The Mike Daisy debacle has intrigued me. I heard Ira Glass apologize for airing the story. While I think Daisy's now getting exactly what he deserves, I think Glass is getting a major pass. There's little excuse for them having aired this story, and if another public radio reporter hadn't called their bullshit, I see no reason to believe that This American Life would ever have retracted/backed off/apologized.
John Siracusa and Dan Benjamin have, over the last couple of months, grown Hypercritical into what I'd have to call my favorite new podcast of the year. Week after week, nonstop nerdery. And on this week's show, Siracusa turned his delightfully critical eye on three companies, trying to identify one potentially fatal flaw for each. Discussion of the first two (Google and Facebook) was up to the usual high standards for the duo, and I enjoyed the listen. But when Siracusa moved on to Pixar, my brain immediately drew a strange parallel to my world, medicine, and I thought it worth fleshing out a bit. In discussing Pixar, John pointed to this talk about engineering and art by Edward Catmull and also discussed the creative genius of John Lasseter. He pointed out that Lasseter has frequently mentioned the inspiration of the great Hayao Miyazaki. Siracusa then made his assertion that Pixar's greatest strength (i.e. the fact that they have figured out how to apply engineering principles to their art such that they never make a bad film) might also be their fatal flaw. Specifically, he doubted if Lasseter would think that the best of Pixar would measure up to the best of Miyazaki, even while acknowledging that, unlike Pixar, Miyazaki has definitely produced occasional duds. The notion being that the engineering principles applied to the art do eliminate the risk of a flop, but also eliminate the sort of risk taking that truly transformative greatness probably requires.
I hope I've done his point justice, but really, trust me, if you're geeky enough to have read this far, you should definitely just listen to the show. I'll wait.
So, as Benjamin and Siracusa discussed Pixar, my medically trained but strangely wired brain made its leap. When Siracusa asserted that truly transformative greatness required the kind of risk taking that would inevitably lead to occasional misfires, it reminded me of appendectomies.
Hang with me for a second. When I was in medical school a couple of decades ago, I distinctly remember being taught that, in order to make sure all the truly sick appendixes were removed, the best surgeons would have their physical exam skills tuned a bit towards oversensitivity such that about 30% of the appendectomies they did resulted in removing a healthy appendix. The reason for this was simple. Ruptured appendixes can definitely kill, while the risk of a bad outcome from severe complications of appendectomy are relatively low. So, the gifted surgeon tolerated the fact that he or she sometimes got the diagnosis wrong in order to minimize the risk of a dead patient. Good medicine.
Today, though, the situation is much different. While that 30% number is still occasionally tossed out in textbooks, the reality is that we've brought engineering to bear on the problem, and the higher resolution and speed of today's CT scanner means that appendicitis can be much more precisely identified, and no surgeon today is removing a normal appendix 30% of the time.
Anyone still with me? Pixar has brought engineering techniques to the making of animated films and has eliminated the risk of a bad movie. Medicine has brought engineering techniques to the diagnosis of a patient with abdominal pain and significantly decreased the risk of removing a normal appendix.
But if this engineering and risk aversion is a potential fatal flaw for Pixar, how could there be any corresponding flaw for medicine and the surgeon? We're now better at accurate diagnosis. No problem. Anyone guessed yet what we've subsequently created?
Yep, worse doctors. The art of the physical exam has declined over the past 30 years and I doubt you could find a thoughtful physician in an academic setting who would tell you otherwise. Has engineering completely filled the gap? Probably, for now, but it's something we should be very aware of.
Back, then, to Pixar for a moment. Catmull seems to recognize the potential stumbling block, and Siracusa points out that Lasseter and the rest of Pixar seem to be cognizant of the issue and are actively bringing in new talent and striving for freshness in an attempt to mitigate (e.g. bringing in Brad Bird). So far, so good, and, unlike Siracusa, I'm not sure that the incredibly dark Wall-E wasn't a pretty big risk. In any event, I'll be fascinated to continue to observe Pixar's journey and I'm quite certain I'll continue to enjoy the company's films long after my kids are grown.
What about medicine? Are we aware of the risk of our declining physical exam skills? And just as importantly what else is declining with the advent of technology? What about people skills? Are today's young doctors as good at listening to patients and gleaning the crucial information from their stories? One thing I'm sure of is that the knowledge base required to practice any sort of medicine has grown beyond what the human brain can keep at the ready. Are we accounting for this? I don't know, but that's why so much of my life now is devoted to electronic health records. Clinical knowledge and decision support needs to be electronically available to physicians often and everywhere.
In the end, Siracusa may be right, and Pixar may never match Miyazaki at his best, but I'm confident that they will continue to get close. Most importantly, though, I'm pretty sure that, unlike Google and Facebook (you'll have to listen to the podcast), Pixar has a pretty accurate self-awareness
I hope medicine does too.
Postscript: Read this post by Siracusa for an idea of why his brain is such a wonderful engine for a podcast like Hypercritical. And if his brain's unique skill is the ability to dissect and identify defect (a potential fatal flaw which he's molded into pure asset), then, no surprise if you've been paying attention for the last thousand words, the prowess of my own noggin has always been the ability/obsession to force analogy onto everything (flaw or asset, I'll let you be the judge).
Take a man.
He is a serial killer.
Or, he is not.
It seems to me that it's okay to just expect that folks aren't going to be serial killers and that it is a baseline assumption of all people that they not be murderers.
An extreme illustration, to be sure, but it's a place to start. Can we also just expect that people not assault other people? What about rape? What about armed robbery? Again, we fairly presume that people won't do these things.
Let's turn the heat down a bit further. Maybe it's just a pollyannaish world view, but I think we can also go ahead and just expect that folks won't shoplift or cheat or lie.
I'm not saying that no one does these things, rather that there is a baseline of human decency that is more or less self-evident and those who fail to meet that baseline are doing evil. Nor am I claiming that all badness is equally bad. I obviously get that cheating on a test is not the same as raping a child. Still, one way to define evil is to fail to meet basic moral standards, and that spelling those out isn't really necessary; at least for the non-insane.
Back, then, to the guy who is or is not a serial killer. Let's say he wears a t-shirt that says, "Don't Kill People." Or, he wears a plain gray t-shirt.
Either way, his evilness is determined by what he does and not what he says and a t-shirt that says, "Don't Kill People" is absurd. Even if he's just a nice guy who doesn't kill people and truly agrees with the sentiment on the shirt, the slogan is inane. In fact, if he wore such a shirt in a sincere way, I'd wonder if he had some sort of psychopathic tendency over which he was endeavoring to prevail. The shirt only makes sense as a joke.
So, Google has this slogan, which they apparently claim not in jest, but with all sincerity: Don't be evil.
Well, no shit.
I assume as much.
Of course we don't get that from every company, but we do expect it. We want Nike to not use child labor. In fact, we have a right to expect and demand it whether or not they have a slogan that says, "Don't abuse kids." And we have the right to expect no evil of Google whether or not that is their slogan.
I don't know. It's just the fact that they feel compelled to put it on a t-shirt that has never made sense to me and that I find, of late, downright disturbing.
UPDATE (8/20): As I said above, I find the whole thing somehow more disturbing recently. John Gruber may have hit on part of the creepy reason why with these thoughts.
You can love or hate the Lost finale, the Lost final season, the tv show in general. You can do so for whatever reason you choose. What you can't do is be angry that it turned spiritual here at the end. Because that's not what happened. The show has been filled with religious and spiritual symbolism and subtext from the very beginning and no amount of wishful thinking is going to change that. We didn't write it. We don't get to say what it was about. Yes, it was Science Fiction. But that's just a genre, not the story. The path of redemption/salvation/meaning is religious/spiritual for the majority of the human beings on this planet and that's the sort of path the storytellers chose for their show.
Look, I even get that you WISH it wasn't so spiritual/religious. That's fine too.
Just stop denying that the thing barking like a dog and chasing cars is a dog. It doesn't matter if you're not a dog person. It's a freaking dog.
Let me just get it out of the way right up front. I fall in the camp of folks who believe that the iPad heralds the next generation of the personal computer. In terms of user interface, the concept of the destop metaphor driven by a mouse is two and a half decades old and inevitably due to evolve. The iPad represents where it's going. I don't want to belabor all of the reasons why. Instead, read what these clever folks have to say: John Gruber Michael Pusateri Fraser Speirs
If you want the word from the heads up their butts crowd, start here: Paul Thurott
For me, though, perhaps the most fascinating criticism that seems to get so much attention is the lack of multitasking. To hear the internets whining about this, you'd think everyone who used a computer had four hands and four eyes and two brains. But guess what, not one of us jokers can really multitask. Yeah, I can walk and chew gum at the same time but that's about it.
So why the hue and cry? I think it boils down to two needs, one psychological and one legitimate, with perhaps a rare fringe case or two.
First, the psychological need. We need to seem productive and feel like we actually are multitasking. But multitasking really means switching from task to task quickly, right. I mean, I just helped my daughter with the cat's collar while typing this post, but I didn't actually do both at the same time. I stopped typing and switched tasks to the collar and back very quickly. Having the cat dropped in my lap helped speed the switching. Same with computer software. I switch from one thing to another and as long as I can switch very fast, I feel like I'm multitasking. I'm not saying the iPad can achieve this necessary speed, but any computer that can switch fast enough, functionally meets this need. Heck, even if I was moving back and forth with an image in Photoshop and Illustrator it wouldn't matter if both were running at once as long as the shutdown/startup time felt just like switching between running apps. Functionally, this speed of switching may require the computer to truly multitask, but that is not an inherent requirement.
Second, the real need, which is not actually for multitasking, but for backgrounding. The classic example of this is listening to music while you work. And, at least on the iphone, the two built-in apps that play media (iPod and Safari) do both continue in the background so that you can do something else while listening to your media. The real complaint of users in this regard is that third party apps (Pandora, for example) can't continue to stream media in the background. Personally, this is one of two major reasons I have a jailbroken iphone, so I don't want to diminish this need. I want Apple to allow me to selectively choose which app will run in the background, but for now it's just the built-in apps that can do this in the non-jailbroken iPhone. Some clever app builders have worked around this. The ESPN radio app, for example, allows you to "switch" a playing stream to Safari so it can continue to play in the background. Very clever. Anyway, my point's are three-fold here. First, this is a legitimate need for multi-tasking; second, iPhone OS already supports it in some built-in apps; and third, clever developers can work around it.
What about the fringe cases. Well, I guess there are cases where a user could want something to occupy a peripheral part of their attention. I guess you could watch a video in a box while you worked, although that has no appeal to me. Another similar use case would be keeping a twitter client live-scrolling off to the side of the main window.
Look, I would prefer the ability to choose myself whether I wanted an app to run in the background at the expense of battery life/simplicity. Apple has chosen a different path, and for anyone who's ever used a Windows Mobile device, some of the reasons for that choice are obvious. Let's keep our histrionics to a minimum, though, shall we, and allow this new paradigm in computing to evolve. I agree with those who've said we're witnessing the infancy of the next generation of computer/user interface and as battery life and processor speed increase, all of this will evolve.
POSTSCRIPT: It seems ironic that this would be an issue at all among Windows users. I've never seen one who doesn't run every app full-screen anyway. In fact, the other day at Best But I chuckled as I watched a Windows guy and the salesman discuss how to make Safari go full-screen on the 27" iMac. The customer clearly had no idea what to do with a window that didn't fill the whole screen. Multi-tasker my ass.
Quite the addition to my site, if I do say so. Courtesy of Jessica Hische at Daily Drop Cap. They're all pretty sweet, but that Q up there to start this post is my favorite so far. Thanks, Jessica. A drop cap is also called an Initial:
In a written work, an initial is a letter at the beginning of a work, a chapter or a paragraph that is larger than the rest of the text. The word comes from the Latin initialis, which means standing at the beginning. It is often several lines in height and in older books or manuscripts sometimes ornately decorated.
UPDATE (March 23, 2012): I'm removing the drop caps. Trying to import to Squarespace and revive this blog and the import keeps failing. Don't know why taking the drop caps out would help, but it's worth a shot. Plus, with new design, drop caps won't make sense. FYI. Jessica Hische is very talented.
From where I sit, the Google Navigation solution for Android 2.0 looks to be essentially the final nail in the coffin of the current generation of GPS navigation devices. I want it on my iPhone yesterday. I've read a lot today about how the requirement for a constant data connection makes the app basically useless. I don't think so. For one thing, a huge chunk of the potential users live and will only use the device in cities or other places with adequate coverage. I've used the MotionX-GPS Drive application which is available right now for a mere $2.99 (about $200 less than the full TomTom iPhone solution). It works pretty well when in a data coverage area. Unfortunately, it acts just like a traditional GPS unit, and as of today, that's not enough. The Google solution will be just as functional but with all the sweet added features leveraged from other parts of the Mountain View campus (voice recognition, street view, satellite views). Game changing.
But what about routes that do go beyond data coverage? Maybe I'm just being too simple, but I would think that for 99% of use cases, the following solution would work: 1. You pick a destination, gNav calculates a route.
2. gNav goes into the massive google data stores and compares your route to the known coverage maps of your phone's carrier.
3. gNav offers "This route takes you beyond likely data coverage. Would you like to cache the necessary maps to complete this route?"
4. It just works.
Perhaps you have some preferences to set (always cache maps for entire routes v. only for areas of probably data loss, cache maps to 5 miles beyond the route v. to 10 or 60 miles, remember that I'm on AT&T and be freakishly conservative when you look at the coverage maps) but it seems this is a pretty easy nut to crack.
And with the head start Google has on satellite imagery and especially Street View, this game is over.
The only real disadvantage I can see to this solution is that for a heavy navigation user, this may take your phone out of commission for too much time, but what's to stop someone from building a dedicated Android GPS drive.
Look, I'm not a rocket surgeon, but I don't think you need to be one to see that the Wall Street reaction to the Google Nav announcement was completely appropriate.
Google will own the Navigation market within 5 years.
So my nurse calls me and says, "[NAME REDACTED] just called. She says the medicines are controlling her nausea enough to stop throwing up, but she's still too nauseous to eat much. She wants you to write a note to her probation officer telling him it's okay for her to smoke marijuana so to expect it in her urine drug test." And, just to be clear, I do not live in a state where medical marijuana is legal.
I've figured it out. Either Obama is wicked wise like good old King Solomon, or he's just willing to have a disastrous hybrid bag of hurt be the required next step to universal health care in the United States. Here's what I mean.
The current healthcare proposals (with or without a true public option) are really just adjustments or evolutions of the current way healthcare is funded in this country, and the way healthcare is funded is broken. These proposals will not work. How do I know this?
1. Healthcare insurance companies are not benevolent, and have gotten on board with the plan. I won't elaborate, but ask just about any doctor in America if they think healthcare insurers are out for anyone but themselves. In other words, if they are for it, it will make them money. There is no other rationale by which they make decisions.
2. Pharmaceutical companies are not benevolent, and have gotten on board with the plan. There's a lot of FUD (fear, uncertainty, disinformation) associated with pharmaceutical companies, and a lot of it is not accurate, but the bottom line is this. When deciding which study to fund, which results to publish, which research to pursue, and which healthcare plan to back, they are also only on the lookout for their own bottom line.
3. It won't be fair. No matter how you regulate it, there's no way so many different payors can be involved and have it be fair. Some will pay more or less. Some doctors will participate in some care plans and not in others, as is the case now with the public (Medicare, Medicaid) and private options. Some things will be covered under one plan but not under another.
4. Costs will go up. Case in point: Massachusetts.
I could go on, but I'm a simple guy and simple points seem adequate. The system is way too broken to use its parts to reassemble a working machine.
So, back to Solomon and splitting the baby. If you don't know what I'm talking about, the second and third paragraphs of this wikipedia entry spell it out. I think the current hybrid proposals are analagous. They will kill the baby.
Perhaps President Obama and company know this, and are hoping one side or the other will say, "Wait, wait, don't hurt my baby, I concede, do it their way." But the reality is that politics in this country don't work that way and both parties are so infiltrated with lobbying worms that neither will ever try to bother to see through to true clarity.
So, since I don't think either side will give in (heck, I don't even think they know what they're fighting for, just that they're fighting against each other), I'm left to conclude that President Obama, who is not a moron, knows that this is just the incredibly painful step we have to take to get to the final goal, nationalized healthcare.
From my seat, then, the best path seems obvious. A majority of Americans feel healthcare is a right. I guess I agree (I agree that it's a part of the sanctity and dignity of human life, but I'm not clear that it's a right that should be associated with/mediated by the state), and in any event, numbers don't lie. There are numerous other polls that agree. This is a democracy; majority rules.
So, if healthcare is a right, and the current system is broken (ask any doctor, if you doubt the politicians), then we just need to accept a purely public single payor system. Period. Nothing else will make for universal fair coverage. But can we please just skip this godawful painful stage they're trying to implement now?
That's right, a religious doctor who lives in Texas just suggested we go all the way to a single nationalized healthcare system. You read it here first.
Here are a few of the implications that matter to me; again, just a simple list of the seemingly obvious.
Will the lives of doctors change? Probably.
Will the applications to medical school drop? Probably.
Will costs go up? Yes. But recovering the profits of insurance companies and the more outrageous profits of pharmaceutical companies might mitigate this.
Will healthcare get measurably worse in this country? Check out this article comparing outcomes in the US and the UK. It intends to dispel right-wing myths, and is reassuring overall. From a Catholic point of view, though, it still hints at a potentially scary situation in terms of possible "rationing" of care. See the next item.
Will all fetuses with Down be aborted, or will all old people be pushed out on ice floes? Goodness, I hope not, but these are potential risks, and we should fight like hell to preserve the sanctity of life if we allow the government to take over healthcare.
Once it's available, will everyone avail themselves of healthcare? The Massachusetts story seems to point to folks using their newfound benefits. On the other hand, I was just talking to one of our residents who delivered six babies over the weekend and only one of the moms had any prenatal care. That's scary, because anyone in this country who's pregnant can get funded prenatal care with just a minimum of effort. These moms weren't unable to afford prenatal care. They just couldn't be bothered. Funding won't solve that problem.
In the end, I'm worried about the implications of universal healthcare, but I'm also worried about folks who cannot or do not receive healthcare for financial reasons. And, in this country, where we've come to the conclusion that healthcare is a right, I think going down this bastardized hybrid path is just splitting the baby. So I'll be the true mother, who was willing to give up her baby rather than see it split in half. I'm a capitalist and libertarian at heart, but on this issue, I give. Don't kill my baby. Let's just bite the bullet and go to a purely public single payor healthcare plan. And let's knock ourselves out fighting to make it work.
The world in which/on which we live is a glorious creation and I thank my God for it every day. However, a lot of what I read today, on Earth Day was either too over the top tree-huggy or too right wing nut job dismissive. The only thing that rang true was a little piece by a certain bike commuter in NYC.
When I thought about it, I realized I really didn't want to do anything that was bad for the environment. Unfortunately, though, since simply washing your taint in the shower is enough to destroy the world, it seemed the only thing I could do to be environmentally friendly (or at least benign) was pick a small plot of land, never leave it, and subsist entirely on rainwater and whatever plants I could manage to grow. Even then, I'd have to figure out what to do with my waste. I supposed I'd have to compost that.
The whole thing's worth a read.
As requested by Carol in the comments of the last post, here's a version without the tasks box.
Recent evolution in my job has me attending what I would consider to be too freaking many meetings. And they really aren't that bad but what has required some workflow adjustment for me is figuring out whether and how to take notes during these meetings and most importantly how to capture the tasks that will fall on me after the meeting. Before getting into my current solution, though, let's step back a year or so to my discovery of Doane Paper. Chad Doane is either a clever fellow who's discovered a paper design that is perfect for a substantial portion of the folks who write/draw, or he's in my head like some kind of Cusack in Malkovich and our brains just happen to function alike. I suspect it's the former. Whichever; Doane Paper is ruled paper combined with graph paper and, at least for me, it just works.
So, back to the meetings. I doodle. I think it helps me concentrate. Some might disagree, but I won't stop. And I have to capture those tasks. Long story short, I started informally dividing my Doane Paper into sections for these functions. It worked pretty well, but I had ideas for customizing it just a bit more. So, I fired up my favorite Mac app, OmniGraffle, and in literally 10 minutes had a Doane Paper Hack (Chad's description) that I thought would work. It's completely customized to what I want, I don't know nor care if it works for anyone else, but if you fancy downloading a .pdf and checking it out, here it is.
Notes from the first of 4 freaking meetings yesterday (taken with my crappy iPhone camera - my apologies) below.
UPDATE: Chad Doane approves, and says he gets about one Doane Paper hack a week and this is the first he's liked and granted "official" status.
A few weeks ago at around 2 pm, on the first Saturday of SXSW Interactive, I got to Austin. It was a brief and hastily planned trip, and I timed my arrival to coincide with the likely wake up time of my son, who had worked his usual 11pm-7am shift ending that morning. First on our agenda, a late lunch at Chuy's. Next up, several hours sitting in a mostly empty coffee shop just talking about life and the future and music and movies and the family. For me, it was much more than a blast. For parets, days like this are rare. For one thing, it's not often I get this much time with just one kid. But even more delightfully for Dad, my eldest is right now uniquely equipped for this kind of encounter. Old enough and educated enough that our talks are intellectually stimulating and challenging, and just at the point where his youth and wisdom have intersected to make me a viable mining resource.
It was a great freaking day.
Ironically, at the same time we sat down with chips and salsa at Chuy's, John Gruber and Merlin Mann opened their "duet rant" at SXSW. I had known this session (ridiculously titled HOWTO: 149 Surprising Ways to Turbocharge Your Blog With Credibility!) was coming, and were it not for the clearly more wonderful opportunity I had in place, I might have thought this one session worth the price of SXSW admission. These guys produce some of my favorite stuff. Gruber's Daring Fireball is THE source for Mac nerdery; it's written with a craftsman's care and skill. Mann's widely varied products are often genius. One example; You Look Nice Today, with Adam Lisagor and Scott Simpson, a podcast which rarely fails to burn my nostrils with spewing Diet Coke (if your sensibilities are even slightly modest, though, stay away, as there's nothing politically correct or safe for work about the show).
Anyway, long story short, I had my cake and now I get to eat it too. The Gruber/Mann session's available as part of the 43 Folders podcast. Check it out, 'cause it's a doozy.
In fact, my few gentle readers, it's sparked in me an enthusiasm to tilt this site towards a political/spiritual/ethical obsession of my own. Stay tuned.
MacHeist has announced their latest bundle. And, as with each previous iteration, discussion and criticism have ensued. I’d like to weigh in with some thoughts from a slightly different vantage point. First, a very brief summary. The main accusation against MacHeist has been that it undervalues the work of Mac developers by offering their products for sale at a massively discounted price. Marco Arment describes this. Apologists for MacHeist point out the advantages for consumers (cheap goods) and developers (cash infusion). No one denies that the folks running MacHeist do very well themselves.
This criticism, careful observers of the Mac world know, has evolved over time. A couple of years ago, Gus Mueller pulled no punches in blasting the offering, but this year his Acorn (a wonderful program for which I've already paid the regular price) is part of the package. He says all his concerns about underpaid developers have been addressed. I’ll take his word for it. Elsewhere, John Gruber of Daring Fireball, a former critic, has since accepted advertising from MacHeist. Gruber's not known for kowtowing; obviously his reservations have also been resolved. There is no doubt that MacHeist has made changes with each iteration. For example, developers are now paid a percentage of sales rather than a flat rate. As such, I can accept that these former gadflies feel their concerns have all been addressed, but that the shift in opinion coincides with money changing hands is nevertheless worth noting.
As for me, the whole thing continues to poke at a corner of my conscience.
First, it's the organizers. Specifics are easily googled (start with MyDreamApp) and I won't elaborate, but MacHeist isn't the first experience these folks have had with ethical criticism and hurt feelings.
Second, I still don’t think it’s best for developers. Okay, I get it, they're adults, they can decide what to do with their software, it’s their choice. Fine, but just because an adult with free will decides to go to a payday lender/loan shark to borrow money doesn’t mean that loan sharking isn’t morally bankrupt. It is. Even if there are people who've been happy with their loan shark experience. That’s not an exact analogy of course, but my point is that doing something of my own free will doesn’t rule out the possibility that someone’s taking advantage of me. In fact, isn’t that how con men work; deceiving the mark into freely making a bad decision. One might even argue that the ultimate con man is the one whose victim who doesn’t even know they’ve been had.
Third, in direct response to one of the apologies made in favor of MacHeist, I have actually already planned to purchase The Hit List and Espresso, so I cannot claim that a fraction of the retail price is more than these developers were going to get from me anyway. Nope, those are both right near the top of my Mac Software shopping to-do list.
Finally, Simone Manganelli sums up a part of how I feel. For me, his conclusion is true:
Fundamentally, what it comes down to is that those consumers who are participating in the MacHeist bundle are tightwads.
So here we are, MacHeist 3 has rolled around, and I don’t think any rational person would say it hasn’t gotten more fair to developers with each iteration, but still, as I outlined above, I won’t be buying it with a clear conscience. If you have no misgivings about doing business with this enterprise, then we can, as Arment also put it, respectfully disagree.
But here’s the rub. My conscience was really ablaze with the first MacHeist. Mueller and Gruber are folks I respect and their criticisms rang true. But guess what, temptation got the better of me. I bought the bundle. Great freaking deal for me, right? By MacHeist 2, I had listened to a MacBreak Weekly series of pros and cons, read some new opinions, seen the Daring Fireball ad, and felt that some of the issues had been addressed. Still, it didn’t feel quite right as I punched in my credit card number and made the purchase. Nice bundle, though. Great deal.
Now, round three, and, despite improvements, as outlined above, I can't purchase this package with a clear conscience. But will I purchase it anyway?
I’m reminded of my all-time favorite Steve Jobs quote, in regards to “stealing” music:
People need to have the incentive that if they invest and succeed, they can make a fair profit. Otherwise they'll stop investing. But on another level entirely, it's just wrong to steal. Or, let's put it another way: it is corrosive to one's character to steal.
I’m not all that worried about the developers in this deal.
I’m certainly not worried about the folks at MacHeist.
I’m worried about me.
It drives me crazy when TV show medical folks call an injury a GSW. That is the written shorthand for gun shot wound that is used on ER charts or paramedic reports. It's stupid to say it out loud because gun shot wound is three syllables long and GSW is five. Language like that, along with every single second of the TV series House is proof that the medical consultants on most TV shows are not who you want to see if you get sick.
The Article Skimmer from The New York Times was already my favorite web news interface, but sometime recently, it was updated and now pops the selected article up in a Lightbox type overlay. This is, to me, the nicest online presentation of a newspaper I've yet encountered.
When Jonathan Leo, a neuro-anatomy professor, pointed out that a JAMA article not only failed to disclose financial bias but also incorrectly implied that a pharmaceutical therapy was better than a non-drug one, the Journal of the AMA (of which I have not been a member since fresh out of medical school) flashed its true colors:
Leo says he received an angry call from JAMA executive deputy editor Phil Fontanarosa last week, shortly after Leo’s article was published on the BMJ Web site. “He said, ‘Who do you think you are,’ ” says Leo. “He then said, ‘You are banned from JAMA for life. You will be sorry. Your school will be sorry. Your students will be sorry.” Fontanarosa referred a call for comment to a JAMA spokeswoman, who said Leo’s retelling of the conversation was “inaccurate.”
Then, the editor-in-chief of JAMA, as cited by the Wall Street Journal, showed her own lack of class:
“This guy is a nobody and a nothing” she said of Leo. “He is trying to make a name for himself. Please call me about something important.” She added that Leo “should be spending time with his students instead of doing this.”
When asked if she called his superiors and what she said to them, DeAngelis said “it is none of your business.”
Maybe we need Jon Stewart to interview her.
Now that Walmart's Sam's Clubs plan to start selling electronic medical records, one has to wonder how long before Vizio gets in on the partnership and starts installing 46" LCD monitors in exam rooms as part of the package. What caught my eye about this news, though, was not the Walmart part, but the emr they've partnered with, eClinicalWorks. I'm very familiar with this Westborough, MA based company, having not only done consulting work for them in the past, but also been a customer. In fact, the one and only program icon I have ever designed is still used by eClinicalWorks; an adaptation of that icon (with a reflection I lifted from a web tutorial) is used in the badge at the center of this image.
I'm even more proud, however, of having conceived and designed the prototype of the patient-centric dashboard that the product currently uses. While the final functional iteration is not as attractive as the initial prototype, it is nevertheless a unique and useful addition to the software, and I think that the engineers who coded it are as proud of it as I am.
The folks who run eClinicalWorks are friends of mine and a fine group of very hard working individuals. I'm very excited for the potential implications of this news on the company.
I wish I had the option of using eCW as my EMR today.
It's doubtful that the currently tiny readership of Ordinary Time hasn't already seen Merlin Mann's notes about Kutiman's incredible YouTube creativity, but as much for my own future reference as yours I have to preserve this stuff.
Unsolicited tip for media company c-levels: if your reaction to this crate of magic is “Hm. I wonder how we’d go about suing someone who ‘did this’ with our IP?” instead of, “Holy crap, clearly, this is the freaking future of entertainment,” it’s probably time to put some ramen on your Visa and start making stuff up for your LinkedIn page.
And, from the department of Aphorisms that are Freaking Brilliant but New to Me (ATAFBBNTM) comes this gem:
Remember: the only person who can sit on your ass is you.
That's exactly why I'm writing again.
Pediatrician Anne Armstrong-Coben offered a bit of editorial comment on electronic medical records in the New York Times last week. Almost all of her comments raise issues which are, I agree, areas of concern. The electronic medical record our hospital and medical school are using, while elegant in some ways, is clunky in others and the cluttered output of its notes makes it particularly susceptible to Armstrong-Coben's hypothetical point about how difficult it is to read the note after it's created.
Now a chart is a generic outline, screens filled with clicked boxes. Room is provided for text, but in the computer’s font, important points often get lost. I have half-joked with residents that they could type “child has no head” in the middle of a computer record — and it might be missed.
Electronic medical records are not the panacea that the federal government would have us believe, nor are they as clever or usable as computer geek doctors like me assume they should be. Further, don't forget privacy issues; you don't want your whole health history trusted to 2009's state of the art version of a national electronic chart. This could make Facebook privacy concerns look trivial by comparison. And while the web is evolving sets of microformats, medical informatics is mired in a messy muck of interoperability called HL7, a set of standards that don't seem to understand what standard even means.
Still, when I was seeing a patient for an ER follow-up this morning, I was able to review all his labs and view his CT scan reports and images in less than 60 seconds. I asked him what the ER thought was wrong with him, he wasn't really sure, but 15 seconds later I was reviewing the ER doctor's chart from Jan 28. I ordered a follow-up lab and the by the time the results popped into my inbox scarcely an hour later, he might not even have made it back home. Electronic medical records are far from mature or ready for unified national rollout, and they are indeed fraught with their own set of shortcomings, but don't doubt that those cons are accompanied by a long list of pros; the benefits of computer medical charting are real.
Conclusion. Medical Informatics is mostly just out of beta, but we're making slow progress, and our 2.0 version will arrive some day. But, in the meantime, if you request your kid's medical records, and happen to read that he or she has no head, before you call 911 or run into the street screaming in panic, I'd go down to their bedroom and verify the presence of a noggin. More than likely, all is fine.