ragebutt
@ragebutt@lemmy.dbzer0.com
- Comment on [deleted] 2 days ago:
A sleep test if you have the resources (health insurance and such). Most common cause for apnea is obesity but there are other potential factors like issues with tonsils, sinuses, septum, turbinates, and/or adenoids that wouldn’t require a cpap but other things like surgical correction
Additionally lifestyle changes can make a huge impact especially if it is related to obesity
Nowadays you often can do sleep tests for things like apneas at home, you usually dont have to go to sleep centers. It can be worth it to make your dad aware of this. Ive had older clients who were very avoidant of sleep studies before they found this out because before a few years ago it was far more common that sleep studies were a much bigger pain in the ass. Youd have to go to the sleep center and sleep there, hooked up to a bunch of machines, uncomfortable bed, not necessarily on your sleep schedule. Now thats really just reserved for certain sleep issues like narcolepsy and severe insomnia
if you can’t get a sleep test and cpap the old school way to manage apneas was to sew a pocket to the back of a tshirt that held a tennis ball, which would force you to sleep on your side. Not ideal but better than dealing with the health impact of an apnea. Not to inspire fear but apneas are terrible for your health. They cause you to wake up briefly and return to sleep.
This happens fast enough for you to not remember and as a result the “cycle” of sleep is interrupted. If the apnea is severe this can happen many times per hour or even per minute, causing you to never get restorative sleep. You “sleep” all night but feel exhausted all the time because you never enter the deeper cycles. Luckily it’s not an immediate danger at all but after years or decades the effects compound just like having a consistent extreme lack of sleep would
- Comment on Life is Strange road-trip 6 days ago:
Cooool
I recently played through 2 and true colors. I have the lost records game too. I haven’t gotten dual exposure yet because I know if I’m patient enough it will be free
- Comment on Nintendo reserves the right to brick your console following "unauthorised use", in bid to prevent piracy 1 week ago:
Hard to say. Consoles have certainly gotten more sercure and people finding vulnerabilities are far less likely to just give them out for free these days
But there is incentive to hack any console and nintendo has historically attracted the biggest dorks. Additionally they also seem to historically make pretty huge blunders, though the switch exploit was nvidias fault tbf
- Comment on Google shares slump as Apple exec calls AI the new search 1 week ago:
AI absolutely is the new search but only because the major search engines normal people use have completely destroyed their core products functionality for advertising revenue
AI will likely follow suit. In 5-10 years chatgpt or bard or whatever will give you a completely and obviously biased response promoting a product or service with a sponsored interstitial that is labeled as sponsored before you get the answer to make it seem like the obviously biased answer isn’t a gamed response
- Comment on What are some good examples of "Where the fuck do you go" kind of games? 1 week ago:
Hint books were an experience back then. I remember the hint book for myst had this whole narrative about some other person who got trapped in the book, which was supposed to be like the player. It was this whole story of how they solved all the various puzzles. I remember it being quite long but I was also like 9 so maybe it was just like 10 pages
- Comment on If it's good enough to keep your house warm, it's good enough to keep your insides warm 1 week ago:
More like the focus group thought the masks were “super gay fauci shit” so home depot went with “guy wearing $2 safety glasses that don’t even have a dust seal”
- Comment on Someone give me money so I can find out 1 week ago:
I’ve never had a gold leaf thing, aside from a shot of goldschlager, but I have wondered this
Maybe the next time I make a dessert I’ll pick up some flavorless, odorless gold to really take my treat to the next level. What a stupid trend
- Comment on What are some good examples of "Where the fuck do you go" kind of games? 1 week ago:
All those old games were so punishingly hard
You’d play leisure suit Larry or whatever and get 3/4 of the way through and get stuck. Then you’d check a walkthrough and realize you didn’t check the trash can on the first screen of the game for a key item and now you’re fucked and literally have to start over from the beginning
Or you’d get to a death condition and get a screen that just mocks you: remember to save early and save often!
- Comment on What are some good examples of "Where the fuck do you go" kind of games? 1 week ago:
Yeah, basically every game that runs on scummvm is a good candidate here: leisure suit Larry, kings quest, police quest, the dig, sam and max, Indiana jones and the fate of Atlantis, all the sierra and lucasarts ones
Myst series is another good one. Journeyman project trilogy. These all ruled when I was like 12 years old
I miss when games were confusing and aimless by default. I know there are still games like this but I feel like the default now is a game that’s like “oh hey, go down this hallway full of locked doors! Except one door is unlocked, that’s a secret area, good for you! But otherwise go down the hallway to the next hallway!”
- Comment on Peepee poopoo 2 weeks ago:
I used to send out my reminders by hand and made it very clear, pretty much what you wrote
I don’t know why you would emulate a script
- Comment on How are people supposed to have secure/private communications in the digital era? 2 weeks ago:
Do you mean for their medical records? Like I would write their medical records into an encrypted file that they hold the key for?
This is an interesting idea but it would be reliant on the client self funding services. I also don’t know if it would be legal because I am not a lawyer and generally the government wants access to your data
The other aspect that I absolutely glossed over here which was probably a bad idea is that payers retain the right to your records for auditing purposes to ensure their funds are not being wasted (which is a whole textbook of issues).
The vast majority of time this transmits data that is typical for medical services and is somewhat minimal - time and date of service, CPT code(s) (aka what kind of service was rendered, diagnosis code(s) relevant to service, who the service was for, charge rate for the service (how much money I bill). The stuff you see on an explanation of benefits. Insurers don’t typically see actual progress notes.
However, they reserve the right to do so in a few instances: if you file a grievance against the clinician, if they feel the clinician is doing something wrong, or if they simply decide to do a random audit (this is astoundingly rare with commercial insurers but happens much more routinely with government funded plans like Medicare and Medicaid).
In the first instance it’s generally a good thing; the insurer is acting as an advocate for you because the clinician did you harm in some way. In this instance the insurer is actually one of the best people you can have on your team. They don’t actually care about you but they are aligned with your mission; if they can prove clinician malfeasance they can usually recoup tens of thousands of dollars of insurance payments going back years.
The second two are where things are muddier. When that insurance ceo got got a light was shone upon the ugliness of these systems for a brief moment but now no one cares again. Audits are increasingly being triggered by automation: if you are an outlier in terms of utilization then you run the risk of getting your therapist’s practice raided by Optum. Insurance regulations are contractual, not legal, and are often conflicting and obscenely complex. They are written in such a way that it is essentially guaranteed that if complex cases are audited they will find issue with dozens of notes. And the law is on the side of the insurance: they can go back years and rescind payments
So what can end up happening is that you come to therapy from a hospitalization. You aren’t doing well. You see me twice a week because of this for 4 months. You do better. We see each other for another 6 months weekly. You regress, and we go back to twice weekly for 4.5 months. You have optum insurance (a subsidiary of United, but they aren’t the only ones who do this), and their internal systems flag you for high utilization of services
They contact me and tell me that is anomalous and as a result they will be doing an audit of records. They don’t just audit you though, they audit anyone I work with who has optum for the last 3 years. Any note that has even a minor issue: did I not make use of an intervention clear enough? Did I forget to change the session times to actual times from the default 5-6pm? Did we have a session where you were doing poorly and it was more just me listening to you vent and process? All those are retroactively rejected. Now my practice suddenly owes optum thousands of dollars, sometimes tens of thousands. I’ve had colleagues with group practices where this ends up being a 20-30k bill due in 15 days or their contract is voided and all their optum clients are fucked.
The problem is self funding services is a mixed bag. With overheads even as a telehealth only practice the minimum I can charge for a livable wage of about 50-60k a year is a sliding scale of $45-60 and frankly that only works because I have about 50% of a caseload that’s commercial insurance clients that pay double that. Even with that 45-60 is a huge ask for a weekly or biweekly service, 90-240 a month is a tremendous expense for most people. Therapy should cost nothing, or maybe like $10 a session at most, but if I charge that I will starve. I don’t know a resolution here.
- Comment on How are people supposed to have secure/private communications in the digital era? 2 weeks ago:
This is funny but in serious mode many of my clients have pretty bad religious trauma and the protections for lawyers and priests and stuff fall apart if they were used fraudulently so even if I just got it and never said anything to my clients it probably wouldnt actually work
This is a bullshit law. You should be able to speak to therapists and medical staff freely
- Comment on How are people supposed to have secure/private communications in the digital era? 2 weeks ago:
I’m sorry, but I don’t think the answer is to be dishonest to you about the reality of the situation
I do believe our government has failed us here and that therapy should be protected communication the same as speaking to a lawyer, for what it’s worth
- Comment on How are people supposed to have secure/private communications in the digital era? 2 weeks ago:
It is legally impossible to have a truly private conversation with a therapist, any therapist should explain this to you. The only relationships where records cannot be subpoenaed are conversations with a lawyer and confessionals with clergy. This is bullshit but it is where the law stands
Any therapist who practices ethically should make this very clear to you prior to engaging in treatment
Any therapist who has their records subpoenaed should question the subpoena and only release records if absolutely and truly necessary.
We have not really had situations where a therapists records are being subpoenaed to justify disappearing an individual and the therapist simply acquiesces in the modern context. If so, I’d love for you to point me to a case where such a thing happens. 95% of subpoenas for therapist records are for custody battles, divorce proceedings, and disability claims. The remainder (which is probably a smaller number) is generally related to criminal cases where a defendants competence is trying to be determined. In these cases the records are often being subpoenaed by the defense to establish a lack of competency.
I will openly concede we appear to be heading towards times that may very well test the moral code of the therapist community in regards to this issue. To further complicate things unlike during WW2 there are now many paths to circumvent a clinicians resistance. If I for example flat out refuse to release a transgender clients records, or alter them, the government will likely go after the vendor of the software I have used to store my records for the past 6 years. I am all but sure they will acquiesce. The overwhelming majority of clinicians are in the same position as me. Many are not independent and don’t even have autonomy over their records; a subpoena may come and they never see it. The agency simply releases them because it is run by executives that do not want to interrupt revenues. It is a scary time
- Comment on How are people supposed to have secure/private communications in the digital era? 2 weeks ago:
I am a therapist, at least in America you should know that your therapy records are not fully confidential and are subject to subpoena. They are confidential in the way that if a cop asks for them I will tell them to fuck off, or if a random person does the same thing applies.
But you should be fully aware that psychiatric and medical records do not have the same rights that you would have with a lawyer or a clergy member during confessional. If I see you, my records are eventually subpoenaed, and I refuse to release them I can be held in contempt and potentially jailed. I can also be compelled to testify but this is extremely uncommon, basically unheard of.
This is absolute bullshit and a good therapist should do two things: they should make this clear to you and they should document in a way that skirts the line between “enough to pass an insurance audit” and “as vague as humanly possible”. There are many ways to go about this.
Additionally if records are subpoenaed I can push back against the subpoena. However, this can be difficult and very expensive. In my experience subpoenas will essentially request everything. “Records including patient notes, assessments, treatment plans, billing information, medical imaging, etc etc etc for the entire duration of treatment”. Stuff that doesn’t even make sense for my scope of practice. This makes sense for them; might as well grab everything you can and avoid potentially missing some juicy detail.
Pushing back is tough though. In some instances I don’t have to; the client is aware of the subpoena and is fine with me releasing records. In instances where I can’t I need to retain counsel. My malpractice insurance provides counsel for this but they tend to provide super cheap lawyers from lawyer mills who are just making sure I’m not fucking up anything that would get myself sued. If I tell them I want to push back and avoid releasing they generally heavily discourage this and if really pressed will flat out refuse.
My only option at this point is to fire them and retain counsel at my own expense. Lawyers are goddamn thieves so this can easily cost 2-5,000 assuming it doesn’t end up in some huge battle where I need to retain counsel for weeks. Like many outpatient therapists I’m self employed so I have to just eat that cost (I think technically I can bill the client for it but that’s kind of fucked up so I’ve never looked into it). If they’re not independent like me and work for a larger agency they don’t have to eat the cost but they also usually don’t have the option to do this; most agencies are run by capitalistic cowards who will bend at the knee to avoid conflict and do not have any interest in principles or ethics
On the electronic medical record(EMR) front documentation management systems are fairly secure, or at least as secure as healthcare management systems can be. Psychiatric management systems are a double edged sword; we tend to have smaller boutique solutions tailored to meet our needs. Hospital networks and large medical agencies will generally have something by Epic or Oracle health.
These companies don’t bother with software packages for small practices like mine though, which make up the bulk of outpatient psychological care in America. They want the huge medical networks that will pay contracts of 150k/month. That makes them huge targets though. My software solution is niche and mostly unknown so hackers targeting it is far less likely. On the other hand the resources involved in securing it are far less.
A growing concern with all software solutions is integration of LLM nonsense to streamline writing progress notes. Generally they want us billing as much as possible so this is being pushed hard to raise utilization rates. Some software guarantees the models are sanitized and that once deployed data fed into the model isn’t used for refinement or reinforcement learning but not all guarantee this. This is concerning from a privacy standpoint. Some more intrusive versions record and process the audio of the entire session and spit out a progress note, which is real gross
As for a cellphone being present, I don’t know how to get around that. Normally I would say I don’t think there’s much risk from a cellphone simply being present in the office but I stopped bringing mine in because i noticed the voice assistant would be accidentally invoked at times. I bring it in now because I have a cellphone that no longer runs a voice assistant. This is gonna be a tall order though. Everyone in the world has a phone on them all the time and they very rarely degoogle or disable siri
I don’t tell you this to discourage you from therapy. I tell you this to encourage you to make an educated decision when you select a practitioner. If confidentiality and privacy are meaningful issues to you (and they should be) when you do your consult or first visit ask about how the therapist handles subpoenas, ask about how they handle documentation knowing subpoenas are a risk, ask if they use AI summarization tools.
- Comment on What if 2 weeks ago:
reminiscent of one of the greatest I think you should leave sketches
also garfeild
- Comment on Why does it seem like everyone is so good looking and beautiful nowadays? 2 weeks ago:
come to my house, i look like shit
- Comment on Annon has not been seen again 3 weeks ago:
- Comment on 4chan Is Dead. Its Toxic Legacy Is Everywhere 3 weeks ago:
There’s a supposed message from one of the admins promising it will return
If it does come back it will likely take ages given much of the 20 year old hacked together source leaked. If they simply relaunched as is it would likely go down again in minutes
- Comment on [deleted] 3 weeks ago:
And maybe you have to be a landowner too
- Comment on DeepSeek: The Chinese Communist Party’s newest AI advance is making repression smarter, cheaper, and more deadly. Even worse, they aim to export it to the world. 4 weeks ago:
Chinese cctv systems with AI are dangerous because they let the government watch their citizens for control and repression
Not like domestic drones, traffic cameras used for surveillance, DHS CCTV networks, the sea of cameras that every citizen owns that can be subpoenaed, and the WAMI program with automation software for tracking that has been deployed since 2013. Those are tools of freedom to keep Americans safe
- Comment on How are the blatant anti-competitive practices of Apple just…allowed? How is this even possible? 4 weeks ago:
at no point did I deny apples practices are shitty and anti consumer
but the history of how we got here is that microsoft spent time lobbying hard to make sure that companies like apple could do exactly what they are doing
apple is far from the only one who does it as well? Basically every modern tech giant flexes their anti consumer muscle every day. the one defense of apple is that you can basically avoid their shit by not buying it, as opposed to a company like google who are actively vying to utilize their extreme dominance in browser market share to change the internet forever to make adblocking impossible (very similar to 90s microsoft behavior)
Those who don’t learn from history are doomed to repeat it, etc etc
Sorry you were challenged to read what was roughly 3/4 of a page. Maybe this is more digestible for you
- Comment on How are the blatant anti-competitive practices of Apple just…allowed? How is this even possible? 4 weeks ago:
Funny enough, apples behavior was enabled by microsoft setting really shitty precedents in the 90s. oh whoops!
Seriously though microsoft was a force in the 90s and early 2000s. If you weren’t around for it you simply don’t realize how insane it was for something like computing to have come around and quickly take over the world with microsoft being the thing. you only had a pc (or maybe laptop). That pc ran windows over 90% of the time, and you used internet explorer over 90% of the time. Like I’m not making this up, IE, the worst browser of all time, peaked at 95% market share in 2002.
Nowadays edge is a minor contender but a distant third (chrome about 70%, safari about 17%, edge about 5, Firefox 2.5). Windows market share still dominates on PC but has fallen significantly from 90+% in the 1990s to 75ish% for windows 10 and falling. Plus nowadays people don’t use PCs nearly as much. I’m on a phone right now, which is the dominant computing device (and windows phone was a joke)
Anyway in true American capitalistic fashion when they had this undeniable monopoly apple was a joke at the time and Linux was for extreme hobbyists and servers and such. So what did microsoft do? Destroy competition, destroy any political machinations that could threaten their future with hefty lobbying, destroy open standards in favor of their own proprietary bullshit, etc. Europe attempted some antitrust stuff against them similar to what is happening to google now (to forcefully break off IE from windows) but it was unsuccessful
So when you’re frustrated about the fact that tech does not play nice together? Does not adhere to open standards, forces proprietary bullshit on you, open displays anti competitive and anti consumer behavior? Blame microsoft and politicians that were grossly ignorant to a rapidly changing world (although to be fair you don’t have to be a tech genius to understand that computers being forced to work with each other and have transparency in how they work is beneficial)
And the next time you see some dork praising bill gates for being the “cool billionaire” because he has a charity remember that his wealth is built on these destructive practices. He lead microsoft through this period and this doesn’t even touch on how he destroyed countless businesses that dared to compete by leveraging the size of his company (eg draining their resources with lawsuits) rather than competing fair and square.
He personally fucked the landscape of technological advancement for generations on top of that because he had the arrogance to think that microsoft knew how best to handle it. Now it’s blown up and he doesn’t care because he got his bag. His charity is the same problem: he holds his wealth and decides what causes are worthwhile, like a king. Fuck him, and fuck all the technocrats that have no sense of ethics aside from “make me more money and do whatever I want”.
- Comment on This gay tortoise is older than the word “homosexual” 5 weeks ago:
They also use vibrations to sense partners but I don’t know if they can tell gender from that
- Comment on This gay tortoise is older than the word “homosexual” 5 weeks ago:
Tortoises use sight and have a good sense of sight to be fair but the also use scent from the cloaca to gather information about things like sex of a partner
he knows what he’s doing
- Comment on America is fucked 5 weeks ago:
This is beyond car brain. This is the increasing amount of people simply not giving a shit about the social contract over the years coupled with cops not doing their actual jobs in favor whatever it is they do (sitting in their cars fucking around in their phones and harassing minorities?)
But you see the lack of concern for the social contract in many other aspects of american life. Asking people to wear a paper mask during a pandemic was probably the most notable recent non car example. We all know how that went. In other cultures it’s a regular practice; you simply do it as a courtesy when you have recently had a cold. In A america during a pandemic 30-40% of the population revealed themselves to be utterly pathetic toddlers that can’t handle being asked to do something by a perceived authority figure or slightly inconvenienced.
- Comment on Will Trump tariffs and implied trade war have a significant effect on the global emissions of greenhouse gases? 5 weeks ago:
Even if it didn’t (it will) his administration is doing all kinds of nasty rollbacks on climate initiatives and regulations related to the environment sooooo
- Comment on Fox Picks Up Four Seasons Of ‘The Simpsons’, ‘Family Guy’, ‘Bob’s Burgers’ & Returning ‘American Dad’ In Mega Deal With Disney TV Studios 1 month ago:
I can’t wait to see how this will fuck up the season numbering even more
- Comment on Luxury bones? In *this* economy. 1 month ago:
I do own a house (finally got one in my late 30s) but part of what got me here is ignoring dental care (missing 2 teeth)
I would be missing three but I went to Costa Rica once for unrelated reasons and got an implant while I was there. Ruined my trip a little bit because getting an implant sucks but it was $750 vs $5100 in America (with pretty good insurance)
If you’re missing teeth for a long time (I’m pushing 8 years now) the rest of your teeth start moving around. It’s a real problem. Additionally once this happens missing teeth can exacerbate hip and back problems! Your jaw misaligns and then your posture gets fucked up
best country in the world
- Comment on I tried THIS and it actually works all the time 1 month ago:
thank god you circled it, I wasn’t sure what was being pointed at