“Don’t let your work self, be your best self.” Is a turn of phrase my boss said to me one time. He was describing his own father’s total inability to be present at home while over achieving at work. That really stuck with me. And is a mantra I repeat to myself quite often.
The struggle is real. Therapy helps. Meds might be worth checking out too as this sounds like ADHD.
I worked in health care tech for about 5 years. AI driven before it was cool. Took processes that normally took years down to a couple hours. Cutting edge stuff.
What struck me over the years was the open hostility we faced from the staff. The admins would buy our product, then have us come do trainings. The clinicians seemed to resent every second of it and would just never use the tool.
Towards the end of my tenure there, a PM said to me “the last thing these people want is to have to learn yet another workflow”. Which is when the penny dropped for me that our tool was just one of a bazillion being force fed to these poor people. They want to spend their time with patients not a screen.
Despite it being the most mission driven I have ever felt about a product (we were literally trying to help cure cancer lol). I’ll never work in health care again. Like education, it’s a quagmire.
> Towards the end of my tenure there, a PM said to me “the last thing these people want is to have to learn yet another workflow”.
I suspect that people entering medicine do so to address human needs, and have very little interest in dealing with technology (or handling traditional paperwork for that matter). Couple that with a perception that pretty much anything digital being obsolete before it reaches market, and even more so when it can take upwards of a decade for the product to reach them, and you are left with a group of people who have nothing but dread about being stuck on a never ending treadmill that is outside their scope of interest and expertise.
Take that opinion with a grain of salt though. My background is in that other quagmire: education. I have seen some amazing tools developed over the years that were abandoned, so everyone had to move on. Worse yet, no replacement was created for most of those tools so everyone is back where they were before the revolution happened. (I'm thinking specifically of software used by teachers and administrative staff, but something similar can be said for software used to deliver the curriculum.)
University of Toronto used to basically run on a homegrown curriculum management system called CCNet up until ~2006. Basically run by one professor on a CPU under their desk. Course notes, grades, that kinda thing.
I guess for future-proofing, the university moved to Blackboard. For a while, some courses were on Blackboard, others on CCNet.
We had a professor poll the class and ask which they preferred, and all 240 of us in unison said "CCNET!"
I still remember a quiz on Blackboard where the answer was something like "2" and it responded, sorry, the correct answer is 1.9999999999.
I have been looking for the term to describe this kind of enterprise software. It has glossy dashboards that are sold to VPs with the flash, "Monitor the entire company from one screen!" The actual rank and file users hate the product because little attention is ever given to the day-to-day workflows. Things barely work, super convoluted, etc.
An accountant friend was just migrated to Workday(?) for their backend. Apparently whatever labyrinth configuration they have can only export 12,000 rows at a time. The official workaround they were given was to run reports in one week batches when a month of data is required. Previous solution could seemingly export unlimited amounts of data and time windows. A complete technical failure for which everyone should be ashamed.
We have the Internet, which was supposed to fix things. Why can't we talk to the developers at workday and make that export issue an issue? How would we force it such that the renewal contract doesn't get signed unless it gets fixed?
I am not invested in this particular issue, but the recurring root cause: the organization is completely disconnected from actual users. No accountant would think 12k rows for a corporate level system was acceptable. How do you handle monthly, quarterly, annual reporting? A single POS terminal at Target could process 12 thousands transactions in a month.
Yet, the entire Workday chain of developers, PMs, management - all slapped their seal of approval on the product and pushed it out the door. Compiles? Good Enough.
> I’ll never work in health care again. Like education, it’s a quagmire.
Remember: there's a lot of "health care" out there. Even if doctors resent EHRs, there's also drug discovery software, telehealth software, embedded software in medical devices, etc!
Maybe that's what they meant: doctors can always switch into "drug discovery software, telehealth software, embedded software in medical devices" and resent those too!
It’s more than that actually. Where is actual interop? It’s been promised literally 10 years ago. It’s not that hard. People in Healthcare IT are just that bad.
The only time I’ve experience interop in healthcare is due to actual organizations merging. That’s it. This entire space is filled with incompetence. Maybe providers will actually use the tools if they work consistently. Food for thought.
It’s also strange to me that every time I go to the doctor I have to sit and fill out forms like I’m a new patient. All my insurance info, again. My entire medical history, again. Consent agreements, again. This experience hasn’t changed in decades, and I don’t understand why.
I’ve asked, why do you need all this again and the answer is usually “oh we have a new system” or “we need to know if anything changed” (but that’s not what the forms ask).
My observation has been that after filling out the form, the office skims it and enters nothing in the computer. I guess that's the "nothing changed" situation.
FHIR was supposed to be the interopt but the end results look more like schemaless blobs of contained fields. But hey, at least I can find all the data related to a patient ID, I guess.
There's actually been significant progress towards interop in the last 10 years. HIEs (Health Information Exchanges) such as CommonWell are steadily improving and covering more patients.
Recently there's been a big push for TEFCA (Trusted Exchange Framework and Common Agreement) as the network-of-networks that federates all the different HIEs. It's been slow, but it's progressing.
As usual, the problem isn't really technological -- it's getting all these different stakeholders, with different business models, etc, to agree on how it should work.
Most of my experience is on the pharmacy side, and tech basically saved pharmacy, from recordkeeping, insurance claims, accounting to inventory.
But it was voluntary (for the organizations, not so much the staff). There was no need for government to shower pharmacies with money to adopt it because it paid for itself.
I'm sure a lot of the staff initially met it with the same hostility. Even in 2010 when I was more in the field, we still had staff where their only computer experience/use was at work and otherwise lived an offline life.
Can't say I saw a pharmacy that didn't have a computer since the early 90s in Canada (and my memory doesn't go before that). And before that, at least they used typewriters. Meanwhile my GP was all-paper well into the 2000s except for some billing stuff. God help anyone that had to read his notes. But sometimes you're reimbursed sufficiently that there is no driver to change workflows even if it would be economic.
In fourteen years at one hospital we have had two completely different EMRs as well as the old electronic record system that didn't have charting but allowed lab lookup, scans of documents, etc. The two older ones are still running in read-only mode because Epic can't look at them, so any records older than 2022 are only in there.
Cardiology, radiology, endoscopy, and labor and delivery all have their own systems for their internal usage while releasing final results to Epic.
I don't object to the idea that these products are made for admins. It's a business and it needs to make money to survive. I object to the idea that making a product for sale to admins precludes making it at least usable for those who actually put in the data.
That resistance to change is just human nature. I work on much lower stakes line of business apps and the new thing can be _objectively_ better in every way and there will still be significant pushback from a large percentage of the userbase.
I work in hospitals and it's just a constant stream from IT of "oh you just figured it out! congratulations! time to change they way you do things! this time we've solved all your problems that you're not complaining about! try to reengineer how to do anything now! lol! we hear you and feel your pain! here read ten pages of drivel that tells you how important and amazing IT is but won't actually tell you how to do anything with the new new tools and lives in some fantasyland that has nothing to do with the work that you actually need to get done!" all while simultaneously making every single computer and workflow somehow slower and more complex. Add another login here... force a quicker logout there... And then admin will come in with "thanks IT! you're doing amazing work! by the way everyone else we expect your productivity and caseload to increase!"
Meanwhile getting things to work is filing tickets followed by "oh gosh that's so complex!" and months of moron pitcrew showing up " to fix it" who can't fix anything and who seem to think it's just that we're dumbasses who can't figure out who to reboot a computer.
Honestly it's difficult to not grow the instant opinion that IT should just shut the fuck up and fire themselves. Who the hell do they even work for?
> Honestly it's difficult to not grow the instant opinion that IT should just shut the fuck up and fire themselves. Who the hell do they even work for?
Management. Management whose goals and incentives don't align with yours. Or IT's.
If management cared about your experience and quality of life, then presumably they'd be riding IT to get shit fixed. They'd be providing staff and resources necessary to resolve the issues. They'd be consulting with the staff using the programs before buying/deploying them. They'd be consulting with IT before buying/deploying them. They're not because they don't care.
They went and bought some EHR system and an expensive support contract based pretty much entirely on price and/or how many golf games the vendor would pay for, dropped the steaming pile of turds into IT's lap, and had them implement it. They probably also told them to go ahead and integrate it with all the other systems in use that they sourced the same way.
Meanwhile, every time they've done a budget for the past 20 years they've cut IT just a bit more because it's a cost center so the lower you can get that on your spreadsheet, the better you look, so there's like two kids and a grumpy old balding guy who spends most of his day working on reports for audit and compliance and they're responsible for the entire hospital.
(At the hospital one friend worked at he was responsible for taking support tickets along-side the two other IT staff, working the on-call, and also _every single integration between systems in the hospital_. He wasn't a software developer or anything. He'd just started as purely help desk and seemed to have a vague idea how to write documentation and only cost like $35k/yr so he was clearly the best person to be responsible for communicating with all the vendors and making sure the EHR system could talk to the MRI machines.)
But don't worry, even if this comedy of errors somehow gets to a working state... when that contract's up for renewal, they're going to look at the price and if a better one comes along they'll do the same thing again. Same for every other system in use all of which will have a ripple effect across every other system.
Hey, at least you have job securi--what's that? The hospital was just bought by private equity and merged with another hospital and the entire IT department's laid off effective immediately?
Yeah doctors hate them because it's just shit software. It's something like Workday trash - software that's made to be extendable to every possible use case and save costs for the developer while being complete garbage to use. Even if it did work, it's then tailored to the priorities of legal and management rather than doctors.
I've developed the following methodology with LLM's and "agentic" (what a dumb fucking word...) workflows:
I will use an LLM/agent if
- I need to get a bunch of coding done and I keep getting booked into meetings. I'll give it a task on my todo list and see how it did when I get done with said meeting(s). Maybe 40% of the time it will have done something I'll keep or just need to do a few tweaks to. YMMV though.
- I need to write up a bunch of dumb boilerplatey code. I've got my rules tuned so that it generally gets this kind of thing right.
- I need a stupid one off script or a little application to help me with a specific problem and I don't care about code quality or maintainability.
- Stack overflow replacement.
- I need to do something annoying but well understood. An XML serializer in Java for example.
- Unit tests. I'm questioning if this ones a good idea though outside of maybe doing some of the setup work though. I find I generally come to understand my code better through the exercise of writing up tests. Sometimes you're in a hurry though so...<shrug>
With any of the above, if it doesn't get me close to what I want within 2 or 3 tries, I just back off and do the work. I also avoid building things I don't fully understand. I'm not going to waste 3 hours to save 1 hour of coding.
I will not use an LLM if I need to do anything involving business logic and/or need to solve a novel problem. I also don't bother if I am working with novel tech. You'll get way more usable answers asking about Python then you will asking about Elm.
TL;DR - use your brain. Understand how this tech works, its limitations, AND its strengths.
I live in LA and have been here for almost 30 years now. This stunt is a provocation designed to get a reaction. He wants an excuse to crack heads in a city he hates and that hates him back. He probably also wants us to forget about Musk outing him on the Epstein files.
Watching this unfold here is reminding me strongly of the Ghorman plotline in Andor S2: "You need a resistance you can count on to do the wrong thing at the right time."
I don't doubt that Trump's goal is to escalate and take advantage of the situation.
But the fact that LA and cities like it accept a high level of lawlessness and destruction of property as "normal" already casts doubt on their willingness or ability to handle the situation.
Their recent track record is not good when it comes to law and order, and people living there deserve to not live in danger or fear of mob destruction.
Why do you seem more concerned about damage to insured property than the civil liberties and rights of human beings being grossly violated?
You should seriously self-examine your thought process here as to why you're more upset about buildings than families and lives. It probably has a lot to do with what media and online content you consume.
I'm concerned about property owned by me as well as my personal safety and that of the people I care about. Mobs can break into my home and kill me or violate my mom. That's a valid concern.
If you please, I would find your argument more compelling if I wasn't personally aware that the damage from protests in 2020 was very little compared to normal day to day activity in cities, or the typical damage after a popular sporting event, as well as my awareness that the most famous incidents of damage from BLM protests were from positively identified undercover police officers and white supremacist agitators.
Given these facts, can you justify moving America towards more of a police state (and abdicating more of our liberties) because of... why?
My neighborhood was severely damaged. Many people left and never came back and many stores never reopened. I live in an apartment building which could easily be compromised and then I'd be a sitting duck for whoever wants to break into my apartment. The riots got out of hand because folks were afraid to implement law and order.
Ironically, we had protests yesterday, the police came out in huge numbers and as far as I can tell everything was peaceful. The protesters got their protest and the rest of us got to keep our lives and property.
Which neighborhood? This is the first time I've heard of that level of deep scale damage, and I was at protests at least once a week that entire period.
I've also heard of not a single instance of protestors breaking into private homes to harm people there.
Sorry to be so skeptical but your experience is apparently singularly novel.
As for police keeping protests peaceful, my experience is the complete opposite - protests are peaceful, and then the cops show up and start pushing people around, or their undercover officers try to kick things off by throwing things or shoving people. American cops escalate.
I hear very similar stories from folks in the greater metro area about what happened in Detroit in 2020 to this day. I lived here then and there were no fires, looting, or destruction here at all. It's been well documented, but that perception can't be broken and they continue to talk about how dangerous and destructive it was.
I'm also realizing now that depending on the time period, stores not "reopening" in a neighborhood (for how long were they closed?) was probably due to COVID.
It doesn't. Just an example from recent memory of how things can get out of hand if there's no law and order. My city suffered a lot from the drstruction and violence and I would prefer it not happen again.
What I’m just not getting is how there should be this new urgency or desire is all. We’ve had protests, some of which turned into riots, throughout American history. A certain amount of law and order has always been imposed by the authorities (when they haven’t made it worse). It seems like you want that amount to change everywhere, “there should be a desire to nip violent protests in the bud,” but the only reason is because you personally experienced a lot of negative results from riots in 2020. Maybe it’s just your city?
It's not a new desire on many people's part. Many residents of eg. LA, Chicago, NYC have been lamenting the decline of law and order since (and also before) the 2020 riots. Politicians and law enforcement in these cities have shown that they either won't or can't enforce the law.
In a situation like that eventually either mobs or federal law enforcement need to get involved. Of those two choices, maybe you prefer the former. Many people prefer the latter though.
I'm a liberal (not progressive) in Chicagoland (in Oak Park, right next to Austin) and this lamentation for the decline of law and order is news to me. Homicides are sharply down since the Rahm Emanuel era.
Do you think federal agents that refuse to identify themselves, present warrants, or follow due process is law and order? Do you think peace officers that shoot munitions at unarmed civilians walking home is a fair trade for suspension of the first amendment?
That's the reason why people are protesting. If you wanna provide evidence about "your city", be specific, because places like Portland, Seattle, Austin, SF, NYC, Boston, and more are doing just fine.
Historically, armed aggressors of the state don’t just give power back to the nonviolent and peaceful.
Further, peaceful protest has been happening vis-à-vis constituents contacting their representatives - and also congregating in the streets - in the months leading up to this.
You're on the wrong side of this, plain and simple.
One thing that you, and many others commenting on may be missing, is that we're getting an uncorroborated, retelling of a story that may well be simply reflecting the teller's own attitudes and reflections rather than a blow-by-blow account of what actually happened.
For example, say I was the interviewee and actually said of the SQL question: "Well, to be frank, that question isn't so good for understanding my SQL abilities." I don't think that would be rude or evidence of "being an asshole". A retelling of that story may simply be condensing it down to how that statement was interpreted: as a nice way to say, "that's a stupid question".
We shouldn't get too far into parsing what's in the story as a verbatim telling of what happened. We have the author's impressions of those events and their interpretations of the outcomes to drive home a larger point the author wants to make. That's it.
I’ve warmed to this tech a bit, but christ would I like to hear more takes from dudes who aren’t running a fucking AI company. It’s impossible to take anything they say as anything other than a god damn ad.
Because nothing matters. Just wait out the outrage cycle. In a week or two the general public will have moved on. Signalgate, the president being convicted of numerous felonies, etc being a few examples that pop into my head. None of this should be status quo but we live in interesting times as they say.
Vanguard's lifecycle funds (picking them because they get promoted a lot as a good choice, courtesy of good marketing and lower fees and generally good returns). Their 2030 fund, the one that people are recommended to select if they're retiring around 2028-2032, is down 4.54% YTD, and down 1.42% for the last year. The current market effects have wiped out over a year in gains for a relatively conservative fund.
And that's all from the last two trading days, it was slightly up YTD on Wednesday. And all of this is before the effects of the tariffs come into play. We haven't actually seen the effect of higher import costs hitting companies and consumers yet.
So people approaching retirement are getting hit and hit hard, but it's not quite 20% for them unless they selected an aggressive investment strategy for some reason.
The worst for the Vanguard funds are down about 8% YTD (and likely to get worse) for anyone 25 years or more away from retirement.
Nobody should be planning on steady stock market gains for their retirement income. The stock market goes up and it goes down. In both the dot com crash and the 2008 financial crisis the market fell significantly more. Even in Covid it fell more. So you should plan for many of these events to happen within your retirement. If you're more conservative (pun?) you should plan for great depression style events within your retirement.
EDIT: I don't usually respond to downvotes but it's really important to understand the stock market is a volatile investment. You shouldn't have money you're planning to use in the short or medium term in the stock market. It's a longer term (10 years+) investment.
> Nobody should be planning on steady stock market gains for their retirement income.
At least in the Nordic countries, utterly uncontroversial conventional wisdom says something like:
* In your youth save almost-only in stocks; via some index fund, if you don't feel like being an active investor, following the market every day;
* Start with (funds that specialise in) high-growth (= high-risk) stocks; then, as you near middle age, slowly move over to lower-risk (= lower-growth) stocks (or funds specialised therein);
* In middle age, move over to having some part in state bonds;
* As you near retirement age, eliminate high-growth/risk stocks/funds altogether, and draw down the proportion of stocks/funds as a whole, going to an increasing proportion state bonds.
* As you retire, possibly move all-out of stocks / stock index funds and all-in on bonds... Except put some in an ordinary old bank account.
As much as HN posters like to pretend they're above them, it's not an exaggeration to say that this site is now about as political as Reddit or Bluesky and votes like them. Depending on the thread, your comments will be downgraded for lack of left-wing partisanship, not because you're wrong or because your post is low-quality. For the record, my vote seems to have removed the low-opacity threshold on your post. I have no doubt that countless intelligent posts have been hidden solely because they do not align with leftist consensus, and comment sections are full of entirely delusional subthreads that fail to comprehend just about anything about politics, economics, or ethics, but are promoted because they align with a simplistic radical framework of "good guys smart, bad guys dumb".
It's starting to matter. Trump's downfall will be his base seeing him as anything but a successful, smart businessman. He's struggling to control the narrative with how many gaffs and scandals have occurred, and it's starting to hit his base and his brand:
I cannot stand to watch, but I am curious how Fox News is presenting the latest events. Without that propaganda piece supporting the administration, how long can support be maintained.
That’s maybe doable as long as the major impact is just the stock market. Most people do not pay much attention to the stock markets, at least not day by day. However, within weeks, price increases from the US tariffs and demand decreases from the Chinese tariffs will start to hit, and those will likely be more difficult to paper over.
A cult problem. But cult problems can be solved too.
Trumpism might be cult-lite but it’s not something people cannot be led to see as harmful. Find what hooked them. Show that the outcome isn’t as Trump implied. Frame the failure as intentional rather than unintentional — Trumps usual approach to avoiding responsibility. Allow them to save face.
Respectfully, it's hard to see Trump himself as compelling. My money is on Eric: behind every great man is a great woman. Lara Trump is pretty dang ambitious.
I do agree that saving face would help but his people are still ready revere him while still being angry at Musk or any fallout from a Trump decree.
His cult sees him as he was presented on The Apprentice -- rich, powerful, rich, and wise, and rich. Rich is good and if he's rich he's double plus good.
I think the only end to his cult is his shuffling off this mortal coil.
The struggle is real. Therapy helps. Meds might be worth checking out too as this sounds like ADHD.