Bed Rest in the Digital Age plus Over-Prescribing Meds

Today I learned:

1. Bed Rest in a Digital Age: Prior to yesterday’s ACL reconstruction, I had two previous arthroscopies on the same knee in the early-1990’s. It was almost 20 years ago but I have two vivid recollections:

  • Dialling my own home phone number from downstairs to make it ring upstairs so I could ask my mom to bring down some ice cream, without getting off my lazy butt. I remember this, partially, because she reminds me of it every chance she gets.
  • Watching ALOT of crappy TV.

As a high-school student who actually attended all my classes, this was my first exposure to the Soap Opera genre. Try as I might I never took to Days of Our Lives and General Hospital, but there just weren’t many other options in those days.

The world is different this time.

I stacked months of reading by my bed in preparation for the down-time but one day out of a general anesthetic and still hooped up on pain meds, my head is not so much into books.  Instead I have watched a few shows recommended by friends on Netflix – The Hour and Justified are favourites so far – and watched a work-related webinar.

As I look at myself now, surrounded by my iPhone, iPad, and macBook Pro, as well as my work laptop and blackberry, I have a sense this round of bed rest will be very plugged in. This blog may in fact prove to be therapeutic as it forces some form of daily creation, rather than consumption.

All the technology comes in handy too – this time I have 4 separate devices that I can use to Skype my mom to see if she can drop by with a bowl if Ice Cream.

2. Over-prescribing Meds:  On discharge from hospital I assumed I would be sent off with a small script for T3’s, but in fact I was given a prescription for a fairly heavy narcotic.  Interestingly, I was prescribed 60 tablets which my close friend (a pharmacist) described as “an awful lot for knee surgery.”

Taken at the recommended dosage of 1-2 tablets every 4-6 hours, the 60 tablets would be depleted at a rate of between 4 and 12 per day. Essentially, worst case I have 5 days of meds, but best case I have 15 days (or more if I don’t need them frequently).

This made me wonder: Why prescribe so many tablets?

Surely if I am in so much pain that I run through these meds at the fastest pace then someone should see me before 5 days to assess the problem. Alternatively it could be that I will have so many tablets leftover when I am done that they end up sitting around in my medicine cabinet long after I need them. This invites abuse by me or someone else.

I trust my doctor – I think he’s great and I am sure he did a good job on my knee – but I wonder how much thought went into the follow-up medications.  It may be that he assessed me and felt a large prescription was safe and low risk. I hope that is the case.

It seems to me though that it is more likely the script size was just a convenience factor for both him and me – an attempt to reduce follow-up visits just to write a new script. If that is the case then I am not too impressed. A smaller prescription would potentially catch and save problems at both ends of the spectrum.

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Disney Day 1: Leapfrogging Technology and It’s (Not) a Small World After All

My quest to learn two things a day, and to blog about it for the first 66 straight days, has moved on the road for a short period. Expect a few travel and/or Disney related posts over the coming days. I apologize upfront as the already scattered theme to this blog could get even less obvious in the coming days.

Today I learned:

1. Leapfrogging technology:  We headed south this morning to visit with Mickey & friends in Anaheim.  On the flight I was immediately pleased to see personal seat-back TV’s on what I assumed was a bare-bones carrier.  The novelty wore off quickly though when I realized it didn’t matter for my family. With a laptop, iPad and smartphone (along with a few old school colouring books, newspapers and magazines) we brought enough entertainment for the whole family. And we were not alone.

I took a walk up and down the aisle halfway through the flight and noticed two things:

  • Everyone was awake
  • No one was watching the TV. Not one person in the 15 rows (with 5-6 people in each row) all the way to the back.

From this you should take-away two things:

  • There were only 15 rows to the back. I clearly fly coach.
  • The seat-back TV, a relative youngster, has already been rendered virtually useless.

In my quick little survey of about 80 people I counted 12 tablets, 17 laptops and 2 smartphones being used, and keep in mind many of those devices were being shared. Several were being watched by 3 children at once. The rest of the people were reading, eating or sitting quietly. No one was plugged in to the seat-back entertainment system.

What should this tell us?

At least for short-haul flights – ours was 2 hours 40 minutes – it would be smarter for airlines to focus on services that supplement the devices people want to use. Wifi, for example, would probably have had takers. It would have added value to me. A Netflix-like service that allowed a pay-per-view option on my device might even get a bit of uptake.

My take way is clear. Adding more seat-back TV’s is like stringing telephone wire in China. There is no point. Airlines need to find a way to monetize the technology we already bring in our carry-ons, rather than trying to provide their own hardware. Without any real analysis I have to assume this approach would be cheaper and offer better margins. If they aren’t installed already I would leapfrog the seat-back TV and move on to the next wave.

2. It’s (not) a small world after all:  Every time I travel to America I need to fight the holier than though attitude that seems to kick in. Obviously I keep travelling here because there are so many cool things to see and do. Now, disclaimer aside…

Just about every Canadian will tell you that as soon as you cross the border the world just seems bigger in every dimension. Particulalry in waistline. I came across one tidbit today that seems timely and hits the point home.  One of Disneyland’s most famous attractions, It’s a Small World, was renovated in 2009. According to “The Unofficial Guide to Disneyland, 2012 Edition” p. 240, one of the reasons for this is the waterway needed to be dug deeper to “accomodate today’s heavier guests.”

There is something oddly appropriate about people today being too big for It’s a Small World. How far we’ve come in 50 years.


Serving Feedback in a Sh*t Sandwich, plus The Death of Cable TV

Today I learned:

1. The Sh* Sandwich: I had a great discussion this morning with a few other managers about performance evaluations and the art of delivering feedback. One person came up with a term that I wasn’t familiar with before today – the Shi*t Sandwich.  Essentially this is the practice of framing a piece of negative/constructive feedback with two positive points.

For example: “You did a job great developing that proposal, John. We need to do a lot of work to get your presentation skills up to par, but in the end you are still great at developing rapport with clients.” Although, we know that with many managers the middle part will be more like, “…your presentation skills suck…” Hence the title.

Regardless, I am not a big fan of this approach.

It is an easy way to get across a tough point but the area for growth can get lost in “the bread.”  I prefer to deliver both the positive and the negative separately, clearly delineating between the two. As well – maybe most importantly – I think it is critical to ensure upfront the person is ready to hear everything you have to say.

My preferred approach would be closer to this: “John, would you like some feedback on our work with Customer X?…Great…I think you did an excellent job in some areas but in a few spots we need to work on improvement. Let’s start with what I think you did very well…”

From my perspective The Sh*t Sandwich is a cop out. It’s an easy way to get tough news across, but in the end if the key piece doesn’t hit home you will just need to revisit it down the road. Better to be clear, with specific examples, up front so you can get to work on the road to improvement.

2. The Death of Cable TV: Admittedly it is not dead yet, but its days are numbered.

In the fall we got a PVR, and we now watch about 5-10% of the commercials we previously watched, mostly when we forget to fast forward.

More recently we signed up for Netflix, and in the last month my 4 year-old daughter hasn’t watched Treehouse TV once. She is only interested in Netflix (via TV, iPad or Computer) as she is in control of what she consumes. She can even pause it to pee.

Add in Apple TV a couple weeks ago and we now stream shows, along with our pictures and music.

Interestingly, with more choice we are actually watching far less TV. Flipping on a slideshow or some music is now viable and fast, so we are turning to more laid back evenings with music, pictures and books. All in all, everything is better, faster and in-line with what we want, when we want it.

Reflecting on it today it occurred to me that it all happened very quickly. Our progression – from basic cable to everything on-demand – took us about 3 months. This spells very bad news for our cable account. If every hockey game was free in HD online we simply wouldn’t need it.

How many years will it take for everyone else to follow the same path? 10 years? 5?