The Digital Doctor by Robert Wachter

The Digital Doctor -Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age

In The Digital Doctor Robert Wachter reviews the successes and disappointments of recent investments in information technology in healthcare in the US.  More recently this  included a €30bn incentive program between 2010 and 2014.  His focus is very much on IT in hospitals and the implementation of Electronic Health Records (‘EHR’).  He compares what people are trying to achieve and what they are actually achieving.

The book provides  excellent background reading

for any clinician or administrator currently involved in planning for an EHR implementation or in building a clinical/ business case for the same.  From the start Wachter distinguishes between the technical and the adaptive challenges,  He argues convincingly that the adaptive changes offer by far the greater challenges and the greater rewards.

Pro Technology Investment

The Digital Doctor should not in anyway be seen as being anti investment in technology in healthcare.  In fact Wachter is clear on the requirements for the investments in EHR and the tangible benefits.  However he shares with the reader some of the mistakes or misapprehensions of previous EHR implementation sponsors.  He would prefer that previous errors are not repeated.  And in the later part of the book the author draws a clear picture of hospitals operating in a highly technology dependent environment.  In this hee also makes the point that all of the constituent elements are already available.

Practical examples and commentary

The book is full of practical and relevant commentary and analysis.  He references patients concerns at doctors focusing on computers rather than patients.  He has a number of suggestions on this.  He references rapid advances in IT in Radiology – but the growing isolation of Radiology from other parts of the hospital.  Again he has a number of suggestions.  On the EHR itself part of the issue relates to trying to serve too many masters. The EHR is important to the clinicians, the insurers, the patients and, sometimes, the lawyers.  As a result having struggled to consolidate/ aggregate the data it may be ‘watered down’.  Lots of discussion also included on ePrescribing and alerts.  His comparison of management of alerts in aircrafts and hospitals provides food for thought.

Relevant to all involved in EHR

We know that to get EHR right we need clinical leadership and sponsorship.  As a CIO and CFO I found the clinical perspective in the book thoughtful and informative.  Would recommend to clinicians, IT and admin/ finance personnel involved in upcoming EHR projects.




Death of Cancer – Vincent C deVita – Review

Did not finish ‘Death of Cancer’  thinking we have arrived – if the death of cancer is arrival. But a fascinating insight for the layman into the work and times of a leading oncologist over the last 40 years.

Would not be qualified to comment on his explanation of cancer and the various patterns of development – but all seemed logical, if somewhat frightening.

Great feel for the journey of a somewhat frustrated cancer killer – one who feels that FDA regulation has unnecessarily delayed treatment of many patients.

Story is personal – in dealing with a number of family and close personal friends and their cancer battles. Indeed his own story features in the end of the book.

I think the overall message is very positive – with the reservation that cancers continue to mutate and that many times patients may struggle to get the best treatment: because doctors may be over conservative, may not have the skills/ resources available to them or the latest potential solutions may be tied up in FDA type regulation.

But a good read and reasonably informative.

Senator David Norris, The Ormond Hotel and James Joyce

Just had the good fortune to hear Senator David Norris interviewed on the lunch times news (RTE) on the subject of Dublin City Council’s decision to turn down an application to build a new hotel (6 floors) on the site of the Ormond Hotel.

Senator Norris was in top form and brought Ulysses to life for all those listening in.  He explained how Joyce used language to capture music – the first page and a half of this section of Ulysses being a passage to describe an orchestra warming up.  He gave a great account of the Sirens Bar and the temptresses and the weak men.  He even sang a song for us (the first few bars of M’Appari).

Senator Norris is of the view that the Ormond Hotel should be developed as a hotel – but in keeping with the hotel of Joycean times.  He was funny in commenting on football club owners having lots of money and also mentioned his preference that the developer would not be a Russian oligarch.

What an excellent news item.  Hope , like Senator Norris, that a commercially acceptable, Joyce sensitive, way can be found to restore the hotel and bring to life the atmosphere enjoyed by Joyce, his father and various others – including he sirens’ bar.







The Pillars of the Earth by Ken Follett

Pillars of the Earth

Just finished listening to Ken Follett’s tome, The Pillars of the Earth.  40 hours of listening via  But have to say that it did not seem that long.  Thoroughly enjoyed Follett’s magnum opus.  It’s a long time since I read any historical novels.  The first  time I remember reading historical novels was Walter Macken’s trilogy – I think I read them 40 years ago.

Follett has reintroduced me to the 12th Century – in England.  Pillars of the Earth features interaction between royalty, church, landlords and peasants.  Mainly we read of god fearing people – although a number are more than willing to do horrendous deeds, so long as they have some expectation of forgiveness from some official of the church.  The author has awakened in me an interest in this period of history – by bringing alive the challenges of life then and the roles played by different people in society, be they monks, bishops, knights, landlords, labourers or kings.

Rather than try to summarise the plot myself I would refer the reader to the summary in Wikipedia.[schema type=”book” url=”” name=”The Pillars of the Earth” description=”Historical novel set in 12th Century in England” author=”Ken Follett” publisher=”Macmillan” edition=”First” isbn=”0-333-51983-3″ ebook=”yes” paperback=”yes” hardcover=”yes” ] .

Interesting to look back 900 years and see the intrigue between kings, landlords and church.  Each needed each other – and switched alliances as the opportunities/ threats arose.  Not that dissimilar to what we see taking place today, in terms of international alliances. However now the important relations are probably between states and between powerful multinationals and states – with lesser roles played by the church.  In the case of royalty their importance/ influence varies widely e.g. all powerful in the Middle East, less so in Europe.

Some of the brutality described in Follett’s novel is awful – the attacks on Knightsbridge, treatment of tenants unable to pay rents, various rapes.  But on reflection this does not seem any worse than what we recently witnessed in, say, the former Yugoslavia.  And in the 12th Century they did not have the potential for mass destruction which we have seen realised over the last hundred years.

Not sure that I am quite ready for another tome from Follett just yet.  In the immediate future will probably spend some time learning more about 12th Century Ireland and England.  But in due course am looking forward to reading his sequel.  Would strongly recommend Pillars of the Earth to anyone, whether with a passing interest in this period of history or looking for a good novel.

Of mice and men – John Steinbeck

Finally got to this book – listened to it,via, over the last few days as I resumed my walking schedule.

This story took me back to my boyhood memories of all those westerns – with ranch hands living in bunkhouses.  In this case George and Lenny arrive at the ranch looking for work. Lenny is in the care of George.  Lennie is a giant of a man but would be classified as special needs.

The book deals with a number of subjects: the ranch owner’s son (Curley), who has notions about himself, and his new wife who is ‘giving the eye’ to anyone looking.  There is one African American – he is not allowed to sleep in the same bunkhouse.  And we have various other characters – Candy (the ranch hand at the end of his career) and Slim, the strong silent type who seems to command everyone’s respect.

George has spent several years looking out for Lennie.  Lennie is apt to fall into traps set for him – which tend to result in his getting into trouble because of his sheer size and strength.  The story centres on George’s attempt to safeguard Lennie in this environment.

I did not think this was one of Steinbeck’s better efforts.  I thought the plot was too predicable and lacked for any real sense of tension.  I thought the character developed was quite limited.






Way back when – The Burgess Boys by Elizabeth Strout

Just finished listening to ‘The Burgess Boys’.  Excellent story of two brother and their sister – I guess calling the book ‘the Burgess brothers and their sister’ was too much hard work.

The book is set in New York and Maine and concerns two brothers living in New York and their sister living in Maine.  The brothers are both lawyers – Jim (the elder)  a successful corporate lawyer, Bob, the other operating at the other end of the scale.  And their sister, Susan (Bob’s twin)  lives with her son Zach in a small town, Shirley Falls,  in Maine, where they all grew up.

Zach gets in trouble and his uncles ‘ride into town’ to sort out the problems.  Well, first Bob arrives and then Jim, as the reinforcement.  In fact Jim seeks to control the process and directs the actions to be taken by both Bob and Susan.

From early on it is apparent that we are going to learn about the siblings background, their early childhoods, their family upbringing, their rivalries and something that happened when they were quite young.  We also see their adult lives, their failed or challenged marriages and how they have managed or struggled to stay in touch as their careers, relocation and their new family lives have separated them.

We have some excellent insights into Jim’s life – married to Helen (who is independently wealthy), a very successful lawyer with many of the trappings of success, but struggling with some of the compromise and required socialising with other partners in the law firm.  The golf trip is nicely juxtapositioned with the breaking crisis for Zach and his mother.  We also see how Jim struggles to readjust when reimmersed in Shirley Falls,.

On the face of it Jim and Helen have an excellent relationship – but there are elements of ‘Gatsby’ about some parts of  their lives.  There appears to be a level of boredom, lack of direction or meaning.  Some of this comes across clearly in descriptions of Helen’s activities – one of the ‘ladies who do lunch’ in New York.

We also see how Bob struggles and we meet his ex-wife and some other friends.  We learn more about Bob in seeing how he inter relates with Jim and Helen, his neighbours, his sister and various other characters.  During the course of the Zach issue Bob meets up with some old friends in Shirley  Falls and generally rebuilds his relationship with his sister.  His relationship with Jim – as the younger, less successful brother, develops as Jim’s world unfolds.

Susan is the mother who is struggling to bring up Zach on her own – and experiences real self-doubt/ guilt when Zach gets in trouble.  She is less worldly-wise – at least on first meeting her – than her brothers and is inclined to imagine the worst and be panicked into action.

The interaction between the two brothers and their sister is intriguing and well-developed throughout the novel by Strout..  And there are a number of surprises for the reader which will hold your attention.  I found the book fascinating as an examination of relationships between siblings – Zach’s issues just provide an opportunity and a reason for more focused interaction between the three of them in later adult life.  In some respects it reminds of situations we all find ourselves in when travelling to a funeral and spending longer together than planned.

As someone with a number of siblings I found the book interesting in that it stimulated some thinking/ reflection re sibling relationships – and how they may develop or be constrained in adult life, as additional people e.g. spouses, become involved in our lives, as people relocate, as careers develop differently, as children arrive.  But Elizabeth Strout, the author, reminds us clearly of the importance of those initial relationships based on childhood and how these can survive many of the challenges over the years.  The underlying message is blood relationships are critical and should last the test of time.

I would have little hesitation in recommending the book to friends.  Good character development and interaction and plenty of material on which to reflect.


Review of @AJKeen #digital vertigo

One of the very few books I have reread.

Andrew Keen’s book is a brilliant critique of social networking as we know it.

Keen did his research – be that it looking back to ancient philosophers, the history of computing, social change in the US and globally – and has managed to explain much of what has happened.

The book is interesting in that he builds it (1) around his interactions at a conference in Oxford, with a number of the  ‘leading lights’ of social networking and (2) the characters of Alfred Hitchcock’s movie, ‘Vertigo’.  He  quotes widely from those who promote the benefits of  social networking and those, like himself, who doubt its real value.

He does not mince his words (P118) – ‘you see, social media has been so ubiquitous, so much the connective tissue of society that we’ve all become like Scottie Ferguson, victims of a creepy story that we neither understand nor control…It’s a postindustrial truth of increasingly weak community and a rampant individualism of super-nodes and super-connectors’.

The references alone could tie you up for weeks.  But I believe he has done all of us a service in highlighting what’s wrong with much of what is being put over as good for society.  Well worth taking the time to read.

Listening rather than reading affords me the opportunity to read lots.

Over the last 18 months or so I have become an avid user of  This has been a great experience – I am back enjoying stories which stretch the imagination, bring me somewhere else, stimulate ideas, provide an escape.  Over the previous several years had found that books were simply piling up – work and family life resulted in efforts to read books when sleep was the order of the day.  I’d pick up a book at 9 or 9.30 in the evening and five minutes later fall asleep.

And, always there was the distraction of this online world – hyperlinking from link to link and not resting in one spot for the time it would take to enjoy a good book.

As a management consultant I continue to read lots of business books – be the subject strategy, lean manufacturing, cloud computing, leadership, whatever. For the most part I read these in hard copy – and potentially 20% online.   But I have reserved my listening time (audible time) for literature.

When growing up we were strongly encouraged to read.  The expectation was that the two books borrowed from the library would be read by the time they were returned a fortnight later.  And many fortnights of this meant that many books were read – notwithstanding other distractions such as football, cricket, Hawaii-Five-O (the real one!).  So getting back to book consumption feels familiar – even if this time I am listening more than reading.

The other main benefit of audible has been that it has supported and, indeed, encouraged me to take more exercise.  A walk in the evening for 60 minutes listening to a good novel is a great way to relax and get/stay fit.

I have not read any analysis yet on the relative merits of listening to versus reading books.  Certain books are possibly more suited to one or the other activity.  And some books, when listened to in the first instance, leave me wanting to read them afterwards.  This is the opposite to the movie experience – when most times after I have seen a movie I am not tempted to read the book.

I have a number of history books slated for reading this year – which I intend reading rather than listening to via audible.  In general I find myself looking to cross reference, to look at maps, etc., when reading history and this just seems to be easier when reading rather than listening.  But the challenge remains to find time when sleep does not beckon.

One other possible down side – walking time previously spend listening to music has now been presold to books.  Still working on a way to stretch the day to more than 24 hours.







Fathers and Sons – Turgenev

English: Russian writer Ivan Turgenev late in ...
English: Russian writer Ivan Turgenev late in his life (Photo credit: Wikipedia)

Saw a reference to ‘Fathers and Sons‘ on facebook a few weeks ago.  Just finished listening to Turgenev‘s Classic this week.  What a wonderful book.

Strikes me that the novelists of bygone days could say so much without saying very much.    We often speak of ‘reading between the lines’ in a modern context – but far too often there is no subtlety in much of what is written.

The account of the two friends, Arkady and Bazarov, of their relationships with their own fathers and of their individual romances (one successful, one failed) makes for a great book.  Arkady seems to be in awe of his friend Bazarov (the nihilist) and yet, when Bazarov oversteps the mark, we see Arkady’s great respect for his father.  We even have the subplot of Arkady’s father (a widower), his new love (Fenichka) and the interference by his father’s brother (Pavel).  The ‘pistols at dawn’ is almost comical.

The backdrop to the novel is mid 19th Century Russia and ‘peasants’ beginning to asset their rights – posing lots of challenges for the landed gentry.  Bazarov, the nihilist, seems equally critical of all social forms.  Nikolai Petrovich, Arkady’s father, is wrestling with the changes on a day to day basis.

Fate in unkind to Bazarov.  His mother worships the ground upon which he walks, his father not much less.  His friendship with Anna Sergeevna Odintsova reamins just that – although he would have it differently.  He removes homself from the company of Arkady’s family – as a logical consequence of his falling out with Pavel.  And finally he succumbs to illness – really not through his own fault.

All in all well worth a read (or a listen).  Turgenev’s characters come alive – through their interactions and their struggles with their emotions.




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High Output Management – Andrew S. Grove

One of the best business books I’ve read in a long time.  Short book, common sense and to the point.  Written by Andrew Grove former CEO of Intel.

I would challenge anyone to review their own workplace, their own work practices using some of Grove’s ideas.

Liked the simple idea on the manager’s preparation for decision making:

  1. What decision needs to be made?

    English: Portrait of Andrew Grove.
    English: Portrait of Andrew Grove. (Photo credit: Wikipedia)
  2. When does it have to be made?
  3. Who will decide?
  4. Who will need to be consulted prior to making the decision?
  5. Who will ratify or veto the dcision
  6. Who will need to be informed of the decision?
Pity it does not happen more often.
On meetings I think he is right: two types.  Are we talking of a process oriented meeting (one-on-one, staff meetings, operations reviews) or a mission-oriented meeting?
The discussion of hybrid organisations and dual reporting is straightforward and recognises the reality of how many businesses need to be structured.
Liked the honesty of his section on performance appraisal. And his clarity on the importance of this process, the need for preparation and the rationale for the process in the first instance.
Not sure I fully agreed with him on his views on trying to retain people who say they are going to leave.
Finally – he is very clear on the manager’s role and responsibility for training – including preparation and delivery of training. I would see this as a major failing with many managers in industry.  And a major missed opportunity.



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