The Inefficiency of Efficiency

An excellent article, finally, on Medical Taylorism, has been published in the New England Journal of Medicinehttp://www.nejm.org/doi/full/10.1056/NEJMp1512402.

Frederick W. Taylor was the fellow who wrote The Principles of Scientific Management, ironically enough, published the same year as Abraham Flexner’s report on how to make medical schools that could educate excellent, humanistic and scientific physicians. Taylor was the efficiency expert who followed his factory workers around with a stopwatch, broke their crafts into single tasks, and insisted that each one do the repetitive, mind-numbing work that has come to represent the twentieth century. He fired those who continued to try to practice their craft as a craft, as “inefficient.”

In this essay,  Hartzband and Groopman analyze how this same approach, Taylorism, is now being applied to physicians, and is not simply pernicious, but wrong. Worth reading.

Hello world!

Testing display of HTML elements

This is 2nd level heading

This is a test paragraph.

This is 3rd level heading

This is a test paragraph.

This is 4th level heading

This is a test paragraph.

This is 5th level heading

This is a test paragraph.

This is 6th level heading

This is a test paragraph.

Basic block level elements

This is a normal paragraph (p element).
To add some length to it, let us mention that this page was
primarily written for testing the effect of user style sheets.
You can use it for various other purposes as well, like just checking how
your browser displays various HTML elements by default.
It can also be useful when testing conversions from HTML
format to other formats, since some elements can go wrong then.

This is another paragraph. I think it needs to be added that
the set of elements tested is not exhaustive in any sense. I have selected
those elements for which it can make sense to write user style sheet rules,
in my opionion.

This is a div element. Authors may use such elements instead
of paragraph markup for various reasons. (End of div.)

This is a block quotation containing a single
paragraph. Well, not quite, since this is not really
quoted text, but I hope you understand the point. After all, this
page does not use HTML markup very normally anyway.

The following contains address information about the author, in an address
element.

Jukka Korpela,
jkorpela@cs.tut.fi
Päivänsäteenkuja 4 A, Espoo, Finland

Lists

This is a paragraph before an unnumbered list (ul). Note that
the spacing between a paragraph and a list before or after that is hard
to tune in a user style sheet. You can’t guess which paragraphs are
logically related to a list, e.g. as a “list header”.

  • One.
  • Two.
  • Three. Well, probably this list item should be longer. Note that
    for short items lists look better if they are compactly presented,
    whereas for long items, it would be better to have more vertical spacing between items.

  • Four. This is the last item in this list.
    Let us terminate the list now without making any more fuss about it.

The following is a menu list:

  • One.
  • Two.
  • Three. Well, probably this list item should be longer so that it will
    probably wrap to the next line in rendering.
  • The following is a dir list:

  • One.
  • Two.
  • Three. Well, probably this list item should be longer so that it will
    probably wrap to the next line in rendering.
  • This is a paragraph before a numbered list (ol). Note that
    the spacing between a paragraph and a list before or after that is hard
    to tune in a user style sheet. You can’t guess which paragraphs are
    logically related to a list, e.g. as a “list header”.

    1. One.
    2. Two.
    3. Three. Well, probably this list item should be longer. Note that if
      items are short, lists look better if they are compactly presented,
      whereas for long items, it would be better to have more vertical spacing between items.

    4. Four. This is the last item in this list.
      Let us terminate the list now without making any more fuss about it.

    This is a paragraph before a definition list (dl).
    In principle, such a list should consist of terms and associated
    definitions.
    But many authors use dl elements for fancy “layout” things. Usually the
    effect is not too bad, if you design user style sheet rules for dl
    which are suitable
    for real definition lists.

    recursion

    see recursion

    recursion, indirect

    see indirect recursion

    indirect recursion

    see recursion, indirect

    term

    a word or other expression taken into specific use in
    a well-defined meaning, which is often defined rather rigorously, even
    formally, and may differ quite a lot from an everyday meaning

    Text-level markup

    • CSS (an abbreviation;
      abbr markup used)

    • radar (an acronym; acronym markup used)
    • bolded (b markup used – just bolding with unspecified
      semantics)

    • big thing (big markup used)
    • large size (font size=6 markup used)
    • Courier font (font face=Courier markup used)
    • red text (font color=red markup used)
    • Origin of Species (a book title;
      cite markup used)

    • a[i] = b[i] + c[i); (computer code; code markup used)
    • here we have some deleted text (del markup used)
    • an octet is an entity consisting of eight bits
      (dfn markup used for the term being defined)

    • this is very simple (em markup used for emphasizing
      a word)

    • Homo sapiens (should appear in italics; i markup used)
    • here we have some inserted text (ins markup used)
    • type yes when prompted for an answer (kbd markup
      used for text indicating keyboard input)

    • Hello! (q markup used for quotation)
    • He said: She said Hello! (a quotation inside a quotation)
    • you may get the message Core dumped at times
      (samp markup used for sample output)

    • this is not that important (small markup used)
    • overstruck (strike markup used; note:
      s is a nonstandard synonym for strike)

    • this is highlighted text (strong
      markup used)

    • In order to test how subscripts and superscripts (sub and
      sup markup) work inside running text, we need some
      dummy text around constructs like x1 and H2O
      (where subscripts occur). So here is some fill so that
      you will (hopefully) see whether and how badly the subscripts
      and superscripts mess up vertical spacing between lines.
      Now superscripts: Mlle, 1st, and then some
      mathematical notations: ex, sin2 x,
      and some nested superscripts (exponents) too:
      ex2 and f(x)g(x)a+b+c
      (where 2 and a+b+c should appear as exponents of exponents).

    • text in monospace font (tt markup used)
    • underlined text (u markup used)
    • the command cat filename displays the
      file specified by the filename (var markup
      used to indicate a word as a variable).

    Some of the elements tested above are typically displayed in a monospace
    font, often using the same presentation for all of them. This
    tests whether that is the case on your browser:

    • This is sample text inside code markup
    • This is sample text inside kbd markup
    • This is sample text inside samp markup
    • This is sample text inside tt markup

    Links

    This is a text paragraph that contains some
    inline links. Generally, inline links (as opposite to e.g. links
    lists) are problematic
    from the
    usability perspective,
    but they may have use as
    “incidental”, less relevant links. See the document
    Links Want To Be Links.

    Forms


    This is a form containing various fields (with some initial
    values (defaults) set, so that you can see how input text looks
    like without actually typing it):

    The following two radio buttons are inside
    a fieldset element with a legend:
    Legend
    Check those that apply

    Tables

    The following table has a caption. The first row and the first column
    contain table header cells (th elements) only; other cells
    are data cells (td elements), with align="right"
    attributes:









    Sample table: Areas of the Nordic countries, in sq km
    Country Total area Land area
    Denmark 43,070 42,370
    Finland 337,030 305,470
    Iceland 103,000 100,250
    Norway 324,220 307,860
    Sweden 449,964 410,928

    Character test

    The following table has some sample characters with
    annotations. If the browser’s default font does not
    contain all of them, they may get displayed using backup fonts.
    This may cause stylistic differences, but it should not
    prevent the characters from being displayed at all.

    Char.

    Explanation

    Notes

    ê

    e with circumflex

    Latin 1 character, should be ok

    em dash

    Windows Latin 1 character, should be ok, too

    Ā

    A with macron (line above)

    Latin Extended-A character, not present in all fonts

    Ω

    capital omega

    A Greek letter

    minus sign

    Unicode minus

    diameter sign

    relatively rare in fonts

    Hyphenation

    In the following, a width setting should cause some hyphenation,
    depending on support to various methods of hyphenation.

    Dr. Virtual and Dr. Personal: Finding the Right Place for Technology in Medicine

    Dr. S. was invited to Budapest to give a TEDx talk, and also to debate Dr. Bertalan Mesko MD PHD, a medical futurist, on Apps. v. Medicine, at the first Annual Brain Bar Budapest. She began the debate with a 2o minute talk on: Dr. Virtual and Dr. Personal, telling three stories about technology in medicine; The good, the bad, and the ugly. Here: https://www.youtube.com/watch?v=dc2MqZR5x80

    Overmedicalizing Death, Underspiritualizing Death, and—Could Death be Enjoyable?

    I’ll be leading a session, along with Dr. Grace Dammann, at the Third Annual meeting of the Lown Institute on Tuesday, March 10, 10:30 am, in the Omni Hotel, San Diego. The idea behind our session is this:

    Since 1969, when Dr. Elisabeth Kübler-Ross first published her groundbreaking book, On Death and Dying, we’ve come a long way towards making death and dying tolerable. Hospice units and hospice care; palliative medicine; advanced life directives; the concept of non-beneficence. And yet we’re still facing—for ourselves and our patients—an overmedicalized and underspiritualized death. What can we do about that? What’s in the way? For doctors, patients, and families? In institutions and the law? And what can we do to remove these obstructions?

    Dying is hard—What can we do to make it easier? What are the next steps, practically, for us to take? Could we ever look forward to Death?