A few days ago, the New York Times ran a story describing studies which measured the “off clock” work performed by physicians in family medicine practices. Off Clock work includes things such as hassling with insurors, making phone calls on behalf of patients or to patients to straighten something out. It all adds up to a very great deal of extra effort, no part of which is compensated. Family medicine doctors are paid by the visit, but this other work lies outside direct patient contact, so no money. The health care measures recently passed will bring large numbers of new patients into the system just at the time when the overall shortage of family physicians is being felt, and the burden of the extra work logically entailed by patient visits, but not covered by any reimbursement is making the profession even less attractive. This is particularly the case for medical students who might have considered family medicine as a career option, but whose medical educaton required them to secure loans which they are now anxious to pay off. One way out of this, according to the Times, is to use electronic medical records. Yeah, maybe. It would be even better to re-arrange the reimbursement scheme which now seems to reward specialty care, which DOES stuff to patients, and disfavors family physicians who try to help people avoid getting sick in the first place.Invisible
A while back I blogged about a joint Microsoft/HP project to produce a tablet computer/reader/whatall, which would be named the Courier. Well, it’s not to be. HP and MS have announced to their respective staffs that the Courier will die aborning. The exact reasons are unclear. Neither partner wants to be seem as the one pulling the trigger, but there are stories that HP was not satisfied with the Windows OS as a useful system for the gizmo. But, that could be bushwah. Maybe HP just got cold feet or simply changed its corporate mind, especially after having gobbled up Palm, in a move that puzzled some. The Courier had an interesting design profile, opening like a book with two independently operating working spaces. Anyway, it’s over.
Well, your correspondent got his mitts on the Thing That Will Change Everything, for a few minutes anyway. With trembling fingers, I clasped the marvelous machine and reverently brought it to my lap. What device could compare with this? The printing press, the machine gun, the light bulb?….OK, that’s enough sarcasm. I will tell you what I thought. It’s rather nice. But, and here it comes, I didn’t find it easy to use. The person who let me try it said that the instructions were rather minimal…I guess it’s sort of a ‘problem based learning’ proposition. If you want to learn how to use, that’s your problem. There are instructions, but it’s not easy to find them and finding them requires a certain level of familiarity with the gadget, which, if you have it, makes the search for a user’s manual pointless. The graphics are very impressive. The design is sleek and minimalist…maybe too much so. Swiping to change screens requires just the right touch. Too light, and nothing happens; too heavy and nothing happens either. You need to sort of hover, in contact, but not too much. On those screens that require text entry of some kind, touching the query line brings up a QWERTY keyboard at the base, and you can use it to enter the terms. You can pick portrait or landscape, or swing between the two as you move the machine, on a kind of gimbals. Winnie the Pooh was the only book loaded onto this copy, so it wasn’t much of a test. But, for all that, the text was presented very crisply and the color of the illustrations came over well: not too washed out and not too bright or harsh. Admittedly, Winnie is not much of a test for the Ipad as a reader, but the text on some other services was easy to read. I noticed an app for downloading e-books from Amazon, so they’re ready. I was a bit surprised at the weight of the gadget. It’s not heavy as in heavy, but it’s not light either and I think you would know it if you were lugging it around all day. I freely admit that these observations are entered in scatter-shot fashion, without benefit of systematic testing, and pretty much as I can remember them. On balance, I think Apple has done a good job with the gizmo, but done a much, much better job with the PR and hype. I won’t be buying one, but I still have Roman numerals on the face of my watch and write with a fountain pen. I may be condemned to technological Gehenna. It just seemed a good idea to write about this, after all the talk and hoopla over it.
The Medical Library is offering UTMB students access to the ExamMaster database, on a trial basis. From now until the end of June, persons preparing for the USMLE, NCLEX, PANCE and certain specialty board exams can practice for them on the ExamMaster site. Students and residents are invited to login via the link on the Library’s web page, or at and are encouraged to send their comments to: firstname.lastname@example.org.
This link should work as well:
Please remember this is a trial subscription to assess the product and judge user reaction. No decision has yet been reached about purchase.
Ken Auletta is a reporter who has a certain gift for getting into things that are important, but complex, and for getting the people involved to explain to him what they think is going on, so he can explain it others. He wrote a piece in the April 26 issue of The New Yorker which tries to net some very big fish. We keep hearing about Amazon’s Kindle and Apple’s Ipad and about how these gadgets will or won’t “rescue” the publishing industry. Whether the publishing industry needs to be rescued, or whether it needs to change, is another matter, I think, but that gets touched on as well. Auletta has earned his stripes. He visited Google and worked with the Googlians a long while. Book TV showed one of his talks to the staff there, and he was at ease and not the least over-awed at the presence of so much high power geekery.Other books touch on publishing, popular culture and TV networks, etc. Anybody reading the article will get a very useful tutorial on the complex network and tangled relationships that underlie publishing, and of how fragile all this is starting to look in the age of e-readers and networked information technologies generally. There is a great deal of uncertainty and not a little fear about the impact of digital publishing, and some of the efforts publishers are making to limit the damage. The point here is that neither Amazon nor Apple has any plans to save anybody or anything. Their plan is to make money, and they both realize that to do so they need content, which, at the moment anyway, comes from publishers. The publishers really disliked being frog-marched by Amazon into accepting $9.99 as the price of a downloaded book. Apple, shrewdly, didn’t dictate the price, and offered to let the publishers do it, within a range. The publishers want, or seem to want, at least some of them, to deal with Amazon/Apple as “agents”, getting a portion of the price, but sending more revenue to the publishers, where it belongs in their view. But Amazon has been toying with the idea of bypassing the publishers entirely, and dealing directly with authors, becoming a publisher itself, so to speak. It’s all pretty exciting, and scary, if you’re on the wrong end. We all have a stake in the outcome, and this report will at least help us understand a little of what’s going on.
The Corcoran Gallery in Washington is a very nice place to visit. It focuses on American art, broadly defined. Currently, the Gallery is showcasing the work of Eadweard Muybridge. Let me explain. Muybridge was the man who brought the techniques of motion picture photography to the matter of analyzing human and animal locomotion. He did a lot of other things besides that, especially in photographing scenes from the American West, which, at the turn of the 19th and 20th centuries, was still a pretty remote place as far as most Americans were concerned. The scenery was spectacular, especially when compared to, oh, say, Ohio or Louisiana and people couldn’t get enough of it. Muybridge was English by birth but came to the States to ‘make his fortune’ as saying goes. He was, in my view, a little bit of a weird duck. He fooled around with his name…originally Muggeridge, and its spelling before settling on the Welsh-ified version he’s known by. He also had a severe head injury from a carriage accident, which may have helped him beat a murder rap. He shot his wife’s lover, but was acquitted. Diminished responsibility? The show at the Corcoran covers the man’s life and career quite thoroughly. What sets him apart though is his work with animal locomotion. How does a cat move, or a horse? Forget that, what about a man? What actually happens? What leg goes first? It was pretty tough to figure that out, because there was no real way to slow down the process of moving limbs to the point at which we could see the events. Motion picture photography made this possible and Muybridge was one of the first to use the method in the analysis of human and animal gait. He photographed animals, men and women, clothed and in the nude, simply walking, or running, or doing chores, often against a gridded background. It was real pioneer work. There is a full-length biography of him by Rebecca Solnit and his name and work pop up in histories of photography. If you are planning to be in DC for anything, take some time to visit the Corcoran and see the show.
The Chief Magistrates of the American Republic are busy people, most of the time anyway. So, it’s a little bit of a surprise to see how much time some of them have given to reading. A story in the Washington Post reviews some of our Prexies and their reading habits. On the whole, it’s good to know that they try to inform themselves about a larger world, one which does not necessarily bend to their policies or inclinations, to put it mildly. Of course, you have to be on the watch for Image Buffing or Agenda Massaging when the topic of presidential reading comes up. The Oval office denizens are not above leaving a few books lying about to suggest to visiting reporters what may be simmering in the Chief Executive’s noodle. John Adams amassed a personal library of over 3000 volumes, which probably made it one of the largest collections of books in the new republic, in public or private hands. The author of the Post piece runs through a number of the more modern Presidents and their reading. Truman preferred history and biography. Johnson was said to have been greatly influenced by the sociologist Barbara Ward, and Nixon by Churchill’s account of dealing with the Soviets at the end of WWII. T Roosevelt and Carter were themselves authors and quite prolific ones. (I’m leaving out the memoir some presidents feel obliged to leave behind….a relatively recent trend, by the way). And Obama seems to be a great reader. I was in Barnes & Noble yesterday and noticed a presidential quote on one of the bookbags they have for sale. “My best friend is the person who gives me a book I have not read”….Abraham Lincoln.
Mozart got sick and died. He was relatively young…35 or so. He was buried in a mass grave, and later exhumed. A couple of other things. All that is pretty much established. But what took the great composer off has been the subject of much lucubration. I know one physician who was going to try fishing in these troubled waters, but wisely gave it up, since he found he couldn’t make sense of the contemporary medical reports and interpret what Mozart’s doctors said in modern medical categories. So rather than guess, he stopped. But the itch continues and the latest candidate for WAM’s COD is strep throat. The defenders of this notion say that there was an epidemic of strep infections going on in Vienna at the time, as shown by their analysis of death certificates issued around the time of Mozart’s own death. There was also a big army hospital near WAM’s digs, and it had plenty of cases, so maybe. Well, maybe. But we won’t really know for sure. Fuggedaboudit! as they say in Brooklyn. Just crank up the stereo, put on the Requiem or Figaros Hochzeit and relax. Your turn is coming soon enough and you can then ask Mozart yourself.
Also in this morning’s Times is a story elaborating on the much publicized hacker or cracker attacks on Google, which we covered in these lines. The paper got hold of somebody speaking without attribution because s/he is afraid of getting canned for letting the secret out. According to the article, one of the attacks led right into the heart of Google’s password manager, a system referred to as GAIA. If true, this is very bad news, for a couple of reasons. One is the fact that the breach started with Googler answering a text message in China, just one. Another is the possibility that the attackers left some kind of malware behind. Finally, the hacker may just have gotten lucky and stumbled upon some vulnerabilities that Google doesn’t or at least didn’t know about. The G’s people say the hacker(s) were’nt inside very long and didn’t do any damage or leave anything. But, who’s to say? Since GAIA is supposed to be a really big deal for password security, the fact that it was penetrated, and apparently so easily, is, at the very least, cause for some reflection, shall we say. Google hasn’t said boo about all this, and some guys at Mountain View probably had their morning cofffee and bagel with cream cheese spoiled rather seriously. A lot of phone calls, and some worried customers, no?
A new book, In Search of Silence, is reviewed in this morning’s NY Times, and the reviewer gives it a middling grade…partly because some of the material in it relies on assertions from iffy or preliminary research. Still, it wouldn’t hurt us all to pipe down a bit, a little anyway, a couple of times a day. I got a laugh out of the story about the Trappist abbey in Iowa, which has an underground chapel so quiet that a lot of people can’t stand to be in it. They just bolt! I met a scientist once, from Rome, who as a young man had studied geological features in the old Italian Somaliland, now Eritrea. He said the same thing about the desert. The silence, at night especially, can be close to overwhelming, especially for newcomers. It takes some getting used to. On the other hand, physicians didn’t see the same degree of presbycussis, or age-related hearing loss, that is found in industrial societies. Old timers there still had almost perfect hearing.