4:00 P.M.

November 5, 1998

Use A Computer

by James A. Fallows M.D.

Assembly Room, A. K. Smiley Public Library

Biography of James A. Fallows M.D.

Rather than a description of his 35 years in Internal Medicine at the Beaver Medical Clinic, this is a review of Jim’s computer background.

About 15 years ago Jim started with Radio Shack computer parts that needed to be programmed in Basic for even simple tasks. Briefly he tried machine language and assembly language. Later developments allowed a message typed in Scripsit to be sent by MCI Mail to Malaysia or elsewhere, or a spreadsheet to be created with Visicalc or, later, Lotus 1-2-3, all now obsolete.

Eventually Jim had a small computer and printer in each office to allow printout of a patient’s findings, diagnosis and recommendations.

During his service as volunteer head of the Redlands Community Hospital Intensive Care Unit for its first 15 years, he had to do with choosing and supervising computerized monitoring equipment and emergency procedures.

He did online searches to aid diagnosis or treatment background for himself and for other physicians.

In retirement he sometimes does online searches for medical information to help previous patients and friends.

He has created and maintains websites for the Fortnightly Club, Redlands Symphony, Kimberly Crest, and Friends of the Library

His computer eases his tasks as Secretary of the Fortnightly Club and the Redlands Symphony and as president of the Beaver Medical Clinic Foundation, and with the Stephen Ministry, AudioVision Radio Reading for the Blind, and a newsletter for Elsinore Middle School.

Instead of medical house calls, Jim makes volunteer computer house calls to friends who are new to computers or who have a problem

Use A Computer

Why and How

I am going to tell why and how you should use a computer. I will talk about three courageous people. Then about one day’s computer diary, a few history notes of computers, the components of computers, some special uses of computers, and finally the gender of computers.

These days age, disability, or unfamiliarity with a computer is not a reason to avoid a tool which will become as common as the telephone in its use..

With their permission I will express admiration for Urban Derkum, CPA, who learned the computer to write his biography for his 90^th birthday, accesses his stock portfolio, organizes Christmas gift giving to all the employees at Assistencia Villa, and sends email to distant family. And for Tom Rash, totally blind, who not only operates a radio broadcast station, AudioVision for the Blind, but also uses his computer to write scripts, create letters and financial reports, and send email. And for Jean Canon, who when I came here was by herself the answering service for the Beaver Medical Clinic and who, retiring after fifty years as a secretary there, bought a computer and learned to use it as a volunteer to send the letters and coordinate the 21 educational grants of the Beaver Medical Clinic Foundation.

How many hours? (An email answer to Gene Ouellette)

Dear Gene, Your question last evening, "How many hours do you spend at the computer in a 24 hour period," gave me pause. I don’t count them, but I know it is a tool or accessory organ that makes so many activities easier, faster, or possible. For me, it is as if I were asked, "How many hours do you use your legs or your eyes --- or your brain?" Fair questions.

Prompted for the answer, to myself and to you, I’ll note today, some computer activities as they happen or come to mind. Don’t feel you have to read them. It is probably a long list.

Organizer

First thing in the morning I  look at "Organizer" for today, a scheduling program in which I have planned meetings (some of them automatically e.g. every second Thursday), activities, reminders of birthdays or anniversaries (they come up automatically yearly), tax due, etc.

Access Netscape, Mail

Then I read incoming mail, answer the letters. Letters come from family, friends, previous patients.

One of my physician friends sent this quick one today:

A patient in the office had a carrot in one ear, a string bean in his nose, and a radish in his other ear.

He asked, "Doctor, what is wrong with me."

After a moment's thought, I answered, "You don't eat right!"

I don’t subscribe to "Newsgroups" as such because they can be overwhelming with stuff I don’t care about.

I don’t go into chat groups, for the same reason.

Daily downloads

I do have some newsletters come to me automatically, such as Slate, which gives a brief comment on the day’s emphasis in the NYT, WP, WSJ, LAT, etc. Also InfoBeat Once a week I access slate.com, usually on a weekend, to peruse about 20 pages of stuff, some more interesting to me than others.

Crosswords

I download and print the NYTimes crossword puzzle for Jean, almost daily.

Browsers

There are websites, I especially like ceoexpress.com, where there are links that provide an extensive list of other sites, accessible by a click of the fingers on the mouse. I usually check the contents of magazines online and read the articles that interest me. These include Adobe, American Spectator, Atlantic, Columbia Journalism Review, Economist, Forbes, Foreign Policy, Harvard Crimson, Harvard Magazine, National Geographic, Pathfinder, national Times, Science, The Nation, NYTimes Book Review, NYTimes Fax, Boston Globe, Mercury, Newsday, USA Today, and US News.

Medicine

I sometimes access Amer College of Physicians, Amer College of Cardiology, BioMed at NLM, Bioscience Medicine, British Med Journal, CDC, Health Commons, Cliniweb, Doctor’s Guide, FDA, Health & Medicine, McMaster, MedConnect, Medline, Mental Health, NIH, Physicians Online, Stanford Travel Medicine, Silver Platter, Virtual Library of Medicine, Visible Human, WHO (these title I copied from my bookmark list).

General Science

Sites on my bookmark list include Bird Song Central, Earth and Sky, Exploratorium’s Science, Nature, Science & Nature Web Page, Science Magazine, Science Technology, Scientific American, Smithsonian.

Sports

I’m not a sports results follower. Since grandson, Tom, is on the team I keep an eye on Harvard Lightweight Crew’s website.

Travel

My bookmarks include, American Airlines, Ancient Athens, Best Travel Sites, Britannia, ESRI, Expedia, Europe Online, Everest, France, Frommers Fares & Tips, Globalearn, Paris, Perseus, Lokace, MapQuest, Expedia, Mungo Park, Les Pages, Nova Ancient Egypt, Out West, Geographic Trivia, Russia Today, Southwest Airlines Home Gate, TFI, Travel Language, Traveler’s Journal, Yahoo Maps, Yahoo Travel Home, Zip Codes, Zip Codes USPS, Emily Lau re Hong Kong.

Web Pages

These include Academic Life Lingua Franca, Agri Lit Site, Bigelow (grandson James’ school site), Bouvier des Flandres, Britannica, Columbia Univ, DeTocqueville, English Server, Feed, (Fortnightly Club), How to do it, Harvard, Intellicar, (Kimberly Crest), Learn2, Library of Congress, A Man’s Life, Paramus, Pasha’s Publications, Quicken Financial, Redlands Chamber of Commerce, Redlands City, (Redlands Symphony), Smiley Library, The Today Page, Univ of Redlands, USPS, World Wide Cobweb.

Sound online

ACSO (Assoc of CA Sym Orch), TileNet Bach, Beethoven’s Bathroom, CD World, InterVU Videos, Midi music, Shockwave, Old Time Radio, Orchestra on the Web, RealAudio Sites, Timecast, Voxware are on my list..

Search

A keyword typed on one of these sites will search the world if you like. Some search engines are All in One Search Page, Alta Vista, Big Book, BigFoot, Clark Net Social Science, Deja News, Excite, Find a Grave, Infoseek, Infospace, Internet, Lycos, Magellan, Name Search, Netfind Search for E-Mail, People, Phone 800 Numbers, Research It, Search Category Page, Switchboard, WhoWhere, Yahoo, Bigbook Yellow Pages, Netscape Yahoo Yellow Pages.

Comment

Al Kamen, All Politics, Electronic Policy, Fallows Central, Feed, Intellectual Capital are on my list.

Computers

Some sites for special computer information are Digital Village Radio Home Page, GNN, KIWI, Microsoft Fine Tuning, Netcaster, Netscape Handbook, New hardware & Software, Office Computing, Prof. Pete’s Webmastering, RealMedia, Soft Quad, Symantec, Norton, What’s Cool, What’s New, Yahoo Computers, Yahoo France,

Computer magazines

These sites are all available and free: Adobe, Corel, Internet, Microsoft Newsletter, Netscape World, Networld, PC Computing, PC World, WebWeek, Windows Magazine.

WebTech

Here are some addresses to help with website creation: BareBones Guide to HTML, Beyond Computing, BotSpot, Browser Watch, Canon, Cache Graphics, Corel Draw, Creative Element Page, Creative Labs, Cyberian Outpost, Delta Point, DiscoverNet Home Page, Eudora Mail Site, Free Win95 software, Front Page, HP Electronic Support, HTML aid microsoft, HTML Guide, Hypercon Internet Guide, IBM Personal Computing, Images for Buttons, InfoWorld, Internet Help Page, Microsoft Software Library, MPEG Player, NetLearning, Netscape Software Download, Symantec Corp, Ten Ways to Improve Your Website, TileNet, Web Developer’s Library, WebSmile, Windows95_com, WWW bibliography, www viewer test page, ZD Internet Mag, Zen and the Internet, Ziff, ComputerCraft.

Art

My list includes these: Fine Arts of SF, Louvre, Mercenary Photographers, Monde de Lahner, Thinker, Tres Riches Heures, Microsoft Art Collection, Web Museum, World Wide Art Resources.

Religion

Bible Gateway, Christian Documents, The Ecole early church history are especially informative..

Vocabulary and Usage

Online reference includes Dictionaries Acronyms Glossaries Thesauri, Elements of Style, and a Thesaurus

Literature

Amazon Books, Independent Reader, Literary Classics, Library of Alexandria, Literature Texts, Books Online, Thinker, Project Gutenberg Index, Bylines are available, some with full text.

French

For the French language I use ABU French texts, Book Stores, ClicNet French Literature, English-French, L’Express, France Pratique, French Teleglobe, Learning French, Le Monde, OU French, Sommaire, France Press.

Organizations

For Fortnightly Club I do announcements e.g. Ladies’ Night, Summary of the Year, Roster, Schedule, Agenda, Minutes.

For the Redlands Symphony I do minutes of exec. committee and board, guild newsletter, marketing, and website.

For Friends of Smiley Library I do the Newsletter, the board agenda, and assist in the word processing for the Silent Auction.

For Beaver Medical Clinic Foundation I do the board agenda and minutes and announcements. I write letters re grants to high schools (premed and AVID), colleges (RN), paramedics, lvn, and medical assistants. These include forms for student application, selection criteria, and funding.

For a monthly dining club I do schedules and announcements and name cards.

For Stephen ministry I help Terry Alexandris by formatting lessons plans and name cards.

For Kimberly Crest I do the website, and assist in creation of the name cards.

For Friends of Prospect Park (Harold Hill) I did wall certificates for the Carriage House, listing donors, etc.

For AudioVision I scanned Tom Rash’s signature and placed it in a macro for insertion at the end of his letters. I assisted in design and printed the letterhead, envelopes, newsletter, and business cards.

Graphics for insertion into documents

I have a lot of graphics in the computer and in Corel MegaGallery.

I scan and save graphics from magazines for future use.

Jean brings me cartoons, some of which I scan and save.

I copy some graphics from internet sites e.g. the graphic of the U or R chapel that is on the first page of the symphony website is from the U of R website. (I asked and received permission of Dave Bragg, head of computing there)

For modifying or creating graphics I use CorelDraw, PrintShop Pro, Photofinish, BMPview, ClipBook, ClipStak, Colrbook, Convert, GIF Show, GrafCat, Graphic Workshop, Lview, MSPublisher, Paint, Draw Perfect, Photofinish, and others depending on my purpose.

Use of my own CD’s to pursue a subject

Here is a list of my own CD’s (from a word file that I use to find one)

Computer House Calls, volunteer

Some of my computer hours are involved with helping others pick out computers, start and learn the use of the components. Also troubleshooting with friends when I may be able to save them the hours of frustration dealing with some problem.

Household personal affairs

I find it more helpful to store stuff in my computer rather than my head. I make notes of anything I might in the future want to know and I store it in a file with sufficient name and directory placement so that I can find it later.

Books Access

When I want to find a book in the house I use Control-F (find) for title or author in a word processor file where I have all our books and their locations.

Diskette Access

To find a diskette I use Control-F in a word processor file that lists my diskettes and their contents.

Zip-It Access

As backup these days (I abandoned tapes because they seemed to break at just the time I needed them) I use a Zip drive. I have a word document that tells me what I’ve copied to each Zip disk.

Finances

I use Quicken for storing check register and investments. For CPA purposes I get easily print out the totals by category. Also Quicken has a convenient way of updating a stock portfolio online.

Computer Housekeeping

I use Norton Utilities (DiskDoctor, SpeedDisk, SpaceWizard, Rescue Disk) and Norton Antivirus.

Last sentence to Gene Ouellette  Wow, this list surprises me, because it is only part of the usefulness of the computer as enhancer. If you are still reading at this point, feel free to call or E-Mail me if you want details of any of this. Jim

Some History Notes of Computers

IIn 1971 the first microprocessor, the 4004, performed 60,000 instructions per second. By 1981 the microprocessor zipped along at 750,000 instruction per second. The present Pentium II runs at 300 million instructions per second.

IBM PS-2 Model 70-A21 in January 1989, 25 MHZ at price $11,900. Now a well-equipped computer, at 300 MHZ can be bought for about $1000.

Windows 3.0 in July 1990, Finest computing experience anywhere

Computer parts that are now obsolete

5.25 inch diskette, 20 pound portables, 2400 bps modems, CGA Monitors, DOS 2.1

Turbo switches, PostScript, EISA, Hand scanners, TSRs, Memory Managers

16 MHZ 386s, Daisy Wheel Printers

Demographics, Market Saturation

Accounts as to how many U.S. citizens are using the Internet vary widely. Personal computer saturation rates are about 40 percent of all U.S. households (about 38 million homes). [Peter Clemente, The State of the Net, (New York: McGraw-Hill, 1998).

Of critical importance to the use of the Internet, and related pleasurable experiences, are the power and speed of the PC, the method of accessing the Internet server, and the capabilities of the server.

Most Internet users access the Internet using a service such as America On-line (AOL). The present number of AOL subscribers (11 million) represents more than the combined daily readership of three prominent national newspapers (The Wall Street Journal, New York Times, USA Today). [Symphony Orchestra marketing and the Internet, Dileep Gangolli, August, 1998].

Computer components

Hardware

Chip

IBM PC, Intel’s chip

Pentium I or II or non-Intel chip

Next big chip, Merced, 64 bit processing, 800 Mhz,

Memory

32 to 64 megabytes is usual now, can be 128 to 512

Hard drive at least four gigabyte

Video memory at least 2 megabytes

Monitor14 to 17 inches

Resolution

CD Drive

Soundblaster

Programs

Music

Mouse

Ball, trac, remote

Zip drive

Iomega 100 MB

Scanner

Canon, HP, Epson

Omnipage pro

Modem

US Robotics 56, V90

Printer

HP, Canon, Epson

MFD Multifunction device

Copier, printer, fax, scanner

Best monochrome one is Canon’s $599 MultiPass L6000

Portable Computer

BIM Thinkpads outdo most desktop PCs

770E for presentations with 14.1 inch screen

600 with 13.3 inch screen and under 5 pounds weight

Software

Windows 95 or 98 or NT for businesses

Windows 95

Invented by Microsoft in 1995

One million copies sold in the first 4 days

Running on 162 million PCs now

Word, one of the best for word-processing, such as letters and reports and Fortnightly papers.

Quicken, one of the best for keeping track of family or business finances.

Graphics, to decorate or demonstrate.

Excel and Access, combined with Word in Microsoft Office, as spreadsheet and database.

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Internet & Mail

Email

An excellent way for quick and easy letters to friends and businesses without the problems of "phone tag".

Server

I use EmpireNet, the library’s server that provides a free website to the Fortnightly Club and to Kimberly Crest, because of their easy access and helpful tech service.

Netscape or Internet Explorer

Quick and easy access to worldwide information on any subject you choose.

Internet2

Superfast network built by more than 120 U.S. universities for education and research

Some special uses

Information gathering

City government Web site opens up city government

SB County Sun, October 8, 1998. Cities all over the county have been turning to the Internet to try to make things a little easier for people who are crunched for time, but still want to keep up on what’s going on.

The City of Redlands opened it Web site last month, which gives the public access to City Council agendas, Job openings within the city and allows people to sign up for recreation classes ¾ via the computer.

City Manager Gary Luebbers said, "It’s a real good way to make ourselves available to the whole city. They can find out what’s going on at a council meeting, look up rules and regulations, and even apply for a job. Public works is already getting questions about potholes, graffiti and the likes. Soon computers will be in every household like a television."

Highland’s city manager added, "It saves the city staff a lot of time and the general public time and money ¾ and they don’t have to drive.

Yucaipa is updating its web site. Loma Linda hopes to have a web site going by January.

Electronic patient-physician communication

AMIA Guidelines

American Medical Informatics Association recently published recommendations to guide computer-based communications between clinicians and patients:

Internet Uses for Physicians

Physician search

Patient access

Medical information, self-help, support groups, medical experts

Presently in universities where students have email, contact with health service has been accepted

Linkage of patient data across multiple institutions for care or research

Videoconference e.g. parents of prematures conference with neonatal intensive care unit

Promise of Medical Email

Patient education

Make appointments

Prescription refill requests

Request information

Low sodium diet

change of insulin dosage based on home monitoring or glucose levels

Answers to frequently asked questions could be chosen by menu

Patient reminder of oncoming visit

Allow frequent brief contact

Ease and speed of adding email info to patient’s record

Asynchronous mode of communication

Unlike telephone which requires both parties to be available at the same time, allows continuous access to the health care system.

Potential pitfalls of e-mail

Inappropriate use of communication tools

Urgent or serious condition

M.D. report of bad confusing or complicated news

Security and confidentiality

Workplace or home email access by others

Encryption with private "keys" is under study

Most violations are by authenticated persons

Need to develop institutional confidentiality policies, education programs, and effective legislation

Guiding patient communication

Need for indicating urgency

Message too long

Small window for text entry

Messages too frequent

Medicolegal liability

Unanswered urgent or emergency mail

Method needed to signal these

Need feedback to patient of received and read

Inequitable access to technology

Present skew to better educated and wealthier

With time computer access will increase. Use

40 million people in U.S. use the internet [[Hof RD et al. Special report: Internet Communications. Business Week. 1997;5 May, 64-92]]

Job Search

JobSmart, run by a regional public library agency in San Mateo, Calif., offers links to 50 free salary surveys on the Web that draw about 4,000 visitors a day. Exec-U-Net, a for-profit job search network, divulges free information about the salary, bonus and stock options offered for about 650 upper-management positions entirely updated every two weeks. For a fee, users can get more specific information and contacts for those listings.

Gender of Computer

What Gender is the Computer?

A pastor of one church, who was previously a sailor, was very aware that ships are addressed as "she" and "her". He often wondered what gender computers should be addressed. To answer that question, he set up two groups of computer experts. The first was composed of women, and the second of men.

Each group was asked to recommend whether computers should be referred to in the feminine gender, or the masculine gender. They were asked to give 4 Reasons for their recommendation. The group of women reported that the computers should be referred to in the masculine gender because:

1. In order to get their attention; you have to turn them on.

2. They have a lot of data, but are still clueless.

3. They are supposed to help you solve problems, but half the time they are the problem.

4. As soon as you commit to one, you realize that, if you had waited a little longer you could have had a better model.

The men, on the other hand concluded that Computers should be referred to in the feminine gender because:

1. No one but the Creator understands their internal logic.

2. The native language they use to communicate with other computers is incomprehensible to everyone else.

3. Even your smallest mistakes are stored in long-term memory for later retrieval.

4. As soon as you make a commitment to one, you find yourself spending half your paycheck on accessories for it.

Summary

My message is

• Get a computer and use it as a tool.

• Use it to ease, augment, and speed your activities.

• Remember when initial frustrations occur . . .

I make housecalls