It's really not the doctors charging crazy amounts, it's the hospitals. MBA types got into medicine and squeeze it like any other industry. GI does a scope? Doc gets $200 for doing the procedure, facility gets $5k for a facility fee.

A lot of DOs go to Osteopathic medical schools because getting into MD schools is crazy competitive. It’s just another path to becoming a doctor that’s an option if you don’t get into a US MD school. The medicine curriculum is basically the same between the two. Though I’ve worked with a bunch of DOs who believe in osteopathy and practice it.

An opthalmologist is an eye doctor. They go to medical school and do a residency for extra training. Optometrists have doctorates in optometry meaning they do four more years of school after their bachelor's. They can call themselves doctor because in the US that's the convention for doctorate's (in Europe ony medical doctors use the term). There's avast difference in intensity, depth, bredth, etc. of training between the two. It's easy to miss the difference if you're not familiar with the system.

Amazon drivers (the ones in budget or Amazon cans, not flex in personal cars) do okish. I just quit working for a third party company Amazon uses to shield them from liability and unions because it's miserable work but the pay was $22.50 which isn't too bad. The workload is crazy, it's all rush rush rush, and they don't care about you at all though so fuck them and Amazon. The drivers would appreciate the tip, they're generally hardworking and decent people.

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.

I can't speak for every hospital since I've only worked at a few but this is rare. Some places might still be doing it, dumping people who can't be placed or don't have insurance, but EMTLA was put in place to combat that stuff and the lawsuit and probably fines would make this a bad move. We've kept people where I work for months because we can't place them or psych won't take them. At minimum they're going to a nursing home.

McKenzie method for low back pain is a starting point. It’s stretching, maybe strengthening I can’t remember. Hip flexors, hamstrings, calves are usually tight and can cause back pain. The front and back of the legs have to be balanced or they’ll pull your pelvis out of neutral. Modern day sitting doesn’t do us any good, tightening all the posterior compartment muscles in the legs.

Core strengthening is important for good posture. Being aware of your overall posture is also really important too. Yoga is fantastic for stretching, posture, and strengthening.

Caveat: sometimes it’s structural and this stuff may only help somewhat but chronic pain is treated with multiple modalities. If this stuff doesn’t improve it significantly along with NSAIDs, follow up with your primary care doc.

How I know: I’m a physician who screwed up his back and had to figure all this out and now I teach my patients how to treat their back pain. I also use physical therapy liberally because it’s fucking awesome.

Fucking not 9lbs that's for sure. Around 1/2lb usually.

Reuters 10:09 ET 02/26/2024

UPDATE 1-Intuitive Machines stock plummets after moon lander tips over

Fantastic headline this morning

So I'm a physician and I support most things people do to import their health but I do try to make sure they're fully informed. In terms of fasting, this cohort study found an adverse association between fasting and cardiovascular death. There are limitations to the study (self-reported diet, etc.) but it followed 20,000 people for 8yrs which is pretty good. Definitely need more study in this area, especially considering the complexity of human metabolism. Here's the highlights from the study but the full text is available at that link:

• People who followed a pattern of eating all of their food across less than 8 hours per day had a 91% higher risk of death due to cardiovascular disease.
• The increased risk of cardiovascular death was also seen in people living with heart disease or cancer.
• Among people with existing cardiovascular disease, an eating duration of no less than 8 but less than 10 hours per day was also associated with a 66% higher risk of death from heart disease or stroke.
• Time-restricted eating did not reduce the overall risk of death from any cause. An eating duration of more than 16 hours per day was associated with a lower risk of cancer mortality among people with cancer.

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."

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.

Couple of things it could be:

1. You locked your knees without realizing it, shut down the blood return from your legs, then had a drop in blood pressure due to decreased blood return to your heart causing you to pass out.
2. You took a big hit, expanded your chest, held it, decreased blood flow through your thoracic cavity due to the increased intrathoracic pressure then a blood pressure drop as above.
3. Your vasovagaled yourself somehow (bearing down on a held hit maybe or just due to weed effects) which is increased parasympathetic nervous system tone that drops blood pressure
4. Some weird shit 🤷🏼‍♂️, the body can be odd and changes as we age so maybe you just can't smoke weed now cause of the earlier mentioned weird shit

I agree with your doc (I'm a family med physician), don't smoke if all of a sudden you're passing out.

Mmmm I’m a primary care doctor and I wouldn’t worry about low T. It’s natural for it to go down with age and the data doesn’t really support TRT. A lot of guys are obsessed with their testicles, sex drive, etc. though so they ask for useless testing.

I’m not your doctor so take this all with a grain of salt since I can’t evaluate you through social media but how’s your mental health? Maybe you’re self medicating with masturbation. Probably best to follow up with your PCP.

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.

I'd love to switch too since I use proton mail and their VPN but the auto sync option on Android using Pcloud and AutoSync is a necessity for me. If they can get added to AutoSync, that'd be great but not sure if it's feasible. I'd switch instantly if it was.

Good hoodie section for quality stuff made in Canada or the US (I didn't check them all). Didn't know about Camber but I'll probably hey something from them. The work pants are dope too. Just bought some from Epaulet and American Trench and digging them.

I've been using Autosync for years with good results first with Drive and Dropbox and now Pcloud. Supports a lot of different cloud services though not Proton which is why I haven't started using that yet.

Autosync

I just got a 8BitDo pro 2 because every PlayStation controller for the last 4yrs has broken in less than 6 months and it's great. Feels good, connects over Bluetooth, and has Hall effect joysticks that aren't prone to drift, which was the Sony controller main issue. All for $50. I think I'm done with Sony controllers.