drknownuffin

The 'fake' price is due to the negotiation of reimbursement between major healthcare chains and insurers. The most regulated piece - Medicare - is the only piece where there's fairly transparent pricing.

I have no words for how completely toxic the surge of PE in healthcare has been. It's driven the degradation of care everywhere I've been. Healthcare chains have no issues with investment (see any annual reporting document to see how much money is sitting in various investments, mostly RE); smaller clinics being eaten up by PE chains is not an answer to centralization, it's just another mechanism of it.

Basically a wrapper around hackmyip, which is itself just reliant on the xposedornot db.

I'm not worried about hallucinations in this context at all.

I think he's saying that his use of the site, via the LLM, is consistent with what the site owner-operator likely desires.

To give a concrete example: I am a physician and have a site for my private clinic. I am not only unopposed to being scraped by bots/LLMs, I prefer it. The only value I gain from users being on my site is referral to my practice, and that same information being surfaced by search engines and LLMs just means I'm getting in front of more potential patients.

To one degree or another, this is endemic among nurses. It's part of a broader cultural element: nursing programs have entrenched a culture of nurses vs. doctors. There are literally questions on their licensing exam to the effect of "which of these orders from a doctor should you refuse to enact?" (rather than, say, "which of these orders should you contact the doctor to seek clarification on?" or some other collaborative take). Nurses are taught their job is to protect patients from physicians. Given they don't have the expertise to do that , the general result is more broadly a power struggle in the guise of patient care.

Future pregnancies.

I don't really understand where this notion comes from. I've used Slack; I've used Teams; I find Teams more than adequate for my organization's use-case. I'm sure that's not the case for everyone, but "Teams is complete shit" is such an odd over-generalization from my vantage point.

Post-viral myocarditis / pericarditis usually occurs in the days to weeks (up to about a month, generally) following a viral infection.

I've never seen that, but I guess TIL. Can you please provide a link to one?

Boil=and-bite only provides cushion between teeth. Sleep apnea mouth guards are designed to thrust the jaw forward, so as to mechanically assist in keeping the airway open. They're so very different in effect and structure that if you feel you're benefiting from a boil-and-bite, you've almost certainly mis-attributed something somewhere.

I second this statement.

Russian Folk Belief by Ivanits is a good one.

My understanding from my readings in the field of mythology is that the parent post is precisely correct: Campbell was an enthusiastic amateur who did a whole bunch of cherry-picking to suit his passionate holding-forth on the topics, but without systematic study.

If he was alive today, he (still) wouldn't be a PhD, but he'd have a YT channel, a vigorously active twitter page, and maybe have penned a couple of D&D modules.

OB is ridiculously stressful, in an antagonistic kind of way.

1. A good subset of patients have wildly unrealistic ideas about pregnancy and delivery, and when their ideas meet reality it's not always reality that wins.

1.B. You will be the target of their ire whenever their desires are not fulfilled, because patients seem to think docs are actually in charge of something at the hospital. We usually are not.

2. It's wildly litigious. Their child was perfect (in their imagination) before being born; then you got involved, and now their child is not perfect. You must have fucked something up in the delivery and ruined the perfection of their child.

3. Way too much family involvement. When you're doing surgery, you're usually dealing with a patient's attempts to understand what's going on. When you're doing OB, you're dealing with the patient, the husband, the mother, mother-in-law, etc. Each person will come up with their own distorted vision of how things should be, and when it doesn't align with reality, the doctor is an idiot who doesn't know what they're doing. (Doctors are not perfect - just people - but it seems like every single person without medical training seems better equipped to identify the proper medical course of action than a physician is.)

4. Lots and lots of on-call time. Lots of unexpected interruptions and lots of drop-everything-and-drive-to-the-hospital.

5. There used to be good money in it. There isn't now, which makes all of the above grate on one's nerves.

The results of the above really add up to demolishing the spirit of OB/GYNs. Points 1-3 really make you feel like you're persistently at war with patients, which is the worst feeling ever. I've never been on anyone's side but the patient's, and having them treat me like an enemy ruins my job, and ruins my ability to do my job.

I ultimately chose to pursue a niche thing that shares a name with an existing medical specialty, but is a distinct niche. I can't really identify it without doxing myself, so forgive me for not.

My immediate thought was that this was a repost from an event earlier this week. But no, apparently this is another noose.

In the US, growth charts for peds are already built into every EMR I know of. But even that isn't particularly nuanced: I want different charts at different ages based on, for instance, whether the kid is bottle or breast-fed. The difference will impact an interpretation of being under- or over-weight, and using the wrong ones can create the appearance that the kid is dropping off the growth curve at around two years old (which is to say, without context you can't even interpret just the trend itself). The EMRs aren't even at the "IF feeding==bottle, display.curveA; ELSE display.curveB" level of sophistication.

Which is another way of saying "even where it looks like the numbers matter unto themselves without context, nope, you still can't meaningfully interpret them without context."

Yes, let's clarify a few things. For starters, I'm a physician, and have formerly worked in health insurance at the management level. I assume your comment was aimed at someone at a different level of familiarity with the topic. I'd be happy to re-evaluate my understanding of your comment if you'd care to clarify with the newfound knowledge that I'll understand a more nuanced argument, if you care to provide one.

Responding to what you have written, however:

1. I provided a direct explanatory mechanism for how physician reimbursement caps lead to low-quality auxiliary services - by pointing out that investing in an activity or service that provides no marginal revenue is a strictly money-losing proposition. You assert, without mechanism or evidence, that this is strictly due to "for profit insurance." You need to clarify how the insurer, and their profit motive, creates this result - as the mechanism I put forward simply requires that the physician is has a fixed fee schedule and is at capacity volume. I won't go so far as to assert you should take my word on it, but you could do worse than listening to a doctor say "this is exactly what's going on in my and my friends' practices."

2. The majority of healthcare dollars in the United States flow through Medicare and Medicaid. Given that these services reimburse quite a bit lower in dollars/service than for-profit insurers, they actually make up a larger volume of total services rendered. I can't argue with a statement as vague as "usually a for-profit entity," but I can state more precisely that it "will be a non-profit entity for more than 50% of services and more than 50% of reimbursed dollars."

3. Minimizing loss ratio has nothing to do with what I said at all. If you can put forward a mechanism that translates my front desk expenses into reduced MLR for the payor, I'm listening with open ears. Look at this thought experiment: let's say my insurer's MLR stays flat, and I can accept a 100$/yr subscription fee from all of my patients to improve front-desk service, with the caveat that I'm taking a profit off the top. Would the insurer care? No? Is there anything the insurer's payment processes would do to affect this? No? Then the issue is my profit motive, not the insurer.

4. The convoluted payment processes are there to aid the insurer in sorting through their giant piles of paperwork (you didn't think that administering a health insurance network was low in bureaucracy, did you?) and, more cynically, to create pitholes for us to step into so patient care is denied reimbursement. You're going to have actually, again, provide a mechanism by which that translates into "Doctor doesn't improve services offered." Because I can tell you that if the bureaucratic hurdle that is insurance billing doesn't step me from billing in the current environment, then it's not going to stop me from billing for higher amounts if I could get them.

Way to oversimplify.

Some healthcare is vital (emergency intervention for heart attacks), some healthcare is grey-area quality of life (do I need glasses vs. LASIK?), and some healthcare is pure luxury (cosmetic). These are not all created equal.

Additionally, removing the profit motive has its own consequences. Ever notice how the front-desk staff that serves as your docs' connection to the rest of the healthcare sector generally suck? Try to get a preauth, or a drug renewal, or an etc. There's a reason they suck: if your doc is working with a price ceiling (as most are, due to health insurance if not due to socialized medicine), they have a hard cap on their annual income for the year. The difference between a 2/10 and a 10/10 service staff doesn't make a single extra cent of income for the doc, but they have to pay the difference in salary straight out of their annual take-home. How many docs are going to get an 80K/yr front desk vs. a 40k/yr front desk just out of charity?

With existing tech? No, not really.

Most of those lab values are more or less worthless outside of context - which is why so much time is spent on training docs on physio, pathophys, and history taking. I know that it's frustrating to hear, but it's why every "helpful" tech solution to date has resulted in increasing doc griping and burnout.

Thank you.

I think it's a poor mechanism because "appeared once in a pop magazine" isn't a good signal for knowledge curation regardless of whether you assign it a positive or negative weight; especially when the original comment implied (to my reading) "the topic has only surfaced once, therefore the existing knowledgebase is only one study."

The existence of a single study in pop literature is a very poor predictor of whether the study was accurate or not, and a very poor predictor of whether there are other studies on the topic. So I think it a mistake to substitute "it has come to my attention once" for "it has only been studied once."

What country were you in? In the US, a nurse is highly standard.

If you're not getting a c-section, the usual array is: OB/GYN, plus or minus a resident or assistant, doing the delivery and doing any post-delivery laceration repairs; and a nurse who brought in instruments and is on hand to assist with repositioning the mother, getting more equipment, etc. In most places it's 1-2 nurses. If everything is expected to be, and remains, stable a pediatrician will swing by at some point to check in. This isn't generally a major source of referrals for the pediatrician - (a) many people have already established a relationship with a pediatrician in anticipation of the birth, and (b) in many reasonably sized hospitals the guy who drops by is either a hospitalist or a neonatologist, and they don't have an outpatient practice. Anesthesiologist may drop by to start an epidural, but otherwise isn't present on a continued basis.

If in the OR for a c-section, you'll have the OB and a resident or an assist; one nurse just looking after scrub and tools; a second nurse on hand for additional assistance and to receive the kid for the initial clean-up; an anesthesiologist handling your anesthesia; plus/minus a med student or two either holding instruments for the OB or speaking with the anesthesiologist. If everything is and remains stable, peds will swing by. If the kid is unstable or things go sideways, peds +/- their resident will be on hand for the delivery - a neonatologist if the hospital has one.

I've seen some variation in different places of course, but that's pretty much par for the course.

(When I was in the latter part of med school I had a brief fling thinking I'd do OB/GYN, so I did sub-I's in a few different hospitals around the country. Thank god that idea passed.)

Skin-to-skin is standard. Skin-to-skin for unstable neonates is not, which is the debate in the medical field and the question that the study sought to answer.

Skin-to-skin for children has been studied for a few decades, and the consensus is strongly in its favor, after a pile of studies have all pointed in the same direction.

This study isn't "skin to skin care is good." This study was aimed to answer the question, as contextualized, "We have established that skin-to-skin care for healthy children is good (pile of studies); for unhealthy children that have been stabilized is good (pile of studies), but is it good for kids that are still unstable? (controversy)"

"I'm skeptical of a single study" is only a valid criticism if you're familiar with the body of scientific literature. Otherwise, what you're actually saying is, "I'm skeptical of results that pop magazines and press releases have only surfaced to my attention once" - which is a shoddy mechanism for curating your knowledge.

I have a little kid. When we watch cartoons, they might point at the villain of the piece - e.g., Jafar - and say "he's a bad man!"

And I take the opportunity to nudge them and ask, "They did a bad thing. Does that mean they're always bad? Can they make things better? Should we forgive them? How do we know when to forgive them?" (not in a single tirade; these are just questions I drop over time.)

Because, in anticipation of the fact that they're definitely going to fuck up along the way, I want them to learn that mistakes and failures and even doing bad things don't make them irrevocably bad - that ultimately, the most important thing is making amends / trying again / etc. That your worst decision is not the sum total of who you are.

I don't see why I should try so hard to teach that to my kid, and then "disavow" friends who may have fucked up.

Now. There are already hedge funds purchasing land based on this idea.

The issue is, as OP demonstrated, that this has nothing to do with your interaction with social media.

Social media was the connective tissue that gave rise to the internet mob, but neither the OPs behavior on social media, nor his response on social media, had any impact on the outcomes. Nor were the outcomes limited to affecting his social media presence. As per the original article, OP got nailed for comments from a twitter account he didn't run, and whose true owner publicly confessed to owning it.

That is, just because you walk away from social media doesn't mean that social media has walked away from you.

I don't see how that would have helped OP. He wasn't called out for things he said or did on social media, barring a few people who piled on over extremely "sanitized" exchanges.

I think your "best solution" aligns well with what the OP appeared to be doing, and he still burned.

It's important to note that just because the mob forms on social media doesn't mean its consequences are limited to social media.

I wasn't trying to make a barbed comment, I just couldn't think of another label to put on it.