Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

Cape Cod

Posts Tagged ‘glassman’

Cost + Quality + Convenience = Value

My wife Beth and I had a rather spirited discussion about how we in the U.S. might be able to pay for the healthcare of our citizens. Being ever practical, and also owning the job of writing the checks that pay for the “health insurance” our company offers its associates (including us), Beth in effect is arguing for a national consensus on something we might describe as a baseline ‘value’ for healthcare. Others would label her concept a ‘floor’, but you get the idea.

What Beth intuitively understands is the tension between cost, quality, and convenience. You pick a baseline or a floor level of value and offer that to everyone. With training as a nurse and 15 years in healthcare administration, her idea of what constitutes the sum of cost, quality, and convenience naturally overweights the integers for cost and quality: outcomes should be essentially equal across the board at the baseline or floor level, and the costs of achieving that should be in some way equitably shouldered by something we could describe as “society”. Very practical. A strategy that lends itself to being observable and measurable.

What’s the rub? Well, only two of the three elements that make up value are covered. To obtain an agreed upon level of medical outcomes (mortality, morbidity, longevity, etc.) the cost is covered. Ah, but HOW you obtain those outcomes is still a variable. It is the FLOOR of value that is guaranteed. Our family is experienced a bit of this recently with Beth’s Mom. After a hospitalization she was living in a setting that ws providing excellent care at a reasonable cost, but it was a setting that did not provide any extras; it was old, not very pretty, and she could  have had a roommate. Her (and her daughters’) experience, what we might call “convenience” or  in our formula, was found to be lacking. The girls opted to move her to a nicer setting, one that will eventually involve a higher cost because of the enhancements to the experience, with no change in the already best possible outcome, or quality.

Therein lies the problem with any discussion about literally anything that we might discuss as a “right”. Is everyone entitled to anything other than the minimal amount of convenience/experience necessary to obtain the best outcome at an affordable cost?

If we examine food, we find something quite similar. No one among us would say that X Million people should go without food. Indeed, we don’t even really talk about true hunger in the U.S. anymore, we talk about “food insecurity”, the concern that we may become hungry. By the same token, though, no one asserts that everyone is entitled to the same quality of food. Not even a little bit. No, quite the contrary, all that is discussed is cost and convenience (access).

Now, of course, we in the CrossFit world (and to a degree in the medical world) argue that quality is an ineluctable part of nutrition, that one must extend the equation outside of food alone so that an explicit choice is made that prioritizes quality calories over other purchases (cell phone, cable, fancy car, etc.). While this is accurate and proper I believe that we can reasonably quarantine nutrition and keep it separate from other needs, at least for the purpose of our discussion. The universal concept of the interplay between cost, quality, and convenience holds true in nutrition/food on a global, grand policy making level:

You can pick any two, but only two, when you are declaring what is the minimally acceptable level.

My formulaic approach to the coverage of needs has a little wrinkle that should be mentioned: quality cannot be increased ad infinitum. In all examples we might evaluate there is a practical limit to the ability to improve quality or outcomes. The law of diminishing returns arrives in the form of the asymptote as quality rises. On the other hand, cost and convenience are unbound and can rise almost infinitely. It is the alcohol in a drink that confers the health benefit; the same outcome occurs no matter what you drink. One person’s jug wine from Costco is another person’s Chateau Lafite served in the Gulfstream V. You get the picture.

What will become of our conversations about issues such as healthcare? Will we arrive at a similar juncture to the one we have now in food, clothing, and shelter? Where quality (outcomes) and cost issues are addressed and everyone is left to make their own call on convenience/experience? Beth can’t see how it can be any other way. Me? I’m much less optimistic. That old “want vs. need” thing just keeps popping up. Confusion arises when a truly generous people confuse what people want with what they need. Need is measurable and therefore finite, whereas want is neither. We can, and should, all work to pick up the check for the needs of each. “Want”, on the other hand, is the proverbial “free lunch”, and we as a society will need to agree on that before we can even begin to discuss begin to talk about the mechanics of paying the bill.

TANSTAAFL. Heinlein was right.

 

Succeeding Through Effective Failure

The secret to success just might be failure. Not abject failure, of course (although it’s always cool to use the word ‘abject’), nor consistent failure. But failure while pushing one’s limits or while exploring the new and the unknown might be the magic ingredient in the success recipe.

Why? Success is not simply the absence of failure, it is the defeat of failure. Success is over-coming failure. Indeed, without having failed at something some time, how do you know what success is? How do you know what it’s supposed to feel like?

Neither success nor failure need be any particular size. Small successes build confidence, and smallish failures teach. It’s important to qualify acceptable failures, though. Failure caused by sloppiness or laziness is ALWAYS bad. On the other hand, failure encountered while stretching beyond one’s limits, while reaching for something new, large, important…well…that’s the type of failure from which lessons are learned.

It takes a certain chutzpa to put one’s self at risk to fail while in the act of reaching further. I like Churchill’s take on it: “Success is never final. Failure is never fatal. It’s courage that counts.”

Be a little brave while failing.

Sunday Protests

One of my all-time, never fails thrills is a pre-game flyover. I get serious chills and a full coat of goosebumps every single time. Doesn’t matter what event follows, or why I’m watching. Unexpected, surprise fly-overs are an even more special treat, that “oh, you’re kidding…I get to see this even AND I get a fly-over?” It’s like getting dessert first at a Michelin starred restaurant. Never having served in any of the branches of our military I have no special call to feel this way. Yet goosebumps arrive on cue whenever a particularly moving rendition of our National Anthem is played, or if I hear Kate Smith or Ray Charles singing one of our other patriotic anthems.

It should come as no surprise, then, that I am quite completely conflicted about the recent protesting of professional athletes done during these tiny interludes of observing our shared nation. I do get, as should all thinking individuals, that the protests themselves are not directed at either the anthem or the flag, and certainly not toward the men and women who have served in the defense of the historical values that these symbols represent. I truly love these tiny moments of patriotic sentimentality. They are, for me, similar to saying “Grace” before our evening meal: a tiny vestige of a once much larger experience.

Sporting events of all kinds used to be a much bigger presence in my life than they are today. Whether playing or watching, it was weird to not have some sort of game front and center. Once I hung up my various sporting implements, and even when I moved away both literally and figuratively from the teams of my youth, I could usually find some sort of sporting event to have on as background noise on a given day. The fact that I watch fewer games, and almost no football, at a time of unprecedented activism on the field is therefore purely coincidental.

Still, I do think about sports, and major sporting events are still a rallying point (or at least a conversation starter) in most walks of my life. To say that this next statement has me conflicted doesn’t really measure up to the truth: the on the field activism of athletes makes me avoid the discussion of sports entirely. It’s not that I feel the athletes have no place expressing their opinions, nor that I necessarily disagree with the opinions they are expressing. The heartfelt conviction that a particular group has been singled out for mistreatment is a righteous cause to which very public individuals could lend their support. By choosing the venue of a sporting event they have removed my ability to choose whether or when I will engage the topic.

By choosing to do it in the manner that they have chosen prevents me from experiencing a tiny thrill that used to at least feel like it was free.

So what? Isn’t that the point of protest, to make the safe and the secure a little bit uncomfortable? Sure, I get that. I really do. It makes little difference to those protesting to learn that people like me really do set aside time to consider the merits of their grievance; creating discomfort is part of the point. Having twice scrubbed my own workplace of all political activity, making it clear that our team is to avoid the creation of similar discomfort in our clients, I sort of feel like my patronage is being abused I guess. Kind of like that old joke “I went to a fight and a hockey game broke out”, except it’s a political expression upending my expectation. Certain jobs just don’t mesh with political action in the workplace. Who wants to see their local police officers in uniform and protesting anything at all? Can you imagine listening to your surgeon expound on some controversial topic just as you slip under anesthesia?

You could very well read this and say that my bleating is nothing but one more example of “White privilege” (funny, given my name), the smug mutterings of someone safe and secure and as close to immune from the dangers being discussed. I would understand your position. I would disagree, but I would understand, and more than that I would inherently realize that no amount of discussion on our mutual parts would change your mind. All good. I’m uncomfortable, and a little bit unhappy, and maybe that was always the point.

The risk is that my discomfort may make me stop listening. That’s probably not what the protesters are aiming for.

Contentment, Complacency, and My Fitness Tracker

Where does being content end and being complacent begin? As an older athlete this question is just dogging me. The parallel question might be where is the line between being content and capitulating? These are both, of course, extensions of some of my recent thoughts on balancing the effects of relatively high intensity workouts with the countervailing effects on recovery, plus or minus injury.

There might be a more scientific answer to these, at least in so far as fitness is concerned, and it would come from of all places the fitness tracker world. As it turns out my latest tracker(s) have the ability to measure the beat-to-beat variation in heart rate (HRV). This measurement is a proxy for autonomic nervous system activity. A lower HRV means autonomic stress. If correlated with the previous day’s workout that would argue for either a lower intensity session or rest.

Is HRV ready for prime time? Well, world class endurance athletes and many professional athletes in other sports certainly think so. How about for us, the regular folks hoping to improve our fitness and along with that our health? Dunno. I’m impressed and frankly a little depressed to find that my HRV responded so classically to what was for me an intense WOD yesterday. For this to work one must have the discipline to dial it back if your HRV is low on a particular day (be content with your work), but also the discipline to ramp it up when your HRV is high (fight complacency and go to work).

In a busy life it is likely the second part that will prove the more difficult.

Careless Joy

Quiet house. Quiet lake. Quiet mind? Not so much.

When you are riding high, hitting all of your numbers, looking out over a quiet lake as far as the eye can see and embarking on another stretch of smooth sailing, are you the type that rides the crest of that wave with the carefree joy it deserves? Or are you rather the sort that cannot shake the awareness that below your tranquil waters there lies a hidden reef that portends despair should you happen upon it? The question is more than just the old “are you an optimist or a pessimist” saw, I think. At its core lies one of the keys to happiness: can you live in a happy moment without simultaneously giving space to another darker, sadder moment?

During the dance are you always on edge waiting for the other shoe to drop?

None among us lives a life filled with only joy and happiness. Indeed, there are those whose lives are a proverbial slog from one tragic moment to another. Blessedly, in our developed world, these “treadmills of tragedy” are actually quite rare. Likely as rare as the Unicorn lives filled with nothing but rainbows and Skittles. No, for most of us it’s simply a question of degree leavened by, I dunno, attitude I guess. Do we approach the smorgasbord of our lives as ones of “quiet desperation” as so many novelists propose, or do we rather travel in a state of “careless joy”?

Beth and I are hosted friends this weekend at Casa Blanco, the invitation having come spontaneously months prior and quite amazingly accepted and consummated. The one, a classmate from college, I’ve known for 40 years. The other is my classmate’s relatively new love. How they’ve arrived together at Casa Blanco is quite fascinating. One has lived a life which from the outside seems to have been charmed beyond belief, while the other has struggled mightily to overcome significant childhood traumas. One looks back and muses on choices made and how things might have turned out if present day insights might have been available when earlier crossroads were encountered, while the other has doggedly worked through each treacherous road into and out of those crossroads.

What they have in common, at least this weekend, is the apparent ability to live fully within the joy of whatever moment they are experiencing right now, without allowing the intrusion of the “other shoe”. I am quite sure that each has some something that weighs on the balance toward the negative side of the ledger, but for the life of me I haven’t seen it. Pollyanna or a gift? I’m going with “gift” and furthermore I’m going with being able to watch this couple give themselves completely to each moment we’ve shared as one of the most meaningful “hostess” gifts Beth and I have ever received.

Those couple of things in my life (or yours, or my friends’) that are sitting there ruining your winning streak? That other shoe you just know will drop at an inopportune moment? Meh, they aren’t going away regardless of how you decide to engage with the joyful steps in your life, on your journey. Right now there’s a workout to plan and a lake to jump into. Bacon’s on the griddle while I watch the chickadees eat breakfast. Tapping or shuffling, the sound of the shoes is that of happy dancing, and I am taking my cue from our guests and simply listening.

That other shoe will drop whenever but I’ll likely not notice.  I’ll be too busy dancing to worry about it.

Of Tradewinds and Science

“A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die.” –Max Planck

So very much of what we encounter as we seek any kind of guiding truth is not science at all, but strongly held opinion forcefully presented. Think about it for a moment. Think about a few of the really big issues orbiting the intellectuosphere. Climate change. Health. Fitness. The search for the cure for cancer. Heck, the decision on what to have for lunch. So many opinions…so much money…so little true science.

Even more than that, scientific truth is continually bludgeoned by the one-two punch of politics and commerce. True science has always been held hostage by those who have vested interests in what constitutes the prevailing truth at any given time. How many promising avenues of inquiry have been blocked, and how much time has been lost because of the failure to pursue additional lines of inquiry that ran counter to “consensus”? One need only think of inflammation in vascular disease or alternatives to “fat in the diet is unhealthy”, both squelched along with the careers and reputations of their proponents while the single consensus theory was pursued. Why? Alternate theories or parallel theories would siphon the spoils from those who fed at the consensus trough.

It’s quite tempting to hold that this is all relatively new, that it is a function of our highly developed Western societies. Tempting, but ultimately false. Has there ever been a time in recorded history when a new scientific truth has upended orthodoxy and there has NOT been an attempt by the entrenched to not only stop an new line of inquiry but also destroy those inquiring? Think Galileo. From where I sit it seems as if a substantial majority of truly disruptive new scientific truth has arisen from the ranks of those who stood aside the prevailing winds and charted their own course.

What does this mean for each of us as we sit in our own little boats and sail along? The trade winds of consensus are strong, and it seems the weaker the science behind them the stronger they blow. It’s fine to allow these to fill your sails, of course, for the majority of them do in fact propel us along a true course. The best course, however, may lie in the breezes that cross the trade winds. Those tiny little gusts that represent the true essence of real science–skepticism accompanied by inquiry, followed by proof–will ultimately propel us to the proper destination despite the power of the commerce attached to the trade winds.

Every now and again the Newport to Bermuda race is won by a rebel who went off alone and discovered a new truth about sailing. We should be open to the possibility of a new scientific truth in all parts of our lives, lest we find ourselves far behind, capsized in its wake.

Or worse yet gone, as Planck suggests, long before we ever had a chance to benefit.

Evaluating Risk in the Mature Athlete

“Achieving a risk level of 0.00000% is costlier than 0.0%.” –Saurabh Jha (on Twitter)

Think about that for a minute. It was written in the context of medicine and medical care, but we should think about risk in the context of our CrossFit or fitness practice, too. Beth and I had a really nice conversation with my sister-in-law Amy (of Champlain Valley CrossFit, home of Games champion Matt Fraser) about CrossFit for the masses. The specific topic was how many CrossFit WODs should regular folks, especially–ahem–more mature regular folks be doing each week and what sort. In a way it was a discussion about managing risk.

As I’ve gotten older my ability to challenge my body without incurring minor injuries has declined. At the same time, my ability to recover from those injuries has declined apace. A far more mundane, but equally actionable observation is that I do not recover from the intensity of the WOD as quickly as I did 5 or 8 or 10 years ago. In other words, there is some risk in continuing to do CrossFit in the same way that I did in years past.

There is a flip side to this, of course. Prior to embarking on my Crossfit odyssey I would be incapacitated with back pain 2 or 3 times each year. Since January 2006 that has occurred precisely once, and that was because I deviated from standard-issue CrossFit to join a friend in his Oly workout while visiting. I am struggling to create a regular workout schedule since CrossFit Bingo/Comet CrossFit closed. Without question I am not as healthy as I was at this time last year.

Each of us is a study group of one, each with a personal risk/benefit ratio that can only be discovered by at the very least coming right up to the edge of “too much”. The more experience you have the more confidence you probably have in your own ability to determine where that is. Others can, and should, put the responsibility for charting that course in the hands of their CrossFit or other trainer. Once identified, though, it makes little sense to flirt with the flame of “too much” when there is so much to be gained from “enough”.

For me what that means is continuing to pursue at least the maintenance of my functional strength by continuing to follow the latest version of CFSB from The Brand X Method(R). I find that 2 high intensity WODs, 3 at the most, is what I can handle each week. As much as I hate to admit it, long brisk walks are becoming a staple of my fitness and health plan. I should probably ask Abbie the Wonder Dog to join me on those.

Nothing is completely safe; seeking yet another zero after zero after the decimal point before starting treatment means never starting. Once effective dosing is established, in medicine or in CrossFit, one must judiciously minimize risk, but not to the extent that the benefit cannot be achieved.

In Which Pooh and Christopher Robin Reunite

Christopher Robin: “I’m not going to do Nothing anymore.”

Winnie the Pooh: “Never again?”

CR: “Well, not too much. They don’t let you.”

Toddlers rule the world. Seriously. Beth and I are watching the Man Cub and his tiny baby sister (“Pippy”, at least for now) as their parents take an afternoon to be the young couple that they are. A two year old is nothing but non-stop movement, all curiosity and instant gratification in a tiny bundle of Brownian Motion. There’s no sorta minding the toddler while you “get stuff done”, either. When it’s your turn on watch you are either on them like a hawk or you beg to be relieved of duty.

We are (mostly) blessed that our little guy is also quite bright and very verbal. It makes the time quite a bit more enjoyable while simultaneously taxing. “What is it?” pops out every 2 or 3 minutes, and every activity is preceded by an announcement–”I gotta do whatever”–and then accompanied by “play by play”. The announcements are quite handy in that they let you know where the next disaster is headed so that you can be ready to avert.

Having said all of this I am nothing short of astonished by how much more I am enjoying this stage than I did with my own kids. Don’t get me wrong, the sense of discovery and the unconditional love were there when my kids were toddlers for sure. The difference in the experience has everything to do with me: I have given myself permission to enjoy it this time. On Sundays now I muse whenever, whereas if I were a muser back then I would have tried to muse while on duty, an impossible task guaranteed to increase frustration and diminish the joy in both activities.

Therein lies the key, the gift of grandparenthood: you realize that you really do have a choice. If you are wise (or live with a wise spouse like I do) you give yourself permission to do what once upon a time felt like doing Nothing. It’s not, of course. Not for you and not for your little one. For you the gift is to re-live the wonder of discovery in a child while you witness the purity of the experience your grandchild is having. What your grandchild receives is you. All of you, all to themselves, for what feels like to them at the time like all the time in the world.

In the end the most fortunate among us are those who get to live in the chapter that A.A. Milne never wrote. The one in which Christopher Robin realizes that “he” has become “they”, and that it is only for him to decide that it is time for him to return to the Thousand Acre Wood. In the guise of his grandchild he will find that Pooh is still there, that he still loves Pooh and Pooh loves him. There to sit doing what “they” would call Nothing.

With his grandchild at his side, to sit together doing Everything.

 

Essential Tech? Really?

The author of an article in last week’s Sunday Times asserted that Google and Facebook are “essential tools.” Jonathan Taplin states that everyone has “no choice but to use them.”

Facebook as an essential tool. He really said that, presumably with a straight face and no irony intended.

The reality of the developed world is that search is indeed essential at some point in most lives. Google owns 90% of search traffic, but there are at least 3 other search engines that are adequate at worst, and likely comparable in terms of information acquisition (if not ad awareness) with Google. Facebook, on the other hand, is little more than a toy in the hands of its users, and likely a dangerous one at that. The nameless, faceless scientists behind the curtain in Oz…er, Facebook…want to get you there, keep you there, and control what you do there. Facebook (and its kissing cousin Instagram) is purposely addictive, and face it, the super-majority of what you may do there is far, far from essential.

It’s very helpful to be able to call up information at the touch of the finger (a sales guy answered a complex, archaic golf question for me yesterday in about 27 seconds). Quite frankly I’m at a loss to think of a single essential aspect of FB in daily life.

My dentist still puts out magazines to help me kill time in the office.

 

Hubris and Humility

“You want to shine but not so bright that you burn everyone in the room.” –Pharrell Williams

The hubris/humility axis an interesting ride, isn’t it? Like you I am watching Matt Frasier run away with this year’s CrossFit Games men’s competition. How will he respond when he is interviewed after his victory/coronation? Where will he land on that H&H line? It’s fascinating to watch someone who is truly extraordinary at what it is that they do walk the line. Indeed, it’s probably not possible to stand out if you don’t stand way to the ‘hubris’ side at some point, at least while you are at whatever it is you do.

This year marked the 26th annual White Family visit to Cape Cod. Like so many of our recent trips this one was filled with talk of illness and cures. We told stories from my Dad’s past (the world’s most arrogant heart surgeon was a favorite) and sadly from my mother-in-law’s present. The morning of my departure was spent seeing patients for whom I’d done surgery, alternately sharing in their delight at vision re-discovered and fending off what felt like over-enthusiastic praise. Like Matt, I’m really good at what I do, and quite frankly when I am about doing what I do I literally go into each “contest” convinced that there is no one in the world better than I am at that particular time.

Is that hubris, or just the confidence that any “athlete” must take into the arena at game time?

The difference probably rests on a couple of things. One must be ever aware that everyone has limits. True, if you are very, very good at what you do your limits may be so far to the right of the Bell Curve that it can seem like they don’t exist. Succumbing to that sense is precisely when confidence becomes arrogance; someone or something is going to break, eventually. One wonders how that arrogant heart surgeon handled the inevitable defeats in the OR.

Pharrell’s quote likely points us to what it is that separates the arrogant from the humble, the realization that what you do well does not necessarily elevate you above those for whom you do it. One who allows himself to bathe too long or too often in the reflected light of his excellence gets burned just as surely as everyone and everything else.

Frasier, like Froning before him in the CrossFit world, will quite likely acquit himself well in his victory interview. He will allow that he worked very hard at his craft, and that his hard work paid off handsomely. His humility will show in that he will also point out that he was given many gifts, born with certain skills that he could then hone through his work and thus produce this singular achievement.

In the end what humility means is the difference between thankfulness and self-satisfaction. Again, Pharrell Williams: “As long as you’ve got your light, people will see you.”