I recently had the chance to sit down with David Bar-Shain MD, of MetroHealth, who single-handedly started the a mentorship program in the PAC (Physician Advisory Council), hosted at Epic in Verona Wisconsin.
The program has been running for 4 years now and has matched over 70 mentor-mentee pairs, over 170 people involved, supporting young physician and APP informaticists by matching them with mid- and late-career informaticists (and some who serve as both mentee and mentor!).
We recently had a chance at the Epic 2022 User Group Meeting to sit and chat about the fundamentals of mentorship, and what I find interesting and fun about being a mentor.
What did we talk about?
The importance of having more than one mentor
Mutual curiosity: telling our own journeys
Who sets the agenda for our meeting?
War stories and are they appropriate?
80:20 rule of informatics: socio-political vs technical skill
Book club and leadership
Learning from outside of healthcare
Mentorship is about asking open ended questions
3 psychological principles that apply to therapy as well as mentorship
Years ago, my pulmonologist spouse threatened to start a new journal called “Spit? or Sputum?”
The idea was rooted in our challenge, when we were medical interns, tasked with obtaining sputum (the thick mucus from deep in the lung that we needed) to spot the predominant organism responsible for a patient’s pneumonia. When done correctly, a patient would bring up a deeply-coughed sputum sample teeming with many copies of one species, that would jump out in technicolor when the correct stain was applied, and voila! We have a diagnosis under the microscope. When the patient gives us spit, however, we would see a veritable smorgasbord of organisms, and a disappointing lack of clarity.
So often, when collecting such sputum samples from patients (“Sir, please cough something up from deep inside”), we ended up with “spit”, the mucus that is generated in the mouth, home to millions of species of organism, and unhelpful in the diagnosis of pneumonia. When we run from the patient’s bedside to the closest microscope, we apply our stains and breathlessly wait to see: was it truly sputum? or just more spit?
Hence the burning question:
Is this SPIT or SPUTUM?
Not that funny? I guess you had to be there. Nevertheless, the title remains stuck in my head.
Reading this article brought that random thought out of the depths.
Fascinating read: researchers identified that Candida Albicans, a common fungus, is often present in our mouths. In this moist, seemingly ideal growth environment, does this organism not cause yeast infections in everyone?
It is a story worthy of Sherlock Holmes. From oral mucus to sugars to glycans to oxygen linking and then …
This is science AND science writing that educates and elevates. Worth a read.
How did I miss this the first time around? in a 2018 article, Gretchen Reynolds informs us that our organs are signaling each other with vesicles and communication molecules that change our physiology in response to exercise. This prompts more cooperation and health benefits and explains more of our internal workings.
We think we are one organism, walking and talking and stressing about our daily schedules. Instead, depending where you put your focus, you are: a human being OR a collection of organ systems (nervous system, respiratory system, cardiovascular, gastroenterological, etc) OR a bag of organs (heart, lungs, pancreas, liver, etc) OR a system of transport tubes (arteries, veins, lymphatics, nerves, or the most recently discovered: highways in the space outside of venules in the brain, activated during sleep!) OR a packed freeway of vehicles (red cells, white cells, platelets) OR a ghoulash of chemicals (thyroid hormone, insulin, interferon, cytokines that trigger fever or attract your immune defense, etc) OR a growing number of signaling vesicles (see the article above).
The rabbit hole goes very deep, my friends. And it is glorious.
As a physician, my advice (and what I continue to do now for myself, my patients, at this point in our Covid world):
Continue masking when indoors in public, mask off ok outdoors
I’m not eating at establishments indoors: I look for outdoor dining OR take out
Keep up with Covid vaccinations (I’m currently at 4 total, and likely will continue every 6-month boosters)
For patients with: diabetes, cancer, kidney disease, immune disorder, or over 65: Paxlovid within 5 days of onset of symptoms if test positive for Covid, with main purpose NOT to stop symptoms, but to avoid hospitalization and severe illness.
At UCHealth, we still have test positivity rates in the 20% and 30%, which is a major underestimate of the illness, since there is widespread availability of home Covid testing, none of which is reported publicly. We are still seeing a substantial number of hospitalizations with Covid illness. The pandemic is changing, but this thing isn’t over y’all.
Ever wonder what the gig economy is all about? What is the experience of drivers, interacting with restaurants, with traffic, with the AI-in-the-cloud, with customers?
My son recently turned to this service to make some cash prior to his upcoming trip. Wonder of wonders, he offered to let me come ride-along for a few hours on one of his outings.
Finally! a chance to see behind the velvet curtain! Is there a Wizard in Oz controlling things?
We spent about 4 hours together, including the dinner rush.
What did I learn, as a parent and an informaticist?
Gas is expensive
at $5 and eats (pun intended) into any profit margin. Food delivery is particularly hard right now, but I can’t imagine it is much easier or more lucrative even with less expensive gas.
This is hard work.
Even four hours is a lot of work, I can’t imagine doing this for more, and day after day. Even my son, after a couple weeks of doing this, notes that “this could be an occasional supplement to someone with an existing job, but I can’t see doing this full time for the few dollars it brings in.”
It is good to go online
and learn tricks from others. I haven’t done the surfing, but it sounds like there are youtube videos for strategies on how Dashers can make money. For example, “don’t take every offer that comes to you over the phone.” Some deliveries only offer a couple dollars for 2-3 miles of driving, working out to about a dollar a mile. From what we believe of the algorithm, if a driver turns down a delivery, the next driver gets a slightly higher offer. IF that is the case, it is the responsibility of drivers to look out for each other and decline overly cheap delivery offers! (see: Fight the Man!).
The informaticist likes end-users who educate themselves to improve their own workflow and experience.
Traffic is terrible
and some drivers have lost sight of their humanity. I occasionally see bad behavior on the streets when I’m driving, but spending 4 hours driving around the city, gives you a concentrated view of your neighbors. The pandemic has done something to our vehicular civility. People honking at folks driving the speed limit, people swerving and gunning their engines to get 1 or 2 spaces ahead in traffic, emotions running high while operating multi-ton vehicles. A dangerous workplace.
The informaticist understands strong emotion and unhappy end-users who act out at times.
Sometimes little physical tweaks
help provide better service. Having a shopping bag that is insulated keeps the food hot a little longer on your drive from the source to the delivery. Wearing comfortable clothing, having a phone with charger (a task-horse! Receive delivery offers, map your drive, text your delivery recipient that you are on your way, take a photo to prove you left it in the right place), and even better if you get good gas mileage.
The informaticist enjoys seeing work-flow tweaks that improve outcomes.
The smells are free, but it costs you
One bad side effect of driving food around, is that the food smells eventually get to you. Maybe not when you start, but a few hours in and inevitably you’ll get hungry. Uh-oh. Those fries … fast food places sure have dialed in the sensory experience. Other times the food is NOT to your preference, and you can’t get there soon enough to let it go. On the other hand, you get to learn where people like to order from, and you’re likely to find some new places to eat (we found bb.q, a relatively new Korean barbecue chicken place in Denver: cool)!
Don’t forget the drink(s)
The algorithm is smart enough to remind you to pick up drinks; having several moving parts to the order (not just the food bag, but also drink(s) and secondary items complicates the process and increases risk of error, so some reminders are built in. Also, some restaurants are on the app and can also call you back if you miss something.
Error-anticipating and error-correcting. The informaticist smiles.
Don’t be greedy. Or, maybe be greedy.
Apparently some gig economy workers run Door Dash and also Uber Eats and sometimes also Uber and Lyft AT THE SAME TIME, just to increase their chance of picking up more offers and staying busy. I can’t imagine the cognitive load (and increased danger) that entails whether stationary or while moving.
Separately, the app will sometimes try to package deliveries together (hey! if you drive another block, you can deliver a second request from a nearby restaurant, want to?) I can see the algorithm trying to lower costs and combine trips within a restricted time-block and geography-block. Kind of like the ‘traveling salesman‘ math problem. Except different.
The informaticist likes the math, hates the multi-tasking.
In this case, how does the algorithm capture you? It tells you “hey, you’re not accepting enough of these offers”. The little joyful “ping” of a new offer keeps us on the edge of our seats waiting to see what pops up next. It is HARD to quit driving at the time you set yourself. “I’ll just do one more, maybe the next one will be the big score!” Like Pavlov’s dogs, we could literally salivate when awaiting the next reward.
The informaticist likes “sticky” design, but only when used for the greater good.
Sometimes the little social tweaks can improve tips
My son learned to use the optional “send a message” tool. He would use it to tell the recipient that he had picked up the food and was on his way, with an ETA. “Hi Betty, Joe here. I’m on my way! ETA 10m” He even worked out exactly how few letters it would take to send a friendly note, with his name included, hoping for a better tip. And it would work, most of the time!
Informaticists like social engineering nudges when used for good.
Fight the man
Not all algorithms are looking out for the front line worker. “Fight the man!” becomes “Fight the code!” It is disappointing that gig economy algorithms have no allegiance to their drivers. No “company loyalty” engendered here: it seems that the algorithm is testing “how low will you go?” Here’s an offer to pickup from McDonalds for $2 to drive 2 miles to deliver. Want it? (no). or, Pickup from Applebee’s for $3 to drive 4 miles? (no). How about pickup from Korean fried chicken for $6 to drive 3 miles? (YES).
Sometimes it is not busy and you have to decide whether to take the lower paying deliveries because THERE IS NOTHING ELSE. But then, is that better or worse than just parking and having your engine off, saving gas, waiting for the next one?
Sure the algorithm has to make money for its Master-in-the-sky, but surely we can take care of our front-line workers and set some sort of regional minimum wage? Deliveries at $2/mile are helpful, but when it is $1/mile, it works out to less than minimum wage, and recipients do not often tip.
Hmm. Can the informaticist learn from game theory to improve user engagement in our common purpose? And are there principles of respect for front line workers in the design of artificial intelligence algorithms that make life better for all, not just the corporation?
when a son or daughter volunteers to let you come along to do something crazy like this. I’m aware these opportunities will not always be there.
The informaticist yields to the parent: YES, the parent says. I’m grateful.
Another sign of the times: older books getting a resurgence in sales from fans posting emotional reactions on TikTok.
Hmm. It seems that one can quickly change minds (and behavior!) on a population scale with super-short emotional appeal.
The good: Shows that Daniel Kahneman’s “Thinking, Fast and Slow” is an important pillar of modern online technology: emotions and story change more minds than just data. (link is to a blog post on The Undoing Project about Kahneman’s life and work).
The bad: Shows that Nicholas Carr’s book “The Shallows: what the internet is doing to our brains” is also right — we don’t have patience to read long-form fiction, except maybe when TikTok tells us to. (link to my mindfulness blog series, and a review of Carr’s book).