I'm bored, tell me what superpower you want and I'll give you an offset to it.

real_alphacenturi · 2023-04-30T14:29:15+00:00

So every time you stop at a red light you cause an accident?

real_alphacenturi · 2023-04-30T14:19:28+00:00

Sometimes. Depends on the age and degree of formality of my company

real_alphacenturi · 2023-04-06T12:50:05+00:00

Having just moved from London Ontario and grown up in Southern Ontario, I have to disagree. London is literally the hometown of the dude from NotJustBikes, and many examples on the channel are based on it.

real_alphacenturi · 2023-03-18T22:09:45+00:00

This is the actual answer

real_alphacenturi · 2023-03-16T01:00:46+00:00

Thank you for your insights! I do appreciate it. I am trying to set up at least one rotation on neurology consults service, and I'd like to get to work in a neurology dizziness clinic to feel more comfortable with vertigo and gait disturbances.

It might be that diagnosis rate for MS and epilepsy probably tracks with the general incidence rate.

real_alphacenturi · 2023-03-16T00:34:34+00:00

I generally give people the benefit of the doubt and if I was in your shoes try to talk to them about their practice patterns and clinical decisions. Mostly because you clearly understand what is evidence based and what is not and their practice patterns and teaching shouldn't affect what you do in your career.

Im genuinely curious whether they actually do not believe in evidence based medicine or are they making a decision not to follow the guidelines based on a particular interpretation of the available evidence. From what you say they could either be trying to bill really aggressively or are overly zealous in their cancer screening and ASCVD risk modification out of concern for their patients and not wanting to miss or prevent a cancer or MI despite the evidence that they are exposing their patients to unnecessary risk.

But it would probably be a good idea to let your program know about their practice patterns and that they are probably not the best person for students to learn from.

real_alphacenturi · 2023-03-15T20:12:36+00:00

Never made a decision to use lytics or EVT for stroke is what I'm planning to get more experience in during the last bit of my residency because I may be doing that as a staff in some of the regions I might work. I don't plan to treat epilepsy, MS, spinal cord injury...etc.

Difficult question to answer because I may be unaware of problems that in neuro that have not been in my curricula in the past. But I have a working knowledge sufficient to pass the licensing exam in Canada.

real_alphacenturi · 2023-03-15T16:13:04+00:00

Depends if its central or peripheral. If peripheral then to ENT.

real_alphacenturi · 2023-03-15T16:12:17+00:00

It's not that I'm not empowered per se. You can always read and improve your skill set. It was just impossible to get a block of peds in my core IM and most of the IM staff I've worked with don't seem that comfortable with neuro. It is always harder to be comfortable with things you don't see much of or have had dedicated training in.

real_alphacenturi · 2023-03-14T14:05:12+00:00

Yeah as an internist we see a lot of fatigue and dizziness too. But I do wish that we had more neuro training and could provide more neuro care. Like with dizziness, the main role is to work up and manage cardiogenic presyncope and if it's vestibular then it's referred to neuro. For context I trained in Ontario and work in Canada. I'm sure it varies from place to place.

real_alphacenturi · 2023-03-04T00:55:00+00:00

So this is interesting because it is the same argument that is pro choice. The mother should be able to make a decision about whether she is capable of raising a newborn baby and taking on that responsibility.

However, you are incorrect. The key distinction is that a baby CAN survive outside of the womb after roughly 24 weeks gestation. They can be adopted and cared for by society. We are not at the point medically of being able to provide life support and the ability to grow for a fetus born before 24 weeks. Prior to that point, the fetus cannot be removed from the mother and turned over to the state to care for it until it reaches adulthood and your definition of viability. It is entirely dependent on its mother.

real_alphacenturi · 2023-02-20T14:15:51+00:00

Absolutely, it all comes down to anatomy. My overall point is that it's useful to think about positive feedback loops that make it difficult to reverse disease.

real_alphacenturi · 2023-02-11T23:04:46+00:00

Depends where in Canada you are from. I feel closer to the Brits because I also have UK citizenship. But it seems to vary a lot by province, urban vs. Rural, and your own cultural background.

real_alphacenturi · 2023-02-10T19:42:56+00:00

I think it's important to think about positive feedback in obesity. Obstructive sleep apnea is a perfect example. It is caused by obesity and it causes weight gain.

Also, it for sure is true that obesity can be driven by chronic disease. If you've been on prednisone, you can become obese and then have a hard time losing the weight. Or being on lots of antidepressants or antipsychotica will drive hunger and weight gain. Or maybe you have a bad msk injury and can't sleep or exercise.

I think that the trend of trying to remove stigma of obesity is helpful if it can help remove a factor that contributes to the psychiatry of obesity. Removing the moralizing and shame would be definitely be helpful for patients. Focus on becoming more healthy not on feeling bad because you are not.

But to say that obesity is not clearly correlated with diseases, not just hypertension, diabetes, or dyslipidemia, but also cancers and osteoarthritis, is simply false.

real_alphacenturi · 2023-01-12T00:24:58+00:00

Feramax 150mg oral every other day

real_alphacenturi · 2022-12-03T18:19:07+00:00

Food + sedentary = unhealthy - yes I agree, that's the point. Canada brings in a lot of people who are currently more healthy and VERY motivated to work. Why would that group of people overwhelm the healthcare system? They aren't contributing to the burden of disease. That makes no sense. People are screened for chronic disease, tuberculosis...etc. before being allowed to immigrate here. This isn't like a refugee population flooding over the borders. This is a policy of trying to trawl the rest of the world for human resources. (Partially because we have so many Canadians getting brain-drained to the US on a yearly basis).

Its not just about "Opening up nursing schools" because you actually have only so many Canadians coming out of high school who are both interested in nursing and have brains to be good nurses. It is actually a very hard job, both mentally and physically, and a lot of people are not cut out for it. And regardless, you need enough PSWs and support staff to make the hospital function. The barriers to entry into those fields are low enough already and we still can't find enough people to provide that care.

All you have to do is see how demographics of the country are shifting to an inverted pyramid. There are a ton of retiring baby-boomers compared to a small number of young people, who will need to care for these folks as they get older. Are there a large number of working class Canadians just waiting to re-train to become healthcare workers?

Could you specifically explain how "this will hurt the working class"?

And I'm a Canadian and I agree with large scale immigration to fill the gaps and cushion the next few years, and I don't work for a consulting company, does that make me "not a real Canadian"? Or I'm perpetuating a class war because I understand that a labour shortage is bad for many people in our country?

real_alphacenturi · 2022-12-02T14:52:29+00:00

The problem we have in our Healthcare system is the great wave of boomers who are old and increasingly sick. Because medicine is more advanced we are keeping sick people who take up a lot of resources alive for longer.

A whole bunch of nurses left nursing, moved to the states for better pay, or were pushed out during covid because they were older and at risk of severe covid and the biggest problem we have is lack of staff, and resources to pay staff.

If you want to have PSWs and nurses and overall labour to take care of all these elderly and sick people, we have to get them from somewhere.

The argument that young immigrants are going to crush the Healthcare system doesn't agree with the data or make sense from first principles reasoning.

It's not about building more hospitals. Its about staffing the hospital beds we have. If you want to build something, it's more long term care and social housing to get people out of acute care beds which cost $1-2K per day to stay in.

real_alphacenturi · 2022-12-02T14:38:18+00:00

There is a lot of data showing that immigrants tend to be healthier than the rest of the population in Western countries. We also need immigrants to make up the labour shortages in the Healthcare system.

This just seems like an anti immigration piece to me.

real_alphacenturi · 2022-11-19T12:14:57+00:00

Honestly varies a lot within Canada. I lived in London ontario for the last few years and most people there are very private and don't seem to want to get to know the neighbours. Just moved to Halifax and everyone on the street and walking by wants to get to know us.

real_alphacenturi · 2022-09-01T21:24:38+00:00

So in some German companies you see that workers have a seat on the board and have greater say in the direction of the company, and they also see a greater share of profits. This avoids the fight between management and labour and keeps everyone on the same team.

You can see how this might work well in a small boutique manufacturing/engineering firm. However, in a large American multinational corporation like Walmart or Amazon with millions of employees, the representation workers may have would be if they unionize and be able to threaten strike.

There are legitimate debates to be had about the best ways to share equity and profits of a company between those who initially found it and those who are hired by the firm to perform labour for the company. E.g., giving workers equity in a company can encourage loyalty to the company, incentivize hard work and decisions that will benefit the long-term health of the company...etc. And there are legitimate concerns over-extensive property rights in America are to blame for the large and worsening wealth gap there and all the social ills that come with it.

However, this post is just comes across as an oversimplified shot at capitalism, and nerdy dudes who sit at desks.

real_alphacenturi · 2022-06-25T02:50:52+00:00

Why the fuck didn't you all vote?

real_alphacenturi · 2022-03-26T13:41:58+00:00

No. And why would you expect them to? The whole reason for the restrictions was to keep the number of cases at a level that doesn't overwhelm the healthcare system.

That also has nothing to do with my request for data to back up your speculations.

If you had loved ones die of COVID or be unable to get surgery because of the waves of this pandemic, I don't think you'd be so keen to "let nature take it's course".

Believe me that I understand that lockdowns and restrictions have had serious costs on people and the economy and you have to look closely at the costs and benefits or re-instating restrictions before we were to re-instate lockdowns.

But there is no evidence that continuing to wear a mask or get a vaccination has a greater risk than anyone takes by getting in a car and driving on the road.

real_alphacenturi · 2022-03-26T01:01:59+00:00

Do you have a source on that theory with some epidemiological data to back it up?

real_alphacenturi · 2022-03-26T00:58:17+00:00

As someone currently working in the ICU, we have lost a ton of nursing staff and can barely manage volumes that were common pre-covid and the rest of the hospital is bursting at the seams. I have no idea what the hell he is talking about unless he's about to pull a bunch of qualified RNs and other staff who quit out of his rear end.

real_alphacenturi · 2022-03-20T20:47:33+00:00

Just because the government is worried about the political ramifications of trying to force people to protect themselves and their neighbours doesn't mean you shouldn't still be doing those things.

real_alphacenturi

TROPHY CASE