The Takeaways: Week 43 of 2021

A periodic review of articles, newsletters, and podcasts that I found interesting, inspiring, or otherwise worth remembering.

Podcasts

Scott Hanselman (host), Hanselminutes. Finding Your Path to Technology with Krystal Maughan (September 23, 2021)

Newsletters

Ken Norton, Bring the Donuts. Reflecting on a Career in Product Management (October 28, 2021)

Fall in love with problems, not solutions. As a PM, it’s easy to see a problem and snap to a solution. That’s what product management is, after all. But if rather than falling in love with the solution, you learn to love problems, you’ll find a steady stream of opportunities for innovation. Even better, you’ll be open-minded and let the problem guide your solution.

Don’t let gaps form between you and your customers and between you and the builders. I’m wary of trends to segment product management across different subspecialties because they often result in new layers forming between these two crucial constituencies (the “product owner” trend is probably the most egregious example of this). If you let a gap open up between you and the customer or you and the builders, you’re not going to be able to do the job.

Hold the door open behind you. As a white man, I’ve benefited from a lot of privilege. That doesn’t mean things were always easy for me or that I didn’t work hard.... But for every closed door I had to open, I must acknowledge that to someone who didn’t look like me, that same door was not only closed but locked and barred. The future depends on the tech industry becoming more diverse and inclusive. If we’re going to build products for the world, our teams need to look like the world.

Web Smith, 2PM. Class System: The Internet is Reshaping Class (October 22, 2021)

Just 82 years ago, before the G.I. Bill, the mass adoption of the automobile, or the advent of the American suburbs, technology steered us into a new definition of class. It seems to be doing so again. The great divide is between those who can afford a life of remote leisure and on-demand commerce and service. And then there will be the Americans who service this commerce-driven future. The rest of us will be steered in either direction until the last of the Middletons are nowhere to be found.

Articles

Rae Ellen Bichell, KHN. Bill of the Month: How Billing Turns a Routine Birth Into a High-Cost Emergency (October 27, 2021)

Some hospitals provide that package of services via an “obstetrical emergency department.” OB-EDs are licensed under the main Emergency Department and typically see patients who are pregnant, for anything from unexplained bleeding to full-term birth. They bill like an ER, even if they aren’t physically located anywhere near the ER.

Health care staffing company TeamHealth — owned by the investment company Blackstone, and known for marking up ER bills to boost profit — essentially says an OB-ED can be as simple as a rebranded obstetrical triage area. In a white paper, the company said an OB-ED is an “entrepreneurial approach to strengthening hospital finances” because with “little to no structural investment” it allows hospitals to “collect facility charges that are otherwise lost in the obstetrical triage setting.”

The Takeaway: Anything in our health system labeled as an emergency room service likely comes with a big additional charge.

Expectant parents should be aware that OB-EDs are a relatively new feature at some hospitals. Ask whether your hospital has that kind of charge and how it will affect your bill. Ahead of time, ask both the hospital and your insurer how much the birth is expected to cost.

Joseph Delaney, West Coast Stat Views (on Observational Epidemiology and more). Lessons from the Russian Steppe (October 28, 2021)

Delaney's thoughts on "Russian mortality trends for 1991-2001: analysis by cause and region"

It is worth noting that the largest changes occurred among those residents who were old enough to be invested in the system and would need to start over when their whole economy change.

What if other shocks - such as the flight of manufacturing jobs from the United States to Asia and elsewhere - were factors in similar declines in life expectancy?

... I think the main point here is that economic disruption without some form of compensation on the losers of the new rules may have serious impacts including on health.

AnnE Diemer, Stripe Atlas Guides. Recruiting outside of your personal network (no publication date)

The amount of time you devote to recruiting is up to you. At Stripe, we encourage our hiring managers to spend some time every day on recruiting. Some hiring managers prioritize up to two hours a day on building their pipeline, particularly when they are actively hiring. However, even when you aren’t actively hiring, I would recommend taking 20-30 minutes every day to reach out to candidates and build your network. Set this as an event in your calendar and treat it as you would any other priority so that it becomes a habit.

Adrianne Jeffries and Leon Yin, The Markup. Amazon Puts Its Own “Brands” First Above Better-Rated Products (October 14, 2021)

An investigation by The Markup found that Amazon places products from its house brands and products exclusive to the site ahead of those from competitors—even competitors with higher customer ratings and more sales, judging from the volume of reviews.

We found that knowing only whether a product was an Amazon brand or exclusive could predict in seven out of every 10 cases whether Amazon would place it first in search results. These listings are not visibly marked as “sponsored” and they are part of a grid that Amazon identifies as “search results” in the site’s source code.

Dan Luu. We only hire the trendiest (March 2016)

Considering how much money companies spend on hiring and retaining "the best", you'd expect them to spend at least a (non-zero) fraction on training. It's also quite strange that companies don't focus more or training and mentorship when trying to recruit. Specific things I've learned in specific roles have been tremendously valuable to me, but it's almost always either been a happy accident, or something I went out of my way to do. Most companies don't focus on this stuff. Sure, recruiters will tell you that "you'll learn so much more here than at Google, which will make you more valuable", implying that it's worth the $150k/yr pay cut, but if you ask them what, specifically, they do to make a better learning environment than Google, they never have a good answer.

Courtney R. Lyles, Robert M. Wachter, and Urmimala Sarkar, JAMA Network. Focusing on Digital Health Equity (October 22, 2021)

Moreover, many digital health tools are developed with homogeneous, highly educated, and advantaged populations in mind. For example, despite the ability to leverage technology to design apps in multiple languages or with audiovisual features to support both personalization and accessibility, most available digital health tools are available in English only and are written at high reading levels (eg, greater than 12th-grade readability). Universal design approaches — defined by the Center for Universal Design at North Carolina State University as “the design of products and environments to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design” — could create better and more effective digital platforms, and these must be core principles for new technology development.

Casey Ross, STAT. The stirrings of revolt: Hospitals nationwide are sidestepping health record giants to better harness patient data (October 25, 2021)

Underlying much of their discontent is a continued lack of technical compatibility between, and even within, electronic health record products. Because each individual piece of software is unique — and formats data differently — hospitals often must spend countless hours and dollars finding and normalizing data, and validating novel apps they hope can improve care, cut costs, or streamline their work. Health data experts said the lack of compatibility means it’s often far cheaper and easier for health systems to default to tools made or promoted by the EHR vendors, allowing them to preserve their market dominance and box out rivals.

Darius Tahir, POLITICO Future Pulse. What the Facebook papers say about sourcing health information (October 27, 2021)

The trove of documents collected by Facebook whistleblower Frances Haugen shows the extent to which the pendulum has swung away from physicians — and how the social media giant has become a hub of medical advice that frequently drowns out public health experts.

Bernard J. Wolfson, KHN. Direct Primary Care, With a Touch of Robin Hood (October 26, 2021)

The annual fees that St. Luke’s collects from Foster’s family and some 550 other paying patients help cover free care for a somewhat larger number of uninsured patients, many of them, like Tiznado, Spanish-speaking immigrants who can’t get Medicaid because they lack documents.

The clinic does not accept insurance of any kind but requires its paying patients to have coverage for major medical expenses outside its scope of care.

The paying patients, whom St. Luke’s calls “benefactors,” say they are happy to participate in this “Robin Hood” model. It gives them highly personalized care with great access to their doctors and the emotional satisfaction of supporting those less privileged, the “recipients.”