Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

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Archive for January, 2014

Reflections: Temperance vs. Abstinence.

The weekend papers introduced me to Charlotte Stockdale this week. I will admit that I’m a bit conflicted about Ms. Stockdale. My first impulse is to view her as inconsequential given her high birth and the subsequent layering of additional wealth garnered solely through genetic entry into the business of “pretty”. However, in an otherwise vacuous interview spent mostly discussing her personal relationship with skin care products, she provided me with the yin for a hanging yang.

You see, Beth and I have been on an adventure cruise, a quest of sorts. We’ve been exploring the wonders of the classic cocktail. Equal parts alchemy and indulgence, our trip has been more exciting (as all adventures are) because of the little bit of risk involved. What if we find one (or two, or…) we really like?

Like many pleasures to drink is to willingly hold the proverbial double-edged sword in your hand; in this case the sword just happens to look like a martini glass. Alcohol as both a substance and a subject is complex and rife with controversy. It’s legal, but only to a point. It’s beneficial, but with a caveat–people who drink just enough live longer than those who drink more or not at all. As a chemical it’s a depressant, and yet in many circumstances it imbues joy in those who imbibe. It all comes down to a fine and delicate balance, not unlike that found in a perfectly aged wine.

The matter of regulation intrudes on the pleasure. Knowing the existence of the second edge and maintaining an awareness of its cut is both necessary and nettlesome. If you find this lurking behind every glass, cannot escape it’s specter, it may rob you of the joy; if you careen from joy to joy you will inevitably suffer the cut and bleed. Temperance, then, is the essential ingredient, the co-pilot who must be ever present on this particular trip.

Ah, but temperance, willful self-control, can feel like a 50 MPH governor on a Ferrari, especially if you make the Indiana Jones-like discoveries we’ve recently made. It might be so difficult and so distasteful, temperance that is, that you decide to roll your dice on the “not at all” line. “Abstinence is as easy to me as temperance would be difficult.” Samuel Johnson. Indeed, temperance seems so often driven by that wraith “guilt”. There’s joy and pleasure to be had, but what if there’s too much? Ah, guilt.

It’s all so complicated, not unlike the math involved in the archaic elixirs we’ve been experiencing. So very hard sometimes to ease off the throttle without the aid of the governor. If the “Gizmo”, the “Sideswiped”, and the “Carro del Lô” be guilty pleasures we might ask my interesting discovery Charlotte Stockdale what she thinks of such things.

“I don’t have a guilty pleasure. I don’t really feel guilty about anything. What’s the point?”

As out of the corner of your eye you see it, the shadow of the double-edged sword, one edge Samuel, the other Stockdale, as the light dances off the blade.

EMR and Underpants, Still

Skyvision Centers has a subsidiary company called the Skyvision Business Lab. We do business process research for pharmaceutical companies, medical device companies, and other medical businesses in the eye care arena. One of the companies we have worked for is a very cool company that produces animated educational videos for  ophthalmologists and optometrists. I had an interesting experience while talking to their chief technology officer. It was interesting because the conversation proved our basic reason for existence at the Business Lab, that it is impossible for any company to develop, sell, and install any kind of product in our world without understanding the ins and outs of every day activities in an eye care practice.

Of course, I always find it extremely interesting when I’m right!

It was a tiny little point, really, but how could you know something as small and seemingly insignificant as our discovery unless you had spent time on the “frontline” of medical practice? The chief technology officer for the video company was frustrated because doctors and their staff were not using this really cool product that they had purchased. Furthermore, because they weren’t using it, they were failing to buy downstream products from the video company. As it turns out the salespeople for this company were telling the doctors that this particular product should be “turned on” by the staff at the front desk of the office. This is exactly the wrong place because the front staff personnel simply have neither the time, nor the understanding, nor any incentive whatsoever to do this. The product actually works beautifully if it is “turned on” by the back-office staff. Bingo! Problem solved.

So what does this have to do with Electronic Medical Records (EMR), and for heaven’s sake what does this have to do with underpants? It’s simple, really. When was the last time you bought a totally new type of underpants, underpants that you had never seen before, and underpants that you had certainly never worn before, without trying them on? Furthermore, what’s the likelihood that you would allow someone else to design, fit, and choose a style  of underpants for you if that someone has not only never met you but has never even seen a picture of you?!  That’s the image I get every time I read an article about EMR.

In theory the concept of an electronic medical record that would allow permanent storage of every bit of medical information, with the ability to share that information between and among doctors and hospitals involved in the patient’s care, is so logical and obvious that debating the point seems silly. If you have ever seen my handwriting, for example, you’d realize that the entire field of EMR was worth developing just to make doctors stop using pens and pencils! Trust me on this… the doctor hasn’t yet been trained who is also a specialist in penmanship.

I actually trained at  two of the pioneering hospitals in the use of electronic medical records, and indeed in the use of computers in medicine in general. Dr. Larry Weed and Dr. Dennis Plante at the University of Vermont were pioneers in the concept of using computing power to make more accurate medical diagnoses. Both the University of Vermont Medical Center and the Maine Medical Center were among the very first institutions to develop and implement digital medical records for the storage and use of clinical data like lab reports and radiology reports. In theory both of these areas make sense, but in practice the storage and display of clinical data is all that’s actually helpful in day-to-day practice.

If this is the case, if the acquisition, storage, and retrieval of critical data is helpful, the next logical step must be to do the same thing with the information obtained in doctor’s offices, right? Well, in theory this makes a ton of sense. The problem is that nearly none of the EMR systems now in place have been designed from the doctor/patient experience outward; they’ve all been designed from the outside in, kind of like someone imagining what kind of underpants you might need or might like to wear, and making a guess about what size would fit you. With a few exceptions, tiny companies that are likely to be steamrolled in the process, every single EMR on the market is the wrong fit for a doctor and a patient.

Why is this? How could this possibly be with all the lip service that is being paid to the doctor /patient relationship and the importance of getting better care to patients? It goes back to that same tiny little problem that the medical video company tripped over: it’s really hard to know how something should work unless you spend some time where the work is going to be done. Electronic medical records in today’s market are responsive to INSTITUTIONS, insurance companies and governments and large hospital systems. System before doctor, doctor before staff, staff before patient. Today’s EMR’s have been designed with two spoken goals in mind: saving money and reducing medical errors. Should be a slamdunk at that, right? But even here the systems bat only .500, producing reams of data that will eventually allow distant institutions to pare medical spending, but neither capturing nor analyzing the correct data to improve both medical outcomes and medical safety. Fail here, too, but that’s another story entirely.

So what’s the solution? Well for me the answer is really pretty easy and pretty obvious. Send the underwear designer into the dressing room! Program design, programs of any type, are one part “knowledge of need” and one part plumbing. How can you know what type of plumbing is necessary unless you go and look at the exact place where the plumbing is needed? How can you know what size and what shape and what style of underwear will fit unless you actually go and look at the person who will be wearing the underwear? It’s so simple and so obvious that it sometimes makes me want to scream. Put the program designers in the offices of doctors who are actually seeing patients. Set them side-by-each. Make them sit next to the patients and experience what it’s like to receive care.

THEN design the program.

I’m available.The  Skyvision Business Lab is available. I have a hunch that the solution will hinge on something as simple and fundamental as my example above — front desk versus back office.  It doesn’t necessarily have to be me, and doesn’t necessarily have to be us, but it absolutely is necessary for it to be doctors and practices like Skyvision Centers, places where doctors and nurses and staff members actually take care of patients. Places where patients go to stay healthy or return to health. Places where it’s patient before staff, staff before doctor, doctor before system.

For whatever it’s worth I’m 5’8″ tall, I weigh 150 pounds, and I’m relatively lean for an old guy. I guess it’s a little embarrassing to admit this… I still wear “TightyWhiteys”, but I’m open-minded. I’m willing to change.

Just take a look at me first before you choose my underpants for me.

The CrossFit Open 2014

The CrossFit Open 2014. Are you in? Of course you are! It’s a few bucks, sure, and you aren’t gonna make it to Regionals, but you’re in anyway. Right?

Of course you are!

The CrossFit Open is the ultimate participatory athletic event. It’s as if the USGA or the Royal and Ancient ran a tournament for every golfer who wanted to take a shot at the U.S. Open or British Open. $20 and you get to play a round on the same golf course as everyone else, even Tiger. Not only that, but in OUR version you get to play 5 times. Who cares if the chances that you will make it to the Big Show are pretty much exactly the same in the CrossFit Open as they are in my hypothetical USGA Open? Like golf (or tennis, or tennis, or Triathlon, etc.) we play the same sport as the pros.

You know, more or less…

How will I approach The Open this year? For people who are new to my bloviations I am at best a middle-of-the-Bell-Curve CrossFitter for my age and I have exactly zero chance of winning local Masters competitions, let alone make it through the Open. At 54 I am in the oldest group of my Masters division, but for the Open I will try the “As Rx’d” WOD each week, try to get a score that I can submit. It’s fun just to be a part of the conversation. You know, the anticipation all day every Thursday. What’s it gonna be this week. Watching the Leader Board is a hoot, even when your name doesn’t show up until page 14 or so (at least for me). Someone should come up with a “Fantasy Football-like” game we could play during the Open!

Or a drinking game. Yeah, THAT’S the ticket! A CrossFit Open drinking game.

Too heavy and too technical is what I expect to see, at least for me, so after my (likely feeble) “As Rx’d” attempt I will then either move to the 55+ group and do that level, or simply scale and do the Open WOD as my Workout Of The Day, my training. Throwing it in there, not knowing what it will be or how it will jive with the day before or the day after, it’s a little like the “Unknown and Unknowable” for which we train, right? In the end that’s the most important thing for me–the training I get from CrossFit.

Got a legit chance to break through and make it to Regionals? Very cool! Good on ya, and good luck! For the rest of us let’s try our best, give it our all, but let’s also remember that we do CrossFit for health, fitness and fun. Keep your wits about you.

As Sarge used to say on Hill Street Blues: let’s be careful out there.


On Water

The view where I write is of an inland sea. Today the sea before me melts, unleashing the power of water untethered as fully as it curbs the equally awe inspiring power of ice on the march. Indeed, the power of water is inexorable and undeniable in any form. After all, it was the glaciers of an epoch long gone that carved the great crevasses of the earth that we call canyons. Anyone with a flat roof can attest to the stealth of water as liquid, endlessly, tirelessly seeking the smallest weakness and pouring through once it does.

Water is the most valuable and least appreciated resource on our planet. Least appreciated, that is, until you are denied access to it. The water intakes of Lake Erie were frozen solid for some 24 hours this week, in some cases rendering indoor plumbing a concept of the mind only. In West Virginia all uses of all tap water are forbidden, a tasteless and odorless poison carried like a parasite on the back of the whale. Indeed, water lubricates the politics of states and nations, literally, as they fight in ways large and small over who controls the water.

In the end we will discover, to our inevitable surprise, that it is the water that controls us.


When CrossFitters Compete

Registration for the CrossFit Open, the largest simultaneous participatory athletic event in the world, begins January 15th. Are you in? Of course you are! It only costs a few bucks (sorry Dave Castro, I haven’t actually been to the Games site yet so I don’t know the actual entry fee!), and you get to take part right alongside everyone. Even Rich, Annie, Julie, Sam, Jason, and, you know, EVERYONE.

Competing in CrossFit, CrossFit as a sport, is not really my thing. I have too many old injuries that take all of the fun out of “unknown and unknowable” as a game, but I totally get the whole “it’s fun to compete at my thing” aspect of CrossFitters competing . The Open is one cool way to compete, and for me it’s the only one that is enough fun for me to throw my hat into the ring, too. Even at that I will approach each event with safety as my priority. I want to be a part of the whole Open experience, but at the same time I don’t want to get injured and miss any training time in the gym because, let’s face it, I really like begin in the Box.

Injuries in competitions pitting CrossFitters against one another have been on my mind lately. Not crazy, freak injuries that are just bad luck, but injuries that appear to be predictable, at least to me. I’ve been a spectator at almost every CrossFit Games, multiple Regionals and Sectionals (when we had them), and many local competitions set up just for the fun of the competition and the gathering. I’ve been to a number of one’s locally very recently. There’s a trend in these non-HQ sanctioned events that I’ve noticed, and I think we need to talk about it. Now, with the Open almost upon us, is a really good time to do that.

The Open as you know, or are about to know, is one WOD per week posted each week for 5 consecutive weeks. That’s it. One WOD. Not 3 WODs with an hour between each, or a weekend’s worth of work that includes epics like “Elizabeth” followed by “Grace” followed by “Fran”, or a Sprint Tri followed by the BUDs obstacle course. One WOD per week. On top of that you will discover that the WODs chosen will allow for the maximum amount of participation; almost no one will be excluded by a movement or a load that is beyond them because of the structure of the WODs to come. This has been the signature of the Open and there is no reason to expect that the wide-open funnel at the entrance to the Games will be any narrower in 2014.

Yet, when I visit a Box or attend an event as a spectator, or even just look at the WODs posted for a competition, I invariably cringe at what I see. There might be enough volume to make even the hale and heartiest from the NC Lab blanch. The loads on familiar movements are so extreme that they are almost self-parody. To top it off there appears to be an “arms race” between competitions to see who can program the most obscure movements in our entire CrossFit quiver, stuff we do on only the rarest of occasions, and even then only for the unique training effects to be garnered more through mastering the movement than maximizing work with the exercise. Think heavy Turkish Get-Ups or ambushes with axel C&J. These competitions are supposed to be fun for Heaven’s sake!

The “Gamesification” of local competitions is a tragedy in the making. Looking at the events in some of them makes me think of some of the WODs I see posted in various places, long chippers with ever more clever names, each meant to out-do the last. These WODs as an Odyssey have been aptly called “Any Asshole” WODs, as in “any asshole” can put together a bunch of exercises and thrash a group of CrossFitters with them. Even worse is programming for regular CrossFitters that simply pounds away, day after day, with this kind of stuff, or pounds away at them in a local competition. People are getting hurt, missing work, missing time in the gym. It’s not OK.

I am confident that this year’s CrossFit Open will be like the last. It will include standard issue exercises and loads we can handle. Coach Glassman will see to that. For the rest of you who are holding “friendly” competitions around the world I am throwing down the gauntlet: stop hurting my people! Think CrossFit Open more than CrossFit Games when you program for your event. Be inclusive with movements and loads–you can very adequately test your competitors fitness with exercises and weights we use all the time. Save those weird and wacky events (100M backward sprints! One-arm barbell Cleans!) for the controlled setting of a training session under the direction of a trainer concentrating on technique.

It’s supposed to be fun, but as we say in my day job: it’s all fun and games until someone pokes an eye out.


A Comma Person

Tons of random stuff banging around between my ears, so much that it’s a little difficult to wade through and make sense of any of it. One little thing keeps bubbling up to the surface, long enough at least to be noticed: the lowly comma. Mathew McConaughy describes himself as a “comma person”. I get that.

What with all of the New Year’s resolution action, here and, well, everywhere, it can get to feeling like there really is a discreet finish to a year. A ‘period’. Full Stop. Does it seem like that to you? Everyone gets all in a rush to finish off a year, in this case 2013, so that they can get started on the next one. All kinds of retrospectives, writ large and small, come cascading down at the end of the year. As if it really was an end. Capped by a ‘period’, you know?

The thing is, though, that I don’t really feel all that different. It doesn’t really feel like anything was all that completed on December 31st. Or, for that matter, like there’s any huge new start, re-boot, or even a mulligan just after that ‘period’. Sure, there’s a really convenient opportunity to take stock, maybe make some adjustments or even re-route, but the longer I’ve been at this New Year thing the less it seems like anything is ever really at Full Stop.

More like a pause. That’s it. Not a ‘period’ so much as a ‘comma’ leading into whatever comes next.

A sentence, a paragraph, a chapter, or the whole darned story ends with a period. The year is over and the last box has been checked, but the story continues on New Year’s Day. Even the most severe pivot is still connected to the other side of the angle, the beginning of the line. The line, the sentence, the story and the life do not really stop at all; New Year, Birthday, whatever. We may pause, indeed we do pause, sometimes quite often. Full stop? Nah. Not us.

That’s what’s got me thinking about the comma. The story goes on and on, one big run-on sentence with an occasional pause but never a stop. It’s connected front to back, side to side, and start to finish by those pauses, by the lowly comma. I think I get what McConaughy is getting at. New Year’s Day is a comma place for sure, but neither time nor life hits a ‘period’ there, either. We just keep on going. The comma means there’s more to come.

I think I might be a “comma person”, too.


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