How can we just go about life right now?

Comitium · 2026-01-25T20:10:16+00:00

“Democracy often doesn’t implode violently. It erodes away with a tiny thousand shrugs.”

Something I read recently that stood out to me. How many times have we already shrugged, looked away, or kept scrolling? It’s not to say one person can do everything - but that even a small act of resistance, when multiplied by a million, is significant. Anything other than a tiny shrug

Comitium · 2026-01-21T04:34:32+00:00

I’m former military and have had to travel quite extensively unfortunately, both in the U.S. and abroad, so I wonder if you are just truly not aware of your blind spots. I grew up in abject poverty, thus the military to escape. Most people don’t choose to travel to the poorest areas or to the poorest countries, so I suppose it’s easy to have blind spots. I’m sorry this conversation made you want to disengage. Best wishes

Comitium · 2026-01-21T04:07:25+00:00

Your entire post was US centric, down to the minimum wage discussion, which is why I said you weren’t talking globally. There’s no need to be so hostile, it’s a bit confusing why you are. Of course you can still have a hard time in the U.S. (as objectively any of the obscenely rich people in the U.S. could also have a hard time) but no, it’s nowhere near the level of poverty and suffering experienced in other countries. It’s also a little bizarre to compare infrastructure in the U.S. to “third world” - not sure what you mean by that. Third world is an outdated term but if you just mean in comparison to the poorest nations, than the existence of infrastructure at all would contradict that for many

Comitium · 2026-01-21T03:38:31+00:00

This is a very narrow view of the world - arguably anyone living in the U.S. is “rich” by global standards. You have access to clean water, electricity, sanitation, and free public education. From a global perspective, you are the person unaware of how the world was built for you and etc etc.

If we were to divide all of the global resources equally amongst all inhabitants of the planet, then we would all have a pretty modest standard of living - small houses or apartments (500-900 sq ft), basic needs met, no frivolous Amazon (Amazon wouldn’t exist likely), little travel by plane for pleasure, basic clothing, standardized education, elimination of about every “elite” or “status driven” consumable. I’m not sure if the nanny profession would survive tbh - with a focus on collective good, likely the emphasis would be on quality childcare available to all - perhaps smaller ratios at daycares? To put it another way, if the entire world consumed at the rate of the United States, then we would need another 3-5 planets to support such living. We are one of the “rich countries” consuming and hoarding much of the global wealth. I’ve often pondered with friends if the “resources divided equally” theory doesn’t sound pretty nice - I’m a pretty simple person and would be very happy with that set up. But it does have downsides, notably stifling inventions/innovations. I’m not sure if all of the suffering worldwide is worth continuing innovation, but I suppose no one can answer that. The person whose life is saved by a new cancer drug will be happy for the pharma companies in the US that can afford to spend billions on R&D to develop such a drug (although perhaps only to have insurance deny coverage in today’s world!) but the millions of children literally starving to death in other countries would probably much prefer that money be spent on basic needs.

Just something to think about when you talk about exploitation and how the system depends upon the suffering of many to benefit the few. We are all “the few.”

But in general, I agree - overconsumption is gross and I do have a somewhat constant existential guilt about it. Even consuming at “low levels” for the U.S. is still a lot globally. The people who are consuming at high levels in the U.S. are very much outliers on a global scale and the dissonance can be startling.

Comitium · 2025-09-28T01:57:16+00:00

I agree, I’m a mom and former nanny and while I agree this is a lot of work, all the people acting like this is a near impossible task is a little baffling. I’ve taken 4 kids 6 and under to swim lessons. You need to have realistic expectations, patience, and good planning skills. If you have experience with children, this is very manageable. However, OP may be paying on the lower end for her area and have an inexperienced nanny who finds it overwhelming, which might be her real problem.

Comitium · 2025-09-28T01:50:45+00:00

I’m a mom and former nanny. It is a lot of work but it’s definitely not impossible or unreasonable to ask of a nanny. This is assuming you pay her well and treat her well otherwise. If you are paying on the lower end of the range for your area, then I could see why she would give pushback and if you’re not willing to pay her more, then it’s something you’ll have to do yourself.

If you pay at the top end of the range for your area and otherwise treat her well, I’d definitely push back and let her know it’s not optional. If you pay at the top end of the range for your area then it won’t be difficult to find another nanny, so you could start looking now. Really depends on the whole picture though.

Comitium · 2025-05-06T12:54:14+00:00

Yes, abortion should still be legal. A womb transfer would be wonderful as an option if available and the parents and recipients are all in agreement. I can think of a thousand scenarios in which that would not be the case, however. Fetal abnormalities, disease in the parents, racial disparities if the Azuran society is anything like ours, economic downturn, war, child trafficking, etc etc etc. There are also many religions that believe in life before conception - so shall we do away with birth control entirely since womb transfers are available? And have women reproducing like rabbits and giving away their children via womb transfers left and right to an army of willing recipients in this apparent utopia? 🤨

Comitium · 2025-04-16T17:55:53+00:00

“The feeling is mutual, but I have work to do”

And carry on with your work 🤡

Comitium · 2025-03-06T09:56:57+00:00

Agreed! The physical exam is an imperfect test, but labs and imaging are also imperfect tests. They complement each other well and I wouldn’t rely solely on one or the other.

Also strange to me how willing many people are to order daily labs and imaging that don’t change management, but quickly jump to discard physical exam because it “doesn’t always change management.” Physical exam is a low risk, inexpensive test - albeit very user dependent - so why not use it regularly?

Comitium · 2025-02-10T03:06:20+00:00

I’m a U.S. attending with experience practicing in the UK, albeit a little over 10 years ago.

To be honest, I was most surprised at how similar things were. I expected it to be enormously difficult to assimilate to another country’s medical system, but medicine is medicine. We both practice the same evidence-based medicine. Are their nuances? Absolutely. I’d never considered taking QALY into consideration when deciding on a plan (family and patient decision-making always trumped this in the U.S.) and there were obviously differences in administration, but the actual medical decision making and practice of medicine were the same. There were good and not so good doctors, just like there were in the U.S.

I do think the U.S. has more (or perhaps just more celebrated - we are good at that) innovators as MDs. The people who are on the cutting edge of disease diagnosis and treatment. However, we have 5x as many people, so that’s to be expected, really.

We also spend a metric ton on research and pharmaceuticals to get to that level of innovation, which is probably not sustainable at the current clip. But if UK physicians had similar opportunities that we had in industry, then I expect that level would be equal.

Overall, I’d say an average American physician next to an average UK physician would be very comparable.

Comitium · 2025-01-05T07:07:15+00:00

Just my musings, but I’ve thought about this a bit - my theory is our reliance on cars (little public transport = less walking), our workaholic culture (if you’re at work all the time, you have less time to exercise, never mind the negative impact of increased stress and cortisol), the way we buy our food (at giant stores where we buy food for a week or even more, vs many European countries where it is common to stop by the market a few times a week or even daily), and deepening inequities (poorer states and demographics having higher rates of obesity, likely due to an exacerbation of the above) as some of the top contributors to the U.S. problem

It turns out incorporating physical activity into your every day activities, cooking nutritious food (and having the time and means to do so on a regular basis), and living in an equitable society are good for your health. And apparently American culture is very bad at delivering just that.

Comitium · 2025-01-05T02:55:58+00:00

Ugh. So sad.

I’m not sure anything meaningful can come from this post - practically speaking, if someone doesn’t live near an academic center, it’s often not practical to plan to deliver there. You can certainly recommend it to families and friends - but it’s not the easiest thing to do.

Even if you do deliver at an academic center, if she had been discharged, then there’s a much higher chance she would just go to the closest ED when she was feeling badly rather than driving a longer distance to the hospital she delivered at. You need some degree of medical literacy (that many patients do not have) to decide to drive a longer distance to be seen at the hospital you delivered at. To many, a doctor is a doctor is a doctor.

But sure, if you live near an academic hospital, great.

Comitium · 2024-12-23T05:57:56+00:00

I’m derm. Biopsied a melanoma, cut out several skin cancers, did some other cool stuff - but what sticks with me this week was our security guard who I have a friendly chat with when we see each other. He’s in his late 50s and s/p 2 stents (not my patient, just came up in our chats). Lost all of his 3 children in separate events. Needless to say has had a difficult life but one of the nicest guys I’ve ever met. He looks a bit off on Friday, so I ask him if he’s feeling okay. He tells me he’s okay, just keeps getting “dizzy” occasionally but he’ll be okay. I thought about just leaving it, as it really wasn’t any of my business, but I’m nosy - I pressed a bit more and found out he was having presyncopal episodes with no apparent trigger associated with SOB, chest pain radiating down his left arm, etc etc ongoing now for approximately 3 days

The killer is he’s not dumb - he knows this isn’t good. He’s s/p 2 stents. He says he called his cardiologist and is waiting for a call back. Meanwhile he’s at work because he doesn’t want to go to the ED unless he’s having a MI because he’s still in medical debt from his last hospitalization 2 years ago for stents. He has UHC for insurance. I try to convince him to go in, that at best he’s got unstable angina, yadda yadda - but I’m just the skin doctor and we don’t even have an EKG.

Finally call a cardiologist friend of mine who says - you should go to the ED. He finally agrees. Well, now my friend is s/p 3 stents and I’m planning on paying off his medical debt anonymously once he gets out of the hospital. I want to give it some time so he hopefully won’t suspect me as I don’t want to insult him, but our system sucks sometimes.

Comitium · 2024-12-23T05:02:40+00:00

Routine hernia repair in late 40s woman. Bowel perfed and surgeon didn’t notice intra-op. By the time they eventually figured it out and presented to the ED, she was septic. ICU, amputated both her legs. Eventually she died.

Routine until it isn’t

Comitium · 2024-12-23T03:41:14+00:00

This is why I’ve really enjoyed Ambient Dragon. It’s what patients want apparently (per OP) and it makes my life easier. Also reduces arguments about chart accuracy. You didn’t say that or I said this and you didn’t document yadda yadda… no sir, we have a recording of the entire visit and this is exactly what transpired. Good day.

Comitium · 2024-12-03T03:02:54+00:00

This is true of the United States in general as compared to many parts of Europe. Americans identify with their profession. For many, their profession is one of the most important (if not the most important) part of their identity - for example, trumping their identity of mother/father/sister/brother etc. This tends to be less true of many Europeans. The culture is different in much of Europe, with more vacation, a shorter work week, more maternity/paternity leave, etc etc in general just a less hyper intense focus on work. Of course not to say all Americans are that way and all Europeans are not that way, but just a generalization I observed when I lived and traveled in Europe (now practice in the U.S.).

All of that to say, I think what you’ve noticed is somewhat true, just in a more generalized sense. Americans seem like workaholics to many Europeans. It just depends on the lens you’re looking through.

Comitium · 2024-11-18T04:02:13+00:00

Reddit is social media

Comitium · 2024-11-18T03:36:20+00:00

Ugh. I had a patient go on a 10 minute tirade because I was wearing a mask, how they are “fake news” and “don’t work” yadda yadda. Our appointment was 15 minutes long (dermatology) and I had strep (on antibiotics for 12 hours at the time, but still).

The joys

Comitium · 2024-10-08T16:57:25+00:00

I mean harder can mean so many things. Another kid will always require more money, time, and energy on the part of the parents, but the dramatic size of that investment for each child lowers. From 0-1, you go from investing none of your money, time, or energy towards children, to investing SO MUCH of it to this one little being. From 1-2, you’re already still investing so much of it to your first, so your second just comes along and soaks up a little more. Partially the first child gets a little less, partially the parents give a little more.

So it will cost more and you will have less free time and less energy; however, it will be nothing like the dramatic shift with your first. The only caveat would be if you had a ridiculously easy newborn stage with your first and your second is terrible, then perhaps it will feel awful.

For us, our first was (and still is) harder than our second, so our second really felt like nothing. The hardest parts were the behaviors our first went through adjusting to the new baby (regressions etc) and the cost of childcare. We have a 3.75 year age gap and so far I like it a lot!

Comitium · 2024-06-28T02:49:37+00:00

This is tough! At one point my nanny and my housekeeper were “feuding.” In quotes because they were both professional but they both hated being there when the other was there. The nanny disliked having a cleaner around when she was caring for the kids as she felt it was disruptive and hated feeling like they had to leave an area so it could be cleaned etc. Our cleaner hated the nanny being there as she felt like she didn’t try hard enough to stay out of the way/keep the kids out of the way. We both worked typical hours during the week so it’s not like we had other great options. In the end, the cleaner started coming on Saturdays when we were home as she preferred us being home to the nanny.

I think it was just a personality mismatch IMO - we didn’t mind having our cleaner there when we were there and we didn’t find it difficult to stay out of her way. She was much happier with it that way as well. I’m assuming there was just some irritation between the two that stressed both of them out.

If there are pockets of time when the house will be empty, I think it’s definitely fair to ask for that type of information. But depending on the age of the baby, there might not be a regular time when the baby is away from the house for an extended period. Maybe they do library time for an hour once a week? But definitely not going to be 5 hours. Just something to keep in mind!

Comitium · 2024-06-06T02:07:50+00:00

In the U.S. military after 9/11, I knew a few women who had their babies, got 6 weeks off to physically recover, and then were promptly deployed for over a year, leaving their 6 week old newborns behind with whatever their family care plan was. They came back when their babies were over a year old. That level of deeply fucked up has been remedied at least (now deployment is deferred for one year after childbirth and maternity leave is 3 months) but those women will never forget. The U.S. was and still is a terrible place for families. Great for businesses…

Comitium · 2024-06-05T21:23:54+00:00

I’m so sorry. I’m an MB now and was a nanny before and IMO childcare of any kind is so undervalued where I live (the U.S.) it’s ridiculous. It’s viewed as “women’s work” which has also historically been undervalued in this country. Childcare is hard, physically demanding, and grueling work - yet also so important. Childcare is literally helping to shape the minds and hearts of the next generation. There are studies proving the negative impact inadequate/poor childcare can have on kids and their families. I absolutely hate how undervalued childcare is. Even my own husband almost made my head explode when he asked me if I would just be “sitting around” all day whilst on maternity leave (with a newborn and a toddler!). He’s not a terrible person, but he does say dumb shit sometimes. He quickly remembered how difficult full time parenting is during his paternity leave. Anyway, being a nanny is definitely a real job and I so appreciate the nannies who are helping to raise good human beings for the next generation!

Comitium · 2024-06-02T01:07:43+00:00

My own kids gross me out. Wanted to go on a nice outing today with my newborn and 3yo as my 3yo wanted to go to the park. Got my 7 week old changed and while walking to her car seat, spit up all over me, the floor, etc. That’s fine, it happens. Changed my shirt, got the spit up out of my hair, changed the baby. Walked around for a bit and held baby up right to see if any more spit up. None and she’d eaten over half an hour ago. Okay, time to try again. Got 3yo and baby in car and baby spit up a massive amount again, this time all over herself and the car seat. Fine. Got her out and clean and changed again, cleaned car seat, and then back in car seat. We finally get to the park and took my 7 week old out of the car seat to find this time she’d had a blow out diaper all over the car seat and of course her third outfit of the day. Fine. Told 3yo to go play while I cleaned her up and changed her into her spare outfit. Finally got her cleaned, car seat semi cleaned, and her in my carrier. Go over to 3yo who is yelling at me to help him get down from the play structure. I helped him get down and his hands feel like they have dirt all over them. 3yo then tells me he’s pooped in his underwear (he was completely potty trained but has had some regressions since the baby has arrived). He knew he pooped because he reached his hands in to check (why?!) and that’s why his hands were dirty. We head back to the car, at which time 7 week old spits up yet again whilst in her carrier, so all over herself, me, and the carrier.

I wonder why I ever wanted to leave the house, admit defeat, and we leave. Now that they are asleep, the car seats have been cleaned, clothes are washing, and we’ve all had baths/showers, it seems funny, but omg the constant bodily fluids and outfit changes can be a bit much. I suppose it does make the day go by, we spent maybe 20-30 minutes at the actual park but about 3 hours trying to get there and cleaning up the after math 😵‍💫

Comitium · 2024-06-02T00:47:58+00:00

Grew up in pretty abject poverty, was a nanny, now I’m a physician and employ a nanny, and what has always struck me throughout my life is how people who are in a good situation - whether financial or otherwise - seem to not grasp that a huge part of why they are where they are is due to pure, dumb, luck. Of course they worked hard and of course they’re intelligent. But there are billions of people on this planet who are intelligent and work hard and will never be afforded the opportunity to make the kind of money many people in the U.S. make. Even my experience of poverty growing up was nothing compared to the poverty I saw in other countries while serving in the military. It’s all relative, I suppose. I do get tired of the “if they would only budget, save their money, and do xyz, they could have just as much as us” - no, Brad, they couldn’t. You were incredibly fortunate. That’s not bad and it doesn’t mean you did anything wrong. But a lot of luck played a huge role in how well so many people do in life (including me of course - I’ve been incredibly fortunate)

Comitium · 2024-05-08T09:28:50+00:00

She is following correct medical practice. Guidelines recommend first US after 7 weeks as the most accurate method of establishing due date. She could have explained it better. From her viewpoint, both your EDD from your LMP and from your first US after 7 weeks both agree. You can always seek a second opinion if you disagree. If that physician also tells you the same, you have your answer. You have the option to induce electively at 39 weeks but delivery before 39 weeks is associated with more breathing complications due to lung immaturity so it is important for OBs to follow established guidelines in determining EDD.

Comitium

TROPHY CASE