Can You Hear Me Now?

“I feel like a little girl at Christmas!” my almost eighty-five year old mother said, from an appropriate social distance, after she received her new iPad earlier this month.
My middle daughter, ever the organizer and planner, asked if her grandmother knew how to FaceTime or otherwise communicate by video in this new world of COVID-19 and social distancing. Her great-granddaughter is growing up in Colorado and she, like the rest of us, has not been able to see the little one, or any of her other great grandkids, for some time now. Something needed to be done to remedy that. My daughter had the marvelous idea that we should get her Grandma an iPad and teach her how to use it. I agreed and ordered one right away.
The look on her face when I saw my mother talking to me by video on the tablet was simply priceless. She quickly learned how to use this wonderful little piece of tech, and connected swiftly with her grandchildren and great grandchildren in Denver and Chattanooga. Something so simple lead to almost immediate joy. A silver lining in this dark gray Coronavirus cloud for sure.
We have found that we can all stay connected pretty easily to friends and family in this time of social connection crisis, but what about connections between patients and providers? What do you do when you have physical symptoms and have been told to stay away from doctors’ offices and emergency rooms? What happens when your depression deepens, your anxiety flares and the voices that were under pretty good control start to scream at you again? What happens when your resolve to stay sober is dashed by the fact that AA meetings are not meeting at all? How do you connect when mental health centers, doctors’ offices and clinics are not seeing people physically due to the worry about coronavirus transmission?
We have found that there are several very good apps and services that help us to do just that. Most of us in the local mental health center world are now working from home the majority of the time but we still have full schedules of people to assess, check for medications, and to do counseling sessions with. I thought I would share some generalities and specifics of this new world with you. It might help as you pursue your own mental health treatment, and you might find that it also goes for other medical care that you might receive as we navigate this new normal.
We communicate with you by phone call or by video calls of several kinds. This is a wonderful addition to our therapeutic arsenal, but it does come with some caveats. First and foremost, you must understand that while these ways of communicating with your doctor or therapist are quite private and secure, they may not be considered 100% HIPAA compliant. As you might remember, one of the primary jobs of the Health Insurance Portability and Accountability Act of 1996 is to safeguard your private personal and healthcare related information. Speaking with me in my office with the door closed and no one else around is about as safe as we can make things. Talking to me on our iPhones via FaceTime not so much, though it is a wonderfully vivid way to see and talk with each other in real time. You see the tradeoff there.
What are some of the other options for communicating in this new way that are being used by the local mental health community? Doxy.me is a video or audio telemedicine platform that is free to use, though it does have a paid tier with a little more functionality. I can send you a link that allows you to be in my “waiting room” until I call you for the session, which can be video or audio only. This service works well but the quality seems to be a little spotty at times, with freezes and restarts and other issues. If you have a Google or Android phone and have Google Duo, I have found that both the audio and video quality with that app are quite good. Google Voice is my go to for regular phone calls, as the connection is usually quite good and the quality of the call is quite nice as well. I have already mentioned FaceTime above, and some folks specifically asked to be contacted via that platform since they have an iPhone and trust it to be secure.
When we see you using these apps and services, we make sure that we tell you why we are doing this, that it is not the same as being seen in the office and that you give us permission to speak with you using these platforms. Most everyone I have seen over the last two or three weeks has been completely fine with these new ways of having a mental health visit. Some of the upsides? Patients do not have to waste time, gas money or effort getting to the clinic from their homes, paramount during this time of social distancing. When I call and you answer, we can get right to the point, cutting out much of the time walking to and from the waiting room, gathering paperwork for labs, etc (I can do most all of that electronically, as well as electronically prescribing most of your medication right from my laptop keyboard as well) and actually finishing many of these sessions in less time than at the center in person.
Lastly, may I leave you with some tips to help make this a smooth process on both ends of the phone screen? Understand that video or phone appointments are still appointments. They are set at specific times, and we expect to “see” you at those times. These are not casual or social calls. That means that you should be set up and ready to receive the call at the time specified, so that everyone may be seen on time for that day. I have called some patients this week, only to have a parent roust them from bed to speak with me, or having to wait for them to complete a task in the kitchen or bathroom before they can come to the phone. Consider your surroundings, as I do. I have had virtual tours of many backyards and decks, and met several cats and dogs on screen this week, which is certainly fun but may make it harder for us to really hear each other well enough to get our business together completed. Find a quiet, private spot for us to talk, just as we would if we were in the mental health center. One more thing. Remember to dress like you are going to talk to your doctor or counselor. I have been quite surprised and frankly startled a couple of times these last few weeks by what folks will wear while FaceTiming on the phone.
We are very unlucky in that we are all living through the first world pandemic in the last one hundred years. We are also quite fortunate to have at our disposal some of the most useful, easy to master technological tools for communication in our history. I am so glad that we still get to carry our work forward, maintaining our mental health even as we strive to stay physically healthy in these challenging times. Stay safe and thanks as always for reading.

Slow Hand

I did some continuing education this week, the old-fashioned way. I inadvertently signed up for both digital and CD forms of my CME programs from the provider the last time I renewed, and this week’s program arrived as a plastic CD in a paper mailer. Talk about a blast from the past! I have not listened to CDs for this type of education for several years now. I decided that I would use the CD in the car on the way to work, which was just fine.

Now, after one is finished listening to the program, one must complete a post test that is graded for credit. I am also used to doing these online, answering the questions quickly, hitting send and seeing instant feedback of scores and documentation of the completed course. As this particular program was not even showing up on-line yet, I had to (gasp) study the written summary of the material and then (double gasp) take the test on a sheet of paper, filling in those little answer bubbles. Remember those? Then I could either fax the completed form or mail it back the old-fashioned way.(I faxed it)

This whole process, one that I had not used in years, felt awkward, slow and cumbersome. I found myself flashing back to the first time I took my shiny new iPad in the car and FORGOT my beloved iPhone at the house. Both times, I felt like I was cheating on my previous technology.

The positives to this retro CME experience?

It slowed me down. Big time. After listening to the program on the CD, I already had a printed copy of the notes and references for the lectures, whereas before I would have to make the effort to print a copy myself if I did not want to simply read it on my screen. I actually looked some things up, read and re-read them, and could go back and use this printed material to research my answers to the questions.

I was more focused on listening to the program and actually thinking about it somehow.

The testing process felt much more deliberate with the answer sheet and its little bubbles waiting for me to fill them.

Doing this again helped me to think back and remember what learning used to feel like before the age of the internet, podcasts, video lectures, audiobooks and TED talks.

It was not altogether a bad experience.

Which way is better for me personally?

Well, like Marty McFly, I don’t mind going back to a skateboard every once in a while as long as there is a flying DeLorean waiting to take me back home to my waiting Toyota Hilux 4X4 in the garage.

No Excuses

I attribute my success to this-I never gave or took any excuse.”

Florence Nightingale

 

I was publically thanked today for doing my job. No, really. By two of my coworkers, actually. It sort of took me aback just a bit.

Over the Christmas holiday a couple of patients, being human like we all are, forgot to get their medications squared away before the clinic was going to be closed for a total of five days running. They panicked, thinking that if they ran out of medications it could come to no good (probably an accurate assessment showing some degree of insight), so they contacted the clinician on call. She, doing her job, texted me, asking if I would consider calling in the medications for these folks.

I was in Atlanta, probably in my bathrobe or at best a pair of shorts and a t-shirt, but reach me she did, and respond I did in kind.

It took a little finagling (it was Christmastime, after all), but the scripts were duly called in, the clinician relayed that to the patients and everyone was free to go forth and celebrate.

This was no onerous task. It was no superhuman feat. It was good care provided when asked for, best practice response, and the kind of support that builds trust not only between team members but between providers and patients as well. Why would I not respond exactly like this, every time the scenario occurred? Nowadays, I try to do just that. A few short years ago, that might not have happened. Why? Come back in time just a few years with me and let’s take a look.

In the days of yore, the old paradigm saw us working pretty standard 8:30 AM to 5:00 PM clinic days, with a half hour to an hour off for lunch. We were on site then, everyone knew that everyone who worked there was in the building,  and it was not really very hard to find people.

There were phones on site, but they were the most basic back then, having two lines, maybe three if you were lucky. It was not uncommon in those days to have to wait for all the little lights to go off so that you knew you had a line open to make a call. There was no voicemail. There were pads of various sizes of yellow sticky notes that were used to leave messages everywhere, from doors to desktops to coffee cup handles.

Communication in the office was largely word of mouth. In other words, if you wanted to speak with someone, you actually had to (gasp) go find them and talk to them! Oh, you could also write a letter or a formal memo that had to go through the office courier to get to the party you sought.

The key thing was, the hours were 8:30 to 5, and that was when most of the work got done. If you did not reach your party and state your case and get your business done within those hours, chances are nothing was going to happen before 8:30 the next morning.  When quitting time rolled around,  most folks headed out toward home, and they did NOT want to be found or hassled or hounded before they came back to the office the next business day.

As you might imagine, this lead to frequent missed contacts, unfinished business, lost sticky notes, and poor outcomes sometimes.

Flash forward to 2017. The new paradigm. Meet the new boss, same as the old boss, but with a few technological and logistical enhancements.

We now have much more flexible business hours, with some folks working until seven or eight at night, and many jobs requiring weekend hours. It is hard to define “after hours” now, especially if you work two very different  jobs like I do, one of which involves shifts of six to thirteen hours and can last until one in the morning.

Our phones are now internet based, meaning that I can have a physical phone on each of my four desks in three separate offices, but all I have to do is sign in with my number and a passcode and all my previously programmed information and my voicemails follow me wherever I am, with little work on my part.

I have had an iPhone since 2007, and my life lives on and in that little pocket computer. All of my contacts, my to do list, my calendar, my schedules all live on that phone. It is with me from the time I wake up until I lie down to sleep at night.

For that reason, voicemails are now ridiculously easy to leave, in multiple places if necessary.

I now have Skype for business open on my computer desktop all day long, so I have yet another way to communicate in real time with my coworkers. I can send a message in real time and chat with someone, instead of sending an email and waiting perhaps all day for a response.

Word of mouth and actual productive conversations are still necessary and effective, but one must be more proactive to make them happen now. Memos and physical letters among coworkers hardly exist anymore.

We are living an “always on, always connected” life in 2017. I am almost always accessible, but it quickly becomes apparent that if I do not decide on what the appropriate limits are for that availability, it will most assuredly be abused. Limit setting is key.

So, the bottom line is, in this day and age, to say that I never got the message from my coworker about the patients who needed medications called in, or that I had not checked my voicemail one single time during the Christmas holiday would simply not fly.

If I put myself out there as available and willing to respond, then I must make good on that promise, build trust that I will do what I say I will do, and allow my patients and coworkers alike to benefit from the trust that builds over time.

In 2017, there is simply no good excuse to do otherwise.

 

Monkey in the Middle

Keep away.

Monkey in the middle.

Urban Dictionary defines “monkey in the middle” as the person who is in the middle of two fighting sides. This person is friends with both arguing sides and wants to stay neutral but is eventually dragged into the fight, and one of the fighting sides becomes mad at them. 

I will be fifty nine years old next month. I grew up loving to read. I read everything. I was thrilled when the new Scholastic Book Club circular, or anything like it, came home with me, to be lovingly perused and marked up with all the paperback books,  Dell crossword books and dinosaur books that my parents would allow me to order. I was more thrilled when the shipments came in, giving me hours of pleasure like no other activity I enjoyed at the time. I was ecstatic when my parents bought the complete set of the Collier Encyclopedia, complete with annual updates, though I can now come clean and say that I wish they had bought the World Book Encyclopedia instead. Colliers seemed a bit too stodgy to an elementary schooler. 

I simply loved the feel of the page. I loved the color glossy pages. I loved doing crossword puzzle after crossword puzzle. I loved the feel of the spine of a book nestled in my hands, the way new pages stuck together until you riffled them the first time, opening up the whole new world that was hidden in the infinitessimal spaces between the papers. I loved that tipping point that came when you knew by feel, without even looking at the page numbers, that you were just over halfway through a novel, and that it was all down hill from here. A race to the finish, the climax, the denouement, the satisfying completion of a mind journey that could have transported you anywhere in the universe.

I still love to buy books, to keep books, to shelve books that I just know I will read one day (sometimes do, sometimes don’t, let’s be honest). I still like to peruse the colorful pages of magazines, especially when I am tired and just want to kick back and do something familiar, something comfortable, something comforting. 

I am a product of my age, my upbringing, my schooling, the modeling of my parents and mentors and teachers. I am an analog man in an increasingly digital world. 

Now, I love my technology. 

I have bought more iPads that I care to admit to. I have owned every desktop and laptop computer from a Micron to a Dell to an HP to a Radio Shack to Apples. I have lusted after the newest Sony PDA, upgraded to a Treo with a stylus, and was fascinated when I first heard about the marvelous little machine that was to be the first iPhone. “I’ve GOT to have one of those,” I remember saying when seeing the image of the prototype on my laptop screen. I have owned virtually every model of iPhone since 2007. 

I get excited when thinking about moving next month and setting up a new wireless system in the condo. I am already salivating over wireless security systems and what might best serve our needs. I am constantly looking for the next excellent podcast, digital newspaper, newsletter, or blog to read. I love audiobooks. I listen to music on three streaming services, only one of which I actually have to pay for. I watch movies on my iPad, which has more pixels and a much better picture than my widescreen television. 

I am a product of my age. I am a digitally connected man in a world that is watching analog constructs fade slowly into history. 

I am the monkey in the middle. 

I am listening to a fascinating audiobook right now that I would recommend to everyone. The Inevitable, by Kevin Kelly, looks in some detail at where we are headed, and why, in the next three decades. While I do not delude myself into thinking that I will still be around forty or fifty years from now, thirty is definitely doable. I get very excited when I think about the world that my grandchildren will be running, of which I may still be an active, though peripheral, part. The book speaks to the way that society and all its wonderful parts is morphing and continues to change over time, cataloging and saving and curating and dispersing and sharing and annotating knowledge and creativity and thought of every conceivable kind. It also speaks to the generation, MY generation, that finds itself squarely in the middle of two camps, one whose tenets are inscribed on cotton paper, and one whose bits and bytes are blinking and beeping into the future. 

I am friends with both sides. I want to remain neutral. 

It is going to be a fun ride for the next two or three decades, that is certain. I want to keep up, to remain relevant, to learn, to continue to produce and create and to learn to access the new technologies and the new paradigms as they present themselves. I very much want to keep working, to keep helping people through my vocation, to educate myself continually about advances in my field. I want to enjoy music and art and books and the vast amount of information that is the collective knowledge of our increasingly connected world. I do not want to become an old man who is too intimidated to reach out and try something new out of fear or ignorance or apathy. 

I don’t mind being the monkey in the middle, as long as the game of keep away does not turn into a game of dodge ball. 

Proclamations 

I walked into the Starbucks and ordered an Americano and a breakfast sandwich. 

I sat down at the small table and arranged my food, my small black Moleskine, a pen, and my iPhone. I was ready to write the day’s blog post before work. 

He was setting up at the table next to me, in the corner. An obese middle-aged man wearing glasses, baggy shorts, a striped polo, and white socks pulled up to his knees, he reminded me of a cross between Steve Urkle and a panda bear. Or maybe think Charlie Brown at age fifty-five after a fifty year love affair with Krispy Kreme. 

On his small table, same size as mine, but spilling off into the chair, he had a large black backpack, a fifteen inch black PC, a couple of brick chargers and long cords, a pair of wired headphones, a few more cords, and a purple mouse. (I’ll give him style points for the color of the mouse, and it was cordless) 

He was bustling and attaching and unwinding and de-tangling and powering up this rat’s nest of 1990s technology. He would drop the end of one cord, then grunt and huff and puff as he laboriously dropped to his knees to retrieve the plug and then reached under the table to plug in the device attached on the other end. He would get back to his feet, bustle some more, sigh heavily and loudly, then move to the next device.

(150 words of the blog post done)

After ten minutes, he went to pick up his coffee at the bar, came back to the station and took another five minutes to fix it just right, slurping loudly. 

As he passed, he said hello, followed by, “So many moving parts to a nice, quiet cup of coffee.” I smiled. He smiled. 

Having for most of his rig at least connected to power, he began to talk into his cell phone, making a recording telling someone that he was at Starbucks and was having trouble getting connected to….something…..somewhere. He then played the recording back, loudly, sans headphones, to check it. The quality, also very 1990s, was scratchy and hard to understand. He did this three times. I’m not sure if he ever sent it to anyone. 

(350 words of the blog post written)

He looked over at me, exasperated, and exclaimed, “I’m very envious of you. You’re already making proclamations, and I’m still forming committees!”

Ten minutes later, he got up again, packed up everything into his backpack except for the PC, the cell phone, the cable between them and the purple mouse. He continued to try to record messages, but other than that, I could not see that one thing had been accomplished so far while drinking his quiet cup of coffee. Not for lack of trying, of course. 

Sometimes, less really is more!

(750 words and done for the morning’s post)

The world is a crazy place right now.

Think, prepare and plan as much as you feel you need to, but then stop preparing.

Start doing.

Have a great week, all. 

I Can’t Feel My Feet

There is a lot of talk, and some considerable action, around the ideas of artificial intelligence (AI), augmented reality (AR), and virtual reality (VR). 

AI has to do with a machine learning how to think like a human, getting smarter,learning to problem solve, and learning how to respond to situations. Think about the supercomputers that can beat chess champions, or the masters of the game Go. We used to think that anything that was cutting edge and had anything peripherally to do with computers was mysterious, wonderful, artificial, and at least a step or two above our pay grade. Not so anymore, as even things like optical character recognition (OCR) can be performed with simple software that I keep in my pocket on my iPhone. 

The central tenet of AI is of course that human thought, reasoning and decision making can be so precisely known and mapped that a computer can simulate us perfectly, even to the degree that we can’t tell if we are interacting with a very intelligent machine or another of our own kind. (See Ex Machina, an entertaining but disturbing film, and Turing Test

I have just started using an Amazon Echo, interacting with me in real time as Alexa. (Thanks, Greer) Embodied as a small, black cylinder sitting on a side table in my living room, Alexa is always on, always listening for her name. I can wake her and ask her for the current weather, how long my commute will be this morning given any traffic delays, or what is on my schedule in two weeks on this date. I can ask her to play some smooth jazz from Spotify, as she is doing now as I write this. I can ask her to read my audiobook to me. I have over three hundred audiobooks in my collection, but she knows which one I’ve most recently been listening to and exactly where in the book I was last, whether I was listening on iPhone or iPad. She knows where I live, which restaurants I’d probably like to have dinner at tonight, and where the best local coffee shops are. She can order things for me, research topics that I have a question about, or discuss quantum physics. 

Did I mention that she does this without my ever being physically near her at all? I can do all the things I mentioned above, or have Alexa do them, without ever touching her. I can call her name anywhere in my home, and because of a directional microphone system, she can hear me even if the music is playing loudly. She has a pretty good USB enabled speaker system that can even play things from my iPhone or iPad if I like. 

Is Alexa smart? Is she intelligent? Yes, and no. She is already a whiz-bang assistant, but I had to tell her what I wanted, what I was interested in,where I live, etc for her to carry out her functions. Do I care that she is always listening, prepared to respond at the mention of her name? Do I think that Jeff Bezos has a direct line to my living room and my life. Of course not. Is she my  favorite tech tool? No, that spot has been occupied by my iPhone for the last decade and is not likely to change any time soon. If Echo and Alexa keep getting better, might she be in the top two? Very likely. 

Listen to this episode of the Maccast for more in formation about AI, Alexa and where things are headed with our eventual robot overlords. It will either leave you tremendously excited or scared to death. I’ll leave you to guess which way I roll. 

How about augmented reality or AR?

The premise here is that we each live in and move through a real world. (That could be another blogpost in itself couldn’t it?) We see what is in our direct vision or hear what is aurally available to us, and the like. AR takes that world and layers other stuff on top of it, like information about what you are seeing, your exact GPS coordinates, or what is coming your way next, so that you can better process what is going on around you. AR supposedly makes your reality better, but you can see how it might detract as well. 

Do you remember seeing some of those movies that have the characters walking down a busy city street, and how information, sales, ads and other things popped up in their field of vision, as if floating out in front of them? This is AR. Its purpose is not to change your reality in a strict sense, but to make it more useful to you. 

Now, some people are extremely hesitant about this technology, even feeling quite paranoid that giving up information about themselves that is then filtered and sorted and processed by a machine and fed back to them in an albeit useful way is too intrusive. They feel that their lives are private, that no one needs to know their comings and goings and buying patterns and tastes. I disagree. As long as I decide how to integrate this system into my own life, as long as I have some modicum of control over how it actually plays out in my day to day life, I say bring it on! 

When I am traveling, I can now take the time to get out my iPhone, open the Starbucks app, search for stores in the area, and even order ahead so that I can stop, run in and pick up my completed order, and be on my way. That is way cool. How much cooler will it be one day when a combination of AI/AR can tell me and show me via a heads up display in my car that the next Starbucks is the last one for fifty miles and that I should probably stop to augment my caffeine levels? Not only that, but it will offer to order ahead for me, my usual of course, leaving a little room for cream in the venti Americano. (Not because I like cream in my coffee, but because the baristas always fill the cup so full that it tends to slosh around in the car) I have no problem at all with technology working with me to make my life easier, more fluid and more fun. 

Still paranoid about all this? You’ve been watching too many Terminator movies. 

Lastly, what about virtual reality or VR

VR is different from both AI and AR in that its mission is to take you and plop you smack dab in the middle of another world. In the past, this might have involved your sitting in front of a large box and a literally sticking your head into it to physically and mentally immerse yourself in this new world. Nowadays, with the advent of Occulus Rift and HTC Vive, one may simply put on a giant honking bulky headset (yes, boys and girls, this is progress) and be on Mars on in the cockpit of a jet or in an otherworldly landscape. VR is like Calgon. It takes you away. (I don’t recommend wearing a headset in the bathtub.)

I have listened this week to a few podcasters describe their recent trip to Facebook headquarters and their experiences with expensive, high-end VR rigs. It’s like listening to teenagers describe their first acid trip. Really. How cool it was, and how, like, man, “I couldn’t feel my legs!” The reason for this? VR reprograms and remaps your brain, if just for a little while. Its visual feast and upside down gravities and haptic feedback and other interface components trick your brain into thinking that the world you are experiencing with the headset, whatever it might be, is now the new, real world for you. This is sometimes so unsettling that users get upset  and nauseated and throw up. It takes them several minutes to regain the use of arms and hands when they leave the simulation. Are we having fun yet? 

Now, I’m all over the AI and AR stuff. The VR side of this?  Not so much. Granted, I’ve never been a hardcore gamer (I still  haven’t finished the first installment of Monument Valley on my iPhone, and a its a fabulous game). As I mentioned, it can make you queasy and physically sick. It’s disorienting and frightening at times. Sounds too much like work to me. It’s also tremendously expensive.  I got my Echo for much less than a hundred bucks, but a top notch VR rig including a powerful enough computer to drive it, the headset, and everything else could easily run you between $5000-$10,000. Uh, no thank you. 

The bottom line? Bob Dylan was right. 

This stuff is already here and working pretty darn well even in beta form. It can be fun, challenging, helpful, frustrating, expensive, exasperating, and exhilarating. 

It’s only going to get better, more available to the masses, and more affordable. One day,  having computers assist us through our days will be as easy and as acceptable as programming a machine to make our morning coffee is now. 

Read about it. Try it out with something like an Echo. It’s fun. It won’t hurt you or ruin your life. Really. 

Thanks for reading. 

Now, if you’ll excuse me, my iPad just informed me that  I missed a call from John Connor. 

Something about his mother Sarah. 

This blog post is terminated. 

But, I’ll be back. 

Rosie and Me: Day 13. Time and Tech

So today was a monster travel day from Salt Lake City to Denver. Five hundred fifty two miles, through some desert areas with wonderful huge mesas and dry expanses, then reaching an elevation of over ten thousand feet, experiencing a temperature drop of over twenty degrees, and actually seeing snow around Vail and the surrounding area.

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I finally made it in to Denver after a few Starbucks stops, one in Colorado that was very beautiful indeed.

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Two broad thoughts crossed my mind today.

The first: how does one manage time when taking a trip like this, where multiple time zones are crossed from eastern to central to mountain to Pacific?

Now, those of you who know me at all know that I like to maintain a schedule, and that has not changed on this trip. I get up at the same time each day, I go to the gym in the mornings, I have breakfast, and then I am on my way for the day’s travels and adventures. Along the way I have met folks for breakfast, lunch and dinner, gone on tours and had other engagements that were time-tethered. My initial dilemma was to figure out how best to manage my time on my computer and iPhone, as well as in my car while I was on the road.

My car, my iPhone, and my computer all update themselves automatically, so that takes some of the hassle out of remembering to actually change the time as a new time zone is entered. The problem is that this can get very confusing when trying to do certain things at certain times if you’re trying to, say, stay on your east coast schedule while actually being in Montana. One way to get around this is to just allow the devices to set themselves based on the time zone they are in, automatically, and then all your engagements and appointments should be on the calendar at the correct times for the place you’re visiting at any one time. I opted to do this for this trip, and it has worked out well overall.

The second thought has been around some of the mechanics of the trip, such as map reading, pumping gas, buying things, and recording parts of the experience.

In days gone by, one would have a paper map or a fancier paper atlas and would map out the trip, sometimes with a yellow highlighter or other physical tool. One person would usually drive while another passenger would be the designated navigator, reading the map and telling the driver where to turn and how to get to a particular destination.

Now, Garmin or other dedicated navigation devices sit on many dashboards and do the plotting and even the verbalizing directly to the driver, giving step-by-step instructions in a clear way. I use my iPhone and the map function to do this same thing, and I find myself wondering how I ever got anywhere without these electronic tools.

The same goes for buying gas, snacks, coffee or meals on the road. Cash was king at one time, and no one used credit cards or debit cards. Now, debit cards or credit cards are the norm. Soon new payment systems like ApplePay, probably to be announced at tomorrow’s Apple media event in California, will find us able to simply point our phones at an NFC enabled device (near field communication) listen for a small beep or feel a silent vibration, and go about our business, the transaction completed just that simply and quickly.

I have already found on this trip that I can pay tolls by throwing coins into a basket sans attendant, parking garage fees by going to an online site after I get home, and parking space fees using an app on my phone. It’s a very different world from the time that my family and I took a cross country camping trip from Georgia to California and back in the early 1970s.

Recording the experiences of the trip used to involve keeping a simple written diary and taking pictures with a film camera, getting the film developed when everyone got home, and hoping that some of them came out well. Now, I can (and do) choose to take some pictures in Instagram, post some to Facebook and Twitter, make journal entries with or without pictures in my Day One journal, or do a combination of all three while referring to notes that I kept all during the day in a Field Notes notebook. Of course, I’m also writing these blog posts to further document the details of the trip. There are many options for documenting on the fly as well as more thoughtfully later in the day.

What do you think about these changes in modern travel?

Do you miss the more hands-on approach to map reading, trip documentation, parking and paying for items on the road?

Do you just set your watch to whatever time you want it to be instead of letting your electronic devices automatically change the time zones for you?

I’d be curious to hear your opinions.

Good night for now, dear readers, from Denver, Colorado.

Join me for coffee in Boulder in the morning, won’t you?

Talking ‘Bout My Generation

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I had had a long day yesterday, starting with a trip up the interstate to Columbia to meet with other Medical Chiefs from around the state of South Carolina to discuss the issues that affect the practice of psychiatry in the mental health system today. We had struggled with the electronic medical record, Medicare paybacks, e-prescribing, CPT coding, content of notes, billing time, and motivating our medical staffs to accept the changes that were coming, inevitably, down the tracks towards us like a governmental bullet train, sleek and fast and unstoppable. We had come up with a plan to educate ourselves as a group, to better understand the issues so that we could pass them on, a major part of the jobs we are tasked to do in our respective mental health centers. We set goals, timelines for implementation of new procedures, discussed training sessions, and then took our leave, feeling reasonably sure that things, by sometime this spring, would go without a major hitch. The session was recorded, and information was presented by the state’s wonderful IT professionals in real time with projector and laptop and other wizardry.

I got back to the office and reviewed file folders, processed emails, looked at applications for the jobs I’m advertising to supplement the present medical staff, aggregated policies from other centers that I would use to write one for my own center today, as requested by one of the powers-that-be in the capital. I organized the information of the day in a format that would allow me to present it cogently and succinctly to the Board of Directors of the mental health center that night at the regular conclave of the group. I reviewed an order I had made online on Amazon.com for a new pico projector and associated connection cable that I wanted to use with my latest generation MacBook Air to present a four hour training session on psychopharmacology to about a hundred people at the end of this month. I checked a program on my iPhone 5s to monitor the process of the flight of a friend who was returning to Atlanta from Munich later in the day. Things clicked along pretty smoothly until six PM, the appointed hour for the Board meeting.

My place on the agenda assigned, I sat and listened patiently to others present their reports about services rendered, budgets and community issues until it was my time to speak. I them went over the main issues of my first medical staff meeting last week, since coming back on board as the Chief of Psychiatric Services at the center. I supplemented that with the information gleaned at the Chiefs’ meeting earlier in the day.

In short, I was feeling pretty good about how everything was coming together and my own ability to handle it and do my job.

When I had finished, a board member, probably ten to fifteen years my senior (I am fifty-six years old), asked to speak.

“I for one really appreciate your being back in this capacity, and presenting all of this information to us tonight. I didn’t really understand about half of what you just said, but I do appreciate your trying to give it to us in a way that we can understand it.”

“Thank you, ma’am.”

“Yes, of course. I want to say one more thing. I’m not sure if this is the right way to say this, or even if I should say it, but I will.”

Hmm.

“I especially appreciate your efforts in all these areas since, you know, you are not of the younger generation anymore. I know all this is hard to grasp. I applaud your efforts to learn how to use all of this new technology.”

I looked to my left at the young woman who had just taken over the position of head of the child-adolescent-family unit. I looked to my right at the slightly-older-than-that young woman who is the heir-apparent to the Executive Director job at the center in the next three to five years. I realized that I was, indeed, not the oldest person in the room by a long shot, but that I was most certainly no longer the youngest gun.

I also realized that this woman, trying to compliment me in the best way she knew how, knew nothing of my history of using a Radio Shack TRS-80, every generation of Palm Pilot made, several Treos, one of almost every IPhone and iPad offered for sale, multiple MacBooks and PCs along the way, and having a home office complete with wireless connectivity, a scanner, two printers, two 4TB hard drives, and a cloud-based backup system just in case everything else goes up in smoke after a freak lightning bolt hits my apartment building.

One day, I hope to be really, really old.

They’ll be talking about my generation.

I’m not there yet.

Tools of the Trade

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I have had some of you ask me what I use day-to-day to get my job done. In other words, what are the tools of the trade for a psychiatrist as he goes about the business of seeing patients in the clinic and the emergency room?

Although the personal interview and personal attention to patients is my stock-in-trade, I could not survive nowadays without technology.

I use a new twenty-one inch iMac in my home office, the machine I use to do most of these posts. I have two 4 TB hard drives attached to it for extra storage of music, video, and other items, as well as to back up my data. Everything is backed up three times, twice on my desktop on two different drives and once in a cloud service off site.

I have a set of harman-kardon speakers as well as a DVD drive attached to this machine for enjoyment of music, as well as for viewing videos, doing continuing medical education and the like.

There is a copier/scanner, a stand alone printer and a Fujitsu ScanSnap iX 500 on another desk adjacent to my main workspace. A shredder lets me securely get rid of paper that needs to be destroyed. I am transitioning to a completely paperless home office, so the last two remaining piles of charts and supporting documents on the floor will find their way into the ScanSnap and from there to my iMac as soon as time permits. 

My iPhone has been my primary go-to computing device on the road since 2007. When I leave home, the iPhone goes with me. Everywhere. Everything that I do on the iMac syncs wirelessly at home and through the cloud without me thinking about it. When I pick up the phone, I can get right back to a post, a project or anything else I was doing on the main machine at home before I walked out the door. Believe me, I have tried more configurations of more machines than you can shake a stick at, including desktops, laptops, phones and tablets. For me, having one main machine at home and one device to take with me just works better overall. 

Of course, you have seen me post about the setup at work, including the Polycom system, an HP laptop, a Dell desktop, fax machine, printers and the like. This is in my telepsychiatry office and is a static configuration that I leave on and operational all the time. As you know, I am an Apple guy, I use PCs and supporting peripherals to do my day job by default, trying not to whine too much about it! Another Dell desktop lives at the clinic office and is tied into the department network, so I can access all databases and notes for either job from either site. 

So tech is cool, but what about analog tools? Is there still a place for them in the twenty-first century? Of course there is! I also love paper, notebooks, pens and other analog tools almost as much as I do my tech toys. In the home office, I always have a couple of Field Notes notebooks and a large cup full of pens around for jotting down ideas as they come to me, later to be captured in my electronic devices for processing. I have a large whiteboard on an easel right behind my desk, so that I can stand up, think about projects on my feet and jot down outlines or notes as I go. On this board I also note books that I’m reading, places I want to visit, and a working budget for my daughter’s upcoming wedding! There’s something about having a large  white space like that that promotes brainstorming and planning for me, which can be very helpful in a way that a blinking cursor or mouse pointer cannot. 

When interviewing patients, especially new patients I meet for the first time, I’m still a clipboard and template sheet kind of dinosaur. I have an interview template that I’ve used on and off, with multiple modifications, for over twenty-five years. It keeps me on track, helps me to remember overall areas that I want to cover, and is sprinkled with mnemonics for various assessment tools that I might want to use. When I get to the bottom of the stack of papers on that clipboard, I make fifty more copies and keep going. 

I also have Field Notes notebooks in my bag for on the go, plus an assortment of charging cables, batteries, pens, paperwork and other goodies that I grab as I go out the door. I keep this bag stocked all the time, so that I never have to remember whether or not I have a USB cable or a uni ball Vision Elite pen or some other equipment that I might need when I’m away from home. 

Prescription pads, printed schedules, paper projects that need to be top-of-mind and various other stuff take up the remainder of the room in my bag. There is always something to send to someone, process, respond to or to read. 

I haven’t covered absolutely everything, but you get the gist of what I grab and go with almost every day as I go about the business of working, writing, reading, seeing patients and living. 

One day soon, I’ll share with you the applications that I use on my iPhone every day. That little device connects me with the world and keeps me organized and productive in ways that I would never have imagined even five years ago. 

What do you use as you go about your day? Are you a digital or analog person, or do you rely on both to keep you productive? 

I’d love to hear from you. 

Different Strokes

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We sat there yesterday morning, all partaking of the proffered breakfast at the hotel that was being remodeled and so was a little more disorganized on this Sunday morning than would be expected. I sat at one end of the long straight row of wooden tables, sampling my oatmeal and fruit. They sat at the other, enjoying the eggs and muffins and coffee. I was headed out for a day of walking up and down grassy slopes and taking pictures. I’m not sure where they were going. 

I couldn’t help overhearing the conversation being lead by a fellow who looked to be in his mid sixties, maybe older. 

“Yeah, he told me he was getting one of those phones, you know, they call ’em smart phones or something like that.”

Murmurs of agreement, slurps of coffee, another bite of egg, another piece of muffin buttered and disposed of. 

“I don’t know why he would need that. I have a phone, and it works fine I guess. But you know,  he says it has this new virtual keyboard, I think he called it.”

Mumble mumble, virtual, mumble mumble, typing on a phone?, mumble mumble. 

“Yeah. Really. Blackberry or something like that. Yeah. Blackberry I think he called it.”

“I don’t know why they like those tiny little keyboards,” piped up another man around slurps of orange juice.

“Remember that Olivetti you used to type on?” brought up one man.

“And the IBM Selectric?” the woman asked, her first foray into the discussion.

They reminisced a minute about the old days of typewriters and correction fluid and ribbons and reams of paper. 

Then the conversation turned to Hawaii and which beaches were best and the last trip each of them had taken there.

We can’t assume that what gets us excited and drives our exploration and jump starts our curiosity does that for everyone else in the world around us. Those of us who love technology anxiously await the fall and the next release of the latest smart phone with near field communication (NFC), fingerprint recognition on the lock screen and multi-layered, parallax driven home screens that move as the viewing angle is changed. 

Others of us look forward to the next trip to beaches with black sand and sunsets that are to die for.

The take home for you on this Monday morning?

The next generation iPhone will have a gorgeous retina display, a virtual keyboard and do things that we never even thought about doing on a phone ten years ago.

If you want sun, fun, and gorgeous sunsets, and you don’t mind a significantly higher cost of living for a little while, head to Hawaii. Skip the big island. The smaller, out of the way places are best. 

Different strokes for different folks. 

I hope you all have an excellent week.