I wonder if an alpha blocker or direct vasodilator might work better for you if you haven't tried them yet. Or an alpha blocker like prazosin on top of a beta blocker.

That is astonishingly stupid.

Ft Leavenworth is the military's prison. They don't send civilians there.

The danger with beta blockers is that they can affect a lot more than just your blood pressure. They also slow down your heart and can effect how certain hormones like thyroid hormones work in your body. It isn't ideal to have someone maxed out on 2 medications from the same class and if that's where you are up to, that's kind of an indication that that medication might not be the right solution.

This is correct. Amlodipine is very effective as a blood pressure medication, but it doesn't get through the blood-brain barrier which is one of the biggest hurdles for any psychiatric or neurologic medication. There's an entire special sub-type of brain cells that control what actually makes it out of the blood and to the neurons and getting things past that barrier is quite difficult.

*Raise taxes on poor people. The billionaires can easily just fly to Europe for a shopping spree attached to their regular weekend jaunt and bring everything home in their luggage (if they cared about the prices of anything to begin with, that is).

But when they're really young you can do things like convince them that trees walk and that's why trees in cities are in those little cages or pens. (They do actually use their roots to pull themselves around a bit, but it takes a very long time for the amount of movement to be noticeable.)

The age group of children that gets put on leashes doesn't have the brain development to feel shame or humiliation. Their brains have literally not developed the cortex that does that yet.

From the age of about 2 to 4, my Dad made a harness out of climbing webbing for me and clipped the leash to a carabineer on his belt when we were out and about. We were constantly going to places like Haight St in San Francisco and hiking on the sea cliffs in Santa Cruz. I 100% would have gotten myself killed without that leash because I was very curious about the fishies in the ocean at the bottom of that 50-100ft high cliff, and my Dad was wrangling me and my sibling by himself while Mom was at work.

I'm pretty sure there's a picture somewhere of me leaning over a cliff being held back by the leash because I was a rambunctious little gremlin that was about 20 years off from having a fully developed frontal lobe. And I want to find that picture and share it with my friends because I think it's hilarious.

As a nerdy gal on the Internet, I envy Joanna.

That's why the trailer has me so hyped for this game. It looks like the game is going to be different because Ciri is the protagonist. Her experience, reactions, and approach to saving a young woman from being sacrificed are totally different than what Geralt's would be. I hate it when games like Mass Effect are like "Oh! You can play as FemShep! That totally counts as representation!" even though it changes literally nothing about the story.

I want more games that actually address the real and significant differences in the experiences and perspectives of different characters. I'm always disappointed when there's a "female" option that's just a re-skin of the male character with no changes in how the character interacts with the world and the story. (This happens a lot in non-video game media too.)

You're right. My brain is absolute pudding because I'm studying for my board exams. Doing a few hundred multiple choice questions about complex medical topics in a row doesn't leave a whole lot of processing power left for anything else.

Unfortunately, it appears that you are correct. They released a list of qualifying conditions and while COPD and brochiectasis are on the list, asthma is not.

Edit: I'm kinda braindead right now. Asthma is the first thing on the list. whoops.

That will usually qualify, especially since Covid is primarily a respiratory illness.

Part of my significant suspicion regarding AI is that most of my medical experience and my intended specialty upon graduation is Emergency Medicine. The only thing AI might be useful for there is to function as a scribe. The AI is not going to tell me that the patient who denies any alcohol consumption smells like a liquor store, or that the patient that is completely unconscious has asterixis and flapping tremors. AI cannot tell me anything useful for my most critical patients, and for the less critical ones, I am perfectly capable of pulling up UpToDate or Dynamed and finding the thing I'm looking for myself. Maybe it can be useful for making suggestions for next steps, but for the initial evaluation? Nah. I don't trust a glorified text predictor to catch the things that will kill my patients in the next 5 minutes.

It's entirely possible that it just wasn't diagnosed until very recently. Prostate cancer screening is not a standard recommendation at his age, and there are a lot of cancers that are very insidious. A lot of times, if there wasn't a screening test done for it, cancer is caught because of the symptoms of metastasis meaning that unless we're screening for cancer, we don't catch it until it's already progressed.

Some people are more attuned to their bodies and might notice the smaller, earlier symptoms, but for prostate cancer, they can be pretty easy to miss and the primary metastasis symptom is usually back pain from the cancer spreading into the lumbar vertebrae. A lot of people will just write that off as regular back pain and not go to the doctor for it.

My mistake, I recalled incorrectly. It got 83% wrong. https://arstechnica.com/science/2024/01/dont-use-chatgpt-to-diagnose-your-kids-illness-study-finds-83-error-rate/

The chat interface is stupid in so many ways and I would hate using text to talk to a patient myself. There are so many non-verbal aspects of communication that are hard to teach to humans that would be impossible to teach to an AI. If you are familiar with people and know how to work with them, you can pick up on things like intonation and body language that can indicate that they didn't actually understand the question and you need to rephrase it to get the information you need, or that there's something the patient is uncomfortable about saying/asking. Or indications that they might be lying about things like sexual activity or substance use. And that's not even getting into the part where AI's can't do a physical exam which may reveal things that the interview did not. This also ignores patients that can't tell you what's wrong because they are babies or they have an altered mental status or are unconscious. There are so many situations where an LLM is just completely fucking useless in the diagnostic process, and even more when you start talking about treatments that aren't pills.

Also, the exams are only one part of your evaluation to get through medical training. As a medical student and as a resident, your performance and interactions are constantly evaluated and examined to ensure that you are actually competent as a physician before you're allowed to see patients without a supervising attending physician. For example, there was a student at my school that had almost perfect grades and passed the first board exam easily, but once he was in the room with real patients and interacting with the other medical staff, it became blatantly apparent that he had no business being in the medical field at all. He said and did things that were wildly inappropriate and was summarily expelled. If becoming a doctor was just a matter of passing the boards, he would have gotten through and likely would have been an actual danger to patients. Medicine is as much an art as it is a science, and the only way to test the art portion of it is through supervised practice until they are able to operate independently.

In order to tell it what is important, you would have to read the material to begin with. Also, the tests we took in class were in preparation for the board exams which can ask you about literally anything in medicine that you are expected to know. The amount of information involved here and the amount of details in the text that are important basically necessitate reading the text yourself and knowing how the information in that text relates to everything else you've read and learned.

Trying to get the LLM to spit out an actually useful summary would be more time-consuming than just doing the reading to begin with.

This attitude is why people complain about doctors having God complexes and why doctors frequently fall victim to pseudoscientific claims. You think you know far more about how the world works than you actually do, and it’s my contention that that is a result of the way med students are taught in med school.

I'm not claiming to know all of these things. I'm not pretending that I do, but there is still an expectation that I know what kinds of health problems my patients are at risk for based on their lifestyle. I'm better off in this area than a lot of my classmates because I didn't go straight from kindergarten through medical school. My undergraduate degree is in history and I worked in tech for a while before going back to school. My hobbies are all over the place, including having done blacksmithing with my Dad when I was a kid. I have significantly more life experience than most of my classmates, so I have a leg up on being familiar with these things.

I know that there is a lot that I don't know which is why my approach to medicine is that I will be studying and learning until the day I retire. I have a pretty good idea of where my limits are and when to call a specialist for things I'm not sure about. I make a point to learn as much as I can from everyone, patients, other physicians, my friends, random folks on the street/internet...everyone.

For example, I know from watching a dumb youtube channel about some of the weird chemicals that someone who worked as an armorer in the Army would have been exposed to that can have some serious health effects, but that wasn't something that was explicitly covered in my formal medical school education. I have friends in the Navy and they're the ones that told me about the weird fertility effects of working on the flight deck of an aircraft carrier. The Naval medical academy did a study on it, but I would have never had the inclination to go read that study if I hadn't heard about it from my friends. The list goes on. There's so many things that are important for me to know that will never be covered in our lectures in school and wouldn't even come up as things to learn about if I didn't learn about them from other people.

Medical malpractice is very rarely due to gaps in knowledge and is much more likely due to accidents, miscommunication, or negligence. The board exams are not taken at the school and have very stringent anti-cheating measures. The exams are done at testing centers where they have the palm vein scanners, identity verification, and constant video surveillance throughout the test. If there is any irregularity during your exam, it will get flagged and if you are found to have cheated, you are banned from ever taking the exam again. (which also prevents you from becoming a physician)

It doesn't know what things are key points that make or break a diagnosis and what is just ancillary information. There's no way for it to know unless you already know and tell it that, at which point, why bother?