I disagree with the use of doctor for anyone who hasn’t completed medical school and their field’s respective post-graduate training. I’ve seen the term watered down to the point that anyone tangentially related to a physician-led field uses the term. Chiropractors, nurse practitioner, administrators, etc. etc. It leads to confusion in patient populations. I’ve had patients in the ER tell me that their nurse practitioner was equivalent to me in temrs of training which is absolutely not the case. I finished 3,000 hours of clinical rotations by the end of med school and another 10,000 hours of training by the end of residency. Patients are lucky if an NP has 500 hours of clinicals before they’re hired to provide “primary care”. The training an optometrist has is specialized but not to the level of an opthalmologist so using the same term muddies the water and makes it difficult for people to discern the difference.

I worked with European PhDs at the NIH and the impression I got was that they don’t use it regularly or even prefer it. Small sample size but at the upper echelons of their respective fields.

An opthalmologist is an eye doctor. They go to medical school and do a residency for extra training. Optometrists have doctorates in optometry meaning they do four more years of school after their bachelor’s. They can call themselves doctor because in the US that’s the convention for doctorate’s (in Europe ony medical doctors use the term). There’s avast difference in intensity, depth, bredth, etc. of training between the two. It’s easy to miss the difference if you’re not familiar with the system.

Well shit, I grew one town over from there. Pretty sure that’s right by our cliff diving spot on the Croton Falls Reservoir. I never went in it most kids in highschool knew some “facts” about that mine.

God what a bunch of whiny motherfuckers in this sub. Thanks for this. I like Thunderbird with the bridge but I might give this a shot, the android apps are good so I’m thinking these will be too.

Fortunately CMS is rethinking the role of primary care and realizing we can save money if we’re able to provide high quality preventive care like we’re supposed to. PCP service payments (RVUs) are up 18% since 2020 which has been a long time coming. Unfortunately physician pay is down vs inflation over the last few decades but thank Christ administration salaries are way, way up over the same timeframe.

What about the 19yo I saw today, with a BMI of 62, who’s so far stuck in the cycle of self loathing, inactivity, depression, and pleasure seeking behavior that he can’t see a way out let alone start creating himself a new reality? What if I have a drug that I’m pretty confident can help him lose 200lbs? Is it ethical for me to not prescribe it because “he should be able to do it on his own?” How many people do you know who have done that? Out of the hundreds or horribly obese patients I’ve seems, I have tow that have done it with diet and exercise. We have not evolved for a world where 20,000 calories costs $20 and is available 24/7.

I agree we need to be cautious with these drugs since long-term adverse effects aren’t known but the long-term effects of obesity are well documented. I have backed off on pitching these drugs since I learned the companies making them have infiltrated the obesity research community in the US (because of course they did). They’re still an amazing tool in the fight against an obesity epidemic which has many, many different contributing factors li ok e trauma, depression, mental health issues, upbringing, genetics, etc, etc. it’s not as easy as “just don’t eat so much.”

It’s not that CPR doesn’t work, it’s that outcomes after resuscitation usually aren’t great. The study doesn’t disclose ages or neurological outcomes post-rescuscitation so that limits my interpretation but quick rescue and quick CPR is key in those acute, single reason emergencies. That isn’t to say in an emergency situation you shouldn’t try especially since you don’t know that person’s wishes. There are good outcomes but usually for underlying healthy people who had one thing go wrong. Think the athlete who’s heart stops on the field for some reason.

I’ve admitted at least a thousand people into a hospital through the ER and I tell everyone that it’s not like on TV. If you’re older, sick, multiple chronic diseases, don’t take care of yourself, etc. the chances of any kind of quality of life after CPR is limited. Death is terrifying and I understand them wanting to try but it’s just not realistic a lot of the time. We need better deaths in the US and more in-depth end-of-life conversations with our patients. That should be starting in the PCP’s office. Trying to discuss that with a patient in the ER who’s already scared isn’t ideal. I’ve seen patients with do not resuscitate/do not intubate orders on file change their mind when they’re suffocating and panicking then once they’re more stable immediately change their mind back.

Thanks, that looks legit, especially considering they got a Nobel for the process. Red blood cells wouldn’t work though, no genetic material to tell the cell what to do. Skin cells sure but deeper layers before they ditch their nucleus. The bottom layer of your epidermis is already made of stem cells that continuously produce new keratinocytes (skin cells). That’d make sense as a starting point for what they did. I’ve been in medicine for seven years and there have been all kinds of crazy claims made but researchers so I’m always skeptical.

Do you have a link for the paper that describes the process for converting blood into stem cells? Curious how they went about it because making red blood cells into stem cells would be hard since they have no nucleus and no DNA. I googled but couldn’t find anything about how they do it.