[FRIAM] Weird observation
Steven A Smith
sasmyth at swcp.com
Fri Jul 13 12:26:02 EDT 2018
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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> Meets Fridays 9a-11:30 at cafe at St. John's College
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