Just curious, are you a medical student?

In a perfect world, I think your perspective is ideal. Unfortunately we live in a far-from-perfect world. Your view requires the following:

-Patients must be able to understand and digest complex medical information, the majority of which simply isn't that clear or even accessible to the average layman. The study that clearly demonstrates superiority of one therapy over another is rare; most are simply various shades of gray that requires a calculus of sorts to come at a decision. The fact is that a not-insignificant number of physicians fail to read research articles critically. These people (we) are, theoretically, smart. How can you expect a layman to do what many physicians fail to do?

-Not every patient wants to know or cares about their disease process. Based on how you're talking about it, you sound like a pre-clinical student (assuming you're in medical school). It will be interesting to see how your perspective changes once you start seeing patients. Many patients want little more than to show up, be told what to do, and feel better. It is the exception rather than the rule for patients to want to know how or why their disease occurs, how our interventions work, etc. etc.. Many young medical students - and I used to be in this category - think that if they can simply distill their medical knowledge to easily understandable terms and make clear the importance of treatment, then patients will "care" about their disease and be more motivated to adhere to therapy. This has not borne out in my experience, unfortunately.

-Tangent about the above note: being in the medical profession - and this is going to sound elitist, I know, but hopefully I can successfully get the point across - you have likely been among a group of peers that is intellectually at the right side of the bell curve. Statistically, you are more than likely from a solidly middle class family; if you're in medical school, it is more likely than not that you have at least one parent as a physician and came from a household in the top quintile of income. I say all this to point out that your perspective of "average" is likely very, very skewed. The people you think of as whatever pejorative you can think of are, more than likely, still above average when viewed in the context of our entire society. Your note about people that "apparently exist" that do not care about their own health not only don't exist but are exceedingly common. I will let you come to these realizations yourself and not beat you over the head with this point, but this is something that you perhaps might consider.

-In my view, people see a physician because they want the physician to exercise their judgment, which they have gained from years and years of training and practice. Let's pretend for a second that 100% of the information on WebMD is accurate and that patients can 100% understand everything presented there or at an even higher quality source (e.g., UpToDate). That is all knowledge that a second year medical student has largely been exposed to. They may not know everything from memory, but they will understand that information. And yet a second year medical student is hardly a competent clinician. More than likely, they'll look like a complete fool once they start their third year. The difference between WebMD and JamesTiberiusKirk, MD is that I have seen tens or hundreds or thousands of patients with the disease you have, and I have treated those patients with a variety of medications using a variety of modalities. I have the ability to pick up on subtle differences that might result in different treatments between Ann and Bob even though to the layman they seem identical. I am more familiar with what various treatments mean and can more likely translate what a patient wants from a treatment into an appropriate medical intervention (I'm thinking of more chronic diseases here where therapy can be a burden). These are not things you can gleam from WebMD. And again - that's putting aside the fact that the average layman can accurately digest medical information (hint: they can't - at least not to the degree necessary to diagnose and treat disease).

In my own view, we have swung too far on the opposite side of the pendulum in pursuit of the "patient-centered decision-making" model. Like you, I agree that patients should be - MUST be - informed about their disease and their various options for treatment. It is the clinician's job to provide that information in such a way such that they are able to make a truly informed decision. We do a terrible job of this in medicine. There is need for improvement. But that said, I also think it's unfair to put this burden at the foot of the patient and say, "you decide." This is doubly true for clinical situations where many different treatment options exist and there is no real winner. Yes, patients should be informed, but I think it's the whole job of the physician to say, "...but this is what we should do." They should listen to and heed patient concerns or reservations about a therapy, and no patient should be forced to do anything against his/her will, but I think it is critically important to understand that patients do not understand - and should not be expected to understand - the myriad of subtleties you learn throughout your clinical training. Expecting them to puts an unfair burden on those folks and could very well lead them to make a definitively bad decision (for a prime example, see how end-of-life care happens in the U.S.).

Hopefully you aren't offended with what I've said, but your view strikes me as hopelessly naive and working under the expectation that your average patient is going to be like you. They will not be. Some will, but they will undoubtedly be the minority. A surprising number of people still don't know what the difference between a virus and a bacterium is, yet you expect to be able to inform them enough to do the calculus required to decide on things like cancer therapies, whether an elective procedure with significant risk (but potentially significant reward) is a good idea, and other clinical quagmires?

Contrary to helping the patient and giving them agency, I think that approach leaves them to drown in what they don't know.

But perhaps I'm just an elitist curmudgeon.

Edit: Having seen the other comments here, it seems I didn't understand the purpose of this post. Regardless, I hope this is some food for thought for the OP and anyone else with an interest in medical ethics.

Doesn't this go against the initial purpose of YouTube: to easily post and share video content? If I'm a band with an independent label and I want to post a music video, I no longer will be allowed to?

Seems like a bad move. I also don't know why anyone would pay to subscribe to a music service centered on YouTube when there are 3-4 other options already entrenched in the market. That just doesn't make sense to me. If you're the kind of person willing to pay for a music subscription service, you have likely already subscribed to one. Why on earth would I switch to YouTube to listen to music - and pay a premium to do so?

I'm sure someone smarter than me thought this up, but on its face it doesn't seem like a wise move.

Thanks for the response. Not being from the Pacific NW I must admit that I'm pretty clueless in terms of local/regional politics. These are things that I never would've considered.

Just to act as a counterpoint - not that I disagree with any of the points that you've raised - what should we as a society be doing for the people who simply can't afford to live on minimum wage? The minimum wage obviously isn't the only policy tool in the tool chest, but at the end of the day we have a whole swath of people working 1, 2, and sometimes 3 minimum wage jobs and failing to make an income capable of rendering them self-sufficient.

Even if prices were to increase, so what?

The GOP's and/or their constituents' expectations that prices on anything will never go up is ridiculous. The expectation that jobs will never be destroyed is ridiculous. This is how economies work and what progress looks like. In a best case scenario, we simply kick the can further down the road; it is inevitable that the prices of natural resources will only continue to go up as their scarcity and the cost of pilfering them goes up. In a worst case scenario, prices go up as the GOP claims and we now have a huge economic incentive to develop renewable energy resources which will hopefully lead us to a more sustainable and environmentally friendly suite of energy sources. That's not to say that there wouldn't be growing pains - there absolutely would be. There were growing pains during the industrial revolution, though, and surely no one thinks using steam engines instead of manual labor was a bad idea.

I see this argument simply as an attempt to rationalize global warming "not being real" or other nonsense like that. As usual, the GOP begins with a conclusion and argues from there. Anyone with half a brain can recognize that most of their bullshit is just that. Unfortunately their constituents don't seem to be able to figure it out.

I say all this, by the way, as a relatively conservative guy at heart. But we need to address the very real fact that burning all this shit is almost certainly destroying the environment and the ecosystem; the degree to which that is happening is really the only point of contention among non-idealogues. I really don't understand how that can be refuted. Is this going to solve everything? Of course not. But, as Bill Nye is quoted, "it's a good first step - let's get started." I agree.

I find it interesting how this story evolved. I listen to NPR quite a bit, and when the story was first announced it was declared that he was captured "while falling behind from his patrol" (as mentioned in this article). A few hours later, it was something along the lines of "he may have deserted." In the afternoon, there was a whole story discussing this viewpoint.

Interesting how the story changes I suppose.

Exactly. A mentor of mine also in psychiatry labeled this as the difficulty of being a psychiatrist specifically and relating to others generally. We were having a discussion in the context of people who reject the very existence of some types of mental illness (e.g., anxiety, depression), and he mentioned his own difficulty in working with patients with addiction issues (opiates specifically) as someone with his own personal history of opiate abuse:

I'll give an example of my egocentrism. I've had multiple back surgeries after a work injury and was on heavy round the clock narcotics for 2 years. After my 2nd major surgery and my wound healed I told myself one day I'm not taking any more narcotics. Period. And I didn't. And went into violent withdrawal. I was curled up in the fetal moaning, waiting for it to pass. So on my addiction psychiatry rotation I was having trouble empathizing with heroine addicts and why they seemed convinced they would die if they didn't get their suboxone. I asked my seniors on the psych forum about my rejection of their experience. Learned from them. And after thinking about it decided I was stuck with the problem of viewing things through my own consciousness which had the resources and ability to go cold turkey. And that not everyone was me. This is both the problem of the doctor/patient relationship in psychiatry and why it is so fascinating. It requires the commitment to imagining the consequences of alien consciousness to our own.

The last sentence especially I think is critical to truly "getting" empathy and understanding your fellow man. Needless to say, that's not the kind of stuff you're typically going to see in online comments, where the whole interaction is extremely superficial at best and totally artificial at worst. Artificial not because it's not face-to-face but because the very nature of an online persona allows it to be edited, created, and willfully produced. Your attempt at relating to an online persona may be futile because the persona is just that and not a real person.

By the way, I absolutely love this blog. One of my favorites.

Thanks for the recommendations. Jiro comes up repeatedly in the "For JamesTiberiusKirk" category, but it seemed a little too personal for me. I'm a fan of documentaries, but I tend to stick to social/political docs as opposed to personal/pseudobiographical ones. Can't say I'm a fan of sushi, but I'll be sure to check it out.

I've heard Lost in Translation is a great film but haven't seen it myself. Will also be adding that to the list.

This sounds fantastic. Thanks for the recommendation.

I'd agree with you as far as the difference regarding date movies and... other movies, though in this case I'm looking for any recommendations. My girl and I live together and have been dating for a while, so in this context it's more about finding an interesting movie to watch than it is a classic "date movie."

Thanks!

This was mentioned vaguely by others, but try and get a sense for the type of people that rent in a particular place. For example, if you want a somewhat quiet, "family-friendly" place, then you probably want to avoid the area filled with college students. On the other hand, if you want a more lively place, then you should avoid the areas filled with gomers like me.

Beyond that, use common sense. "If it's too good to be true, it likely is" is a good adage to follow. But then again, you can occasionally get excellent deals. Just do your research and don't rush into anything if you can avoid it.

Redditor migrant.

As a native Texan who moved away but wants to come back, this is reassuring. I never considered living anywhere but Texas for the majority of my life, but the politics is so batshit crazy that I'd rather move to what I consider a more "northern Texas" (Minnesota, Wisconsin) instead.

Maybe there's hope yet.

With all due respect, that was an absolutely terrible review. Even the writing was garbage.

I'm also not sure why this sort of thing is posted on Hubski. I'm assuming this is spam considering the submitted has an hour-old account.

That's just gold. That'll smack down his ego just a bit.

I actually agree with your position and think calling these events "honor killings" is just ridiculous. But that said, I think there's a not insignificant portion of the population - in the US at least - that likes to serve as the PC police and would respond to a change like this with claims of Islamophobia and cultural insensitivity. I think that's why, for example, you don't see this more in the mainstream media. I think it's important to remember that not all Muslims are terrorists, obviously, but Islam has a huge PR problem and fails to address the elephant in the room (namely, that a not-insignificant number of its adherents worldwide believe some pretty crazy things). In the US, this is parried with "but we don't believe that!" by many American Muslims, which I don't necessarily doubt. But it's hard to reconcile that with the many fundamental problems Islam presents to the traditional idea of a liberal (liberal in the classical sense), Western democracy. Rather than poke at the beehive, we in the US seem to prefer a more "leave it alone and maybe it'll go away" approach - or at least that's my interpretation of the situation.

But Islamophobia?!?!?!?!

The big secret on non-profit hospitals is that they are nothing of the sort. There's all kinds of waste that goes on in hospitals. Look at how much administrative costs have increased (see table 2 here: http://www.nejm.org/doi/full/10.1056/NEJMsa022033). Notably, this excludes administrative costs related to insurance plans. Given that roughly 2/3 of US hospitals are supposedly non-profit (http://www.aha.org/research/rc/stat-studies/fast-facts.shtml), what would've otherwise been profit is instead squandered in hugely wasteful and totally unnecessary ways.

Non-profit hospitals are just as shameless as the for-profits. They actually have the gall to run development offices dedicated to raising donations while simultaneously charging uninsured patients huge sums of money that they know are totally divorced from reality. They create aesthetically beautiful hospitals at a cost of tens to hundreds of millions of dollars while waxing poetic about the single-digit millions they devote to charity care. They engage in billing practices that are questionable at best and leave the patients with unnecessarily large bills. My institution, for example, knowingly keeps patients in the ICU longer than is medically necessary in order to preserve beds for the particular service we receive patients from (there are a handful of patients on our census that could've left the ICU and gone to the general floor days ago - I'm sure the cost difference between an ICU and standard bed is not inconsequential). They claim medical residents are a financial drain on their system - despite giving only half of the roughly $100k provided to them by the government per year per resident to the residents themselves - failing to take into account that residents, rather than attending physicians, are almost single-handedly responsible for the day-to-day work of delivering healthcare (and, interestingly, pay midlevels that perform the exact same role roughly double what they pay their residents).

In short: fuck hospitals (except, perhaps, St. Jude's in Tennessee and the Shiners Hospitals).

Fantastic, thanks. I disappeared from Hubski for a month or two due to real-life business, so I must've missed the uproar.