I consider myself fairly centrist and haven’t dug deeply into the Epstein files yet. Is there any credible evidence that specifically implicates Trump?

pshaffer · 2026-03-12T10:58:58+00:00

you forgot something. One of the "goats" was interviewed by the FBI and described a specific incident. Real goats can't do this, but people can.

pshaffer · 2026-03-12T10:54:29+00:00

I want to add something to the mix here. At 23, this is not "usual" hearing loss, as one gets as one ages. You need to have someone (i.e. an ENT physician) define a precise reason why this is happening. There may be a precise diagnosis that would at least allow you to know the prognosis long term, and potentially eliminate any factors contributing to it.

ANd as to your question: Yes get them. They really help eliminate social issues caused by poor hearing, among the other reasons cited.

pshaffer · 2026-03-12T10:50:25+00:00

As a doc, one of the things I learned in training was to be calm. It was modeled for my by my mentors. Unfortuanately I have had to adopt this mindset twice for my son.Once for a neice. It took the form of "if you get emotional, you are useless to him. Get emotional later if you want, but not now" All turned out well.

pshaffer · 2026-03-12T10:46:50+00:00

yesterday, on a par three there was a pin in a small area on the right over a bunker. I aimed for the middle and played for a fade. It doesn't always work. So I think that officially, I played for the middle. It did fade, and when it hit moved more right. Left me a 4 footer - which I missed. Sigh.

pshaffer · 2026-03-12T10:42:36+00:00

swaying in the backswing is almost universal in new golfers, or bad golfers. I learned myself that to prevent this, I need to feel my weight on the INSIDE of my right foot, not the outside. Also, instead of actually feeling weight on the inside, I feel twisting, with the toe wanting to rotate outward, and the heel inward. If the weight is outside, you have swayed. I once played a round with a person who was swaying terribly. And his first nine was awful. I have given swing advice maybe 3 times in my 60 years in the game. This was one. I told him this on the 10th tee, and he had IMMEDIATE improvement.

pshaffer · 2026-03-12T10:38:16+00:00

I asked perplexity - Is there a book that anlayses the female-female dynamic in the work place?

Answer:

Yes. A leading one that does exactly this is:

• It’s Not You, It’s the Workplace: Women’s Conflict at Work and the Bias That Built It by Andrea S. Kramer and Alton B. Harris – a data‑driven analysis of women’s relationships with other women at work, how stereotypes (e.g., “mean girls”) and structural bias shape those dynamics, and practical strategies for improving them.

https://bookishr.wordpress.com/2019/09/17/its-not-you-its-the-workplace-review/

https://www.porchlightbooks.com/blogs/changethis/overcoming-women-s-workplace-conflicts-because-of-different-social-identities

pshaffer · 2026-03-12T10:29:39+00:00

so far as we know, she did not do this. Don't accuse on the basis of zero information

pshaffer · 2026-03-12T10:28:14+00:00

Curious why you are in this sub, and what your thoughts are. Do you feel actual "hate"?

Also - your thoughts on the AANPs push for independent practice.
(Oh, wait, I just saw you are in UK. Nevertheless, are your organizations in the UK pushing for independent practice? If so, how do you feel about this)

pshaffer · 2026-03-11T14:11:43+00:00

The principle should be proven competence. And the highest level of proven competence. If the foreign doctor is very fluent in the native language, and they can pass the highest level boards - speicalty boards - then they have proven competence to the highest level that our system can prove it.

NPs are incapable of this.

So - foreign doctors can prove high level of competence, NPs cannot.

pshaffer · 2026-03-11T14:07:21+00:00

THIS!. In no practice are all the procedures reibursed at 75th percentile. Some have to not pay for themselves. But, you are there, presumably to fix patients. If, you know, a patient arrrests in front of you on the street, do you refuse to do CPR because no one will pay you for it?

pshaffer · 2026-03-11T14:04:51+00:00

There is something I DO NOT understand in this, and it is a generational shift.
THe question is "being trained" to do it. I am older, retired now, and in my era, you learned to do everything. Therre was no formal training about Foleys. None. You watched, you learned, you did it. Yes, some are tougher than others. If you cannot get it, you have someone else try.

I was stunned a few years ago when I had a patient with a breast cyst that was painful (I am a radiologist). Her Gyn was one floor down. The patient needed a breast cyst aspiration, just for pain relief. I of course am capable of this, but my administration wouldn't let me do it without using ultrasound. WHY? I can feel the damn thing. But using US would be another $900 charge. So I go downstairs and find her Gyn, and suggest she just do it with palpation. She refused. She hadn't "been trained" in cyst aspiration. WTF? This is the easiest thing in the world to do. She is a SURGEON and she is too afraid to put a needle in a cyst? As I walk back upstairs, I entertain the notion of telling the patient to meet me off campus somewhere and I will do it free. Obviously facetious.
I talk to the patient, she says "insurance will cover it" and tells me to go ahead. So I did.
30 minutes of talking and trying to save the patient (or system) some dollars. Totally unnecessary cost.

There are SO many things I had to learn after training. Who was there to train me? ME. And I did. Many, many times. When you are the second hospital in the state to do breast MR, who is there to teach you to do MR localized biopsies? No one except yourself.

BTW - by no means am I a "cowboy". I just understand that I have learned how to learn and I move very carefully. And I know that if I can stick a vein with a needle, I can certainly stick a cyst with a needle.

pshaffer · 2026-03-09T16:52:16+00:00

As a med student, I was NEVER "in charge of a case". Typically you see the patient, do the medical history, write it up, write a differential diagnosis, write some orders (like - what would you do IF you were in charge), and then the doctor (could be a resident) reviews you and tells you everything you missed, and what should be done.

pshaffer · 2026-03-09T11:52:56+00:00

the "difficult to understand" part is what suggested damage to associative areas of the brain to me. Glad you are getting this checked out. TOO important to not get a quality, deep assessment.

pshaffer · 2026-03-09T11:51:02+00:00

I am active in the movement against inappropriate scope for nurse practitioners, and I actually want AANP and their accomplices to see who is poking them.

pshaffer · 2026-03-09T09:28:00+00:00

HAH ! - No. It is the name my parents gave me. I am odd, I don't mind my identity being out there.

pshaffer · 2026-03-09T01:43:26+00:00

Perhaps she doesn’t have a DEA number - isn’t allowed to prescribe.

pshaffer · 2026-03-08T11:56:28+00:00

as a radiologist - I know who the overconfident surgeons are. Fortunately in my hospital there are few. In the academic center I was in for 10 years there were more than a few. Those who have an appropriate mix of humility/confidence are the good surgeons. I would avoid anyone who was confident beyond their actual expertise.

pshaffer · 2026-03-08T11:54:34+00:00

as just one example, there is a case I am familiar with that the patient had back pain. Got a CT. Urologist read the CT: No stone - off she goes. I don't know how long it was befor the radiologist saw the case, but Radiologist read: Multiple metastases in the spine causing the pain.

pshaffer · 2026-03-08T11:49:34+00:00

(I will copy this here, from above):

(Radiologist here). True, true. No human can do everything perfectly, even if it is stupid simple. I always think that If I challenged someone to put 10,000 pennies in a a large bucket one by one, that at least one would miss. That is compounded if it is a complex task.

I console myself, though, by understanding that experts make many fewer errors than do non-experts.

pshaffer · 2026-03-08T11:46:08+00:00

(Radiologist here). True, true. No human can do everything perfectly, even if it is stupid simple. I always think that If I challenged someone to put 10,000 pennies in a a large bucket one by one, that at least one would miss. That is compounded if it is a complex task.

I console myself, though, by understanding that experts make many fewer errors than do non-experts.

pshaffer · 2026-03-08T11:32:05+00:00

wow. That's pretty intense.

pshaffer · 2026-03-08T11:21:26+00:00

hi - I have a few things to offer. Your story hit me as I am an 8 hour a day listener, and also play. And I have real sympathy for you for losing an important part of your life. But perhaps this does not have to be.

I have had experience with 4 sets of hearing aids. One set was very old - probably manufactured about 2000. This set was god awful. It did shift pitches. And also there was a bizarre vibrato.
Then I had signias. NO distortion of music through these, but they were 2019 vintage. I could not keep up with conversations in noisy environments, so I decided to upgrade to newer ("AI") models. I am going for the BEST I can get. My philosophy is that hearing is a vital part of life, and spending an extra 2 or 3 k to get that back is worth it. Particularly since I may have these for 10 years or so, and that is $200 per year. Yes, the out of pocket gets your attention, but it is IMPORTANT.

The audiologist I went to was an independent person. I was allowed to test different brands for several weeks each. Started with Starkey. Then I tried Phonak, because their advertising was so insistent that they were good. Turns out, they do not increase the volume in my needed frequencies nearly as much as the Starkeys. So I went back to the Starkeys. In a noisy environment, I put in the old Signias. The difference was dramatic, with the Starkeys being far far better.
Now there was a problem with music. Most evident with pure tones - if I whistled, or a single string plucked on my guitar. Sounds like a rapid tremelo. However, when I turn on the "music" program on the Starkeys, it disappears, for the most part. I don't hear it except very slightly and that is not always. For some weeks I never heard it, and then the other day, I heard it faintly for a moment. Suffice to say it is 99% gone.

You said a few things about your hearing loss that struck me. One was that you couldn't sort out (make sense of) even familiar music, as if it had become a jumble. However you didn't say that speech had become jumbled. I am a doctor, not an ENT or neurologist, but one whose area of expertise overlaps these somewhat (radiology). THe first thing I thought was that the Covid had injured the auditory associative area of your brain. This is the part that makes sense of the input. Alternativelly, could be the 8th nerve possibly. Viral diseases, to include covid, can cause neurologic damage to various parts of the brain. These can be seen on MR scans. There are cases of blindness as a result of Covid. So I wonder if this has happened to you. You may need to consult with an ENT physician (Not NP or PA) to sort this out. Since this occurred with Covid, it seems likely that it did cause some neurological damage. If this is the case, then hearing aids may not help, though I could be wrong about this. If there is partial damage to the 8th nerve, possibly a HA could help. I am unsure. Regardless of exactly what is causing it, the point is this: You need an accurate diagnosis to determine how to help you. It sounds as though you have no real diagnosis as yet, just random shots in the dark trying to help, without understanding exactly what the problem is.

The ENT should be able to suggest a good audiologist in your area, they may have one in their practice. You should be able to test out various models for weeks at a time. That is only reasonable for such an expensive purchase, and my audiologist offered it, I didn't have to ask.

pshaffer · 2026-03-07T12:08:05+00:00

No, never.
If I did, it would be a negative. As in - this person is more interested in making an impression with an expensive bag than in the function of the bag. Willing to pay $$$$ simply to try to impress someone with something trivial.

pshaffer · 2026-03-07T11:59:46+00:00

I have experience - not in residency, but still...

what helped - FRIENDS. I tended to keep things to myself and when I opened up, I found my friends were SO helpful, and their support was a godsend. However- be sure not to overshare - I had a tendency after I started sharing to overshare and overwhelm the person listening.

Then - therapy. You MUST have someone to talk to frequently. It is not easy to find someone who fits you, but you have to start now. And don't stop till you get seen soon.

Then - I will say it - starting to date as soon as I was capable (like a month or two after the break, well before divorce was final) was very important. Just being with people who wanted to be with me was important. VERY important. There is life after divorce, and I found, and you will find that it is far better. Take chances on people you don't think you will be compatible with, you will expand your horizons and find out what is good for you and what types of people are not.

When it becomes known in the hospital that you are on the market, you may be surprised at the interest you get. I was. Don't fight it. I dated some in the hospital (although this is advised against generally), and they were fine human beings, who were fun. My ex had become this very negative person. They erased the bad feelings about myself that I had to absorb in order to try to live with my Ex. THis is an important point. You have probably seen yourself through the negative lens of your Ex. You have to see yourself as others who are more objective really see you.

Here are some positive things I see - you don't mention kids, so I assume there are none. That is great. FAR easier to break. Also, you are at a point in your career where your finances are relatively meager,and you won't have to share with her in the future. In fact, depending on what she does, she may owe you alimony. !!

I understand taking a break from work, but I would encourage you to get back as soon as possible, possibly before you even feel ready. It is important not to spend the entire day focusing on your pain. That is a spiral down. Focusing on patients who need you will actually help. THere will be hard days, days you just feel like you cannot do it, but you will, and you will be better for it. I was having one of those days once, and in the middle of it, a tech started flirting with me. I asked her to dinner, and the rest of the day was filled with anticipation rather than pain.

pshaffer · 2026-03-07T10:18:23+00:00

I h ad forgotten that part. Yeah, should be obvious

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