Navigation: The Deciding Factor in the Android Vs. iOS Battle? (for now anyway)

Link: http://www.wired.com/gadgetlab/2012/05/apple-maps-ios6-report/

I rely extensively on navigation through my cellphone and from my previous posts you known I am not (yet, sic) an iPhone user. Thus, you guessed right, I use Google Maps... For the most part, I have been happy (or OK) with it, as it is (somewhat) convenient. Certainly when compared to nothing. Perhaps even when compared to standalone GPS (unless built-in) as lugging around the GPS unit (you can't leave it in your car), attaching it on the dashboard (or other alternative locations) is a pain.

However, the Google Maps based navigation solution (running out of my cellphone) is not without pain either. Sure, it has traffic info, but for what? I always had doubts if the traffic info assists with designing the route in real time. Sometimes it felt like even bad traffic on the route that is otherwise the shortest won't deter Google Maps to push me through that shortest route, despite however horrible the traffic might have been.

Now I had an opportunity to fully test (and prove) that suspicion. I was driving toward DC, from my Baltimore office on a Saturday evening. There was a dinner reservation so it was time-sensitive. I left in time. However, when I got in my car and fired up the navigation (which I do sometimes even when I know the route well, mainly to see traffic), I got a one hour 58 min estimate (for a route that is typically barely over 50 min). "WHAT???" was my initial reaction. I could not believe it.

In any case, I proceeded and headed my usual way (295, Baltimore-Washington Parkway), assuming there was some error. It was somewhat concerning though that the traffic indicator light was the darkest red I have ever seen it. I still suspected an error, because even with traffic, it is simply impossible to have a more than twice the normal time to get through.

Then I turned on WTOP radio. I was listening to the traffic news... Well, they announced that Southbound 295 is ENTIRELY SHUT DOWN due to a major accident. Traffic is being diverted, but there is already a several miles long traffic lot prior to that. Wow! I said. At that point 295 was moving nicely around the speed limit (or above, shh); there were no ominous signs. However, my Google Maps based navigation was still showing dark red and some one hour + 51 min travel time estimate to my destination.

I took the very first opportunity to cross over to 95 (I think it was 195 I used). I was expecting that if the 1 hr 51' travel estimate was because of that accident and closure on 295, my getting off 295 and moving on to 95 will make a difference in the travel estimate. So here was the next shocker! It DID NOT. Not only that, but my travel estimate even added a minute or two. What's going on here?? I asked.

Well, as I was tuning up my mental effort to solve this riddle, I recalled that the IMF has its meeting downtown DC, near my destination and they had previously announced some road closures. Traffic can become truly horrific in DC and I just assumed that now that I moved away from the closed 295 the extreme (near 2 hours) estimate must be related to something like that, although it sounded excessive no matter how bad the traffic is downtown.

in light of this new hypothesis, I called my GF (we had a reservation with her and her parents who were in town for the weekend) to see if we can perhaps find another restaurant closer to her home so that we won't have to go downtown.

As we were considering those options (while I continued to drive down on 95), I was passing by other major corridors connecting 95 and 295. I passed route 100, only to see that the estimate worsened even further. But then when I passed 32, something miraculous appearing happened. The estimate went from something like 1 hr and 48' to 41'. First I just could not believe it as both were in the forties, except the hour difference (mind you, the 41' from the 32 intersection is still bad, and there indeed was some traffic issue besides the 295 closure, but you get the point). This was an even greater WOW.

So basically what was happening is that NOT ONLY did Google Maps fail completely to direct me onto 95 in the first place (which BTW would have saved me time as 95 and 295 are somewhat divergent going South from Baltimore), DESPITE the clear and major traffic situation (which it apparently even registered), BUT it actually wanted me to GO BACK into the traffic nightmare even though I was already in the clear!!! Only when I passed the point when it OTHERWISE thinks was shorter to go on 95 and getting back onto 295 would have been a detour did it update the estimate.

In other words, it did not update the incredible long estimates even after I was on 95 (which was perfectly clear) because it was thinking to send me back on 295, which was closed!

This unbelievable experience demonstrated that the traffic information is NOT AT ALL being taken into account by Google Maps to design your route. This is very disturbing, so much so that I question if I want to use it at all. Assuming major traffic problems are still relatively rare, and the minor differences are negligible compared to the benefits of getting help in areas you don't know, this still bothers me. What if you don't know a place, it sends you through a route that is an hour and a half long, but then it could have been 25 min shorter if it sent you some route else. You will never know. In the example above, I had the opportunity to know, because I knew the local driving info and I could test my hypothesis.

The link above is a report that in iOS6 Apple may decide to part ways with Google Maps. Good move! If they also set up some navigation functionality that actually works (I wouldn't be surprised if that is what Apple has in mind exactly), that may be the end of my Android career.

Another Communication Gem with BoA

I would like to share a "secure" email exchange I recently had with BoA customer support as I think it is humorous. It relates to the fact they closed my savings account without my knowledge or consent. I just logged in one day and found that my account was gone. I thought this was some sort of an error or display issue, so I sent them an email. I am not enclosing all of the initial ones, only the most recent ones. Basically they informed me that due to zero balance and no account activity, they closed my account. They maintained they mailed me a letter a month before closing the account. I confirmed they have my correct postal address on file. I never received any letter from them about this.

The issue is of course not a big one, as far as my Savings Account is concerned. I cannot care less if I have that account or not, I don't even remember why and when I opened it, I most certainly have not been using it (if I have to save money, I can transfer to other accounts with higher yield than BoA savings). The fact they would just close it without my consent is another matter. It is not that I am a lost, deadbeat, inactive loser-user, who cannot be found or barely uses his accounts. I also have 2 credit card accounts with ample activity, plus my main checking account is also linked, with at least $25k cash flow monthly, including direct deposit, etc. I would think I deserve a bit more attention and respect than unilaterally intruding my finances and closing accounts for me, WITHOUT making sure I know and am OK with that or offering/discussing an alternative.

But even more bothersome or interesting (depending on your point of view), which ultimately is why I decided to write, their response to this fiasco is highly typical. Instead of owning up to it, offering to reopen the account, or at least apologizing, they go out and insult my intelligence with heavy and deep BS.

The moral of the story is two-fold. First, even though banks may be offering email customer service it isn't worth very much. I have posted some of these emails on other matters in the past and 90% of the time their agents are either do not get it what your problem is or they do not want to get it. One way or another, you are no better off, after wasting time emailing. They are probably disincentivized escalating matters as that could negatively affect their performance measures or bonus, whatever. They try to "solve" the problem, but without the experience, intelligence, or authority that would be needed to help.

Second, if it is true they mailed something and for some reason it was lost and wasn't delivered (if you would like to give them the benefit of the doubt), then they have an insufficient system in place for a number of reasons. First, I have fully digital banking, for years I have not received any statements or anything, I manage everything on-line and all notifications and correspondence comes by email. Why on earth would they then send a snail mail over this relatively important matter? Also, it would seem to me that closing an account would warrant some confirmation; some proof that they actually reached me. Keeping the account alive until I get back and confirm that is OK probably is more costly to them by 15 cents than just closing it and worry later about the possibility the customer never got the note. That is the customer's problem, not the bank's. Which likely what happened here. They saved 15 cents up front, but then my many emails, even if handled by a barely literate $5/hour worker some distant part of the world, probably created more than 15 cents in cost, so it may just be another example of trying to cut costs mindlessly in the short term eventually ends up costing more. I am not a business analyst therefore it is also possible that I am only one in 10 customers causing a stir (and thus extra cost in the back end) and overall it still makes sense to them to save the 15 up front...

"Subj: RE: Other Online Banking Features

Dear Zoltan Mari,

Thank you for your inquiry dated 2/22/2012 regarding the closed account. We will be happy to assist you.

We apologize for the inconvenience in resolving this matter via email. You are a valued customer, and we would like the opportunity to retain your relationship with Bank of America.

Please be informed that we are unable to assist you regarding your closed account. To assist you better please contact us on 1.800.432.1000. We are available 7 a.m. to 10 p.m. Monday through Friday 8 a.m. to 5 p.m. Saturday and Sunday Local Time.

We value you as a customer and appreciate your business. If we may be of further assistance, please contact us again by email. Thank you for choosing Bank of America.

Sincerely,

Aayan Kites
Bank of America

-----Original Message-----
Hi,

I did not know that policy. I really wish you notified me before you are closing any of my accounts without my permission or even notification. That actually is rather drastic and I am baffled. I don't really need that savings account, so it is not a big deal, I only used it occasionally, but the fact you would even do such a thing, not even letting me know (please allow me to not eat the BS that you sent anything, I check my snail mail every day, I did not get any letter, plus you obviously have my phone number and email address, so it is bizarre to propose you cannot reach me). Anyway, it is a bit of an insult to my intelligence what you are saying (that you mailed anything), I am sorry. You did not mail anything as I would have received it if you had. Besides, if you wanted to reach me you could have. What happened is you closed my account without my consent or knowledge and you should acknowledge it like a man, rather than coming up with BS stories like you mailed !
me about it. Please.
ZM

---------Reply Separator---------

Dear Zoltan Mari,

Thank you for your inquiry dated 02/18/12 regarding the closure of your account. We are committed to provide you with the best banking experience possible and we will be happy to assist you.

We understand that you are concerned with the closure of your account.

Please be advised that accounts in a zero balance are closed after three months of inactivity.

When the account is inactive for two consecutive months, a letter is sent to your home address indicating that a deposit must be made in order to avoid closure.

We apologize for any inconvenience that this may cause. We value you as a customer and appreciate your business. If we may be of further assistance, please contact us again by e-mail. Thank you for choosing Bank of America.

Sincerely,

Alejandro Cabezas
Bank of America "

Spine Surgery in Community Hospitals: Outcomes Please?

First of all, I would like to declare that my utmost respect goes to all my surgery colleagues who are solely driven by their professional mandates, care only about the well-being of their patients, and practice accordingly. Undoubtedly, this most certainly applies to all my neurosurgery colleagues at Hopkins and likely at other academic institutions. Second, I don't mean to come across as elitist or anything like that, so I would also like to extend my appreciation to surgery colleagues in ANY hospital, institution, geographical territory, or organizational level who operate according to the above principles. However, years of practicing as a neurologist, plus to some extent my own experience as a patient as well as stories by friends, made me wonder if some of my personal observations are actually trying to show or adding up to something relevant.

This is a blog and not a scientific work. Also, as you can see on the main page, none of this is in any way related to my daytime job or shared by Hopkins or anyone in particular or anything organizationally related to Hopkins. The opinions are solely mine, an individual with a personal blog.

Here is the essence of my observations. I have yet to see (or hear of) a single neck pain/back pain patient that experienced lasting clinical improvement from any spine surgery performed in the setting of community hospitals and the like. I am not talking about the obvious cases, with trauma, abscess, tumor, etc. I am talking about those patients who complain of neck pain and/or back pain, get imaged, and then on the MRI some degenerative disc disease (DJD) or spondylosis will show and, perhaps, to the point that there is (usually) "moderate" narrowing of the spinal canal or the foramina. Usually at multiple levels. Typically with no significant (or just minimal) impingement on the cord and/or the routes.

Chances are if you image the spine of 100 random people off the street in their 60s and older, at least 51 of them (if not more) will have some degree of DJD (and even some impingement if you really want to see it that way). If something is so prevalent (and obviously not causing much of any symptoms in most) then the causal connection of back pains and neck pains to these changes is already highly questionable. But what is even more questionable is how at the community level we go about managing these symptoms...

I have seen so many times that the community neurosurgeon, after reviewing those MRIs and allegedly examining the patient, will conclude that he is very pessimistic about the outcome of conservative management options, which, in his opinion, have been "exhausted". And then the nature of the procedure, the risks, etc have been explained to the patient, blah blah blah.

Then the surgery is scheduled, if the patient is fortunate nothing really bad happens (such as screws breaching the spinal canal or the foramina), the patient recovers and finds that they are either no better (or sometimes worse) and a revision is immediately necessary (typically multiple) OR they are better, but that doesn't last long. I have seen hundreds of patients with history of back or neck pain who underwent one of these decompressive spine surgeries, with the overwhelming majority needing additional surgeries down the line, and none with a lasting improvement.

So what is happening here?? There seems to be some form of a symbiosis of sorts, where both parties get something out of it. This may sound like a blasphemic or at least harebrained idea, but considering I have seen a lot of psychosomatic issues from the neurology/movement disorder perspective, I think it is not implausible. Pain is a subjective complaint and we doctors all take patients' words at face value on reports of pain, and we should. However, what if some of the back pain and neck pain (especially when following some work or other external party liability related injury) represents at least in part a psychosomatic component. Of course that can never be either proven or ruled out, but for the sake of assumption let's say that's the case. What would be this patient's prime interest? Obviously to have objective proof or record showing their illness is valid, "organic", and evident to anyone with medical and medico-legal expertise. Will MRI deliver such proof? Well, not necessarily. What if it only shows those rather banal, minimal to moderate, changes that the majority of the 60+ (but perhaps even 50+) population has (mostly without any symptoms). Clearly, not all physicians would unequivocally conclude that this is THE proof. There would be skeptics. And if there is a medico-legal or other type of review where such skeptics are abound, then the evidence may even look weaker.

How about surgery then? Well, then we are talking about a whole different level. Surgery sounds like a good proof... To even propose that a surgery was "unnecessary", skeptics would need not only to be much bolder, they actually should have strong proof to that effect (i.e. the surgery was unnecessary). So is there a way to have such strong proof (that a surgery was unnecessary), after those rather unimpressive MRI changes, unimpressive physical exam findings, AFTER the surgery? There is absolutely no way to do that. In fact, assuming the patient after the surgery reports (temporary) improvement in pain, there actually seems to be proof to the contrary. In other words, the fact somebody was willing to operate this patient WILL de facto provide THE evidence needed to prove their illness was "legit", i.e. organic.

So now you can see how the patient "benefits" from this symbiotic relationship, usually not realizing that their "improvement" (which is temporary) is only a placebo effect and probably would be exactly the same had they had "sham" surgery (i.e. opening up the wound but actually not doing anything to the spine).

What is it in for the surgeon then? That is why I singled out community hospitals. In community hospitals surgeons are absolutely incentivized to operate. The more, the better: the greater their income, the more secure their job, the better their leverage when negotiating about anything with their management/administration, etc. In other words, their greatest currency is their volume. If they see a patient, who is desperate to have a surgery, either because they just want to do anything to get rid of their (psychosomatic or not) pain and not knowing better that the surgery is not the panacea for their pain OR in order to get the ultimate stamp proving that their problem is "legit" or organic, when there is even the slightest potential for medical justification, what will the surgeon do?

Then of course after the surgery there will be multiple notes, from the neurosurgeon, neurologist, PM&R specialist, PCP, you name it, documenting that the patient had a good outcome, BUT there seems to be this and that, so they will need a repeat surgery. One year, two years, multiple years later, doesn't matter. Usually multiple repeat surgeries. The story may continue such that the original problem, albeit helped temporarily, now returned, or the scar tissue is now the culprit, whatever.

You can of course say that all that time, even if temporarily, the surgery helped, no? That is a very valid way of helping patients that suffer from pain, right? Not necessarily. I have seen patients, who relate that their original pain (before the first surgery) was nowhere near the pain they are experiencing now, years later, after multiple surgeries. And no matter how many additional surgeries they have now, there is no help. Scientifically, you can't really say whether or not they would be better or worse off: you don't really have a good control, i.e., the patient himself or herself, taken back in time and taken into an alternate present where they had NOT had the surgery they had. Any other control would be some way flawed.

The academic setting is much different from that community setting. Here the surgeons' most important currency is NOT their volume, but much more so their reputation, with their outcomes vigorously tracked. Their referrals go through the roof so they do not have to operate on every patient that walks in, because they CAN afford to be selective and conservative. They CAN restrict their surgeries to those who are without a doubt in need of surgery and operate ONLY on those. They can still fill their quotas easily as they have plenty of appropriately referred and selected patients waiting and they are under no pressure to increase their volumes. In fact their currency relates to job performance measures, including teaching, publishing, grants, and quality of their work, which is constantly monitored or even scrutinized constantly by trainees, colleagues, and administration.

Although you cannot change the culture of medicine as a whole easily, I think there must be a way of altering the current "currency" system in the community hospital level, where volume should be a very small factor and outcomes would be a huge factor in determining "currency". Where surgeons would be totally incentivized to produce medically superior outcomes as measured not only by patients (who, for one reason or another, may be willing to go along with unnecessary surgeries), but by peers and/or independent reviewers. I believe this would be the only way to eliminate questionable spine surgeries that increase health spending and produce little true and lasting help to patients.

BoA's Handling Another Dropped Ball! Educational (Typical?) of Advanced Corporate Customer Care Habits...

Wow. This is very interesting! I'll try to be brief, even though right now I'm rather dazzled by this.

Here is the story, straight and simple. On 12/20/11, around midnight, I went to an ATM near my house, to deposit a check. I did that and that's all I wanted to do. The machine was unusually slow processing every step, which was a bit concerning (after taking the check it was showing a blank screen for very long seconds), but eventually the deposit did go through. When I asked for the card to be returned, it made an apparent attempt to eject it, but the card stopped at a point just short of sticking out, inside the slot. The screen instructed me to take the card, but there was no edge of it to grab.

I quickly looked for any make-shift forceps, like small pieces of wood, to try to get it out, which I almost managed to do, but I got timed out: the card was pulled completely back into the machine and it announced that the card was taken and blocked and that I should call customer service. Which I did immediately, only to learn that they had no service after hours. OK.

I called the next day, on the 21st, to report this and ask for a new card. I spoke to a rep, who seemed to understand the situation. I also explained that within a day I'd be going on vacation abroad. She said the mailing of the card was to take 7-10 days, which obviously meant I would not get it before my trip. She also said I could get a temporary card in the meantime, by walking into a branch. SHE ABSOLUTELY, POSITIVELY, UNEQUIVOCALLY confirmed that a replacement card was being mailed to me ASAP (irrespective of whether or not I decided to go to a branch for a temporary card).

I decided to not get a temporary card because I actually had enough cash on me to get through my travels. I then returned to the US, thinking my card would have arrived by now. In the mail, I found some checks that I needed to deposit, but what I did NOT have in the mail was the replacement ATM card! Even though it wasn't technically 10 business days since I made the request, I find those estimates typically way overstated, so I suspected something was wrong and I called BoA.

The guy I got on the phone informed me that he saw record that on 12/21/11 the card was blocked due to being left in an ATM, but that there was no record of a replacement card ever being mailed or requested (!). I got pretty agitated hearing this and requested to speak to the supervisor, who soon joined the call. She introduced herself as Andrea Anooshian. Both she and the entry tier rep consistently called me "Mr. Mari", despite the fact I introduced myself as Dr. Mari, but this was just a very small issue.

She confirmed that there was no record of a replacement card mailed or requested. Here comes the interesting part. She said there is no way to find out what was said during my 12/21/11 call, essentially questioning my claim that I did request one (and that I was told one was being mailed). I asked her if it made ANY sense to her that no such request would be made. In other words, would the assumption be that the customer reports a lost or stolen ATM card, which then gets blocked, and that's the end of story? The customer declares himself ATM card free and no longer in need of one. Does that make sense? I asked her.

Her response was just as sensible, which is to repeat it over and over that all she can tell me was what she saw in the system, which is that there was a report of a lost card and it was blocked, without a new/replacement card being mailed. She repeated what the first rep on 12/21/11 said, which is that I can go to a branch and ask for a temporary card. I explained that I cannot, because I am working from early AM to late PM on business days, being a doctor so I cannot just walk to a branch at a chosen time during normal business hours.

I made a specific request to have the FedEx $20 charge waived. I explained that this whole story is a string of BoA's dropped balls while I only did everything by the book with no mistake whatsoever on my part: (1) the dysfunctional ATM that failed to return the card; and (2) the incompetent rep who failed to have a new card mailed. These errors caused significant frustration and inconvenience. I also pointed out that I pass some $20k a month in various transactions through my multiple BoA accounts and that I have been a customer for some 11 years. I asked if all this was worth BoA to through in a $20 one-time consolation.

The answer was repeated and unwavering no. Andrea left no doubt over her conviction this issue and my frustration was not worth $20.

I actually don't really care about the amount, this is a story about principle. Andrea is absolutely confident in handling the issue this way because she knows I will get no better service with another bank. She is certain that the convenience of online banking among other perks will be a force strong enough to making it unnecessary for BoA to concede in this dispute in which they clearly were morally obligated to expedite the shipment of the replacement card at no extra charge.

I wish I could just say here that she is wrong. But I can't. (Not yet anyway.) At this time, out of the 4 or so banks I currently have checking BoA is offering the most comfortable and convenient banking between a really strong Android app, bill paying system, etc. However, the way they treated me suffice to say I have zero loyalty and should the smallest reasonably compatible alternative emerge, I will get rid of all my BoA accounts.

And that day, I think (hope) is not too far. Online banking is already pretty good (I also have an e*Trade account that has some of the functionality at least as good, but I can't just walk into a branch, which at this point may still be a small issue). For example, I enjoy the fact that BoA ATMs are so ubiquitous and I can just find an ATM everywhere (at work, near home, etc), which I mostly use for depositing checks. Paypal (where I have an account too) already allows scanning checks (with some limitations, such as a very long takeover, maximum amount) using my Android phone and other banks are starting to offer this as well. I trust close is the day when I can finally wave goodbye (or badbye that is) to BoA and never look back.

We need better email functionality to tackle subjectless emails

Link: http://community.spiceworks.com/how_to/show/1410

Below, in quotation, I paste here the post I made on Google Labs suggestions box, for consideration. Of note, in Outlook, albeit no "empty subject" rule can be made, there is a workaround, which works for me (please visit the link above).

"Emails with no subject are more than just annoying. You can't
efficiently overview listed emails on your mobile device by subject
(to give you a sense what they are about), you can't file, group,
organize emails efficiently, which all depend on subject/easiest done
by subject. Also, it is violating basic email etiquette I think.
When a loser sends an email with an empty subject, they are kind of
saying "I don't care if this is a nuisance to you, I can still do it"
which of course these days when email clients even ask you if you
really want to send it w/o subject, is particularly inconsiderate.

Therefore, ideally, a function should be available, which allows Gmail
users to add a filter that identifies incoming emails sent with empty
subject, auto-replies a canned response, and moves them out of the
inbox.

The filter as it is currently available in Gmail cannot do that. As you
can Google this issue, many people tried many different ways: 'no
subject', "no subject", (no subject),< no subject >, < isnull>, etc in
the "Subject:" filter option. Some of these will find a few emails
with no subject, especially if those were already replied to or
forwarded with the subject actually saying "no subject", but it will
not find the emails with truly empty subject.

If anyone is capable and willing to develop a lab that can address
this, it would be huge I think."