kyouens

Please let the zillions of people still fogging into my hometown (an Austin suburb) know!

Funding is mostly controlled by the federal government, via Medicare and Medicaid, and if I am not mistaken the funding levels are set by Congress.

I am a doctor and I run a graduate medical education program. The constraining resource is generally funding, not limits imposed by ACGME. For example, my program is ACGME-approved for two trainees per year, but we have funding for one.

In this conversation, it’s important to distinguish science itself (which, along with facts, are already under attack in our politics) from failings of the research industry.

You are right, to an extent. Health systems and EHR vendors both have historically had an economic disincentive to share data. Think “ecosystem lock-in”. My impression is that things are gradually changing for the better.

Couple of points: The 21st Century Cures Act has recently expanded rules for information portability, which will make it much easier to get access to your data in the future. The challenge here has nothing to do with radiologists hoarding your data. The lack of interoperability typically stems from limitations of electronic health information systems. Most radiologists would love to be able to look at your scans from multiple previous hospitals where you were imaged previously, but technical barriers currently make that difficult.

I'm also a physician. I am generally satisfied with my work, but I do feel distressed by what feels to me like erosion of the social contract between doctors and society that flourished during the second half of the twentieth century. It sounds like we agree that some of that erosion has occurred because of nakedly self-serving political action by medical professional societies.

When I made the decision to become a physician twenty years ago, I thought medicine was my calling. I believed that the personal sacrifices one makes to be a physician--and there are many--would be rewarded with professional pride, the respect of my community, the gratitude of my patients, and a secure and well-paid living. I have gotten a little wiser, I think. I make a good living, my work is interesting, and I still think medicine is a great career. But times have changed, and I no longer consider medicine a calling for which one should be willing to sacrifice one's personal well-being. I find myself defending my profession on the internet a little more than I'd anticipated :)

Those who control the business of medicine take economic advantage of the patient-first mindset of our medical tradition, and it cheapens what we do, both literally and figuratively. It is for that reason that, despite its many flaws, I do think organized medicine does have redeeming qualities. It gives physicians at least some voice in politics, where they would otherwise have none at all. Maybe one day health care reform will right the ship.

The limiting factor to creating more skilled physicians is not medical school admissions. It's residency training slots. Most residency training slots rely on federal government funding. Pretty much everyone, including the AMA, agrees that there is a looming undersupply of physicians. There may be disagreement on the best way to address the issue, but there is little disagreement among physicians about the fundamental problem.

I have seen comments talking about "physician cartels" purposely encouraging a labor shortage to drive up physician pay. There is no physician cartel. Only about 15% of physicians even belong to the AMA, and only a subset of those have any political involvement at all. It just doesn't exist.

One of the things that I think contributes to the general dissatisfaction of physicians in 2017 is the increasingly negative public opinion of the medical profession and the imputation that there is some sort of evil conspiracy at work. A lot of the negative opinion is misdirected. It should be aimed at the for-profit health care system itself. Most physicians I know have very little control over the things people complain about, including cost.

The issue of positive predictive value versus specificity comes up almost every day in my work as a pathologist. There is widespread misunderstanding, and in my own anecdotal experience, it very frequently results in unnecessary lab testing and misinterpretation of test results by clinicians.

When I was a pre-med student, for some reason the prerequisites required a year of calculus. That succeeded in weeding out people who can't make an A in freshman calculus, but I'm not sure what else it accomplished. Calculus has little to do with the daily practice of medicine, unless you're a radiation oncologist or doing some hardcore research.

A year of statistics would have served me and my patients much better. That goes double, given the current firehose of data that is part and parcel of the personalized medicine revolution.

I am doing the same thing without the HDMI audio extractor. The Chromecast is plugged directly into an HDMI port on the receiver. It works fine. Maybe whether the extractor is necessary depends on the receiver.

Whether it will work seamlessly may depend on the receiver, but I have a Chromecast plugged into an HDMI port on my Yamaha unit. (Note, there is nothing plugged into the HDMI out port on the receiver.) This setup works flawlessly for streaming audio throughout my house. Some people say they had to use an HDMI audio extractor to achieve this, but that was not necessary in my case.

Don't think so. I think it'd be the same force as it would be anchored, just distributed along more of the rope.

As long as Rdio isn't in the same boat, we'll be OK.

I can tell you why I use the NY times mobile site instead of the Android app on my Galaxy Nexus: the ads. The ad on the mobile app stays on the screen when you scroll the content. It's frequently an obnoxious color that distracts from the article. In the browser, the ads are similar but as you scroll down they leave the screen.

Simple, but it's enough to make me abandon their Android app.

I am really starting to like Google docs as a possible Evernote replacement, as soon as they improve their offline editing support. One thing I can't figure out is how to change the default font for new documents. I try saving the "Normal Text" style with Ubuntu as my font, but new documents always revert back to Arial.

I actually like the ribbon, especially when working on tables, charts, and the like. My only complaint is that it takes up so much vertical screen real estate.

Yes, I think you're right. I guess my feeling is that I would rather pay for the service. That way I am the customer, I'm not the product.

Should I worry about my privacy if I use this "free" service? I don't really want them to serve me targeted ads based on the contents of my Google Drive. I don't know whether they plan to do anything like this, but still. Giving Google access to my files (in addition to my email, social network, voice mail, contact list, calendar, and reading preferences . .) makes me uneasy.

I can't speak for everyone else, but for myself, "tunnel vision" explains it pretty well. At some point in high school, I just decided being a doctor was a totally awesome thing to do. I can't remember the real reasons why I chose medicine, but I know it was somewhat vague. I knew doctors were smart and I thought I was pretty smart. I am embarrassed to admit I also may have fantasized about driving a BMW from my big house with a pool straight to the OR, busting in with an "S" on my chest to save somebody's life.

In college, I was drawn to the humanities and to computer science more than to biology, but I stuck with it. I was a willing victim of the rather unhealthy obsession with "getting in" that most pre-meds develop. Medical school, at least at first, was a rude awakening. It was not intellectually challenging (other than by virtue of the sheer volume of material), it was rote, the hours sucked, the and the culture was unpleasant.

It was not until a couple of years into my residency that I started to really appreciate more of the nuances, and to enjoy practicing medicine. As it stands today, I love what I do. I help people in a tangible way, I make a good living, I am respected and valued by my community, and at as I described above, my creative and intellectual muscles get a daily workout. However, I don't do any busting into ORs and, sadly, I don't drive a BMW.

There is a certain element of truth to what you are saying. When I was early in my training I was dissappointed in my choice of medicine as a career because I also thought it lacked an outlet for creativity. As a now experienced physician, there are still times when you get to a point in the care of some patients at which the next step is programmatic and rote (if A then B).

However, sometimes--probably most of the time--the patient's presentation is so unclear (e.g. "I just feel weird. . . ."), there are so many variables to juggle in your head at once (twenty different lab values, the way the liver feels, the imaging findings, the color of the patient's sclera, the smell of their breath, their mood) that things become far too complex for any flowchart. These are the times when you need creativity, "book smarts" and perhaps above all, "emotional intelligence" to be a good doctor. There are plenty of doctors lacking one or more of these elements, and they just aren't very good at the job.

In my view, one of the reasons for runaway healthcare cost may the way that insurance coverage distances the patient / consumer from the true costs involved. (e.g. "My statin costs $5 a month because that's how much my co-pay is." No.)

Insurance is necessary and useful for catastrophic events like the OP's. By contrast, for routine, predictable health care expenditures, insurance spreads the cost among policyholders / taxpayers to the extent that there is no conception of the actual cost of care. It's like having insurance to put gas in your car, or to pay your utility bill. Every time the money changes hands, you can bet the insurance company takes it's share.

This model will allow (or even cause) drug companies and hospitals to keep costs high to protect reimbursements, all via back-room deals with huge insurance companies. Expensive, government-mandated (or provided) insurance coverage for routine health expenditures will get in between doctors and patients and will drain employers and taxpayers while the insurance companies get richer.

Microsoft Office. LibreOffice is pretty good as a standalone product, but when I used it regularly I had nagging document formatting problems when exchanging files with my work colleagues.

While I'm as much a fan of productivity pr0n as the next guy, every time I look at an org.mode customization walkthrough or something similar I'm reminded of this classic blog post by Merlin Mann: http://www.43folders.com/2005/05/18/because-buying-new-runni...

I agree. This is also evidenced by the way they dribble out their leaks in the most politically damaging (for the US government, particularly) way possible, accompanied by press releases and interviews. If they are about freedom of information, why don't they release all of it, immediately, and free of editorial comment from Assange?

Agreed. There's got to be a happy medium between failures on this end of the spectrum and failures on the other. GIMP? Really?