Monday, January 28, 2008

Dell Technical Support

For all its recent investments in customer support I would still give Dell a score of 1/10.

Sunday, January 27, 2008

Towards an ideal medical record

A medical record should be problem based and action oriented. I do not consider this a controversial statement.
Actions should be contextual and stakeholder associated and prioritised. It is natural that some desired actions will be mutually exclusive and that many actions will be variably desired.

This all sounds very obtuse. Carers, patients, healthcare providers, families and friends and society may all want mutually exclusive things. Autonomy is most important, but is not absolute.

Problems should be listed by the biopsychosocial frame and should be sorted by time and resolution as acute or chronic or recurrent, open or resolved, assigned or not, actionable or not and prioritised.

Holistic care requires a document that is complete and comprehensive and current to support it. An interactive document would be ideal.

Wednesday, January 23, 2008

Opacity, stupidity and ignorance

I try not to be opaque in communications that matter: the principles of good communication are clarity, consistency and redundancy and I do keep those in mind when dealing with complex or involved or important subjects. Simplicity can be very challenging.

I find it difficult, nevertheless, to educate. People don't come to me in search of an education and so sometimes I find that our aims are not aligned and I cannot simply walk away. I have to educate and I go unheard or misunderstood. It is frustrating.

If an attempted solution fails one should try something else.

I suspect that I am often perceived as stupid and that disappoints because stupidity is irremediable. I think that a lack of aggression is misconstrued as a lack of conviction, but force of personality is not preferable to valid argument; neither is seniority or position (ipse dixit and ad hominem).

I am inconsolably ignorant. I am less ignorant than most, but I know that the difference between 10^(-19) and 10^(-20) though an order of magnitude is not significant. Even two orders of magnitude would make no difference. The saving grace of ignorance is that it is remediable and it is a natural and pandemic state that is without shame. I can learn.

I write because my measure of ignorance is almost universal and because I am tired. I am tired of many things and I am just tired. I think that patients should take some responsibility for their own ignorance and that colleagues should look and see that they live in glass houses....

All my best wishes for the new year!

Tuesday, January 22, 2008


Knowing is not enough; we must apply.
Willing is not enough; we must do.
Johann Wolfgang von Goethe

Saturday, January 19, 2008

Architecting capability

In order to mine experience one must map experience, that is, one must describe or define a topology so that the experience in its entirety is meaningful. We cannot learn from the chaotic. Making meaning out of chaos is in itself an act of learning, but it is necessarily a prerequisite to further, deeper learning.

Learning itself is instrumental: we learn to effect; we learn to solve problems or to extend solutions. Learning without application is indeed wasted labour.

Thursday, January 17, 2008

Consistency over time

In all things consistency is triumphant: investing, learning, rearing, relationships. The problem we have is that we are not designed biologically for persistent action over long periods of time. The long term is counterintuitive.

We can make sense of causes and effects that are not widely separated in time. It is progressively more difficult to separate cause and effect with increasing spans of time between them.

Age is an important factor in the ability to consider the long term.

Saturday, January 12, 2008


If you can walk up the side of a three-storey building wearing only calfskin gloves and socks before the age of 20 you will live at least until age 150. A great deal of research makes analogous claims: alleviating the poverty of orphaned African girls will improve their health and longevity.


Much research seems entirely divorced from the realities of life: life is complex, fuzzy, stochastic and the problems we have to solve are wicked. There are many silver bullets; there just don’t seem to be any vampires; or more simply: there are many hammers and most things are not nails.


“Limitations of this study…. The results of this study cannot be generalised….”


We generate googols of information that is unrelated to action. We need to learn some discrimination before we expend our resources.

Friday, January 04, 2008

Compassion fatigue

Everything is personal; and however statistically common a diagnosis may be the personal trumps everything else. We are also comparators and all comparisons are with our own recent experiences: my broken finger has greater immediacy and relevance than another’s broken hip the latter’s seriousness notwithstanding.


We are human. We are all human together.


That I see broken arms and broken hands and broken legs frequently makes them routine. I care and still my caring lacks some element I lost more than a decade ago worn away by routine. I could not do my work well if cared like my novice self. And I do not want to care like my novice self: disease and distress are emotionally and cognitively burdensome.


I laugh. I laugh because laughter is healthy; and because it is unusual and because it is sometimes incongruous. I laugh because laughter is contagious; sometimes. And sometimes, laughter is prognostic.


I hope the holidays were good; I hope today is better and tomorrow better still.