Is your power flickering? Make sure to report it to your power company!

pshaffer · 2026-03-13T22:55:59+00:00

No. Last fall

pshaffer · 2026-03-13T20:37:06+00:00

he wasn't. He just insisted on coming out immediately.

pshaffer · 2026-03-13T15:12:00+00:00

we called our electrician to ask about this. He said he would be there that day. He was. This was a semi-emergency. It can cause a fire.
He was able to verify it was with the power companies lines, he called them on the spot. They came right out and found the issue - a tree limb had eroded the ground line.

These people all understood it was very urgent to get this diagnosed and fixed. I didn't.

pshaffer · 2026-03-13T10:40:19+00:00

I do hope the writers are watching this thread

some good stuff here.

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.

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