It was a legitimately nonprofit hospital and he probably was overpaid, but at least he was a practicing physician at one point and did seem to give a damn about his staff.

I once worked at a hospital in the ER where the department director was a union-busting bastard, but the CEO was pretty reasonable. After I left, one of the other ER techs went to the CEO about our pay being messed up and got everyone $5-6/hour raises to actual market rate. Also, there were a few weeks when we were really understaffed that the hospital encouraged admin folks to volunteer as “candystripers” in the ER to do stuff like help clean/turn over rooms, and answer patient call lights for water, blankets, etc. And the CEO was down in the ER for a couple hours every evening helping out most of that time period. It was encouraging to see the CEO of the hospital putting on some gloves and helping us with basic stuff like cleaning and stocking.

The problem with AI and poorly educated professionals is not the ability to diagnose and treat based on evidence-based medicine. The problem is that you have to know enough about medicine, and enough about real human people to know what kinds of questions to ask in the first place. If nothing else, there is a massive amount of information gained from a patient’s body language, mannerisms, behavior, and the physical exam itself that would be extremely hard to quantify in a meaningful way for someone without the background education and experience to come to any useful conclusions.

Were I in any other field, I might agree with you, but given that I am in the medical field, stupidity and incompetence cost real human lives and I cannot tolerate that if it can be at all avoided.

It’s not quite a catchphrase yet, but when discussing cases or whatever, I frequently use the sentence: “I’m not sure, lemme go look that up.”

I worked professionally in medicine for a few years before starting medical school, and thus far my approach has been to entirely disregard anything they said on the subject and continue as normal unless the nonsense they’re spouting has the potential to cause serious harm. Our patient care professor is training us to listen attentively, then dismantle the nonsense as politely as possible while guiding the patient’s viewpoint back to something approaching reality.

There’s some things you look for that are difficult to describe to someone who hasn’t seen it before. That’s part of why experience is so valuable in Emergency Medicine, and it’s not uncommon to put your best nurses out in triage. People will do this kinda twitchy/wilting/loss of focus/change in pallor/change in posture right before they go down. I don’t have a good way to describe it, and it might be easier to draw even, because it really is a body language thing and the general appearance of the patient that can inform your decision making.

I have thought about trying to plan out a learning algorithm that could spit out suggestions for triage level and preliminary tests based on input data like vital signs, symptoms, and complaints… but I would never implement something like that as anything beyond a tool for the nurses at triage to use. There would have to always be an option to override the algorithm because there’s some aspects of patient presentation that are not easily quantifiable. I’d never be able to explain it in a way that one could input it into a computer, but even with my limited experience, I can tell which patients are going to crump on me.

NPs working under a physician with actual oversight is fine. The ones I have problems with are the ones that have a physician sign the hundreds of notes a month while maybe reviewing a handful, and worse, the ones pushing for independent practice without even that sham of oversight involved.

At least I can rest assured of the fact that AI will be next to useless in my intended field. Emergency medicine is an environment where you get a random constellation of symptoms and complaints with very little direction on which are related to the current illness, and which ones are not currently relevant. Also, in the time it would take to get all the info into the AI for a trauma/cardiac/code situation, the patient might be dead or rapidly heading in that direction.

I try to remind myself that I’ve only gotten as far as I have because of hard work. I don’t have any special talent, I’m not some kind of genius, I just know how to work hard for the things that matter.

Day by Day Cafe in downtown St Paul is lovely. They have a nice library room to sit in during the winter and a patio with a koi pond out back for summer. They have some of the best breakfast food I’ve ever had and their early bird special is a really good deal (especially when I’m on nights).

Makeship is having a sale on their new Glow in the Dark plushies. It’s not a huge discount, but the proceeds go towards supporting independent artists which is always a good thing.

https://www.makeship.com/shop/gitd-2023

Let’s rewind to the part where you look at why they are mortal enemies, and realize that the same problem is still happening in the West Bank at the same time as the mass murder in Gaza.

Israel lost 0.014% of its population to the Hamas attack. Gaza has lost about 0.52% of its population to Israel’s rampage and that over 40% of those deaths are children. How is that comparable at all?

The music and food you mention specifically are the products of Black culture. They only come from the South because that’s where the African people were taken to and enslaved, then left destitute with no means to leave after their liberation. Some artists and luminaries from the South have been white, but many of the best ones have been Black and the most moving and powerful pieces of their work are rooted in the oppression they grew up with.

If I was going to be selfish, yes, I would move to a country that has more progressive policies and government. I refuse to be selfish though. I’m in medical school and hoping to become an ER physician in the safety net county hospitals for the express purpose of doing everything I can to help the people that have no way of escaping. I probably would have a pretty easy time taking my medical degree and moving almost anywhere because doctors are in demand pretty much everywhere, but it would be against everything I stand for and would be in complete opposition to my goals. I know that I won’t be able to move the needle very much, and as an ER physician I’d be making a difference just to my patients and perhaps my community, but I still have to try. I want everyone to be able to access food, housing, education, and healthcare equally and I can’t work towards that reality if I just run away from the worst of it.

They are entirely different drugs with different mechanisms. Taking too much paracetamol/Tylenol/acetaminophen is extremely dangerous for your liver and dosing instructions should be followed exactly. Prolonged use of ibuprofen or other NSAIDs can lead to gastrointestinal ulcers and kidney damage, so only take it for as long as you have to. They both have instructions to take a dose every 6 to 8 hours, so if you’re in significant pain or you have a really bad fever, you can alternate them every 4 hours. For example, paracetamol at 8am, ibuprofen at noon, paracetamol at 4pm, etc.

Also, be careful of “cough” or “cold” medicines like NyQuil/DayQuil, because they usually have paracetamol/Tylenol in them and that counts towards the daily dose limit.

Having worked in ERs…nah. People can be pretty damn dumb sometimes.

I’ve worked in ERs before, and there is more to this story that the article sidestepped quite neatly. Most ERs these days are filled to capacity with dangerously low staffing ratios, and the general public’s definition of an “emergency medical condition” and the medical definition of an “emergency medical condition” are very different. Some nights I’ve worked, we had people with chest pain and a cardiac history wait in the lobby for 5+ hours because there were no beds available and their EKG was mostly okay for the time being. A big contributor to this problem is a lack of mental health resources which results in ERs losing beds for up to weeks or even months at a time to hold psych patients that have nowhere to go. It is heartbreaking when we had to turn away people who mostly needed a social work consult…but when there’s two doctors and twelve nurses for a 40 bed ER and 2 out of 3 resuscitation bays are in use for active codes, there just isn’t anyone or any resources available to help someone who isn’t actively dying.

The inpatient side isn’t a lot better. Skilled nursing facilities and rehab centers are increasingly rare and increasingly expensive, and the hospital can’t keep a patient forever if they don’t meet criteria for hospitalization. The nice thing about inpatient is that they get to enforce their staffing ratios so that each nurse only has so many patients to handle. In the ER with EMTALA, it doesn’t matter that a nurse is caring for 6 patients (3 of which are waiting for an inpatient hospital bed, and 1 is waiting for an ICU bed…), that nurse will have to take on another critically ill patient that is stuck on a bed in the hallway if that’s all that’s available. The inpatient problem exacerbates the ER problem, and then you have people stuck in the lobby for 12+ hours before there’s a physical space for someone to see them, that provider’s capacity to take on another patient notwithstanding. It’s a true crisis and it’s only going to get worse until the full healthcare system (i.e. all the non-ER parts) are as accessible and available as needed.