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Unanswered questions, never asked

I got in the elevator this morning at the hospital where I work, and the man who boarded next to me said, in a friendly tone, "So did you get in to see the doctor?"

I was taken by surprise.

This was a presumptive question, in the sense that it presumed I was waiting to see a doctor.

Answering the question truthfully with a "No" might still leave the wrong impression.

That's the problem with a presumptive question.

"I work here. I'm a researcher," I responded. I had put my badge in my bag as I departed my meeting. Next time I'll keep it on.

My first thought was that he mistook me for someone he saw in the waiting room. People have been known to wait for a while to get in to their appontments in our hospital...

I was wrong.

"Oh, I thought you were a sales guy from a drug company, those guys are always trying to get in to see the doctors."

Our brief ride came to an end, leaving me with unanswered questions, mostly because I did not think fast enough to ask them before my outgoing companion disappeared into the day.

My main question was: What did I say or do that led this gentleman to believe I was a drug rep?

There was a cascade of unspoken questions behind that: did he see being a drup rep as a good thing or a bad thing? Was it my appearance? My demeanor? My clothes? Should I be flattered or insulted? Was this the first time in history a systems engineer had been confused with a drug rep? Has anyone ever approached a drug rep and confused them with a systems engineer?

The presence of drug reps is controversial in clinical settings. Basically, where they once roamed the land with relative impunity, they are now banned or on their way to being banned. Many feel that their sales mentality embodies the potential for corruption in our fee for service health care system, where health care providers and producers make more money by pushing more treatment. With this background knowledge, I felt somewhat threatened by my elevator companion's casual branding of me as a pariah. My self-image is much more the knight in shining armor - the patient advocate who helps people work with their doctors against the conflicting forces of insurance companies cutting costs and pharmaceutical companies driving revenue. 

I did see the whole interaction was a gift. I try to be pleasant on elevators, but I'm guarded. This gentleman, who if I may counter with my own attributions, was dressed like a recreational golfer (bright blue collared polo and long green shorts), was not guarded. He gave me the Robert Burns gift: "to see ourselves as others see us."

"Jeff," he was saying, "You may think you are Mr. Patient Advocate, but under some conditions you can come across as Mr. Corporate Rep."

I really wish I had been quicker to ask my follow up questions. This led me to ponder how much we miss because we are too slow to inquire. We often respond to any interaction defensively rather than with curiosity.

For example, I noticed a few years ago that when someone gave me a compliment, I tended to deflect it. Now if someone says, "I really enjoyed your talk/paper/program," I immediately respond, "Thank you. What did you like about it?" I have gained so much valuable, actionable feedback that I would have missed if I had just stammered some awkward thanks and turned the conversation to another topic.

In general, when I hear someone evaluate anything, I now try to get them to say more about what is driving their impression. You can't always trust the specifics you get. Sometimes a holistic impression is driven by unconscious reactions that are not easily surfaced. But often people are aware of their preferences and inferences.

I enjoyed the conversational gambit that my elevator friend employed, opening with a presumptive question. It gave me a lot of food for thought.  It's entertaining in a social setting as an icebreaker.

I don't recommend it professionally though. Your patient or colleague may become as distracted as I was by the implications of your presumption.

But I do recommend developing the conditioned reflex to ask productive questions. Whereas a presumptive question stimulates distraction, a productive question stimulates more concrete and specific examples or gets people to illustrate their reasoning.

Imagine the mysteries we could solve if we surfaced responses to those unanswered questions that we never asked.




Life and death in other professions

Last week I hosted a meeting in which premedical interns working in my program at UCSF got to ask questions of two of our most experienced clinicians at the UCSF Breast Care Center - an advanced practice nurse and a medical oncologist. 

One of the interns asked about how, as medical professionals, they cope with the life and death responsibility that can accompany their work (e.g. how the right move can save someone but an error can kill them). Both clinicians pointed out how even routine daily activities like driving a car can be come a matter of life or death, and certainly many other professions are responsible for public safety. 

The following day, another colleague drove this point home with the story of her mystery illness. She was pregnant and started experiencing fainting spells, headaches, dizziness, and a cognitive fog (not able to think straight or concentrate). Her physicians ran all kinds of tests, ended up attributing it to pregnancy, and put her on bed rest. She got worse in a matter of days. Through sheer coincidence a Pacific Gas and Electric inspector came out to her house at this time, and it turned out that my colleague was suffering from carbon monoxide poisoning. The landlord had upgraded a water heater before my colleague moved in, and did not realize that pipes that should have been slanted were horizontal, creating a backup and leak of gases including carbon monoxide. The building inspector signed off on it without realizing the hazard. Both of these people, in somewhat more everyday professions than our nurses and oncologists, ended up poisoning her through their errors. The building inspector said to her, “I’ve been doing this for decades and sometimes I wonder if what I do really matters. This is such a wake up call that it is critical.”

The happy ending to the story is that my colleague was fine (it was low level carbon monoxide poisoning at that point) and her body apparently filtered out the poison so the fetus was fine, and is now a very healthy toddler. So it was more of a close call or potential harm than actual. But it could have been a lot worse.

One of my take-aways from this anecdote is that western medicine still doesn't pay enough attention to the environment and system in which patient complaints arise. My colleague had dozens of sophisticated tests, but no one really probed the angle of where she was living and what might be going on in that environment.

I have been known to complain about our smoke detectors and carbon monoxide monitor at home waking me up in the middle of the night with that intermittent beep they make when their batteries are low. Which one is it? So annoying!

I think I'm going to reinterpret that intermittent beep as reassuring. And just change the batteries on all of them.


Decisions and reversals of fortune

I feel fortunate that my schooling led me to discover my professional calling. Based on undergraduate and graduate work in statistics and engineering, I now help people improve their leadership, teamwork, and decision-making skills. The most challenging decisions I have encountered are those involving a family health crisis.

One of the key concepts I learned early from my teachers (especially Professor Ron Howard) was the difference between a good decision and a good outcome.

In theoretical terms, you can look at decision-making in terms of coherence or correspondence. The coherence approach says, "How coherent is this decision at the time you make it?" In other words, you judge the quality of a decision at the time you make it, along a continuous spectrum. The correspondence approach says, you can't tell how good a decision was until you see the outcome.

The implications are significant for medical decision making. But before I get into that, let me illustrate them using an example from everyday life.

In early February, 2011, we had a busy father/son day in my family. The Giants were celebrating FanFest and we were given passes to get in early. My son was also looking forward to his playoff game in a local basketball league. Then we were celebrating Chinese New Year with my in-laws. (None of us is Chinese, but we live in San Francisco where this feels like a national holiday for all to enjoy.) To conclude this busy day, we had an invitation to go to a Cal basketball game as guests of my in-laws, or stick with our plans to watch USF play Santa Clara.

As the day progressed, we faced a series of decisions. It started early in the morning. I was intent on getting my son out the door so we could catch the bus (my wife and our daughter had the car). We needed to look ahead at all the gear we would need that day. I printed out a color map of the FanFest events. My son was sure that with our early passes we would have unlimited access to autographs etc. I figured out the bus schedule online and off we went. I was feeling pretty good. Ten minutes into the bus ride, my son asked me if I had the FanFest tickets. No! We jumped off the bus and headed back home.

Now we were going to be running late for the 9:30 gates at FanFest. As we rode another bus home to get the tickets, I formulated some scenarios. First I called my wife to see where she was with the car. No answer. I didn't leave a message, figuring I shouldn't bother her. We can work this out on our own, right son?

Next I told my son we could call a cab. But cabs are notoriously unwilling to come out to our house on the outskirts of San Francisco. They almost always pick up rides off the street even after accepting the dispatch to our house. Another alternative was to call Uber. This is a unique company that dispatches airport limos that have downtime, and redeploys them as city taxis during each hiatus between booked rides. You can order them using your smartphone and see their progress on a map as they come and pick you up. But it's two or three times as expensive as a cab.

My son thought we should just call a cab. I did, and got an estimate of 5-20 minutes. Twenty minutes later, no cab. Now we were really stuck because going with Uber would cost a lot and still not get us there on time.

How am I doing, son, with my decision-making?

Just at that moment, we got bailed out. My wife came home with the car. I called and canceled the cab (still no sign of it). We all dashed down to FanFest. We got there in time for the opening of the gates at 9:30 am.

Now here's where things get interesting from a decision making point of view. The gates did not open at 9:30 as scheduled for us special pass holders. And when we got there at 9:30, as opposed to waltzing in with no line (as in previous years), we had to find the back of the line... which was a 20 minute walk down the Embarcardero, practically at the Ferry Plaza. Apparently winning the World Series changes the dynamics at the Giants FanFest.

I despaired of ever getting into FanFest. I asked the kids, "Should we bail on the line and go get an ice cream sundae at the Ferry Plaza?" I don't EVER offer food bribes as distractors, so this captured their interest. But they were more intent on FanFest.

The line started moving at 10:10 and we got in at around 10:30. It was jammed. No hope of getting autographs by noon (our departure time for my son's basketball game). My son lamented the timing of his game - without it, he would have gotten in line for the autographs and grab bags, and maybe even viewed the World Series trophy (longest line for that one). But one of my management principles, for family and work alike, is that we keep our commitments in the order we make them. We attended some Q&A, watched some video highlights of backstage at the World Series, and wandered around. Then left for my son's game. As we left the attendant reminded us, no coming back in.

As soon as we got to a quiet place, my wife checked her voicemail and indeed there was a message. Our son's game was canceled - rescheduled to Monday. Aargh! Had we known this 10 minutes earlier, we would have stayed at FanFest for another couple hours before meeting my in-laws for lunch. There was much wailing and gnashing of the teeth and bemoaning of our fate, particularly by a certain 10 year old for whom this was a big big deal.

For the second time that day (an all-time record), I offered a junk food bribe as a distractor, this time successfully, and we all went to Jamba Juice.

Of course, when we got to lunch at Shanghai Dumpling, the line was long and we then faced the decision of, should we stay or should we go? We stayed. Service was slow. The food, when it arrived, was divine.

Finally, we went to the USF game. This was a make-up game because I had been too sick to take my son to the USF-Gonzaga game earlier in the month. Which turned out to be a cliffhanger pulled out by the home team, USF. This one, against Santa Clara, was OK. Meanwhile, the game we didn't go to turned out to be a triple-overtime thriller at Cal.

So how did we do in terms of decision-making?

Let's recap. First, except to my son, there was nothing terribly high stakes on this afternoon. I would say I made a low-quality decision when I spent a lot of time printing out a color map of the Fanfest events and lost sight of what should have been a higher priority, locating and bringing the tickets. This was a low-quality decision regardless of the outcome: I would recognize that as an error even if it never cost me anything.

I also made a foreseeable error when it came to ordering a cab. At that point, my son and I believed that arriving by 9:30 would be critical to our enjoyment of an event we had been looking forward to for weeks. Given what I value in clear-headed moments, this was not the right time to save a few dollars, particularly given my long and negative experiences getting cabs out to our neighborhood in a timely fashion. The Uber airport limo service, in contrast, is a lock. I should have splurged. Note that I feel that way even though we had a happy outcome, in that my wife and daughter showed up with the car.

With the benefit of hindsight, some would say, "Fanfest was over-run. You would have wasted money on a car service, and the delay associated with returning to get your tickets turned out to be immaterial." True, but given what I believed and what I valued at the time I made those decisions, they were lower quality decisions than I could and should have made. Regardless of the outcome.

Leaving FanFest was, in contrast, a good decision even though the outcome was unhappy. We experienced much regret over leaving when we learned we did not have to be at my son's playoff game. But again, given what we believed and valued, it was the right thing to do and I would do it again under the same circumstances. Perhaps my wife could have checked her voicemail before leaving the park, but it was too noisy, and anyway we share a family value of not being obsessive about checking our voicemails and emails when we are together.

At the restaurant, we chose to wait because my mother-in-law assured us the food would be worth it, based on her prior experience. We loved it. It would have been a good decision, based on what we believed and valued at the time, even if the food had turned out badly.

We attended a decent USF game and missed a splendid Cal effort in their triple-overtime loss to Arizona. My son doesn't quite subscribe to the coherence theory of decision quality (yet!), so his consolation was that Cal lost, and in retrospect, three overtimes preceding a loss would have simply prolonged his suffering. Better for him to have enjoyed the USF win. This logic is impeccable among sports fans, and matches the correspondence theory of decision quality. As a management scientist, I feel this is indeed incoherent. Attending the USF game over the Cal game was a good decision before the games took place, based on what we believed and valued that afternoon. How could the outcome of the night-time games change the quality of our decision?

Coming back almost full circle to the Chinese New Year, I just read my daughter a Buddhist fable that illustrates the different reactions we all may have to reversals of fortune. The gist of the fable is that a villager's most prized possession, his horse, disappears one night. Others come to express their condolences, or perhaps revel in his misfortune. "What bad luck," they say. "Good luck, bad luck, we'll see." shrugs the villager. Next, the horse returns with a dozen wild horses. "Congratulations on your good luck," sings the chorus. "We'll see" says the villager. Then the villager's son breaks his leg while taming the wild horses. "Such bad luck" say the neighbors. Again, from the villager: "We'll see." As the son is limping around, the Emperor's army sweeps through the village and drafts all able-bodied men. The son escapes this fate. "So lucky," say the other parents. "We'll see" says the son, who has internalized his father's attitude.

This fable illustrates that even the quality of outcomes cannot be judged in the short term! So even if you subscribe to the correspondence theory of decision quality, you are stuck waiting an arbitrarily long time before you can judge a decision. The correspondence view of decision quality is indeed incoherent.

The coherence theory of decision quality - judging a decision based on what is known and valued at the time it is made - allows us to surf on the sea of uncertainty without drowning in regrets at every reversal. This philosophy of decision making is perfectly captured in the Serenity Prayer - "Give me the courage to change the things I can change, the serenity to accept the things I cannot, and the wisdom to know the difference."

Conversely, many in our culture tend to judge outcomes. If things turn out well, conventional wisdom supposes the happy events must have been preceded by good decisions. If things turn out badly, it was because of bad decisions. 

Over the years I have directly worked with hundreds upon hundreds of patients making life and death decisions. I have reviewed hundreds more such cases through my work with organizations implementing decision support programs. Bringing the coherence theory of decision quality to the patient bedside or examining room has been rewarding because people recognize and embrace it as the most productive way to take positive action while recognizing the limits of our control. Decision support programs encourage patients to review information, ask questions of their doctors, and reflect critically on the responses they get. In practice, this usually means slowing down, challenging authority, and getting second opinions, among the seven steps I have described previously. And, having followed this process of critical reflection, we can move forward with confidence and recognize any reversals of fortune as simply bad outcomes that sometimes follow even good bets.

Recently one of my colleagues saw a patient who had experienced a recurrence of breast cancer five years after her initial treatment. In addition to suffering from the recurrence, this patient was experiencing significant distress over her recollection that she had declined the most aggressive possible treatment the first time around, opting instead for a slightly less aggressive strategy with significantly fewer side effects and a slightly higher rate of recurrence. My colleague showed this patient the list of questions  and consultation records generated five years ago as part of our decision support program at UCSF. The patient was relieved to be reminded of the coherence of her original decision, based on what she and her doctors knew and valued five years earlier. Although no one likes to think of medicine as a gamble, she recognized that she had made a bet that was right for her at the time. With a reminder, our patient was able to separate her decision from a subsequent reversal of fortune. Indeed, she might have recurred even with the more aggressive and invasive treatment. Who knows? We will support her in moving forward with courage, serenity, and wisdom.

My personal and professional experiences leave me more resolved than ever to promote the coherence view of decision quality. Others have used fighting words such as logical or rational to describe this view of decision making. Fighting words because people can have different standards for logic or rationality, and will resist the imposition of someone else's definition. But decision quality is not binary like logical/illogical or rational/irrational. It is a spectrum. Please join me in asking this question, especially in high stakes situations: to what extent do our decisions reflect what we know and value at the time we take action?





Structure empowers and constrains

Oulipo is an artistic movement committed to creating works of art based on constraints. The most famous constraint-based art forms are probably the haiku and sonnet.

I've been reflecting on the Oulipo recently because patients and colleagues have commented on my SCOPED model for structuring notes about decisions. I teach people to use the SCOPED model for writing lists of questions (e.g. for their doctors); for taking notes at a consultation; and for arriving at a decision. (See It's not limited to medical decisions, but those are particularly well-suited to this kind of analysis.

SCOPED stands for Situation, Choices, Objectives, People, Evaluation, and Decisions.

Some people love the structure. One patient recently wrote:

"I loved the way my summaries were organized, i.e. "Situation"; "Choices/Questions" etc. It is an excellent way to make this confusing process more clear. I don't know if this is standard. If it is not standard, it should be. This program should be shared with all major medical centers. It is an amazing method of actually educating patients and involving them in their own healthcare decisions, rather than just being passive patients who "receive" treatment."

A physician once told me that SCOPED was the next-generation standard for documenting informed consent.

I coined SCOPED as an homage to the SOAP note in medicine. SOAP stands for Subjective, Objective, Assessment, Plan. It is the rubric that doctors and nurses use to guide their patient interviews and notes today. Notice, however, it does not actually mention decision making. So SCOPED is intended as the SOAP note for shared/informed medical decision making.

One reason to have a mnemonic is that it helps with thinking. People can hold 7 or so thoughts in their short term memory. But if you form a hierarchy out of your thoughts, you can retain 7 items within each of 7 categories. So the six elements of SCOPED can be a scaffolding to hold 7 items per category. The people I train to process decisions using SCOPED go from being able to think and talk about 7 items at once, to balancing 42 decision issues in their heads. 

Another reason for structure of this type is simply analytic. We can communicate more clearly when we focus our communication on one subject at a time. We can cluster topics under a rubric and then deal very efficiently with related topics together. So, for example, I recommend that doctors and patients discuss the key facts driving a Situation (e.g. the key prognostic indicators) before going on to discussing what treatment Choices are available. Otherwise, decision conversations become a spaghetti jumble of past, present, and future issues.

Communication can also become much more efficient if people adopt a common scaffold or structure. If people adopted SCOPED (or another worthy framework) as a common structure for thinking, talking, and writing about decisions, they could focus in very quickly on the sparse or underdeveloped dimensions. It's great to be very clear on the Situation (physicians spend a long time taking a history), but not so good if that only allows 3 minutes for Evaluation of how each Choice affects each Objective. A structure like SCOPED allows you to see where the gaps are in your current thinking.

Admittedly, this is a very propositionally oriented view of communication. Much communication is non-verbal and that is very important. But in discussions where some factual learning is going on, such as patient-physician conversations, we want to make sure the verbal communication is as good as it can be. I have found that, somewhat paradoxically, being more business-like about communication (e.g. following an agenda) provides structure that is very conducive to intimacy and relationship-building. In my view, a structure like SCOPED can enhance the therapeutic alliance. 

But some people think SCOPED is too complex. A very popular author told me, "For every letter you drop, you'll see an exponential increase in adoption." A very experienced medical school professor told me, "students can't handle something so conceptual. Maybe four letters." Another colleague asks, "Is there a SCOPED light version?"

Maybe we'll get there. But I am not giving up on the idea that people can quickly learn and hold a 6-item scaffold in their mind. I also like the fact that SCOPED is a theory-based framework. Decision and organizational theory suggest that these dimensions are necessary and sufficient to critically analyze any decision. In other words, if you leave one of the SCOPED elements out (the People section is often under-developed), you are at risk for making a poor decision, one that may not be fully endorsed and implemented by other participants and stakeholders. Conversely, the theoretical claim is that there is nothing you can think, say, or write about a decision that does not fit into one of these categories. You need all six, but you don't need any others.


Reframing our approach to teamwork

I rely on Argyris and Schon's work in Action Science for key frameworks that help me serve as a more effective collaborator and program leader. Lately I've been paraphrasing some of their key observations and concepts using terms that are more comfortable and natural for me.

One of their key insights was the ubiquity of our mental models favoring unilateral control. They articulated a whole model, Model 1, with governing variables, core values, predicted behaviors.

After living with (in?) their frameworks for a decade or so, I want to share what I think are some of the manifestations of Model 1 that we can all recognize in ourselves and around us:

  1. Look good
  2. Save face
  3. Cover up mistakes
  4. Defend your turf
  5. Avoid conflict

These are natural tendencies that arise out of insecurity and defensiveness. Of course I want to look good! Especially if the alternative is what, looking bad?

The problem occurs when my attachment to looking good (or saving face, covering up, etc) inhibits me from being an effective leader or collaborator with respect to other worthy goals such as, say, providing a high quality product or service.

I've come to a point where I don't try to fight these natural tendencies in myself. But I do try to subjugate them to the higher callings in my roles as a leader or collaborator.

It reminds me of the subtleties around an old expression: "money is the root of all evil." Apparently the saying actually goes, "the love of money is the root of all evil." Similarly, I don't think we should suppress our insecure and defensive tendencies, so much as recognize them and let go of them at critical times.

I've been leading my program for several years now around a different set of practices:

  1. Curiosity
  2. Fallibility
  3. Perspective-taking

These are also totally inspired by Argyris and Schon, this time their Model 2 which characterizes mutual learning.

I try to cultivate in myself and others these tendencies as replacements for the control/insecurity/defensiveness habits.

Curiosity is the notion that we should approach collaboration as a puzzle.

Fallibility is just the notion that each of us is missing pieces of the puzzle, whenever we engage in collaboration.

Perspective-taking is the need to work a little harder to see the angles that others are seeing, in order to really understand what they are saying and doing.

These simple habits have been transformative for me. They appeal to the scientist in me. Many of us with scientific training are used to using these values over the life of an initiative or project, through quantitative and qualitative data collection, analysis, writing manuscripts, etc. Argyris and colleagues taught me to practice using these habits in real time, in every conversation. When you bring scientific attention to simple conversations or meetings between colleagues, these become incredibly challenging intellectually. (For this reason I have also found parenting to be the most intellectually stimulating and challenging role in my life: if you take every interaction seriously as a potentially formative occasion for your child, it deserves your best thinking as a chess player.)

I like to emphasize, to myself and others, the power and attractiveness of the new habits, rather than beating myself up (or judging others) for abusing the old.


Request cycle

Sometimes the same concepts converge on you from different directions. That has been the case for me in regard to a simple but powerful word: request. The idea is that in collaboration, all we can really do is issue requests of each other. Fernando Flores wrote that the request and its corollary, the promise, were the fundamental units of coordinated work. Professor Ron Howard of Stanford University adapted Flores idea into the notion of a quality commitment being one that both parties create and monitor. My version of the quality commitment is the request cycle. It goes like this:

Request - Person A has a need or complaint and expresses it as a request of Person B. A fully-specified request (I heard this phrase from a colleague who consulted at General Motors) includes the conditions for satisfaction of the request. See postscript.

Reply - Person B indicates they have heard the request, understand the conditions for satisfaction, and either accept it or decline.

[Renegotiate] - In this optional step, Person B may run into difficulties or otherwise learn that they may not be able to meet the conditions for satisfaction. The idea here is that with maximum lead time, Person B lets Person A know that they need to renegotiate the conditions for satisfaction (e.g. the deadline).

Report - Person B reports to Person A that they believe they are done. 

Recognize - Person A recognizes the report from B, and either accepts the work product as meeting the conditions of satisfaction, or rejects it and renegotiates a new understanding of what's needed and possible. Ideally the process converges on positive recognition such as thanks for a job well done.

Importantly in this kind of framework there is no reward other than recognition - the professional completion of a request cycle is intrinsically satisfying.

The college interns who work with me always wanted to add two more R's... Respect and Represent. Respect being a kind of recognition, and Represent relating to the broadcasting of your pride.

I have used this framework to manage both up and down. The only kind of relations worth having are consensual/voluntary, so we are all limited to requests, even if/when we have some kind of formal organizational authority.

As it turns out, the concept of a request is core to at least two other organizational frameworks: Non-Violent Communication and Appreciative Inquiry

PS Conditions for satisfaction

I use an old project management framework for specifying conditions of satisfaction: size, quality, resources, and timing. Size means how big a job are you asking for, what is the scope of work? Quality refers to your expectations for quality. Resources refers to, what resources do you think will be needed to complete the job? Timing usually comes down to a deadline. For example, I might ask a colleague to analyze some data. I need to specify the boundaries of the job (what data? what analysis?); the quality level (is this for a peer-reviewed manuscript or do I just need a back of the envelope analysis?); the resources ("please use the copy of Stata that we bought you using project funds last year") and the timing ("I see this as taking 8 hours, please get it back to me by noon tomorrow or let me know if I am off base in my estimate").


Samsung U5 mp3 digital audio-recorder

I use digital audio a lot in my work. I have a simple set of requirements for recorders: must record straight to mp3; must connect by USB to a computer; must have a rechargeable internal lithium-ion battery... For years these simple requirements have been somewhat hard to come by. Lately I'm using (and recommending) the Samsung U5.


Squarespace website authoring and hosting

When personal blogs and websites took off, I wanted to create my own but I didn't want to become a computer programmer. I wanted an authoring environment that would provide great flexibility with a point and click UI. That probably describes quite a few tools now, but I've stuck with the first one I've found: Squarespace. For a long time Squarespace was just some young computer prodigy named Anthony Casalena. Then, in a small world coincidence, my childhood buddies at Index Ventures made an investment and Squarespace is going even bigger. I like the fact that it is easy to use but has some sophisticated features, like user access controls so I can create password-protected portions of my websites for collaborators.


Freemake video editing software

Do you ever feel caught in the middle of video format wars? I often need to edit video for personal or professional reasons. I'll spare you a lot of the technical issues, partly because I don't fully understand them, but for years I have suffered from having video in, say, mp4 format, and wanting to display it using, say, Microsoft Powerpoint. I needed to convert from one video format to another. I spent a lot of time shuttling between Quicktime software and VLC Media Player. RealPlayer proved useful, but came with a lot of overhead - additional software that I didn't want nor fully trust. Along comes Freemake, a free software program that provides a very user-friendly interface for editing and converting video.


Seven Steps to Survive

March 6, 2006 (en français)

Seven steps to survive a high stakes situation, such as a serious medical diagnosis:

1. Face the facts – Everyone has a fight, flight or freeze reaction when confronted with danger. You need a lot of courage to harness your emotions and face the threat directly, and realistically. In the past, you may have denied there was a problem, delayed taking action, fled the scene. No more. The first step is to name the type of situation you’re in, recognizing what’s at stake and how much time you have.

2. Take charge (own it) – Your life or livelihood is at stake. Your health or wealth is at risk. Wouldn’t it be great if you didn’t have to worry? If your doctor/spouse/boss/friend could protect you and defend you and make everything turn out right? Think about it for a second though. It’s your life that is on the line. Who owns your life? You do. Take responsibility for your response to whatever situation you face, no matter how much you may need and deserve a miracle out of thin air. Previously, you indulged in wishful thinking about someone else solving the problem for you. Now, you declare yourself your own guardian angel, white knight in shining armor, and miracle maker.

3. Stop the train – Your first job as officer in charge of your situation is to call time out. In a high-stakes situation, other people tend to start moving. Their motion usually leads towards their goals, which may not be yours. Previously, you went along. Now, you’ll stop the momentum and reassess.

4. Pick your team – You can take charge, but that’s not to say you must deal with a high stakes situation alone. Find help. But notice that finding help is different from waiting for help to find you. The kind of help that finds you may not be what you need. Before, you were grateful for whoever showed up – now you will figure out who is best suited to help you, and go get them on board.

5. Use your resources and do your homework – We all have different resources. Some have a lot at their fingertips, others face barriers. Barriers are unfair and dangerous. If you’re poor, or marginalized, or the victim of discrimination, you face additional burdens. Anyone, though, can make the most of what they have. You need to take stock of your resources, and then use them. All of them. If you’re among the poor, downtrodden, and forgotten, you will need to use some of your resources simply to overcome barriers that others don’t even face. Again, this is unfair. Before, you might have given up, or engaged in self-pity about your plight. Now, you make a list of resources, and a plan for using them effectively to do your homework. Doing your homework means figuring out what the world has to teach you about your high stakes situation. Usually, you will learn that you have some choices to make.

6. Decide and conquer – As the leader in charge of your high stakes situation, you will respond. Your response will usually involve choosing between different alternatives. You can’t control the future, but you can play the odds. You know the difference between a good bet and a bad bet, and how to make smart bets.

7. Follow through – now you’ve got the train rolling on your tracks. Trains do get derailed and you’d better not come unglued. Back to step 1 if the train gets off track. You face the facts, take charge, stop the train, pick your team, use your resources/do your homework, divide and conquer, and follow through.