Tim Ferriss - Lessons Learned

After reading the 4HWW, watching Tim Ferriss interviews and reading his blog, these are the action items I've implemented. The goal: a simple focused day with (very) few distractions.

• Stopped all pop-up notifications: those annoying outlook envelopes, gmail notifiers, IM pop-ups, and twitter device updates. The moment these appear you lose focus on what you're doing. No matter how good you are at multi-tasking, when you see that message appear on the bottom right of your screen, its in your head. That takes away from what you're doing in the moment. Check these things on your own time, twice a day or more depending on what your needs are, but don't let them rule your present time.
  

• Started a notebook of ideas: during the day we all have crazy ideas that pop into our head. Time-trending these by writing them down helps to figure out when your thought process is most clear. Also, I haven't written anything in what feels like ages. Writing is the mode of learning I grew up with and my retention is far better when I jot things down.
  

• Practiced being deliberately attentive: its easy to allow yourself to get distracted because there's so many things on your computer, desk, phone that draw you away. Forcing myself to stay on course with the task/project at hand has in fact made it more enjoyable. You can't force flow, but you can make an effort to avoid what leads you away from it.
  

• Began tracking what I eat: it seems like a hassle at first, but is really easy to do. I keep a log of all my meals on Google Calendar. Since you can see the blocks for each day next to each other, its easy to spot patterns in your diet. Its really helps me see when I veer away from the norm (whatever that may be for you personally).
  

• Minimized my taskbar: the amount of time I spend on the computer completely warrants this. As I'm working on one thing, I have a a habit of taking quick glances at the various screens that accumulate on my taskbar as the day goes on; Outlook, Gmail, articles, presentations, videos, etc. Having the taskbar hidden seems like such a small thing, but it has made an enormous difference in my "in the moment" concentration level.
  

We need a Medical Facebook

Deloitte's Health Care Consumerism Survey has some pretty interesting results. I think it attracted a biased sample of consumers though, mainly because of this finding: 1 in 4 consumers maintain a personal health record. I find that very hard to believe, especially when the word, "maintain", is used. "Started", "created but never used" would be more fitting.

PHRs are ubiquitous - hospitals, insurers, popular medical websites all provide them - but people rarely use or update them. You put your information in, register a login and never look at it again. Why? Because its not connected to anyone. Even with all your medical info in one place, you don't have the ability to share that information very easily. Docs have to know about it, support it and use it in order for it to work. Otherwise, its just a Facebook profile without any friends!

Here's another reason why PHRs won't take off any time soon:

"Tethered" means linked only to a provider or a hospital and "standalone" refers to a web-based service like WebMD or Microsoft's HealthVault. Its hard to build a Facebook, let alone a medically-based version with all the privacy/security issues involved. The need is obviously there. PHRs won't take off without it.

EDIT: Doctors don't trust PHRs because they don't link to anything they use on a regular basis. Get connected!

Worker, Interrupted

"Want to get something done? Turn off Twitter. Turn off Facebook. Turn off blog comments. Turn off FriendFeed. Turn off Flickr. Turn off YouTube. Turn off Dave Winer’s blog and Huffington Post. Turn off TechMeme.

Turn off the distractions."

--Robert Scoble

After reading the above from Scobleizer's productivity post, I of course looked up all the references I didn't know and lo and behold I was signing up for another Web2.0 application. Classic.

Yet this also gave me insight into my own assimilation within the grab-and-go, click-through culture that's been rapidly developing over the last decade. Procrastination-induced internet escapism is an easy habit, and at the sake of projects and work. Reading may broaden one's perspective, but it doesn't lend to daily, efficient production. What Csíkszentmihályi describes as flow.

Mastering information, i.e. diligently taking notes to be referenced later and forever committed to our personal knowledge bank, is infrequent in today's look-up-on-wikipedia, web-bite world. Rather, we take snapshots. Into fields, philosophies, lives, ideas, hobbies and even vocations. We don't really know these things, but we feel like we do. Vicarious information gathered and stored in bookmarks on del.icio.us or google notebook make up our reference libraries now. Learning doesn't happen through osmosis though. And the doing must be done (channeling some Yogi Berra here!). Keeping pace with our reading/browsing through personal accomplishments, whatever they may be, is important so that when we look back we see our own contributions among the multitude.

Marc Jacobs on Simplicity

“The thing I love about the gym is not having to make choices,” he notes. “My trainer says, ‘You’re gonna lift this; you’re gonna do that ten times.’ Okay, great—just tell me what to do and I’ll do it. It’s the same thing with my nutritionist. All I have to do is follow instructions. I love that. This is not about ‘Would it be better in red or blue?’ There isn’t a lot of abstract, circular thinking involved. And it’s great. Those times are really nice for me.”

--Marc Jacobs from this GQ article

Bloggers Galore!

I spend a whole bunch of time reading a wide variety of blogs. So much so that (like email) I had to force myself to limit my blog reading to specific times during the day. A quick check of google reader can sometimes lead to a 2 hour wayward session out in the blogosphere. Below are a few bloggers I keep up with and mostly discovered through my random traverses.

1. My friend, Deep, started blogging around the beginning of the year. She offers a unique, personal perspective on (actually living) life as a med student. Her idea of doctors using twitter to keep in regular touch with their patients is just brilliant!

2. Cameron's commented on my blog several times. His blog is filled with pointers on relationships, fitness, and life in general. Here's one of my favorite posts.

3. If you're interested in health care IT, John Halamka's your man. He's professionally involved in an array of things, from being a CIO of a hospital system to ice climbing to playing the Japanese flute. This post gives you a humorous, insider perspective into what he's all about.

4. Jason Shafrin, the healthcare economist, is running a great segment comparing health care systems around the world. If you're interested, here's France, the first in his series.

5. If you can keep up with Tyler Cowen, then subscribe to marginal revolution. His interests are varied, but the common theme is economics. I learn something everyday from his posts!

Monday Afternoon Recap

Here's a few interesting things I came across over the weekend & this morning.

1. Hospital Compare went up late March. See if your hospital is there. The site still has a long way to go though on useful metrics.

2. Study finds link between drinking and breast cancer (for post menopausal women). I'll give this finding about 2 years before its refuted. I have no clinical research experience to speak of, but research news over the past 5 years certainly doesn't boast a great track record.

3. It was hard to miss this article on rising co-payments for drugs if you opened up the NYTimes this morning. The anecdotes are disheartening and the sad fact is that after decades of highly subsidized drug prices, we're only now being faced with the real costs of innovation. Longer life and better health come with a big price tag.

4. On a lighter note, check out Clear, an ezpass for airport security!

5. Also, I saw this on a friend's key chain the other day. What a great way to keep your favorite pictures with you all the time. And its cheaper than those wallet-size shots!

Why not showing up to your doctor's appointment is such a big deal

No show rates for doctor's appointments are frustrating on all counts. Patients who don't show up are most likely not going to get rescheduled for another 4 weeks due to a consistently packed schedule. The doctor could have gotten another patient in and if known ahead of time, another patient waiting to get in would have taken the empty slot.

Solving this problem has always been a slippery slope. Charging patients a fee for not showing up or failing to cancel 24 hours prior to the appointment can seem antagonistic and turn patients off to your practice. Yet letting a few patients continue their lax or tardy behavior at the sake of not providing care for those that are in need can be costly as well.

There are ways to solve this problem that satisfy both patient and doctor. What got me on this topic in fact was an article that described one really innovative solution:

"We added a new doctor - first name "Virtual," last name "Physician" - into our scheduling database. When our habitual no-shows scheduled an appointment, we place them on Dr. Virtual Physician's (or Dr. VP, as we have come to call it) wide-open calendar. The primary care physician's schedule is not affected by the chronic no-show's appointment. If the no-show patient does appear for the appointment, they are placed in the queue behind the on-time patient."

EDIT: Doctor's offices do get walk-ins (GPs, Pediatrics, etc.), but the timings are never predictable. Regardless, keep in mind that doctor's offices keep very static schedules. A lot of practices use the virtual scheduling solution above to block off times daily or on Fridays for catching up on administrative activities. The reason they don't just fit it in when a patient doesn't show up is because the expectation is that there is a real medical reason for the visit and many potential medical reasons for a delay. So time lost due to a no show is all real time.

Why are the Insured Crowding ERs?

Emergency departments (EDs) are almost always overcrowded and a new study sheds some light on the who, the how and the why. The increased number of visits from the mid '90s to now are in fact coming from insured patients who have access to a usual source of care (PCPs)! Visits by the uninsured, who would normally be considered the more likely culprits, have actually stayed stable in the past decade.

This is really important on the policy end, considering universal health care (if enacted) may exacerbate, not reduce the ED overcrowding problem. Also, if the uninsured aren't the main concern behind this issue, safety net funding for bad debt may take a hit.

But back to why the insured might be responsible for more visits in the ED. The authors say the

"increase in ED use may be attributable to lack of ready access to primary care and other structural problems in the health care system."

Structural problems such as long waiting times for appointments, lack of relevant patient info such as medications and prior medical/surgical history, sub-par diagnostic and treatment capabilities, and poor post-visit communication between patient and their PCP. This is really disconcerting since EDs are being filled up with patients who have minor complaints or illnesses, thereby diluting triage meant to prioritize those with urgent needs.

Looks like there's a lot of work cut out for all of us in health care.

EDIT: In regards to Di G.'s comment about clarifying how insured patient's actually wind up in the ED, here's one elaboration. Say you're experiencing horrible stomach pain and your PCP is out of town. You go to another doc to get a referral for a GI specialist. The new doc has no history of your prior history of bulimia or the gall bladder operation you had a couple years back and now neither does the GI guy. The GI doc, unaware of the lack of your medical information, sees you and when you're prompted to provide information about the meds you're on, you have no idea and start listing the colors of the rainbow you see every morning in your pill box. Your prior history is incomplete, you don't know what meds you're really on, and you're pretty high on the pain scale. You're an easy triage to the emergency department regardless of who sees you. But in the ED, the triage nurse will most likely put you towards the bottom of the list after the gun shot wounds and car accident patients. Hence, the 4 hour wait.

Electronic records are just one part of the solution. More importantly the flow of information from one site to another is the key to making this all work. The VA does it well, but most other clinics use different vendors that don't talk to each other.

Real-time Tap

It would be really nice to have some way of knowing the minute details of certain events real-time. I'm thinking along the lines of wait times for gaining entry into a live show or sporting event, travel times and actual timings for airport shuttles, delay alerts for traffic and flights, stadium seating availability due to cancellation or no shows and so on.

With a smartphone, you can access the web and look up the time and location of an event via its related website (if there is one). But that's a static, passive way of communication. We need some way to automate that friend who gets there early and calls you about a long line, a delay, or a saved seat.

Dysfunction junction, what's your function?

What's the deal with Southwest's boarding policy? I just can't find a reason for it. I'd heard about their alphanumeric system of boarding passengers by groups A, B and C in that order with a # attached to indicate your location within the group, but experiencing it was similar to what cattle must feel like when being prodded to pasture. And I was in group A!

I got the seat I wanted, but that would have been the case with any other airline, as long as I booked early. Southwest fills the niche of booking anytime and checking in early (which is why they constantly overbook and have to make concessions). If I hadn't checked in exactly 24 hours prior to my departure time, I wouldn't have gotten the seating group I did. If Southwest doesn't believe in first or business class, then simply get rid of it and let people pick their seat when they book and see if they can grab a better one based on availability at the airport (like JetBlue does). In fact, the system is so dysfunctional that websites started popping up to automate early check-in for a fee. Gaps in efficiency get closed and Southwest has fought well and hard to block these websites from closing them. But why bother when you can just spend the money on creating an efficient process in the first place?