The Latest Crop of Instagram Influencers: Medical Students
slate.com
slate.com
I asked a handyman community the other day if my furnace running 22 hours a day during the winter is normal and how furnaces work.
I got about a dozen "it depends..." answers that enumerated all the factors involving a house heating and cooling until someone basically said, "no it doesn't really depend. That's very much not normal regardless of any factors. You'd have to be in a really unusual situation for this to be normal and not warrant further investigation."
See, this is the problem with you not being an expert in the field.
For example, if your house had terrible insulation and it was -10 out. Yea, that thing is going to run all day. If you had a new house, but left all your windows open, yea it will run all day too. So, yea, "it depends' is a perfectly cromulent answer without you giving lots of information.
People that don't have much experience are the ones that will say "yep, it's broke" right off the bat. When I was younger and you asked "Can you make my software stack faster", I'd have answered yes. These days "It depends", probably followed by "How much money do you want to spend".
TL:DR; The complexity of reality doesn't give a damn how simple you want your problem to be.
As a non expert I wouldn't have been surprised if someone said, "yeah it's pretty common for furnaces to run non stop in cold winters. That's their design."
This was not uncommon in rich (big houses) older (built up before WW2) towns in MA because the houses are big and old and state law regarding who can perform plumbing/electrical/hvac work greatly drive up costs and are a massive incentive to always minimum amount of work possible so tons of people would have poorly insulated houses with smaller than ideal heating systems. For the coldest days in the winter many people's furnaces would run all day to keep the house warm (whereas poor people just turn down the heat).
This has changed recently because the state is pumping a ton of money into incentives for people to make their homes energy efficient now basically every old house has had insulation blown in everywhere because with state subsidies the cost to do so is now justifiable in the overwhelming majority of use cases.
Importantly in this case, the outside temperature at which your heat or AC runs constantly is the maximum where your house will maintain temperature. So, because of the different tradeoffs of oversizing heat vs AC, normal practice is to put in enough AC for a typical summer (and just let the house get a little warmer during a heat wave) so that dehumidification remains optimal, and to put in enough heating for a worst-case cold snap because, well, it doesn't hurt much and people REALLY complain when their house gets cold in the winter.
In Germany, the healthcare system is readily accessible for people who are insured by one of the providers of national health insurance [1]. However, doctors need to process a large amount of patient per day to make ends meet.
Note, I chose the word "process" with intent, because that's what it feels like with 9 out of 10 doctors in Germany's cities nowadays. Go in, have a less than 1min chat about your health, get screened with a medical move set that rivals street food artists in Bangkok, then get a run-of-the-mill answer with little effort to personalize treatment according to your medical history.
The younger the doctors, the more intense is this issue. This isn't because younger doctors are less empathetic or something. The system simply demands this or else. People are more cattle than anything...
Oh and fitting right in with the Instagram fame, young medical professionals are all moving to the fun cities in Germany. Smaller towns and villages are hemorrhaging doctors. They are just not attractive in any way, especially with Germanys catastrophically bad Internet and mobile infrastructure.
Last time I was at my general doctor, I was in the room for an hour with Doc and nurse. Talking about how I’m eating, how I feel after running long distance, if this blemish has changed shape, how I’ve been sleeping, etc etc.
It took 10 days to make an appointment which is annoying, but I have never once felt rushed or that staff was rushed.
Like I said. Annecdote, but polar opposite.
Not too long ago, I still had my general physician who could sit down and talk it all through. He retired... and another one in another city did as well. Younger ones seem under much higher economic stress. Maybe also stress from peers?
It seems more of an emergent problem to be honest.
Recently my wife & I were forced to use the public service, and after 3 days of traveling back & forth, day after day, to another city, being told to visit another ward next day, and come back the day later, I was begging for someone to throw money at to make our problem go away. And I'm not really blaming the staff; they're all severely overworked, underequipped and underpaid. There's a huge problem with public health care here, kind of an opposite to the US problems. Poor or rich, you will get medical attention, just possibly months after when it's needed.
Imagine visiting a hospital for an emergency, and receiving 10 bills from different doctors totaling to few thousand dollars then fighting with insurance to pay for it.
Universal healthcare brings OVERALL cost down. It makes private treatment cheaper. A crown and root canal costs about $2k in the US. Plus, it is nearly impossible to find cost of a procedure prior to it. It is fking weird.
For comparison, with insurance in the US my root canal cost about $250 out of pocket.
For instance Internet connectivity is not "catastrophically" bad, (could indeed be better, though).
An overlooked trend that has has changed communication patterns with patients for the worse is a trend towards larger joint practices with doctors as employees often not working fulltime. Joint practices tend to have larger, fuller waiting rooms, and which necessarily results in (in my experience) a more stressful doctor-visiting atmosphere.
Moreover, paperwork has become more complex also for patients, e.g. when agreements and waivers (for operations) have to be signed, nobody has the time to explain these. Nobody can explain finer points of medicine prescriptions, and usage of technical helping equipments (e.g. hearing aids). The staff at the front desk can't explain this, and the doctors do not have the time to either.
These are all general problems, not Germany-specific.
However, I heavily disagree about Internet connectivity. In cities like BER, HAM or MUC it is "meh". On the country-side and in smaller towns it is catastrophically bad for the 4th largest economy on the planet.
This is Deutsche Telekom's fiber network in Hamburg, today: https://i.redd.it/r4a07co2x4y11.png
"The further you are from mainstream medicine, the greater the confidence signaling. Doctors tend to express the least confidence, and crackpots the most. This is why alternative medicine thrives."
I have a relative that was diagnosed with EDS, it is a very serious disease with no cure. This relative has spent $20k+ on prolotherapy. There is 0 scientific evidence that prolo works, and 0 evidence that it works on this specific disease. Those doctors just make up claims and for sources link to their site. But what they sell is hope, which is really saddening considering that person will be unable to afford housing/food soon. Just thinking about it makes me angry that people like that exist.
People simply have a hard time accepting their fate. REAL doctor will tell you what you don't want to hear, a doctor that sells snake oil will promise BENEFICIAL treatments based on bs.
I still think they're wrong though since (1) experience is a too crude metric, (2) development is such a broad profession that IMO any competent CS grad is able to make a CRUD app and that's still the rage today and (3) they are not taking into account that people are able to learn (especially uni students). But I digress, sorry about that :)
If only this were universally true. I've so far had lackluster results actually hiring CS grads compared to self-taught people that moved in from the trades.
I do have to agree that a lot of CS grads are unfortunately not competent and that quality varies a lot though.
Can't Count, Can't Code
Conversely, the best developer I know is self-taught.
All I'd ask from a new grad (other than coding) is to keep in mind that experience teaches you more about what NOT to do, and keep your ego under control. I can hire coders right out of high school if that's all I want, engineers take a little bit of seasoning to be valuable ;-)
My wife is a recent med school graduate, so I have some exposure to this from seeing her IG timeline. She was also explicitly recruited by one of her more shameless influencer friends to try to make some side cash with some scheme.
I do comment on the odd medical post on HN. Usually trying to dispell myths or offer some evidence that helps the discussion - a Cochrane review, or a Lancet article, etc. Occasionally I try to defend the profession, or explain some of the difficulty that doctors are in that leads people to be frustrated with them. I also blog a little, as an outlet for all the crazyness and feelings that come with medical training. That said, you won't be seeing and product endorsements from me.
I don't see any harm in offering reasonable advice or adding a little evidence to discussions. I'm always careful to point out my student status, and not to offer medical advice directly.
Real questions I've been asked:
- Can I dissolve these tablets? Turns out the answer was in the Product Information - yes, you can.
- What happens if I mix my SSRIs with illicit substances? I don't know, could be bad, please don't, if you do consider standard harm reduction strategies.
My brother is a medical student, and I find myself asking him for opinion on medical issues from time to time. I do that when the problem isn't (or doesn't seem) serious, and I don't treat his answers as if they came from MD. The reason is simple: going to a doctor is an expensive and time-consuming endeavour, whereas I can ask my brother things casually whenever I come visit.
If you ain't gonna go to the doctor over something anyway, asking a medical student you know still beats trying to "research" things on the Internet.
Having talked to a lot of med students, I just don't think it is the best idea.
OTOH, better to ask at least someone who might refer you to an actual doctor than just keep it to yourself I guess!
It is actually not as bad anymore now that I am older, somehow :)
Because it's often free. Getting proper medical advice has a barrier of entry (money) and if someone is on the edge (should I worry about this? It's probably fine but let me check with this person before spending money).
An appointment with my PCP costs me at least $200 (insurance pays for 90% of it only after I max out my spending of over 3k) and a specialist will take at least $400.
I'm lucky for my insurance and my paycheck but I can see how a lot of people would try to avoid paying that $200 especially when they have something kinda like medical advice available for free.
In my opinion It's not the people, it's the high price of medical services.
If there is any hint that the issue is serious they tell you to go your doctor (or emergency). But for many minor ailments advice over the phone is sufficient.
I suspect the service cuts down a lot of unnecessary visits to emergency.
Then they charge you the full rate as if you had gone into the clinic.
I suppose if the service gets abused they will need to address this.
That's TV though, and Frasier was written as a character with high professional integrity. Real life isn't so cut and dry. Some Doctors already have a shady relationship with pharma companies.
Given everything we know about how FB makes it easy to advertise to targeted populations (in this case, desperate people and the extremely naive), I can see this becoming a problem 5 years down the line when these students have completed residencies and are full-fledged doctors.
Frasier: What cuisines are being fused?
Niles: Polynesian and Scandinavian. It's called Mahalo Valhalla.
I wonder if any of this is correlated to negative health outcomes? Nah, maximizing shareholder value and doing what’s best for the patient are totally compatible.
https://www.bostonglobe.com/news/nation/2015/08/05/doctors-l...
https://ethics.harvard.edu/event/drug-companies-and-medicine...
You wot mate? Deepak Chopra is as much a physician as I am a swimwear model.
Edit: And maybe HN ought to switch the "web" link to https://searx.me/, because it has https://web.archive.org/ links for just about every result. Arguably less baggage than Google cache.
If you are an EU reader this means that Slate is not collecting or processing data from your current browser session. If you believe that you have previously granted Slate access, it is possible that you did so from a different browser. By returning to this page from that browser, you can remove the identifying cookie.