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

Evidence

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.

Saturday, February 28, 2015

Books Read in February 2015

New:

1. The Oracle Glass by Judith Merkle Riley
2. And the Mountains Echoed by Khaled Hosseini
3. Calculated in Death by J.D. Robb
4. Cataract City by Craig Davidson
5. The Ig Nobel Prizes 2 by Marc Abrahams
6. Wave by Sonali Deraniyagala
7. Thankless in Death by J.D. Robb
8. Sanaaq by Mitiarjuk Nappaaluk (English translation by Peter Frost)
9. Taken in Death by J.D. Robb
10. Aunt Winnie by Elspeth Cameron


Reread:

1. Delusion in Death

Monday, February 23, 2015

Door etiquette

Proper door etiquette is normally to let people out first and only enter once everyone has exited.

This makes perfect sense for enclosed spaces like elevators and trains, and everyone should diligently follow this rule at all times.

However, it occurs to me that the rule should be the opposite for entrances to buildings, especially in bad weather: you should let people in first, and only exit once everyone waiting to answer is inside.  This means that the people in the cold/heat/wind/rain/snow/humidity can get out of the uncomfortable environment as quickly as possible, and all waiting is done in the comfortable environment.  In other words, wait inside the comfortable lobby to let people get out of the cold rather than vice-versa.

In cases where both weather and enclosed space are factors, such as a train with an outdoor platform, I think we have to let the enclosed space rule take precedence.  Regardless of the weather, it's still logistically necessary to let people out so there's room for new people to get in.  Plus, in the specific case of a train, it's easier for the person in charge of the doors to see that the loading/unloading process is still ongoing if there are still people on the platform, so they'll be less likely to close the doors and tell the train to leave while people haven't gotten on or off the train.

But in cases where there's plenty of room for everyone and no one is going to drive away and leave anyone stranded, let's let people in out of the cold as quickly as possible, shall we?

Thursday, February 19, 2015

There is no incentive to falsely take a citizenship oath

Recently in the news is the story that the government intends to appeal the Federal Court ruling that it is unlawful to require people to remove their clothing (in this case, a niqab) before taking a citizenship oath.

Sitting here steeped in white girl cultural hegemony, I tacitly assumed that they wanted people to uncover their faces during the oath for identification or fraud prevention purposes.  But it occurred to me in the shower this morning that no one would cover their face during a citizenship ceremony for nefarious purposes, because there's no incentive to do so - nothing would be gained or achieved by doing so, and it wouldn't change anything.

Let's unpack this.

Scenario: Cindy the New Citizen has gone through the entire immigration process and permanent resident process and citizenship exam and all the hoops and paperwork and everything, and has just received an invitation to attend a citizenship ceremony and take the citizenship oath.  Congratulations, Cindy! But Cindy doesn't attend the ceremony and take the oath.  Instead, Irene the Imposter attends the ceremony, pretending to be Cindy, and takes the oath in her place.

So what would the outcome of this scenario be?

Would Irene become a citizen by taking the oath?  Of course not - it's not a binding magical contract like in Harry Potter!  The record would show that Cindy, who is fully qualified to be a citizen, is now a citizen.  So Cindy would be a citizen and Irene's status would not change. 

This means that Irene has no incentive to impersonate Cindy, because it would have no impact on Irene's status.

But what if it's not Irene whose intentions are nefarious, but rather Cindy?  What if Cindy is trying to get citizenship without being beholden to the oath?  Let's think about this.

Suppose, Cindy breaks her oath and is caught.  When called out on it, she says "Nope, you can't hold me to that!  I didn't take the oath - I sent an imposter on my behalf!"  She's still in trouble, since the content of the oath is, essentially, promising to fulfill your duties as a citizen and obey the law, so she'd be in trouble for being derelict in her duties and/or breaking the law.  And, on top of everything else, she'd also be guilty of fraud! 

This means that Cindy has no incentive to send an imposter on her behalf, because that would only make things worse.

But what if Irene isn't there on Cindy's behalf?  What if she's there without Cindy's knowledge?

I can think of two possible motives for that: either Irene is trying to steal Cindy's identity, or she's trying to inflict citizenship upon Cindy without her knowledge.

If Irene is trying to steal Cindy's identity, she would have had to start long before the citizenship ceremony.  She could only find out about Cindy's citizenship ceremony if she has access to Cindy's mail, in which case she's either successfully stolen her identity, or has access to far more useful things like credit card statements and tax documents.  Going to the ceremony and taking the oath as Cindy will have no impact on the extent of her identity theft.

If Cindy doesn't actually want citizenship and Irene is trying to inflict it upon her without her knowledge, Cindy wouldn't even be having a citizenship ceremony.  There's quite a lot of work to do and steps to take to become a citizen, and if Cindy didn't want it, she could just do nothing. 

There is simply no reason why anyone would falsely take the oath with nefarious intentions, because it would do nothing to help them achieve their nefarious intentions and basically wouldn't be worth their time.  Therefore, there's no reason to fret about being able to see everyone's faces at all times.

Tuesday, February 17, 2015

Downton needs to explain why Tom thinks they'll have a better life in America

This post contains spoilers up to and including Season 5, Episode 7 of Downton Abbey (the one that includes a cute scene of Tom and little Sybbie dropping sticks off a bridge into the creek below).  Please do not include spoilers beyond that point.

In last week's Downton, Tom mentions to little Sybbie that he thinks they might be able to have a better life in America.

The show really needs to elaborate on why he thinks it would be better.

At Downton, Sybbie enjoys a much higher baseline level of security than she would living with Tom alone.  Even if we take luxury out of the equation and don't consider it a contributor to quality of life, the fact remains that at Downton she will have a roof over her head and food in her belly.  She will have new shoes whenever she needs them and a warm winter coat and a fire in her fireplace.

In America, Tom would need to find work and remain steadily employed to provide these things, but Downton has enough resources to provide these things regardless of what happens, and Sybbie will always be able to benefit from this security because everyone from Lord and Lady Grantham to Thomas the Evil Underbutler loves her.

Also, since Tom is a single parent, he would need to find childcare in America, whereas at Downton there's already childcare fit for a future earl.

Looking forward a few years, at Downton, education will be available to young Sybbie. If Tom wants her to go to school rather than being taught at home by a governess, I'm sure that could be made to happen without compromising her place within the security of Downton. If, when she gets older, she wants to go to some posh school or go on to university, her doting grandparents will make that available.  She will be constrained by nothing but her gender (given the era), and I'm sure she'd be similarly constrained by her gender in the US as well.

What would Tom do to earn a living in America?  Be a chauffeur or a taxi driver?  That's not necessarily going to provide his child with security.  Run a business?  If he feels that he has the business savvy to build a stable life for his child, he can already make use of it in his current role as estate manager at Downton, in support of the estate that provides his daughter with a secure life. 

Now don't get me wrong, I'm not saying that Tom would necessarily fail in America.  He could probably eke out a perfectly reasonable working class cum middle class living.  We all know people who've done it - in fact, we probably all know people who've done it despite being a bit of an idiot!

But I just don't see why he's confident it would be better, especially from the point of view of building a future for a child. Normally this 20th century Europe to North American immigration arc involves people who are oppressed or otherwise have limited opportunities in their homeland, and Sybbie isn't and never will be in either situation.

Little Sybbie Branson the daughter of a widowed Irish chauffeur would probably have a better life - or at least more opportunities - in America, but you can't assume that Miss Sybil the granddaughter of an English earl necessarily would.  Some insight into Tom's logic here would be helpful to the viewer.

Monday, February 16, 2015

Journalism wanted: how did the Toronto Star's HPV vaccine story end up being sensationalistic?

I recently wrote a blog post complaining about a Toronto Star article about HPV vaccination that presented the story very sensationalistically and failed to include necessary context.

This week's public editor column agrees with that assessment.  Public editor Kathy English says:
In looking at all of this, I have to wonder why the Star published this at all — especially at this sensitive time in public health. If there is no proof that any of the young women’s illnesses, or the 60 adverse reactions in the database, were caused by the vaccine, then what is the story?
In that same column, she says:
To be fair, in the Gardasil investigation, reporters David Bruser and Jesse McLean absolutely do not conclude or state that the vaccine caused any of the suspected side effects the young women talk about. The article was written carefully to try to impart to readers the message that there was no conclusive evidence.
Also, on CBC radio program As It Happens, Toronto Star publisher John Cruikshank said:
"We failed in this case. We let down. And it was in the management of the story at the top."
What I want to know: how did the front page layout and presentation and tone of the story turn out sensationalist if the public editor and the publisher both think this is inappropriate and it's not consistent with the reporters' stated intentions?

I know the writers don't write the headlines and aren't necessarily involved in layout, and I know that senior editors might not necessarily vet every single page layout in the whole newspaper every single day.  But you'd think they'd approve the front page!  You'd think they'd edit an article extra-carefully if it's going to be the first thing people see, and you'd think they'd look at the big, front-page, above-the-fold headline and make sure it reflects the writers' intended thesis.

It would be informative to readers to write a story about how this sort of thing comes about.

Sunday, February 15, 2015

My second Dell depot repair experience

The good: Dell appears to have fixed my computer by implementing the solution I suggested

The bad: It took two months after I suggested the solution, two separate depot repairs totalling 13 days computerless despite the fact that the problem occurred under an on-site service warranty, and an assortment of additional stressers.

The details:

The problem was that, following an in-warranty replacement of a failed hard drive, my BIOS sporadically failed to recognize the presence of operating system on the hard drive.  This was a particularly stubborn problem, and had persisted through all possible troubleshooting and one previous attempt at depot repair.

I felt like they were grasping at straws when the best idea they could come up with was another attempt at depot repair and I was very reluctant to send my computer away and have to spend some time computerless, but the telephone technician told me it would be expedited since it's the second attempt (5-7 business days, rather than the standard 5-10).  Since my first attempt at depot repair had only taken 4 days all in, I reluctantly agreed to give them one last chance.

I received the shipping box on a Monday, which was the day before my grandmother died, and when I learned of her death I decided to postpone sending out my computer for a week.  Being computerless is very stressful to me, and I didn't want the additional stress when I was freshly bereaved.

So the next Monday, I dropped my computer off at the closest Purolator shipping office (a local print shop).  I decided to drop it off rather than having a courier pick it up so I could use my computer for part of the day on Monday and prepare it for shipping at my leisure rather than having to have the whole thing ready by 9 in the morning because I don't know what day the courier will come.

Unfortunately, there was a snowstorm on Monday, so the Purolator truck didn't show up at the store to pick up my package!

After a frantic Tuesday morning spent trying to figure out why my computer wasn't in the Purolator system, it was ultimately picked up on Tuesday evening, and arrived at the Dell depot on Wednesday morning.  I figured no big deal, last time around it arrived at Dell on Tuesday and was back in my hands on Thursday, so I'll probably still get it back this week.

The Dell tracker showed that they received my unit at 8:30 and began diagnosis at 2:30.  Okay, a bit more of a delay than last time, but still reasonable.  I was heartened to see the expected return day showing Thursday.

But on Thursday at 10 am, the status changed to "Customer Hold", which meant it was on hold until they got some information from me.  I waited and waited, willing the phone to ring, obsessively checking my email, but no one contacted me. 

As you might have noticed if you follow me on Twitter, this stressed me out. What was the problem?  Why did they need to contact me?  And if they so needed to contact me, why hadn't they done so yet?  Had they lost my computer?  Was it going to take months to fix?  What could possibly be going on?

I spent much of the day stressing and crying and catastrophizing, and when I hadn't heard back by the end of the depot's business hours I started emailing and tweeting at anyone I thought might have information.  I finally got a snippet of information from @DellCares: apparently, the depot hadn't been able to reproduce the problem.  But that just raised more questions.  Why did they need to contact me?  And why hadn't they? If you need information from the customer about how to reproduce the problem before you proceed further, what is gained by not contacting the customer?  It seems like in this case you'd either ship it straight back with "could not reproduce" to keep your numbers up, or you'd contact the customer right away so you could move forward.  Both @DellCares and one of the techs I'd been emailing with said they'd have the depot get back to me the next day, so I eventually managed to soothe myself to sleep.

On Thursday at 10 am, I still hadn't heard from anyone.  So I checked the tracker again, and it said the hold had been lifted at 9 am.  But no one had contacted me!  What was going on here?  From where I'm sitting, it looks very much like they wasted a day (thereby doubling my number of computerless days because of the weekend) for no particular reason! 

At 11, the tracker said they'd begun repair.  I was glad to see progress, but how could they be repairing if they couldn't reproduce the error?  I hoped this was just an interim step towards shipping my computer back to me.

Meanwhile, the email tech told me that the hold delay was due to the depot having to find out whether I have a complete or limited warranty.  How does that take a whole day?  And why did the tracker say "customer hold" when that wasn't information that they'd find out from me?  And what kind of strange crazy problem did I have that required them to double check the warranty?

On Friday, the tracker still said the computer was under repair and the next update would be Monday.  So I bolstered myself for the stress of a computerless weekend, exacerbated by all these questions about the mystery hold.

On Monday, I eagerly refreshed the tracker over and over, but it hadn't been updated despite the fact that it said Monday was the next update day.  Had the repair failed?  What if they couldn't figure it out and insisted on holding onto my computer for weeks and weeks?  Partway through the day I received an email the email tech, but all he had to say was that the computer was still in repair.  It seemed like the email was either automatically generated or he was blindly transcribing the tracker status into email without regard for utility.

Then, towards the end of the day on Monday, the tracker said the repair was complete and they were shipping my computer back to me!  I was half delighted and half nervous, uncertain if the problem would actually be fixed or not, and, because of the various horror stories I'd read online, partly dreading that my computer might come back in worse condition.  I'd already decided that if this repair hadn't fixed it I wouldn't accept a third depot repair because it was just too stressful for me, so I was also partly dreading having to be assertive to get my computer fixed without Dell marking me as a problem customer.

I received my computer on Tuesday.  I was so worried that something might have gone wrong that I videoed the unboxing and the first few boot-ups, just in case I needed evidence of any damage or evidence of the problem reoccurring.

The first mystery was on the slip that came with the computer, telling me what work had been done. Under "The unit was received with the following cosmetic issues which is not covered by Dell's HW Warranty", everything was checked (Scratches/Marks on top cover/Case, Scratches/Marks on LCD Screen/Bezel, and Scratches/Marks on Palmrest).  There were no scratches or marks when I sent it out!  I inspected it closely, and discovered...there were no scratches or marks on it when I received it back either!  Did the depot check all those off as a matter of course so they wouldn't be obligated to repair any damage they did???  Yet another source of distrust!

Dreading the prospect of having a damaged computer in hand that Dell would refuse to prepare, I booted up, still taking video.  On the first boot-up, it said "Setup is preparing your computer for first use", just like it did after my last depot repair.  Figuring that meant they hadn't tested it like I asked, I created an account, finished the installation of Windows, and decided to boot up a couple more times to see if the problem reoccurred.

On the first boot-up after the installation of Windows was completed, I saw that there were in fact two Windows accounts: my own, and one named "Dell".  Maybe this meant they had tested it!  I did two more boot-ups from complete shutdown, and the problem didn't reoccur. 

I looked at the device manager, and saw that the hard drive they'd installed wasn't Western Digital this time! The device manager said my hard drive was a "ST1000LM024-HN-M101MBB", which, according to google, is a Samsung hard drive - just like I originally had and I requested after the first round of hardware troubleshooting failed back in December!

That appears to have solved the problem (so far at least, knock wood).  Since I got the computer back, I've had 8 boot-ups from a power-off state and 3 boot-ups from a hibernate state, and it has worked every single time.  I sincerely hope this means it's fixed!

A squandered opportunity

This whole saga has been a squandered opportunity for Dell to delight me and win back my unquestioning loyalty.  As I mentioned in my post about how Dell needs to empower its employees, the telephone tech was not empowered to dispatch a Samsung hard drive as I requested, even after we'd eliminated every other variable.   

 If he had been empowered to do so, the whole problem would have been solved with the second on-site service call.  I would have been delighted with Dell for, once again, saving my ass in the dying days of my warranty, and would have blindly gone with Dell for my next computer purchase, buying the best gaming laptop they'd be willing to sell me with all the warranties and upgrades available.

Since the problem would have been solved before xmas, I would have told everyone at xmas (empty-nester baby boomers and millennial young professionals, most of whom have more disposable income now than they ever have before) all about how Dell saved my ass.  But, since the problem was still ongoing at xmas, I instead was telling them about how Dell was stressing me out by wanting to send my computer to a depot even though the problem occurred under an on-site warranty.

Since I wouldn't have had any reason to google up other people's Dell depot experiences, I wouldn't have seen other people's horror stories and therefore wouldn't have been stressing out nearly as much.  I wouldn't have been saturating my Twitter feed with worries about Dell.  I wouldn't have been blogging extensively about everything I found stressful about Dell.  I would simply have written one blog post praising their warranty service, and gotten on with life.

But, because the Dell telephone technician was not empowered to take my suggestion of using the original brand of hard drive, and because the first round of depot repair either couldn't or didn't this suggestion, my loyalty was not won over and all the word of mouth and social media I produced about Dell over the past two months was full of stress and worry.

They should be able to do better, and it's rather their loss that they didn't.

Thursday, February 05, 2015

Horrid journalism from the Toronto Star

The Toronto Star wrote very sensationalist front-page story about people who report having various illnesses after receiving a cervical cancer vaccination. 

As they mention in the subheadline (with some weird conjuction use), they found 60 people who reported illnesses, out of hundreds of thousands who have received the vaccine

The problem: they don't mention the statistics of these kinds of illnesses occurring in similar populations who have not recently be vaccinated.  We're talking tens of times among a sample size of hundreds of thousands, which is hundredths of a percent. It is certainly plausible that the number of illnesses reported are consistent with what would happen ordinarily in the general population. 

Back when I did my research before getting Gardasil, my research found just that: the number of reported conditions in the sample group was consistent with the number in the general population.  That could certainly be the case here.  But the Star doesn't provide the numbers!

If the number of illnesses found in this investigation is significantly higher than what would have occurred in the control group, then that is important information that supports the Star's thesis and they should include it.

But if it is not, then this is an irresponsible piece of journalism.

By failing to include these numbers, they've made the article non-credible in the eyes of the most-informed audience who will read it critically, while sensationalistically creating paranoia among the least-informed audience who will only skim the headlines.

The article ends with one of the interviewees saying “I am not against the vaccine, I want people to be responsible about Gardasil. I am trying to inform people.”

In order to inform people so that they can make responsible decisions about Gardasil, you need to include control group numbers!

Wednesday, February 04, 2015

The opportunity to experience life's simple pleasures

I blogged before about how if I'd lived in a different time and place, I'd never have had the opportunity to be good at anything.

Today in the shower, it occurred to me that if I'd lived in a different time and place, I may never have experience any of the things that destress me or make me happy.

The first of which is the shower!  It relaxes me, makes me feel human, makes me look civilized, and is where I get all my best ideas.  And it wouldn't have been available even 100 years ago.  Or even 50 years ago in poorer areas where housing hasn't been upgraded to include modern conveniences.  Or even in the present in some parts of the world.

As I blogged about in my resilience braindump, the things that destress me are very externally dependent, and many of them are very 21st century.  Fandom is a huge destresser, and it's entirely dependent on the constant creation of new stories involving beloved characters.  For nearly all of human history, this simply wasn't possible.  There was no media, and new stories were few and far between.  And, apart from fandom, most of my pleasures and destressers are on my computer, which is why sending it out to be repaired is so upsetting to me.  But personal computers didn't exist before my lifetime, and the internet as we know it didn't exist even during the first half of my lifetime!

Even my other simple pleasures and necessary destressers - comfort food, privacy, curling up safe in my cozy bed as a storm rages outside - would have been impossible for all but the very wealthiest for the vast majority of human history, and still aren't available to the general population in many parts of the world.

So in another time or place, would I have found pleasure and destressing in other things in life?  Or would I simply live my whole life on edge, never completely at peace?

However, it also occurs to me that if I'd been born in a different time and place, I wouldn't be alive anyway.  Even if I'd survived being born, I probably wouldn't have survived my annual bouts of strep throat (which, the internet tells me, is the same infection as scarlet fever), and even if I'd survived that, I probably would have died on a fainting couch from my reflux incident where I just couldn't swallow food.

Things They Should Study: how does people's likelihood of having survived in more difficult times and places correlate with their likelihood of thriving in those times and places?  Would a disproportionate number of the people who are fragile and sensitive like me have died at birth anyway?

Tuesday, February 03, 2015

Hats

In the world of Downton Abbey, etiquette dictates that ladies don't remove their hats indoors. They don't wear hats in their own home (or in the evening), but if they go to a shop or a restaurant or someone else's home they don't remove their hat, even if they do remove their coat.

It occurred to me that this could make wardrobe planning difficult.  Do you choose a hat that goes with your dress or a hat that goes with your coat?  Or do you have to make your coat match your dress too so the whole ensemble works?

Obviously, not everyone has the budget for multiple hats and coats to go with every dress, and they actually show this on screen.  When a working-class character is visiting someone's home, she's shown wearing a hat that doesn't really complement or enhance her outfit.  And this is because it's her only hat, the best she could do to go with her only coat, which was the best she could do for as sensible a coat as possible.

You can't have a red hat, because then you won't be able to dress properly for a funeral. You can't have a dainty floral summer hat, because then you won't be able to dress properly for the cold and the rain. You can't have a delicate hat, because it has to last you several years.

But still, you have to wear a hat every time you're indoors but not at home during the daytime. No matter how carefully you dress and groom, you still have to wear this piece of pure pragmatism quite prominently, next to your face, so it's the first thing that people see.

In the 21st century, people talk about unrealistic standards of beauty projected by Hollywood, with fashion being set by celebrities who have access to all the beauty treatments in the world and plastic surgery and hair extensions and stylists and custom-tailored clothing.

I wonder if, in the olden days, people talked about unrealistic standards of beauty being set by the upper classes, who had access to a flattering, custom-made hat to go with every outfit?

Saturday, January 31, 2015

Books read in January 2015

New:

1. The Hangman by Louise Penny
2. Ruth's Journey by Donald McCaig
3. The World of Post Secret by Frank Warren
4. An Astronaut's Guide to Life on Earth by Chris Hadfield
5. Tenth of December by George Saunders 

Reread:

1. Celebrity in Death

Wednesday, January 28, 2015

The condolence script

This bereavement has given me some insight into the condolence script.

During my last bereavement (which was 15 years ago!!) I hadn't yet read up on etiquette theory, so I didn't know what people were supposed to say or how the bereaved is supposed to respond.  (It didn't really come up IRL though, because I was in university and the funeral was on a day when I had no classes, so I just went about life without telling many people.)

I used to think that you had to say something awesome to the bereaved person, that would make them feel better.  And I used to think that, as the bereaved person, you have to give a mitigative response, because condolences are such an intense and one-sided thing to receive that you have to sort of balance out the conversation (like how if someone compliments a specific aspect of your outfit, you might look at a specific aspect of their outfit to compliment.  Or if someone thanks you extra-profusely for something, you might feel like saying "Please, it's no big deal.")

When I started reading Miss Manners, she said that a simple expression of condolences or sympathies is sufficient ("I'm so sorry" or "My sympathies" or "My condolences"), and that "thank you" is a sufficient response.  These seemed woefully inadequate to me, but Miss Manners said they suffice and I certainly couldn't come up with anything that was as awesome as I thought it needed to be, so I began using them.

With this bereavement, I've come to the realization that there's no such thing as a series of words that can achieve the level of awesomeness that I thought was necessary in an expression of condolences.  Words uttered just exist on a completely different plane and scale than bereavement, even simple bereavement. It's like trying to knit a sweater that will refute a political argument.  It's just not a tool that can be used to achieve that goal, no matter how awesomely you do it.

So why bother?  Because the expression of condolences acknowledges the elephant in the room.  Death is huge, and it can seem weird and wrong and assholic to avoid the topic if you're talking to someone who's recently bereaved.  So "I'm so sorry" or "my condolences" is the standardized code for "I acknowledge that you were bereaved", and "thank you" is standardized code for "I acknowledge that you acknowledged it."  Then you can proceed with the business at hand without anyone having to worry about being rude about the elephant.

The existence of a standardized script helps because it's so difficult to say something right.  It's like saying "please" or "thank you" or "you're welcome".  Imagine trying to express those concepts if we didn't have standard words for them!  And, of course, bereavement is a far more sensitive and emotionally fraught situation than asking someone to pass the salt!  So the standard, etiquette-approved script allows us to acknowledge the situation and then move forward. No more, no less.