Shout out to those who love manga/anime: there's an anime called "Dr Stone" that's quite appealing to us nerds as it showcases real life chemistry and physics.
In one episode, the protagonist shares the recipe for making natural "cola" (called "Senku Cola" if you want to look it up) and it's actually apparently very close to the real thing
It's still hard to get a high enough dose to dangerous level from other supplements. Bad b6 effects typically start over 500mg/day. Usual pills of just b6 are 100mg in countries that don't limit it otherwise. The reviews that I've read normally described the issues as going away within days of stopping.
I wish there was better research on this, because so far only weird isolated cases make the news.
I'm willing to assume I'm non typical, but I definitely had temporary nerve pain effects from a B-complex supplement; I can't remember if I noticed that after the first night or the second; my spouse reported nothing like that though. Looking through my cabinet, looks like 50mg B6 pryidoxine HCl (which seems high compared to another brand I looked up and a sibling comment). Not sure why I kept those, tossed it out now.
But I was really just wanting B1 and a bit more shopping found drops (annoying) and tablets with only B1 and negligble other stuff.
Vegans can actually inadvertently stumble into this: a lot of tofu scramble recipes call for 2tbsp of nutritional yeast, and the bottles sold by e.g Braggs in America are heavily fortified.
Then it’s also used in cheese sauces, etc - to the point where it’s somewhat of a meme to just add it whenever you want umami. Then many vegans already take a B multi to handle B12.
Point of all this being that this particular diet can lead to overdosing on B6 without realizing it. Once I got myself a non fortified Nutritional Yeast for baking/cooking, I noticed changes in myself for the better.
Disclaimer: Dentist here (and programming enthusiast)
The other side of the story, that nobody really talks about, is the psychological abuse that -dentists- are subjected to, by patients.
As an introduction: I was above average at my uni in terms of clinical and theoretical skills, bought my own practice from a retiring dentist and always behaved 100% ethically (I'm one of those that don't overtreat at all and I built a reputation and a client base that allows me to have more than enough work without resorting to that).
You should know that our days are basically spent in an almost PTSD status after having undergone years of abuse by patients in the form of dark, frustrating patterns that repeat every week. These are behavioral patterns that typically leave us in a frustrating and infuriating lose-lose situation through no fault of our own, and they seem ingrained in the general population.
A few examples: in my clinic and those of my colleagues about 75% of african immigrants that book an appointment, and confirm it 2 days before, end up no-showing for the appointment, and don't even answer the phone when we call them. this happens several times a week. I haven't found a solution because I can't just say "you're an immigrant and I won't book your appointment", nor can I make them prepay while holding native residents exempt from this rule. No-showing means I lose a sizable amount of revenue while having to pay the staff for nothing.
Example 2: a good percentage (20%?) of those with an infection are given antibiotics, I explain they should come back when the pain has subsided, -usually a few days- to perform the root canal / extraction (which will allow me to use anesthesia effectively - it doesnt work when you have an infection) and they also end up no-showing because "it doesnt hurt any more", without bothering to answer their phone when we call them. They call back 2 months later, in pain, demanding to be seen -today-, at which point my blood is boiling. Bear in mind I explain this at least 3 times during the first appointment.
Example 3: randomly, a good patient will turn rogue and decide that the crown I'm doing on her canine "looks too big" or "is too rounded" or some other subjective aesthetic bullshit like that. it's typically a middle-class 50-60 woman. This happened today to me, I showed the crown's thickness to the patient with a measurement tool, it was 0.5 -millimeters- and explained it's physically impossible to make it any thinner. Her answer "it's your problem, I'm not a dentist". These patients will typically then refuse to pay for about 1000$ of work, despite the work being first class, because "they are not happy". This happens randomly and is not predictable despite my best efforts, and is peppered with ridiculous episodes like crying in the chair, calling their husband who will typically back their claims and then start guilt-shaming you with gems like "my wife is so distressed by this. we are both deeply hurt."
Example 4: a patient will randomly decide he will try to leave a bill unpaid, and they will adopt every kind of trick and dark pattern in the playbook. Lies, asking to delay the payment so they can stiff me out of 4 fillings instead of just one etc..this happens multiple times a year.
Example 5: patients taking impressions for, say, a night guard, after being explained the cost and days it takes to make it. We typically deliver then a week later. They will then call a day before their delivery, when the night guard has already been made, saying "doctor I've decided I don't want it any more, I want to cancel the appointment, k thx bye". That is the average message, and I stress the "k thx bye" part where they make it clear they don't even want a reply and it's all said and done (typically because they think they can buy a 20$ nightguard on amazon instead). They will refuse to pay for the nightguard that's already been made and the laboratory has already billed me.
I could go on for hours and cite about 40-50 of these patterns that we see day in and day out, they put you in a very frustrating position where choice 1 is bad and choice 2 is even worse (say, suing the patient for collections as option 1 and taking a direct loss as option 2).
It almost got me burned out and I know several colleagues who either have burned out, or completely changed profession because of the widespread lack of basic respect and fairness from patients.
This happens while, as someone else said, you're in xxx,xxx$ debt, so you can imagine being told unfairly that you have to eat a 1000$ loss for something that's not your fault, tends to make you want to scream. I know I went home shouting in my car more than once asking what I did wrong to be subjected to this bullshit day in and day out.
It's a incredibly abusive profession and it has a very high suicide rate (at like 3x the average for other professions, this is true for most medical professions by the way).
And I won't even talk about the physical toll it has on you because I don't mind working 8 hours even in uncomfortable positions, but seeing the way people lie, cheat and try to blame-shame you tends to take away all faith in humanity.
So yes, there are bad dentists just as there are bad -anything-, but there are also bad patients.
I guess I just wanted to vent and let you see the other side of the coin...we say "no good deed goes unpunished" and it's true indeed
This might be a naïve idea and you didn't ask for any advice, but have you considered doing free/reduced cost work for children or the impoverished? I'm sure you'd face a similar range of responses, but that last line - "no good deed" - made me wonder if using your considerable skills for a bit of charity work might help with the burnout.
Side note: I've had to prepay for appliances and night guards in the past when the cost exceeded some threshold - the latter wound up being supremely disappointing considering it was ~$600 and broke within a fortnight, but I didn't bother complaining to the dentist since the staff would just have to argue with the fab.
>So yes, there are bad dentists just as there are bad -anything-, but there are also bad patients. I guess I just wanted to vent and let you see the other side of the coin...we say "no good deed goes unpunished" and it's true indeed
I hear you, the vast majority of humans are fucked up. On an average the patient is more messed up than the medical practitioner, what to do?
IANAD, but I work at a dental clinic, so I certainly empathize with your complaints. If you don't mind a few suggestions?
If you have a certain profile of patient who often break their appointments, you can simply double-book a certain percentage of them. That is, if you need to schedule three such patients, have two come at 1 PM and the third come at 2 PM. If you expect that one will break, you'll still take care of the other two in two hours. (adjust these times if you are faster or slower) If neither of the 1 PM patients break, or especially if none of them break, somebody will have to wait for a bit. So what? You're a dentist; your time is more valuable than your patients'. If one of these patients gets pissed about this, that's two strikes against her since she is already more likely to break appointments. You don't need a patient with two strikes.
Patients who don't have insurance or who have insufficient insurance (granted, this latter situation is sometimes hard to know in advance) have to pay when they receive service. If you explain this before the work is done (since you have informative treatment plans, patients are never surprised by a bill), then someone who doesn't pay can be referred to the prosecutor for fraud.
Never run "payment plans" through your office. Always use an outside agency like CareCredit or Lending Club. If they won't loan the patient money, then you certainly shouldn't. You do have to pay these firms, so if your schedule is full then nobody gets credit. If your schedule isn't full these fees come out of the marketing budget. If you try to handle loans yourself you'll end up paying more.
Procedures that require lab work are billed on the first appointment, and the patient has to pay half in order for the case to be sent to the lab. You explain this ahead of time, and if you're using the right labs (hint: most of them are in China) you'll still make a profit if someone breaks the second appointment.
The effective dentists I've seen have set up policies that automatically handle bad patient behavior without need for argument or personal involvement. These policies can change based on your experience. You shouldn't be on the front line of implementation, however. The people you have on the phone have to be able to schedule defensively, so you won't be sitting around with no patients. The person you have handling treatment plans has to properly communicate payment terms before you begin expensive procedures. You might have to get involved with particularly evil patients, but if you don't have to address these problems for most patients you'll probably avoid some frustration. Good luck!
Thanks for taking the time to write the suggestions! I work in Europe so the situation is somewhat different here as insurance is used by a very small percentage of patients compared to the US, and I'd say 99% of other offices do not make patients pre-pay, so some of those policies, while probably very good in the US, do not fit our situation very well (the double-booking one I will probably try, though..I've always refrained from it in order to not make patients wait but I guess a little flexibility on both sides is OK).
I work in Europe so the situation is somewhat different here as insurance is used by a very small percentage of patients compared to the US...
I'm jealous of this. Most of our problems come from dealing with insurance.
...99% of other offices do not make patients pre-pay...
This is interesting. By "pre-pay", you mean "pay on the same day that work is done"? Expecting payment afterward seems destined to lead to an untenable collections situation, especially with poorer patients.
Usually patients pay on delivery, so for treatments like a filling it would be the same day that work is done. For lab work such as a mouth guard, they don't pay when we take impressions but rather when the work is delivered
Yeah, that's a tough one. Actually many insurance plans (and Medicaid) say they only accept claims for multi-visit procedures after they're totally done, and we generally follow that rule for insurance. With private-pay patients, however, we've always said pay half at the first visit and half at the last visit (so there's no payment at e.g. a wax try-in). Some patients complain, but I just smile and explain that I can't change the rule.
I'm curious: what would your other top 4 most valuable skills be?
I'm asking because I was genuinely unaware of django admin despite being a developer for several years and I wonder how many more "open secrets" I'm oblivious to
* Having extreme fluency in one data wrangling tool for text and tabular data. Could be bash + awk + grep/sed/cut and other shell tools, Python + numPy, Ruby, etc. The point being that given a table or a text file you should be able to extract whatever information you want quickly without thinking.
* Fluency in Postgres, specifically its aggregate functions, window functions, and CTAs. Again, given a company's dataset you should be able to write complex queries to answer business-critical questions in a few minutes to be able to drive decisions. As an aside, knowing that UNIX system usually has sqlite installed and is the fastest way to analyze local tabular data.
* Being a competent writer. Some people command clear thinking, gravitas, and vision when they write. It is easily the most important skill when remote working, and a definite shibboleth when you want to sound convincing to overeducated knowledge workers. Being able to explain complex topics to a lay audience had gotten me many jobs.
* Knowing how to use AdWords, Google Trends and mailing lists to quickly validate product ideas. This is one of the easiest ways to discard or validate ideas. It's so useful and quick and such a simple way to avoid months of wasteful work.
* Knowing the basics of Western philosophy and psychology. Everything humans do fits within a system of values a loosely consistent logics. 99% of people rarely think outside of those value systems, and if you understand the history of philosophy you'll see that we're quite predictable in our wants and desires. It helps you be more persuasive, choose the right work for your own preferences, put people to work where they'll feel useful and fulfilled, and will help you see the pitfalls of certain group dynamics for whatever institution you're working for.
