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Giving up on Facebook

facebook_logoFacebook has been good to me.  Really good.  But today, I deleted my Facebook account, and I feel great about it.

There was always an upside and a downside to Facebook.  For someone like me who has spent his adult life joining a succession of amazing communities that were always — sadly — time-limited and unstable,  Facebook was a godsend.  The routine usually went like this: I would go somewhere, usually for school but sometimes for a job (Alaska!), and I would meet a lot of great people.  For the three or four years that we were together as classmates or co-workers, these people made up my daily life.  They became my good friends.  But then, predictably, we’d graduate and each of us would pursue whichever option seemed best to us at the time, which usually meant that we scattered ourselves all over the country and the world, attending different graduate schools or taking jobs in different cities.  Like most of my friends, I would go somewhere new, and the cycle would begin again: another great group of people, more great friends, another scattering and another losing touch.

Facebook was great because it let me reconnect with my friends.  Amazingly, I even reconnected with people I knew from high school.  It was amazing.

But I said there was a downside to Facebook as well, and the downside was always privacy.  Actually, I should really say “privacy” with scare quotes.  No one with a blog ought to delude themselves that anything on the internet is private.  I don’t do anything online “anonymously” because I don’t believe such a thing exists.  But even if privacy isn’t something you can expect on the internet, there is such a thing as exercising control over one’s online persona.  I’ve got pictures of my doggie that I’ve posted in one place, but not in another.  The point is, I think I ought to be the one to decide what to do, say, or show to other people online.  Facebook made that difficult.

The latest privacy glitch from Facebook isn’t the problem.  Instead, it’s that Facebook repeatedly changes the rules about what gets shown to whom.  Sure, they always give you the ability to restrict information; the problem is that they keep requiring you to restate how you want your information to be handled.  Every six months, they send another notice that says “unless you tell us not to, we’re going to publicize all this information in ways that six months ago, you told us not to.”

That kind of behavior isn’t evil, but it is annoying.  All of the information on my Facebook page could be made public tomorrow and it wouldn’t hurt me, but I’d like to be the one to decide to do that.  I’m tired of having to fight with Facebook over the control of what I’ve placed online.  I’ve already decided what I want posted where; when I change my mind about that I’ll change it.  I don’t like having to constantly watch out for Facebook’s efforts to make those decisions for me.

So I’m deleting my Facebook account because the downsides finally started outweighing the upsides.  It’s nice knowing that I’m pretty easy to find online.  My friends can always find me without too much effort.  I am going to miss parts of Facebook, but I won’t miss constantly telling them the same thing again and again.

ACEP’s health care reform survey

ACEP (the American College of Emergency Physicians) recently asked me to participate in a survey.  I didn’t do it, because I’m tired of being asked to participate in surveys.

Shadowfax didn’t participate either, but he has a better reason.

Shoddy construction?

Cables, concrete, corrosion...

Cables, concrete, corrosion...

This post is either about shoddy construction or shoddy journalism — I can’t decide which.

The question is, why is this building in Seattle built in 2001 already so damaged that it needs to be torn down?

Sadly, this article that I read only says that “the issue involves cables, concrete and corrosion that have become so costly to repair that it would be cheaper for the owner to tear down the building than to fix it.”

Cables, concrete, and corrosion.  Ah, yes — that explains everything.

When it comes to high-rise construction, I’m what you would call a “layperson” or, if you prefer, an “ignoramus.”  So I’m not expecting a detailed explanation all the nuances that make this building worth less than a pile of rubble.  But I’d like to think that the reporter could have done a better job of dumbing it down for me than “cables, concrete, and corrosion.”  That kind of catchy, uninformative phrase is beneath even local newspaper journalism.  It’s fit only for the lowest dregs of America’s news media — local TV news.

But wait; reporter Lindsay Cohen is identified in the byline not as a newspaper journalist but as “KOMO-TV staff.”  Aha!  I knew it.  Seems the local Seattle paper is so hard up that some of their web stories originate with KOMO-TV.  Like most local TV news outlets, I’m wholly unsurprised to see it putting out crap.

Massive missing marble chunks...

Massive missing marble chunks...

Ok, though, so even if we don’t know anything beyond “cables, concrete, and corrosion,” whew!  Are you kidding me?  Not even ten years old and the building is so damaged that it has to be torn down?  That sure does seem like some mighty shoddy construction, or shoddy design, or something.  Not that this kind of thing hasn’t happened before.  I’m reminded of the mid-1970s fiasco in Chicago, where the Aon Center (then the Standard Oil Building) started to shed big chunks of its marble cladding just one year after the building was built.  That goof-up cost half the original cost of the entire building to fix.

I wonder what the local TV news in Chicago said about that?  “Marble, missiles, and mistakes”?

John Scalzi has China Miéville’s new book. Grrr….

krakenThanks to John Scalzi, we know that the arrival of China Miéville’s new book Kraken is imminent!  Per Scalzi:

This book features mysteriously disappearing cephalopods, squid cults, crime bosses and, of course, very possibly the end of the world. Because if you’ve got squid cults, can the end of the world really be that far behind? No. Not at all. China’s having a good year; his previous book The City and The City was deservedly nominated for the Nebula, and the buzz on this one is pretty strong. Folks in the UK get this on May 7; here in the US, we have to wait until the end of June.

First of all, thank you to Scalzi for giving us this vital information.  Secondly, and as usual, I’m going to say a few things again about why I think China Miéville is great — hopefully I will convince at least one other person (you, perhaps?) to give him a try.

Miéville is one of those few writers who can reliably convert a certain percentage of new readers into drooling, slavering minions who never miss a chance to persuade others to become drooling, slavering minions.  I know this from personal experience, having myself been minionized several years ago by Perdido Street Station.

So why is Miéville so good?  He certainly doesn’t exemplify the stuff I usually enjoy.  Most of the genre fantasy that I like simply recreates a pseudo-medieval world.  I’m OK with that, because if it’s done competently, it’s a fun world to set a story.  People travel by foot or on horseback; they drink ale in inns; they fight with swords and knives.  What’s not to like about that?  The typical political and economic system of such worlds is some variant of feudalism.  Magic almost always exists, but may or may not be a prominent day-to-day feature of life in that world.  Usually, my favorite genre fantasy has minimal magic and maximal realism of the trudging-through-mud-for-days-to-reach-the-castle-so-you-can-slay-your-enemies-in-a-week-long-siege variety.  Joe Abercrombie and George RR Martin are two excellent (but far from identical) examples of my favorite kind of realistic fantasy.

Usually, an author that plays too fast and loose with the otherworldly, the magical, or the fantastical will lose me pretty quick.  Most of them just aren’t able to build a world that’s believable — it’s always too hokey, or it’s too inconsistent.  I find it hard to trust these authors, because their taste for innovation usually means that as soon as their hero is in trouble, the author will conveniently introduce us to some entirely unexpected feature of their world that — surprise! — allows the hero to escape unscathed.  Grrr…  I hate it when that happens.

So even though the publishers call it “fantasy,” the best stories in this genre are usually set in a predictable, mundane world that looks a lot like Europe circa 1500 a.d.

China Miéville’s books are something altogether different.  His city of New Crobuzon, for example, has a neighborhood of ant-headed women who make sculptures from their spit and communicate with each other using odiferous aerosols.  The floating city of Armada is made of hundreds of old ships tied together and is ruled in part by a vampire.  A lesser author wouldn’t have a prayer of making any of this stuff believable.  But Miéville draws you in, and keeps you wondering when he’ll unveil the next mind-blowing vision.  Plus, he keeps you guessing whether that vision is going to be beautiful or horrible.  He’s a master of world-building suspense.

There’s a lot more to say about why I love his books.  He’s known for his socialist politics, and most of his books have a substantial political dimension without being proselytizing or preachy.  His creatures are truly amazing.  Want to meet a spider-god with a scissor fetish, or a flame-throwing parasite shaped like a human hand (some are left hands, some right) that commandeers other creatures bodies?  You might not think you need to meet such creatures, but Miéville will make you realize that your life without them was a little dull.  Not much of a creature person?  Then read The City & The City.  Miéville will blow your mind with a world full of nothing but humans, too.

So, getting back to where we started — I usually have nothing but admiration for John Scalzi, his books, his baconated cat, and his blog.  But now that I know that he has an advance copy of Kraken, I’m exclusively, seethingly, jealous of him.  Bad John Scalzi!

Don Berwick

Don Berwick

Curious about Donald Berwick?

Maggie Mahar at the Health Care Blog gives us plenty of reasons to be excited by Obama’s choice of Berwick to head Medicare and Medicaid, but my favorite bit was this:

In a 2005 interview published in Health Affairs, Berwick expressed his concerns: “I would draw a very dark line between the incentives that apply to organization .  .  . where I do want incentives in place — and incentives for individuals. . . . I want it to be good for an organization to be safe, and I want it to be good for an organization to manage chronic illness carefully . . .”  He applauds the pilot projects in the health reform legislation that encourage Medicare to “bundle payments to doctors and hospitals,” with a  bonus added to the bundle when teamwork leads to good outcomes at a lower price.

But “at the individual level,” he insisted, I don’t trust incentives at all . . . I think it feels good to be a good doctor and better to be a better doctor. When we begin to attach dollar amounts to throughputs and individual pay, we are playing with fire.  The first and most important effect may be to disassociate people from their work.”

Few of us are willing to question the orthodoxy of monetary incentives, but those who do will generate some powerful new ideas, I think.

Another article on John Dugan

The NYT has a nice article on John Dugan, a banking official that I think should be taking much more heat than he is, and who should probably be fired.

Post-call handoffs less than stellar, but why?



Vineet Arora, whom I mentioned in a post a few days ago, is a co-author on a new study showing that when post-call interns hand off their patients, important information often fails to be communicated to the receiving resident team.  In other words, the post-call handoff isn’t very good.

Vivian Y. Chang, Vineet M. Arora, Shiri Lev-Ari, Michael D’Arcy, and Boaz Keysar
Pediatrics 2010; 125: 491-496  [PubMed citation]

OBJECTIVE Theories from the psychology of communication may be applicable in understanding why hand-off communication is inherently problematic. The purpose of this study was to assess whether postcall pediatric interns can correctly estimate the patient care information and rationale received by on-call interns during hand-off communication.

METHODS Pediatric interns at the University of Chicago were interviewed about the hand-off. Postcall interns were asked to predict what on-call interns would report as the important pieces of information communicated during the hand-off about each patient, with accompanying rationale. Postcall interns also guessed on-call interns’ rating of how well the hand-offs went. Then, on-call interns were asked to list the most important pieces of information for each patient that postcall interns communicated during the hand-off, with accompanying rationale. On-call interns also rated how well the hand-offs went. Interns had access to written hand-offs during the interviews.

RESULTS We conducted 52 interviews, which constituted 59% of eligible interviews. Seventy-two patients were discussed. The most important piece of information about a patient was not successfully communicated 60% of the time, despite the postcall intern’s believing that it was communicated. Postcall and on-call interns did not agree on the rationales provided for 60% of items. In addition, an item was more likely to be effectively communicated when it was a to-do item (65%) or an item related to anticipatory guidance (69%) compared with a knowledge item (38%). Despite the lack of agreement on content and rationale of information communicated during hand-offs, peer ratings of hand-off quality were high.

CONCLUSIONS Pediatric interns overestimated the effectiveness of their hand-off communication. Theories from communication psychology suggest that miscommunication is caused by egocentric thought processes and a tendency for the speaker to overestimate the receiver’s understanding. This study demonstrates that systematic causes of miscommunication may play a role in hand-off quality.


This study suggests that the post-call handoff is potentially a dangerous one.  The authors write “… the inability of the postcall intern to gauge accurately the on-call intern’s understanding of patient information may greatly affect hand-off quality; not only are on-call interns failing to receive important patient information, but also the postcall interns are systematically failing to realize that breakdown of communication.”  The authors suggest a few possible reasons for these failures (“egocentric thought processes and a tendency for the speaker to overestimate the receiver’s understanding”), but ignore what seems to me the most obvious one — the postcall interns have been working without sleep for 30 hours.  Whatever quirks of human personality prevent clear communication, it seems likely that these obstacles would be harder to overcome after you’ve been significantly sleep deprived.

Given these results, I’d like to see a study that compares the quality of the handoffs performed by a post-call team to those performed by a team that’s not on call and has only been on duty for a normal working day.  Does the oncoming team get better handoffs from a team that’s not post-call?  I’m disappointed that the authors did not mention this possibility in their paper, given the controversy surrounding duty hours.

The authors don’t suggest that the results of this study support either side in the debate between those who want to make patients safer by decreasing resident work hours, and those who want to improve safety by reducing the number of dangerous handoffs.  I hope that no one else will argue that it does, either.

Obama’s problem

Daniel Larison summarizes the poll evidence that suggests Obama’s problem is that he isn’t liberal enough.

Influential Books

Matt Yglesias posts a list of books that have influenced him.  I shall do the same, nonexhaustively, in no particular order.

  • Wendell Berry, What Are People For? — I could really list any of Wendell Berry’s books of essays, but I’ll list this one because it’s the first book of his that I read.  Berry’s assessment of the dangers posed by our modern way of living to many of the things that I find profoundly valuable is persuasive convincing.  I think that everyone, ultimately, has to have a political philosophy, and Berry comes closest to anyone I’ve read to describing mine.
  • Gavin DeBecker, The Gift of Fear — I’ve been lucky enough to have lived a fairly safe and mundane life, that for the most part has been free of fear.  So, luckily, much of how I like to handle threats and danger, I learned from this book.  Plus, Gavin DeBecker tells you exactly why local TV news really sucks.
  • J.R.R. Tolkien, The Lord of the Rings — Despite what China Mieville says, this is a great story and it will outlast all of us.  I’ve read it about ten times, but I’ve been rereading it throughout most of my life, so it’s possible that I’ve lost count.  When the day comes to assemble an army of minions at my compound, I’m naming that compound RivendellEven Mieville might understand.
  • Various, The Hardy Boys Mystery Stories — Back in the 1970s, when Carter was in the White House, I was reading a lot of Hardy Boys books.  Sometimes four in one day.  Specifically, I’ve read all of the first 58 books plus The Hardy Boys Detective Handbook (the “Hardy Boys canon”) in their 1959-1973 revisions.  Maybe I love to read because of the Hardy Boys?  It’s possible.  Baffling, but possible.
  • Ferdinand the Bull

    Ferdinand the Bull

    Munro Leaf, The Story of Ferdinand — Why am I such a sucker for creatures?  I don’t know.  Why am I not a neoconservative?  Because neoconservatives are catastrophically stupid, of course, but how do I know that? There are a lot of books from my childhood that may claim responsibility for some of these traits of mine, but this one is surely one of the most influential.

  • Hannah Arendt, The Human Condition — I read this during my senior year of high school on the recommendation of my favorite teacher, and I’ve now read it almost as many times as I’ve read The Lord of the Rings.  If any single thing is responsible for my decision to study political philosophy in college, it’s this book.  My choice of college major, in turn, has been hugely consequential.  I doubt I would have gone to law school otherwise.  Hell, medical school might have seemed a lot less attractive to me had I not been insulated, on account of writing a thesis on Hannah Arendt, from the icky, obsessive, preprofessional premed culture in college.  Even if that’s all it ever did for me, I’d still be grateful for having read this book.

John Dugan: banking regulator or banking industry lobbyist?

John Dugan (Reuters/Kevin Lamarque)

John Dugan (Reuters/Kevin Lamarque)

John Dugan is at it again.

The head of the Office of the Comptroller of the Currency is still looking and sounding like a banking industry lobbyist, arguing that the already-weakened Consumer Financial Protection Bureau proposal in Chris Dodd’s reform bill is still too strong.  From the Financial Times (via the NYT):

“In every case consumer protection has the edge and will trump safety and soundness and I think that is backwards,” said John Dugan, the comptroller of the currency, at an American Bankers Association conference.

Mr Dugan, whose office regulates national banks, said a Consumer Financial Protection Bureau proposed in Mr Dodd’s financial regulation bill, which was published on Monday and is to be revised next week, was too strong.

The comments were unusually forthright from an influential regulator and came amid a surge of lobbying from regulators and banks before next week’s mark-up of the bill in the banking committee.

Dugan is also arguing for greater federal preemption of state consumer protection laws affecting banks — which is coincidentally the same argument the US Chamber of Commerce is making.

How this guy John Dugan has any credibility left as a regulator is a mystery. As I’ve said before, I think Obama should replace him now.