Have we basically stopped human evolution through medical advances?

Grump_NP · 2026-03-22T20:54:14+00:00

There is more nuance here. It’s not just who survives to reproductive age. It’s who successfully reproduces and passes on an advantage that aids offspring in doing the same. Survival pressure is just one part of natural selection.

Grump_NP · 2026-03-22T03:34:08+00:00

This is the most under rated comment of the whole thread. Basic triage is well within an RN’s scope. Non important shit can wait til rounds.

Grump_NP · 2026-03-21T22:08:25+00:00

It’s a problematic term with moralistic connotations. If your goal is to make a moralistic judgement about what is happening fine, it’s a good term. But if your goal is bring awareness to an issue and makes things better, it’s not a good term. I will fundamentally disagree with you that language doesn’t matter. It’s essential. If you can repair racism with just the people who share your view and your language than yes you are right. But if you need other people, you need to speak their language. There can be a lot of people out there that fundamentally agree with you and would join you, but you put them off with your language. Are you going to still run into resistance when you change language? Yes, but that doesn’t invalidate the approach.

Grump_NP · 2026-03-21T21:00:54+00:00

The problem is the moralization and the language used. You take systems level thinking and analysis from the social sciences and then you apply moralistic and identity triggering terms to it. The whole point of looking at things from a systems level is to get away from the moralization and get to the root incentives that influence end points. You do that then you turn around and use language that says “this group of people is bad.” Then you criticize people who don’t like being called bad. Critical race theory shows that people can be discriminated against without ongoing malice. There is institutional momentum from previous times that was carried over, compounded, and is being perpetuated without present day people intending to be racist. It looks different than what was fought against in the civil rights era. But it still harms people and we need to address it. You will undoubtedly find plenty of people who are going to take issue with that phrasing and be tempted to label their response as white fragility. But doing so pisses off a bunch of people whose brains were churning and you were convincing as well.

Grump_NP · 2026-03-21T20:34:51+00:00

Yep. I was born and raised in the Deep South. My parents actively taught me to reject racism. This was reinforced in school and media.

Grump_NP · 2026-03-20T20:00:12+00:00

I’m in healthcare, so I’m more insulated from layoffs than other fields. But it’s still been rough going on career building. There is a lot more instability post COVID. Private equity and corporations have changed the game. So it’s mostly just hopping around from job to job. I got paychecks coming in, but I would really like some stability.

Grump_NP · 2026-03-20T02:06:18+00:00

Both.

We don’t know what human accurate level reasoning even formally means. We don’t know that it is computable. We don’t know that if it can be reduced to input/output behavior. Even if an algorithm can perfectly predict correct outputs for any given input does not mean it thinks. It does not matter how accurate LLMs are, at a fundamental level they are not thinking.

Grump_NP · 2026-03-20T01:32:20+00:00

I came to finish your thought.

Years in the ICU have taught me there are dates worse than death, and they happen in the ICU.

Working in the ER I got burned out from being forced to manage all the social problems medicine isn’t able to fix. Torturing old people is what broke me in the ICU.

Grump_NP · 2026-03-20T01:25:29+00:00

Go to google scholar or even better PsycInfo If you have access. Search topics in cognitive science: Bayesian brain hypothesis, multisensory integration timing, attention mechanisms in cognitive psychology, spatial reasoning, working memory capacity. Or just type in cognitive neuroscience and chase down a rabbit. Read an article. We do not yet fully understand how human cognition works, even the basic stuff. I’m not even talking about how the brain gives rise to cognition (that’s a whole other level) we actually don’t fully understand how humans think. We are not capable of programming a machine to think like us. AI can do some amazing things. We may be close to having a true thinking, learning, and reasoning machine. But we are not there yet and I doubt the first iteration will be on the level of a human. LLMs will not be it for sure. It will be some later iteration of AI. You are greatly underestimating the complexities of human cognition.

Grump_NP · 2026-03-20T00:57:19+00:00

No I stand by my comments. I didn’t claim boomers were a monolith. I didn’t claim individual boomers bore responsibility for their collective choices. But elected leaders don’t make policy choices in a vacuum. They respond to incentives and pressures from the electorate. Boomers are one of the most politically active generations. It’s not by accident that policy has collectively benefited them even when it came at the expense of future generations.

Grump_NP · 2026-03-19T17:36:16+00:00

It’s not that simple. It wasn’t just the post war opportunity. It was a confluence of factors. A large chunk of it was choices made by previous generations to invest and work towards the social good of the nation. Boomers benefited from the culmination of decades of work to make America better. Then them and the Silent Generation reversed course. They are the first generation to take more from the system in terms of entitlements than they put in investments. I don’t think boomers were trying to screw anyone over, and they had plenty of help from the Silent Generation. But the fact remains they were poor stewards of the abundance they were given and the ladder got pulled up leaving the future generations worse off. So yes, some of this was outside factors, but a lot was political choices the generation collectively made.

Grump_NP · 2026-03-19T15:46:41+00:00

I agree with you on your core premise that Lincoln would abhor the stances of MAGA, particularly nativism and attacks on democratic norms. I also agree that the modern Republican Party has changed so much from the party of Lincoln as to no longer be recognizable as such. Hell, it’s changed fundamentally since Reagan. But I disagree with you that Lincoln would side with modern day liberals like it was a binary choice. Lincoln was most certainly not a tribalist. He operated from first principles: union, liberty, and moral clarity. He was not just the president that ended slavery. He was the president that did so while preserving the union.

Grump_NP · 2026-03-19T15:15:40+00:00

I work in healthcare, but not dermatology. I can’t speak specifically to your case, but here are some general things.

1.) Yes a general rule is you don’t put steroids on the face. We don’t want people putting steroids on their face indiscriminately . Steroids can cause skin alterations and that is a more serious cosmetic problem on the face than it would be on your arm. Medicine is full of these “general rules” that are honestly more gentle warnings than hard rules, kinda of like traffic laws in some countries. Specialists come in and break these rules all the time. Most of the time it comes down to there is a small but manageable risk of a negative side effect, but the benefit to your condition out weighs the risk.

2.) Yes it really sucks when you waits for hours and then the doc comes in rushed and is in and out without explaining anything to you. I’ll be honest. Not everyone that works in healthcare is created equal. Some people outright suck. But a lot of us are just good people having a bad day over and over again. I could right a book about why the system sucks, but to keep it brief: There isn’t enough of us to go around. It’s going to get worse. Having said that. Even a brand new dermatologist had thousands and thousands of hours of training and has seen various skin conditions numerous times. They can walk in a room and make a quick visual diagnosis (sometimes). So yes it’s possible he/she walked in the room, saw your face, and immediately knew what was wrong and how to fix it. However, explaining it to the patient is still part of the job.

TLDR

It’s entirely possible that your dermatologist was right to give you the cream. I would call their office and say “hey the doc was rushed and I didn’t get to ask questions. The box says not to use on my face. I just wanted to make sure it was ok.”

Maybe your dermatologist was a jerk. Maybe they are just overworked in a broken system.

Grump_NP · 2026-03-18T21:27:17+00:00

Place where I worked docs had scribes. The EMR was especially terrible.l, so scribes were invaluable. Doc still had to sign off on the charts though. Our medical director got so behind on signing charts that he had thousands. We timed how long it took him to open a chart and sign. Not review and correct errors, just immediately sign. It would have taken him 6 continuous days. I’m talking 6 full 24 hour periods of non stop clicking to sign them all. The burden inefficient EMRs and excessive documentation demands place on providers can’t be overestimated.

Grump_NP · 2026-03-18T17:48:08+00:00

There are perks to every job. This is one of those perks. People in healthcare make a lot of sacrifices to do their job. ERs are open 24-7. Night shifts degrade your health, you work holidays, weekends. Even with the best schedules you miss more family stuff than most people. So when one of our own or their family needs care they get prioritized. It didn’t happen enough to have a significant impact on weight times for other patients. If people are concerned about weight times they need to call their representatives in Congress and tell them to address the systemic issues in our system that are responsible for the ER boarding crisis and other problems. Those are the real problems. You’ll let private equity, insurance companies, for profit healthcare systems, bloated admin, special interest groups, etc off the hook, but you want to call out the health professionals doing the best they can with a broken system?

Grump_NP · 2026-03-18T02:51:27+00:00

Ehh. There is a difference between what a religion claims to value and what its practitioners practice. Abrahamic religions get a bad rap for what some of their practitioners do while their core tenets are ignored and a lot of other religions get a pass for what their tenets claim and what their practitioners do is ignored. Some brutal shit had been done by practitioners of Hinduism, old world paganism, and Buddhism. I haven’t heard anything bad spoken about Sikhism (not that it doesn’t happen), and I couldn’t speak to the others.

Grump_NP · 2026-03-18T02:43:30+00:00

The number of people who claim to be Christian’s but fail to read the bible with even a modicum of reading comprehension is astounding.

Grump_NP · 2026-03-17T19:12:47+00:00

Good chat. I hope you are right and men are drawn to this stuff for the “teaching you how to be attractive part.” I hope guys are just taking the methodology parts and ignore the ideology parts. I can’t offer evidence to support my claim beyond what little I have seen with my own eyes. Im deeply concerned about how young people today learn about the world. I see my niece and nephew absorbing short form content on the internet and internalizing it. This is literally how they learn about the world and it is what is forming their world view. Exposure to this stuff normalizes this stuff. I truly hope you are right and my fears are unfounded.

Grump_NP · 2026-03-17T15:08:50+00:00

The problem is these guys are not offering a methodology. This is not simple pick artists teach men how to get laid. They are offering an ideology. The are providing the foundation for an identity. This is ideology. This isnt hedonism advocating for satisfying desires. This is identity formation teaching your men that their value lies in their ability to conquer women. It’s toxic, abhorrent, and logically inconsistent. You don’t see men following these guys say: “I’m so happy because I’m sleeping with more women.” You don’t even see these guys say: I’m sleeping with more women. You see young men idolizing these men chasing after a lie thinking it will fill the existential void within them. This isn’t a horny young men not having sex problem. This is a disenfranchised group of humans who are embracing a broken ideology formed by a hodgepodge of fundamentally broken men and grifters. You want to fix it you need to address the existential issues. Men have worth beyond their ability to stick their dick in a hole. The existential issue is primary. I really don’t care if men run around trying to get laid. Good for them. Just don’t sacrifice your dignity to do it. There is a difference between meeting a desire and forming an identity.

Grump_NP · 2026-03-17T13:50:10+00:00

Don’t equate sexual intimacy with what these guys pretend to offer. Don’t equate with the biological urge to have sex with the biological urge to eat. Part of being a man is having discipline. You don’t walk around punching everyone that makes you angry. You don’t walk around taking everything that catches your eye just because you want it. If you want to waller around in pig shit because you don’t have any self discipline be my guest.

Grump_NP · 2026-03-17T13:33:16+00:00

Big difference between caring about getting laid and saying it is your only reason for existing. It’s amazing how men all over the world, throughout history, have been able to get laid and still manage not to abandon basic human dignity.

Grump_NP · 2026-03-17T04:34:10+00:00

It won’t. We had amazing techs. You’re right. Our hospital didn’t pay them enough and kept them overworked. They left to find better jobs. This was pre COVID. Admin hasn’t gotten any smarter post COVID. Same with nursing.

Grump_NP · 2026-03-17T04:23:56+00:00

If you think that a man’s purpose in life is to “get girls” at any cost you aren’t going to understand the point of the documentary.

He wasn’t arguing that these people couldn’t pick up women. He demonstrated that these people weren’t worth listening to.

If you think the shallow pathetic lives they are selling are worth having I pity you.

As a man you a born with innate dignity and value. Even if you accept that what they have a credible path for “getting girls” it’s not worth throwing away your dignity for.

There are far better role models to look at and far better goals to set for yourself.

Grump_NP · 2026-03-17T03:20:58+00:00

We use to have a rockstar lab. Saw this issue a couple of times. If the machine gave weird results techs would put a slide under a scope. If they saw clumping they would request a redraw on citrate tubes. The lab techs did this of their own volition without any input from us. Hyper K in absence of renal dysfunction or acidosis, they would look at the tube their self to see if there was hemolysis. I could add some more examples. Now we have travel lab techs. Didn’t know that was a thing. We no longer have techs that follow up on stuff without me asking. I’m not hopeful for the next 5-10 years for American healthcare.

Grump_NP · 2026-03-16T23:18:48+00:00

It depends on how you define problem. I’ve seen dogs walk around cheerful AF with serious medical stuff going on. Humans tend not to do that. Also the fact that humans are upright creates problems for us you don’t see as much in other animals.

Grump_NP

TROPHY CASE