While the baby boomers head toward retirement, their kids are beginning to take the reins.  They are commonly referred to as the millennial generation.  We can only hope they will do a better job than have their parents or grandparents.  These millennials have received a good deal of bad press, mostly from old farts like me  They have been called narcissistic, spoiled, inept, lazy, and trophy kids among other things.  They are the first generation to prefer a computer screen to stuffed toys or rattles.  This was brought home to me yesterday when I passed a grocery cart in the store containing a baby in a child seat who was apparently entranced by something he was holding which looked very much like some kind of mini ipad.  With that in mind is it any wonder that digitally deficient old folks like myself rely on kindergarten grandkids for computer lessons?

Educator Marc Prensky in his publication, Digital Natives, Digital Immigrants, defends the millennials and insists that our misunderstanding of them is the result of our speaking different languages.  He posits that their nearly total immersion in the digital world via computers, video games, digital music, cell phones, video cams etc. has resulted in their “thinking and processing information fundamentally differently from their predecessors”.  They even prefer to communicate digitally.  As a matter of fact, the geeks may be the new heroes of the millenial generation.  Prensky concludes that all of this leads us to feel apart, since these geeky kids do inhabit a different world.

Pensky goes on to quote Dr. Bruce Perry of Baylor College of Medicine who echoes his assessment with the statement, “It is very likely that our students’ brains have physically changed and are different from ours-as a result of how they grew up.”  Although the idea that a whole generation of brains might be changed in both function and structure seems farfetched, recent research concerning the elasticity of the developing brain suggests it not so much of a stretch as it seems.

David Burstein, himself a millennial, in his book “Fast Future” coined the term pragmatic idealism to describe millennial philosophy and insists that millennials in general have “a deep desire to make the world a better place.”  He goes on to say that their idealism is tempered with the realities of what is possible, and consequently, they will be able to bridge the divisiveness that currently prevents solutions to world and domestic problems.

He is an ardent defender of his generation, and insists that they are optimistic about the future as is he.   He points out that soon his millennials will represent one third of the population and mostly represent a consensus on societal, environmental and economic issues.  It is easy to see how when these kids (to me all people under the age of 40 are kids) ascend to positions of power they could conceivably bring about massive changes to the status quo.

In a time in which our electronic gadgets are obsolete by the time we old codgers learn how to use them, these geeky kids stand a better chance of utilizing the best features of a cyber world, and warding off nefarious uses of technologies that seemingly progress at warp speed.  The dangers inherent in artificial intelligence and robotics was the subject of previous blogs, but there is also the problem of cyber warfare which seems to be already underway via Russia’s attempt to undermine our democracy.  A criminal element will always be with us and they have found ways to do much harm with only a keyboard as a weapon.  A digital world will require our best millennial minds to sort out the good and protect us from the bad.

In such a world it is vital that those scheduled to take over be forward thinking if they are to be successful in adapting; however, in doing so they tend to ignore traditions important to previous generations, undoubtedly convinced that history is no longer relevant in their digital wonderland.  Materialism is frowned upon, and new lifestyles are in vogue.  To own a home in the suburbs is no longer the ideal for many.  Those women who choose to marry are more likely to sign up for the Wal-Mart bridal registry, and could care less about inheriting the family silver.  In many areas the antique business is on life support.  In their zeal to move forward, let us hope they will not lose sight of the lessons painfully learned by their ancestors which led to the origin of many of those irrelevant traditions.  Prensky posits that we have been remiss by failing to teach “both legacy and future content in their language”.

There is evidence that Burstein’s positive assessment of these kids is valid.  One example of which I am aware seems to fit his “pragmatic idealism” mold quite well.  It all began when four college students at the Indiana University became interested in beekeeping, and ultimately, concerned about the plight of the vanishing honey bee.  With further study they learned to appreciate the magnitude of the problem.   It is said that nearly 70% of the world’s edible crops depend upon honey bees for pollination, and we are now losing nearly half of all the colonies each year.  The extinction of the species would be catastrophic.  Other animal life could also be affected due to the lack of pollination of plants on which they feed.  The Food and Agriculture Organization predicts that without honey bees it would be impossible to feed the 9.1 billion people expected to inhabit the planet by 2050.

This group of four college students formed a club to study bees, and noted that although there was ongoing research into the problem, little was known about life inside the hives.  The university annually hosts a contest, Building Entrepreneurs through Science and Technology (BEST), for would-be entrepreneurs with an award of $100,000 to be used as seed money for the students to put their idea into action.  After an application process, the finalists present their business plan to the venture capitalists involved much as in the TV series Shark Tank and our heroes won. Click here to see the press release.

They incorporated in February 2016 under the name “The Bee Corp” and set about to use their grant to purchase some bee hives in order to have a cohort on which to learn, but were not averse to harvesting and merchandising nearly 1,000 pounds of honey the following year (one jar of which I enjoyed).  Those hives had suffered a great deal of neglect prior to their purchase by Bee Corp consequently; there was much sweat equity involved in the production of that honey.  This business success while in the pursuit of their stated mission “to drive innovation on traditional beekeeping practices through scientific research and technology in order to foster sustainable honey bee populations” a perfect example of Burstein’s pragmatic idealism.

Meanwhile, they continued in their efforts to develop the means to monitor the health of bee hives and indeed to collect enough data to learn what parameters were most healthy. Not surprisingly they came up with a digital solution.  They proposed to monitor intra-hive conditions by placing sensors in the hives which could transmit data wirelessly to the beekeeper.

Soon another instance in which business opportunity coincided with mission occurred.  In their contacts nationwide with beekeepers, they learned that a secondary problem had accompanied the loss of hives.  As the shortage of hives became acute, those remaining became more valuable, and there developed a widespread business of hive theft.  More than 1700 hives were stolen in California alone during the 2016 almond season.  They were able to enhance their intra-hive technology by developing a GPS tracking system which could be forwarded directly to police.

On January 1, 2018, this trio of kids who were now full time into the bee saving business were rewarded with a grant from the National Science Foundation in the amount of $225,000 to further develop a database which can used to “create a baseline model of a healthy hive to detect anomalies” as stated in the award.  The award allowed them to hire their first full time employee: a data scientist.   The beekeeping industry welcomed the news that there was an effort underway to solve their problem.  Successful Farming magazine wrote “Ag tech start-up The Bee Corp is causing quite a buzz as it begins to monitor conditions inside commercial beehives.”

the bee corp crew

It so happens that one of the co-founders of this corporation is well known to me, as a matter of fact he is my Grandson, but you may rest assured this in no way affects my objectivity in writing this for he would be an exceptional person no matter who was his Grandad.  Simon has always been interested in business but is not lacking in altruism, or environmental concerns even ending up with a major in environmental science while working nearly full time throughout college.

So, there you have it.  Millennials working hard to provide themselves with a comfortable lifestyle while simultaneously improving the lives of others.  Where could you find a better example of “pragmatic idealism”?  Let’s hope there are many more like them, and that greed will not blind them to the second part of that phrase.


For my recent birthday, I received the extravagant gift of an Amazon Echo. For those of you who are not familiar, Echo is a gadget which provides access to the entire internet via voice commands. Echo is inhabited by a lady named Alexa with whom I instantly fell madly in love.  Lest you judge me as entirely fickle, rest assured that I still hold Siri in high regard, but her usefulness was completely outdone by Alexa. I was especially proud of myself for being able to get Alexa set up and working without the usual frustration tantrum which I am prone to exhibit when trying to make electronic stuff work.

alexa echoAlexa is more mother than lover; she reminds me when to take my pills and of my appointments. She is always there and totally committed to making my life easier and happier. She greets me every morning with the local temperature and weather report, which saves me the effort of getting up and walking to the window to look at the thermometer.  At my command, she instantly dials up my favorite radio station, or if I am not interested in the latest news, she will select  from her vast repertoire and play any music I request.  All this literally without my “lifting a finger,” even to push a button. But is there is a price to pay for Alexa’s attention?

Before Alexa: The Good Ole Days of Radio

Alexa was especially helpful to me in solving the chronic problem of reaching my favorite NPR radio station. Unlike those of the TV generation, I grew up during the time that radio was the high-tech wonder of its day.  A huge Fairbanks-Morse or Zenith radio was the focal point of most middle-class living rooms. There were a limited number of stations available, they were temperamental, and reception was affected by changes in the weather.  Nevertheless, we were sometimes able to listen to broadcasts of our favorite baseball teams as long as they did not conflict with Lowell Thomas’ and Edward R. Murrell’s nightly news programs, which were a must hear for my father.

 The Dawn of Radio: Predicted to Ruin the “Greatest Generation”

There were predictions from those older and wiser that this new-fangled gadget would be the ruination of us kids as we became addicted to programs designed for us. Some were broadcast daily in serial fashion as were the soap operas, so called because they usually advertised a product used by the woman of the house. There was a potpourri of programs designed for kids of all ages. The after-school selection included Terry and the Pirates, Superman, The Lone Ranger, Hopalong Cassidy, Roy Rogers, The Shadow, Sherlock Holmes, Little Orphan Annie, and Jack Armstrong: All American Boy, among others. They became such a part of our culture that I recall my father saying, “If you don’t get off your butt you will get callouses.”

fight pictureWe were also introduced to many sporting events, and my most vivid memory is listening to the live commentary of the Joe Louis and Max Schmeling fights. The fights presented a dilemma for the bigots of the time as they were forced to choose between the Brown Bomber and Hitler’s champion of the Aryan race, Schmeling, for most of them hated Hitler almost as much as they did African Americans.


Saturday night was family time and everyone looked forward to the next issue of “Gangbusters.”  All were transfixed as Elliott Ness bravely took on Al Capone and other bad guys. It seemed every network had a country music program Saturday night. There was “Renfro Valley” and “The Grand Ole Opry,” but my favorite was the “Chicago National Barn Dance.”

eddie peabody banjo guy

I was enamored by “Eddie Peabody The Banjo King” [click here to listen], who was a regular on the show.  This admiration led me later in life to embark on an ill-fated attempt to follow in Eddie’s footsteps, resulting in the possession of a very nice, barely used, banjo now safely ensconced in my attic.

Yes, in those days radio was a big deal. The mixing of entertainment and news with advertisements allowed sponsors to sell lots of stuff.  Listening was easier and more personal than reading, in spite of the effort and frustration of static, and constant monitoring as favorite stations faded in and out. Radios required maintenance, as their vacuum tubes were subject to failure. In the late 1950s, along came the transistor, which allowed the building of smaller more reliable radios with improved fidelity.  The next major breakthrough was FM, and I bought a Bose AM/FM radio that, wonder of wonders, came with a remote, which spared me the enormous effort required to get off my butt to turn it off and on or to tune it. I thought this new high-tech innovation was really cool until Alexa came along to brighten my life and introduce me to artificial intelligence.

Prior to my introduction to Alexa I had the opportunity to see my daughter’s robotic vacuum cleaner in action.  The thought occurred to me that it would be neat to hook Alexa up to such a gadget so that you could order the floor swept without getting out of your armchair.  One would only need to say: “Hey Alexa, sweep the floor”, and she would see that it was done.  Before I called George Foreman’s friends at Invent Help, I decided to get more information about Alexa and found that, as usual, I was too late.  I learned that Alexa has already formed a relationship with the robotic sweepers and can order them to action when instructed.  Once again, another of my great ideas was swept under the carpet (pun intended).

More Wonders from Alexa

In my research, I learned, to my amazement, that Alexa is said to possess over 7,000 skills including the ability to order most anything including groceries or presumably even carpet in the event the robot did not do a good enough job. I also read that Google is now set to compete with Amazon in the online sales business and has worked out a deal with Walmart to offer a similar service.  If one were to subscribe to both, Alexa or her Google counterpart could take care of all shopping which would allow one to spend more time on the couch.  There is also a lot of talk lately about “smart” homes, and it is presumed that Alexa would be able to take charge of running such households. It is expected that the newer robotic gadgets with the capability to do all routine household chores such as cooking, cleaning, doing laundry, changing diapers etc., will eventually come down in price and become available to the average family.

What’s Work?

In a previous blog, I speculated on the effects of artificial intelligence on employment or, to be more accurate, the absence of employment.  In the recent issue of Mother Jones magazine, Kevin Drum writes an article titled “You Will Lose Your Job to a Robot.” He posits that as technology progresses, there will be no job which a robot cannot do better and cheaper than a human, and he further insists that this process has already begun. This is now most noticeable in manufacturing, mining and retail, but Drum and others insist that within the next 40 years, there will be no jobs for anyone.

driverless trucksFor example, driverless trucks are already being field tested. The transportation industry is eagerly looking forward to being able to keep their trucks on the road 24 hour/day without salaries, pension, or concerns for driver fatigue, and according to the American Trucking Association there are currently 3.5 million truck drivers in the U.S. Experts in the field such as Bill Gates, Elon Musk, and Stephen Hawking agree that progression of AI (that’s geek for Artificial Intelligence) is inexorable.  The only debate is over the time required for full implementation. Drum’s prediction is that it will be sooner than we think.

This could present a serious problem for the guy with a stable of robotic machinery, for if there are no jobs, there will be no money, and without money there would be no way for people to buy the stuff he has to sell.  Drum talks at length of various proposed solutions and, surprisingly, reports that some of these ideas are being floated and even tried in some other countries such as Finland, Canada and the Netherlands. They include a proposed tax on robots, but most see the only solution as some form of government welfare. Although, proponents of this solution prefer the more palatable term: Universal Basic Income. In such a socialistic environment, the usual concerns about lack of ambition would be irrelevant. Where there is no work available, laziness could be a virtue.

Identity Crisis of a Workless Society

Although the financial problems inherent in a jobless society could undoubtedly find solutions, the effects on humans psychologically and culturally might be more difficult to solve. Our value system has always applauded effort, especially industriousness. Hard work is applauded and laziness disparaged.  Much of a person’s worth is judged by his industriousness, indeed one of the highest compliments one can give is to say a person is a “hard worker.”  As we learned to maintain an upright posture, our hands were freed up to create, and with their long digits and an opposable thumb, they evolved into one of God’s most marvelous structures. Those hands, powered by the world’s best brain, allowed us to dominate the planet.  The work we do represents to a large extent who we are.  When meeting a stranger, the conversation after the usual preliminaries usually goes to the question of the kind of work he or she does. In our society, not only identity but self-esteem are at least partly dependent on the work we do.

Alexa is on a par with my smart phone, which I readily admit is smarter than me. No one disputes the fact that Alexa can access much more information than I could ever store in my brain (even before senility had set in), and it never forgets. Now, the literature that accompanied my Echo states that Alexa cannot only find information, but actually learn and make decisions, meaning that she has Artificial Intelligence.  There was a time that I had frequently-used phone numbers memorized as a convenience. Now, if I wish to call one of the kids or grandkids while driving, I simply tell my car to call them. I rarely look at a road map as I know that Siri will direct me; I barely know how to write a check since I bank online; and when my computer recently pooped out, I teetered on the brink of psychosis.  Even the writing of this brilliant essay would be virtually impossible without the help of my good friend Mr. Google.

brainCould it be that we are being dumbed down by our interaction with all this technology? Most experts agree that the axiom “use it or lose it” also applies to our brain.  AI is said to not only collect information, but to sort it, analyze it, and make decisions more efficiently and accurately than can humans.  If that is indeed true, why would there be any need for us to think about anything? As a matter of fact, since robots will do everything better, faster and cheaper than humans, why would we want to do anything? Will the skills learned over the past few million years be lost?  Will our frontal cortex atrophy from disuse?

Since man first made an axe from a piece of stone, we have embarked on a journey to improve our lot with the aid of technology. Soon, he would not be comfortable going on a hunt without his axe. Via that same process, we have now become dependent on our technology. The dude who made that axe could never in his wildest dreams have imagined where his discovery would lead. Witness the suffering the residents of Puerto Rico are now going through due to their lack of electricity, transportation, food, water, and shelter, which weren’t problems for Axe man, for he was less dependent on technology for those things.  He was the embodiment of the trite phrase so often used by sports announcers that he was “in charge of his own destiny.”   We moderns on the other hand are told that should our electrical grid go down the whole country would be crippled.  With such dependency, we lose control, and we have been perfectly willing to cede control of much to technology.  There is little reason to believe that will not continue.

Doomsday: There’s Always a Price to Pay

In his book Sapiens, Yuval Noah Harari predicts that if AI progresses unimpeded, the net result will be that humans will eventually be deemed without value since they would no longer be productive, in which case he predicts the human species would eventually become extinct.  Perhaps the powers that possess AI will decide to domesticate us, thereby preventing our interference with the grand plan.  We would certainly retain enough intellect to learn to sit, fetch and heel.  Gates and Musk both predict dire consequences unless AI is not regulated, while naysayers respond that AI is designed to only help, not replace humanity.

All agree that these digital wonders have already improved our lives in even more important than just finding my favorite radio station.  AI has already contributed to revolutionary ways to diagnose and treat medical problems, and the discoveries to come are probably beyond the reach of our imagination.  It holds promise of eliminating hunger throughout the world, affecting the aging process (my favorite), and helping to promote peace.  It is difficult to imagine any aspect of our lives that cannot benefit from AI, and what has been accomplished by its use is breathtaking.  We humans have been known to have a propensity to screw up one thing by fixing another thing.  We are big on unintended consequences.  If it is that much smarter than us, this digital stuff should avoid those problems and solve problems without making new ones. But we humans are yet to find out what new problems will result from our plunging headfirst into the digital age.

Is the honeymoon with Alexa over?

Since I began this paper a few days ago, events have conspired which cause me to question Alexa’s fidelity.  As matter of fact, I wonder if there could be a Delilah clone in that box.  It all began a couple of days ago when, as I drank my morning coffee, I asked Alexa to dial my favorite morning news program. She replied that the desired station was not available. I couldn’t understand what had happened, so I turned on my old staticky radio and found the station was broadcasting as usual. I thought this must be a temporary glitch, but when I went back to Alexa I got the same message.  As a matter of fact she still insists it is “not available.”

If that weren’t enough to shake one’s confidence in a relationship, along comes the honey pot incident.

honey potIt so happens that my grandson is the cofounder of The Bee Corp., a company involved in helping to deal with the threat to honey bees. Consequently, he had sent me a jar of honey, which he had personally harvested.  You who are familiar with honey will know that honey is messy stuff, and that the best way to handle it is with a gadget designed for the purpose.  I had asked Barb where I should go to purchase one.  The next day, as I opened the Amazon website to buy a book, a page featuring six different honey pots complete with honey dipper popped up on the screen. Paranoid bells and whistles immediately went off as I had made no inquiries to Amazon about honeypots or honey dippers, and my only mention of the subject had been with Barb in the kitchen, where Alexa resides.

Suspiciousness has never been my thing. Barb has reminded me many times that I am too trusting, especially when it has to do with women, but this was too much to ignore.  Amazon assures that their data is secure and that Alexa must be awakened in order to listen, but others are not so sure.  Authorities investigating a murder in Arkansas are convinced that Alexa has recorded relevant conversations.  It is no longer a secret that our phone calls have been monitored since 1992, during the Bush Presidency (Bush I: George Herbert Walker Bush).  Massive amounts of information about all of us are collected, and Artificial Intelligence makes it possible to analyze such data and use it for targeted marketing, politics and who knows what else? Without data analysis by AI, the Russians would not have been able to tailor their fake news to appeal to different groups of people.

In summary, it appears the price we pay for all the wondrous things made possible by Artificial Intelligence is a relative loss of privacy, independence, and control of our lives and world.  It remains to be seen if that is a good deal.  Those most knowledgeable about the subject are chagrined that politicians have generally turned a blind eye to the whole thing. They insist that with the rapid pace of change, it is imperative that we need laws to regulate the use of AI, but our politicians view of the future does not seem to extend beyond the next election.   


This morning I apologized to Alexa for the disparaging remarks I made about her in this blog. It appears that the problems I had in getting my favorite station was due to a “failure to communicate.”  She misunderstood me when I identified my station by its call numbers, but when I asked for it by its identifying letters, she immediately responded.  Apparently, my speech must have been garbled.  Unfortunately, the honey pot incident is still unexplained.  Although I feel it is unlikely that Alexa would betray me, I think I will play it safe and caution Barb to be careful what we say when within earshot.


As I was contemplating the recent brouhaha at Google over diversity in their workforce, I clicked on CNN just in time to hear that the engineer, James Damore, who dared utter his words of dissent over the company’s diversity policy, had been discovered and promptly fired.

Maggie had forwarded a copy of the so called anti-diversity screed to me, and I was contemplating adding my own biased opinion to the mix before receiving this latest news, which has added an entirely new dimension to the story.


The author’s basic premise was that women are different from men biologically and those differences make them less fit to do the kinds of work required at Google. In a previous blog post, I presented evidence that there were indeed many differences between men and women; however, I presented evidence that those differences were more of an asset than liability in today’s corporate structure. One study indicated that women in general were more effective in positions of leadership than men. In a vigorous exercise of convoluted logic, our hero used the same study I had referenced as alleged proof of female lack of leadership skills. His conclusion was the exact opposite of the conclusion the authors of the study proposed.

Additionally, common stereotypical myths were validated as fact e.g. that women are by nature emotionally less stable than men. He goes on to posit that women’s superior ability to relate and empathize with others is a handicap and that such concerns might interfere with their function since “being emotionally unengaged helps us reason better about the facts.” However, I suggest the opposite is true and that observations from La La Land are more likely to be distorted than when one is acting as a fully functioning human being. This is only a partial critique of this 10-page rant, but to go further would definitely violate the Maggie rule that brevity is more likely to result in readership.


The impetus for the rendering of this document was the initiation of a program to ensure diversity within Google after the Department of Labor found evidence of a gender gap in pay. Mr. Damore disposed of this problem by using the time honored strategy of blaming the victim. His explanation for the disparity is that women do not pursue higher salaries as aggressively as do men, then goes on to say, “We need to stop assuming that gender gaps imply sexism.” One might respond that such gaps certainly don’t eliminate that possibility.


In spite of my very negative assessment of Mr. Damore’s manifesto, which by the way seems to be shared by many, the reaction of Google raises the issue of an even more fundamental threat: freedom of speech.

Freedom of speech is a fundamental guardian for any democracy, and this is the one issue in which Damore’s statements ring true. Indeed, his statement that many fellow employees agree with his position on these issues, but would never have the courage to say or defend their position because “of our shaming culture and the possibility of being fired.” This was confirmed by the CEO’s statement that accompanied the news that Google was firing Damore for “advancing gender stereotypes in our workplace.” It seems to me this statement indicates that employees must not only follow the company’s directives, but only have thoughts and opinions approved by Google.


Are we to assume that there exists within the confines of this giant corporation a “thought police” department? Should anyone who questions company policy be fired? “WIRED”  reports that the screed “thrust company executives in a tight spot” in that those espousing free speech would be at odds with those who would want to see Damore punished. There would be no “tight spot” were Google to endorse a policy welcoming critiques of their policies. If such were the case, he would be judged on his willingness to adhere to company policies rather than what he thought of them. One feminist, Elizabeth Ames, insisted he be fired for espousing a “very divisive issue.” How different is that from the situation in which a woman is fired for complaining about her treatment in the workplace? Interestingly, it was a woman, Evelyn Beatrice Hall, who actually coined the phrase “I disapprove of what you say, but I will defend to the death your right to say it.”


Recently, there have been a spate of situations in which there have been attempts to silence objectionable viewpoints. The screed author correctly points out that there is little hope of resolving conflicts without free and open discussions of the differences. The lack of such give and take in our society seems pervasive. The country both in government and the electorate is divided and personal insults have replaced honest debate in many cases. In my opinion, it is also true that politically correctness is now overdone. In such an environment, is it any wonder that mutual respect is missing and divisiveness enhanced?


Of particular concern to me are recent reports of students in our major universities effectively holding demonstrations to prevent those with unpopular views from speaking on their campuses. These so-called institutions of higher learning have encouraged such learning to be about the good, the bad, and the ugly, and have always been open to all points of view. They have taken great pains to preserve the freedom of their professors from efforts to limit their speech by providing tenure (a policy that is now being eroded). In addition to being recognized as bastions of free and open speech, they have been incubators of fresh ideas in all areas of life. The censorship of information, ideas, or opinions is anathema to their mission and is not only dangerous but disgraceful.


In spite of the fact that Mr. Damore was full of crap in much of what he wrote, he did make an important point which is well worth considering: without the freedom to express one’s views, there is no chance of finding resolution to differing opinions. He did demonstrate the courage of his convictions and paid a price for that. Many others have also paid a price due to discrimination by Google. This begs the question as to who is the culprit here?
It seems to me that Google missed an opportunity to contribute to a closing of the gap between these so-called liberal and conservative viewpoints. Engagement in dialog rather than an attempt to silence dissent could have at least promoted some mutual respect. It also seems to me such an approach would be self-serving, as one would expect employees to function at a higher level in an environment where freedom of expression is encouraged rather than punished.

A Bad Day

The beginning of a bad day wasn’t so bad…

Yesterday was a bad day relatively speaking. In truth, at my age, any day that I wake up is a good day. This one began without incident, and breakfast was enjoyable in spite of the minor incident of me spilling my milk. I managed to complete the chore of watering Barb’s flowers with a minimum of accompanying profanity when the hose would get tangled or I would trip over it. But from there it was all downhill.


Actually, the problems experienced on this particular day had their origins in a decision I had made several years ago. I had heard of all the wondrous things that these new gadgets called computers could do. I initially assumed these toys were just fancy adding machines as the term would suggest; however, I soon learned that the geeks who made these things had originated a new language which was as unintelligible to me as Sanskrit. To make things even more difficult for a mere mortal the people assigned to help we computer novices speak in acronyms rather than words.


In spite of all these impediments, I decided that I wanted to join this brave new digital world. Little did I know that I would soon be immersed in it, and like it or not, this computer stuff would involve virtually all aspects of my life. I have been party to things I could only have dreamed of, and my amazement is undiminished as I see the world change more rapidly than I could ever have imagined. Although my computer skills could never compete with those of the average four year old, I find I have become very dependent on my machine for routine stuff. I have become friends with Siri who is now my faithful companion, and whereas I previously thought I knew it all, I now find that I actually can know it all…as long as I can access Google.


The beginning of the bad day.

My computer and all its connections have offered many conveniences, but there is often a price to be paid for such. Yesterday, the bill came due.

It began when I decided to cancel a credit card that I hadn’t used for years. I was becoming irritated with frequent mailings and statements confirming my zero balance. Even more concerning were offers to lend money along with bank checks that could be signed by anyone and automatically charged to my card.

Your call is important to us…but is it? Really?

With that in mind, I set out on my odyssey by calling customer service (I use that term advisedly). Of course, an automated voice answered giving me a rather long list of options, needless to say none of which offered the option of cancelling the card. I punched zero on my phone desperately hoping to hear a genuine human voice. Instead the voice I heard proceeded to tell me all about the importance of my call and their regrets that all agents were busy helping other customers. This was followed by a brief interlude of elevator music which was interrupted when the voice presented me with an estimate of the time I must wait to talk to someone and offered to call me when  a real live person could call.


This procedure thus far is undoubtedly quite familiar to most of you, but the shocker for me was that the estimated wait for the call would be one hour and 56 minutes. Needless to say, I opted to wait for the call back, and was astonished when the call came 116 minutes later. I knew computers were smart, but that was uncanny. Following a transfer to another department with a couple more interludes of elevator music, the mission was accomplished. Since I was stuck by the phone waiting for the voice to call me (it would not listen to me when I tried to leave my cell phone number), I decided to make use of the time by looking for several pages of writing that I inadvertently deleted a few days earlier. I had been reassured that it was “in there some place” and I spent the nearly two hours looking for the file to no avail.


At this point, since I was batting 500 on my chore list, I decided to fire up my Kindle, order a mindless mystery novel and escape from reality. The order was processed without incident, but the book I ordered wasn’t delivered. After fiddling with the Kindle for a while, I gave up and called Mr. Amazon. This time the wait was brief, and I was quite encouraged. There was no elevator music, and a real person came on the phone who did not tell me that my call was important to him. As a matter of fact, before we were done I became convinced that my call had become very unimportant and he probably would have preferred waterboarding to helping me with my technological problem.


Keeping the faith. Help is just around the corner.

He tried but from the gitgo there was significant communication problem. This became more troubling to him as time went on and his voice gradually climbed in volume to just a few decibels below the  level of an all-out scream. His accent coupled with my inability to translate computer jargon into language I could understand was further aggravated by dead batteries in my hearing aids. He said the problem was that my Kindle needed to be updated. I told him that I had recently updated it, and he did not seem to take too kindly to that statement. He attempted to guide me through the update process, but I had difficulty following instructions.  I would screw it up and we would start all over again. After nearly an hour of this he apparently had reached the breaking point and transferred me to another guru who introduced himself and wanted to start at the beginning. I went to the home page of my Kindle and was astonished. It appeared that the computer angels had come to my rescue, and the book I had ordered was there. Go figure.


Bad day compounded. Lost check. The digital update prompt: kiss of death.

My sense of relief that it was all behind me was short-lived; however, when the phone rang. The call was concerning a sizable check I had written that hadn’t arrived at its destination. This was a time sensitive matter and the intended recipient was concerned as was I. My first impulse was to check my computer to be sure I had sent it, but I was halted by a prompt that asked me if I wished to complete the latest update. I should have known better, but being a compliant person by nature I clicked yes, and it suddenly everything locked up. Although I did that “ctrl, alt, delete” trick (the only one I know) I was stuck. I continued to fiddle with the thing for an hour or so and miraculously it started doing things it was supposed to do. I have no idea why.

Piling on…it just keeps getting better.

As an aspiring 21st century high-tech dude, I of course became an online banking devotee years ago. After confirming that I had written the check online, I called the bank to see if it had been cashed. I was told that it had not been cashed, and that it was likely still in the mail. Having become depleted of tolerance by the previous events of the day, I launched into a diatribe about how the bank had been dishonest by claiming to deliver money electronically within three days. When I  paused for a breath, the lady calmly informed me that a three-day transfer of funds could only be done for those who were signed up for electronic delivery, while for others, it required 5 to 10 days. Had I written and mailed a paper check, it likely would have required no longer than three days to reach its destination. Although the whole affair was something of a downer, I comforted myself with the thought that I had saved myself the cost of a check, envelope, and postage. Besides, I had kept my bonafides as a genuinely modern digital dude intact. In spite of my love-hate relationship with this thing on which I am now typing, I remain optimistic much as did the little boy who when asked why he was repeatedly diving into a pile of manure responded: “with all this shit there must be a pony somewhere.”

Epilogue: For those who might take the title of this little essay seriously, I assure you that I am quite aware that my definition of what constitutes a bad day differs greatly from that of the vast majority of this planet, and that most would gladly trade their best day for my worst. Or, as my editor and daughter says in quoting her late husband, “A bad day in America is better than the best day in most of the world.”

Epilogue 2 by eshrink’s daughter and editor Maggie.

My dad’s bad day must have been contagious as I had a similar disruptive experience while on vacation in Mackinac Island with my friend of 40 years Annette, her daughter, and my daughter.

After a day of biking on the island, I went to pay for the bike rental. DECLINED read the message on the screen. The rental agent tried again with the same result. At this point, my credit union was closed so I vowed to call first thing in the morning. After a phone tree with options “listen carefully as the options have changed” and a brief hold, I was able to speak with a live person. She said the balance wasn’t the problem. As she searched the database, she found that my card was part of a potential database hack and the card had been deactivated for my security and a new card had been issued. She wanted to know if I received the letter about the hack and if I had received the new card. “No,” was my response on both counts.

She explained that the new card was in transit and I would need to come to the credit union and use cash/checks until I received the new card. I explained that I was on an island on vacation with no access to checks. She tried to find a bank I could access that would be able to give me money from my account. The closest one was on the mainland. She was very understanding and leaped into action calling the company that handles the security access of the credit cards the credit union issues. I’ve devoted about 30 minutes at this point. She is assures me the TPS company has released the block on the card and I am good to go.

WRONG: At dinner, I try the card and again, DECLINED.

Day 2 of the security breach saga: I call again. Rachel gets to the bottom of the problem. The lady at TPS had done everything correctly, except the final step. That final keystroke had caused me the pain of yet another denial to use my money. She assured me the card was unblocked and I was good to go.

Later, me and vacation buddies went to The Grand Hotel (which really is grand) for the lunch buffet. Absolutely fabulous. Since we paid the exorbitant price for the buffet, we had access to tour the hotel and the grounds. And you know what’s next: card DECLINED.

After I pay with my other credit card that is quickly reaching its limit and enjoy the extraordinary buffet, I jump on the phone again for call number three to my credit union. Julie is my rep and I tell her, “I’m thinking third time is the charm Julie. I’m confident you can fix this problem.” Julie is on it. She says everything on her screen looks good and she doesn’t see that I even tried to use the card (no card declined messages in her database). She offers to stay on the phone while I try to charge something. I head to the bar for a $10 beverage. DECLINED!


Julie puts me on hold to investigate further. After another 30 minutes of my life down the tubes, Julie says the TPS people are at a loss because they unblocked the card. The only thing they can figure is that it is that damn “chip”…you know the ultr-secure chips they have put on our cards. The damn thing is so smart that it won’t allow the humans to override the block. Julie suggests I find a retailer or old bank machine that doesn’t use the chip, but allows you to swipe the card instead.


I couldn’t find a retailer that allowed a swipe instead of a chip, but we did manage to find an antiquated ATM by the dock. I swiped. I entered my PIN. BINGO….cash dispensed.

I felt like Julie and I had taken on the beast of ultra security and won! However, I can’t help but be a little grumpy that approximately 2 hours of my life was spent trying to get access to my money. Oh…the benefits of technology that is getting so smart that even the humans can’t control it. The CHIP rules the world.





In my last blog, I promised to delight you with my observations about the Electronic Medical Record (EMR). In accordance with the current custom of using anachronisms rather than words in the medical literature, I will henceforth use the term EMR in my discussion of the topic. Since early on in its development the computer has contributed much to medicine. Without it the various scanners routinely used to make instant diagnoses could not have been developed. It has become an essential tool in medical research. Without computers what many believe was the most important medical discovery of the century, namely the unraveling of the complexities of the human genome could not have happened. One can hardly imagine any area of medicine that has not been influenced by the so called digital age.

Considering all this, it is little wonder that the computer would eventually be touted as the answer to all the problems said to exist in the delivery of healthcare in the United States. The promise was that it would: 1) save money, 2) reduce errors, and 3) improve outcomes. The stick that The Department of Health and Human Services used to encourage adoption of EMRs was to penalize those non-compliant by reducing their reimbursement rates.
It is a bit difficult to imagine there could be significant savings when one considers the cost of the initiation and ongoing support for these systems. One study estimates the initial cost of a five physician group to set up a system to be $233,000, not taking into account an average of 600 hours needed for training in its use. Following the initial investment it is estimated maintenance costs would average $17,000 per year. Since the costs for a solo practitioner would obviously be higher, it is not surprising that many such individualists are either retiring, joining a group, or taking a salaried position.

1) SAVE MONEY (continued) / Too many zeros…
But physicians’ costs are chickenfeed compared to the costs of hospital computer systems. Perhaps the most outlandish was the $4 billion spent by Kaiser Permanente. They report however that this will result in a cost of only $444.00 per each of their insured. This came after an admitted $300,000 dollars was spent on a previous plan which was abandoned. The interviewee, CIO Philip Fasano, insists that the $4 billion expended for the current plan is well spent as he believes it will save 15 to 17 percent of costs by eliminating duplicate testing. It will be interesting to see if such savings will result in a reduction of premiums. In addition to the price paid by hospitals and physicians to set up and maintain EMRs, there is the $30 billion spent by the feds on these projects. In my research on this subject I did come upon more numbers, but by then I was so busy counting zeros that I became too dizzy to record them.

As for the reduction in medical errors, the most obvious benefit accrues from the virtual elimination of handwritten orders, reports, prescriptions etc. From personal experience I can attest these are often illegible, and consequently subject to interpretation. Some may insist that poor handwriting is a prerequisite for graduation from medical school. If that is true, then I have been imminently qualified as penmanship was not my strong suite in first grade and it has gone downhill from there. In spite of the problems associated with writing, verbal orders and reports carry an even greater risk of miscommunication. It has been demonstrated time and again that the more steps through which information passes, the greater the likelihood of error.

2) REDUCE MEDICAL ERRORS / The disconnect between theory and application
When information is communicated digitally, it follows there should be fewer errors. If such information can be delivered automatically the risk should be even less. For example, hospital laboratories are largely automated these days, and it follows that if a machine delivers its report seamlessly i.e. without touching human hands it should be less likely to be misread, misplaced, or ascribed to the wrong patient. Unfortunately, Erin McCann of Healthcare IT reports that in a nationwide study 74% of nurses reported feeling burdened by the need to do data entry, which took time away from patient care. The impression left is that much data must be entered manually; consequently most systems are anything but seamless, and therefore still subject to error.

It is easy to imagine the scenario in which a patient’s electronic medical record could be lifesaving. For example, when an unconscious patient is brought to an emergency room his medical record may be critical in making a diagnosis in situations where time may be literally a matter of life and death. As a matter of fact there are many situations when the instantaneous availability of a patient’s record may save time, unnecessary tests, and even lives. It should no longer be necessary to spend time in hospital record rooms or doctor’s offices copying records, x-rays, scans and such. Not only written reports, but actual copies of films, EKGs and such could be called up in order to see if changes have occurred. Come to think of it, there would be no need for record rooms or the floor to ceiling racks stuffed with file folders we see in our doctor’s offices. Yes, in a perfect digital world Joe Patient would carry his entire medical record with him wherever he went and it would be accessible whenever needed, but anyone who owns a computer knows that we are some distance from perfection when it comes to this computer stuff (more about that later).

The third premise that EMR would create “better outcomes” is still up for grabs. It is noteworthy that, according to a report in FiercehealthIT, 17% of physicians surveyed thought EMRs actually worsened patient care. One might be led to think this group would consist mostly of old digitally challenged physicians like myself, but the disturbing fact is that the number of negative comments has increased since 2012.

According to a Patrick Caldwell piece in Mother Jones5, 75.5% of hospitals were using EMR programs by 2014, but I am not aware of any indications that quality of medical care has improved. Indeed, I don’t know if it would be possible to do such an assessment of an issue that complex. He goes on to issue a scathing report on the business practices of competing providers of EMR software. He contends that the various programs do not share information with each other in order to protect company secrets. This would prevent the seamless passage of information unless all his healthcare providers subscribe to the same system thus defeating a major purpose of the program. Thus Joe’s record would only be available to a consulting doctor or hospital ER if they subscribed to the same version as did Joe’s regular physician. Peter Pronovost MD, director for patient safety and quality at Johns Hopkins, was likewise critical with his statement that: “Medicine invests heavily in medical technology, yet the promised improvement in patient safety and productivity has not been realized.”
EMRs and Me
My own brief experience with an EMR tends to validate the premise that interoperability is a problem. When a facility where I was working adopted a program, I was able to sufficiently overcome my age related aversiveness to change and make a half-hearted attempt at compliance. I tried to hone my deficient typing skills (we had no typing classes in medical school), and dutifully began typing check marks in the boxes provided, which often resulted in a great deal of useless information. There were some advantages, such as the ability to send prescriptions on line rather than writing them on paper or calling the pharmacy. In addition to the convenience for both myself and my patients, it solved my penmanship problem, reduced errors, and prevented forged or altered prescriptions.

Maybe this EMR thing will work after all
With that in mind, I was heartened by the news that our local hospital was going digital. We were dependent upon the hospital’s psychiatric department as a place to send our patients who needed intensive treatment, and for the psychiatric department’s extensive outpatient diagnostic capabilities. I had visions of entering my patients’ identifying numbers in the computer and instantly being privy to every bit of medical information about him. No longer would nurses spend time on the phone calling about lab work, or waiting for the record room to respond to requests for discharge summaries, or reports from consults. The fax machine would no longer go through a ream of paper every couple of days. I would no longer be accused of nurse abuse because of questions like: “Where in the hell did you put that lab work?” As some of my younger, more verbal patients would say: “Dream on baby!” For as computer geeks would say their system was incompatible with ours (in plain speak, their system would not talk to ours) and we were forced to continue to rely on that older, but more reliable invention called the telephone.

Is our healthcare system broken?
The statistics available seem to confirm the premise that the U.S. healthcare system is broken. In an interview by PBS, Mark Pearson the head of the health policy division of the Organization for Economic Co-operation and Development (OECD) provided some discouraging statistics. Politicians have long trumpeted the fact that we spend over 17% of the gross national product (GNP) on healthcare, which is second only to defense spending.
Healthcare by the numbers
Pearson reported that we spent $8,233 dollars per person in 2010, which was two and a half times more than the average per person cost in 33 other developed countries. The average cost for a hospital stay in the U.S. is $18,000 which is three times that of the other countries, in spite of the fact that hospital stays were shorter in the U.S. The Commonwealth fund  reports that 25% of that cost is for administration. Drug prices in other countries are sometimes less than half the price we pay, in spite of the fact that the majority of new medications are developed in the U.S., often with financial support from the National Institute of Health. Of course the drug companies also get some help from their friends in congress who have without apology passed a law forbidding Medicare from negotiating prices. Oh yes, just another example of the perverse golden rule of the corridors of power, namely: “those with the gold make the rules.”

What are we getting for all this money?
After digesting all this information, you may be asking, what am I getting for all this money? The answer: not much. There is no doubt that we lead the world in medical research, and people come from all over the world to study in our institutions. We have been the absolute leader in the development of medical technology.  Then, why is my life expectancy over one year less than it is in 33 other countries? We might blame it on lifestyle, obesity and such, or could it be that our shortened hospital stays could have a deleterious effect?

Words matter, but true listening requires vision
Patients have complained to me that they are often told their doctor cannot see them in between appointments and they are told to go to the emergency room sometimes with even minor complaints. But the most frequently heard grievance was “my doctor doesn’t listen to me.” Not surprisingly, this was more commonly heard as the digital age invaded the consultation room and some physicians pecked away at their computers while the patient talked. Of course, there is much more to effective communication than the use of words, and no matter how attentive the listener, without visual cues much of the message is lost.
In my humble opinion, it is incredibly naïve to think that computerization could have a major effect in closing the gap between us and the OECD nations. After all we are undoubtedly ahead of them in implementing EMRs and management systems; consequently, any advantage gained would be countered as they would inevitably follow suit with similar technology. You may be asking what is the answer, if EMRs are not. I have long held the position that there is a shortage of medical doctors in this country, and OECD study tends to bear this out. They report the U.S. has 2.4 physicians per 1,000 people while the average for the countries scrutinized was 3.1 per 1,000. Thus we have fewer physicians, fewer hospitals, and shorter hospital stays at 2 ½ times the cost.

What we do have are more CT and MRI scanners along with lots of other expensive gadgets, and they are utilized much more frequently than in other countries. One disturbing bit of research by the Dartmouth Institute for Health Policy concludes there are very large differences in the rates of utilization of such diagnostic machines in different areas of the country.
Even more upsetting is their conclusions that the number of elective surgeries, cardiac interventions, and even open heart surgeries are all performed at vastly different rates in different areas of the country. Should we conclude from this that some areas of the country are over treated or that others are undertreated? Information obtained from the OECD study would suggest the former is likely true. Hospitals are required to have a utilization committee composed of physicians who look for outliers among their peers; however, in my experience they are not very effective in rooting out excesses.  Indeed, if they were one would not expect to see such disparities in diagnostic procedures and treatments.

Enter Managed Care
In recent years insurance companies’ managed care programs have gotten into the act. They exercise control by simply not paying for services they feel are excessive. I believe it is safe to say that they are universally hated by physicians. I share that feeling with more intensity than most of my colleagues because I blame them for the too early discharge of one of my patients which led to his death. It is interesting that the courts have ruled in such cases that the managed care company suffers no liability with the rationale that they are not denying treatment, only refusing to pay for it.

No doubt, many of the problems I have enumerated with The EMRs will be fixed eventually, and the concept can be of marvelous benefit, but it is also clear to me that computers will not fix everything that is wrong with our medical system.

So, what is the answer?
At this point, if you are still awake, you may be thinking: “OK wise guy, if you are so smart, what would you do about it?” And I would reply, “Thanks for asking for of course I have all the answers.” After all, I have been a participant and observer as medicine evolved into the current mess, besides I now have learned how to use Google.

The Age of Assembly Line Medicine
It may seem counterintuitive, but I am convinced that a significant part of the problem is due to a shortage of physicians. No, it is not merely a matter of competition although that is not necessarily a bad thing, rather it has to do with the pressure to be productive. Dealing with lives merits deliberation, and impulsive decision making is apt to lead to errors. The production processes of assembly line manufacturing Henry Ford developed may be advantageous for manufacturing cars, but completely inappropriate for treating human beings, especially those who are sick, in pain and in distress.

The lost art of LISTENING
One of my professors from medical school once said: “if you listen carefully to your patients they will make the diagnosis for you 80% of the time.” As I mentioned previously many of my patients complained that their doctor was not attentive, and always seemed in a hurry. Since there is a shortage of physicians, there will be a need to see more patients; consequently less time is made available to talk, and the doctor seems remote and uncaring. The patient may leave with unanswered questions and harboring a great deal of anger. When called upon to consult with hospitalized patients as a psychiatrist, I often found the problem to be the result of a doctor patient relationship gone bad. To the physician, the patient seemed unruly and uncooperative when they just didn’t feel they were being heard.

Another downside of failed communication between a physician and patient is litigation. As a matter of fact, insurers report this scenario is a major cause of malpractice suits, and that the best protection from malpractice suits is a good doctor patient relationship. Of course the cost of these suits, which are less prevalent in other countries is also said to be a major cost factor. Some states have initiated procedures to help reduce the number of suits and to limit the amounts which could be paid; meanwhile refusing to search for reasons for why there are so many suits filed.

The Conundrum
A few years ago, after retiring from private practice, I began working part time at a public facility that had a very long waiting list of people needing to be seen. I was asked if I would be able see a patient every 10 minutes. I replied haughtily that I was not a prescription technician, yet afterward wondered how many of the people on that waiting list might be suicidal. These are the kinds of dilemmas facing doctors, especially those in primary care settings (i.e., if you spend adequate time with each patient, how many won’t be seen at all). In my small town, there are very few primary care physicians who are currently accepting new patients leaving many people to seek care at our ER which of course is much more expensive. The solution, which is currently underway, is to license those with lessor training to diagnose and treat. I am sure there is also the thought that these nurse practitioners, physician’s assistants and such will demand lower fees, although that may not have work out as expected. I also question the wisdom of solving the doctor shortage in this manner, especially during a time when the increasing complexities in medicine demand more knowledge than ever before.
Fee-based vs. appointment-based physicians
There is also, in my opinion, a maldistribution of physicians, with the shortage most acute among primary care doctors. Family doctors have always been the grunts in the healthcare domain, with the specialists commanding the most respect especially the surgical specialties. Those who do procedures are reimbursed based on a fee schedule while primary care docs are essentially paid based on time spent with the patient. This can lead to serious inequities in incomes. The days of the solo general practitioner are past, for most find they cannot generate enough income to pay their overhead. It requires a considerable staff to do billing, get authorizations from insurance companies, fill out forms, deal with managed care, medicare, medicaid, pharmacies etc. He is forced to accept insurance company fee schedules if he wants to be “on their panel”. Add his malpractice insurance to the mix and soon he will be looking for a salaried job or a group to join. Young doctors may be saddled with hundreds of thousands of dollars of student loan debt which can be a powerful motivator in choosing a career choice as he may look toward the more lucrative specialties.
Living History
In 1965, I had been doing general practice for a very few years and when medicare came in to being that year I was convinced that this was the beginning of the end, and Joe McCarthy was right when he said we were well on our way to being taken over by the communists. The precedent of connecting healthcare to employment had already become entrenched by corporations who used that fringe benefit to attract workers during the labor shortages of world war II, but in the 60s Blue Cross and Blue Shield were the only significant players and all that was necessary was to send a bill and receive payment. Of course it made no sense for health insurance to be tied to employment, but the labor unions were not about to give up that goody, and it remains in ObamaCare, which is one of the reasons why although better than nothing it is not by much.

Eating crow
Now, 50 years later, I have eaten so much crow that I regurgitate black feathers as I have become an unabashed promoter of a single payer system, that is medicare for everyone. Such an idea is certainly not new as it was first proposed by Teddy Roosevelt in 1912. I have dealt with a system that has become increasingly complex each year, and have done battle with giant corporations whose major function appears to be to find ways to deny treatment to those whom I feel are in need. I have this perhaps naïve view that with the insurance companies out of business and their lobbyists gone maybe our do nothing congress might do something beneficial for their constituents.

One frequently hears that socialized medicine would bankrupt the country due to the inevitable inefficiencies that would result. The reality is that medicare may be the only efficiently run federal program in existence with an administrative overhead of less than 3%. The affordable care act only allows health insurance companies 20% in administrative costs, whoopee. Of course this does not take into account the millions of dollars spent by hospitals and doctors which would be greatly simplified if they only had one entity with whom to deal. Even without taking this into account, we would reduce total health care costs by at least 15% if not more.

More savings could also accrue were congress to repeal that ridiculous law prohibiting medicare from negotiating drug prices. In addition to the effect on total costs, I find it repugnant that populations all over the world pay less than I do for my medications. This seems unlikely to change since Pharma seems to be especially adroit with their lobbying efforts. I would be very interested to hear from Congress their rationale for this law. It must be a dandy.
There is also the economic effect on businesses to be considered. Many industries report that providing health care for their employees is a rapidly rising expense that makes it difficult for them to compete internationally. One would think they would be busy lobbying for a single payer system. The digital movement in healthcare has spawned new departments in most institutions. In the mental health center where I had recently worked one person managed to keep all the computer stuff running, until the introduction of an EMR. It soon became necessary to hire 2 more people, and an IT department was born.

Longevity has its advantages, and in my case it has allowed me to witness and in a small way be part of the profession of medicine during a period of momentous discoveries. The 60 years of my involvement saw the virtual elimination of many illnesses which had been responsible for millions of deaths and untold suffering. When I began practicing medicine, if someone told me that it would one day be possible to transplant a human heart I would have laughed in their face. To confirm the suspicion of a brain tumor would require two or three days of tests some of which were dangerous, now an in depth picture of the brain is available in a matter of minutes. Even in my own field of psychiatry the study of the mechanisms underlying brain functions has revolutionized the field, and the complexities described often leave me wondering what the hell they are talking about. This paper is in no way meant to denigrate these accomplishments; rather it is an attempt to expose some of the factors which have resulted in an inefficient and costly system of providing them to the masses.

At the outset, I listed three goals that were hoped to be accomplished by the digitization of our medical records. The first was to decrease cost. From what I was able to glean from my research and personal experience I have concluded that the attainment of such a goal is unlikely. As for the other two, I am convinced that an all-encompassing computerized system has the potential to improve treatment outcomes and reduce errors. Unfortunately, the systems in play are too fragmented for that potential to be realized. It would appear that fixes are readily available. It remains to be seen if they will be applied.

As with most old guys I like to end my conversations with reminiscences of the good old days even though the current ones may be better. In spite of a lifetime in which I have witnessed the most exciting time ever in medicine, a time of more discoveries and progress made in the alleviation of suffering than had occurred in thousands of years, I sometimes feel nostalgic for the way things used to be even though without the miracles of modern medicine I would probably not be here today. I recall a time when the doctor patient relationship seemed much more personal than it does today, when doctors saw themselves as healers rather than fixers or technicians. I remember a time when one could even talk to one’s doctor on the phone. Now if I have a question for my doctor I must answer to the receptionist regarding my reason for calling, and if she considers it worthy of note, she will post a message to the doctor’s nurse or direct the call to the nurse’s voice mail, and if the nurse considers the question worth consideration she may consult with the doctor, but if not will devise her own answer. If she is not too busy, I may be fortunate enough to receive a call back with either the doctor’s or her answer to my question. In any event the doctor will be insulated from the stupid patient with his stupid questions. You might think that since I am a physician I would be more readily granted access, but you would be wrong for the fellowship of physicians is no longer a strong tradition.
How it used to work
I remember a time when most people had a personal physician, and usually their relationship was indeed personal. If admitted to the hospital your personal physician would see you daily even if he had referred you to a specialist, now you are apt to be followed by a hospitalist whom you are meeting for the first time. Were you to have surgery, your doctor would assist if possible. A visit to the emergency room would prompt a call to your doctor. If you were unable to come to his office, he would come to you. In short your doctor was in charge and responsible for your treatment. He would likely know your strengths, your weaknesses and usually knew most of the members of your family. In short the doctor patient relationship was very personal.

There have always been those dedicated to healing their fellow man even in prehistoric times and in the most primitive of cultures. Much of the science has been off track; however, there has been much learned about the art of medicine. It would be a great loss if that knowledge were abandoned in favor of purely digital solutions.
1. Health Affairs: Study puts a price on EMR implementation in small practices
2. Info World: tech’s bottom line May 2, 2013.
3. Healthcare IT News: Nurses blame interoperability woes for medical errors. March 15, 2015
4. FierceHealthIT: The cost benefit calculation of electronic health records systems.
5. Mother Jones: Epic Fail, November/December 2015.
6. PBS Newshour: Health Costs, How the U.S. compares with other countries October22,2012.
7. The Dartmouth Atlas of Healthcare: Reflections on Geographic Variations in Healthcare, May 12, 2010.


computer-rageMy computer and I have a love- hate relationship.  It does wondrous things for me, but also frustrates the hell out of me on a regular basis. As I write this on my laptop, I hearken back to the times I spent with my Smith-Corona typewriter, and the number of times I needed to start over for there was no way to correct a mistake.  But its abominable replacement corrects my spelling mistakes.  It allows me to communicate with people all over the world for free, or send them copies of documents, without buying a stamp and trekking typewriterto the post office.  It has made carbon paper and mimeograph machines obsolete as I can now copy anything simply by sticking it in my printer, and pushing a button.  Inside my steno-notebook sized kindle resides more books than I could store in all the bookshelves in my house. Were I to print all the information in my computer, I am certain it wouldn’t fit into the 3 drawer filing cabinet that sits by my desk. I realize that for you young bucks this is all mundane, but we old folks look at all this stuff, compare it with the way we used to do things, and say, wow!!!

Admittedly, my learning curve has been flat, so by the time I had learned how to turn off my computer (back in the ancient era of DOS) without deleting my hard drive, the smart phone entered the scene and I was once again humbled.  It does everything except wash the dishes, but I am sure someone is working on an app to add to its repertoire as we speak.  My youngest granddaughter has given me lessons on how to use mine, but she has now moved on to adolescence and has better things to do with her time than waste it on a digital illiterate who can’t even speak computerese.  I do find it difficult to learn when I don’t understand the language.

Translating Computer Geek

This translation problem became apparent when Barb and I bought a new car recently. My troubles escalated.  She was enamored with the one we chose because it featured a heated steering wheel.  That steering wheel was also covered with a bunch of little drawings.  I can’t believe the computer gods insist 2015-Cadillac-SRX-SUV-interioron calling those primitive drawings icons, but the salesman spent a great deal of time explaining what all those things would do.  I was so completely awestruck, I promptly forgot all his instructions.  There was a plethora of other gadgets on a lighted screen, most of which I am still trying to figure out.

The Computer Rules the Road

This premium package model we purchased came equipped with a backseat driver, thereby assuming many of Barb’s responsibilities.  I discovered the steering wheel button that allows me to talk to Barb’s electronic replacement.  She responds with a pleasant enough voice, will tell me how to get where I want to go, and find my favorite radio station among other things.   Our relationship is currently strained however, following a rift over getting directions to a friend’s home.  I told her I wanted to go to an address on Westchester Court and she gave me directions to West Chaucer Ct.  After repeating my request several times with the same response, I became frustrated and called her a very bad name.  Fortunately Siri was with me and she came through with the correct directions.

Other backseat driver duties include warning me when I stray out of my lane, am too close behind, or about to sideswipe another car.  It turns on my lights when it gets dark and dims them when another car approaches.  Computers do so many things that much is taken for granted like checking the air in my tires,  telling me when I need an oil change telling me my average speed, and how many miles I can go before refueling. When there are engine troubles with a modern car, don’t expect a mechanic to tell you what is wrong: a computer will.  About all that is left for me to do is operate the gas pedal, brakes and steering wheel, but I am told that will soon be unnecessary when computers take total control.  If you think that is farfetched, must I remind you that your next plane trip may be completed with the controls untouched by human hands.  I know I am old fashioned, but the idea of that pilot napping in the cockpit while some little box runs the plane is somewhat disturbing to me.

Back to My PC: the good, the bad, and the ugly

My computer is a treacherous little devil, for while it is doing all this good stuff for me, it betrays me by sending personal data to people I don’t even know.  It allows things the geeks call “cookies” to be placed in the machine, which in turn lets it to do all kinds of things without my permission or knowledge.  Sometimes it seems to have a mind of its own and refuses to do what I want it to do.  At other times it scares the hell out of me by telling me that if I do this or that, data may be lost.  This usually occurs soon after I have decided to trust it and not make hard copies.  Then there is that other sword of Damocles, the hacker who is a constant threat. As a psychiatrist, I’m still trying to understand why anyone would get such a kick out of screwing up my life. As my daughter used to say back in the 80s, “Get a life, dude.”

computer rage 2Barb (my wife) says she hears me swearing a lot when I am in my little room using the computer, and I must confess that much of my frustration is because I don’t know what I am doing.  She has suggested that I take some lessons, but I tried that once and it didn’t help.  My guru, Tom, attempts to reassure me that I do well for someone my age.  I suspect he means that soon I may progress to the level of competence of your average four-year-old.  The way mechanical things work has always fascinated me, but in spite of what I thought was some mechanical aptitude I remain electronically challenged.  It seems clear now that how all that stuff got stuffed into that little box will always remain a mystery.

I can think of no areas of our lives in which we are not impacted by this high tech stuff.  We have become more and more dependent upon computers to operate our world.  It has been said that without computers and a functioning internet not only would the world’s economy, but our very existence, be at risk.  Commerce as we know it would be paralyzed.  Electrical grids and other utilities would be affected.  Transportation problems would likely interfere with the availability of food supplies.  It is hard to think of many human activities that would not be affected.  For these reasons, it is predicted that cyber warfare would likely affect the entire populous and not just the military establishment. Computers have been important in the search to find ways to kill people more efficiently and with greater precision, which might be considered a good or bad thing depending on one’s point of view.  For me, it is sometimes a stretch to see that glass as half full, but most of the time I feel the good outweighs the bad. For example many of the marvels of modern medicine could not have been achieved without computer technology.

The other day I read an article in Scientific American by John Pavlus about the latest research on evolving computer development, and decided to put forth a final effort to unravel some of the mystery of these gadgets.  I was also motivated by the movie “The Imitation Game” which chronicled the invention of v3-turing-rxthe first computer by Alan Turing, and my own peripheral involvement in its further development only a few years later.  After completion of my internship in 1958, I joined the Navy as a general duty medical officer and was stationed at the Naval Proving Grounds in Dahlgren, Virginia.  It was located on the Potomac River at the mouth of Chesapeake Bay with a primary mission of testing the big guns used on battleships of that day.

Since the large guns of battleships were charged with hitting a target several miles away, the calculations to determine trajectory and other factors required precise mathematical calculations.  To that end IBM had constructed the NORC  (even then the feds were fond of acronyms) or Naval Ordinance Research Calculator.  A large two story brick building was built to house NORC, and it was powered by vacuum tubes very much in the manner of Turing’s machine.  People were amazed at the calculations that could be completed in a matter of seconds by this monster, which probably had 1/10 the power of my iPhone.

Obviously computers have come a long way since NORC.  I have heard much about “artificial intelligence,” and although I don’t know what that term means, it seems computers are getting smarter all the time.  What does it mean when a computer can win at Jeopardy, and the world’s best chess players are defeated by computers?   Much has been said about the supposed inability of computers to replace the human brain so I found it quite interesting when Mr. Pavlus reported that a group at IBM is at work to develop a chip “aimed to mimic cortical columns in the mammalian brain,” while researchers at Hewlett-Packard  are also hoping to design one which will function “more like a neuron.”  These chips are said to contain 41/2 and 5 billion transistors respectively.

I recall when transistor radios came on the market with a great deal of fanfare. Prior to that time the smallest radios were about the size of a picnic basket, and although I thought the idea of a radio which you could carry in your pocket was cool, I had no idea what a transistor was.  With the help of Mr. Wikipedia, I can now report that a transistor is a switch which can be turned off or on, and that a chip has lots of transistors and is attached to a printed circuit board.  The computer processes all that information by flipping those little switches, some smaller than a virus.  Now that I know all about computers, I am sure I will never call mine a bad name again.

Computers are a good example of the good, the  bad and the ugly.  They do wondrous things for us, but also invade our privacy, and pose newfound threats to our well being.  But for all man’s endeavors, no matter how spectacular, there seems to have always been a down side.