Various Whiteboards on Solid State Medical Operations

This was from when I tried to “prove” to Steve that “you can’t just write stuff on scraps of paper.”

Basically, the conclusion of this conversation was (as Steve will attest), “your egghead airforce crap is all ‘lazers and shit,’ but here on the ground I have a wall of bodies here beating down the door and every dumbshit chuck-a-chuck two bits to an NPI is gunning down every open phone line to get me to sign something or read something and then refuses to pay me and meanwhile I have two infant children and people in the hospital, so get this fucking billing out. I can’t just type this into a computer, patients hate that, and I’m dying here.” But as you can see from previous posts, Steve and I have mutually made some progress.

Basically: I’ll trust you that this shit works… if you trust me to give me the shit that actually works now.

This was “why you can’t just throw a nurse at it.” There was another board where I showed that every staff member you add that isn’t a provider themselves adds overhead downstream of the actual event which accumulates exponentially per unit medical provided. The idea here was that it greatly mattered in medicine how easy it was to enter the data into the iPhone because there was an inflection point where technology just required too much attention and the doctor has to revert to paper, and that if you can’t reliably overcome that activation energy of attention, then all your computer systems are worthless.

Haha, this was from when I taught Steve binary; I think because he asked something about “why 128 ASCII characters?” or something like that, so I made him figure it out over the course of the day. This was also a bad day; I remember some real estate agent had tried to sell Steve a “great unfinished property in an upcoming neighborhood” in the cold rain, and over subsequent lunch with the agent at Greenwich Hospital, I told the agent to his face that his property was a “knock down piece of shit” and then listed the construction and neighborhood flaws I had noticed, and then I scolded him for wasting my time. So this hotshot thirty something blueshirt is sitting there while some kid in a t-shirt deconstructs his entire psyche over salads. This agent now tries to avoid me —for some reason— when he tries to pitch Steve other real estate opportunities.


My goal is to build a “solid state” medical office. The idea is that if everything in “one unit doctor” can be represented by a graph of [web addresses] (emails, HTTP requests, ICD, CPT, and medical keyword addressing), and that this “one unit doctor” itself operates at a profit independently, that one could then continue to add doctors to the system without incurring the overhead which currently keeps medicine local while “solving medicine” as we currently know it via graph analysis.

This is hard to do in practice.

I’m posting some of my ideas because frankly: I need more help because I’m tapped on activation energy running both the office and my personal life which, as a preview, here’s how I spent today:

  • Woke up in a hotel to “engineering” demanding to know from behind me door if “my floor is damp.” Why am I in a hotel? Yes. Is my floor damp? Not that I noticed, but considering that yesterday the problem was “the fire alarms keep going off because ‘they’re drawing too much power in the conference room’, this was an improvement. I bet you that this hotel costs more per day than a mortgage for a house.
  • Waited for an hour to get expensive salad. Tried to connect to Internet.
  • Waited for an hour to get a car pickup.
  • While in the hotel lobby waiting for said car, had to track down the contact information for a patient on my iPhone internet, call several times from three different phones while in the hotel lobby trying to get past the patient’s family’s screen of “telephone calls are always solicitors and debit collectors”, and inform irate “member of the family who handles persistant phone calls” that the patient had an INR of [GO TO THE EMERGENCY ROOM, NOW] to “GO TO THE EMERGENCY ROOM, NOW.”
  • Car took me to other side of town to car rental agency, car agency refused to rent me a car without a credit card because a debit card is not acceptable by “Connecticut law?” The girl at the desk at this dank car depot wanted me to produce paystubs and home utility bills “like, from the Internet or something.” I told her no. Car drove me back to hotel.
  • Called another car, $20 cab ride to office; it is now 3pm.
  • Started doing work, but then an elderly patient wandered into the office because I forgot to lock the door and I scheduled an appointment for her and talked with her about “life.”
  • Locked door.
  • Wrote these posts.

So yah, could use a little help… and unless you’re into the unemployed-if-not-now-then-soon mortgage derivative finance blueshirt scene… not really much of a culture here in Connecticut that doesn’t make you want to go all Tyler Durtin all the time.

In software, I’m currently writing authenticated robots to navigate insurer websites for Google App Engine. (I’ll share my code so far at Google I/O for anybody into Python Google App Engine.) This is hard because insurance is not in the business of telling you how to bill them for money. Also, this is hard because of the organic profitability of incompetence and a culture of “typing is for secretaries.” This is also hard because I can’t effectively do data entry and write software to do the data entry at the same time from the back of a cab.

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