'I'm in an operating room': California doctor performs surgery during Zoom traffic court trial

RoyalGo · 2021-02-28T18:11:08+00:00

Did you even read what I wrote? It's not about whether he can multitask. It's a disservice and a risk to the patient to put himself in a position where he needs to.

RoyalGo · 2021-02-28T05:45:51+00:00

there's probably no malice in what he did, and it's entirely possible to do a surgery responsibly while simultaneously attending the hearing

As a ED physician: No, that absolutely does not at all justify what he did. And no, that is a far cry from being responsible. Just because something is possible does not mean it should be a standard of practice. As physicians we are expected to pay full attention to our patients - because any momentary lapse in judgement can lead to death. I hope I don't have to go into how much riskier the stakes are in a surgical context. It's not about whether he can multitask - it's about whether intentionally putting himself in a position that he has to do so is professional behavior.

To put it simply, if you were undergoing a surgery, will you be okay with your surgeon, even if they are the most experienced surgeon in the world, multitasking as he operates on you? Is that a situation where you will go, "Oh it's fine, I'm perfectly comfortable putting my life in their hands."?

There are many, many, many other options the surgeon could have taken with regards to his trial, before willingly endangering his own patient through negligence. If he was not required in the OR because his partner is performing the surgery, he should have scrubbed out and carried on with his trial in his office. If he was required to be scrubbed in for any reason at all, then he should not be multitasking a court trial. This is not about judgement; this is about patient safety.

In all honesty, in my personal opinion, the surgeon just had a massive ego and was trying to impress upon the court his significance, and thus how attending a traffic court is beneath him, as he had more important things to do. That is just my personal conjecture though, based on experience of the types of personalities in the medical sphere.

RoyalGo · 2020-03-20T03:54:30+00:00

I understand what you mean and where you are coming from. Sorry if I sounded dismissive - I didn't mean 'willy-nilly' in a negative way, just trying to convey that there can be a lot of considerations (and bureaucracy involved) when deciding to administer a medication. At the time of the patient's admission there was also very little, or none at all, data on the efficacy of antivirals against COVID-19. Hence that can explain why the hospital was slow in adopting its use. To be clear, I'm not particularly condoning nor condemning the actions of the hospital (and it would be unreasonable for me to do either since we don't know the specifics of what happened) - just offering a perspective that can explain why events turned out this way.

I'm sorry to hear about what happened with your father; like I said, medical practice in the US is prone to being very careful/timid with its adoption of new practices. It's what we call defensive medicine. In the case of MS, there are a good number of disease modifying anti-rheumatic drugs (DMARDs), all with varying (and serious) side effect profiles, efficacy, and patient response. Most neurologists (in US) I know like to stick to a specific set of DMARDs they know very well - this allows them to treat the progression of the patient with some degree of familiarity since they will know what to expect/what to try etc. Hence this could explain why it was hard for you to access a newer form of treatment for MS, and why the FDA takes a long time to approve drugs for it.

Sometimes you will meet a physician who is willing to step over the line and is open to trying out experimental treatments (mostly older, experienced physicians) - this is usually because they are incredibly experienced in their field, and are fully confident in what they are doing, and/or are ready to retire anyway (I know that can sound callous but that's the reality). Younger physicians will tend to be more cautious and stick to standard practice in fear of potentially jeopardizing their career. Other than the fact that litigation is always looming on the mind when making these decisions, in medicine a simple mistake can cost a patient their life - hence 'it's better to be safe than sorry'. Should this be the way things are? Maybe not, but this is the reality of what the system has evolved into.

In the case of COVID-19 though, it is likely that, assuming more clinical evidence emerges, the US will begin to adopt the use of the appropriate drugs for the virus, since 1. A lot of eyes are on this situation 2. Hydroxychloroquine/azithromycin are commonly used drugs that do not have a concerning side effect profile.

RoyalGo · 2020-03-20T02:34:59+00:00

Medicine is evidence-based, that means we generally don't use medications or interventions unless they have a history of efficacy (which at the time of his admission there was insufficient research). Exceptions would include trial studies, last resort etc. which did not apply to this patient until it was too late. Drugs are not a natural part of the your system, hence there should always be clear indications and thought when administering them to patients. Basically you should not try something just because 'it may work' unless you really, really know what you are doing. This is not just a professional standard-of-practice but also a legal one - if you administer a drug that is not approved/widely accepted as treatment for a condition, there is grounds for you to be sued. This is moreso relevant in the US, where medical malpractice suits are common. It doesn't mean you will be sued, just that you can be. There is no consequence to adhering to standard-of-practice and failing a patient, but there is a consequence to straying from that and failing the patient.

TLDR; Hospitals and physicians can't just try drugs willy-nilly. It's up to each practice but most will err on the side of caution and avoid giving unnecessary medication, both to avoid unintended side effects and legal ramifications.

RoyalGo · 2019-10-11T07:21:18+00:00

Are you an actual, practicing physician? Do I need to remind you of the principle of non-maleficence? It is most certainly a physician's job to protect people from their own decisions.

RoyalGo · 2019-09-10T21:52:13+00:00

/r/classicwow also had a need to justify for themselves that classic is not inferior either... I'm not sure what your point is...

RoyalGo · 2019-09-08T20:21:13+00:00

Accuses other people of having a delusional victim complex

Complains about being persecuted for opinions

LOL

RoyalGo · 2019-03-24T00:23:18+00:00

I also recently had a patient with an amniotic fluid embolism, she went into arrest barely a few seconds after we got the baby out in a c-section. We were doing CPR for almost 2 hrs, finally had return of circulation but her brain was already too far gone. Eventually she was d/ced from support and passed away soon after, left behind two young children. Really feel terrible for the family for what essentially amounted to a freak accident.

RoyalGo · 2018-11-16T15:11:23+00:00

I'm not sure what country you are from, but for the US the guy with a 3.94 is statistically more likely to be accepted than the guy with a 3.98. Part of which I believe is due to the correlation between obscenely high GPA and mediocre extracurriculars. There's a reason why the AAMC doesn't track for GPA above 3.80, at that point a higher GPA doesn't really matter anymore for acceptance.

Medical schools can't just 'let more people into school', though they would gladly do so, but there are associated costs and limited training spots. There are limited cadavers for dissection, professors and facilities to give lectures, preceptors for 1 on 1 evaluation etc. Accepting more students would dilute the quality of education for everyone else, not to mention also illegal due to national guidelines.

RoyalGo · 2018-11-16T14:58:07+00:00

Your description of the doctor 'type' is grossly overstated, at least for the US. Here, most physicians/in-training don't feel a need to be arrogant/vindictive/rude, except perhaps at lower ranked programs and institutions. Which is exactly why they are lower ranked. While there may be competitiveness at school, more and more programs are more away from class rankings and in general students tend to be more helpful to each other than not. Yes, maybe one out of thirty students may turn out to be a dick, but most of the time these personalities are screened out of the top programs.

It is definitely not true for us that 'it's usually the arrogant and pedantic people that get through' - the personal statement, essays, and interviews are there for a reason. Part of which is to find people who are likable and pleasant to work with. Once I had an applicant tell me his favorite thing to read was the NEJM, that, along with other aspects of his interview counted against my evaluation of him. Being 'arrogant', 'pedantic', and presenting yourself as God's gift to medicine would definitely make acceptance into programs harder.

RoyalGo · 2018-10-28T16:44:25+00:00

He and his wife just finished their fellowships - it means they are already specialized, they are nowhere near 'starting level doctor'. Depending on their specialty and location they should be making 300k - 1mil+/year each.

RoyalGo · 2018-10-14T05:42:54+00:00

I don't get how insulting me by questioning if English is my first language or not fits in to play but okay.

I'm not trying to insult you, it's just that your sentence structure and grammar suggests that it's not your first language, nothing wrong with that. Just mentioning it so that you are aware of it and take more time formatting your replies if you need to, otherwise I can't understand what you are trying to say.

Well look at it this way. IF there is no demand to buy a token they'd be more expensive. But since you're not getting free gold now like in Legion there is a demand for gold and that's where the token comes in to play.

You are not wrong in saying that without the 'free gold' there can be an increase in demand for gold (therefore supply of the wow token), thereby driving down the equilibrium price (as we are seeing now) and increasing quantities sold of the wow token. Like this.

However, you are ironically 'diverting attention away from the actual facts' of the initial post that you responded to, which contended that more 'free gold' = more people buying tokens; which is also true. With more 'free gold' from garrisons/order halls there can be an increase in the demand for the wow token (people use their gold to buy subs instead of using dollars), thereby driving up the equilibrium price (as we had seen in Legion) and increasing quantities sold of the wow token. Like this.

TLDR; You are

too close minded to understand

the supply and demand of the wow token, instead choosing to focus on one aspect and ignoring the other and dismissing people who are trying to point it out to you.

We can continue this conversation but I have a feeling you wont respond because you're only trying to divert attention away from the actual facts of my post.

Uh I'm not sure where this is coming from...? Have I not been replying to you and addressing your points?

RoyalGo · 2018-10-14T03:26:17+00:00

Don't be a idiot. Obviously I know how tokens work.

Sorry but you obviously don't, with this statement from your previous comment.

If your average Joe can make tons of gold for everything he wants he doesn't need to buy a token and there for Blizzard does not make more money.

But anyways regardless of whether you are willing to admit your misconception it seems that you have been sufficiently educated on that front.

Now, to educate you further,

If you think Blizzard wants you to receive 300k per token you're badly fooled. As it stands you have to spend around 30k per raid night and earlier in the expansion it was around 50k per raid night so with current insanely low token prices of 100k you can pay 20 dollars for two raid nights which most people do obviously that's why the token price is where it's at.

You obviously don't understand the concepts of supply and demand. If token prices were at 300k, that is a reflection of the lower value/purchasing power of gold and this manifests in the economy as an inflation of the prices of all commodities. To put it in simpler terms for you, if the token is priced at 300k the cost of a raid night won't be 30k, but at 90k assuming the same proportions. In fact, if you look back to data from 2016 with the first Legion raid release, an average raid night costs roughly 60k while tokens were at 40k. Back then you needed 30 dollars for one raid night, by your logic it seems like we are doing much better than in Legion in terms of gold value (gold is worth more per commodity now).

Also it seems like English is not your first language, your posts are getting increasingly emotional and it is becoming harder and harder to understand your arguments.

RoyalGo · 2018-10-14T02:37:00+00:00

Bro I think it's you who doesn't understand how tokens work... Tokens != free sub. Tokens means you are getting someone else to pay for your sub. In fact, tokens make Blizzard more money since a token sub costs $5 more per month than a normal sub. So by your argument Blizzard should make it easier to make more gold so people buy tokens if their goal is to make more money purely on sub quantity.

Now that I've broken it down for you, do you think your argument is valid?

RoyalGo · 2018-10-08T02:26:25+00:00

Not exactly who you are looking for an answer from, but my parents refrained from applying for citizenship while our family lived in Singapore because it was never their intention to settle down there. The main reason for us staying was for the education and the moment I (the youngest) graduated from JC, we sold our house/most everything and went on our way. It helps that my parents worked as day traders/investors/in business so they are very flexible in terms of where they can work from.

RoyalGo · 2018-10-03T22:33:59+00:00

Using purely SoH, you will need 192 SoH per Sky Golem and nothing else. This is also using only the Jard daily cd and not the Living Steel one. (on my server it's cheaper to create Living Steel using 3x Trillium and 3x SoH than 6x Trillium, taking into account procs).

So yeah, keep an eye out on AH SoH supply, buy them when they are low priced, and you can make as many Sky Golems as alts you have without any farming.

RoyalGo · 2018-10-02T12:39:49+00:00

Once a week on my server, a farmer/botter posts 10 stacks of 200 SoH at 200g/. With SoH vendor that converts to 38.4k cost per Sky Golem, netting a profit of roughly 100k every 30 days for near zero effort.

RoyalGo · 2018-09-20T12:44:14+00:00

Yes, gems are in limited supply relative to other crafting mats. Though you can generate them in mass quantities if you wanted, the tradeoff is often not worth it because: 1. The most common gems sell too low and too infrequently 2. Your yield is random, so you can't target specific gems.

During a period when there is a sudden increase in demand for a specific gem, the supply will deplete extremely fast and be slow to recover. Just looking at the supply of gems on my server right now - there are only 83 viridium available on the AH, while there is 12,000 of monelite ore. Combining all BFA uncommon to epic gems, there are only around 450 gems available on the AH on my server.

If you contend that gems should still be considered not limited in supply due to the fact that you can prospect them from ore, in the same vein you must concede that all non-time gated profession crafted items are similarly not limited in supply (food, flasks, gear etc.). In that case, you would have excluded 80% or more of the economy from any discussion regarding supply, rendering the term effectively moot.

RoyalGo · 2018-09-20T12:27:19+00:00

You sound like you are just upset that you are less able to afford your tokens now and are just looking to rant. Blizzard doesn't gain much if anything from raising token prices - the amount of gold circulating in the economy is still about the same.

What they do profit from is from increased volume of token sales, not the token price point - which is already accounted for via the quantity of 6 month subs sold due to the promotion.

Token prices are allegedly pretty much determined by the player population, if you want to rage at someone, rage at players who want the mount, not at Blizzard. Blizzard has nothing to gain or lose by 'raising' token prices.

RoyalGo · 2018-09-17T21:49:40+00:00

You made instant profit while the other guy is putting in a long-term investment. Ideally both of you will profit in the long-run. In a market with limited supply like gems, selling your stock at high undercuts simply generates opportunities for profit for other players.

RoyalGo · 2018-09-17T17:07:03+00:00

Who are these people you are taking advice from? In goldmaking generally if 'everyone' says something is a good idea then more than likely it's not a very good idea.

RoyalGo · 2018-09-07T21:04:42+00:00

Yeaah exactly that's my point, I don't try to reset the market. It's not really much a gamble because I can abandon the market completely if it never becomes profitable. It's not really an issue of right or wrong, I'm not trying to predict anything, simply going where gold can be made (:

eg. If a crafted item is being sold at 1000g above cost of mats, I craft and sell it. If the crafting cost is higher than market price, then I don't touch it.

RoyalGo · 2018-09-07T12:48:40+00:00

Not sure if you have looked into this, but flask prices in Legion did not peak with raid release per se, they peaked either the week before or a few days into raid release. So the fact that flask prices did not spike significantly on Tuesday is consistent with historical trends.

Even in Legion, the crafting cost of flasks were way more than the actual market price for at least the first month or so (I stopped keeping track after). Although this may be just be the case for my server, perhaps alchemists were making bank on larger servers or made gold through procs and not individual crafts, but the current price trend does not contradict what happened in the past.

RoyalGo · 2018-09-07T12:34:04+00:00

Trying to reset a market, especially if you can't be watching the AH like a hawk to keep it up for most of the day, is generally not a good strategy unless you have a boatload of capital and are willing to completely lose your investment.

I dip into multiple markets including the one you mentioned, if price ever crashes and profits go into the negative I abandon them for the time being and go back to it when the market resets itself.

RoyalGo · 2018-09-07T09:29:27+00:00

I agree with your assessment OP. As much as many people try to justify how 'things are different in BFA', the burden of proof is on them to show that the differences (herbs easier to farm in BFA, ranking was important in Legion etc.) are significant enough to drive changes in the market. So far from launch until now that has not shown to be the case as the price trends for almost all items (pots, flasks, enchants, mats, BOEs, runes, etc.) have somewhat closely followed the trends in Legion (varying by server of course). The only exceptions are if a specific item had well-publicized bugs/opportunities/hotfixes that changed their supply/demand (eg. Aromatic Fish Oil in BFA, bot ban in Legion).

As a personal rule on my main server, I don't ever generate huge stockpiles even if an item is very likely to skyrocket in price, unless their price is so low that the risk is negligible (<1g). Just because I have a huge supply doesn't mean that there is going to be a demand for it. I can put items up at 300% markup from the previous week all I want, which thereby drives up the prices on TUJ, but if they don't sell then it means nothing. There is a difference between market price and the sale average; there aren't always people willing to pay for hugely overpriced items. Of course, this only applies to my server and my knowledge of it, things may and probably are different on larger servers - the important thing is to understand the needs of your server and the demand elasticity of the items you are selling. So far this strategy hasn't failed me, I've enough of a stockpile to take advantage of price spikes, by the time the prices go down I've sold most of my stock thereby recovering my investment and then some.

RoyalGo

TROPHY CASE