Anonymous asked:
Future anthropologist: “In the early 21st century, there was a superstition against writing your True Email explicitly. You had to write it obliquely, like ‘scott at symbol shireroth dot org’. They believed that if anyone wrote their email out explicitly, it would draw the attention of hostile spirits, and the person would never again know peace.”
Related to the “toxic masculinity” discourse from the other day:
Today I had to go to a committee meeting on doctor burnout. According to a survey, a lot of doctors in one of our departments felt overworked and burnt out, and the committee was supposed to come up with suggestions.
The committee was mostly administrators, mostly female, and although they didn’t use the exact phrase “toxic masculinity”, they talked about “macho culture” a lot. I think their theory was that male doctors had a macho culture where they felt like they didn’t need to take any time for self-care, and they shouldn’t speak up about excessive workload, and they had to look perfect or else they would lose their aura of invincibility. And that having to be this way all the time produced burnout.
So then I, as the doctor representative at the meeting, got up and said that I knew a lot of the doctors in this department, I’d talked to them a lot, and they all said the same thing. They would all love to take some time off for self-care, but there were too many patients and not enough doctors to deal with them, and if any one of them took extra time off, then one of their equally overworked colleagues would have to work even more hours covering for them.
The reason they “weren’t complaining” was that they had already complained to every administrator they could think of, and the administrators had said stuff like “you shouldn’t just complain, you have to be proactive in coming up with a solution” and refused to devote extra resources to the problem.
I said that doctors were really good at complaining about things, and really some of the best complainers-about-things you will ever meet, but that they weren’t going to keep banging their heads against the wall when nobody listened to them and there was no good solution.
The administrators thanked me for my input and went back to talking about macho culture.
I wish I could just start appointments by asking “So, do you prefer mildly condescending platitudes, or medications with a bunch of side effects?”, and then people could just tell me, and I wouldn’t have to guess, and they couldn’t get angry if I gave them the one they wanted.
Public service announcement: if you have a kid with some kind of horrifying predatory criminal, and now your kid is a horrifying predatory criminal, and you have no idea how this happened because the father left before he was even born and your new husband is a great guy and you’ve both always done your best to raise your kid well and give him a good home, your kid’s psychiatrist will listen empathetically to your story, and then empathetically give you a copy of The Nurture Assumption.
…maybe not actually. But it will definitely be on his mind. And maybe it would get people to stop having so many kids with horrifying predatory criminals. Seriously, I’m doing inpatient child psychiatry now and I get multiple cases like this every day.
K and I learned how to shoot guns today. It was interesting. And by interesting, I mean “loud”.
There was some helpful safety training beforehand. But it missed the most important part, which is that the gun will eject the spent bullet casing in a random direction. Somehow I managed to live in a “gun culture” and watch a bunch of action movies without realizing this was a thing. When you’re firing a gun for the first time and really nervous, and a bullet-shaped thing shoots out of the back of the gun and hits spectators in the face, this is NOT a minor point that you can forget to warn people about, even if it turns out to be nothing and everybody laughs that you were so worried about it.
Otherwise everything went okay. I think if I ever have to write a story involving guns, I can use words like “magazine” without sounding ridiculous to people who know what they’re talking about. I think the friend who brought me was expecting that this was going to be some sort of revelatory experience where I realized that Guns Are Your Friends and so gun control was a vile lie, but I feel like if guns were *really* my friends then the person who held one at a slightly different angle than everyone else would not have had a big security guy run up to him and freak out and yell at him until he changed the angle back.
Also, Ada Palmer (author of Too Like The Lightning) was at the shooting range and I got to get a picture with her!
It’s a good thing some bands sell out, because I can’t make out without a
girlfriend, and whenever I have responsibilities, I want out.
Today I learned: Ten-year-old Ayn Rand was best-friends-forever with Vladimir Nabokov’s little sister, and they would meet at Nabokov’s mansion and have adorable ten-year-old-girl political debates with each other.
So I was watching Levity(the 2003 movie) for a theology discussion, and the entire time I couldn’t help but think
‘wow, even unsong is less heavy handed with religious imagery’
“Levity is more heavy-handed than Unsong”
“Levity…more…than…Unsong”:
“Levity…than”
“Leviathan”
!!!
I wish I could just start appointments by asking “So, do you prefer mildly condescending platitudes, or medications with a bunch of side effects?”, and then people could just tell me, and I wouldn’t have to guess, and they couldn’t get angry if I gave them the one they wanted.
And if they said “Neither!”, I would answer “Oh, so you must want placebo. I know a really great acupuncturist, let me give you her number.”
I’d also include “or (1) actual examination of what you’re doing that makes your life better and what you’re doing that makes your life worse, and how you can do more of the former and less of the latter, and (2) examination of what important life skills you lack, and exploration of ways for you to develop them and/or work around their absence,” with selection of that one to be followed by “okay, let me refer you to a therapist, that’s not really something I can provide in 20 minutes once a month.”
My impression is that the chance of this reducing to “mildly condescending platitudes” varies with the patient’s intelligence and social class, from “wait,you’re saying I should get a good night’s sleep? I never thought of that before!” among confused schizophrenics, to “of course I’ve used black-market d-cycloserine to potentiate the effects of cognitive-behavioral self-help workbooks, what kind of moron do you think I am, you’re wasting my fucking time” among people I talk to on Tumblr.
When I tried the “Wow, you mean diet and exercise help lose weight? Goodness me, in all the years I’ve been fat, I never heard of that, much less tried it!” retort to the “mildly condescending platitudes”, it didn’t end well.
So you’ll have to take the platitudes plus the side-effects if you want any treatment at all. Be nice to get the “talk to me like a human being and even an averagely intelligent one at that” option but doesn’t happen often (did happen with one doctor which is a refreshing change but not too frequent, alas!)
Be even nicer if the “I can’t take that medication you want to prescribe me and are pushing me to take, because it will react badly with a medication I’m currently taking, and no I didn’t just read that off the Internet, the last time I got prescribed that I turned blue in the face and had to be rushed to the ER” option was on offer, but we can’t expect miracles, now can we?
Though re: social class and judgements of status and intelligence, I don’t know if this is more pronounced over here, but because I’m (a) fat (b) naturally talk widda native aksent like, bye, I do tend to get the “plainly thick as two short planks, do the condescending talking down bit and the ignoring what they’re saying bit” unless I use my “the nuns at school taught us elocution lessons” voice and then I get the “hey, evidence of a brain here, talk to them like a real person!” reaction. But it needs to be finely judged, if you show too much intelligence that triggers the “who do they think they are, I’m the doctor here” reaction which also goes badly.
Which is kind of a shame, given that I have the same level of comprehension and intellect in both instances, and only my vocabulary and diction has changed.
I think the problem is that there are lots of genuinely…let’s politely call them “confused” people who don’t realize even very obvious things, and if you don’t know your patients well enough to predict who they are you might as well just give the “eat well, exercise, and get a good night’s sleep” spiel to everybody. But it sure does sound condescending if you’re not the right target.
(and this gets harder when we go into subtler things like “have you tried sleeping in a cool room with good white noise” or “have you tried melatonin” etc)
Again, I wish I could just ask “Are you aware of basic things that it would be very surprising if you weren’t?” but everyone would define this differently and it would be useless.
I’m going to go out on a limb here and suggest the wild’n’crazy notion that if a fat person is going to a doctor semi-regularly (e.g. this is not their first appointment ever with a medical professional), they kinda sorta maybe have heard the “do you realise you are fat?” part before, even if they are as dumb as a rock.
I realise that there’s not really a tactful way of going about it, but suggesting (rather than assuming they have no idea that “eating more = putting on weight”) that if they’d care to discuss their problems with weight loss you might have some suggestions that would be helpful could work out better.
And there are physical conditions which do make weight gain easier and weight loss harder; again, I know that the idea that fat people like to blame their “glands” and it’s only an excuse has some basis in reality, but for instance - when I found out very late in life that I had PCOS and that this contributes to weight gain, I was about fit to kick in a window. Nobody had ever explored this with me before, nobody believed me when I was saying ‘no, honest, I really am trying to diet and exercise and the weight is not coming off’ and all the years since puberty when the weight started to pile on and I was feeling guilty (because “blaming your glands is only an excuse, the reason you’re fat is because plainly you’re eating too much of the wrong food”) and miserable and fighting with my mother over my weight and going on crash diets that didn’t work as soon as I went off “you eat one bowl of soup a day”so the weight all came back and hating myself for being fat and ugly and stupid and all the other things society tells you that being fat means about your character and intelligence - well.
Yes, eating too much of the wrong food is to blame there, but there was a real, physical, not in my control cause there as well, and had I known, that would have made a difference.
tl;dr - yeah, sometimes us fatties are stupid and ignorant and it is eating too much and not exercising enough. But sometimes there are other real medical problems there too.
On the one hand, I totally sympathize with what you’re saying and I understand it must be really annoying.
On the other hand, this has actually been discussed and studied, and current very-carefully-considered recommendations are to say the thing. See eg The Impact Of Physician Discussion Of Weight Loss In US Adults, GPs Should Not Worry About Offending Obese Patients Study Finds, et cetera.
As always, none of these studies is unimpeachably super-impressive, but considering the low risk I think it’s fair to do this even on weak evidence.
I wish I could just start appointments by asking “So, do you prefer mildly condescending platitudes, or medications with a bunch of side effects?”, and then people could just tell me, and I wouldn’t have to guess, and they couldn’t get angry if I gave them the one they wanted.
And if they said “Neither!”, I would answer “Oh, so you must want placebo. I know a really great acupuncturist, let me give you her number.”
I’d also include “or (1) actual examination of what you’re doing that makes your life better and what you’re doing that makes your life worse, and how you can do more of the former and less of the latter, and (2) examination of what important life skills you lack, and exploration of ways for you to develop them and/or work around their absence,” with selection of that one to be followed by “okay, let me refer you to a therapist, that’s not really something I can provide in 20 minutes once a month.”
My impression is that the chance of this reducing to “mildly condescending platitudes” varies with the patient’s intelligence and social class, from “wait,you’re saying I should get a good night’s sleep? I never thought of that before!” among confused schizophrenics, to “of course I’ve used black-market d-cycloserine to potentiate the effects of cognitive-behavioral self-help workbooks, what kind of moron do you think I am, you’re wasting my fucking time” among people I talk to on Tumblr.
When I tried the “Wow, you mean diet and exercise help lose weight? Goodness me, in all the years I’ve been fat, I never heard of that, much less tried it!” retort to the “mildly condescending platitudes”, it didn’t end well.
So you’ll have to take the platitudes plus the side-effects if you want any treatment at all. Be nice to get the “talk to me like a human being and even an averagely intelligent one at that” option but doesn’t happen often (did happen with one doctor which is a refreshing change but not too frequent, alas!)
Be even nicer if the “I can’t take that medication you want to prescribe me and are pushing me to take, because it will react badly with a medication I’m currently taking, and no I didn’t just read that off the Internet, the last time I got prescribed that I turned blue in the face and had to be rushed to the ER” option was on offer, but we can’t expect miracles, now can we?
Though re: social class and judgements of status and intelligence, I don’t know if this is more pronounced over here, but because I’m (a) fat (b) naturally talk widda native aksent like, bye, I do tend to get the “plainly thick as two short planks, do the condescending talking down bit and the ignoring what they’re saying bit” unless I use my “the nuns at school taught us elocution lessons” voice and then I get the “hey, evidence of a brain here, talk to them like a real person!” reaction. But it needs to be finely judged, if you show too much intelligence that triggers the “who do they think they are, I’m the doctor here” reaction which also goes badly.
Which is kind of a shame, given that I have the same level of comprehension and intellect in both instances, and only my vocabulary and diction has changed.
I think the problem is that there are lots of genuinely…let’s politely call them “confused” people who don’t realize even very obvious things, and if you don’t know your patients well enough to predict who they are you might as well just give the “eat well, exercise, and get a good night’s sleep” spiel to everybody. But it sure does sound condescending if you’re not the right target.
(and this gets harder when we go into subtler things like “have you tried sleeping in a cool room with good white noise” or “have you tried melatonin” etc)
Again, I wish I could just ask “Are you aware of basic things that it would be very surprising if you weren’t?” but everyone would define this differently and it would be useless.