1) I am both smarter and better educated than most of my peers - as are most of the people on/. I have a post-graduate education in an area where only about 20% of my "peers" have a college degree. (I'm aware that not everyone without a college degree is unintelligent. It is, however, a fairly good proxy, in that plumbers and carpenters with good heads on their shoulders are counterbalanced by [insert your favorite joke major here].) I may or may not be smarter than you, but I'm pretty sure that both of us are several standard deviations above the norm for my area.
2) Call it weaseling if you like, but for a lot of people jury duty represents a significant hardship. I'm still in residency, which means that if I miss more than ten days of a month, I have to repeat the month - at the end of residency. That means that I can't go on to pursue a fellowship for another year, if at all. Sure, the hospital that employs me will give me the time off, but that ten days of jury duty (unlikely for a basic criminal jury, but entirely likely for a major case or a civil trial) will cost me the difference between a resident's income (under $15/hr) and a full independent physician's income (>>$15/hr) for a full month, as well as causing severe hardship for my fellow residents (who would have to cover all of my call duties). I would be insane not to try to get out of it (and, in my state, being a physician pretty much excuses you without having to appear - just write a letter to the court clerk). Would you like it if your doctor's appointment was postponed for another three to six months because she drew jury duty? What if the carpenter rebuilding your kitchen had to call it quits halfway through, for an unspecified period of time, just because he worked for himself? Many, many small businesses consist of one or two principals and would be absolutely killed by jury duty.
Mind you, my municipality recently had a series of incidents involving jurors' cars - having transported themselves at their own expense to the courthouse, they were required to pay for parking; having parked on the city streets, they were ticketed for expired meters; having found streets without meters, their cars were broken into. All this for $5 a day (which won't even pay for your parking)?
As for 3), well, it's not that people who do jury duty are dumb. It's that they have nothing better to do. That might mean a group of retired professionals (including, when I'm retired, me) - but where I live, it's infinitely more likely to be a bunch of people in their twenties and thirties who don't have jobs. You can imagine how, in a civil court, those people will take one look at my (future) income statements and ignore the past that went into it.
It's unfortunate that during the one time in my life - the summer between college and medical school - that I was really able to do jury duty, I didn't get picked. I'd enjoy doing it when retired, I think. You're right that jury duty should not be disparaged, but the modern justice system creates an incredible burden on those called to duty without any hint of compensation.
I'm an anesthesiologist. It's virtually impossible for judges and the lay public to determine, really, whether I committed malpractice (absent blatantly criminal acts). In fact, most doctors would probably need a fair amount of exposition to determine whether or not I committed malpractice (as I would, in turn, if faced with a case from another specialty). And yet we are judged by twelve people who could not escape jury duty. Yes, I'd prefer if I were judged only by my colleagues, and so would you. But if that were the case, nobody would ever trust us. It's the price you pay for having a society.
... and I just posted a reply to CleverNickName in the Star Trek visor sale story in which I told him to Shut Up Wesley, at great risk to my otherwise untarnished karma. Oh, the glory.
The discs can only be spun so fast - only so many cm of linear disc "groove" space can pass the laser in one second. The increased data rate comes from increasing the density of information on that disc so that there are more bytes per cm. The density difference accounts for capacity increases from CD to DVD to BD/HD-DVD.
I wish I had mod points. True, very true. I've had any number of ideas over the years that - within a couple of years - became highly successful products. Of course, I lacked the financing and technical know-how to make them into those successful products, which is why I'm not a billionaire. Consider the MP3 player - anybody could have figured out it was going to be a big product. But you had to put in the time to make a compact device with good battery life and a decent UI, which was the hard part.
I know this is/., but really -- listen to the link, I didn't put it there just because it looks pretty. It'll take you the better part of an hour. It's a rather thorough account of a guy trying that theory out for real. He rapidly finds that antelope can outrun us with ease, and that all they have to do is get over the nearest hill for you to lose track of which specific antelope you're trying to run down. The way to kill bison and antelope without a mount is to drive them off a cliff in a stampede.
That's a nice story, but experience disagrees with you. Quadrupeds move much more efficiently than we do. We're smarter than they are, so we take advantage of their behaviors to kill and eat them. Driving herds off cliffs, e.g. However, the experience of the Plains Indians with horses pretty clearly shows that people will take any advantage they get and use it to master their surroundings. If people on horses were inferior to people on foot, they wouldn't have bothered to become expert horsemen.
Here's one for you: in my hometown the one-way streets downtown have a speed limit of 30 mph. The only way to get a "green wave" is to travel at 40-45 mph. This is entirely logical at rush hours, when traffic already at those lights will need a bit of a head start, but at night it's just a speed trap.
So... why are you Linux-based? I'm all for FOSS, but aren't you just making your life a lot harder than it needs to be? After all, if you're in health IT, your life is hard enough as it is.
Well, anesthesiologists are in a special position. Most of the time we put people to sleep for surgery, although some of us do some advanced work in controlling chronic pain. When we put people to sleep for surgery, we do something no other doctor does regularly: we administer the drugs ourselves. If I get a bunch of, say, morphine, and take it with me, and write down that I gave it to the patient, there's nobody who can really verify whether or not I did. If I'm diverting it (either for sale or straight into my own veins), it should become apparent over time that my patients are always hurting really badly in the recovery room despite having gotten what looks like a lot of pain medication, but that's really about the only way I'll get caught if I don't use in the hospital.
One consequence of this is that when we waste our excess controlled substances, we don't just do what nurses on a regular hospital floor do (which is squirt it down the drain while another nurse observes and verifies). We have to package it up and drop it in a baggie. Every day the pharmacy randomly chooses a few syringes to test to see if what you say is in the vial is what is really in the vial. If the two don't match (i.e., there's saline in that vial that's supposed to be full of morphine) you'll be doing urine tests and non-random sampling of all your cases for months on end.
So while I believe in treating surgical pain (and postsurgical pain), there's really no purpose for people to get opioids for much else. They may make you feel a little high, temporarily, but they don't treat chronic pain worth a damn. There's no good demonstrated reason for people to be on chronic opioids except cancer pain. Unfortunately, that's something we've only realized in the past couple of years (because we didn't much give chronic opioid therapy for non-cancer pain until the mid-90s). Most chronic pain people will benefit from a mixture of therapies, and unfortunately a lot of them are just going to have to live with the pain and hope to improve their functionality. (I know this sounds cruel, but if you interview these people carefully you'll find that their pain that is normally an 8 on a scale of 1 to 10 is reduced to a 6 or 7 by high-dose opioids. That's a tiny change for a big risk.)
So, to answer your questions: I am a firm believer in pharmaceutical treatment of pain and, for that matter, anything else. You just have to have a clearly defined goal for treatment that your patient understands and buys into. If you wander into my pain clinic, don't expect me to become your candy machine; I'm happy to set up a plan to treat and improve your pain, but chronic opioids aren't going to be it. I'm a subspecialist and there's no way I know you as well as your primary care doctor does. And given the special nature of my profession (and its concomitantly high rates of abuse) we will tend to get slammed faster and harder than other fields of medicine if we overstep the line. Let's face it: if you were into drugs, which field of medicine would you go into? Pediatrics, where you get all the free antibiotics you want? Or anesthesia, where you can secret away enough to give yourself quite a party every weekend? Too bad the addiction rates are so high...
If so, it would definitely qualify as the "pointy-haired boss" sort of thing. Realistically, the problem isn't that people want to look at random health records; they're looking for the records of friends, neighbors, enemies, and celebrities.
That's a problem with it, I suppose, if you're trying for purity in your systems, but aren't all your in-hospital systems running Windows anyway in order to interface with all the ancient software packages running your hospital?
I have no idea what iSite is like as a back end app - the UI is brilliantly intuitive (and, as you might suspect, it was originally designed by a radiologist with programming experience).
Oh, if I were a nurse I'd hate the system even more. See, we docs have a pretty Iif slow) new web-based interface to labs, history, etc. The nurses have to enter lab and medication orders into the system using a 3270 emulator that is... suboptimally designed. Too many clicks.
BTW, if anybody reading this writes medical software, please please please try to include a history function. It's a tremendous time-saver if I don't have to look up their medical record number and can just click on them from a list of "last twenty patients". If you don't have that magic number on you, and he's not an inpatient (who can be looked up by room number or admitting doctor), and your patient is named John Smith, you can imagine what trying to find him is like. I understand that most of this stuff has to be tied into the system bought twenty years ago to run the lab and pharmacy, and that the back end may limit what you can do. But Stentor (see above) does this, and it's a massive time-saver when you want to look at an X-ray or CT scan with someone else.
While I'm wishing, there's a shorthand we use to represent lab results - a little skeleton for commonly-ordered chemistries, where each value fits into a box (e.g., top left is sodium, bottom left is potassium). There are similar ones for blood counts and coagulation tests. If you can display the values in that format on your web app, doctors will thank you unto time immemorial. I've seen hospitals that do have that system, and you can imagine how much it speeds us up to be able to see the whole thing at a glance.
Oh, that's someone else. The only "medicine" I give for "back pain" is a steroid injection into the joint. If we start playing candy dispenser, they come down on us fast and hard.
AMEN BROTHER! I'm a doctor in a hospital that just deployed an electronic health record system that is slower than the system it replaced - which was slower than the TTY system it replaced - that refuses to search patient names if you can't provide a first initial. I'm an anesthesiologist, so I see people I don't have long relationships with, and remembering someone's first name is just damned hard when you remember their medical conditions better than their name. The one piece of medical software I've seen that is really fantastic - and no, I don't own a piece of the company, I just wish I did - is our radiology system, Stentor iSite (now bought by Phillips, I think). It's very easy to use, yet the advanced user can access all sorts of features that improve the experience.
If you'll go back and review death penalty history, you'll find that at the time of Furman v. Georgia, the Supreme court decision that struck down all extant death penalty statutes in this country, sixteen states (and the federal govt) permitted capital punishment for rape of an adult. That was only two fewer than allowed it in 1925. When Coker v. Georgia came down, essentially banning death as a punishment for anything other than murder, Georgia was the only one making rape a capital crime - but other states had tried and had their laws struck down. In other words, there is pretty good evidence that in some states there was support for making rape a potentially capital crime, and the Supreme Court told them to take a hike.
Now, given that this was law in a minority of states, there's no way to make it a constitutional amendment that will pass (and thus override the SC). So while I understand your frustration with the comment, his community didn't get to make the choice about that. Neither did yours. None of them did, because the Supremes said otherwise.
Uh, you can't charge somebody 6 figures for a surgery. Now, total bills from the hospital might get that high, but the surgeon typically gets a fixed (and not all that high) fee for the surgery and the first 90 days of care after it. Generally speaking, they're more than happy to provide their services free of charge (for both the original and the redo) if they leave something in you. That doesn't mean the hospital will do the same.
Aah, I am enlightened. I thought that the minutes expired 1 yr from purchase, regardless of other activity on the account. It makes it an even better deal.
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You know, until I started down that thread, I had never thought of it that way either. Serendipity, I suppose.
You anal? Maybe you should give that guy a call...
1) I am both smarter and better educated than most of my peers - as are most of the people on /. I have a post-graduate education in an area where only about 20% of my "peers" have a college degree. (I'm aware that not everyone without a college degree is unintelligent. It is, however, a fairly good proxy, in that plumbers and carpenters with good heads on their shoulders are counterbalanced by [insert your favorite joke major here].) I may or may not be smarter than you, but I'm pretty sure that both of us are several standard deviations above the norm for my area.
2) Call it weaseling if you like, but for a lot of people jury duty represents a significant hardship. I'm still in residency, which means that if I miss more than ten days of a month, I have to repeat the month - at the end of residency. That means that I can't go on to pursue a fellowship for another year, if at all. Sure, the hospital that employs me will give me the time off, but that ten days of jury duty (unlikely for a basic criminal jury, but entirely likely for a major case or a civil trial) will cost me the difference between a resident's income (under $15/hr) and a full independent physician's income (>>$15/hr) for a full month, as well as causing severe hardship for my fellow residents (who would have to cover all of my call duties). I would be insane not to try to get out of it (and, in my state, being a physician pretty much excuses you without having to appear - just write a letter to the court clerk). Would you like it if your doctor's appointment was postponed for another three to six months because she drew jury duty? What if the carpenter rebuilding your kitchen had to call it quits halfway through, for an unspecified period of time, just because he worked for himself? Many, many small businesses consist of one or two principals and would be absolutely killed by jury duty.
Mind you, my municipality recently had a series of incidents involving jurors' cars - having transported themselves at their own expense to the courthouse, they were required to pay for parking; having parked on the city streets, they were ticketed for expired meters; having found streets without meters, their cars were broken into. All this for $5 a day (which won't even pay for your parking)?
As for 3), well, it's not that people who do jury duty are dumb. It's that they have nothing better to do. That might mean a group of retired professionals (including, when I'm retired, me) - but where I live, it's infinitely more likely to be a bunch of people in their twenties and thirties who don't have jobs. You can imagine how, in a civil court, those people will take one look at my (future) income statements and ignore the past that went into it.
It's unfortunate that during the one time in my life - the summer between college and medical school - that I was really able to do jury duty, I didn't get picked. I'd enjoy doing it when retired, I think. You're right that jury duty should not be disparaged, but the modern justice system creates an incredible burden on those called to duty without any hint of compensation.
I'm an anesthesiologist. It's virtually impossible for judges and the lay public to determine, really, whether I committed malpractice (absent blatantly criminal acts). In fact, most doctors would probably need a fair amount of exposition to determine whether or not I committed malpractice (as I would, in turn, if faced with a case from another specialty). And yet we are judged by twelve people who could not escape jury duty. Yes, I'd prefer if I were judged only by my colleagues, and so would you. But if that were the case, nobody would ever trust us. It's the price you pay for having a society.
... and I just posted a reply to CleverNickName in the Star Trek visor sale story in which I told him to Shut Up Wesley, at great risk to my otherwise untarnished karma. Oh, the glory.
(Yes, I'm going to hell for saying that.)
The discs can only be spun so fast - only so many cm of linear disc "groove" space can pass the laser in one second. The increased data rate comes from increasing the density of information on that disc so that there are more bytes per cm. The density difference accounts for capacity increases from CD to DVD to BD/HD-DVD.
The movie's older than a college senior. There might be a few people on here who don't get the reference.
Wow, I hadn't thought of that game since it came out. It was pretty good, though a bit short IIRC.
I wish I had mod points. True, very true. I've had any number of ideas over the years that - within a couple of years - became highly successful products. Of course, I lacked the financing and technical know-how to make them into those successful products, which is why I'm not a billionaire. Consider the MP3 player - anybody could have figured out it was going to be a big product. But you had to put in the time to make a compact device with good battery life and a decent UI, which was the hard part.
Dang. You're right, and I must simply have misremembered the story's ending. I still think he's wrong, but it doesn't say what I thought it did.
I know this is /., but really -- listen to the link, I didn't put it there just because it looks pretty. It'll take you the better part of an hour. It's a rather thorough account of a guy trying that theory out for real. He rapidly finds that antelope can outrun us with ease, and that all they have to do is get over the nearest hill for you to lose track of which specific antelope you're trying to run down. The way to kill bison and antelope without a mount is to drive them off a cliff in a stampede.
That's a nice story, but experience disagrees with you. Quadrupeds move much more efficiently than we do. We're smarter than they are, so we take advantage of their behaviors to kill and eat them. Driving herds off cliffs, e.g. However, the experience of the Plains Indians with horses pretty clearly shows that people will take any advantage they get and use it to master their surroundings. If people on horses were inferior to people on foot, they wouldn't have bothered to become expert horsemen.
Here's one for you: in my hometown the one-way streets downtown have a speed limit of 30 mph. The only way to get a "green wave" is to travel at 40-45 mph. This is entirely logical at rush hours, when traffic already at those lights will need a bit of a head start, but at night it's just a speed trap.
So... why are you Linux-based? I'm all for FOSS, but aren't you just making your life a lot harder than it needs to be? After all, if you're in health IT, your life is hard enough as it is.
One consequence of this is that when we waste our excess controlled substances, we don't just do what nurses on a regular hospital floor do (which is squirt it down the drain while another nurse observes and verifies). We have to package it up and drop it in a baggie. Every day the pharmacy randomly chooses a few syringes to test to see if what you say is in the vial is what is really in the vial. If the two don't match (i.e., there's saline in that vial that's supposed to be full of morphine) you'll be doing urine tests and non-random sampling of all your cases for months on end.
So while I believe in treating surgical pain (and postsurgical pain), there's really no purpose for people to get opioids for much else. They may make you feel a little high, temporarily, but they don't treat chronic pain worth a damn. There's no good demonstrated reason for people to be on chronic opioids except cancer pain. Unfortunately, that's something we've only realized in the past couple of years (because we didn't much give chronic opioid therapy for non-cancer pain until the mid-90s). Most chronic pain people will benefit from a mixture of therapies, and unfortunately a lot of them are just going to have to live with the pain and hope to improve their functionality. (I know this sounds cruel, but if you interview these people carefully you'll find that their pain that is normally an 8 on a scale of 1 to 10 is reduced to a 6 or 7 by high-dose opioids. That's a tiny change for a big risk.)
So, to answer your questions: I am a firm believer in pharmaceutical treatment of pain and, for that matter, anything else. You just have to have a clearly defined goal for treatment that your patient understands and buys into. If you wander into my pain clinic, don't expect me to become your candy machine; I'm happy to set up a plan to treat and improve your pain, but chronic opioids aren't going to be it. I'm a subspecialist and there's no way I know you as well as your primary care doctor does. And given the special nature of my profession (and its concomitantly high rates of abuse) we will tend to get slammed faster and harder than other fields of medicine if we overstep the line. Let's face it: if you were into drugs, which field of medicine would you go into? Pediatrics, where you get all the free antibiotics you want? Or anesthesia, where you can secret away enough to give yourself quite a party every weekend? Too bad the addiction rates are so high...
If so, it would definitely qualify as the "pointy-haired boss" sort of thing. Realistically, the problem isn't that people want to look at random health records; they're looking for the records of friends, neighbors, enemies, and celebrities.
I have no idea what iSite is like as a back end app - the UI is brilliantly intuitive (and, as you might suspect, it was originally designed by a radiologist with programming experience).
BTW, if anybody reading this writes medical software, please please please try to include a history function. It's a tremendous time-saver if I don't have to look up their medical record number and can just click on them from a list of "last twenty patients". If you don't have that magic number on you, and he's not an inpatient (who can be looked up by room number or admitting doctor), and your patient is named John Smith, you can imagine what trying to find him is like. I understand that most of this stuff has to be tied into the system bought twenty years ago to run the lab and pharmacy, and that the back end may limit what you can do. But Stentor (see above) does this, and it's a massive time-saver when you want to look at an X-ray or CT scan with someone else.
While I'm wishing, there's a shorthand we use to represent lab results - a little skeleton for commonly-ordered chemistries, where each value fits into a box (e.g., top left is sodium, bottom left is potassium). There are similar ones for blood counts and coagulation tests. If you can display the values in that format on your web app, doctors will thank you unto time immemorial. I've seen hospitals that do have that system, and you can imagine how much it speeds us up to be able to see the whole thing at a glance.
Oh, that's someone else. The only "medicine" I give for "back pain" is a steroid injection into the joint. If we start playing candy dispenser, they come down on us fast and hard.
AMEN BROTHER! I'm a doctor in a hospital that just deployed an electronic health record system that is slower than the system it replaced - which was slower than the TTY system it replaced - that refuses to search patient names if you can't provide a first initial. I'm an anesthesiologist, so I see people I don't have long relationships with, and remembering someone's first name is just damned hard when you remember their medical conditions better than their name. The one piece of medical software I've seen that is really fantastic - and no, I don't own a piece of the company, I just wish I did - is our radiology system, Stentor iSite (now bought by Phillips, I think). It's very easy to use, yet the advanced user can access all sorts of features that improve the experience.
Now, given that this was law in a minority of states, there's no way to make it a constitutional amendment that will pass (and thus override the SC). So while I understand your frustration with the comment, his community didn't get to make the choice about that. Neither did yours. None of them did, because the Supremes said otherwise.
Uh, you can't charge somebody 6 figures for a surgery. Now, total bills from the hospital might get that high, but the surgeon typically gets a fixed (and not all that high) fee for the surgery and the first 90 days of care after it. Generally speaking, they're more than happy to provide their services free of charge (for both the original and the redo) if they leave something in you. That doesn't mean the hospital will do the same.
Aah, I am enlightened. I thought that the minutes expired 1 yr from purchase, regardless of other activity on the account. It makes it an even better deal.
... but those expire at 1 year, no?