CrackaAssCracka

Fortunately CMS is rethinking the role of primary care and realizing we can save money if we're able to provide high quality preventive care like we're supposed to. PCP service payments (RVUs) are up 18% since 2020 which has been a long time coming. Unfortunately physician pay is down vs inflation over the last few decades but thank Christ administration salaries are way, way up over the same timeframe.

Schwab app works for me on Graphene and that's my main bank/stocks app. I've found I don't really need all my credit card apps or my other bank app. I check once a day if that and just keep a bookmark. It hasn't been bad at all.

Oof this is definitely wrong. A blood thinner is one of the most important things whether a patient is taking or not. It's the nurses job to let the doctor know whether the patient is compliant not only for medical reasons but for documentation. That's outside the argument about profit in healthcare in US, that's basic medicine. What if that patient falls and hits their head? Do we need to know if they're on s blood thinner? What if they're hemoglobin starts dropping? What if they need a procedure? What tif their platelets start dropping? Etc, etc, etc.

Don't be a dick and not do your job, that makes your coworkers miserable and puts people in danger especially in medicine. I agree with burlit being and issue and chronic understaffing but be an adult and quit or move positions if you don't like it.

What about the 19yo I saw today, with a BMI of 62, who's so far stuck in the cycle of self loathing, inactivity, depression, and pleasure seeking behavior that he can't see a way out let alone start creating himself a new reality? What if I have a drug that I'm pretty confident can help him lose 200lbs? Is it ethical for me to not prescribe it because "he should be able to do it on his own?" How many people do you know who have done that? Out of the hundreds or horribly obese patients I've seems, I have tow that have done it with diet and exercise. We have not evolved for a world where 20,000 calories costs $20 and is available 24/7.

I agree we need to be cautious with these drugs since long-term adverse effects aren't known but the long-term effects of obesity are well documented. I have backed off on pitching these drugs since I learned the companies making them have infiltrated the obesity research community in the US (because of course they did). They're still an amazing tool in the fight against an obesity epidemic which has many, many different contributing factors li ok e trauma, depression, mental health issues, upbringing, genetics, etc, etc. it's not as easy as "just don't eat so much."

It's not that CPR doesn't work, it's that outcomes after resuscitation usually aren't great. The study doesn't disclose ages or neurological outcomes post-rescuscitation so that limits my interpretation but quick rescue and quick CPR is key in those acute, single reason emergencies. That isn't to say in an emergency situation you shouldn't try especially since you don't know that person's wishes. There are good outcomes but usually for underlying healthy people who had one thing go wrong. Think the athlete who's heart stops on the field for some reason.

I've admitted at least a thousand people into a hospital through the ER and I tell everyone that it's not like on TV. If you're older, sick, multiple chronic diseases, don't take care of yourself, etc. the chances of any kind of quality of life after CPR is limited. Death is terrifying and I understand them wanting to try but it's just not realistic a lot of the time. We need better deaths in the US and more in-depth end-of-life conversations with our patients. That should be starting in the PCP's office. Trying to discuss that with a patient in the ER who's already scared isn't ideal. I've seen patients with do not resuscitate/do not intubate orders on file change their mind when they're suffocating and panicking then once they're more stable immediately change their mind back.

That makes sense. I don't think there's been a moment like that in the podcast, the DM keeps expectations in check.

I'm a casual D&D fan since my only exposure is from Not Another D&D Podcast but I think it adds to the overall story telling experience. Super charges the lows and highs if it's a 1 or 20 especially on an important role. Does it break the game? Eh, not that I can tell and I've listened to hundreds of hours of the podcast. Though this is my opinion and not based on D&D rules, history, etc.

I also highly recommend Not Another D&D Podcast if you like silly shit mixed with crass humor, some good emotional content, and players fucking with their DM.

Gave Fallout 76 a shot again after trying it early in it's release and quitting due the travesty it was (also because I was disappointed in Starfield). It's good now, very similar feel to 4 though with some differences. It's a Fallout game so not perfect but the feeling of endless possibilities you get when stepping out of the vault for the first time is classic Fallout.

I won't say every doctor is innocent of ignoring legitimate concerns they hear from patients but your argument is missing context. Subjective symptoms from a new patient or one I know doesn't fret over every somatic sensation they get in their body? Sure, I'm looking into that deeper. Coming from my known anxious, health obsessed patient who wants evening done all the time? Nope, that's a conversation and possibly some blood work just in case/to reassure. I can't give everyone a million dollar workup, it's inefficient use of resources and usually unwarranted. You have to listen to your patients, they give you a lot of useful information, but you have also have to be healthily skeptical at the same time.

I just finished Breath of the Wild and was thinking I wanted a zkorok for around the house. I'd definitely buy the drunk Korok

Listening to Making Money, read it a few years ago. Pretty good though I'm not a huge fan of the voice actor doing the reading. it's tolerable though. Pratchett is what got me into sci-fi and fantasy, he'll always be one of my favorites and always holds up when I go back to something of his.

If you ever want to go further, pathology as an MD or DO would be perfect. Sounds like you might work with them already. Med school is difficult, annoying, and expensive though.