Another medical system misstep

In the past, for the most part, if one of the kids got sick we would immediately make an appointment with of the many children’s clinics that seem almost ubiquitous in Hsinchu. If late at night, a quick visit to emergency might also be in order. The only real hesitation we had was the time and stress required to fight traffic during the long rush hour(s).

Other than determining the seriousness of their affliction, and overprescribing medication, doctors in Hsinchu provided a great point of contact for understanding what illnesses were making their way through the city. That way we could be better prepared for the progression of their symptoms, and prepare ourselves if we were also to get afflicted.

That almost reflex to see a doctor is something that I fight against here, as everything is weighed against “is it worthy of a 5-7+ hour wait in emergency”. This is a rather risky equation, as I am no nurse, and some problems are hard to diagnose.

This week Camren had severe vomiting and diarrhea. I initially didn’t take him to a walk in clinic as it seemed like a serious but common gastro intestinal virus. We all eat the same food and he didn’t have an infection. As a result he had a day of rest, kept hydrated, and managed to go to school the following day.

Last night before Jujitsu he complained of stomach pain. He characterized it as being super hungry, so I fed him a banana, and he helped himself to some bread with peanut butter. I then dropped him off at class and ran some errands nearby. But when I arrived back at his class to watch him grapple, he was sitting at the side and the teacher, or professor as he likes to be addressed, told me his stomach was too sore to work out. He hobbled out the door of his dojo, hunched over like an old man might be characterized in a cartoon, and made his way to the car. I saw cold sweat on his forehead which indicated real pain.

When we got home I checked to see if there were any clinics open Island wide. It was 6:30 and they all seemed to be closed but for the one at the Murphys Pharmacy in Stratford, which was scheduled to remain open until 7:30pm. I called the clinic to check if they were still seeing patients and was presented with a recording stating they were open until 7:30.

I packed Camren into the car to go to the clinic and told him not to get his hopes up, as experience has taught me that last minute visits to walk in clinics here are often unsuccessful – they may not be able to see more patients. Enroute I asked him to rate his pain. I said if your broken arm was a 10, how would this rate? He said an 8.

We arrived at the clinic to find that they closed early. Lovely. With no other clinics open we really only have one other choice, the emergency room.

We drove home and I gave him a cursory exam – no fever, no blood in stool, stomach not distended or hard, and he wasn’t vomiting. I used the “is it worthy of a 5-7+ hour wait in emergency” equation and decided to let him rest until morning. He agreed.

Luckily this morning he was fine. But I regret having made this decision. And I don’t appreciate having to make this decision in the first place.

Stomach pain is one of the symptoms that is usually worthy of a trip to an emergency room if other options don’t exist, and so I wasn’t overly concerned about adding stress to the system from an unwarranted visit. My concern was the real possibility that sitting in a chair all night in order to see a medical professional, might make matters worse for him, and to a lesser extent me (I’ve come down with yet another wicked chest cold).

Perhaps this limited access is the norm in most countries but it certainly adds unneeded anxiety to our lives here.

*Peter helpfully points out that there is a service that will help you decide whether your symptoms are worthy of a trip to the hospital. Just dial 811.


Reframing the conversation on patient experience: Three considerations

In experience, every voice matters, and each of those individual voices are contributing to an ocean of ripples that are positively impacting countless lives. In experience, no one organization owns, nor should claim to own all the answers, but many contribute to the possibilities found in elevating the human experience in healthcare. In experience, when we ensure this is a true strategic focus at the heart of healthcare we will find our way to achieving all the outcomes we aspire to achieve and know are possible in healthcare. This issue helps frame that reality though contributions from around the world touching on a broad range of topics, but yet in their distinction, find a powerful commonality, a commitment to the humanity of healthcare. If we reframe the conversation on patient experience to one that is about all we aspire to achieve, about how every role matters, every voice contributes, every perspective brings value and seasoning to an ever expanding mix of possibility, than what we can do in healthcare is boundless. A conversation on experience is not tangential to this opportunity we face, rather it rest squarely at its core and it is incumbent on each and every one of us to contribute. That may be our greatest opportunity in a global healthcare system where access and equity, quality and safety, empathy and compassion and health and well-being are not just what we do as work, but the fundamental reality of all do as human beings caring for human beings.

“Far too many healthcare conversations still identify the concept of experience as separate from other points of focus, such as quality or safety. This perpetuates that idea that experience is simply the service provided and minimizes the perspective that those receiving care bring to healthcare themselves”.

Jason Wolf ~ Patient Experience Journal (Volume 6 Issue 1) *You have about 3-4 clicks before you can read the journal article, but you can read for free.


The Value of Ritual in Your Workday

His acrobatics were impressive, but they were merely a demonstration of his strength. The source was this tea ritual and many other rituals like it. His power as a warrior came from his patience, precision, attention to subtlety, concentration, and his reverence for the moment.

Both of my children had the benefit of attending a private elementary school in Taiwan which eschewed the current trend for using tech for tech’s sake in schools, and instead focused on more giving children more time to slow down and think. They took classes in Chinese calligraphy, Farming, Kendo, Art, and Tea Making. All required otherwise hyper kids to slow down and focus on what they were doing at the moment, and importantly, all were physical to some degree. Tea making not only taught them the importance of ritual, but also taught them how to make a proper cup of tea (a not to be dismissed skill).

The power of ritual is profound and under-appreciated. Mostly, I think, it’s because we live in a time-starved culture, and ritual is time-indulgent. Who can afford the luxury of doing one thing at a time? Who has the patience to pause and honor an activity before and after we do it?

[…]

Here’s what makes it easy to get started with this: no one needs to know.

Start with just yourself. Sit at your desk in the morning, pause before booting up your computer, and mark the moment. Do this by taking a deep breath. Or by arranging your pens. Whatever it is, do it with the intention of creating respect for what you’re about to begin. Do the same before you make a phone call. Or receive one. Or before you meet with a colleague or customer.

Though I find computers to be lifeless things, preparing yourself for a work sprint seems like a good idea to me.

From The Value of Ritual in Your Workday


A smooth sea never made a skillful sailor

I had an interesting conversation yesterday with “Naga”, my Chinese teacher, around a number of very simple topics like foods, our past life in Hsinchu, and some of the differences we have discovered between Canada and Taiwan. With the exception of a brief foray into low carb diets, this is about the level of conversation I can handle these days.

We talked briefly about challenges, or the comparative lack their of in my day to day life here.

Some long term residents of Taiwan might chuckle, but just walking outside your door in Hsinchu presents some challenge; you never know when a scooter or a car might come screaming down the side walk. Crossing the street safely introduces a whole other level of difficulty. Add learning a complex language, a culture which beneath the surface is radically different from my own, and high stress work environments, and it might be easy to see how life here is far more sane.

With the exception of possibly being malled by a scooter, I do miss the challenges I faced there – the insanity. Living in a foreign land, even for the length of time I did, keeps you on your toes, forces you to constantly learn new things, and in the case of Hsinchu force feeds you a steady diet of stress. Perhaps it’s telling that I miss the workplace most of all – the hard problems, ridiculous timelines, and the difficulties in communication (I do recognize that my family doesn’t miss the amount of time I needed to normalize after work).

She brought up a salient conclusion that being in the place where you grew up can make you too comfortable, and that I need to create the conditions here that allow for the same amount growth that I experienced there (but for the sake of those around me, without the stress). Achieving that kind of growth alone might be the biggest challenge of all.


Writing … provides students with powerful opportunities to learn about themselves and their connections to the world. Through writing, students organize their thoughts, remember important information, solve problems, reflect on a widening range of perspectives, and learn how to communicate effectively for specific purposes and audiences. They find their voice and have opportunities to explore other voices. By putting their thoughts into words and supporting the words with visual images in a range of media, students acquire knowledge and deepen their understanding of the content in all school subjects. Writing also helps students to better understand their own thoughts and feelings and the events in their lives.
Literacy for Learning: The Report of the Expert Panel on Literacy in Grades 4 to 6 in Ontario, 2004, p. 79


Goals

After coming from asking my young downstairs neighbour to not play her boom boom music so loud in her bedroom after 10pm*, I just procrastinated for 30 minutes trying to write a sentence in Chinese.

I’m looking for a new Chinese tutor and a good teacher always asks what your goals are. In the past I would reply by saying I would like to speak like a native speaker or sound just like you. I liked impossible goals. Now I simply state that I hope it will slow down or reverse cognitive decline. Perhaps, also an impossible goal.

Cognitive decline could be either 認知能力的衰退過程 or 認知力下降. I’m not sure which is best and my learn Chinese network is all asleep.

* I think I need to take Kirstin Lunds Conflict Resolution course because my well established methods don’t work here.


Negative communication

Someone was angry when they created the messaging for this sign.

In a recent post, Peter gives an excellent example of how we can use language to frame a reality – in this case a street sign which sends a negative message in what should be expressed as a positive. That area is pretty much the lifeblood of the city in summer.

The picture above taken at an old exit inside the Confederation Court Mall, takes this to a needlessly hostile level. In this case you need to find a way to balance the requirement for an exit/entrance with peoples tendencies to make mistakes without treating everyone like a criminal. What message does this sign give to visitors to the space?


Giving it away is more profitable

The day before yesterday, despite the protestations of my son, I sold a Samsung 40” TV that has been sitting under my desk for the 10 months I have been here on the Island. It sat there mostly due to laziness and some vague idea that I might “use it for something”.

I listed it on Facebook for $50, which I thought was reasonable, and would guarantee a quick sale. Later I learned that that might have been a tad low, as it wasn’t 5 minutes after posting, that a flurry of messages starting dinging on my phone from interested parties. And the messages kept coming.

I initially tried to respond to each and every message that came my way. Eventually it was becoming too laborious, so I created a template in Drafts to help automate replies. This too was taking too much time so I set up a who-looks-like-they-deserve-this-old-TV filter to help me decide who to interact with.

I fell into the same trap I criticize companies of; poor communication (it’s only an ad on FB but I felt bad about how I interacted with people).

Eventually the buying customer came all the way from Kensington just before I had to go pick up my daughter from choir. All in all, it took over an hour of my time to sell that old TV.

I should have given it away.


Early home office

Circa ~ 2003 home office. Coffee culture didn’t exist in Hsinchu at that time so I killed myself with Diet Coke. No wifi either.

My copy of “Metaphors We Live By” by George Lakoff was pretty fresh then. A valuable text for anyone employed as a writer or in UX, or simply trying to understand the text we read. Wikipedia describes it as:

“Conceptual metaphors are seen in language in our everyday lives. Conceptual metaphors shape not just our communication, but also shape the way we think and act. In George Lakoff and Mark Johnson’s work, Metaphors We Live By (1980), we see how everyday language is filled with metaphors we may not always notice. An example of one of the commonly used conceptual metaphors is “argument is war”.


A Ghurka rifleman escaped from a Japanese prison in south Burma and walked six hundred miles alone through the jungles to freedom. The journey took him five months, but he never asked the way and he never lost the way. For one thing he could not speak Burmese and for another he regarded all Burmese as traitors. He used a map and when he reached India he showed it to the Intelligence officers, who wanted to know all about his odyssey. Marked in pencil were all the turns he had taken, all the roads and trail forks he has passed, all the rivers he had crossed. It had served him well, that map. The Intelligence officers did not find it so useful. It was a street map of London.
From Bugles and a Tiger, My Life in the Ghurkas via Steven Pressfield

Confidence.
Optimism.
Faith.


District 5

I went to the Green Party’s district 5 headquarters a couple of times before I voted in the advance poll. The first time I had hoped to talk to Michelle Beaton about a range of issues that are important to my family, and to get some clarification on a few contradictory statements I heard in Peter Bevan Bakers speeches (the second time was simply to purchase more of her mothers excellent baked goods). I was impressed by her genuine interest in engaging with her potential constituents, her belief that this was “her life’s work”, and how we could find common ground for a conversation that lasted just shy of 45 minutes. What most impressed me about her was the simple fact that she upon realizing that she didn’t know the answers to all my questions, admitted as much, and set out to find the answers. Which she immediately did and my questions were answered. That quality is valuable I think and I suspect rare amongst those engaged in politics (or leadership in general).

I’m confident that district 5 is in good hands.


It’s broken and no one knows how to fix it

My son has been suffering from an infection from an in-grown toenail for about the past month. Of all the problems one can experience this is certainly no where near the top of the list, except that is, for the infection and the blood. And of course the discomfort.

The first time we went to a walk-in clinic I was surprised by the efficiency of it all. I was also surprised by having to pay a small fee to “Skip the Waiting Room” (previously I called this Skip the Wait I error). Isn’t this socialized medicine? That time we left with some medication and instructions for self-care.

That didn’t work, and the infection got worse, and was having an effect on his ability to enjoy his time training in Jujitsu. And well it’s an infection.

So we found time for another visit to the walk-in clinic – it can be difficult to see a doctor, but this doctor graciously worked over the Easter weekend. Again, no wait and the doctor agrees with me that something more invasive needs to be done. So a referral to another doctor is made.

This morning I received a call from Dr. Flemmings office about a referral for my son. After clearing some initial confusion about his name, I explained that his toe is swollen, bleeding, infected, and rather sore. I was given an appointment for 2 months from now (with an appointment booked that far in advance there is no guarantee).

I did my best to hold back my laughter.

These conditions are apparently have a hereditary component, and my daughter suffered the same problem when we were in Taiwan. There after the initial consult, she had to wait a week, as it was for some reason deemed surgery.

The situation here on PEI is of course ridiculous and peaks my interest as to how despite an increase in taxes by over 260% this year (compared to Taiwan) we can’t manage to enjoy the considerable talents of Canadian doctors, in any reasonable period of time.

This can’t compare to cancer patients or broken bones or the Charlottetown woman who waited 13 hours in an emergency room, but I can guarantee that this issue absolutely scales, and no matter the severity of the condition the problem of access to care remains.


Sobey’s Self Checkout Terminal

Processing, processing. Love the IT admin stickers on the screen.

This is a quick shot I took with my phone while I was trying to purchase a bottle of milk and jar of yogurt at the Stratford Sobey’s. The experience was terrible and required 2 attempts on my part. The context of this particular picture was when I had finally gone through a series of extremely complex screens, full of icons which match nothing from my world, and I was attempting to pay. Apparently there was an error on the interact terminal of some sort, the fact of which I didn’t know except that the attendant told as such, and the screen above was in some kind of loop until it received a message that the payment was not processed. I have a tendency to exaggerate, but it’s a complete garbage implementation. If you like usability heuristics, it’s fun to see how it violates: 1) Visibility of System Status, 2) Match between system and the real world, 5) Error Prevention, and 9) Help users recognize, diagnose, and recover from errors. The role of the attendants that work beside these terminals is not to guide new users through an unfamiliar system but to diagnose errors, fix the systems when they inevitably break down, and help people complete their purchases when the look of utter confusion sets in.


The Servant Economy

An unkind summary, then, of the past half decade of the consumer internet: Venture capitalists have subsidized the creation of platforms for low-paying work that deliver on-demand servant services to rich people, while subjecting all parties to increased surveillance.

These platforms may unlock new potentials within our cities and lives. They’ve definitely generated huge fortunes for a very small number of people. But mostly, they’ve served to make our lives marginally more convenient than they were before. Like so many other parts of the world tech has built, the societal trade-off, when fully calculated, seems as likely to fall in the red as in the black.

The inequalities of capitalist economies are not exactly news.

Also, linked to in the above article is 20 Facts About U.S. Inequality that Everyone Should Know written by the Stanford Center on Poverty and Inequality.

When we first started discussing how we could survive in PEI with it’s limited employment opportunities, one of the main motivations for creating a business was the sense that by working as a remote teacher my wife would become nothing more than a glorified dog walker for the wealthy. Granted, it’s much easier to join someones else’s platform, but I felt that would be a complete waste of 25 years of hard work and her talent for helping children flourish as human beings. Sometimes good things take time.


Always on surveillance

Chinese schools are prototyping facial recognition to monitor students to identify distractedness, level of engagement, responsiveness and other attributes. Every culture has different notions of privacy that are present in social and technological norms and what is considered creepy one day can become the status quo the next and vice versa once underlying dynamics are revealed. The relative importance of education in China, and the invasiveness of these systems will make school monitoring systems a bellwether for Chinese privacy norms, until the next wave of invasiveness arrives.

Chinese schools are using facial recognition on students

If in-classroom facial-recognition systems are teaching students and staff to “perform” for the cameras—in the theatrical rather than pedagogical sense of the word—then how will similar systems extrapolate to society at large? Or for populations whose belief systems are considered at-odds with central government? If you live in a democracy, or a country such as the United States whose current leadership is leaning-towards autocracy then “at-odds-with” means any community that didn’t vote for the existing power structure.

How China’s Surveillance State Overwhelms Daily Life

You get used to having different personas for various aspects of your life. It’s only when you are in the comfort of your home, can you be your true self.

Via studio D.


There’s no shortage of individuals and individual freedom. In America, people are willing to sacrifice their well-being, social cohesion, stability and sustainability for the false notion of individual freedom. But the truth is, there is no individual. There’s no such thing. It’s an utter fiction. It was created in order to promote more consumption. The more people spend time with one another, the less stuff they buy. A deep connection to other humans makes you an enemy of the marketplace.
Douglas Rushkoff — Fighting for #TeamHuman


彭記燉

Discovered in one of the many small alleys near FE21.

There is much that I miss about living in Hsinchu – low taxes and a functioning health care system being on my mind most this season – but aimlessly walking the alleys only to discover some small hidden treasure is certainly near the top of my list. Weather permitting we would walk a lot in Hsinchu and I was always amazed at the sheer number of interesting places to eat.


First item on my Wishlist

I was looking at the US Amazon site this evening when I had a quick look at what items I had in my Wishlist – I haven’t used the feature much these past few years, as most of my purchases have been at Amazon.cn (which recently failed) or Amazon.ca. The item listed above was added over 17 years ago, which reflects perhaps the longest relationship I have had with any single retailer, online at least.

Most off the early products were books, all that was available I think, and included topics that ranged from art, design, business, HCI and sewing. I wanted to read about sewing, as at that time I was determined to start a bag company and do all the work myself. A familiar theme. It failed shortly thereafter. Also, an all too familiar theme.

My first purchase on Amazon.com was in 1999 and included “Teach Yourself Html 4”, “Midnight Without You by Chris Botti”, “Midnight Martini by Guido Basso”, and “Lonely Planet Vietnam”.

It’s interesting how lists like this can give you another snapshot into the changes in your interests and activities over time – a bit like finding old stuff in an attic.


I Voted Yes!


I'm not a fan of the "upgrade our democracy" trope either.

Prior to arriving at the polling station on Thursday I was all set to vote for the status quo, a term I’ve adopted for situations like this, after 20 years of following Taiwan politics. It was more a reaction against what I thought was completely ill formed communications from both sides of the debate, than an out right disbelief in the positive aspects of this proposed proportional system.

Both sides showed a complete lack of empathy, exhibited little understanding about how the human mind works, lacked the ability to educate people on the pros and cons, and politicized the whole process. And I was annoyed that the current government gave such little time for people to understand a change that would may a greater effect on peoples lives than who becomes premier.

On Wednesday, I had a meeting with Anna Keenan of the Coalition for Proportional Representation and she helped me put aside my criticism’s of the other paid campaigns and focus on the positive. Forget ugly billboards spreading FUD or ads emphasizing how easy it is, it’s these kinds of grass roots efforts, simple conversations between people, that real change can occur.

I think Prince Edward Island is at a point where it can handle this kind of change, a change where people of more disparate viewpoints are required to work together in government. A little well directed conflict will be a good thing.