Posts Tagged ‘mileage’

Metric ambivalence and slices of Canadian life

June 5, 2017

Out here where it’s too north for wheat,

People use both meters and feet

The confusion rebounds

Between kilos and pounds

But can Celsius make Fahrenheit delete?

Synopsis: I’m a Family Practitioner from Sioux City, Iowa. In 2010 I danced back from the brink of burnout, and honoring a 1 year non-compete clause, traveled and worked in out-of-the-way places in Alaska, Nebraska, Iowa, and New Zealand. After three years working with a Community Health Center, I went back to traveling and adventures in temporary positions. Assignments in Alaska, rural Iowa, suburban Pennsylvania and western Nebraska have followed.  I finished my most recent assignment in Clarinda on May 18.  Right now I’m in northern British Columbia, getting a first-hand look at the Canadian system. Any identifiable patient information has been included with permission.

Canada officially uses the metric system, but, unlike New Zealand, they have a lot of ambivalence. Today, at the grocery store (the town has a very good one) we bought things by the ounce, pound, gram, kilo, fluid ounce, quart, milliliter, cc and liter. Carpenters use 2×4’s, plywood comes in 6’x8’sheets.  Most everyone uses Celsius to talk about the weather (even I know my favorite metric temp is 18), but when I ask about fever, half the people answer in Fahrenheit.  One patient described an involuntary loss in pounds, but all the clinic scales weigh in kilograms.  Almost no one knows their height in meters, but they do know their height in feet and inches.   People talk about their cars’ mileage in kilometers per liter, but don’t recognize the linguistic dissonance until I point it out.

At one point this last week I sat with the patient while waiting for a staffer to bring some documentation. The patient told me about an American TV game show, where contestants were asked how safe they feel in their homes, and some didn’t feel safe at all.  The patient asked, “Are things really that bad in the US?  Are people really that fearful?”  I said that it all depends on the place.  I had just finished 14 weeks in a small town in Iowa where people leave their houses and cars unlocked despite the presence of a prison in the town.  On the other hand the big cities have their high crime zones.  “How safe do you feel,” I asked, “In Vancouver?”

Gasoline runs a little over a dollar a liter here, which comes to $3.17 per gallon at current exchange rate. Quite inexpensive compared to New Zealand, and very reasonable considering the distance it must be trucked to get here.  The country has no posted speed limit higher than 100 kilometers per hour (about 62.3 MPH).  Because I take speed limits seriously, as I have no wish to get another international speeding ticket (I had one in New Zealand), I get great mileage in the small Korean car I rented.  But I get passed a lot.

Cigarettes here run $12/pack, a little less than twice the price in Iowa. The national rate of smoking in the US dropped to 16% two years ago, in Canada it’s now 15%.  Still, more than half of last week’s patients smoke.

A surprisingly large majority consumes no alcohol, and almost no one uses marijuana. At least, that’s what they tell me.  And I believe them.

 

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Efficiency as the enemy of flexibility: a drawer’s maximum utility comes at 2/3rds full.

November 28, 2012

Time will flee by the slice

A slower pace would be nice.

All work and you’re dull,

If your day is too full

Efficiency comes at a price.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  In May 2010, I left my position of 23 years, and honoring my non-compete clause, traveled for a year doing locum tenens work.  In June of 2011 I joined up with the Community Health Center, which provides care for the underserved.  I’m now working part-time, which, for a doctor, means 48 hours a week.

The throes of student poverty kept me from owning a motor vehicle till I was 29, and I learned a lot about bicycles.  Efficiency rose with tire pressure as rolling resistance fell, but the efficiency came at a cost.  The extra hard tires did poorly on rough roads, skidded dangerously in the wet, could not be ridden at all on dirt, and punctured with the shortest of thorns.

My first vehicle, a Karmann Ghia, sported a Volkswagen engine, known for accessibility.  I soon found I could tune and tinker and get exceptional mileage, but I could only maintain 32 miles per gallon in ideal conditions.  Head winds or tire pressure loss from a drop in ambient temperature would shave 5 to 8 miles off of a gallon of gas; carrying a passenger made things worse.  And if the car sat for a week between trips, evaporation of gas from the tank dropped the road efficiency noticeably. 

Any system that gains efficiency loses flexibility; a drawer’s maximum utility comes at two-thirds full.

Our health care system stands as a paragon of inefficiency but it does well for flexibility.  Most years, our hospitals meet influenza’s challenge head on.  We have enough overbuilt infrastructure to handle a 30% rise in hospital cases.   

In the dark days when I worked 84 hours a week, I did so with tremendous efficiency.  I knew as soon as my foot hit the floor in the morning where my steps would take me till I dropped into bed that night.  Yet I paid a terrible emotional cost for the tiniest of delays, and I always ended up running behind before the last patient finished.

At that time I learned great efficiency in making rounds on hospital patients, but my system doesn’t tolerate glitches well. 

I need an early start.  On first arising, people don’t talk much, but by 10:00 AM the urge to speak has come to full flower.  It doesn’t spare doctors in general, nor nurses, nor this doctor in specific.

I used to joke about MYF, Morning Yack Factor, a hormone that drives people to verbosity.  Others have asserted it has more to do with caffeine finally reaching a threshold level.  Yet I don’t use the stuff and I still lapse into eloquent excess at midmorning.  I do my best to avoid physician conversations between 9:30 and lunch if I don’t have a morning running on leisure.

If our government in Washington doesn’t hold the world’s record for inefficiency, it should.  Note that we were able to wage not one but two wars without noticeably increasing the personnel in the capital. 

If the Affordable Health Care Act brings efficiency, our system will lose flexibility

Life comes down to a series of tradeoffs.

But realistically, I’ve never seen government regulation increase the efficiency of anything.

 

An exercise in Kiwi calculations

April 6, 2011

Attack these problems with vigor

It’s something you surely can figure

   Do you know which is smaller

   When it comes to a dollar?

And is a quart or a liter the bigger?

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical to avoid burnout, while my non-compete clause ticks away I’m having adventures, visiting family and friends, and working in out-of-the-way places.  Just back from a six-week assignment in Barrow, Alaska, the northernmost point in the United States, right now I’m working on the North Island of New Zealand.

KIWI QUIZ

Steve and Bethany drive their rented Toyota Corolla 571 kilometers on 42 liters of petrol (gasoline) which sells for $2.18 NZ per liter. 

1:  Express their mileage in kilometers per liter.

2:  What would you multiply the answer to # 1 by to get miles per gallon?

3:  If the New Zealand dollar is worth $.75 US, how much does gasoline cost them per gallon?

4:  Why does a country so metric still use inch as a verb? 

5:  Why do they talk about their fuel economy as mileage?

6:  Why do they sell their marijuana by the ounce?

7:  Why are cooking measures still in cups and teaspoons?

Steve and Bethany go out for breakfast.  They have eggs, hash browns, and toast for $8.50 NZ each. 

8:  Assuming an exchange rate of $.75 US per $1.00 NZ, what would that breakfast have cost them at home?

9.  How much would that breakfast have cost them in Sioux City, where wait staff expects a 15% percent  gratuity and the government expects 7% tax?

10:  Steve’s 41 kilometer commute takes him 40 minutes.  What is his average speed in miles per hour?

11:  How fast does Steve really want to drive?

12.  Assuming Steve works at Wellsford four days a week for six weeks, how much time is he not getting paid for?

The New Zealand dollar compared to the American dollar varies. 

13:  If the exchange rate changes from $.70 to $.80, how much will Steve gain when he returns to the US?  How much more will expenses cost him in US dollars while he’s there?

Answers:

1:  13.6

2:  2.5

3:  $6.67

4:  Because there is no such thing as a centimeter worm.

5:  Because kilometerage has too many syllables, especially with the accent on the third syllable.

6:  There’s a reason they call it dope.

7:  The cooking is great.  If you put the recipes into metric they’re not going to work out.  Don’t rock the boat.

8:  $12.75.

9:   $15.55

10:  33 mph.

11:  4 mph, the same as a brisk walk.

12:  33 hours.                                                                                                

13:   Heaps.

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Why is a tire pressure gauge like a time sheet?

December 13, 2010

Take this from the wisdom’s true fount

Or you’ll never know the amount

     Of things saved or spent

     Or where the time went

Unless you keep true account.

The day started with dropping my car at the garage.  When my gas mileage plummeted I checked my tires and found a slow leak in the right front, which I couldn’t have done without a pressure gauge.  As I walked away from the service station in the clear sunshine and bitter cold, I reflected on the damage done by estimation in the absence of accounting. 

A vague answer to a specific question means either “I don’t know,” or “I don’t want to tell you.”  Navajo has a specific word, hola, which means exactly that.  In English, we just prevaricate.

When I ask patients, “How much does your smoking cost?” frequently the answer comes back, “I know.” But when I press, I find out that they haven’t done the arithmetic. 

With alcohol, my query starts “When was your last drink?” and goes on to “How many did you have at that time?  Is that typical for you?  When was the last time you had more than five in a night?”  The vaguer the answer, the more I worry that the person really doesn’t know and doesn’t want to know.  I never ask “How much do you drink?” because the only accurate answers come from people who don’t have a problem.

The same thing happens with eating.  The greater the overweight, the less well the person knows when they’re hungry or keeps track of how much they eat.

When I worked in private practice, I did a lousy job of keeping count of my hours.  When, in Barrow, I filled out a time sheet to the tune of 63 hours in a week with a lot of leisure, I realized I hadn’t been working 56 hours a week but usually 80.  I hadn’t counted the calls at home, the time spent in medical records, the after work documentation, or the time spent doing Continuing Medical Education (CME).  Nor had I amortized the hours spent on weekend call over the course of the month. 

Though most docs receive good pay for their services, we perform many professional duties for no reimbursement.  A fifteen minute patient visit generates five minutes of dictation; one visit in two results in lab work for review; one visit in six demands a call to another doctor.  Time spent reviewing refill requests or lab data generates no income.  We don’t get paid for phone calls to worried patients.

The corporate parent of Care Initiatives Hospice asked me to start filling in a time sheet.  Why should it matter, I asked, if I’m paid straight salary?

I started keeping track of my hours.  I was surprised at how fast twelve phone calls, five minutes each, add up to another hour.

Estimation never compares to keeping count.  If we don’t have a gauge, we won’t know about our leaks.