My Review of Columbia Sportswear Highland Crest Sweater - Zip Neck (For Men)

Originally submitted at Sierra Trading Post

Closeouts . The Columbia Sportswear Highland Crest sweater has a comfortable, casual style that pairs nicely with jeans or slacks. Microfleece collar lining is luxuriously soft Traditional styling works with jeans or slacks Neck zip: 7” Length: 27” Fabric: 55% ramie, 15% acrylic, 15% nylon...

Columbia Sportswear Highland Crest Sweater - Zip Neck (For Men)

Comfy sweater

By deepdrop from New Hampshire on 10/10/2009

 

4out of 5

Chest Size: Feels true to size

Length: Feels true to length

Sleeve Length: Feels true to length

Pros: Warm, Comfortable

Best Uses: Casual Wear

Comfy sweater that is nice because it's not all wool and is not itchy. I received compliments starting the day I first wore it. I certainly didn't need another sweater but it's a good deal for a warm, comfy sweater, and sometimes that's enough to ward off the winter blues.

(legalese)

My Review of Boker Hunting Knife - 4¼” Fixed Blade

Originally submitted at Sierra Trading Post

Closeouts . This classic hunting knife from Boker features a genuine stag handle, 440 stainless steel blade and full tang construction. 440 stainless steel drop-point blade Genuine stag handle Full tang construction Pommel eyelet Includes premium leather sheath Blade: 4-¼” Overall ...

Boker Hunting Knife - 4¼” Fixed Blade

nice

By deepdrop from New Hampshire on 10/10/2009

 

4out of 5

Pros: Sharp Blade, Good Weight

Describe Yourself: Casual Adventurer

I like Boker knives. This one is really nice and the sheath is also very nice. Many times you get a crummy sheath with a knife but this one is good. It's a little hard to get out of the sheath at first but it eases up in a short while. The stag handle feels a little like plastic and is on the thin side. Also, I prefer a knife with a finger guard but this one still feels safe. All in all, it's currently my favorite and it feels like a high quality knife at a good price.

(legalese)

Fathers are parents too

Today I dropped my children off at day camp.  My son Jesse, who is 4 years old, was clinging to my back as I hung their backpacks and lunch-boxes, and led my children to the main room.  I was about to leave and reached behind me, taking hold of Jesse's shirt, and pulled him around to my front, telling him for the nth time that I don't like him clinging onto my back and that it was time for a hug and a kiss goodbye.  At this point, the camp director stepped in and said "no, no, no" and took over.  She "comforted" Jesse and suggested that I get something of mine to let him hold for the day.

I found myself becoming irritated.  Why?  My initial reaction is that I don't need or want someone to direct my parenting.  She knows my children superficially, but doesn't know much about my relationship with them, my values, how we resolve issues, whether this has been dealt with before, or whether I want him to learn how to get through the day without having to rely on holding a reminder of me.  She probably acted in a way that was based on her experiences with her own children, or, my worst fear, her assumption that as a father I was an incompetent parent.

As I thought more about it, I began to wonder whether she would have done the same thing to a mother.  As a father of young children, it sometimes seems that the assumption is that I struggle through my interactions and various challenges with my children, when in actuality I have read a great deal about parenting and have a style that I am comfortable with and that evolves as the children grow and change.  At the same time, I am not opposed to hearing suggestions on parenting when presented as just that, suggestions, rather than dictations.

Finally, I began to stew because I am not just a father, but a father whose marriage ended in the last year.  I sometimes feel that there is a bias against divorced fathers based on the assumption that they must have been bad husbands or bad fathers to have ended up divorced.  Perhaps there are rumors about what kind of husband/father I was.  This camp director also knows my wife.  In my experience, most of the people who are involved in taking care of my children outside of the family are women.  This includes camp counsellors, teachers at school, and teachers at extra-curricular activities.  My sense is that these women, although not openly hostile, tend to have a bias of sympathy with my children's mother rather than with their father.

In the end, I realize that this woman was trying to do what she believed was the right thing and the helpful thing, but it makes one think of the Golden Rule, which is not "Do unto others as you would have them do unto you".  A more proper interpretation is "Do unto others as they would like to have done unto them".  This requires communication.  It requires asking "Would you like some help with your son?", "Would you like me to suggest something to do about this?", because my answer might have been "No, I prefer to handle this myself".    It is important to remember that people do things differently and if you are trying to help them, it is wise to inquire  about the situation first, especially if you don't know the person well.

Obviously in cases where there is neglect or abuse we accept that others can step in and act, but even here, the definitions of neglect and abuse are subject to interpretation.  She may have felt that pulling my son off my back by his T shirt was abusive. 

I'm reminded of the recent case of a woman who let her kids go to the mall unsupervised.  She ended up charged with endangering the welfare of her children.  Her children were 7th graders left at a mall in a small, safe city - Bozeman, Montana.  Both children had attended babysitting classes which teach CPR and infant care.  The girls were also with three other children at the mall, aged 8,7,and 3.  My point is that there are many variables involved and many arguments could be made for either side of the endangerment issue.  The question is at what point the criminal system should appropriately become involved.

When divorced, a parent is under more scrutiny than parents in an intact marriage.  It can create a sense of paranoia, leaving one too afraid to speak up and defend one's parenting style, especially after reading about cases such as the above. 

I like this day-camp, and I like the camp director.  My children socialize with other children, learn new skills, and develop their growing sense of independence and accomplishment.  I wish that there was more sensitivity and understanding shown to single fathers, not just at this camp, but in general.  Fathers are parents and one should assume that parents know how to take care of their children and enjoy doing so.

Doctors should lead healthcare reform

Medicine is in a time of change. Hopefully we can create a healthcare system that provides rapid access to quality medicine for all of us. The details will be difficult to work out, but there is no question that physicians should be involved in helping to craft the new plan.

After all, physicians ultimately know what the day-to-day care of patients entails and what issues contribute to making the delivery of quality healthcare efficient. Of course the creation of a plan will also require the input of other groups including politicians, various industries, and patients, but without physicians, there will be no healthcare, and it is important to hear their voices.

So what do physicians think? Who represents their opinions? What do physicians want in the new healthcare plan?

The AMA, founded in 1847, has typically been perceived as the "voice of physicians", yet physician enrollment in the AMA has waned to a current level of 245,000 members representing about eighteen percent of American physicians. I don't think it can be said any longer that what the AMA says is what physicians believe.

Recently, an organization called Sermo, the Latin word for conversation, has become active politically and has engaged in debates with the AMA on national television. Sermo has about 100,000 physicians in its community and it's CEO is Dr. Daniel Palestrant. Membership is for physicians only. Their relationship with the AMA is antagonistic at best.


These societies may be the only exposure the public has to the opinions of large numbers of physicians as a group, and the message sent by these societies greatly impacts how physicians are viewed and whether their message affects policy decision making.


So, how does the public know what physicians think? Upon visiting the website of the AMA, there is a section for physicians as well as one for patients. The section for patients presents resources on healthcare as well as the AMA's vision of healthcare reform.

Although they do not offer membership to non-physicians, Sermo does maintain a blog , accessible from their website and available to the public, which purports to represent the Sermo physician community's perspective on select issues, presumable issues selected by Dr. Palestrant. The blog is heavy reading and focuses mostly on physician discontent with the current healthcare system, rather than presenting to patients a discussion on how fixing these problems would improve healthcare for patients, ultimately what the public wants to know. Unfortunately it sounded like doctors complaining, rather than doctors working for a better healthcare system.


I posted a message on the Sermo message board suggesting that a section be created for patients, on which Sermo could explain the issues facing medicine, doctors, and what doctors think should be done to help our healthcare system. The responses reminded me of something I learned in college psychology. A rat was randomly shocked in order to create a stressful environment. A stuffed animal was placed in the cage and the rat attacked it. On the Sermo message board, I was the stuffed animal.

Although I explained carefully that I thought a physician-only organization was great, Sermo had an obligation to present a face to the public once they had entered the debate on healthcare. The Sermo blog does this in a sense, but is difficult to read. I suggested a simple link from the homepage to a site where the public could read about the realities of medical practice from the people on the front line, not from politicians and insurance companies. The response to my suggestion was unanimously negative.  Doctors have become so stressed that they need a place where they feel safe. The sad thing is that doctors could help make the whole healthcare system a safer place for doctors and patients.

Medicine is an honorable field. I can think of nothing that feels more rewarding than making another person stop hurting, or fixing them when they are broken. Many years of training go into becoming a physician, typically at least eight years following college, and often several additional years. Physicians usually leave their training in enormous debt, and having sacrificed much of their youth to serve fellow humans. It used to be a sure bet that one would be successful as a physician, and physicians were a happy lot.  Most physicians would not want their children to go into medicine. This is troubling. 

In crafting a new healthcare plan we must not neglect the needs of physicians, but it is up to physicians to make their needs known. Both the public and doctors want the same thing and they need to be working together against the enormous political clout of the insurance and pharmaceutical industries that fear a loss of profits. Most doctors are in favor of a single payor system that would eliminate for-profit insurers and curb the power of big provider chains, thus allowing more dollars to go to patient care. This is similar to the 67% of the general public who support a single payor system. Doctors want healthcare decisions to be made by doctors, not by insurance companies. The New York Times reported that between 2000 and 2005 the number of Americans with private health insurance fell by 1 percent, while employment at health insurance companies rose 32 percent. The implication is that the insurance companies are working harder to decide who does and does not deserve healthcare. Denial of care is often a decision made by an insurance clerk with high a school education. The result is a burden on doctors to deal with the insurance companies when they could be taking care of patients and the need to see more patients in less time. Doctors views are really pretty much in sync with that of the public. Doctors can't be perceived as an isolated group of fat-cats that don't care about their patients and don't want to interact with patients except to make money. In general, physicians are people who want to help people, and they have chosen this path as a living. It's time for physicians to become the strongest unified voice for healthcare reform and I think the public will support them.In searching the internet for public opinion of physicians I found almost all positive reports. People seem to still trust their doctors. Doctors should stop complaining among themselves and lead the way to a better system.  A good indicator would be when doctors want their children to be doctors again.

Medical Technology-confusing even in 1955

Medicine has changed so dramatically since I graduated medical school in the 1980's, that it is hardly recognizable.

Certainly there has been an enormous growth in knowledge which is often beneficial, but has often led us down the wrong path.  For example, when advanced imaging techniques such as "CAT" scans and MRI's became available, we were able to see the inside of large numbers of patients but we didn't know what was really normal.  One thing we found in quite a few people was a small growth on their adrenal gland.  Many of these patients were subject to operations and it ultimately turned out that the growths were harmless.

This is one of the problems with undergoing medical tests.  You have to deal with the results.  Sometimes the results are incorrect, leading to further testing and treatments.  Sometimes the results are correct, different than normal, but still harmless.  An example of this would be the "bulging discs" seen on so many MRI's of the spines of patients with back pain.  It seems logical to assume cause and effect in a patient with back pain and a spine abnormality, yet it turns out that bulging discs are a common finding and usually not associated with pain.

We have certainly improved our treatment in many areas of medicine, but it has come at a price, both in cost and in quality of care.  Too many people can't be seen quickly.  Our attempt to provide care for everyone gas created problems.  We have lower level people doing higher level functions, and they simply can't do them as well.  This ranges from blood drawing to EKG's.  A controversial area is the autonomy given to caregivers that have less formal training than physicians, such as midwives, nurse anesthetists, and nurse practitioners.  The overload of patients has led us to treat by email or video, an idea which is hard to accept when one learned that the basis of quality treatment is a good history and physical exam, neither of which can be done electronically. 

Physicians had it good for a long time, and really didn't take care of the field.  Now there is conflict between physicians and the AMA, and a new voice has arisen at Sermo
Unfortunately Sermo does not have a section for non-physicians, although I think it would be a good idea.

This post was inspired by an item in the Journal of the American Medical Asociation (JAMA) from December 24, 1955 by G.W. Pickering M.D..  It reads as follows:

Machine Age Overtakes Medicine-
As year succeeds year, some new physical or chemical technic and some new and elaborate machine are applied to the study of disease; great claims are always made for the precision of the answers yielded by these technics and machines.  One of the greatest struggles that a practicing doctor has is to keep up-to-date with advances of this kind.  No sooner has he mastered one than another is upon him.  Moreover, the machines or technics are often so complex that he cannot understand them.  He has to take what they tell him on trust...There is a growing tendency for doctors to rely on the information given by such technics and machines in preference to the information which they gain themselves from the history and physical signs.  I am extremely doubtful if this is in the interests of good doctoring, and for three reasons.  First, the errors and limitations of these new technics are not at first appreciated...Second, a thorough clinical examination, which will be carried out only by doctors who appreciate its worth, is the best method of establishing that spirit of mutual understanding and good will which is the core of the doctor-patient relationship.  Finally, to rely on data, the nature of which one does not understand, is the first step in losing intellectual honesty.  The doctor is particularly vulnerable to a loss of this kind, since so much of therapeutics is based on suggestion.  And the loss naturally leaves him and his patient poorer.
End.

I think there was a lot of wisdom and foresight in this 1955 article.  Technology has advanced medicine without doubt, but a good history and physical exam remain the basis of good care.  The explosion of medical technology has introduced many useless and expensive technologies as well as pure snake oil, in addition to the useful technology.  Marketing directly to patients has made it more difficult for physicians to practice good medicine and avoid the use of treatments that look wonderful on television but are not in the patient's interest. 

We have a lot of work to do, but I think that physicians still have the best interests of their patients in mind and are the only ones who can fix what has broken, even if we played a role in breaking it.

Another customer gone

Consumerism is down and companies are trying harder to get your business.  Well, at least some of them are.

I'm amazed at some of the sales I see.  25% off plus free shipping.  As one would expect, prices fall  when people have less money to spend, but is it all about money?

As companies cut prices, they have to cut costs too.  Have you ever called a company, any company, to become their customer?  Almost immediately you will have a live person on the phone.  Call the same company now that you are already a customer and try to get live support.  You will probably wait on hold through a series of voice menus (listen carefully, because their voice menus have recently changed) and you may end up with a person in a half hour or so.

For many online retailers, it is almost impossible to find a contact phone number.  The price we pay for low prices is the inability to contact the seller if something goes wrong.  Sure enough, I checked on the Epocrates website and they have links for live chat or to email them.  No phone number that I could find.  For an interesting story about Amazon's contact number, see this link.

Companies must do research on how severely service can decline before customers flee, even if prices are low.  Of course if service is poor everywhere, then we shop based on price alone.  I would think that when one buys a household item like a washing machine, low price is the main factor and one will take the risk that service won't be required. 

If you buy something like internet service, or phone service, then you want a company that takes good care of it's customers.  It's worth a little extra money.  I suspect that when the economy turns around, it will be the companies that provide good customer service that do well.

I had an interesting experience recently.  I received an email from Epocrates, a company that provides information on medications and other medical information to portable devices like Palm Pilots and iPhones.  The email informed me that in appreciation of my being a loyal customer (since 2002) I was being given special notice that they will no longer be supporting Palm devices that go with Macintosh computers.  I wonder what they do for their non-loyal customers? 

Now, I don't want to be too hard on them.  There was a special offer for me by which I could receive an ipod touch and Epocrates software for $199.  This is actually a pretty good deal since an ipod touch costs about $180 and the software costs $159.  But the thing that bothers me is that they are abandoning a loyal customer, and the only way I can remain a loyal customer is to shell out $200 for a device I don't need.  They point out that the offer saves me almost $200, but I went to their website to find that the regular price, for non-loyal customers is $309, so I'm really saving $110.  It probably makes sense to you if you took marketing courses.

I wrote back a thoughtful email, explaining how it was disappointing that they would drop support for the Macintosh and expect their loyal customers to spend $200 to get something they already had-a working epocrates system.  I have an ipod and I don't need another one.  I love my Mac and I'm not going to buy a Windows computer.  My suggestion to them was that they treat their loyal customers to a free ipod touch with a paid renewal of their subscription to Epocrates.  That way they would maintain their customers and would be making a genuine good will gesture.  I know I would have been swayed.  I should also mention that I always thought Epocrates was a good product and I used it frequently.

I probably would have been swayed just to receive a real reply from a real person.  Instead I received a canned reply from "Gold Support" at Epocrates thanking me for my suggestion, and letting me know it had been forwarded to the Product Development Team for consideration.  Nobody signed his or her name at the end of the email from Gold Support.

I don't expect to hear from them again, but if I do I will post it here and eat my humble pie, but it seems to me that customer service, like so many things, is just words and not action.  "Gold Support".  "Loyal Customer".  It all means nothing.  Show me the money.

In the meantime, as it turns out, there is now competition for Epocrates.  Medscape Mobile is free.

Fireflies

From my childhood I remember the magic of fireflies.  I associate them with vague memories of warm damp summer nights when I was up past my bedtime.  They would flash like impossible beings that symbolized the magic of childhood.

The kids in the neighborhood would chase them with nets and jars, and sometimes our bare hands, for they were one of the few bugs that we were not afraid to touch.  They were good.  A few holes would be punched into the top of a jar and the poor bugs would become night-lights, shaken until they lit up or until we fell asleep.

There was always someone who would squash one and we would look in amazement at the continuing glow that outlived the fly itself.  This was a cruel act of childhood, like burning your friend's foot with a magnifying glass in the hot sun while he was busy trying to burn ants with his magnifier.

I live in the country now in a place where the nights are so dark that the milky way is brightly visible and the stars burst through the clear night sky vividly.  There are no kids in the neighborhood except for mine.  The woods are alive with sounds that could be crickets or deer, but are always wolves to my children.

One night I was out looking at the sky and I was surprised by the flash of a firefly.  I hadn't seen one for decades.  I felt the same excitement I had as a child, a response that I think is a part of the human genome.  I rushed to find the butterfly nets from where they had last been carelessly thrown, and a jar.

There were only a few fireflies out and I ran from one end of the yard to the other as I saw them appear, and then disappear, the flicker turning into just a dark bug, barely visible, flying higher out of reach into the night.  Finally I caught one and breathlessly placed it into a jar.  I proudly brought it upstairs to my sleeping daughter and woke her to see it. 

I think it was one of those moments for her that was hard to distinguish from reality.  One minute she was sound asleep, dreaming and the next she was looking at a bug that could produce light, a strange concept to accept, perhaps blending with that night's story about something equally fantastic.

In the morning we released the fly together.  The next night I caught two.  I would have liked to have her catch them with me but they were out too late.  It became my nightly ritual, rewarded by the glow of excitement my daughter showed as she cupped the jar and took it into bed with her, the only bug I can think of that she would happily hold next to her. 

It remained a nightly ritual for about a week, at which point the fireflies stopped coming, and the wonder it all faded, as things do once kids accept them. 

Now, a year later she barely remembers them, but for me they were a moment of my childhood relived and shared.  A happy moment. 

Next year maybe she'll be up late enough to catch them with me.