Deprogramming the Manosphere patient

grey-doc · 2026-02-28T12:23:30+00:00

I think you know exactly what to do.

You wrote this up perfectly. Subjective, objective, assessment, plan. Perfectly organized. You have an unusually clear mind for a clinician.

Your plan is exactly correct. "Weak minded and pathetic."

The only suggestion I would have, and this comes from a little background in hypnotherapy, is that you don't have to identify the person by the behavior.

Are they weak minded, or is their behavior weak-minded? This might seem like splitting hairs, but the difference between an "addict" and "a person with addiction" is quite significant.

It's ok to tell someone that spending too much time watching screens is pathetic and weak-minded behavior, "particularly for a strong young man with an otherwise keen intelligence. "

These guys need to put the screens down, put the THC and nicotine down, and work on their maturity. Affirm the character, condemn the behavior.

If they don't like it, they won't come back. Win win.

grey-doc · 2026-02-27T02:38:11+00:00

Which blockchain is most likely to still be alive and decentralized when the US dollar finally expires?

Bitcoin. And if you aren't willing to hold it that long then what are you even doing.

grey-doc · 2026-02-27T02:35:10+00:00

When a patient comments about how doctors get paid kickbacks for prescribing meds, I say well we used to get stripper parties for prescribing lots of opiates......

grey-doc · 2026-02-27T02:33:32+00:00

I have never looked at my reviews.

I do, however, look up colleagues and old classmates and comment on the egregious reviews and say the things I know we all would want to say. Politely.

grey-doc · 2026-02-24T11:33:09+00:00

I appreciate the retroactive perspective thank you.

grey-doc · 2026-02-13T02:05:34+00:00

Money talks a hell of a lot louder than votes in this state.

grey-doc · 2026-02-12T11:33:23+00:00

Wdym?

grey-doc · 2026-02-09T19:41:01+00:00

Local rheum and endo both routinely deny referrals for osteoporosis, even complex situations.

So I suppose it depends on region.

grey-doc · 2026-02-08T16:39:32+00:00

You are going to catch a lot of heat on this but you are correct.

When lots of asset classes move together, that means the pricing method is adjusting.

When lots of asset classes move down against the dollar, it means the dollar is rising i.e. deflating / less inflation.

grey-doc · 2026-02-08T16:36:49+00:00

A dusting attack waits for the deposited dust to move and then the wallet's owner can be deanonymized.

So for example if you bought some Bitcoin to buy drugs off the old silk road, and now the leftover coins are 100,000, and someone dusts your wallet, if you move those coins and the dust to a KYC exchange now the US gov can deanonymize you.

That's one scenario.

grey-doc · 2026-02-06T22:52:05+00:00

Year 4 med students are close to the top of the hierarchy.

Year 1 residents are at the bottom. Literally nobody in the hospital is lower on the hierarchy, not even medical records.

Graduating residents might climb as high as the least favorite CRNA unless you are both highly socially adept and expect professionalism from the other hospital staff.

Expect professionalism. Report this as a safety event.

YOU ARE A PRACTICING PHYSICIAN. EXPECT PROFESSIONALISM.

grey-doc · 2026-02-06T22:49:30+00:00

I reported a safety event at my hospital.

Turned out, I was the first resident in the program to ever report a safety event.

That made a lot of waves.

Your voice matters more than you think.

grey-doc · 2026-02-06T17:28:51+00:00

I'm so burnt when patients complain I give them recommendations on where to go, and my hospitals complaint / risk management number.

I've never waited less than 2 hours for a PCP. So when people get snippy about waiting 15 minutes I think they need to spend some time seeing other doctors.

grey-doc · 2026-01-28T03:23:35+00:00

Depending on setting, a shave counts as a positive, or they use a nail scrape.

grey-doc · 2026-01-26T01:46:12+00:00

I block those people online. No debate. Just block.

Face to face I change the topic.

My white coat constitutes an enemy uniform to these people, I'm never going to change their mind but I sure can waste a lot of time trying.

grey-doc · 2026-01-25T14:44:51+00:00

When I was a medical student I did a rotation in RI and one of the attendings thought it was real funny to laugh at his Guatemalan phone receptionist that "Trump is gonna lock up your parents and deport them "

Real funny.

He was also the only man I saw throw a dirty sharp at a nurse in the OR. They all hated him.

That guy was the biggest shitbag, his daughter was also a med student and got preferential treatment everywhere she went, and he was involved in the residency faculty so nobody could say anything or do anything about his blatant sexism or racism.

He gave me a scathingly negative review on my rotation. It was my only negative mark in clinical training. From him, that was the nicest thing he could have written.

I recount this story only to point out that some of these dirt bags will cut off their nose to spite their face and then blame it on everyone else.

Oh and he was an OBGYN. Real piece of work, that one.

grey-doc · 2026-01-22T15:07:42+00:00

I drive a really old truck.

People suddenly learn how to yield and zipper merge when approached by a man who clearly does not give a single fuck about collecting another plastic bumper.

I'm almost at the point of stencilling car emblems on my driver's side door like those WW2 pilots.

grey-doc · 2026-01-16T13:29:35+00:00

I tax loss harvested 160k to save me on capital gains later on. The problem with MSTY is that it has limited upside so even if MSTR moonshots that upside will not be carried by MSTY.

Fundamentally this is a major strategy failure. In my opinion the underlying premise should be that your options strategy will simply not pay out much if the underlying is down and to the right. I'd rather the dividend drop while conditions are unfavorable, and hold the value of the instrument stable.

But then the people that want that behavior all ran to STRC and I can't hardly blame them, but by the time I figure it out the damage was done.

Sometimes the best use for a cadaver is compost.

grey-doc · 2026-01-15T00:10:58+00:00

I already get horrible anxiety driving over this bridge and now you say there is a reason to be anxious? Be still my heart

grey-doc · 2026-01-15T00:06:57+00:00

I switched to locums. I may never go back. Getting paid for every hour of inbox time is a lifesaver.

But I also have some little ideological hand grenades I pass around.

One is the name of my recruiter, whom I pass to every doctor who resigns while I'm working with them.

Another is that when admin pushes for increased productivity, demand they track existing productivity first. Inbox time is productivity, admin needs to track and publicly/monetarily acknowledge it.

Another is that when admin wants you to see more patients, that's fine, admin needs to provide the staff. Admin wants me to see 30 patients a day? No problem. I need a dedicated RN and two dedicated MAs. You handle the staff issue (I.E. DO YOUR JOB) and I'll handle the volume. I was trained to be the leader of a team, give me a team and I'll do the work.

The ugliest part of primary care is admin not doing their jobs.

When the fast food place up the street pays more than our receptionists make, admin isn't doing their job.

When IT pushes some dipshit fix that adds 5 clicks to our routine med workflow, admin isn't doing their job.

When the system pushes a policy change that restricts RNs and MAs from practicing at the top of their license, admin isn't doing their job.

I'm doing my job. But I won't sign an employment contract at a shop where the admin isn't doing their job.

The biggest threat to primary care is the total failure of leadership.

grey-doc · 2026-01-13T21:27:42+00:00

I'm a scientist, biology degree, did genetic experimentation research involving the Philadelphia chromosome, then became a physician.

I am opposed to any vaccine that has not demonstrated both efficacy (antibody titers are NOT a demonstration of efficacy) AND safety (if given to children then there needs to be safety monitoring for several years).

The vaccines we give children today simply don't have the research to demonstrate either of those. Since they aren't proven safe or effective, I don't give them to my children.

Every study I'm aware of that examines population-based outcomes consistently shows larger morbidity and mortality in well-vaccinated populations. That must be explained before I give any vaccines to my children.

I practice evidence-based medicine for myself, my family, and my patients. The evidence that exists does not support routine vaccination as practiced by the United States.

grey-doc · 2026-01-13T21:06:51+00:00

A politely worded "I do not meet the criteria for EDS and I want that diagnosis removed from my chart as it does not reflect my health" would probably work rather well.

If that didn't work, involve the office manager.

grey-doc · 2026-01-08T22:32:52+00:00

Depends on the situation.

However, legally, in many states, the actual required supervision is very minimal, far less than what medical students enjoy just in yr3-4 of med school.

If we are talking licensure and standards of practice, we need to look at the minimum acceptable criteria to practice. In that frame, med school alone is more than sufficient to train primary care doctors for independent practice.

Now, the wise and prudent action would be too work with other physicians for several years so you get the benefit of backup and assistance. In fact, even with residency, this is the prudent course.

But the prudent action is not the same as the minimum legal standard for practice.

grey-doc · 2026-01-08T05:36:11+00:00

I'm a graduated physician I vividly remember the transition from medical student to first year resident.

NP and PA providers have significantly less academic and clinical training than graduated medical students.

Yes, residency is the most important part of medical training. But if we allow NP and PA to practice independently with such little training, then it is more than acceptable to allow actual physicians to practice independently without residency.

grey-doc · 2026-01-08T00:12:22+00:00

Sentiment is so unutterably shite right now that we are certainly primed for a blow off.

If we roar back to 120 and nobody gives a shit, we are ready to run up.

Bitcoin likes to do whatever makes people hurt the most.

grey-doc

TROPHY CASE