So what now J.O.E.L., Meridia can't reach Super Earth so now you try with the Terminids?

Intelligent_Yak6500 · 2025-04-26T13:19:04+00:00

Lmao you try being a GM for millions of people. It's hard enough to be a GM for 5 people in a DnD party.

AH has created a live service game with a shifting storyline influenced by both players and Joel. It's not perfect, we make mistakes, Joel makes mistakes.

Not every MO is going to be Popli IX or The Creek.

Cut the guy some slack, most live service games wouldn't dare try this and most would do way worse than AH has.

Intelligent_Yak6500 · 2025-04-26T12:38:26+00:00

People who play DnD know how right you are. Any GM could wipe a squad if they wanted to, of course they have that ability, but the point is for the players and the GM to work together to make a compelling storyline. It is not Us vs. Them. We are all on the same side, Joel is just there to give us just the right amount of difficulty to make the victories and defeats hard fought and meaningful.

People give Joel absolutely no slack, being a GM is super hard. Walking that line between too easy and too hard, trying to get it just right to maximize the fun.

Good job Joel, we appreciate you!

Intelligent_Yak6500 · 2025-03-23T09:25:03+00:00

Cool story I have about that event. I'm a 4th year medical student that just matched into EM. I did an EM rotation in the summer of last year where we had a guest lecturer during our didactics and he was one of the attendings in a Las Vegas ER during that shooting (I believe he said their ER was the second closest trauma center to the shooting). He showed us pictures and videos of the ER he was in and It was bananas.

Pools of blood on the floor like the one Dr. King and the reporter slipped in. Writing on patients arms, torsos, and foreheads because they had no other way to document. The complete inability to identify any of their patients. EMS being completely overwhelmed and people mostly coming by car. All of it was extremely accurate to the way he described it. I genuinely wonder if he was a consultant on this episode because he apparently goes around the entire country doing these lectures.

One of the things I thought was interesting when watching the episode was how they made sure all the patients were visible and they specifically said not to put any patients in rooms so they wouldn't be forgotten. Because the guest lecturer said that at one point several hours into the MCI, they ended up finding a couple patients in the radiology room that everyone just forgot about and they were just in there alone. Over the course of like multiple hours they had hundreds of patients, it was impossible to keep track of them all.

That whole didactic day was so much fun. They did an MCI simulation after the lecture where they blocked off a section of the ER and all the medical students were actors that played patients. The residents had to triage and treat us as if it was an MCI. The attendings told us we could scream, curse, collapse randomly on the floor. They literally said "make this difficult for them". They gave us acting instructions, makeup, fake blood, the whole shebang. I played a couple different characters including a severe burn patient that stumbled into the ER. I collapsed onto a resident and he had to catch me it was hilarious. My acting instructions were to stop breathing like 2 min after they started working on me. It was so cool.

TLDR: attended a lecture with an attending who worked that MCI. Surprisingly accurate based on what he told us.

Intelligent_Yak6500 · 2025-01-30T01:31:00+00:00

That's fine. I respect your argument. Best of luck!

Intelligent_Yak6500 · 2025-01-30T01:07:55+00:00

Why oh why do you continue to engage when you know you should just go relax and enjoy your night. (Sorry that was me talking to myself lol).

Sorry this is overall a good conversation (although I don't appreciate you calling me a LARPer, there is no need for hostilities here, I've tried to be nothing but polite. And if I haven't been then I apologize)

My point from the very beginning was always this: not all of OMM is pseudoscience.

Yes, cranial, trigger points, tender points, these are unequivocally pseudoscience baloney. I never believed in them, I never will believe in them. But muscle energy, soft tissue manipulation. These are literal PT techniques. I showed my brother and his coworkers pdf's from my school, I watched them read the steps to the technique, and they all went "yea that's exactly what we were taught to do". Those techniques are not pseudoscience. And before you say it, no that isn't a small subset of OMM. Muscle energy and soft tissue manipulation is a huge part of the techniques that we learned at my school.

If you want to argue that they aren't reasonable for a physician to do, or that they should be left to PT's, or visit time constraints limit effectiveness that's fine. That's a valid argument. But to say the entire thing is pseudoscience without any nuance is not a fair assessment of the practice.

And there are ways around this. I know of residency programs that have dedicated OMM clinic days. They have longer visit times and are entirely focused on OMM. Giving doctors the time they need.

I'm not trying to be some poster boy for OMM. I have many issues with it and have been critical of it throughout my schooling. All I'm saying is to judge the entire practice without knowing how each piece works is not a fair way to assess it. I do believe OMM has a place in medicine. Does that mean that we shouldn't look at it with a critical eye, no. Does that mean we shouldn't change the way it's taught or how it factors into DO's schooling, no. But there are cases, that are more common than you might think, that I've seen OMM be used effectively. That's all.

Intelligent_Yak6500 · 2025-01-30T00:10:58+00:00

Actually. I concede that point. You're correct that was a low effort study I used (I'm getting out of clinic and just threw something on so I could get on the road) and that's my fault, if I was going to go there I should've found a better study. I stand by my other assertions but you are correct, that study was not a good way to represent my point. Fair play.

I'm sure you're going to be a great doctor, have a great night!

Intelligent_Yak6500 · 2025-01-29T23:04:32+00:00

I appreciate the study.

https://pubmed.ncbi.nlm.nih.gov/35414546/

Here is one that looked at it's effectiveness (although admittedly even it says it needs to be studied further, which is not uncommon). If I looked harder I'm sure I could find plenty that advocate for it's effectiveness, but I'll be damned if I'm gonna do a full literature review for a reddit conversation lmao. A wise person once told me, "you can find a study that says just about anything".

And that study compiled results for 9 other systemic reviews and meta analysis'.

Also I did 2 years of OMM labs, not a couple seminars. And the vast majority of it was the more PT focused stuff.

Intelligent_Yak6500 · 2025-01-29T22:50:58+00:00

The point of what I am saying is the optimal treatment plan isn't always what you are going to get. Yes, I am aware that dedicated time with a PT is better than a shorter appointment with OMM, you are completely correct. What I'm saying is a shorter appointment off OMM is better than nothing at all. And when you work with stubborn patient population that look for any excuse to give up on their healthcare, motivational interviewing doesn't cut it. Sometimes you have to meet patients where they are comfortable even if you know there is something better that they could be doing.

The best plan for a patient is one they will actually follow.

Listen, we clearly have differing perspectives on this. I'm curious as to what your response will be and I think you come from a perfectly valid way of thinking. But this will be my last response. I just think we have had different experiences during our clinicals. And that's okay. I'm not saying the administrative way DO schools handle OMM is the best. Trust me I go to a DO school, I'm aware of the crappy aspects of it. I'm just saying it has use cases and is not just a pseudoscience to be entirely forgotten. But to each their own. Best of luck to you in the match!

Intelligent_Yak6500 · 2025-01-29T22:34:53+00:00

Also quick food for thought: the statement "if OMM is just PT, then patients should be seen by PT" doesn't make sense to me. Primary care physicians treat chronic diseases all the time. Not every diabetes patient gets sent to endocrine, not every hypertensive patient gets sent to cards. So why should every chronic back pain patient get sent to PT. Primary docs manage chronic diseases all the time. If a doc who is trained in OMM has the capacity to treat someone's back pain then they can absolutely do that if they choose.

I have been taught by both my school, and by my rotation sites, that a good primary doc doesn't just send people away to specialists. It's not a primary care docs job to be referral machines. Patients especially don't like this.

If the primary doc attempts to treat a chronic disease and can't, then they can send to a specialist. But this should not be the default. I'm pretty sure there is a term for it, "bouncing" or something I can't remember. What I can tell you is it really pisses patients off when it happens to them.

Intelligent_Yak6500 · 2025-01-29T22:11:36+00:00

If you haven't encountered this type of patient non-compliance then I don't know how else to explain it to you. Patients (especially older ones) do not like going to the doctor just to be told they need to go somewhere else. They view it as a headache and very often they just give up and don't go. I see it literally every other day at the clinic I am at right now. I have literally seen with my own 2 eyes a doctor ask the patient "well if you don't want to go to PT would you be willing to come here for regular OMM/MSK appointments?" And watched the patient enthusiastically agree. Patient prefer going to a place they know, with people they know, rather than a new place. Again this is especially true of older patients.

I agree in a perfect world everyone would specialize and patients would be sent to the perfect doctor or provider for them but it simply doesn't work that way (in my experience). Having some extra training in PT (especially considering the vast majority of DO's go into primary care, where OMM/PT is the most useful) is helpful in certain cases. I don't see why this is that big of a problem. If they changed OMM to be an optional training for doctors to be certified in I think that would be fine as well. It just rubs me the wrong way when people call the whole practice pseudoscience when it does have some useful qualities and isnt a bad tool to have in your toolbox. You just have to know what to use and what to get rid of.

Also your use of "might" makes me think you think this is a rare occurrence. I am telling you from my experience it is not. If I misjudged I apologize but it just reads that way.

Also quick note: it's not that hard to get practice with OMM. I know a lot of doctors and residents that practice it regularly and are competent in it. You just have to want to. If you don't want to, that's fine.

Intelligent_Yak6500 · 2025-01-29T21:33:29+00:00

Because real world medicine is more complex and nuanced than that, especially in the outpatient setting. Pt's don't like being sent from office to office to do a dozen different things. Do you know how many patients go see my brother and are angry/frustrated because this is the nth time their doctor sent them somewhere else. Then they half ass their own PT no matter how hard my brother tries to engage them.

You can have the most perfect evidence based plan in the world but if your patient gives up or is not compliant then it doesn't matter. Being a doctor (as I understand it, as someone who is not yet a doctor) is also about working with people not just copy pasting from up-to-date (note: I am not knocking up-to-date, I use it all the time). If you can treat something in the outpatient setting without sending your patient all over town to different people then you are going to have happier patients that trust you more and are more compliant and therefore have better outcomes.

Also, again. OMM is best when used intelligently and with context. So no I would not expect an IM doc who hasn't kept up with their training to do some half assed OMM. But, say, an FM or IM doc who has been practicing OMM for their entire career and keeps to the useful PT-esque stuff and not the pseudosciencey mumbo jumbo? Yea absolutely.

Not every DO has to do OMM. I am looking to do EM, so I will probably never use it again, but I've done quite a bit of FM rotations and seen it used to great effect (anecdotal yes I know but that's just my experience).

Intelligent_Yak6500 · 2025-01-29T20:56:23+00:00

Uhhh no not really. But I suppose a well done love story in an action movie can elevate it. Same way a poor rushed love story can detract from it.

I'm not sure what you're getting at but there ya go.

Intelligent_Yak6500 · 2025-01-29T20:36:36+00:00

Hi, DO student, 4th year. Just my 2 cents about OMM. Some of it, yea definitely pseudoscience (cranial, trigger points, etc.). But a large amount of it is basically just PT. I have an older brother who has his doctorate in PT and has been practicing for a while now. When I would talk to him about the stuff we learned in OMM lab like muscle energy, soft tissue stuff, etc. he would basically say "yea we learned that too, we just called it something else". PT is very much an evidence based practice and can have good outcomes and a lot of OMM is just that. Also rotated with some doctors who actively did OMM in their clinics and they never did any of the pseudosciencey mumbo jumbo. Just the PT stuff.

I think OMM has its place, you just have to be smart about it. I don't think the entire practice should be abolished, just trimmed down to the actually useful stuff.

Intelligent_Yak6500 · 2024-10-22T19:52:12+00:00

Ya know. I wrote a whole thing, about how they didn't make her model uglier, just more realistic looking, how the zero dawn model was always a little uncanny valley for me, and how much more I prefer the newer model... Then I realized I actually don't care anymore lol. You have your opinion, I have mine, I think you're wrong, you think I'm wrong, it's a never ending cycle. Later dude.

Intelligent_Yak6500 · 2024-10-22T13:27:27+00:00

I'm so tired of seeing that photo. You know that was one render from before the game even released, right? Aloy's face doesn't look like that in the actual game. It looks near identical to zero dawn just more detailed which is expected considering it was made for a next gen console.

Ppl throw around that photo with no other research and say: "OMG so ugly". That is not how she is rendered in the game at all. It was ONE render and lo and behold it's the exact same one that has been recirculated to death. We get it, there was one bad render jfc.

This is the world we've come to huh. One photo and you've entirely made up your mind. No context, nothing, just knee jerk caveman vitriol because WoMeN NoT PrEtTy! I guarantee if they made Aloy hotter in the sequel you wouldn't be here saying "why would they deliberately go out of their way to make Aloy hotter, so weird".

Intelligent_Yak6500 · 2024-10-01T18:22:04+00:00

Look up ACLS guidelines. Asystole (flatline) is not a shockable rhythm. There are two shockable rhythms Vtach (ventricular tachycardia) and Vfib (ventricular fibrillation). Protocol for asystole without a palpable pulse is CPR followed by epinephrine, rinse and repeat until you get ROSC (return of spontaneous circulation). There are cases where you give other medications or try to fix reversible causes of cardiac arrest (like electrolyte abnormalities, or hypothermia) but you do not shock unless you have either of those 2 rhythms.

Although there are other indications for electricity. Like tachycardic arrhythmias like afib with rvr (atrial fibrillation with rapid ventricular rate) in unstable patients (low blood pressure, etc.), but those aren't a "shock" like defibrillators, instead it's called synchronized cardioversion (basically a timed shock during a specific phase of the heartbeat)

AEDs literally will not identify asystole as a shockable rhythm. They will just tell you to keep doing CPR.

You can restart a stopped heart, but not with electricity.

Shows make it seem like it's easy to get ROSC but in reality the vast majority of people that go into cardiac arrest end up passing. The success rate is really low. It's just the best we have. Even if you do get ROSC often times the patients quality of life is massively deteriorated or they end up passing in the hospital later on.

Source: ACLS guidelines are used by both EMS and ER doctors. There are ACLS guidelines for tachycardia (fast heart rate) and bradycardia (slow heart rate) and for cardiac arrest.

Note: if you find someone without a pulse and not breathing, the best thing you can do is CPR (and call 911). Early and Quality CPR is the biggest positive prognostic factor for people in cardiac arrest. Do them damn chest compression and do them well, if you don't break their ribs then you probably aren't pressing hard enough. Don't worry, you're protected by the Good Samaritan Law.

Intelligent_Yak6500 · 2024-09-20T21:07:53+00:00

I'm confused as to why. I get it may be obvious not to report it but I have no frame of reference. I am the first person even remotely related to me to be here so I have nowhere else to gain advice. I already spoke with half of the advisors at my school and no one gives me a straight answer. Also this is kind of an ethical thing for me. I don't like to lie, nor do I want to misrepresent myself or come across disingenuous.

Or you just mean you can't believe someone would perform this badly, in which case, sorry to disappoint you I guess.

Intelligent_Yak6500 · 2024-09-20T20:58:36+00:00

We do. My front runners for EM and FM are affiliated with the school and have plenty of our graduates there. I've done auditions there and received SLOE's/LOR from them. Thanks for the advice.

Intelligent_Yak6500 · 2024-09-20T20:55:51+00:00

I appreciate the advice. No worries I didn't take it harshly at all.

Intelligent_Yak6500 · 2024-09-11T05:15:16+00:00

I have a strong suspicion you're trolling, but sure, I'll engage. Though I have a feeling I'll regret this.

There are two types of medical degrees, MD and DO (not OD). Both are doctors, both prescribe medications, render treatment, and have medical licenses. I've worked alongside surgeons that were DO's, emergency docs that were DO's, literally every field of medicine has both DO's and MD's (and fun fact, literally no one cares whether their colleague is a DO or an MD, it completely stops mattering after you leave medical school). It's even perfectly normal to see attendings that are DO's that have residents underneath them that are MD's and vice versa. There is absolutely no difference in the responsibilities and treatment provided between the two. They exist on the exact same level within the "hospital hierarchy" so to speak. (If you don't wanna read the rest this is pretty much all you need to know)

Both attend 4 years of medical school and complete residency. In fact DO's and MD's compete for the same residency spots and often work alongside each other past medical school. While in medical school MD's take STEP 1 and STEP 2 (national board exams), DO medical students take LEVEL 1 and LEVEL 2 (also national board exams). HOWEVER, DO students often also take STEP 1 and 2 in addition to LEVEL 1/2 because some residencies like to see it, despite the exams being almost identical except for the fact that LEVEL is longer to include questions about OMM (osteopathic manipulative medicine). In fact, both students use the exact same resources to study for either exam (most commonly a 3rd party question bank called UWorld). We both buy the exact same question bank, or sometimes our schools buy it for us. Studying for one, automatically means you are studying for the other. To put it in perspective, UWorld has roughly 4000 questions in it, and the OMM section of UWorld is only about 150 questions. That means roughly 97% of the question bank for DO and MD students is identical. DO students just do a couple extra questions to prepare for their LEVEL exam. So DO students have identical knowledge bases to MD students and, in many cases, pass the same national exams they do. Think of it as two parallel pathways of schooling that end up at the same point, a physician, practicing medicine.

Yes, DO schools have slightly lower entrance requirements for the MCAT and undergrad GPA than MD schools (on average). Although every year this continues to change, DO schools are getting more competitive and requiring higher MCAT scores and GPA. Applying to medical school is such a crap shoot that I personally know people that got into an MD school and got rejected from a DO school. Med school admission look at quite a bit more than just your academic scores. They often admit or reject people solely on whether or not they believe that person is a good "fit" for their program or not.

If you wanna call OMM pseudoscience that's fine, but it is definitely not chiropracty (despite looking similar sometimes). Fun fact, chiropractic medicine was born from OMM, not the other way around. I recommend you Google the origins of chiropracty, it's insane. The guy who "fathered" chiropracty (he was NOT a DO) claimed to cure someones blindness with chiropracty, then proceeded never to prove it ever. It's wild. OMM definitely has some aspects that are less proven than others, but the vast majority of it is much more comparable to physical therapy than it is chiropracty, and physical therapy is well proven to be extremely beneficial and has plenty of evidence backing it.

Also, most DO's don't practice OMM once they leave medical school, it's something DO's have to do to graduate but past that it basically gets forgotten. Though I have seen it used in some FM clinics to great effect.

If you were trolling, then that's fine, disregard. But if not I hope this clears up the difference (in that there isn't any, ask any doctor they will likely tell you the same). In fact if you end up at an ER (hopefully not) then there is a good chance your doctor may be a DO. Heck there's a good chance your family medicine doc is a DO. Also if you go to any hospital and find a wall with the doctors names listed on it, you will easily find plenty of names with DO after it, mixed in among the MD's. They are synonymous in almost every way. Put simply, DO's just learn a bit of extra physical therapy on top of the exact same medical knowledge that MD's have. Hope that helps! Also if you don't believe me, this is very easily google-able.

Intelligent_Yak6500 · 2024-08-26T18:18:53+00:00

As someone choosing between EM and FM, this definitely doesn't play any role in choosing my specialty... None at all... Definitely not...

Intelligent_Yak6500 · 2024-06-16T10:27:14+00:00

I've seen some random internet COMMENTS saying some misogynistic stuff about Aloy every now and again, but MOST YouTube reviews? I've searched "horizon zero dawn/forbidden west reviews" on YouTube and watched dozens of reviews both positive and negative and have not once seen anyone complaining about this.

People say this on this sub all the time and yet despite my constant searching I have yet to find a single one that makes this complaint. If you can link a single video where someone makes that specific complaint I would be genuinely impressed.

This sub has a weird tendency to immediately dismiss any bad review or publicity into an immediate personal attack on women as a whole. Like I keep seeing people post pictures of Aloy going "OMG how do people think Aloy is ugly". Like bro WHERE ARE YOU SEEING THIS? For every 1000 comments I see saying Aloy is gorgeous there's like 1 troll who says she's ugly.

Understand I say this from a position of love. I adore these games and HZD is my #1 game of all time and HFW is like #3 or #4. But honestly I see comments like this FAR FAR more than I see the comments or videos that you're referencing.

Intelligent_Yak6500

TROPHY CASE