Why Healthcare Costs are Ridiculous

Twice a year I take my son to see two doctors in one appointment at one of the premier children's hospital in the country. He has been seeing these doctors for approximately ten years. During that time our health insurance has never changed. We book these appointments approximately three months in advance. So, this should all be simple, right?

We arrive for our 9:30 appointment at about 9:25. I immediately put our name on the sign-in sheet. We start getting signed in at 9:43. For one of the two doctors, they can accept any form of payment; for the other, they can accept only cash or check. OK, I have cash. The co-pay is $15; I have both twenty dollar bills and five dollar bills. I say that I can pay cash, but will need either a five or a ten for change. Without batting an eyelash, the woman checking me in says, "I don't have any cash." Unable to stifle it, I laugh. Fortunately, she sees the humor.

[Interrupt: it is 9:53 as I type this -- we overhear one of the administrators say, "Right now, everyone is rolling along right on schedule." Um, in what universe is it the case that at appointment time+23 we've not yet been called into the office "on schedule"?]

Back to our story: She proceeds to check me in with the one doctor for whom we can use any form of payment. This entails approximately five sheets of paper and seven sticky labels, not including the credit card receipt and the receipt that she printed for me. Oh yeah, did I mention that this hospital actually has all its medical records online? I kid you not -- in the doctor's office, everything is online and we can pull up any old visit or test done at this hospital (at any of the hospital's three facilities that we use regularly).

Now we get to deal with doctor number 2 who can only accept cash or check. I have pleasantly left $25 on the counter, dying of curiousity to see how they are going to deal with this, since it is so not my problem ^TM. Once again, the woman checking me in says, "I have no cash." Another parent checking in, however, has change for a twenty. Whew. Disaster averted. She changes my twenty, I pay then in ten ones and a five (to give them a nice variety of change for future clients). Now we get a hand written receipt, in duplicate using carbon receipt paper (honest!), another seven sticky labels, carefully affixed to various pieces of paper, and at 9:51 we are fully checked in.

Is it any wonder that the system is inefficient? What a collossal waste. It's now 10:04 (we got called in for height, weight, blood pressure check; my son is now officially taller than I am). We are in the doctor's office and I'm guessing by 10:15 we'll see doctors -- a full 45 minutes after our designated time. Once here, the two doctors will work like a well-oiled machine. Seriously, they are efficient, friendly, informative and treat us well -- I like and respect these folks, but why can't the rest of the process work as smoothly as they do?

Math, Gender, and Race

Here I am at the Massachusetts State Mathcounts competition. These are arguably the top middle school mathematicians in the state, and I have to confess at being struck by some interesting demographics. I don't have the actual numbers for this, but the organization is run by grey-haired white males; the preponderence of the coaches are women; the vast majority of the competitors are male. The male to female ratio is about 4:1. My impression is that if you are a private school, that greatly increases the probability that there are women on the team.

The top 10 students in the state are all male. Of those, by appearances, only 2 are Caucasian. The remaining 8 appear to all be of Asian descent, perhaps either Chinese or Indian.

I'm not sure what to make of all this, but as a woman in a STEM field, I find it pretty depressing.

Margo meets the ChromeOS laptop

I was one of those lucky recipients of a Chrome laptop just a week or so ago. Just for fun, I thought I'd blog about my experience with it.

First, the box arrived without any labeling - I had no idea what it was, who it came from, why I was getting it, etc. Being near the holidays, I thought perhaps my husband had bought me another piece of electronics. I checked with him, but he pleaded, "Not guilty." So I opened it up -- it looked kind of like a laptop ... I know I didn't order one of those. The only documentation was a single 8.5 by 11 inch piece of white paper that had a picture of the open laptop and in the window, it said, "Chrome." Aha -- this is a Chrome OS laptop. (I later found a second piece of documentation -- a half-size brown card with the safety notice that told me I could read it and throw it away and showing me how to plug it in, open it and install the battery (all of which I figured out before finding said card.)

Cool -- who sent it? No clue. Then the rumors started trickling out about Google sending a boatload of these to "some people." OK, I could imagine that someone might put me on a list, but who? I know a lot of people at Google ranging from employee 7 or so to the guy just hired yesterday. I took a guess and sent email to the person who rose to the top of my "Googler most likely to think of me as someone who should play with a Chrome OS laptop." Bingo -- I hit it -- I'll let said person remain anonymous unless said person wants to identify him/herself. But, thank you -- this will be fun.

OK, so now I have a machine and I know who sent it -- let's try it out! First, a bit about myself, since different people are going to have different reactions to this device and those reactions are going to be influenced by what kind of user is using it, so who am I?I use computers and laptops a lot -- but I use them as tools -- I don't really play with them. Although I find it immensely satisfying to write code, I rarely do it for fun (the one exception is writing simple game-show frameworks for my annual soccer banquest). I have been carrying a MacAir with me pretty much nonstop for the past 18 months. I really love it -- I can program on it, read mail, check out news, and do whatever work I need to do. It is my main machine for both of my lives (as an academic and as an architect for Oracle). At the same time, I'm really mad at Apple (like they care). I also have a tablet that runs Windows and when Apple announced that they were about to release a tablet, I got very excited -- instead of carrying two devices, I could carry one -- I was expecting something that looked like my MacBook Air and then opened to let me write on it -- after all, I WANTED A COMPUTER. When I saw the iPad I was devastated -- they had given me an overgrown iTouch; that was *not* what I wanted. Anyway, back to this -- I use my Air constantly and I carry my tablet with me when I'm grading or reviewing written work where I want to scribble on things. I also use the tablet to take notes in 1:1 meetings (because I prefer the pad dynamics to the keyboard/screen dynamics) and if I can get it all to work, I'll lecture off the tablet so that I can scribble on my notes and still project them (as opposed to scribbling on transparencies, which I only abandoned a short time ago).

Back to the Chrome OS laptop -- from a tactile perspective, it's different -- the case is rubberized so it feels rather different from anything ever I've ever carried. It's a tad smaller than the Air in footprint, but about twice as thick. It's about the same size in all dimensions as my tablet, but a bit heavier. All-in-all, the size seems OK, but it feels heavy. Without pulling out the scale, I'd say about 1.5 to twice the weight of my Air, but I'm curious -- let me get the scale out ... fascinating, the machines weigh in at: Air: 3 pounds, Tablet: 4 pounds 13 ounces, Chrome: 4 pounds 10 ounces. So, the air is lighter, but not by the 50-100% it seemed, and my tablet felt lighter even though it isn't.

Ok, let's boot it up! As you open it, the ChromeOS logo pops up and within just a few seconds you get to pick your language and wireless network. The keyboard is pretty similar to the Air, with the click built in to the touch pad -- I still have them separated, so this was kind of awkward for me, but I'm guessing that I'll grow to like it. Then again, the mouse feels sticky -- I can't move the cursor around smoothly -- it feels like it gets stuck and is somewhat irritating. Tried connecting to my home network, on which my Air is happily talking, but Chrome OS was unable to connect ... checked proxy settings and they were off, as they should be. I can still type from the Air onto the network, but ChromeOS can't connect, and it's completely unclear what else I can try. Guess I'll just try again ... aha -- after three tries, it worked. Yippee.

OK, signed in with my gmail account, decided not to take a picture (it's Saturday morning and I'm just not in profile-picture form, thank you very much). But, it was a cute way to demo that you have a camera here.

Now, I've never used Chrome before (I'm still a satisfied Safari user), so I guess I'll go poke around learning about that for a bit. (BTW -- mouse is driving me crazy ... just doesn't move smoothly.) I think I'll end this segment now and write more as I play more with the laptop and figure out what I like to do with it.

Ankle Rehab: Mental Rehab

So for those of you who follow facebook, you may have noticed that I returned to the soccer field a few weeks ago (September 26 -- 5 months after the fracture). The planets aligned -- we were playing on a turf field (i.e., no unexpected bumps) and we were playing a team whose average age was close to our own. It was a few weeks earlier than I'd anticipated, but a trip to Maine got unexpectedly cancelled and I found myself home on a Sunday morning.

So, how was it? It was Great!!! My teammates were fabulous -- welcoming, supportive, happy to see me, etc. I played in 5-10 minute shifts and loved it. We all decided it made the most sense to put me in at forward as any ineptitude was likely to cause the least harm there.

As I had kind of anticipated all along, the hardest part of coming back is the mental part. Once I started running around the ankle felt pretty good -- I was making some runs and seemed to be able to handle a ball. But ... I was wimpy -- yeah, she who dives in goal and never shies away from a tackle just couldn't do it. I couldn't make myself go in for a tackle. I could kick with my left foot, even take a shot on goal (which would have gone in had it not been for the annoying player on the opposing team who decided to get in the way), but as soon as it came down to stepping in for a tackle (with either foot), I just couldn't do it. I suppose it's to be expected, but it makes playing frustrating.

I'd love to hear from others who've come back from injuries and struggled with this. I'm hoping that it will just take time, but I'm not sure how to be effective in the meantime. I don't feel I can play anywhere other than the forward line -- it's just too risky to put a wimpy player in the midfield or backfield. Forward has always been my weakest position, so I guess I can see this as an opportunity to learn and grow -- developing that killer 'go-for-goal' instinct would be a good thing.

Advising Grad Students

It's that time of the year when I have new first year advisees, concentration advisees, new grad students, old grad students, and junior colleagues. I find myself dispensing lots of advice - some of which will (and should) be ignored; some of which might be handy. Just for fun, I thought I'd try to do a series on the different types of advice I give different people.

Today's installment is about advising grad students. Advising graduate students is really quite unlike anything else you've ever done (except perhaps advising your grown children, but I don't have any of those yet, so I don't know; I can hope that my experience advising grad students will make me a better parent; being a parent certainly makes me a better colleague and advisor).

Anyway, there are a couple of statements that ought to be obvious, but that aren't always spelled out in black and white. First off, grad students are adults (then again, I think undergrads are too). And they don't actually work for you (exception: if they are your teaching fellow for a course, then they actually do work for you and different rules apply in that specific context) . If you're a good advisor, they will work with you and they will align their goals with your goals, but they don't really work for you. They work for themselves (face it -- in the sciences and engineering, the stipend we pay them doesn't come close to a fair wage). Their goal is to acquire a PhD and they've entrusted themselves to your guidance. Yeah, really, I view it as an incredible compliment and a huge responsibility when a student decides to work with me. Given the quality of students who apply here, they have choices to attend many fine institutions and work with many talented faculty. If they choose to work with me, they've placed an enormous amount of trust in me.

I don't get to tell my students what to do. I can suggest they do things, but if I do, I darned well better be prepared to explain why I think they should do it and what's in it for them. If the only answer I have is, "I need you to do this." then I'm better off being honest about this and not suggesting it, but saying, "Hey -- I really need you to do this, do you think you could?" If you have a good relationship with your students, they will do that in a heartbeat. If they won't, then it's time to ask yourself where you've messed up. In general, whenever I'm about to suggest that a student do something, undertake a particular project, write a paper, etc., I like to be prepared to answer the question, "What's in it for me?" I've never actually had a student ask that (mostly because I tell them explicitly), but I think it's important that I understand my own motivations.


Let me tell a story -- as I was approached my tenure review, my group got a paper published in one of the top conferences in our field. This was clearly a group project -- we'd built a large system and this was the first real paper where we told the world exactly what it was and how well it worked. The paper was the result of a lot of hard work of three students and myself. Normally I'd have tried to give the talk presentation to the most senior student or the student who'd carried the lion's share of the work -- neither of those two questions was easily answered, and as I said, "tenure was approaching." I explained to the group that I wanted to give the talk. I was pretty blunt -- I explained that I was fully aware that this was a group project and that I could entrust the talk to any of them, but that I felt I needed to do this. It's easy to say that they had to agree, because I was their advisor and they dare not disagree, but I'm reasonably confident they agreed, precisely because I didn't try to justify my request on any meritorious grounds -- I didn't try to make it sound like I had more of a right to give the talk than they did. In fact, I did quite the contrary, I admitted that all of us had a right to give the talk and made it clear that I was asking their permission. By this time, we had a multi-year trust relationship built up -- they knew that I would always look out for their interests and were happy to do the same for me. Fifteen years later, I still think of these people as my friends. Yes, they are former students, but they are friends and colleagues, and those relationships had already started forming oh so many years ago.

Another job of an advisor is to be an advocate, marketing department, and sometimes "mama bear" for her students. For every student, an advisor must be his/her marketing department -- it's your job to introduce your students to the people in your field, talk up their work, give credit for their work when you give talks about "your group's" work, etc. That is the easy part, but what about when things go wrong? Here's an example that actually happened to an undergrad, but the principle was the same. The undergrad undertook a project with another established person in my field. That person then sort of took the work and claimed it as his/her own. The student was upset.


What did I do? Following the principle of, "Students are adults," I first let the student vent. Next I counseled the student on actions he might take. When those actions didn't help, I finally stepped in. it wasn't pleasant; I was jeopardizing my own relationship with the individual; and it wasn't particularly pretty, but it had to be done. If your students can't count on you to really support them when the going gets rough, what kind of message are you giving them about the relationship? Sure, most of the time, students are fully capable of taking care of themselves (as are we all), but every once in awhile we need to pull in the big guns and know they'll support us. I can still think of people who did that for me when I was a grad student and young faculty member, and I'm still grateful.


Then there are the less obvious questions -- how do you teach someone to conduct research? It took me many years to figure this out, but I believe that apprenticeship is the only way that really works. What this means is that you bring new students in on an existing project and let them watch how it works and contribute in small, well-defined ways. Once they've had that experience, with some assistance, they can identify and tackle a small project of their own design. After that, most of them really begin to soar. Along the way, there are moments to put forth your beliefs about research methodology, what constitutes a good problem, LPU (least publishable units) versus meatier papers, writing, giving talks, etc. However, I firmly believe that the groundwork you lay in those early apprenticeships are critical. The two failure modes I've observed are, 1) assuming that since they've done well in the past they know what they are doing and simply turning them loose and 2) assuming that only you have good ideas and if they aren't working on your ideas, they aren't doing anything valuable. Both approaches can have dire consequences -- I've met highly recommended, very strong PhDs who did not seem capable of identifying a good research problem or setting a research agenda and I've seen really smart gifted graduate students flail, being unsure how to get started.

There are dozens of other parts to advising graduate students, but I'll stop here for now with this: Treat your graduate students as you would have liked to be treated as a graduate student, not necessarily how you were treated as a graduate student.

Ankle Rehab: 12.5 weeks post-cast

I knew it had to happen -- Carli made it back on the field before I did.
From last night: Second-half substitute Carli Lloyd, making her first appearance for Sky Blue FC since breaking her ankle in a game on April 25, fouled FC Gold Pride’s Ali Riley drawing a yellow card.

That said, earning a yellow card the first day back isn't something to which I aspire.

And I'm not doing badly myself -- the orthpedist said that the physical therapist gets to decide when I'm ready to play (I think this scared the living daylights out of the PT). So, I'm now starting to jog -- and when I say starting, I mean starting -- I'm jogging slowly (4.5 MPH instead of 5 MPH), and right now I can do 2 minutes on/3 minutes off. Much more than that and I feel it in my ankle. So, I have to work both on increasing speed and increasing endurance.

Once I can jog, I get to run -- I imagine that will be another long slow process.

And once I can run, then I start cutting and before you know it I'm back on the field.

Overall, I suppose I can't complain too much -- it's almost 3 months since the cast came off and I'm actually beginning to think that I'll be back "soon." Of course, my endurance sucks at the moment and I've got to get back to some serious weight training, but it will happen. If all goes well I'll sign up to do some kids' reffing within a few weeks and ideally I can manage a few minutes for the Chucks' fall tournament.

Here's hoping.

Two steps forward, one step back

Here I am wrapping up week eight since the cast came off. Things were going well. At the end of last week I started asking about running -- well, I continue to ask about running, but now I feel like I've progressed backwards. I have this sharp burning pain right at the ankle. The PT responded by backing off a bit -- she still lets me do 7 minutes on the elliptical (a very cool one with free moving foot rests), but we're not pushing much. I saw the Orthopedist's PA (Physician's Assistant) and she didn't seem terribly worried -- said that sometimes you get nerve entrapment from the scar tissue.

So, no one thinks it's a big deal, but well, it's annoying. Having worked hard to become relatively mobile and pain free, it's a drag to be limping again and in pain. I continue to have pretty good mobility, I can feel my little ankle work its heart out when I do all sorts of interesting balancing exercises (hmmm -- I should play Wii FIT this weekend), so I think all is good, but I'd like this pain to go away.

On the other hand, when I asked the PA about soccer, she thought winter was safe, but thought three months might actually be doable -- that would get me on the field in time for our fall tournament! It seems that the fracture is healing nicely -- almost all the gaps are filled in with new calcium and there are only a few small pockets left. I go back in 4 weeks for another X-ray and what I hope to be a solid bone with no gaps.

As for now, Go Breakers! (We're in 3rd place and while 1st place seems out of reach; 2nd doesn't seem that far away.)

- M