#MidLevel

[kamalkafir-blog]

Entry to Mid-level Environmental Scientist

Job title: Entry to Mid-level Environmental Scientist Company: Groundwater & Environmental Services Job description: When you join Groundwater & Environmental Services, Inc. (GES), you are not a number – you become the reason…’s leading organizations solve their most complex environmental challenges. We work hard, and we have a lot of fun while we’re… Expected salary: Location: Pinellas Park, FL…

[qhsetools2022]

Mid-Level Private Equity/Finance Associate Attorney

Job title: Mid-Level Private Equity/Finance Associate Attorney Company: Direct Counsel Job description: Mid-Level Private Equity/Finance Associate Attorney Location: New York, NY (Hybrid) Direct Counsel is seeking a mid…-level Private Equity/Finance Associate to join the growing private equity practice of a leading global law firm in New York… Expected salary: Location: New York City, NY Job…

[wonderinc-sonic]

It sucks to me that Charmy and Marine never got to be friends. Like, Blaze couldn't bring Marine over once to hang out with the Chaotix? Criminal.

[autism-industrial-complex]

Buckle up, this post is going to be a bumpy ride. I originally intended to make a point about language barriers and systemic misdiagnosis of POC and ESL/non English-speaking patients, then I went down a rabbit hole of information.

Key Takeaways

Medical mistakes (including misdiagnosis, inappropriate/inadequate treatment, pharmacy error, and procedural mistakes) are the 6th leading cause of death in the US.

Patients who face language barriers are more often misdiagnosed, less likely to receive adequate treatment, and more likely to have their medical privacy violated.

Midlevel practitioners misdiagnose patients more often than physicians, despite ordering twice as many tests.

Overall, 21% of patients seeking specialty care were initially misdiagnosed.

Read more below the line break.

The Language Barrier

“Patients who face language barriers have a greater risk of misdiagnosis, lower adherence to treatment, lower satisfaction, and differences in prescribed treatments.”

Dr. Gaibrie Stephen wrote a fantastic article in November of 2019 aimed at Emergency Medicine physicians in Canada.

Dr. Stephen goes on to note that language minority communities are not adequately treated for their pain, less likely to provide informed consent for treatments, and are more likely to have their personal health information (PHI) compromised without their consent.

Cognitive Error in the Emergency Department

This podcast episode is a little older. Drs. Chris Hicks, Anton Helman, and Doug Sinclair spoke about common decision-making error in the Emergency Department (ED) in February of 2011.

Rates of misdiagnosis in the ED have remained relatively constant for the past century, and studies estimate the misdiagnosis rate at 1-12%. Cognitive decision-making errors are present in 95% of misdiagnoses.

Patients are more likely to be misdiagnosed in the following scenarios:

Night shifts, especially around 5am when shift work fatigue sets in

Handover, especially during the shift change from night shift to day shift

Overconfident learners and overconfident physicians

Very young and very elderly patients, especially when the patient cannot communicate clearly or is hard of hearing

In a busy ED with a high volume of patients, especially when the physician is interrupted multiple times.

Delayed lab or imaging results

The “difficult patient,” who is likely to be agitated, noncompliant, and communicates aggressively with ED staff but fails to provide key details about their chief complaint

Patients who are exhibiting uncommon symptoms of their condition, or who have a secondary issue leading to symptoms that rule out the primary issue

Patients that present with uncommon conditions that require extensive testing and specialist consultation, especially if symptoms of that condition mimic a more common ailment

Midlevel Practitioners vs. Physicians

In this study, researchers compared the misdiagnosis rates of physicians to the misdiagnosis rates of midlevel providers (nurse practitioners or physician assistants). The scope of the study was limited to one dermatology clinic in Lubbock, TX that employed 2 physicians, 2 nurse practitioners, and 1 physician assistant. The study focused on the diagnosis of non-melanoma skin cancers over a 5 year period.

The midlevel providers had a misdiagnosis rate that was 3.84% higher than that of the physicians. The midlevel providers did approximately 2x the amount of testing (ie biopsy) as the physicians before coming to a diagnostic conclusion.

Conclusion

According to the Mayo Clinic, 21% of patients who sought a second opinion from a specialist were initially misdiagnosed by their primary care team.

If you suspect that you may have been misdiagnosed, the most important thing you can do is to find a patient advocate, whether that is yourself, a parent/sibling/adult child, a partner/spouse, a close friend, etc.

As a patient, you have the right to quality healthcare and adequate treatment.

You have the right to certified and fully vetted interpreter services to ensure that you understand exactly what your doctor is telling you, and that your doctor understands what you are telling them.

Your doctors are obligated by their ethics board and required by law to release your medical records at your request.

You can and you should seek a second opinion when you feel like you are not being treated appropriately.

Appropriate treatment is, unfortunately, not always easy to access. Many areas of the US are designated “medically underserved areas,” meaning that physical access to healthcare of any kind is difficult. Personally, I drive 1.5 hours to see my neurologist. My primary care physician is a 30 minute drive from my home.

The world of healthcare is a beast, especially for those with chronic illnesses and/or disabilities, POC, and those living in poverty.

Some quotes from the article:

Top medical researchers are sounding the alarm that an estimated 795,000 American patients continue to die or become permanently disabled each year because they are being diagnosed with the wrong conditions.

The enormous numbers of misdiagnoses are a public health emergency, the report's lead author said. “Diagnostic errors are, by a wide margin, the most under resourced public health crisis we face," said Dr. David Newman-Toker, director of the Johns Hopkins diagnostic excellence center. Medical professionals almost always misdiagnose diseases when a person's symptoms look like possible symptoms for a different condition, Newman-Toker told USA TODAY. The more subtle the symptom appears, the more likely it is the patient's problem will be misdiagnosed, he said. "We don't miss strokes when somebody is paralyzed on one side and can't talk," he said. "We miss them when they look like something else that's benign."

On the lower end of the spectrum, only 1.5% of heart attacks are misdiagnosed, researchers found. On the higher end: 62% of spinal abscess are incorrectly diagnosed. Heart attacks have such a low rate of misdiagnosis "because we're made a sustained investment over decades" on better diagnostic resources and have passed regulations saying they must be put in place, Newman-Toker said.

Just five diseases account for nearly 40% of all deaths and permanent disabilities stemming from incorrect diagnoses, according to the report. Stroke Sepsis Pneumonia Blood clots Lung cancer Because a small number of diseases make up a large share of the problem, researchers say they are hopeful it will be easy for medical care providers to focus their efforts in certain areas.

[lvmimis]

i’m crying so i was like why do we have to explicitly tell an ordering provider to get a psa if we’re recommending a follow up mri, that’s literally basic medicine to my attending and he goes listen mimi these days there is just straight up quackery and reflexive ordering, assume nothing

[lilbittymonster]

Eorzea Collection used to have all of the craftable gear items listed, too, right? I'm not tripping? Currently all I can find under "crafted glams" are shit like the map material items, nothing from the crafting log is turning up.

[ladyinshiningarmor]

the only inaccuracies i've seen in the pitt so far are 1) how little time they spend charting and 2) how often we don't have a diagnosis for someone's symptoms. we rule out emergencies. and then i try to do what i can to ease their suffering until they can follow up for the more specialized testing they need

[kethsi]

Shout out to the level 90-100-something combat people who take time out of their evening to start boxing feral vampyres near the morytania herb patch armed with nothing but magic secateurs and a prayer to protect my noob ass when I'm trying to harvest toadflax and fail at trapping em. You guys are legends and I owe you my life.

[amrv-5]

seeing all this fellow travelers content… feeling Intrigued… Looking Respectfully……. can i ask what it is & would you recommend?

HELLO!!!!! Okay yes I would recommend, I thought it was a great watch, I enjoyed myself! I have more thoughts on it but I'll save 'em cause spoilers--generally: It follows a number of queer relationships / characters over the course of the Lavender Scare through the 1980s. Its primary focus is the relationship between Hawkins, a WWII vet and midlevel govt. bureaucrat; and Tim, a congressional staffer fresh out of college. They meet during the height of the Lavender Scare and begin a fraught romance as they struggle with their own careers in DC, political complicity, and identities personal and public. The show covers about 30 years of their lives together (and apart). Go into it expecting solid performances (incredible Jonathan Bailey vehicle, at the very least) and (imo) fun if slightly uneven structuring, but also know (I don't want to sell it as Fun Gay Love Story!) by virtue of time period and what it's most interested in, story spends most of its runtime trying to show how national attitudes and even seemingly very localized political machinations impacted the lives of queer and especially queer Black people.

[razmerry]

conspiracizing about megalodons still being alive makes me grit my teeth like they're about to shatter

[kamalkafir-blog]

Geologist or Environmental Scientist - Entry to Mid-Level

Job title: Geologist or Environmental Scientist – Entry to Mid-Level Company: Groundwater & Environmental Services Job description: Groundwater & Environmental Services, Inc. (GES), an industry leader with a reputation for excellence in providing… environmental consulting, engineering, compliance, and technical field services to clients in diverse market sectors, seeks… Expected salary: Location:…

[slicksquid]

return of the king

[ilyssak64]

18+ Witcher rp group! Looking for active fun people!

Join us in an 18+, OC and Canon, literate, text-based Witcher roleplay server.

Explore your creativity with the ability to rise through the ranks of society as a noble, hunt monsters as a Witcher, sing the tales of the Continent as a bard, or become a powerful mage. Or even play as you’re favorite canon character!

We offer: 

● LGBTQIA+ owned community 

● Resources and friendly staff to help new and old fans alike 

● Player-driven plot centric content 

● Lit-based roleplay

 ● All Witcher schools available 

● Female and Non-Human Witchers allowed 

● Playable monster races 

● Numerous roleplay channels 

● 18+ exclusively

Players Must Be

Be 18+

Be able to post at lest 2 paragraphs. More is always better!

Be kind and respectful (This is a hate free group!)

Be active

Keep in mind this group is still new and growing! Hoping people will help me make it better!

Do you have what it takes to survive in the dark monster filled world of the Witcher? We need both Canon characters and OCs! Why don’t you come join us? Trying to make the group active. If you like the group please do invite you’re friends! 

[scleroticstatue]

Not exactly. There is a sheer cliff that has some of these features, but no actual caves. It's a fun place to go rock climbing, if you've got the Skill.

The cave network that does exist is actually in the Southern portion of the Endless Sea. It's a lot more...

Fingal’s Cave (Staffa, Scotland)

via: welcome.jpeg

[steampunkforever]

I believe wholeheartedly that if you're some sort of tough guy you really need to get into namby pamby stuff to at least a midlevel understanding and if you're some namby pamby softie you need to get into toughguy stuff as well. It's can't be ironic or subversive either. No edgy hello kitty or only engaging with art about Spartan warriors.

If you wear corduroy overalls and listen to Phoebe Bridgers you need to watch through at least seven John Woo films and get really into The Predator and if you're into MMA or read a lot about the Navy SEALs you need to be monday night quarterbacking local performances of The Nutcracker and getting really into oscar nominated short films from Iranian directors exploring family and identity.