Lurker > NightingaleMD

CSCA33 posted...

I wonder if he also needs to know more about the etiology of being gay

.....yes?

Knowing why anything happens is valuable. It's not offensive. It's helpful. Why does heart failure happen? Why do some kids get juvenile arthritis and end up in a wheelchair? Why does schizophrenia develop, and why is there a hard association with cat ownership especially around age 9? (For real, a wild systemic review just came out about this)

And why did you put etiology in quotes? Do you not know what it means?

How is it harmful to know why something happens?

DnDer posted...

A lot of words to just tell CSCA "no."

I didn't say "no."

Wishing more was known of etiology does not mean, "no."

I also wish more was known about etiology of pulmonary fibrosis but I'm okay with them getting lung transplants

Knowledge is never a bad thing and helps guide future care

If it makes people happy and it's supported by policy, go for it

DnDer posted...

No. It's that your answers showed you were incapable of providing proper medical care to patients who came into your ER or office.

Dunning-kruger

The board should strip your license if they ever heard about how you treated your patients the way you told us you did.

Dunning-kruger. Jesus, you make it sound like like I'm just killing people left and right

You shouldn't be managing anyone's care but your own. Maybe not even then.

Okay

CSCA33 posted...

Do you support gender affirming care for trans children?

Depends on how you define "support."

Personally, this feels like something that needs more research. The confounding psychiatric conditions I see on these patients make it difficult at times to assess. This is such a controversial area I won't say anything further beyond my wish more is known about etiology of gender dysphoria.

But if you mean "support" in terms of professional work, my opinion is irrelevant. I have very rigid guidelines to enforce. If I get a letter from their psych doc saying it's okay, I see good documentation of the gender dysphoria, continuous hormone therapy usage (depends on age), and a few other things I approve surgery.

The hardest requirement to meet is "exclusion of incongruency." This is hard to meet since it becomes a cart-before-the-horse phenomenon. Ie, I had a case where one doc documented a 14 year old wanted reassignment because she was angry at her parents. I don't know if that's true but I can't by policy approve if someone documents that.

These are pretty rare anyway but can involve over 100 pages of chart to review. Even one thing out of line like what I mentioned can derail the whole thing.

Same for any procedure, really. It's not a secret that insurance companies don't want to pay for things. Personally I think that's a part of the overall Healthcare problem but what do I know...

And I feel like I've derailed this topic enough so I'll step out.

DnDer posted...

We remember your last "honest" look at healthcare. Your purg was earned.

I don't understand this logic. I truly don't. Whether you like me or not, I'm an expert. I'm board certified in emegency medicine. I'm a medical director of a national insurance company. I am an expert of managed care (medicaid/medicare policy).

Again you might not like me, but there can't possibly be a person here that understands how healthcare works better than I do.

You just don't like my answers. I didn't make a system that incentivizes profit. I just work in it. Pays the bills.

I'll not engage in debate, but I will ask you to Google the dunning-kruger effect. Confidence is very high when knowledge is very low. That's the reason half my patients would tell me I'm wrong or explain some made up medicine to me works better than antibiotics.

Hell. I've only been doing this for less than a year in my current role and some of the bureaucracy is still overwhelming (and i think InterQual was made to punish). So how you know more than me is mysterious.

I used to be an emergency physician and now work as an insurance director

I have so much I want to say about this as one of the few people that can expertly speak of the situation

Not worth another purg though as it involves an honest look at Healthcare

I'll just say I don't agree with some of what is said in this topic for nuanced reasons and things posted as response here shouldn't necessarily be taken as fact

I miss free speech

Whole situation is a bummer tho

Such vague

What detail

Zikten posted...

It's because of how much power Police Unions have. And something called Qualified Immunity which makes cops virtually unaccountable no matter what they do. American cops only have like 6 months training and then are given power over life and death

In Germany I think it's multiple years of training to be a police officer. It's insane that America doesn't see a problem here

You're increasing barriers to entry

keep in mind, being a cop here now means being under the microscope. A lot of cities are having a problem with filling open positions.

So you can either

1) have inadequate officers
2) have no officers if you increase barriers to entry

While there's a sizable "defund the police" movement, I personally am a fan of having police. A semblance of law and order is better in my opinion than anarchy.

it's a broken system for sure but no one here is exactly coming up with realistic solutions, so....

RAGE OFFFFFFFFFFFFFF INFERNOOOOOOOooooooo

Great show

where does it actually say horny posting isn't allowed

I must have missed this

taking away free speech is one thing

boobs, another

DrizztLink posted...

He's also an "insurance doctor" who's oddly comfortable with diagnosing public figures over the Internet.

I have eyes

And the title is medical director thank you. Prior authorization, medical necessity, reviewing hospitalizations, all the boring things most docs ignore but honestly better than clinical work imo

Dat_Cracka_Jax posted...

He was a Vivek supporter

Now all about haley

Still hoping she pulls it out at the convention somehow. Or if trump goes to jail first or something. Contrary to what people say I'm conservative but not pro-trump/MAGA at all.

Nothing wrong with changing viewpoints. Politicians demonize "flip flopping" but realistically I'm more suspicious of anyone that gets a polticial viewpoint at age 10 and keeps it until 90

[LFAQs-redacted-quote]


That probably depends on your goals, which I didn't clarify. I'm a big fitness enthusiast myself and couldn't possible use a "set of dumbbells" to accomplish any of my goals. Bench pressing pressing is my aphrodisiac and getting to 405 takes a massive, multimodal push to achieve, especially since my frame isn't exactly built for it.

But I can refine my answer and state if someone wants to "casually" exercise I suppose it's reasonable and indeed better than nothing.

I go a gym. Never saw a point in home exercise equipment unless you're insanely wealthy with a full service gym in your house.

Wife wanted a Peleton bike. She used it 5 times. Two years later I threw it out and I'm pretty sure she still doesn't know because it was in a room in the house she doesn't use

Hes definitely gonna win

Dems gave it away by keeping biden

Bummer

Food is a right

Internet is not

Tanthalas posted...

What kind of medicine do you practice? Homeopathy?

Currently, insurance medicine. It's a broken system but being an insurance medical director has a better future than being an emergency doctor.

[LFAQs-redacted-quote]


My bad

hockeybabe89 posted...

Let me tolerate a party that plans to fucking murder me and is corrupting my own family against my wellbeing. No thanks.

People who tolerate intolerance are worthless pushovers

So you have an excuse to be rude and profane and everyone else doesn't

I'm sure this logic tracks in your mind but I do ask you at least consider perspective rather than cognitive dissonance to allow you to be just as hateful but from a different ideological standpoint.

Otherwise you're just left saying you're better than everyone else, which ironically is the radical rights view, and that's why no one gets along anymore.

I didn't attack you or use profanity.

hockeybabe89 posted...

No one gives a fucking shit what your opinion is on anything. Close your fucking account

A message from the tolerant left I keep hearing about, no thanks

Heineken14 posted...

No. You're wrong. Not agree to disagree. You saw what you wanted and you're wrong.

I saw a stiff gait, limited range of motion at shoulders, shuffling, no longer wears dress shoes and wears sneakers when wearing a suit, and limited facial expressions, all consistent with parkinsonism (note I don't say Parkinsons, but clearly there is some obvious dopaminergic signaling consistent with a serious progressive disorder) combined with significant word finding difficulty and disinhibition when talking off prompter.

But that's just the medical side of me talking. What do you see?

ClayGuida posted...

Yes, he's quite coherent, has a noticeable stutter, but is pretty concise with delivery a message.

The alternative however, jesus that's a word salad mixed with a brain fart.

Agree to disagree

We don't see the same thing

I'm not saying trump is fully there either

I dont think either candidate is, and biden is worse (trump is more with it, you just don't like his ideology, which is a separate question from competency)

Heineken14 posted...

Please explain how the left has "lost their marbles."

Have you seen the president talk

Off of a teleprompter

Mecha_Sonic posted...

through your teeth.

Democrats don't support their leaders the way Republicans do. that has a serious impact on enthusiasm. it's fucking lame bro.

Dems did this to themselves.

All biden had to do was let go of the reigns of power. A successor would easily beat trump.

But he couldn't. He just couldn't. He disguises it well but is just as power hungry as trump is.

And we all have to suffer for his greed

This probably comes down to economics

20% of gamers being LGBT means 80% aren't

Marketing to the 20% isn't profitable

Gotta be honest, judge me however, not interested in playing "gay themes." It's just not my thing. I doubt I'm alone there.

Catering to minority views is a way to crater sales

So really no story here

I was going to say processed foods and free radical damage from bad diets combined with record-breaking obesity

I feel my answer is more technically correct but i see your point

Site has nothing of value. As a globalist I doubt he's even thought about it

KaZooo posted...

Like Feinstein, I'm thinking the guy was a mere vessel in the end, and now the GOP has no use for him with a new front man to take his place.

improper comparison

Feinstein was essentially mentally gone and clearly didn't even know where she was by the end. Her handlers were on video telling her what to say during proceedings. She never gave an unrestricted interview in the last several years of her life, likely shielded by supporters for that very reason.

Mitch clearly has problems but profound cognitive decline wasn't it.

Glad he had the personal insight to step down from a leadership role.

And to all those celebrating this: keep in mind sometimes the devil you know is better than the devil you don't. His replacement is likely to be more radical, though the house has this problem moreso than senate as radical populism/right hasn't swept the senate in the way the house has been struck.

Never understood the hate for watchmen

And I don't want anyone to explain it

Read the GN

Saw the movie

Both are good

[LFAQs-redacted-quote]



Hopefully you mean type 2 or his doctor is committing malpractice.

This is from Semaglutide/Ozempic's official indication:

Use: Labeled Indications
Diabetes mellitus, type 2, treatment (Ozempic, Rybelsus): As an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus; risk reduction of major cardiovascular events (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke) in adults with type 2 diabetes mellitus and established cardiovascular disease (Ozempic only).
Weight management, chronic (Wegovy): As an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in adults with an initial BMI of 30 kg/m2 (obesity), or 27 kg/m2 (overweight) in the presence of at least one weight-related comorbid condition (eg, hypertension, type 2 diabetes mellitus, dyslipidemia) and pediatric patients 12 years of age with an initial BMI at the 95th percentile standardized for age and sex (obesity).

And separately, as a contraindication:

- Diabetes mellitus: Do not use in patients with type 1 diabetes mellitus or for the treatment of diabetic ketoacidosis; not a substitute for insulin.

This is all very intuitive if you know the medicine well. Type 2 works with this medicine because this increases insulin sensitivity in people that are insulin-resistant.

It cannot be used for type 1 diabetics because Type 1 is an insulin deficiency (usually auto-immune destruction of pancreatic cells responsible for making insulin). So taking a drug to make your body more sensitive to something it doesn't have is illogical.

More likely than your doctor committing malpractice is you not knowing what kind of diabetes your father actually has. Or maybe you made a typo. I did that already just writing this. Easy to do.

This whole thing would be invalidated if the makers of Euthasol would just give in and let prisons buy it.

There is literally a drug that is used on animals that works 100% humanely and frequently used on animals. It's a powerful barbiturate mixed with a seizure medication and in high doses completely disconnects your brain from your body and causes immediate loss of consciousness followed by no respirations. No animal ever appears to suffer when given.

Unfortunately states try to do fancy cocktails and weird shit like this when better methods aren't available.

Or just go back to the guillotine. Seems pretty effective too

Mew posted...

Were most of them family-owned pit bulls?

Yes. "random dog attacks" are much, much less common than the dog the child is around 90% of the time.

I don't have actual statistics. I only have my own personal experience with dog bites. Maybe what I see is more or less common. Whatever it is, it's always sad, especially when a child is involved.

I saw countless pitbull attacks against kids in my clinical years

Almost (not quite) every single one of them--Owner said dog had never done "anything" before.

People don't realize killing machines don't kill...until they do. You can have that dog 2 days, 2 months, 2 years or more and one day it'll just rip some kid's face off.

Or, maybe it won't. Either way the animal is banned in my household and my kids will never have one.

Irony posted...

Ozempic is used to treat diabetes, one of the side effects helps with weight loss. Shut the fuck up.

*type 2 diabetes.

Not type 1. You contradict yourself by not realizing type 2 is a "lifestyle" disease.

DM2, much like diverticulitis, is what you call an "artifactual" disease: ie, it is not natural and prior to 100 years ago was extremely, extremely rare. Happy to educate you about the history of the illness or the difference between type 1 (true genetics) vs type 2 (I don't know how else to say this other than lifestyle-induced).

There are indeed some genetic variations but please be aware a doctor is telling you to look up and verify DM2 was a very, very rare disease a long time ago. There is a reason.....

Daremo posted...

Fuck this mentality.

You like going to the gym? Good. Do that. Enjoy it, get the most out of it.

Not everyone likes going to the gym. And your response to that should not be, "Suffer, fatties!".

People have to live their own lives, and most of them aren't going to revolve around the things you like. If someone doesn't like going to the gym they should feel free to take whatever alternative steps they want to maintain their health to the degree they want.

This sneering superiority serves no one and and aids nothing. You're supposed to be a medical professional? Quit. Unless you can grow some empathy and lose the narcissism.

Um

I did

I work administratively now

I don't miss the days of working with 6-8 other people to move an unconscious 700 lbs sack of potatoes from stretcher to ED cot

Random fun fact: the state worker's compensation department is putting out an RFP for projects to reduce work injuries while moving obese patients. People are literally getting so fat healthcare workers are injuring themselves moving those patients around at rates creating substantial workflow gaps!

And again, their care is completely different. Ever tried intubating a 500+ lbs man/woman? it's incredibly dangerous and can easily result in the patient dying. People may indeed "have their own lives to live," but if they live so unhealthy they injury others they are a financial burden to society, this is fact, sorry

Iodine posted...

I wouldn't expect a PS6 until 2028.

Then can someone explain the "end of life cycle" comment

cuz 4 years doesn't seem like that

pinky0926 posted...

* now it's at the end of its life cycle, apparently

um

wut

did I miss something

Although one of my fans is making a wonky noise so if a PS6 is coming out soon I'm fine with this

Horrible invention to make society even lazier

"there's a pill for that" is the bottom-of-the-barrel of avoiding putting effort into anything

Get surgery

take pills

do anything, anything at all, other than take responsibility and make personal life changes

Even before med school or I knew anything about health, I've always prioritized physical activity. I build my daily schedule M-F around WHEN I get to the gym. Everything else is scheduled around this.

*insert 1,000 excuses*

Very political.

As much as people don't like trump, he can't possibly be "last." James Buchanan holds that distinct privilege. He literally did nothing or possibly even encouraged a civil war. You can argue trump tried to do that, but the fact is it didn't work and there wasn't an actual, all out, brother-vs-brother war between states during the trump administration.

Probably lower quartile but last is just politicking.

Oh man

Those t 45 are kinda nice. All political messaging aside.

Unfortunately that's not possible and I'd be killed wearing them

I found out about this from a friend that bought 3 of the gold ones (to invest and sell)

Dancedreamer posted...

No it doesn't. It literally doesn't. I hope someone has pointed this out already, but it literally says 61% want him to run again.

He wasn't even on the ballot in New Hampshire, and he won a write-in campaign handily. He got 64% of the vote without even being on the ballot.

Oh sorry. Anyway that was old data, here's newer data with higher numbers. Thank you for correction. This says 73% of dems say he's too old to run. See if there are any incongruities here I suppose.

https://abcnews.go.com/Politics/poll-americans-on-biden-age/story?id=107126589

[LFAQs-redacted-quote]


This 100% killed Pete. He actually had quite a few presidential checkboxes. Maybe he didn't have the biggest administrative roles but as transport secretary he now fills it.

Unfortunately finishing with....1%? I think it was? Of black vote makes him unelectable.

Kind of sad considering he's essentially a younger biden ideologically.

havean776 posted...

Yes I deny you are a doctor.

Hard to argue with facts. Dunno what to say.

I can actually help any other doc do insurance medicine if they like. It's actually a pretty easy field to get into.

I started by doing medical necessity work as an IC as a side gig. Used that to buff my CV and approach my health system to be a physician advisor to help determine inpatient vs obs status payments. Insurance companies value that experience because I'd have to argue with an insurance director to get payments.

Then I just used all that to apply for an insurance director spot. Gonna do my time for a few years and apply for a regional position. End goal is to be CMO of one of the bigguns.

But, of course, I just made all of that up.....?

havean776 posted...

Also a "doctor" who does not understand how the USA healthcare system works.

That's the saddest post in the topic. You don't like my opinions to the point where you just deny what I am?

I'm literally the best person on this site to ask about healthcare. The. Best.

Not only for my years as an emergency physician but also in my current role as an insurance director. Not only am I an expert of healthcare I am very much a cog in the machine turning the gears of healthcare. MCG/MTUS all day, errryday

Will_VIII posted...

Who did you vote for in 2020?

I voted for a local levy and some city counsel folk/school board. Believe it or not, there are things on the ballot other than president.

I thought Trump as president ("outsider") was an interesting experiment and voted for him in 2016. I voted for neither in 2020 since I didn't care for either candidate. At the time I was leaning towards biden but his...decline...has been precipitous and I'm further from him now for that reason exclusively in 2024.

So this year once again I'll just be voting locally. I don't want to vote for either and will just accept the outcome as is. If DNC is smart Biden will win and immediately step down to settle all questions of competency to make way for Harris. If he doesn't, more talk of the 25th amendment will predominate, I predict...

--Zero- posted...

To clarify, TC is a known MAGA and anti vaxxer. This is just concern trolling.

I like vaccines and I don't support MAGA

you saying otherwise doesn't change this, but okay

Will_VIII posted...

What the fuck do you think he's referring to then?

Who cares what he's referring to? Speeches are not laws. Laws are laws, and this one hasn't even been signed yet.

Will_VIII posted...

Multiple lies in this sentence

That's a poor retort. I gave you a description of the bill that I linked to and said what you said was in it...wasn't.

I won't respond with gifs or retorts just facts, sorry.

Will_VIII posted...

https://m.youtube.com/watch?v=YwXwjG9093E

Pay attention more "doctor"

I asked you about a bill, not a speech, "user"

Guide posted...

None of this has any basis in anything true. Giving you the biggest possible benefit of the doubt, you're a reasonable person who bought into all the false axioms of right wing talking points.

Like, to be clear, there is an immigration policy, and it's not letting everyone. If you really believe "no policy let everyone in" to be the case, you have been lied to. What is your source, exactly?

I'm unclear why I'm being attacked for being more knowledgeable about this than anyone here.

HR815 increases funding for asylum officers, increases legal immigration, allow afghan asylumees to to seek citizenship, provides alternatives to detention and expands detention especially for those that do not have reasonable grounds for asylum and specific restrictions for when crossings are > 4,000 people averaged over a week.

There are litany of other details but that's it in broad strokes. It does not "close the border" as someone stated. It does not address aliens in the US without a legal status.

Most importantly it does nothing to address the root cause of migration to begin with, an entirely different topic.

But please, tell me more about how little I know about this bill due to drinking MAGA koolaid?