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_thoracic's profile
_thoracic


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hubskier for: 1316 days

ER tech/EMT/nursing student.

Climber/hiker/back-country skier.


recent comments, posts, and shares:
_thoracic  ·  695 days ago  ·  link  ·    ·  parent  ·  post: Cape Town runs out of water on April 22.

What do you foresee happening when/if the water runs out? The assumption seems to be that it'll lead to sizable unrest, at a minimum. What are your thoughts?

    ...when does a person accept that their ambition is leading them in the wrong direction?

    I think there's an important difference between hardship due to you being on the wrong path, and hardship due to bad conduct by people with power you encounter along that path. I also think conflating the two smacks of victim-blaming, so getting the difference right is important.

      For example, say a medical student is distressed because an attending physician frequently overreacts at small, med student-type mistakes and berates them mercilessly. I think we could all agree that the problem here lies not with the student's ambition of being a doctor, but with the attending's poor temper. If the student can't overcome their distress at seeing blood or other bodily fluids, then the problem is with their choice of direction and the fact that their capabilities don't match their ambition.

        In this case, Bond's ambition to be a lawyer doesn't appear to be the problem. The problem is a judge like Kozinski who would take advantage of his power over his clerks' careers.

          I think we need to be careful not to roll human misconduct (sexual and otherwise) into the list of things that we accept as obstacles to achievement. There is a point of distress and suffering where a person should stop and reevaluate if their ambitions and choices aren't right for them, but we shouldn't accept it when the malice or misconduct of a person's superior leads them to that point.

          One of the most frustrating things about working in healthcare, for me, is the assumption of conspiracy. The idea that because I wear scrubs and hand out bandaids, I'm in on some grand scheme that entraps people into unnecessary/harmful treatment, (or purposefully denies them necessary treatment) is a recurring theme among patients and the public. It's incredibly frustrating.

            Part of the reason it's incredibly frustrating is that I too get the gut feeling that there are bad actors in the healthcare system. Hell, it's not even a gut feeling, it's frequently proven to be true (Looking at you, Purdue, Mylan and Kaleo).

              But because the average person's contact point with the healthcare industry is a primary care doc, ER staff or EMS personnel, and not insurance or pharma execs, us grunts get tarred with the same brush. And let me tell you, we didn't go into these jobs because we have a sadistic interest in hurting you for cash. There are more lucrative jobs that are easier, require less training, and involve much less poop.

                To get around to my point: Please don't treat the American College of Cardiology and a thuggish life insurance company as the same entity. Believe me, those of us on the other side of the stethoscope think insurance companies suck too. The cardiologists who worked on these revisions have doubtlessly each had countless conversations with patients trying to convince them that cutting some salt and going for a run once in a while will literally extend their lifespan, and have seen most of those conversations go nowhere. So now they're trying harder.

                  “We're recognizing that blood pressures that we in the past thought were normal or so-called pre-hypertensive actually placed the patient at significant risk for heart disease and death and disability,” said Robert M. Carey, co-chairman of the group that produced the new report. “The risk hasn't changed. What's changed is our recognition of the risk.”

                The intent here pretty clearly appears to be to try and get Americans to pull their heads out of the sand a bit and realize that we treat our bodies horribly. Hell, taking lower levels of hypertension seriously might even lead to stopping serious cases before they start, possibly reducing the number of new prescriptions!

                  Will insurance companies find a way to profit off of this? Probably yes, because they're run by scum. Is your average practitioner happily skipping hand-in-hand with them as they do so? No. And as mentioned:

                    The four main classes of drugs for blood pressure have generic versions and can be as cheap as a few dollars a month.

                  Probably not gonna be an oxycontin-style surge of scummy marketing for these drugs any time soon. And if the sudden surge in prescriptions you posit does come to pass, and some Shkreli type buys them and jacks the price, you can believe that among the first groups to yell about it will be docs and nurses.

                    It's not as simple as "Oh, hey, let's make more people hypertensive and write more scripts so that our buddies at Cigna can buy another boat". It's easy to play the cynic here and to plaster over the truth in the nuance, but sometimes healthcare providers do things because they care about people's health.

                    Fourth paragraph in:

                      But the report's authors predicted relatively few of those who fall into the new hypertensive category will need medication. Rather, they hope that many found with the early stages of the condition will be able to address it through lifestyle changes such as losing weight, improving their diet, getting more exercise, consuming less alcohol and sodium and lowering stress.

                    Further down:

                      The guidelines suggest that doctors recommend lifestyle changes for people found to have elevated blood pressure. Those with Stage 1 hypertension should be assessed for their 10-year risk of heart disease or stroke under the parameters of a widely used matrix for cardiovascular health. Those with more than a 10 percent chance, or other complicating factors, should try medication.

                      “An important cornerstone of these new guidelines is a strong emphasis on lifestyle changes as the first line of therapy. There is an opportunity to reduce risk without necessarily imposing medications,” said Richard Chazal, the immediate past president of the American College of Cardiology.

                    A revision of hypertension guidelines with an eye towards encouraging better early lifestyle intervention seems like a pretty solid idea to me. I'm not seeing the drive towards greater prescription of antihypertensives that you are here. Frankly, with the amount of deaths from cardiovascular problems in this country (not to mention the preventable load on the healthcare system they create), giving cardiologists and general practitioners more leeway to tackle hypertension sounds like a great idea.

                    _thoracic  ·  791 days ago  ·  link  ·    ·  parent  ·  post: Today's Writing Prompt: This Is What It's Like

                    Thank you! Glad you enjoyed it.

                    _thoracic  ·  792 days ago  ·  link  ·    ·  parent  ·  post: Today's Writing Prompt: This Is What It's Like  ·  

                    “This is what it’s like” says your instructor, watching you carefully for mistakes

                            Training you on bandages, splints, and the cruel rhythm of chest compressions

                    Teaching you what kills right away, and what takes a while longer.

                    Telling you that sometimes all you can do is hold a hand and say something kind.

                    And you listen, wide-eyed.

                    “This is what it’s like” says your crew chief, pulling you up into the ambulance.

                            Showing you streets, the bad stretches of interstates, the homes of frequent fliers. 

                    Reminding you to check pockets for knives and arms for track marks.

                    Relaying experience’s thousand little lessons, unteachable in the classroom.

                    And you listen, working hard to show your worth.

                    “This is what it’s like” say your patients, pointing to where it hurts.

                            Screaming with pain, clutching an extremity turned the wrong way. 

                    Groaning and sweating, grabbing at their chest saying it’s just like the last one.

                    Lying still and silent, unknowingly trusting a stranger with everything.

                    And you listen, replying with soothing words.

                    “This is what it’s like” says your gear, speaking in clicks, beeps and error messages.

                            The defibrillator whines its way up to 300 joules, saying it’ll try but no promises. 

                    The ambulance growls, bouncing and rattling over potholes as you try to start an IV

                    The BVM whooshes, fighting to push breath into a ruined airway.

                    And you listen, hoping that together it’ll make a difference.

                    “This is what it’s like” says the nick in your shears, bearing witness.

                            Reminding you of that one, the one no one could have saved. 

                    Pulling you back into the dirt and blood of the scene, unbidden.

                    Making you feel old, far older than you should be by now.

                    And you listen, wishing you didn’t have to.

                    “This is what it’s like” says the calendar, slowly passing time

                            Marking out your shifts, 12-hour gambles on what’ll come your way. 

                    Quietly telling you it’s almost time to renew your license again.

                    Studded with anniversaries you’d prefer not to remember, but can’t quite forget.

                    And you listen, stunned that it’s been this long.

                    “This is what it’s like” you say to the newbies, watching them carefully for mistakes

                            Training them on bandages, splints, and the cruel rhythm of chest compressions

                    Teaching them what kills right away, and what takes a while longer.

                    Telling them that sometimes all you can do is hold a hand and say something kind.

                    And they listen, wide-eyed.