Your Daily Mindjob
This is my personal blog where I'll offer up some political straight talk as well as thoughts on technology and pop culture. That should give me plenty to talk about. The world can give you one heck of a mindjob. Think like me and get your daily dose.

Saturday, August 22, 2009

David Gergen Gets It Oh So Very Wrong

Anderson Cooper is hosting a special on CNN with a panel of familiar CNN faces. At one point, Dr. Sanjay Gupta began discussing tort reform and defensive medicine. Then David Gergen followed up with his own example of what an ENT he talked to calls defensive medicine.

Here's the problem. The example is an absurd one. Unfortunately, Dr. Gupta didn't speak up to point out how asinine the example was. Like an episode of House, the example had that far fetched medical practice sound to it. I'm sure physicians everywhere groaned in disbelief, just as they do when watching House.

I don't know what ENT David Gergen spoke to about defensive medicine, but physicians I work with don't order tests just because the patient asks for them to be done. I certainly don't bend over backwards to appease a patient asking for a test just for the sole purpose of getting the test done.

Let's use the example Gergen gave us.

Patient X comes in and asks for an MRI. Doctor gives the patient the MRI, afraid that the patient will sue him or her for not providing the investigation the patient asked for.

That's not evidence based medicine. If your doctor gives in to that sort of thing, he or she is not a good doctor and cannot seem to muster up the sense to explain to the patient why they do not need the MRI. The patient did not go to medical school. The patient, no matter how informed, cannot just snap their fingers and order any test they'd like.

Here's how the situation should have been handled. Communication! The ENT should have asked the patient why they wanted the MRI. Then, after listening to the patient's own reasoning, the physician should have explained what an MRI would tell them and whether or not the reason is really justified.

An MRI is a peculiar example to use because the patient is not exposed to radiation. Let's twist the story a bit and show you how doctors really behave when it comes to patients who demand tests that could do a little more harm.

Instead of an MRI, let's say the patient is asking for a CT or a chest x-ray. If there is no justification for the test, the doctor is going to expose the patient to an unnecessary dose of radiation. That's malpractice. That's bad medicine. That is something they could be sued for, not denying the patient the CT.

Let's go a little further because the next example is a more common form of defensive medicine. A mother brings her child in to the pediatrician. The child has a cold and the mother says she wants antibiotics. The physician has determined the infection is viral. Antibiotics would not treat the viral infection.

Here are the choices the physician has at this point.

1. Deny the patient antibiotics because it's not evidence based medicine. Tell the mother to treat symptoms, have the child rest, and drink plenty of fluids. No lawsuit.

2. Give the child antibiotics to make the mother happy because they know unhappy mothers tend to complain and want the magic pill to make the infection go away. To avoid confrontation, the physician practices some defensive medicine. It's a bad practice and paves the way for superbugs resistant to antibiotics. Lawsuit.

There are other options if the physician feels the mother is confrontational. Those other options are not relevant to this discussion, although again, an open line of communication would have been the best course of action.

In clinics across America, physicians have regular conversations about the overuse of antibiotics and the rise of bacterial resistance to those antibiotics. Superbugs are the last troublesome obstacle we want to face. Just because a patient demands antibiotics is no reason for a physician to throw those concerns out the window.

Let's give an example of defensive medicine that is also evidence based. For the sake of clarity and understanding, let me skip some of the jargon and clinical details and just go for the basics.

Let's say a patient presents with a set of symptoms. The physician recognizes these symptoms and orders the tests to confirm the diagnosis he or she already suspects. However, these symptoms could also be a sign of a malignancy, something that if missed, could result in a much worse situation for the patient. If missed and the malignancy were to progress to the point where outcomes vary tremendously (surgery, removal, and recovery vs metastatic disease and palliative care for example), you've got a lawsuit on your hands. The physician orders the initial tests for the most likely diagnosis and will probably order the other investigation soon to make sure cancer is not the underlying cause.

In that case, the physician is covering his or her ass, but at the same time, understands that cancer is in the list of differential diagnoses. At some point prior to ordering these tests, the physician would have sat down with the patient and discussed his or her concerns and possible diagnoses which warranted the investigations.

Monday, August 10, 2009

The Three Amigos...Summit

Barack Obama went down to Mexico to meet with Mexican President Felipe Calderon and Canadian Prime Minister Stephen Harper, a trio being referred to lately as the Three Amigos. The swine flu is apparently dominating the summit. I thought I'd throw a bit of humor at the situation with movie references. Have you seen The Three Amigos? One for each other and all for one!

Wherever there is injustice, you will find them. Wherever there is suffering, they will be there. Wherever there is swine flu, you will find the Three Amigos.

They discovered H1N1 originated in a scum sucking pig.

While consulting the Singing Bush on swine flu, someone accidentally shot the Invisible Swordsman.

The swine flu is our El Guapo.

If you cough after crossing your arms over your chest, putting your hands on your hips, and turning your head while thrusting your hip, you might have swine flu.

The bullets are still real.

Their rendition of "My Little Buttercup" was a huge hit with the locals.

Now they are being pitched for roles in a Cochise picture.

Saturday, August 8, 2009

KSLA reveals its ignorance

KSLA News 12 out of Shreveport revealed its ignorance on the health care debate this Friday by posting a poll question on its web site which did not represent the reality that is health care reform at this point in time in Washington DC.

Let me explain by showing you the poll.

Here is the poll question and the possible list of answer choices.
Should the president's health care overhaul plan be passed?
1. Yes, as it is
2. No
3. Yes, but it shouldn't be rushed
4. Not as it stands now

Alternatively, here is the screen shot I took.

The thing is, there is no presidential bill yet to overhaul health care. The House and Senate are each working on various aspects of health care reform with their own bills. There is no single plan on the table.

Will someone explain answer choices 1 and 4 to me then? Which bill are we leaving as is? Since no single bill currently exists, "Not as it stands now" is certainly not possible.

Did somebody forget how the legislative and executive branches of government work?

Have the folks at KSLA discovered time travel and jumped ahead into the future?

It seems quite a few people are uninformed. Talk about a sad day for journalism. Thing is, it slipped right by the person typing it on the teleprompter as well as the anchor who read it out loud.

KSLA sucks. KTAL sucks. KTBS sucks. We don't have one decent news station in this area. It's times like these when I'm glad I can at least listen to NPR during the day instead of these chuckleheads. It's bad enough we have a ton of misinformation out there. Now even our news outlets need fixing. Yes, KSLA has been notified by phone regarding this poll and its inaccuracies.

Tuesday, August 4, 2009

The Shipping Business Sucks From Start To Finish

If you are a consumer like me, you buy lots of things online, especially if you live in a rural area or a small city. Local businesses just don't have the selection I want most of the time. It forces people like me to hop online and make purchases.

But that's where the real fun begins. Shipping. It's a bitch these days.

The shipping process has many levels starting with the order and ending with delivery. Everything in between is a painful experience no matter where you shop, it seems. It starts with the order, moves on to order processing, the item ships out the door, then travels via the shipping service, and finally ends with the delivery.

Let's start at the top. Once you place your order, you are given shipping options ranging from ground service to expedited air. The cost alone has gone up from around $5 to $6 to closer to $10. Fuel costs have probably affected these prices, so I can't complain about that too much. The thing is, I never get my money's worth. A 3-day is not really a 3-day. Overnight shipping is more like 3-day delivery. I'm glad some places still offer free shipping, but at a lot of sites, you still have to pay an arm and a leg to qualify for that free shipping. If you want overnight shipping, expect to pay $40 or more. The catch with overnight and 3-day shipping is a sly one on the part of retailers. The clock doesn't start until the package is out the door. They can take their sweet time "processing" an item.

So once you've made your selection, your order has been placed and you get the receipt in your inbox. A blurb in that message might suggest shipping info will arrive in your inbox shortly, including a tracking number. At this point, you're already screwed. At least I usually am. First, the item takes forever to ship, even if you place your order before 3pm, noon, or whatever time the site says for same-day processing. You won't get same day. Your item will probably take 2 days to process before it actually ships. Like I said, the clock does not start until the package hits the pavement. Countless major retailers sit on their hands while I wait for shipping info in my inbox.

To give you an example, I placed two orders on Sunday afternoon. It's now Tuesday and neither company has shipped either package. That stinks. My $10 worth of shipping costs (each order) were just wasted by both companies. That's $20 vanishing into thin air. I received an email yesterday from one stating shipping info was on the way. I have yet to receive that information.

In the past, I was frequently faced with options with regard to the company shipping my precious cargo. Now, I'd be lucky if FedEx or DHL were listed. UPS has a stranglehold on the shipping business. I can't remember the last time I received anything via DHL or FedEx. The USPS even has a leg up on FedEx and DHL.

Sometimes I never receive any shipping info, especially if the item I ordered is coming via USPS. Some sites will give you the USPS or UPS tracking number. That number may or may not work. You see, in order for you to track a package, the middle-men need to scan it. In addition to knowing when your packaged was shipped and where it is located at any particular point in time, you also get a delivery date. That's assuming the package can be tracked. Let's just say that if you have a tracking number, all it tells you is how painfully slow it is moving across the country. UPS is better at tracking that the USPS, which rarely has the information readily available. UPS tracking information online lags behind the scanning process. There's nothing you can do about it either.

While your item is moving its way across the country, it gets handled by a number of individuals. These employees don't seem to care about how fragile a package might be. They might as well be working for the airport tossing luggage as far as I'm concerned, especially if they work for UPS. FedEx is certainly no angel with regard to package handling, but compared to UPS which is a nightmare, other options are far better. But remember, you frequently are not given those options. The USPS carriers are somewhat better with regard to package handling too, but there are other issues with the USPS I'll get to in a moment.

Assuming your package survives the trip, two or three days after you expected the package, it gets delivered. Oh, the delivery. Here's another mess I have to discuss. Let me share my experiences. The time of delivery varies from company to company. Regardless of whether or not your package requires a signature, you'll likely spend the entire day being held hostage by the delivery guy or gal. UPS tends to make an evening run where I live. If I know the delivery date and UPS is the carrier, I can expect the package to arrive between 4pm and 6:30pm, but that's still no guarantee. Some carriers have left packages at the wrong house. Others have been known to drop it at the end of the driveway, not at my doorstep. The USPS carriers can be moody and may be on a power trip. USPS packages typically require a signature, so if you're not home, you get a nice slip of paper in your mailbox telling you to pick it up at your post office the next day. Here's the kicker. My carrier has been known to leave the box at the post office and toss the slip in the mailbox anyway. Yes, even if I'm home, if a box is coming via USPS and it requires a signature, there is a good chance I'll have to drive to pick it up. Again, the shipping fee I paid is meaningless if I have to be the one driving to pick it up. FedEx has what I like to call morning people. They're awesome. Between 8am and 11am, the FedEx truck or van will pull up and drop off the package. It's guaranteed. Never had any problems with FedEx or DHL in this department.

I wish I could give you all a few tips, but we are at the mercy of the delivery trucks and the packaging folks. I try to place orders on a Friday or on week ends so that the clock starts ticking on Monday, not Tuesday, but as you can see from my most recent expenditures, that did not help a single bit.

If you are a retailer, here's some advice. Ship no later than 24 hours after the order was placed. If there are multiple items to assemble in a package, it's understood that processing will take longer. No big deal. One item should not take more than 24 hours to go from point A to B. Give your customers more options too. I know UPS probably cuts you a deal. Pickup services probably suck on your end no matter what, but trust me, your customers will love you for giving them options. I love using FedEx if at all possible. Add them to your list please. Get tracking numbers for your customers, even if it's through the USPS. You might want to institute a survey of sorts evaluating the shipping experience so your customers can identify weak spots for you.

I'm seconds away from mentioning companies by name. You don't want to be on that list. Service is at an all time low people. I don't know what's wrong with workers these days. I can't get anything done. In my line of work, it's my ass if I'm not punctual and on top of my game. Lives are on the line in my line of work.