London Reading Tube Map

London Reading Tube Map Originally uploaded by Annie Mole.

I have got a bit bored with the endless stream of London Underground mashup maps (station names changed in line with some theme). But this one is a bit different: "London Reading Map".

From the London Underground blog:

"Now the next is not entirely accurate when it comes to the Tube map and locations as a lot of artistic licence has been used. It’s the cover of a book – London by the Book – by Rough Guide in association with a campaign to "Get London Reading": "From Bloomsbury to Bromley, Geoffrey Chaucer to Zadie Smith, London by the Book is a guide to the city through writers and their writing. Packed with obscure and intriguing information (How did Graham Greene survive the bombing of his Clapham house in 1941? Which nineteenth-century poet was in the habit of sliding naked down the banisters?), it chronicles the waves of novelists, poets and playwrights who have lived in London over the centuries, written about it, and developed its identity as a result."

Apparently copies are being given out at some tube stations next week, or you can download it via a link on the London Underground Tube blog. (I have just been to take a look and it is 66 pages long. Luckily I noticed before pressing "print".)

Productive meetings

9 tips for running more productive meetings 43 Folders

This post I love! Edited highlights below:

"1 Circulate an agenda – An agenda should show the planned steps that get the meeting from “here” to “there.” It helps the participants prepare appropriately and anticipate the kind of information they might need to produce. It works as a contract: “here’s why this is a great use of your time for n minutes.”
2 Have a theme – Meetings shouldn’t be meandering tours of each participant’s frontal lobe (unless — well — unless that’s the actual agenda). Make it clear why this meeting is happening, why each person is participating at a given time, and then use your agenda to amplify how the theme will be explored or tackled in each section of the meeting.
3 Set (and honor) times for beginning, ending, and breaks – There’s nothing worse than a rudderless meeting that everyone knows will just prattle on until its leader gets tired of hearing himself talk.
4 No electronic grazing. Period. – Laptops closed. Phones off. Blackberries left back in the cube. You’re either at the meeting or you’re not at the meeting, and few things are more distracting or disruptive than the guy who has to check his damned email every five minutes.
5 Schedule guests
6 Be a referee and employ a time-keeper
7 Stay on target Any item that can be resolved between a couple people offline or that does not require the knowledge, consent, or input of the majority of the group should be scotched immediately. Close ratholes. As soon as the needed permission, notification, or task assignment is completed, just move on to the next item.
8 Follow up
9 Be consistent Meetings do not run themselves, and if you have any desire to make best use of valuable people’s time, you’ll need a firm hand and a lot of thoughtful planning."

My favourite part is the sentence about the Blackberries.

Giles G-B said…

10 – carry a big stick

This addition is not as facetious as it sounds. I have a friend who recently took a softball bat to a meeting and held it casually over hsi shoulder whilst he delivered a presentation about the need for everyone to follow a certain protocol within the organisation. He says folks paid attention without him needing to ask them to. And they’re following the new protocol to the letter.

8:36 PM

Maxine said…

Sounds like a good cure for those Blackberries, too!
(Signed, a Blackberry victim — by no means limited to meetings.)

7:19 AM

Misdiagnosis

In the nested manner of blogging, 3quarksdaily reports on a New York Times article on a JAMA (Journal of the American Medical Association) article*. Chilling:

"With all the tools available to modern medicine — the blood tests and M.R.I.’s and endoscopes — you might think that misdiagnosis has become a rare thing. But you would be wrong. Studies of autopsies have shown that doctors seriously misdiagnose fatal illnesses about 20 percent of the time. So millions of patients are being treated for the wrong disease.

As shocking as that is, the more astonishing fact may be that the rate has not really changed since the 1930′s. "No improvement!" was how an article in the normally exclamation-free Journal of the American Medical Association summarized the situation.

This is the richest country in the world — one where one-seventh of the economy is devoted to health care — and yet misdiagnosis is killing thousands of Americans every year.
How can this be happening? And how is it not a source of national outrage?
A BIG part of the answer is that all of the other medical progress we have made has distracted us from the misdiagnosis crisis."

This extract pitches the story as a "national" outrage that thousands of "Americans"(by which I presume the writer means US residents, as opposed to Canadians, Brazilians, Argentinians, etc) are being killed by misdiagnosis every year. I am sure it is not just a US problem, though. Cold comfort indeed.

Accuracy of language aside, there is a spirited defence of the medical system in the comments (by an anonymous person):

"Comparing the diagnoses of myriads of diseases that afflict the human body with flying a commercial airliner is simply specious: no matter how complex the airliner, it was built by man, with every aspect of its construction, its parts and its operation documented and detailed.

By contrast, a physician sees a patient with limited information and a very limited amount of time (no thanks to the health insurance system), and is then expected to deliver near-perfect diagnoses about just what is wrong. Should I add that they are also expected to do this while keeping the admittedly soaring healthcare costs under control?

Physicians and surgeons make mistakes because they are overworked, under-resourced, and have limited amounts of time with each patient. But even more importantly, mistakes occur because the myriad human diseases each have myriad presentations, many that are basically (overlapping) non-specific symptoms. Should physicians send every patient who comes in with a splitting headache off for a CT to rule out a brain tumor? "

So the situation is that more people are being saved by modern medicine than were saved 100 years ago, but that because medicine is now technical and sophisticated, the definition of "mistake" has become more elastic. See my post below about ability to operate new technology as one gets older and has to forget old knowledge and relearn new, over and over again. Must be hard for doctors to keep up. What "anonymous" is pointing out is that the baseline is much better, even with errors (if they can be called errors when they might be things like not ordering every possible test for every possible condition for every presenting patient) taken into account.

* There is no JAMA article. I read the NYT article, after having to register for their site (they require personal info), and found it a string of anecdotes with an unreferenced one-word quote from JAMA somewhere in the middle. No context. No year, even. Low-standard journalism (not to mention zero marks for scholarship).

Dave Lull said…

The "No improvement" quotation is from this article:

Low-Tech Autopsies in the Era of High-Tech Medicine by George D. Lundberg, JAMA, Oct. 14, 1998.

It’s linked to from this article: How Often Are Patients Misdiagnosed? which is linked to from the article you quote from; the link is near the bottom of the page below some ads and under the heading "Related Articles."

6:35 AM

Dave Lull said…

"No context. No year, even. Low-standard journalism (not to mention zero marks for scholarship)."

And no link to the JAMA article right at the place of quotation. Zero marks for saving the time of the reader. To find it I used Google to travel a circuitous path that took me back to the NYTimes website. Then I had to backtrack to find it’s connection to the article you quote from. BTW I think the first NYTimes reference to it at least on the web was in this article:

Buried Answers, by David Dobbs, published: April 24, 2005.

Mr Dobbs refers to it more fully than Mr Leonhardt but doesn’t link to a copy of it:

"Dr. George Lundberg, a pathologist who edited The Journal of the American Medical Association from 1982 until 1999 and now edits the online medical journal Medscape General Medicine, has, like Schiller, spent much of his career trying to revive the autopsy. The heart of his plaint is that nothing reveals error like the autopsy. As Lundberg noted in a 1998 article, numerous studies over the last century have found that in 25 to 40 percent of cases in which an autopsy is done, it reveals an undiagnosed cause of death. Because of those errors, in 7 to 12 percent of the cases, treatment that might have been lifesaving wasn’t prescribed. (In the other cases, the disease might have advanced beyond treatment or there might have been multiple causes of death.) These figures roughly match those found in the first discrepancy studies, done in the early 1910′s. ‘No improvement!’ Lundberg notes. ‘Low-tech autopsy trumps high-tech medicine . . . [Mr Dobbs' ellipses] again and again.’"

3:31 PM

Maxine said…

Thank you for these clarifications, Dave. You have been more assiduous than the journalist or editor appears to have been.

What strikes me most about your research is the fact that the quoted JAMA phrase was written in 1998, 7 years ago. The distinct impression given in the NYT piece is that this is "news". The NYT piece does not actually lie, but comes pretty close.

(The Dobbs piece you cite is more accurate, making the source, and its date, plain. However, the extract you have given here, Dave, can hardly be used to make the point being made in the NYT piece, can it?! Some extrapolation, to use that piece, and quote about that piece about autopsies showing undiagnosed illnesses, to support the points the NYT article made about doctors’ errors.)

I am already very cynical about accuracy of media, so I am not entirely surprised about the laziness of the whole thing. (The commenter on the blog post is more knowledgeable than the NYT journalist, which makes me wonder if the NYT guy bothered to interview any working doctors before he wrote his piece.)

When I "grew up" and learned a few things, I was struck by how TV and most newspapers invariably get wrong a report on anything one happens to know anything about. So I don’t trust them on what I don’t know about either!

3:46 PM

Dave Lull said…

Based on part (/22leonhardt-side.html) of the URL for the article How Often Are Patients Misdiagnosed? I’d say that Mr Leonhardt also wrote that. He attempts to bring Dr Lundberg’s article’s relevance up to date by concluding that short piece with "[Dr Lundberg] said recently that it still reflected his views."

4:16 PM

Making technology simple

Making technology simple

I couldn’t agree more with this posting by Niall Kennedy on his weblog:

"In our quest for the latest and greatest technologies we may be overlooking the masses of users waiting for technologies to enrich their lives.
My mom’s a blogger but doesn’t know it. She passes along chain mail and jokes to family and friends on an almost daily basis. Each week she updates everyone who’s interested on the latest news from my brother in Iraq. Both activities are ideally suited for blogs and syndication, but it’s easier for her to fire off an e-mail to 25 people with her latest funny joke or piece of chain mail than connect to everyone through a blog or reader.
My 18 year-old sister has never used MySpace, Facebook, or Xanga. Her social networking app is a cell phone she carries everywhere, including sending text messages from her bed. She creates content using still cameras and video, but never shares the content online because she finds the process too complicated. It’s easier to connect her video camera to a TV than to send it to a video sharing site.
As geeks we put up with all the complexities to explore a new service but most of the world just wants to plugin something that works. "

I would go further than Niall, actually. I am pretty above-average technical, and laughed when I brought my first video recorder (1980?) at those jokes about people asking their children to work it for them. But I’ve turned into one of those people. I can’t work the DVD recorder without reading the manual (and forgetting how to do it next time). Not that this matters because the fate of anything I did manage to record would be for it to sit on the shelf with the 100 or so DVDs waiting for me to watch "one day". Another example: I used to be a keen photographer. I took thousands of b&w pictures and developed them myself, using all kinds of techniques. Yet I can’t work a modern digital camera. By the time I’ve worked it out, the technology evolves and a yet new type of device is out there, cheaper than before. Another: I have to have the most simple mobile phone possible. I have been forced to use a colour screen but no camera as yet. I am amazed at the "integrated" phone/internet/TV goodness knows what mini-handsets that people have nowadays and could not imagine coping with it. But I am not a technophobe, I would like to be adept at this stuff, but I am not prepared to put in the amount of time it would take me to learn how to use all these things.

I am not sure I agree with Niall Kennedy about the younger generation. Cathy (15) is adept with MySpace, mobile phone, email, applications like powerpoint — Jenny (10) similarly uses excel, Flickr and even photoshop with confidence. Both girls have blogs (and both can work the DVD recorder with ease).

What am I saying here? Niall is right. All over the web, via rss or whatever, one reads about fantastic little bits of programming or great applications to do wonderful things — search, retrieve, categorise, share, send, organise information. Just go to the Firefox or Technorati homepage, or read some library blogs, and dozens of ideas for great things to do come to mind. But for the "normal" user, by which I mean technically able but not an infotechnical professional, too much time investment is required to work out how to use all these developments.

There must be a market for an interface between all the "geeky" suggestions and the "non-geeky but keen" users. Online help! Of course there are plenty of user-friendly applications out there — Connotea, Flickr et al. But at the "below product" level, there is huge scope for spreading and accelerating the use of ICT developments by — well, dammit, just explaining how to use and apply these bits of programmes or cute little tools in language that we can all understand.

Movies over the internet, though, that’s something I can get my head round. When are we going to get enough broadband (or whatever the technical term is if not that) to be able to look at a menu of TV shows we missed, or a movie database, select one, and watch it on our computer screens, when and where we like? I think even I could work that. And it would get rid of the piles and shelves-full of DVDs and videos littering the house. (Yes, Superpatron, like the books, uncategorised.)