Tuesday, March 31, 2015

Books read in March 2015

1. Paul a un travail d'été by Michel Rabagliati
2. Give and Take: A Revolutionary Approach to Success by Adam Grant
3. Concealed in Death by J.D. Robb 
4. Elizabeth is Missing by Emma Healey 
5. Le silence du banlieusard by Hugo Léger

Things that I learned about having a mammogram

1. At the beginning of the appointment, they screen you for pregnancy. They do this by asking if there's any chance that you're pregnant. When you say "None whatsoever," they take you at your word. This is a vast contrast to those various adolescent medical appointments where they interrogate you about choreography and bodily fluids.

2. If you're of childbearing age, you get a lead apron to put over your abdomen so your uterus is protected.  Then they tell you to lean over further so your head is closer to the machine.

3. The machine compresses your breast as far as humanly possible, and then another 10% further.  The pain is exactly what I would have expected from this - it's not a shocking new disproportionate kind of pain, but neither is it painless.

4. The pain stopped as soon as they took me out of the machine.  There was no residual pain, and no marks or bruising left on my breast.

5. What was weirdest to me about the whole experience is that you literally can't move once you're in the machine.  You're held in place by your breast.  That's rather a disconcerting experience.

6. If your hair is breast length or longer, you should wear it in a bun for the appointment.  They don't tell you this in your pre-appointment instructions, but your hair can easily get caught in the machine.

7.  The mammogram is taken by a technician. The images are then sent to a radiologist, who writes the report. The report is then sent to your doctor. This means that your doctor doesn't have access to the images, and the person who interprets the images isn't present when taking them. So the person interpreting the images might wish she could pan over to the left a bit, but she can't unless she calls me back in for more imaging (which is not a step taken lightly). Or my doctor might be wondering how the mammogram findings jibed with what he was feeling in my breast that he believed to be a cyst, but he can't just look and see. That seems inefficient to me, and likely to magnify any human error that may occur.

Saturday, March 28, 2015

Why copayments for medical appointments are a bad idea: a breast lump story

When conducting a routine breast exam during my annual physical, my doctor detected something on the armpit side of my left breast that wasn't present on the right side.  He ordered a breast ultrasound, which found some of my  lymph nodes in that area were larger than perhaps they should be.  A mammogram was then ordered, which found that a few individual lymph nodes were enlarged, but there were no malignancies or other problems.  I was therefore instructed to return in six months for another breast ultrasound to see if the lymph nodes in question returned to normal.

While I was in the middle of this process, Steve Paikin posted a blog post sharing his doctor's idea for copayments for each medical appointment.  I commented on that post expressing my concern that the majority of medical appointments I get aren't even my idea but rather are required by red tape (I've previously blogged about that here), but this breast lump diagnosis process was an even better example.

During this little adventure, I had five appointments in a nine-day period (and a minimum of three more if I opt to follow up in six months as recommended), none of which I actually wanted or would have thought to request for myself.

I only got the annual physical because it's the price of admission for getting my birth control renewed. I'd be more than happy to buy my birth control over the counter (as some have recommended should be possible for public health purposes), but I have no choice but to go to my doctor and get the recommended screenings if I want a new prescription.

I didn't think the thing my doctor found was a problem - to my touch it felt just like a normal part of my breast anatomy. After reading up on breast cysts, I didn't think getting a potential breast cyst diagnosed was especially important - they're not a problem, most often non-actionable, and quite often go away by themselves. That area of my breast is squishy and mobile, it's nothing like the description of hard, immoveable lumps that I've always been told indicate possible cancer.  But I went along because it's a quick, easy, non-intrusive test and it was probably faster to get the test than to argue.  And, I figured, once the test shows it's nothing, my doctor will be more likely in the future to take me at my word when I say that's just how my breast is.

After the test, I had to go to the doctor for test results, which I think is a suboptimal way of doing things. I'd rather have the results emailed directly to me, and schedule an appointment with the doctor if I had any questions. But my doctor's policy is that they only contact you with results if action is required, so if I didn't go for that follow-up I'd never learn what action was apparently required.

On an intellectual level, I didn't think the mammogram was necessary as a follow-up to the ultrasound either.  After reading up on breast ultrasounds, I didn't see why a mammogram would be helpful or informative as a follow-up to an ultrasound - all the information I found talked about how ultrasounds saw things that mammograms didn't see.  But, frankly, I was scared into it.  Getting a phone call telling me I needed a mammogram (when this wasn't on my "things that might happen" list) was shocking and disconcerting.  I have it mentally categorized as a "cancer test", so it triggered fears of cancer, and I went along with the test to rule out cancer.

And, again, I had to go to the doctor for the mammogram results even though they were clear to me and I didn't need any help with interpretation.  Because I have no way of getting the results without going to the doctor, I had to take that appointment or I would never have received confirmation that there were no malignancies.

So that's five appointments, all of which were required by my doctor as opposed to by me, none of which I would ever have asked for myself if it were completely up to me.  And if I follow up in six months, I'll need three more (one with my doctor to get the ultrasound requisition, one at the imaging clinic for the ultrasound, and one with  my doctor for the ultrasound results.)  I'm really disinclined to follow up - it feels like a fishing expedition - but I'm concerned about being considered a non-compliant patient if I don't, and I do need my doctor's goodwill to keep getting my contraception.

At this point, some of you are thinking "Breast lumps are serious business!  It's good and important that you got it checked out - you really shouldn't skimp on that sort of thing!"

If that's the case, that's a very good reason why there shouldn't be a copay for each appointment.  A copay would disincentivize patients like me from following up on lumps in their breasts, or perhaps even having these lumps detected in the first place.

Besides all that, before they can even consider a copay, they'd have to streamline the process so that fewer appointments are required by red tape.  For example, as I mentioned above, they shouldn't make you go in to see the doctor to get your test results.  It would be much more efficient to just email them to the patient when emailing them to the doctor, and the patient can contact the doctor if they have any question.  When I'm doing medical translations, I find it a fairly simple matter to google up any terminology I don't understand and the implications of the test results become apparent once I've worked out the meaning of all the words.  If they want to cut down on the number of appointments, they need to at least start by eliminating unnecessary appointments like test results that can just be replaced by a simple email!

At this point, some of you are thinking "That would be hideously irresponsible!  Many people can't accurately interpret medical results and there's all kinds of ridiculous information on the internet! People who aren't medical professionals need the guidance of medical professionals."

If that's the case, that's another very good reason why there shouldn't be a copay for each appointment. A copay would disincentivize patients like me from discussing our test results with our doctors, and instead leave us making decision based on our haphazard informal education and Google.

Wednesday, March 25, 2015

"But I made it just for you!"

I'm sure by now you've seen Rockstar Dinosaur Pirate Princess's post called "Consent: Not Actually That Complicated".
If you’re still struggling, just imagine instead of initiating sex, you’re making them a cup of tea.

You say “hey, would you like a cup of tea?” and they go “omg fuck yes, I would fucking LOVE a cup of tea! Thank you!*” then you know they want a cup of tea.

If you say “hey, would you like a cup of tea?” and they um and ahh and say, “I’m not really sure…” then you can make them a cup of tea or not, but be aware that they might not drink it, and if they don’t drink it then – this is the important bit –  don’t make them drink it. You can’t blame them for you going to the effort of making the tea on the off-chance they wanted it; you just have to deal with them not drinking it. Just because you made it doesn’t mean you are entitled to watch them drink it.

If they say “No thank you” then don’t make them tea. At all. Don’t make them tea, don’t make them drink tea, don’t get annoyed at them for not wanting tea. They just don’t want tea, ok?

They might say “Yes please, that’s kind of you” and then when the tea arrives they actually don’t want the tea at all. Sure, that’s kind of annoying as you’ve gone to the effort of making the tea, but they remain under no obligation to drink the tea. They did want tea, now they don’t. Sometimes people change their mind in the time it takes to boil that kettle, brew the tea and add the milk. And it’s ok for people to change their mind, and you are still not entitled to watch them drink it even though you went to the trouble of making it.


If someone said “yes” to tea around your  house last saturday, that doesn’t mean that they want you to make them tea all the time. They don’t want you to come around unexpectedly to their place and make them tea and force them to drink it going “BUT YOU WANTED TEA LAST WEEK”, or to wake up to find you pouring tea down their throat going “BUT YOU WANTED TEA LAST NIGHT”.
The blogger is clearly setting up the mundane analogy with a cup of tea to quite effectively demonstrate how ridiculous it is not to respect someone's "no".

But what struck me when I first read this is that I've seen people actually, in real life, take similar offence to similar mundane everyday things.  This often (but not always) happens with parents and their kids, and often (but not always) involves food.  The offerer (often the parent) does something (often making food) that the offeree (often the kid) doesn't want and/or didn't ask for, then complains that the offeree doesn't want/take/eat/love it. Especially in a parent-kid scenario, the offerer has been known to scold the offeree for not wanting/taking/eating/loving it, or force/coerce the offeree into going through the motions of taking/eating/using the thing. And, especially in a food-related scenario, there seems to be a rather loud school of thought that etiquette requires putting on a show of taking/eating/using the thing, and that quietly abstaining is actively rude.

Now of course as adults, dealing with peers, sometimes we may find it's strategic to make the deliberate choice of putting on a show of appreciation in service of fostering the interpersonal relationship in the long term, and then just quietly go home and make our own damn cup of tea just the way we like it. (Just like, as adults, sometimes we may choose to consent to an act of intimacy that we aren't quite dripping with enthusiasm about in the service of fostering the interpersonal relationship in the long term.)

But, as adults, we understand that this is an option that one may choose to exercise, not a broadly-applicable expectation or a baseline requirement of social behaviour.  Kids are still working out, mostly from example, what constitutes broadly-applicable expectations and baseline requirements of social behaviour.

And when you're dealing with kids who are still developing their framework for what constitutes normal human behaviour and what constitutes reasonable expectations for people to have of each other, it could be detrimental to normalize the idea that you're Being Bad if you say no to something you didn't want in the first place.  And it could also be detrimental to normalize the idea that you're entitled to a positive response to your unwanted and unsolicited solely on the grounds that you presumptuously took the initiative.

If parents want to raise kids who respect other people's "no", and if parents want to raise who understand that if someone disrespects their "no" it isn't an act of love, maybe they should start by keeping an eye on the tone with which they offer their kids a cup of tea.

Tuesday, March 24, 2015

Signs I'm getting old

Baby Cousin 1.0 and Baby Cousin 3.0 are brothers, just a year and a half apart in age. I've noticed that sometimes when I mention one or the other of them in conversation, I use the wrong name - I call Baby Cousin 1.0 by Baby Cousin 3.0's name or vice versa.

In the past year, I've noticed this happening quite a few times.  I'll be talking about one person, and refer to them by the name of another person with similar characteristics.  For example,  I found a picture of Fairy Goddaughter when she was 9 months old and said aloud to myself "Aww, look at [Baby Cousin 2.0]", (Baby Cousin 2.0 being a 9-month-old girl).  Or when mentioning an uncle, I'll use the name of another uncle (who is the first uncle's brother).

When I was a kid, older adults (especially my grandparents' age) would mix up names like this from time to time.  I thought they were actually getting the people mixed up or forgetting the people's names, and their response when their errors came to light didn't disabuse me of this notion.

However, when I do this myself, I'm not forgetting names or mixing people up.  I know with absolute certainty which baby cousin was born first and which was born second, and I can even tell you their dates of birth and distinguishing characteristics and recent accomplishments.  This isn't like when I first started my job and got the names of the two petite francophone ladies of a certain age confused and didn't realize I had the names wrong until one lady retired.  There's no confusion or uncertainty whatever in this case.  It's just that sometimes the wrong word comes out of my mouth.

Thursday, March 19, 2015

Idea for a new economic indicator

This post was inspired by, but is not directly related to, this article.

When talking about whether the population as a whole is making economic gains or losses, people often talk about middle class vs. low income vs. high income, or they look at average or median incomes for the population as a whole and for various demographics.  Less often, but sometimes, they talk about the ratio of income to tuition to housing prices. (The Globe and Mail has a useful comparison tool.)

It occurs to me that another useful indicator would be to look at changes in income over time with people who bring various levels of education, skills and experience to the table.  For example, how has the income level of a person with an undergraduate degree and 10 years of work experienced evolved over the years?  What about a newly-minted Ph.D.?  What about a student working their way through college?  What about people who have been freelancing for 5 years?

It might be useful to get somewhat specific (Is the person with an undergrad degree and 10 years of work experience a translator or a teacher or a computer program?), but the data would cease to be comparable if you got too specific (I don't know how informative it would be to track the income of social media specialists or FORTRAN programmers over decades).

If the data is available, it would also be interesting to track negative factors.  How has the income of people who were laid off one year ago evolved?  (i.e. were they more or less likely to get new jobs within a year in previous decades?)  What's the situation of people who started a business within the past two years?  What about people who are involuntary entrepreneurs (i.e. they didn't want to start a business, but couldn't get hired)?

I think this would fill in some blanks, and it has the potential to draw attention to certain problems that may be hidden by the other, more commonly used indicators.

Monday, March 16, 2015

Things They Should Invent in Fiction: Getting To Know You magic spell

A trope that exists in fiction - especially fantasy genres where magic is present - is the love potion.  You get the object of your affection to ingest the love potion, and they fall madly in love with you!  Of course, the problem is that this will never be true love, because it's just the effects of the potion (e.g. Merope Gaunt in Harry Potter).

It occurred to me that what these makers of magic in fictional universes should invent instead is a "Getting To Know You" spell. You cast the spell on the object of your affection, and they instantly know you - your likes and dislikes, hopes and dream, everything that you need to learn about a person to know if they're a good match and to fall in love with them.

In fiction, the protagonist and the love interest often fall in love after plot points allow them to get past their preconceptions and get to know each other's real selves.  (And, in real life, people suffering from unrequited love often feel like this would happen if the opportunity would only arise.) 

At this point, you're probably thinking "But that would ruin the story! They'd get to know each other and fall in love instantly and then there's be no story to tell!"

But what it actually does it open up whole new story avenues!

What happens if the protagonist casts a Getting To Know You spell on their love interest, and this doesn't cause the love interest to become interested in them?

What if someone casts a Getting To Know You spell on the protagonist, but they aren't interested?  And suddenly they have all this knowledge of some random person they're not interested in?

What if the protagonist casts a Getting To Know You spell on the love interest and the love interest appears by all signs to fall in love with the protagonist, but never casts at Getting To Know You back on the protagonist, so the protagonist doesn't know the love interest as well as the love interest knows the protagonist?  Would this mean the love interest is up to something nefarious?

What if spies started trying to beguile their targets into casting a Getting To Know You spell on them in the hopes of learning their secrets, or at least making them more manipulable?

What if the spells aren't reversible, and casting them is a Big Life Step?

What if the spells are reversible, but you have to go on a quest to acquire a MacGuffin in order to reverse them?

And the person you thought was your love interest but who is in fact nefarious and now knows everything about you is trying to use this knowledge to hinder your quest?

In a universe where magic exists and the pitfalls of love potions have been proven, the next logical step would be for someone to come up with a Getting To Know You spell.  I think this would open up new and interesting story avenues.

Monday, March 09, 2015


There is a cigarette pack on my balcony.

This is noteworthy because I don't smoke, and no one has ever smoked on my balcony in the entire history of this building.

This has actually happened a few times over the years - random cigarette packs or cigarette butts ending up on my balcony - and it turns out the wind blew them there.  They always show up on a significantly windy day, and sometimes even disappear overnight. (I'm sure as hell not going out on my high balcony on a cold, windy winter day to pick up someone else's dirty cigarette litter, so sometimes they're there for a few days.)

But this makes me wonder about criminal evidence.  If detectives were investigating me, they could logically conclude that someone has smoked on my balcony.  They could also reasonably conclude that the person whose DNA is on the cigarette has been on my balcony.  If the person who smoked the cigarette ended up dead or something, I could turn out to be a person of interest just because of the vagaries of the wind.

From time to time, a hair falls out of my head.  I often find them on the floor of my apartment, but surely they sometimes fall out when I'm outdoors too.  And if a cigarette pack can be picked up by the wind and blown onto my balcony, a loose hair can certainly also be picked up by the wind and blown somewhere, maybe even further away.  It could also stick to someone's coat or shoes and be carried into their home or something. So if I was abducted or murdered and the police were looking for evidence, they might find one of my hairs somewhere I've never been.

In detective fiction, they often find the bad guy based on one tiny bit of physical evidence - a cigarette butt or stray hair DNA showing that a person was in a specific place, and that's what cracks open the case.  In real life, I wonder if they take into account that stuff is sometimes blown around by the wind?

Saturday, March 07, 2015

Contemplating the ethics of donating food to the Salvation Army food bank

I do not donate money to the Salvation Army because their history of anti-gay action.

However, the easiest way for me to donate food to a food bank is to put it in the food bank bin outside my local supermarket. This is the only place I know of in my immediate neighbourhood where you drop off a food bank donation.  And this bin happens to be for the Salvation Army food bank.

I don't normally buy food for food banks, choosing instead to give them money so they can buy what they need and take advantage of bulk discounts and wholesale pricing, but from time to time I find myself with unwanted food or household products (I buy something that ended up not being right for me, I get a free sample box that includes stuff I'm never going to use, etc.), and I feel that the food bank is the best place for these things.

So I'm wondering where food bank donations fall ethically.

On one hand, they can't use food donations for anti-gay actions like they can with money donations, and having a busy food bank to run might take their attention away from other things.

But, on the other hand, would donating food to the food bank free up money that would otherwise be spent on the food bank for harmful political action? 

Also, what would happen if their food bank failed because they didn't receive any food donations?  Would people who need food suffer, or just be redirected to another food bank? Would the Salvation Army suffer, or just have more time and attention for activities that are less helpful than a food bank?

In short, could the Salvation Army do harm with donations of food like they've been known to do with donations of money? Or is the only possible outcome that the food goes to hungry people?

Tuesday, March 03, 2015

Best Customer Service Ever from Soak

I've been using Soak to wash my bras ever since I was introduced to the product by the bra-fitting geniuses at Secrets From Your Sister. It's super convenient for someone like me who lives in a small apartment with no access to a laundry tub because, as the name suggests, you just have to soak your delicates - no rinsing!  I've also discovered it's useful for knits (which is very helpful given my love of cashmere), and for spot-cleaning things that can't easily be rinsed (put the tiniest dab possible of Soak on a damp cloth, and scrub well).  The internet has also suggested that it could be used for stuffed animals, although I haven't tried this myself yet.

Unfortunately, the Secrets From Your Sister location in my neighbourhood closed, and then Très Jolie also closed, so there was nowhere to buy it in my neighbourhood any more!

(Retailers in the Yonge-Eglinton area: there's a business opportunity for you here.)

Then I discovered that you can buy directly from the Soak website! Awesome!  Since they had free shipping on orders over $75, I ordered several bottles, figuring I'll certainly use it all eventually.

But when my order arrived, I discovered that many of the bottles weren't what I ordered!  Soak comes in a number of different scents, and most of them were in a completely different scent.

I retraced my steps, and discovered that there was a fluke on their website (my best guess is a copy-paste error in some code) that caused the wrong scent to be listed in one of the items on the page of the scent I was shopping for.

I figured I didn't want to deal with an exchange since it would be expensive to ship back (being liquid) and I could live with the incorrect scent.  But I decided to email the Soak people to let them know of the website problem anyway - some future customer might be more upset or inconvenienced about receiving the incorrect scent.

To my utter astonishment and delight, they promptly sent me replacements in the correct scent, and told me I can just pass the incorrect bottles on to someone else rather than having to pay for returning them!  The replacement bottles arrived by FedEx first thing in the morning on the next business day, and, even though they were already sending me free product at non-negligible cost the box even contained a few little free sample packets!

This is literally the best customer service I have ever received in my life! Thank you Soak!

Therefore, I am strongly recommending Soak to everyone who's in the market for a hand-washing and/or rinse-free laundry detergent.  Not just because it's a useful, convenient and effective product (which it is), and not just because it's a local, made-in-Canada product (which it is), but also because they're an awesome company and deserve to win.