[FRIAM] Weird observation
Gillian Densmore
gil.densmore at gmail.com
Sat Jul 14 12:26:05 EDT 2018
And you aright steve IMO anyone sane or sober should be beyond pissed at
what is litterally making news: what healthcare? what government? Health
is one of the few things you can not ignore the older you get the more
you'll (in my experience anyway) have to use it at least some. Even if it's
a routine check up. It is (bluntly said) IMO a horribly set up system. The
whys are mere speculation from me.
On Fri, Jul 13, 2018 at 10:26 AM, Steven A Smith <sasmyth at swcp.com> wrote:
> Gil -
>
> I am intuiting from your current riff of questions/anecdotes here, that
> you are feeling out of sorts on many fronts. With a significant
> engagement with the health-care system, THAT interface is an important
> one for you and is broadly, if not categorically not working for you
> right now... various providers and interface staff are not responding
> well to you and it is adding to your "out of sortiness". It sounds
> like a positive feedback loop, where you are anticipating being
> mishandled and sending signals that lead staff/providers to then go off
> their normal "bedside manner game" in some way or another which just
> reinforces your feelings of being mishandled, etc. I don't mean to
> "blame the victim"... just pointing out that you are probably
> participating in the breakdown in some way which you might be able to
> change and get a better result.
>
> I have any number of "service" interactions which I know I don't handle
> well by my nature. I don't engage in the health care system much at
> all (sometimes avoiding for decades) for this reason... I find the whole
> paradigm flawed and I wear that on my sleeve when I *do* engage and THAT
> naturally puts some of the people I'm interacting with off. Similarly
> I have to be thoughtful/careful when I try to buy technology (in person)
> or seek repair or parts for my technology. I used to have lots of
> problems with cell phone companies (who doesn't?). I often have trouble
> with ISPs... and all because I often *do* know more about their
> technologies and service than the average customer, and maybe (in some
> cases) "just enough to get me in trouble", or at least enough to
> irritate the first line service/sales people trying to just get through
> their day and sell/install/service 100 more commodity (to them) items.
>
> Our "service" and "care" systems are optimized to deliver their services
> on *their model* and they appear very fragile if you try to get them to
> interact on YOUR model.
>
> Even fast food... "have it your way" is a little like Henry Ford's "you
> can have your Model-T in any color you want as long as it is black".
> Many can handle simple substitutions/deletions but that is about it.
> When I was a young vegetarian I learned to order a "cheeseburger, hold
> the meat, and if the cook can handle it, toast the bun upside down"....
> What I often got was the "grilled cheese sandwich with lettuce, tomato,
> pickle" I wanted but was not on their menu. I don't think I *ever* got a
> grilled cheese just by asking for it if it wasn't on their menu, but
> nobody ever turned me down on deleting the meat from a cheeseburger. If
> the place had served me before it usually went easy and the bun was
> usually toasted and "inside out" as I asked. Sometimes I paid full
> price for a burger, other times they followed the formula for what an
> extra patty would cost and I'd end up with the grilled cheese at a steep
> discount: "$2.50 for the cheeseburger - $1.00 for the patty... that will
> be $1.00+ tax!" If they were busy, I would just come back another
> time... it wasn't in my interest to stress their system for my quirky
> preferences. Today it would be gluten-free, keto-friendly,
> paleo-compliant, non-gmo, grass-fed-dairy... and $15.
>
> TLDR: (Auto Mechanic Anecdote) I had the same problem with auto repair
> until I recognized what I was doing and made a very acute effort to meet
> them on *their turf*. Until I started a 60 mile RT daily commute I had
> done most if not all of my own car repair, up to and including swapping
> out engines and replacing stripped gears in transmissions. I was not an
> expert, but for other shadetree mechanics here, you may know that the
> resources are amazing at some level... half the parts you need are
> already stocked at a store nearby and they can get virtually any other
> within hours or days just by specifying the details of the vehicle and
> it's subsystem... third party manuals (Haynes/Chiltons) are far from
> perfect but once you find a good one for your vehicle.. and if that
> isn't good enough... dealer service manuals are available for about the
> price of an hour or three of shop time from a real mechanic, etc. The
> bottom line was that I *thought* I knew more about my vehicle than the
> mechanic (well, in some ways I did) and I wanted him to start with MY
> diagnosis and MY preferred solution when it just didn't fit his
> paradigm. Generally mechanics don't trust civilians to know their cars
> and the subsystems and diagnose them well, and in fact, if I hadn't dug
> into the problem up to my armpits myself, I was often guessing (and
> guessing wrong) based on superficial symptoms. In any case, they
> almost always disappointed me with their bedside manner... they didn't
> want to listen to what I already knew about the problem and they REALLY
> didn't want to listen to my repair suggestions. They were usually
> superficially polite but my empathetic self had me radiating my own
> hostility or doubt in them I suspect. Eventually I tried a mechanic
> that was known to me, very convenient and with a generally good
> reputation and I backed off and put my vehicles in their hands. I let
> them change oil, rotate tires, top off fluids, etc. and I let THEM
> tell me when they noticed a growing problem (e.g. oil leaks, bad tread
> wear patterns, etc) and they proved quickly to me that THEY were as
> competent as I (or more) to notice growing problems and recognize
> reasonable solutions. I occasionally mention things to them to look at,
> but unless the symptoms are acute, I leave it to them to notice and they
> (almost) always do! They have better shop manuals and better tools
> (especially a lift in a heated space) and extra hands when a job is
> easier with two people. I paid $50/hour (the good ole days) for them
> to do things I felt I could do in half (in reality, twice) the time and
> it irritated me, but almost exclusively, they *never* lied to me or
> mislead me. Previous mechanics I'd tried this with would do a job or
> two OK then they would tell me something I knew was patently false
> (e.g." you need a new clutch slave cylinder" on a vehicle I knew to have
> a mechanical linkage). In retrospect, I don't think they were trying
> to cheat me, but might have been being lazy or sloppy... they may have
> "guessed" at something without looking closely, not realizing that *my*
> model had a different subsystem than the one they were most familiar
> with, or they cross-remembered another vehicle, or ??? In any case, I
> would go away mad and go back to not trusting mechanics, etc.
>
> Today it has been almost 20 years I've been with my primary mechanic...
> his son has taken over (most of) the business and they know all my
> vehicles by heart and are happy to do pre-purchase inspections on new
> ones I am considering. Some problems and vehicles I don't bring to
> them because they aren't familiar with them. I don't expect them to
> work on the hybrid components of my Gen1 Hybrid Insight and I don't ask
> them to do much on my 1949 Ford Dump (though they do like the truck, it
> doesn't fit in their bays easily and can only be raised about 3 feet on
> their lifts, and parts are *very* hard to get, complicated by the fact
> the engine is from an early 60's ford farm equipment and while a
> standard Ford design, has oddities specific to the tractor/thresher/???
> it was pulled from. I only asked them to try to tune the mechanical
> fuel injection on my mid-80s VW Cabriolet once... then did it myself
> after not finding an obvious mechanic with specific familiarity. I'm
> in the midst of trying to get a new (used) 20Kwh hybrid battery
> installed in my 2011 Chevy Volt. It weighs 400 lbs, carries 360V when
> energized, has sophisticated battery management subsystems and
> integrating systems internal and external to it, and has to interface to
> a number of computerized subsystems including the main computer, the
> ECU, a charging control system, etc. The service manager at the dealer
> is waaaay over his head on this project and I get the sense that the
> factory trained tech (for this specific model) has not had occasion to
> ever remove or replace (or diagnose beyond pulling DTC codes from the
> main computer). But I know I am at their mercy. The vehicle
> subsystems are so specific to GM that (almost literally?) nobody except
> GM dealers have the specialized tools and computer codes/software to
> handle the re-energizing/calibrating of a battery. The physical
> aspects of swapping the battery are daunting enough, especially without
> a lift, and I wouldn't expect ANY sane mechanic with a lift, etc. to
> want to mess with this HV system. I have done enough hybrid/EV/HV
> electronics work to feel I could do it safely myself, but it would be
> only *my life* on the line. So I had to talk the service manager
> through discovering that his Volt trained technician *could* install a
> battery not provided by GM directly (a very few others have done this
> around the US) and come up with the shop hours (7@$111) for the
> procedure so I could order up a salvaged one (from a low-mileage
> recently wrecked vehicle) to be delivered to them by freight. (BTW, a
> NEW (refurbished?) GM Battery System is $8K retail plus installation).
>
> I'm sure the service manager was frustrated with me *many* times along
> the way and his demeanor often left me wanting to cop my own attitude
> and "go away mad". I think now that we are at the point of having
> scheduled the work and the battery is en-route... he has become
> intrigued by the project and probably wants to see it succeed rather
> than just "wanting me to go away" which is how I felt through more than
> a little of the process. And *I was aware* of the pitfalls of wanting
> non-standard things that I have more knowledge about than the service
> providers and I *still* stressed them almost to their limit. I *wanted*
> to blame them and be angry and resentful, but I had to acknowledge that
> my kind of task is NOT their bread and butter, that the individuals (and
> the whole system) has to see an upside to working with me before they
> are going to be willing, much less positive about it.
>
> Gil... YOU may be the Chevy Volt of the human world. Your needs may be
> unusual enough that it is *hard* for the standard systems to meet you on
> their terms and as you probably already know/guess, it really is up to
> you to understand what the system is capable of and how to meet it on
> terms where neither you nor they are too stressed by the interface to
> function properly. I don't know you *well* but believe you to have the
> self-awareness to find productive ways to change your
> interface/expectations enough to begin to reduce the stress you are
> feeling right now. Your other stated activities (hiking, gym, dancing,
> etc.) seem like very positive directions to help you regulate (physical
> activity is almost always a positive thing for virtually everyone) and
> find new and varied friends and interests. I don't make it to WedTech
> often (annually if lucky?) but next time I'm in town with some time on
> my hands, maybe we can get together for a bite or some coffee or tea and
> we can bore (entertain?) one another with anecdotes about trying to
> interface with a world of commodity objects and services.
>
> - Steve
>
>
> On 7/13/18 9:20 AM, Marcus Daniels wrote:
> > Perhaps the first step needs to be "How sensitive is this patient to
> bedside manner?", and from that estimate then prioritize the relative
> timing of one sort of analysis over another. I assume I'm dealing with an
> intelligent, if imperfect, person. I think it takes some self-control to
> be a good patient, too.
> >
> > On 7/13/18, 9:13 AM, "Friam on behalf of ∄ uǝʃƃ" <
> friam-bounces at redfish.com on behalf of gepropella at gmail.com> wrote:
> >
> > Perhaps. But if that's the case, I would immediately leave and find
> another Dr. As I explained before, and is peppered throughout Renee's
> training, the "assessment of the patient", which involves really *looking*
> at the patient, is more powerful than any other (set of) metric(s).
> >
> > To be clear, the patient assessment machine can be completely
> autistic. But they must "assess the patient" by looking at her.
> >
> > On 07/13/2018 08:06 AM, Marcus Daniels wrote:
> > > Is it not possible the doctor looking at her computer is just like
> Glen listening to music without moving? Focusing on the facts of the
> matter and not on distracting emotional signals?
> > >
> > > On 7/13/18, 9:03 AM, "Friam on behalf of ∄ uǝʃƃ" <
> friam-bounces at redfish.com on behalf of gepropella at gmail.com> wrote:
> > >
> > > For what it's worth, my Dr. thanked me after our 1st
> interaction. He walked in with his laptop, sat down and started poking at
> it. I then used my familiarity with electronic medical records (I was a
> product mgr at such a company at one point) to finagle his attention and
> demonstrate our mutual affinity for how computation can help him provide
> good healthcare. I even explained how I'd looked him up online beforehand
> and knew all the schools he went to and that he had no active malpractice
> suits against him. (Which was no small feat since he's an immigrant from
> India.)
> > >
> > > That interaction successfully grabbed his attention. Perhaps,
> since you're also computer literate, you could use the same trick next time
> a Dr's attention is too focused on the computer?
> > >
> > > On 07/13/2018 07:48 AM, Marcus Daniels wrote:
> > > > It is a bigger problem that people are more concerned about
> `getting along’ than they are about maintaining a functional government.
> > > > As for doctors, I don’t want them to my friend. I want
> them to take their limited time and focus their extensive training, to
> rationalize the symptoms I present.
> > > >
> > > > From: Friam <friam-bounces at redfish.com> on behalf of
> Gillian Densmore <gil.densmore at gmail.com>
> > > > Reply-To: The Friday Morning Applied Complexity Coffee Group
> <friam at redfish.com>
> > > > Date: Friday, July 13, 2018 at 8:39 AM
> > > > To: The Friday Morning Applied Complexity Coffee Group <
> friam at redfish.com>
> > > > Subject: [FRIAM] Weird observation
> > > >
> > > > While at doctor's office trying ask a nurse to politely
> express to a doctor that it comes off as rude when that doc is obssed with
> a computer gets a reaction like you've invented warp drive.
> > > >
> > > > Is it really that unusual for people to try to actively be
> cordial these days? If so captian we got a problem!
> >
> >
> > --
> > ∄ uǝʃƃ
> >
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>
>
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