I often feel the same working in mental health, especially with medically complex patients who have lost their own legal-medical decision making rights.

There’s the obvious high stakes ethical debates like if someone has a gangrenous limb that will kill them should you force them to have it removed. But there’s a lot more common / lower stakes examples I run into more often. Say someone has a dietary restriction that not following will likely cause great harm. Say they can’t swallow effectively (more common than you think, especially with strokes). This person is demanding a burger. It’s more likely than not that they will choke and die on that burger. Do you let them have the burger? You could argue that a sane person would obviously choose life over a burger but I might argue that American culture in particular makes the ability to consume burgers enjoy life more important than lengthening it (not entirely true, OP is probably one of the few people here who wouldn’t be shocked what people put elders through in the name of extending life). In the end its a complex debate with a huge amount of individual nuance that I don’t claim to have all the answers to.

I can tell you that I kinda wanna go work hospice where I don’t even have to ask any of those questions and can just give them the fucking burger.

My brother in whatever the fuck this is, I’ve gotten more out of tarot card reading than any therapist I’ve had in the past few years.

Teeth. Teeth right the fuck now. And if somehow there is nothing wrong with them see if your insurance will cover a flouride coat to keep them that way.

Oh and literally every cancer screening possible. Get your butt checked, your nuts checked, some dermatologists will literally check every inch of your skin. Tell your doctor about every bad habit you have and see what else they’re willing to look for.

Honestly this discussion also highlights the issue that what’s considered inappropriate varies widely and often changes both in terms of prejudice and in terms of context. Most people would agree that an image of a penis entering or inside of a vagina is pornographic unless it’s a medical diagram laying out the anatomical and physiological aspects like the one in the anatomy book my otherwise puritanical parents let me read at the age of six. Most people would agree that nudity is sexual except for, again, anatomical diagrams, but also many classical artistic depictions such as paintings and statues. Hand holding isn’t generally considered sexual except to some people if the people happen to be of the same sex but not if you come from a culture where hand holding is a normal level of intimacy for non sexual friends. Breasts are for some reason considered sexual in most of the areas heavily colonized by people from the places where lactose tolerance past childhood evolved but not most other places which is super handy if you like being able to feed infants. Most people agree that kissing for an extended period while rubbing areas close to the genitals is sexual, but often not enough to restrict it from being viewed by teenagers.

TLDR; what’s even considered “sexual” or “porn” can vary wildly and has historically been used to suppress education, various minorities, and general freedom of expression.

That was the whole purpose of tumblr so yeah. I kid, as I did get started on there at like 14 as a part of various Fandoms, but by the time I was 18 I had been using it for porn for quite some time, largely because fandom is also mostly for porn.

It’s not even the "needs help themselves aspect. That screws them, they say most psych nurses are crazy too, it’s whether they’ve done the work on it, and I think you’d find similar levels of low competence from somebody who just didn’t pay enough attention in school (AND they wouldn’t have the life experience to know what they’re talking about).

Yeah to me I see it as the commoditization / paywalling of normal human supportive interaction. Therapy should be there to supplement normal supportive relationships when they’re unavailable to you or you have a large enough stressor in your life that they’re inadequate to help you manage.

I don’t like the idea of moving towards a society where it’s just expected that most truly supportive interactions have a strict professional-client paid relationship instead of a naturally ebbing and flowing give and take between two friends who are close enough. To me that just feels like capitalism further encroaching into my life by tallying up the worth of every interaction I have so they can demand their cut.

I’m already seeing a therapist for my existing severe mental illness through one of those online gig style therapy services because that was the only place I could find any openings, and they’re already taking their cut that way. I can’t imagine choosing this if I wasn’t already someone who had been hospitalized several times. Difficulty sustaining stable interpersonal relationships is literally a key hallmark of my disorder, and if I was better at it I’d much prefer it! (I’m working on it, LOL).

Well I’m night shift so it’s while I’m sleeping. But they can’t just give you a day off either because that would also just solve the real issue. Not that therapy is never necessary, but having worked in mental health 8+ years now, 90% of the time 90% of people just need a damn day off (often more than one). Traumas and chronic dysfunctions will absolutely always exist, but we really need to stop focusing (as much) on the “everybody should go to therapy” side and much more on the “what the fuck are we doing to all of these people that all of them need so much therapy???” side (spoiler: It’s too much work for too little pay, and the rent, as always, is too. damn. high.).

I’ve mostly found that smart alerts just overreact to everything and result in alarm fatigue but one of the better features EPIC implemented was actually letting clinicians (like nurses and doctors) rate the alerts and comment on why or why not the alert was helpful so we can actually help train the algorithm even for facility-specific policies.

So for instance one thing I rated that actually turned out really well was we were getting suicide watch alerts on pretty much all our patients and told we needed to get a suicide sitter order because their CSSRS scores were high (depression screening “quiz”). I work in inpatient psychiatry. Not only are half my patients suicidal but a) I already know and b) our environment is specifically designed to manage what would be moderate-high suicide risk on other units by making most of the implements restricted or completely unavailable. So I rated that alert poorly every time I saw it (which was every time I opened each patient’s chart for the first time that shift then every 4 hours after; it was infuriating) and specified that that particular warning needed to not show for our specific unit. After the next update I never saw it again!

So AI and other “smart” clinical tools can work, but they need frequent and high quality input from the people actually using them (and the quality is important, most of my coworkers didn’t even know the feature existed, let alone that they would need to coherently comment a reason for their input to be actionable).

It would be nice to be able to have a view that only tallies the votes from your local server, but IDK about listing all the individuals in an easily accessible manner.

What I really want though is a rolling deletion of my activity that’s older than 3-6 months. I understand there’s no way to erase these things entirely, especially from decentralized servers, but I do wish the internet could revert to being a little more ephemeral. You can also go look through public records and go back years in real life, but it’s not easy.

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