Door-dash ride along, a parent’s and informaticist’s view

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.

The attention economy

This usually refers to advertising, social media, how they are all now optimized to capture your attention and keep it. See: Made to Stick, The Shallows, Reality is Broken. Also see: every social media app on your amazing phone.

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?

Be grateful

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.

Creativity DOES NOT come from our laptops

For all the great mind mapping tools out there, for all the shiny new apps that covet my attention, when it comes to creative thinking, designing things, or brainstorming a new talk, paper is it. #whyinformatics #hitsm #hcldr

Here are some examples:

Designing my Failure Resumé talk

Designing my AI talk

Designing my Sprint talk

Attending the Stanford Design Thinking for Social Systems

Of course, you should know that it is never this clean, never this simple. You don’t see the crumpled sheets, the trash can overflowing, the angry scribbles, the hair torn out and the yelling into the void. No, you don’t see it.

I’ll give John Cleese the last, inspiring words on this.

We don’t know where we get our ideas from. What we DO know is that we do not get them from our laptops.

John Cleese

City Scooters: an informatics viewpoint

A colleague and I were recently making fun of tourists and others riding the city scooters around Seattle and other large cities. Nearly no one was wearing helmets, they’re zipping in and out of traffic, going up against SUV’s and 16 wheelers. Just asking for it. Now, it is true that Seattle has some the best bike lanes around, with dedicated ‘green lights’ just for bike lanes, to improve safety. It IS a bike friendly town.

As an aside, my son and daughter, when they were 9 and 11, were riding their Razor scooters to the park, when I overheard them:

S: my scooter has a turbo boost to go fast.

D: oh yeah? My scooter has jets.

S: So, my scooter shoots out flames

D: Well, my scooter has apps, and I can download anything and plug it in to make mine better.

Wow, kids of the smartphone age.

I thought of my children, while I hopped on this scooter, downloaded an app to unlock and pay for a day of scooting, used Google maps to find the Art museum, used Yelp to find a good chinese noodle place, and Weather to see if I needed a rain jacket. All from one device. We are living in the future, folks.

So I’m humbled to report, dear reader, that I stooped to try one myself. I have returned from that ‘undiscovered country from whose bourn no traveler returns’. Hmm. Not exactly, but you get my meaning.

Seattle Chinatown gate

Here are some quick personal observations.

$ a city scooter is a nuisance – Some folks ride the scooter on the sidewalk, endangering pedestrians. Then they ride the scooter down wrong way streets against traffic endangering themselves. Often though, they ride in the many bike lanes, merging easily with bike traffic and other electric motor powered personal transport. It even looks harmonious!

$ a city scooter is a danger to the rider. There’s no way I would ride one. Okay maybe once. Okay, I’m pretty tired after my bike ride yesterday and maybe I could try it. At least it will be an interesting blog post. Hey this is scary. Hmm. Good design, my first ride is speed limited so as to protect the newbie. Wow, after a half mile of starts and stops I’m getting the hang of this and can’t wait to unlock a full speed ride. Zoom! Full speed second ride! This is a blast!

$ A city scooter is an app. The founders of this idea realized that their potential customer base is THE ENTIRE CITY of people who have a smartphone and need to get somewhere. With a QR code, snap a pic, set up an account, and in 3 minutes you’re on your first ride. Clever.

Museum of pop culture. Where are the ukuleles?

$ a city scooter is transportation disambiguated. I’m here in Seattle for an organized bike ride later, but don’t want to put my nice bike on the street with a lock. This is a great alternative: scooters on many street corners with an app-map to show you the nearest. Then, when you arrive, park (safely) and leave it.

$ a city scooter is micropayments. Even better with a day pass. $7 per ride or $21 per day, up to 6 rides. Cool. It’s like you own a fleet of scooters all over town.

$ a city scooter is a network which grows in value with more nodes. And Seattle supports several! not only are there Link scooters, but Lime scooters and bikes, and several other brands of mobility. Unlike the first generation of e bikes that required charging and locking stations, these can be left any where for convenience as long as they don’t obstruct.

$ a city scooter is an information highway. Interesting to think about what data is reported in real time, what adjustments leadership and management need to make to redeploy, fix, recharge, see where the scooters are needed and ‘rebalance’ their locations.

Seattle art museum

$ a city scooter is modular. The components of the network are easily swappable. Riders will report issues, the scooter will tell when the battery is low or needs repair. It is self-repairing as a network.

$ a city scooter has to gain popularity while promoting safety. After my second ride I received a mandatory quiz: which scooters are parked legally? What are the relevant city laws that apply to me? And yet there is the need to grow the business, so ‘helmets are required’ but a photo proof of a helmet is not required. ‘Photo proof of parking correctly’ is required. Hmm.

$ a city scooter has soooo many customers: the city government, employees, riders, the driving and waking public, shareholders. it is interesting also to think about how many city regulations had to be addressed and met, how the public perception must be managed, how the pricing and profit models have to continually be tweaked. Is there ‘surge pricing’ like with Uber? How do you balance all these demands and make a profit? What are the guiding principles?

Well, you recognize this one

$ a city scooter shrinks a city. This is perhaps my most profound observation. After the first nervous scoot, I had a face-splitting grin the entire time I was riding. Kick start, push the thumb lever and ZOOM I could see the city literally shrink in size as I rode. Blocks whizzed by, hills flattened, and I was master of the domain, blending into bike lane traffic with all my best friends. From Pike Place Market to the Space Needle and Museum of Pop Culture to the Seattle Art Museum to Biang Biang Noodles and back to the hotel. So easy.

CMIO’s take? Multi-dimensional thinking like this is common in healthcare informatics. I enjoy thinking, feeling, and working through hard problems like this. Do you? If so, come join our ranks! We and the larger healthcare industry need your brains and emotional intelligence.

CMIO teahouse menu

How can tea improve clinical decision support? How does it help change organizations? Are you kidding?

Links to some of these teas:

CMIO’s take? Those of you who have worked with me know that one of my favorite things is to have 1:1 meetings in my office and serve tea. Taking inspiration from my spouse who enjoys throwing cocktail parties and creating a fanciful drink menu, I recently put together a CMIO’s teahouse menu. I hope you enjoy it.

Here’s your moment of zen – cactus images from Arizona

Here is the “burr in my sock” or “pebble in my shoe” that bad EHR design can become. In another context, this is can be beautiful.

Found this in my sock in the middle of my hike.

The only way to hike in Tucson in the fall is starting at 630am and being done before 9am.

CMIO’s take? Be present, get outside, take a breath.

I am now just eyes and brain in a chair

(okay and fingers on a keyboard)

Is this a universal condition or what? It is nearly 2 years since I set up my basement command center and accepted the 10-12 hour days of zooming and teaming my way through meetings, collaborations and seeing patients.

Charleston Gazette-Mail: Key TCU-WVU stats; brain-scrambling offenses | KillerFrogs.com ...

I just want to acknowledge that visionaries like Gene Roddenberry (Star Trek and the big brain people, above) and Matt Groening and Futurama saw clearly from decades ago, our present condition.

I’ve heard that there is a thing called “outside” that I’m going to go up the stairs and find out, if it exists.

“The best minds of my generation are thinking about how to make people click ads.”

https://www.wired.com/story/plaintext-time-to-talk-about-facebook-research/

This article above is a disturbing, quick take on Facebook research and the lack of transparency in what is being done, from a researcher who recently quit working there, and left this quote behind.

Chilling, the use of data by social media titans with a critical lack of oversight. The Cambridge Analytica – Facebook scandal, it seems, has not mitigated the giant’s appetite to turn their data about you, against you.

The other quote that disturbs me about this is: “If you’re not paying for the product, you are the product.” I’m not sure how to attribute this quote, and some dispute the accuracy of its pithy claims, but it does make you stop and think.

And if you are as disturbed as I am, maybe you’ll make some changes in the way you use Facebook. For example, I have:

  • Removed the Facebook app from my phone. It is a power hog, and I am uncertain how much it tracks me and my activity. Instead, I the Safari browser to log in to Facebook when I want to and then quit the page when I’m done (unlike the app that can be on all the time in the background).
  • Cut back my personal posts by 95% or more to Facebook. Instead, I write wordpress.com blogs and cross-post them to various platforms.
  • Spend 95% less time browsing Facebook posts (and ads) by deciding to be more of a content creator than consumer (see above). I’m only browsing about once a week or so.
  • I considered deleting my Facebook account entirely, and I may still take that step, however, the network effects of connecting with so many family and friends, is, as all of you know, very seductive and difficult to sever.
  • Also, I now use DuckDuckGo as my default phone search engine, and as a plug-in to Google Chrome, so that it will purge my search history and so that Google, Facebook and others (when I use their website through DuckDuckGo’s filters and blockers) are prevented from placing and tracking cookies without my knowledge.

CMIO’s take? I’m certain I’m still leaking a data online, but I’m trying hard to throttle my bit-torrent down to a bit-drip. And I’ll keep looking for ways to take control back from the big guys (Facebook, Amazon, Google, Apple). What efforts are you making to protect your current and future privacy?

Thanksgiving #2 During Pandemic: giving thanks

Dear Reader. This is an email I sent to my Large PIG (physician Informatics Group) this week. I wish you all a restful holiday. CT

Dear Provider Informatics Group members: My General Medicine Division Chair sent this today, and it makes me reflect about Thanksgiving. I wanted to pass this along to you. It has been 20 months of chaos, emergency changes and emotionally draining life at work and outside work.

“The arc of the moral universe is long, but it bends toward justice.”

Martin Luther King

It is a reminder that in our day-to-day, all we see are boulders and rockslides in our path. In the long run we are bending the path to reduce burnout, improve connection and improve care. Our work affects 6000 providers, 15,000 nurses, and a couple million patients. 

I am thankful to be on this journey with you. I hope you can take some time this week with family and loved ones. CT

—–

From: Earnest, Mark
Subject: Giving thanks 

Dear GIM Colleagues,

Ms. Sutton, my third grade teacher, taught me to start letters that way – with the word “dear.”  

Since leaving her classroom, I’ve not really given the word much thought.  Aside from placing it at the start of letters, or employing it generically as a term of endearment for my wife, I haven’t used it much.  I use it even less now since “hi” or just a stand-alone first name have become de rigueur for email greetings.  Using it less, I think, is a mistake.   According to Google, “dear” means “regarded with deep affection; cherished by someone.”

Today, I want to use the word with intention. 

So, let me start again.

Dear GIM Colleagues,

We are approaching the one day in our calendar each year that we set aside for thanks.  I’ll confess that after 20 months of the pandemic and all the associated fire-drills, chaos, and public acrimony, I’m much more facile at bringing to mind the things I’m not thankful for.  That may be the most compelling reason to devote my attention this week to its intended purpose – focusing on the things in my life that I cherish and regard with deep affection. 

I’ll not bother you with my gratitude list in its entirety other than to say how much I look forward to a house that is again filled with its full complement of family.  I do want to reflect for a moment on work.

As a young man, choosing a career path, I was clear about one thing.  I didn’t want a job.  I wanted a purpose.  I was fortunate to find that calling in medicine and ultimately in GIM.  I chose well.  I have always loved caring for patients.  Along the way, I’ve found other, related opportunities for growth and points of purpose: teaching, mentoring, helping others find and actualize their purpose…  In all honesty, work for me has been a great source of joy and satisfaction.  A wonderful side effect to finding my purpose, has been the privilege of working alongside other purpose-driven people.  If I could start from scratch and hand-pick a group of people to take this journey with, I could do no better than you – my dear GIM colleagues.  It is a profound privilege to be part of such a caring, committed, selfless group of people. 

Now – after twenty long months and in the midst of a surge – is almost certainly not the easiest time for any of us to hold our work dear.  It has been hard.  Nevertheless, it is possible to be tired, even exhausted, and thankful at the same time (ask any marathoner at the finish line).   Unfortunately, we are not yet at the finish line.  We have a challenging winter ahead of us.  That in and of itself should be reason to pause and reflect. 

I hope this week that each of you can find a moment to consider our common purpose(s) and find the space to be thankful for it.  Doing so need not deny the challenges we’ve faced or the sacrifices made.  Each day, in ways big and small, you have all made our world a little better.   Because of your work, each day there is a little less suffering, a little more hope and a little more knowledge and understanding.  Surely that is worthy of thanks. 

I am not aware of much more we can do to turn the tide of the pandemic.   Somewhere ahead of us is a finish line.  We will face more challenges before we cross it.  We cannot control all of those difficulties, but in the months ahead, we will be focusing on the ones we can change.  We will be looking closely at the circumstances and structures that impede our purpose and make our work, particularly our clinical work, more difficult and less joyful.   We will be looking for meaningful, actionable ways of rethinking and restructuring our work to make it more joyful and sustainable.

In the meantime, I hope you all can find the space to feel thankful for what you’ve done through this great time of trouble.  I am thankful for each of you my dear colleagues, and hope that this week you will enjoy rest and gratitude among those you hold most dear. 

With gratitude and thanks,

Mark

Mark Earnest from History Colorado dot org website

Mark Earnest, MD, PhD, FACP|Professor (Pronouns: he, him, his)
Division Head –  General Internal Medicine
Meiklejohn Endowed Chair of Medicine

Canyonlands, the Zen of Sand, and my most embarrassing moment

Canyonlands Utah in the 1990’s was a beautiful getaway for me and my then-fiancée. Having heard of this wonderful mountain-bike mecca, we had come, bikes-on-top of my subcompact, met up with our tour group, a diverse crew of men and women of various ages.

100 miles

It would be 100 miles in 4 days across rugged terrain on mountain bikes with a group of 12, a couple of guides and a required-escort (at that time) park ranger. Check it out for yourself, it is a quintessential southwest wonderland.

https://www.nps.gov/cany/planyourvisit/whiterimroad.htm

We begin with a 1000 foot descent into the canyon along a jeep trail. We had brought our old unsuspended bikes with hand brakes. Although the ride was hard on our bodies, we were pleasantly surprised that our equipment was up to the task.

wildflowers from nps.gov
from nps.gov

Our ride was a blast: wildflowers, spectacular vistas, and good company, with mostly flat single track.

Great Canyonlands photography at traveldigg.com

Our guides drive a 4×4 SAG wagon with our gear and food and set up not only our first lunch, but all our meals for the coming days. We have gallons of water that we don’t have to carry! Our camelback hydration backpacks are fantastic for on-the-bike refreshment. This is the life.

Glamping (glamour camping)

At about 25 miles into the trip, at the end of the first day, we get to camp: our guides have driven ahead, set up our site. Dinner is ready and all we have to do is pitch a tent, grab a plate and a folding chair, sit and eat. So awesome. And after dinner, a campfire (apparently forbidden in recent years in the park) and then the Milky Way. Canyonlands, and other national parks, are famous for the lack of light pollution and the spectacular view of the night sky.

photo by the author on an iPhone (!), but in Gunnison National Forest, not Canyonlands

At the end of our third day of riding, as we set up camp, our guide tells us: the Green River is about 4 miles away for anyone wanting an extra excursion. Only I take up the challenge, others choose to rest at our campsite. At the time, I was training to ride my first (and only) double century later that summer (200 miles in a day: the Davis Double, but that is a story for another day), and I was anxious to get in some additional miles.

The Zen of Sand

Solo, I head out. We had learned from our guides about long patches of deep sand on the trail, and the “zen” trick of sitting back, focusing on being “smooth and circular” on the pedals, having a fingertip light touch on the handlebars, and gazing far down the track to improve balance. If done just right, one could “float” over deep sand on the trail. Turns out, this guy agrees with me (youtube).

I actually had a few moments of success doing the sand-float in the shadow of the Airport Tower formation, entirely alone with the crags and formations of the Southwest landscape. Other times, I did the meditative sand-bike-walk.

Sun God

Arriving at the river, I stash my bike in the shrubbery. I see a flat rock jutting out into the river and I determine that I’m going to skinny dip, be clean for the first time in days, and sun myself dry on the rock. Should be great.

To my parched, sand-and-sunscreen-caked, sun-blasted body, splashing in water is heaven. I soak in the cool, rub off the grime, submerge my head and hair and luxuriate.

Then I climb out into the rock, buck naked and unafraid. It has been days since I’ve seen more than our merry biker band, and they’re all kicking back at camp. I shall air-dry, sensually alive and glorious.

Author sitting on a rock outcropping. But not naked. And not the same rock.

I am a glorious human form.

I am one with nature.

I am a Sun God.

Tinnitus?

In the back of my head, I begin to hear a buzzing. What is that? Do I have tinnitus? Odd.

It gets louder. Hmm. A washing machine? Absurd.

Yet louder. An airplane? I look overhead. No contrails. Nothing. Clear blue to the horizon.

Unmistakably the sound of machinery. Rrrr-rrrr-mmm-mmm.

cdn.getyourguide.com

… and around the bend of the river, a 20-seater tour boat, 20 feet away, a gawk-fest of tourists, with a couple kids pointing out the naked man with a bike-shorts-tan splayed out on a rock in the river.

I believe all parties were mortified.

What was there to do, but wave? And then =plop= back into the river.

author, hidden

I am a bottom-dwelling salamander.
I am a shrinking violet.
I am an overexposed slide.