MURDER, POLITICS, AND THE END OF THE JAZZ AGE
by Michael Wolraich
Order today at Barnes & Noble / Amazon / Books-A-Million / Bookshop
MURDER, POLITICS, AND THE END OF THE JAZZ AGE by Michael Wolraich Order today at Barnes & Noble / Amazon / Books-A-Million / Bookshop |
The I.B.M. software engineer Frederick Brooks, in his classic 1975 book, “The Mythical Man-Month,” called this final state the Tar Pit. There is, he said, a predictable progression from a cool program (built, say, by a few nerds for a few of their nerd friends) to a bigger, less cool program product (to deliver the same function to more people, with different computer systems and different levels of ability) to an even bigger, very uncool program system (for even more people, with many different needs in many kinds of work).
Spencer plotted the human reaction that accompanied this progression. People initially embraced new programs and new capabilities with joy, then came to depend on them, then found themselves subject to a system that controlled their lives. At that point, they could either submit or rebel. The scientists in London rebelled. “They were sick of results that they had gotten one week no longer being reproducible a week later,” Spencer wrote. They insisted that the group spend a year rewriting the code from scratch. And yet, after the rewrite, the bureaucratic shackles remained.
As a program adapts and serves more people and more functions, it naturally requires tighter regulation. Software systems govern how we interact as groups, and that makes them unavoidably bureaucratic in nature. There will always be those who want to maintain the system and those who want to push the system’s boundaries. Conservatives and liberals emerge.
Comments
Was going to post this but then forgot. Just another example of how anyone who cares about the health care situation needs to read everything Dr. Gawande writes.
I've seen and felt the results of this one up close and personal. Computerization has just upped the terribly faulty "treat the test, not the patient" nature of the system astronomically.
Whole situation has had this strange effect I've noticed lately among the activist patient contingent on the net. Some people are taken with seeking providers (as in m.d.'s, physical therapists, optmetrists etc.) who are recent immigrants from third world who first worked in their home countries. Because they are experienced at treating the patient, not the test and the computer. Which is the experience you need to practice medicine properly as an art and not a science. Likewise, if you are having trouble getting diagnosed with a vision problem by fancy opthalmologists, it's worth a try to see what Lenscrafters affiliated optometrist thinks, one who has seen thousands and thousands of patients with all manner of problems and actually has to deal with patients who come back because the new glasses don't work. Rather than having more specialists pouring over your retinal images and not seeing forest for trees.
by artappraiser on Thu, 11/08/2018 - 1:32pm
Good article w a lot of takeaways:
1) it's 2018 - computer systems should evolve, not be static - even at large scale
2) in eXtreme Programming/Agile projects, the range of stakeholders are included in the design process - say every few weeks, not at product release date.
3) yes, the major benefits may accrue to someone else - lowest hanging fruit or most critical need. One I keep harping on is the benefits of global trade have drastically fut global poverty, just prolly not helped US workers the most
4) like in a M*A*S*H unit, time to think and analyze may take backseat to handling an incoming glut of wounded. The largest needs of our healthcare system may skip some niceities for a while.
5) Remember Search in the 90's? Alta Vista, Dogpile, Yahoo - they all sucked until 2000. This new healthcare system sounds like a 1.0/first generation. With luck it'll improve reasonably quick or be replace with the better variant, where data overload is replaced by the 8 or 12 areas you might need to actually see.
5b) Waiting for the next Amazon that understands user flow and support as well. I've watched a local computer shop grow from easy walk-in service to fully integrated online/mobile/bricks-and-mortar experience, expanded line of digital items/household appliances, coffee shop while u wait for warehouse pick-and-place, 24 hour express order/delivery window, food-and-drink catering for long Xmas lines, more std shops and courier delivery plus dropoff points w cabinets &pin code around the country to get your order w/o waiting around for a dropoff... They just keep getting better.
6) waiting also for the next AirBNB and Uber, which may have the most disruptive effects and might enhance the user experience at the expense of the whole market.
7) yes, humans count, and the human interactions in the system workflow count.
8) I remember my dad's physician seeing to him and maybe 1000 or two other seniors. There were moments of quality care, but overall it was feel-like-a-number. I read Down The Rabbit Hole recently about neurological diagnosis in a high intensity last- chance hospital ward, but despite the author/doctor's insistence to think outside the data, there was extremely little time to do this - say precious minutes, not hours - the rest was bedcare work.
9) 3rd world - at some point brown people may not be our support reserve of call centers and cheap doctor analysis, but for now I suppose it may help...
10) Scribe is ok, but I think there are much better, more fluid ways of hands-free, human-computer interaction. I was rather amazed there was so little mention of new devices - medical testers, machine learning, alert systems, et al. Another area to pull together as a holistic, smooth workflow system.
11) and yeah, insurance - getting authorization, treatment, problem resolution, ... mix this in with tratment and doctor/patient communication to confuse and convolute - but it's also the customer's pain point outside of the actual affliction. Are they doing a good job of reconciling? How's that digital message board with full case history and conversations, 24 hour access to <5min support...?
by PeraclesPlease on Fri, 11/09/2018 - 12:40am