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.

TIL: JRR Tolkien’s great granddaughter, Ruth Tolkien, is the only blind person in the UK to be a competitive fencer. She is currently ranked the #186th best fencer in the country.

There’s a court case called Tarasoff where a psychiatrist’s patient killed someone, and they found the psychiatrist liable for failing to warn the victim. The case established a “duty to warn” - psychiatrists need to warn anyone threatened by any of their patients that there’s a guy out there trying to kill them. This makes sense and has basically been universally accepted.

The other day I went to a lecture on so-called “Tarasoff expansions”. The guy giving the lecture basically admitted they made no sense. The principle seems to be that if anyone ever does anything bad, people can sue their psychiatrist and and win.

So for example, suppose you treat a psychotic person in the hospital, and after they’re better, you let them out. There are no signs of any problems and they are exactly like all your other successfully-recovered psychotic patients. Then a few months or years later they stop taking their medicine, snap, and attack someone. Can the victim sue you? You bet they can. Can they win? If the judge and jury really want someone to blame, absolutely. The specific charge will be that you failed in your “duty to warn”. To warn who, exactly? Uh, the general public. About what? Uh, that somebody might become a threat a few years down the line.

None of these cases specify what it means to warn the general public. Also, you can’t actually tell the general public about any specific patients of yours, or you could be sued for violating confidentiality. Also also, you have only the faintest idea which of your patients might become violent in the long-term future.

(also, it doesn’t have to be violence. One person got successfully sued under a Tarasoff expansion case because their patient drove under the influence and killed someone in a car crash)

One of my colleagues suggested some kind of non-specific warning. We came up with the idea of hiring one of those skywriter planes to write the message “PSYCHOTIC PEOPLE MIGHT BE TRYING TO KILL YOU” in the air above major cities. Sounds like this can’t possibly go wrong.

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.

It’s horrible to call anything about a terrorist attack “funny”, but it’s definitely something that the ringleader of last week’s terrorist attack in London was featured in a documentary about jihadists living in Britain. Kind of makes it harder to pull the “nobody could have predicted this” card.

But I sympathize with the British police in this one. Every so often some mentally ill person commits a violent crime, and the news focuses on how their psychiatrist had written in their notes that they were potentially violent, likely to commit crimes, et cetera. And people ask “everyone knew this could happen; why didn’t anybody do anything?”

And the answer is: being the sort of person who seems likely to commit a crime isn’t illegal.

I assume that if someone reports a potential terrorist to the British police, they tap their phones and keep a watch on them and so on. But (especially if the potential terrorist is a citizen) I’m not sure what else they can do without sacrificing the principle of “innocent until proven guilty”. Freedom of speech isn’t just about being able to say politically incorrect things at colleges, it also means you can’t lock up a Muslim for saying “Those ISIS people seem to have some bright ideas” on national TV.

I wonder if someone in intelligence services has put together a list of people they would like to be able to lock up forever if we ever became a police state. And I wonder if anyone has ever looked back on the list a couple years later to see how many of those people actually ever caused any problems. My guess is that even a really good intelligence officer would have a lot of trouble coming up with a list like that where fewer than 99% of the entries were false positives. And that means that even knowing that some recent suspect was on a list like that doesn’t mean anything necessarily went wrong.

On third thought, everyone else is right and I am wrong. The Dragon Army group house is a very bad idea, enough so that it’s okay to be forceful in encouraging Duncan to modify it or other people not to join it. This is true even if the required modifications are so hard that they end up sinking the project.

I’m not sure what my point was except that it’s wrong to make fun of people who are trying to do interesting things with their hearts in the right place, and that if despite all the light social pressure we can muster people still want to join it they should be legally allowed to do so. I still think these are true, though more weakly.

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!