"...better is possible. It does not take genius. It takes diligence. It takes moral clarity. It takes ingenuity. And above all, it takes a willingness to try."

This line from Atul Gawande's "Better" sums up the book - "a surgeon's notes on performance". It is an amazing book. To be honest, I felt a little bored while reading the first three chapters which are about how doctors in three different, yet trying circumstances overcome difficulties to succeed. But that only served as a backdrop to make the point Gawande was trying to emphasize - better is possible.

In the medical field, as in any other profession, you have people who go about their job as a matter of routine. Like an everyday chore. They do not have any real passion for their job. And then you have what Gawande calls the "positive deviants", the people who raise the bar, the people who dream about their job in their sleep, those who constantly improve not only their own abilities but also the system.

Medicine is full of such examples. These are the people due to which we have innovations. The human body is terribly complex. To innovate in treating such a complicated system has its pitfalls. The risks are great. Yet, we find individuals who have the willingness to try and the ingenuity to back this determination. Fortune, as they say, favors the brave.

Very often, in our jobs, it is easy to 'fit in'. You have set processes. You have established procedures. It is easy for us to follow them. In doing that, however, we lose out on improvising. We lose out on finding new and better systems. Most of us go about our lives in this manner. It is important to come out of our comfort zones, to take risks and try to be better. It is the "positive deviants" that make an impact on the world around us. It is these people who actually change the world.

In the medical profession, more than any other profession, this is so important. The impact of such endeavors is much more because it is human suffering that is being addressed. The effect is much more fundamental to our existence. It is more basic than developing a nice-to-have gadget, for example.

People in the medical profession should definitely read this book. Others will also take away a lot from it.

... http://www.kamaldshah.com/2010/10/better-is-possible.html

"I asked for 1,25 dihydroxy cholecalciferol. The invoice also says that. The report you gave me, however is for 25 hydroxy cholecalciferol."

"Hmmmm. Ok. Let me check."

(Calls someone.)

"Madam. There's a patient here. He says he asked for 1,25 dihydroxy cholecalciferol but we gave him the report for 25 hydroxy cholecalciferol. They are the same? Ok. I will let him know."

"No, no, one second, let me speak to her."

(hands over the phone to me)

"They are not the same ma'am. 1,25 dihydroxy cholecalciferol is the active form of Vitamin D3 while 25 hydroxy cholecalciferol is the inactive form. I want the level of the active form, not the inactive form."

"Hmmmm. But the bill said Vitamin D."

"Ma'am, I asked for 1,25 dihydroxy choilecalciferol and that is what the bill also says"

"Ok sir, please give me an hour and I will call you back"

This is the state of our labs. I paid a huge Rs. 2290 for this test and I wasn't going to accept a mistake someone else made. I asked for the correct test. I actually made the receptionist making the bill show me the monitor and made sure the correct test was chosen because I knew this could happen. And inspite of all this, I get a wrong test report!

For the last time, here is a summary of Vitamin D3:

25 hydroxy cholecalciferol is the inactive form of Vitamin D3. It is not of much use to the body. What the body needs is the active form - 1,25 dihydroxy cholecalciferol. 25 hydroxy cholecalciferol is what we get from our food and sunlight etc. The kidney converts this inactive form to the active form - 1,25 dihydroxy cholecalciferol. This is the form that is useful in our body. This is what absorbs Calcium from our guts into the blood. In people with impaired renal function, obviously, the active form will be less because the inactive form is not being converted into the active form. So, people with kidney disease need to take a supplement of the active form.

... http://www.kamaldshah.com/2010/10/conversation-at-lab.html

I have worked on a large number of projects in my software development career. The team sizes have been between one and about fifty. There is one thing common to most projects. In the beginning, most of them are over engineered.

During the beginning of a project, people are generally very gung-ho about the project. Right from the project manager to the developer to the tester, everyone is very excited to be on the project. So, every minute detail is discussed to death. Discussions are held with every single member on the team whether the database column to store the id of a product should be varchar(32) or char(32).

Towards the end of the project, it is usually about getting the damn id into the database and wondering why the id is not being retrieved at all, never mind the data type!

I had a terrible sense of deja vu recently when at my office we starting discussing a new project. The kind of detail we went into was mind numbing. I couldn't help but shake my head thinking about the futility of it all. A few more days and anyway everything would change. Why bother then?

In new projects, I strongly believe, we should always go about things in a top-down manner. Look at the big picture. What is the problem we are trying to solve? What are the pain points that are being addressed? Then get down to the rest of the stuff.

Often engineering teams spend hours trying to solve problems that the customer couldn't care about. I have seen this all too often. That is where the Project Manager must step in. She must never lose sight of the 'big picture' - what exactly is the problem we are trying to solve? Every decision taken in the project must keep this in mind.

That way, a lot of unnecessary effort and heartburn can be avoided in most projects.

... http://www.kamaldshah.com/2010/10/over-engineering-projects.html

The swine flu vaccine is now available in India. I just got my shot a couple of days back. All people on dialysis should immediately check with their nephrologists and if advised, take their shot.

Even people not on dialysis should check with their primary physicians and get their shots if advised to do so.

And while you're at it, check with your nephrologist/primary physician and take the vaccine for pneumonia too. I took that vaccine too yesterday.

I am sure you have taken your Hepatitis B vaccine already. If you haven't, please do so asap. This is a no-brainer. When there is a vaccine available for such a deadly disease, why take chances?

People on dialysis should definitely get vaccinated against Hepatitis B. In fact, people on dialysis are advised to take a double dose each time for The HBV vaccine. We must also get a yearly check of our HBsAg titers and then take a booster shot if necessary.

... http://www.kamaldshah.com/2010/10/have-you-taken-your-swine-flu-vaccine.html

I subscribe to Google Alerts on Apple stuff using Google Reader. Yesterday, I learnt that Apple has sent out invitations to an event on October 20th that said "Back to the Mac". The invitation had a hidden picture of a lion indicating that Apple might be coming out with a new version of its Operating System.



This is expected to be a major upgrade from the previous version, Snow Leopard which had mainly performance enhancements. People are speculating that Apple might eventually merge their iOS with Mac OS X and this might be the last version of the desktop OS.

Well, with Apple, you can never be sure. The entire world expects something and then Apple comes out with something totally unexpected.

I am going to be keenly awaiting the October 20th announcement. I have been using a Mac for years now and am really excited to see what Apple has in store for us! They have revolutionized the phone and the tablet in the last few months. Let's hope they have something equally great for the desktop now.

... http://www.kamaldshah.com/2010/10/mac-os-x-lion.html