gigachad
3hr ago
Crime is still lower than it was in the 1970s-1990s pretty much everywhere in the 1st world, and everyone who can actually remember the bad old days knows this
Are you sure this isn't more of a US / Anglosphere thing? Sweden went from a left-wing meme about the glories of social welfare and prison rehabilitation, to a right-wing meme about the dangers of immigration. Data from any country that has the guts to record the ethnicity of criminals tends to show that whatever crime they have, is mostly attributable to immigrants.
The only people who see brown faces on the streets and assume that crime is out of control are American racists.
What is this bit supposed to bring to the discussion? If it turns out you're wrong, are you going to admit to your racism, or does it only go one way?
MadMonzer
Temporarily embarrassed liberal elite
3hr ago
Then again San Francisco exists so perhaps I am wrong.
When I was in SF, the derelicts who were making the place unlivable were far more likely to be black-looking (i.e. presumably ADOS blacks) than any of the immigrant groups people are complaining about. If I had to guess, I would say the second-largest subgroup were white American druggies.
You have to wonder how accurate a record they have of murders in Haiti though. One part of the murder rate is just the ability of the state to gather accurate statistics and discern murders from accidents etc.
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