markroseman

BC actually has both privately run and government run liquor stores.

In 1Password's case, I understand their desire to switch over to subscription pricing, and also have some sympathy with the notion that moving people to a cloud-based model reduces confusion and complexity (including their support costs). I also have no doubt that they now intend to take security as seriously in the future as they have in the past.

Beyond the not-insignificant risks of them screwing up, despite the best of intentions, there's nothing that prevents a change of company direction/priorities that could greatly increase the risk of a significant security breach. New senior people get brought in, crises happen that lead to poor decisions for financial or other reasons, and companies get sold to people who may well have completely different priorities.

Keep in mind the technology has to fit into the existing regulatory and legal framework. Which also includes, if something goes wrong, who are you going to sue?

Or look outside the USA at dozens of other countries that may have some problems with their healthcare systems, but aren't anywhere close to as completely fucked up.

Read the comments and listen to the debates, and understand that it isn't going to get better until Americans believe that the availability of healthcare shouldn't be solely dependent on income, and that "freedom" around payment and insurance shouldn't be the primary value.

My wife is a doctor, over a dozen years in practice. Tell our mortgage about how she's a millionaire. And to me, a life of her choice would likely have a lot less stress and shorter hours, and not worrying that the income would dry up if she has to stop working.

Two bad things that can happen... one, the order entry procedure on the computer (besides being more time consuming) has usability problems that make it easy to enter the wrong thing accidentally. And an incorrect order looks as official as a correct order. In the old scribble system, where everyone deals with the same physical chart, things that may be a bit more ambiguous/indecipherable are more apparent. Plus, equally importantly, there's more communication between different professionals around the chart. The EMR takes a lot of the ad hoc communication out of the equation. For an example of this in another domain, air traffic controllers used paper "flight strips" to represent current state; initial attempts at computerizing these completely missed that the strips were not only information but also a vehicle for ad hoc communication, and that latter part, critical to work actually being done, was missed in the computer systems.

Doing things via pen and paper can be safer than doing things by a complex, poorly designed computer system that doesn't take into account actual work practices, patterns of collaboration that involve artifacts like paper as an essential part of communication and work flow that isn't captured by these computer systems. You need some serious perspective if you think just computerizing something is necessarily making it better, and that it can't turn out to be a disaster.

I'll just pick up on one piece of what you said, "meds from a psychologist." While I don't disagree that greed may be a part of it, unless that person's extra training involved a medical degree... that's truly been a crazy idea given the things that can go wrong even with "simple" medications, even when you know what questions to ask about other preexisting conditions and how to interpret the answers.

The other thing is that with the current system (i.e. medical doctor prescribes), there's liability coverage through the doc's liability insurance, which unless psychologists are interested in taking on huge liability insurance premiums...

One theme coming up here is the idea of just graduating more doctors, but even ignoring artificial pressures to keep supply low, it's not that simple. Many disciplines, particularly things like surgery, have a lot of requirements beyond just doctors, i.e. nurses, anaesthesia, OR's, hospitals, etc.

In Canada, we have a fair number of people in certain specialties that cannot find work - think a radiation oncologist who needs some pretty specialized and expensive equipment that only exists in a few places to be useful. But also even more basic... gastroenterologists who can't get enough OR time to do scopes on their patients.

Agreed, this culture of abuse goes way back, and is as much rooted in a macho "I went through this, you're damn well going to" mentality.

I do think the increasing corporatization of medicine in the USA has accelerated the loss of autonomy and satisfaction, which makes the abuse and overwork far more difficult to take.

Absolutely it's about the administrative end and not patient care. We've got a situation in our regional health authority (Vancouver Island, BC, Canada) where they're trying to roll out a significant update/expansion to their EMR (Cerner-based) in the hospital in Nanaimo. Despite immense pressure, some docs have been now suspended for refusing to use it and switching back to paper, despite the massive increase in time it takes to provide the same patient care, and also because of notable examples where the EMR has endangered patient safety. (Google 'ihealth nanaimo' if you're curious for details, then rinse and repeat for the same story in so many other places)

Dr. Pamela Wible has long been a very loud voice on the issue of doctor suicide. Check out her website http://www.idealmedicalcare.org, which includes a link to her TED talk on the subject.

Not so much. There are pockets, with poor interoperability between them. Multiply this by the different health systems (one per province, plus assorted others) and it's still a mess unfortunately.

Improperly managing side effects (i.e. letting people know ahead of time about possibilities, using compensatory medications or switching altogether) is a big problem with many people who prescribe psychotropics. In competent hands, most people can generally find a medication or combination that works for them with tolerable side effects.

For GP's, it's because there's an increasing amount of information in every single field, so it stands to reason they'll be more on top of some than others. Where it gets bad is when they choose not to keep at least slightly up to date (well, literally UpToDate) on things like basic mental health that make up a huge portion of most GP practices.

Agreed. Doctors would never get away with the level of shoddy care or outright patient abuse they often do in any other field except psychiatry. There are some fantastic psychiatrists and GP's who do a fantastic job with psychiatry, but just as many if not more crappy ones. Very frustrating, and a disaster for patients.

I find drugs.com useful, which seems to be derived from product monographs. Knowing that "very common", "common", "uncommon", "rare" and "very rare" have specific meanings (e.g. common -> 1%-10%) helps.

While there is some work done on matching people up with specific drugs, this is still very much in the research phase.

Still, for many people, it's more trial and error than it needs to be. Many family doctors still don't match up symptoms with neurotransmitters, and then put people on the wrong class of drugs altogether (e.g. something like Wellbutrin which works on norepinephrine and dopamine instead of an SSRI for anxiety which is more associated with serotonin).

Part of the reason is that new drugs keep coming out so it's difficult to keep up, and eventually they all start to blur together.

The best practical predictor of success on a given medication today is if you have a close relative who's had success on that medication.

The separate process stuff has been in there for a very long time. There is still an option to run as a single process but it has long been deprecated (and hopefully disappearing soon too).

That matches my experiences when I was looking at desktop GUI toolkits for another project. I understand it though given most things are web or mobile these days.

A recent poll I had on the TkDocs site showed documentation is definitely the big issue for what people are trying to accomplish with Tk.

Exactly the target audience. I'm not a hardcore Python guy, but got involved because I had reason to try IDLE again recently, and after the initial "oh my $DEITY this is embarrassing" realized that not much effort would be needed to bring it up to the "entirely reasonable" level.

I think Tk is entirely reasonable for the types of "utility" applications that people are primarily using it for; nobody is going to start writing a flashy new cutting edge app in it today.

For those with legacy code or other constraints where it makes sense, the TkDocs site is all about getting the most out of Tk by documenting the newer pieces that people likely haven't seen.

IDLE itself is in that category of using Tk by constraint. There have been multiple forks of it, sometimes using alternate GUI toolkits. But for it to stay as part of the Python standard library, it has to only depend on other things that are part of the standard library. Which for GUI stuff, means Tkinter. And having it built into Python is a very big deal for a lot of people teaching Python, which is the main target audience.

I was doing CS at U of C same time he was. While I have a lot of respect for him in many areas, and found him entertaining to hang out with at times, there is just no way to overstate how abrasive and how much of an opinionated arrogant asshole he can be. (Something I don't think he'd disagree with.)