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Finding the Best Medical Professionals Using the Internet in Six Steps

Image of Medical Professionals Research Spreadsheet

Introduction

This topic is close to my heart. There are those I love who really really need to get medical attention but have been frustrated by the ineptitude of some medical professionals. I’m writing this for you – yes, I really mean you! Pretty Please???

I’m also writing this to you, passing traveler on the information highway, because I want to see you find the medical care you need as well. I know you may be frustrated by multiple negative experiences, but I hope you’ll try using the method I outline below – I have been repeatedly satisfied with the results.

1. Finding Medical Professionals Covered By Your Health Insurance

The first step is to pull up your health insurance website and find the directory of providers covered by your insurance.[1] Here are links to those directories of providers on several of the largest health care insurer’s websites:

To get accurate results you’ll need to enter information about the health insurance plan you have (see your health insurance card) as well as the geographical locale in which you live. You should see a list of providers once you have provided the necessary information. Found it? Great!

2. Creating a List of Medical Professionals

Your next step is to create a list of medical professionals covering the sort of care you require. At this point I recommend creating the list without concern for who will be best or worst – instead, look at how close they are geographically to where you live.

I find that it’s best to add all of these individuals to a spreadsheet, and I’d recommend using Microsoft Excel,[3] Google Sheets, or AirTable. I’ve created a list provider spreadsheet template/example you can use.

Image of Medical Professionals Research Spreadsheet

In the first row you can place your column headings, which describes what will go in that part of the listing. I recommend starting with Provider Name, Distance (from your location), and Location (city).

Once all of the potential medical providers are listed in the spreadsheet, we are ready to move on to the next step…

3. Adding Health Professional Reviews to Your Spreadsheet

The next step is to go to a search engine (Google and Bing both work well) and to type in the title and then name of one of the providers followed by the city they are located in. This helps ensure that you get results for the correct practitioner – oftentimes multiple providers share the same name – even unusual ones!

In the image below you can see the results I received when entering “dr michael looney delmar” into Google. Notice how there are stars next to some of the results? These are the ratings the people on these review sites have given Dr. Looney–just like a product review on Amazon! You can visit the sites to see more details, but usually what we need is available right on the search results page. We are looking for the name of the review site, the rating the provider received, and the number of reviews the average is based on.

Image of Google Search Results

Now the spreadsheet you’ve created will need additional columns- two for each health review site we want to use. I have found the following to be among the most helpful review sites:

  • Healthgrades
  • Vitals 
  • Zocdoc – The nice thing about this one is that you can set up appointments through the web and there tend to be numerous reviews for doctors who participate in Zocdoc.
  • RateMDs
  • UCompareHealthCare
  • Wellness
  • PatientFusion – Good resource, but reviews seem to be largely limited to practitioners who use PatientFusion.
  • WebMD – They got into the game quite late, and while I expect them to continue to grow in quality, it’s hit or miss whether there are reviews of any given practitioner.

Here is a screenshot of the example spreadsheet I mentioned previously:

Image of Medical Professionals Research Spreadsheet

Note what I’ve done:

  1. I’ve shrunk the size of each column relating to the review sites as small as I can. This allows us to see all/most of the relevant rating info at once instead of needing to scroll right and left.
  2. I’ve shrunk the names to fit within the columns by using an abbreviation.
  3. I’ve created a column on the far left that explains the abbreviations I’ve used, for example, HG means HealthGrades.
  4. For each review listed on the Google Search results, I added the rating to the first column for that review site and then the number of reviews to the second column for the same review site.
  5. I also created another column that covers sites that I’ve found don’t usually have reviews of practitioners, but when they do can be a helpful source of information – in this case Facebook and Yelp.

I usually look at the first 2-3 pages of results to see what review sites/ratings show up. You’ll note that a number of the review sites columns are empty – this is because the review site/rating did not appear in the search results I’m seeing. That is perfectly okay!

You’ll then repeat this process for each provider on your list.

4. Picking the Best Medical Providers from Our Spreadsheet

Once we have our spreadsheet filled in we can begin to analyze the list of providers. Look for those with the highest scores across the most sites and from the most people. Soon you should have a few stand-out choices. If you don’t come up with any good choices, you can go back to the health insurance site and look at other providers further away. I know that isn’t what you want, and in most cases you shouldn’t need to, but it does happen sometimes – especially if you live in rural areas.

A couple tips on choosing the best providers:

  • I like to bold scores / number of reviews that are particularly high, this helps certain providers to stand out – especially if they have good reviews across several sites.
  • I like to italicize reviews that are particularly low, especially if they come from a high number of reviews. Again, the providers who have consistently poor scores across sites should begin to stick out as well.
  • While searching you may notice news articles or other helpful sites outside of review sites about a given provider, these can be of significant value.
  • Because you are looking at the consistently highest rated providers you may run into a few who have full schedules or for some other reason can’t see you, that’s okay, just move to the next person on your list.

5. Additional Things to Consider When Choosing Healthcare Providers

  • Don’t abandon the tried and true ways of finding a provider – talking to friends, family, co-workers, and neighbors! Their advice can be golden and you can then validate their recommendations by adding them to your list. You may find there is significant overlap between who people local to you recommend and who seems the best based on online reviews.
  • Don’t forget to talk to any medical providers you currently have that you do like. They are often more than willing to make referrals to other providers who can meet your needs. Once again, you can validate the recommendations by adding them to the spreadsheet and comparing them to the providers you have looked at on your own. Hopefully you’ll see significant overlap!
  • Remember that we humans tend to review services we feel strongly about – positively or negatively. Just because a doctor has some bad reviews doesn’t mean they are a bad provider overall. This is why I recommend looking across multiple review sites. In general, the more data you have, the more accurate the results (which providers are best) will be.
  • In my experience, some professions have generally lower scores than other professions. For example, you may find pediatricians who have 5 stars on multiple sites from multiple reviewers, whereas for psychiatrists or oncologists you might find that the highest scores are 4’s. There are various reasons for this, one being that some professions deal with more intractable problems than others.
  • Just because the reviews say so, doesn’t mean the medical provider is perfect or infallible. Use your own best discernment to determine whether the provider is a good fit for you.
  • Some really good practitioners are eccentric or abrasive. You have to decide if their particular type of eccentricity / abrasiveness is something you are comfortable with. For me, I don’t mind a practitioner who lacks social graces and is a bit abrupt at times, but this may not work for you – and that is okay.

6. Getting the Care You Need at the Appointment

Some medical professionals will walk you through the care process from beginning to end. Others will do so only if you specifically point out to them the issue you are having. Yet others will be effective in their particular niche but won’t provide any sort of overall support when multiple providers are involved. I think all of these types of providers can be good providers – but the way you approach them needs to be different. Don’t assume that the doctor knows what you need or want, tell them the information you believe is relevant (try to be as concise and specific as possible).

If the provider recommends a medication or treatment and there is another you’d prefer, tell them so, and ask them if that would be okay or if there are specific reasons they are recommending one course of treatment over another. Providers oftentimes have a “go to” treatment/medication that they have seen success with, but if you mention another treatment of equal quality, they’ll oftentimes be willing to start you off on that medication/treatment.

Don’t be afraid to leave a provider that you feel is not meeting your needs, or who is not willing to work with you to get those needs met in some practical way–even if other people have had a good experience with that provider. Sometimes things just don’t work out, and that’s okay–but it shouldn’t hold you back from receiving the care you deserve.

Your Thoughts?!

What are your thoughts on this article and process? How do you find quality medical care providers? Is there anything unclear in the article? I look forward to your feedback!

  1. [1]If you don’t know the website of your healthcare provider type it into a search engine like Google or DuckDuckGo and it should appear in the results.↩
  2. [2]Requires you to login to your online account. Come on UHC!↩
  3. [3]If you don’t have a copy of Excel available, you can use the free online version.↩
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Turmoil in the Medical Transcription World – A Career Path Full of Potholes and Dead Ends

Photo of a Pothole in a Road

In my last post I discussed working from home in general.  In this post I’d like to delve a little more specifically into what it is like to work in the medical transcription field.

Many people are familiar with the term medical transcriptionist.  We are also known as medical language specialists.  I think that is actually a more accurate title, because to do this job well requires so much more than typing.  You have to understand what you are transcribing and have a really good grasp of anatomy and physiology as well as medical terminology, pharmacology and grammar.

The medical transcriptionist listens to and then transcribes recordings of physicians describing their interactions with patients.  These may include clinic visits in cardiology, gastroenterology, neurology, psychology, orthopedics, physical therapy, etc.  You may type emergency room visits or descriptions of surgical procedures.  If you were to work for a local physician, say a neurologist, you would type mainly neurology reports and you would quickly become proficient in neurological terminology.  When working for a transcription service you must be proficient in all the specialties and familiar with all the medical terminology that goes along with them. In addition to that you will have a very large number of physicians you will be typing for, which often presents a challenge as you strive to learn all of their varying accents and idiosyncrasies.

With the advent of new technology the transcription of reports is frequently being replaced with editing of reports.   Computer software translates the physician’s spoken words into text which the transcriptionist then must edit while listening carefully to the dictation.

I personally prefer typing over editing, finding editing too monotonous, but I know people who love to edit.   You can edit more lines per hour than you can transcribe, but don’t get too excited – the companies also pay less per line for editing!  For transcribing dictation the rate may be 8 cents per line but the editing rate will probably be closer to 4 cents per line.  Yes, as a transcriptionist you work for pennies!  These pennies really do add up though and it is possible to make a good income as a transcriptionist or editor, but it takes a lot of skill, determination and self discipline…and often a good dose of luck as well, as I’ll explain  in just a bit.

There are, however, many drawbacks in the field that make it difficult to earn that good income. “Back in the day” it was a lucrative career, a profession.    Today it can be quite difficult to make even a decent wage in this profession.

I am currently sitting here typing this article instead of working at transcribing reports because there is no work available this morning.  I was tired, but got up with the 4:30 a.m. alarm to prepare for my day at work.  Settled in at 5 and ready to begin my workday when the all-too-familiar message appeared on my screen “While your queue is empty, work arrives continuously.  Please contact your QManager.”  Well, 1 hour and 20 minutes later and still that continuously arriving work is nowhere to be found!

I didn’t even bother to contact the QManager this morning…choosing instead to write this article. The days I do contact the QManager I either get a message back saying “keep waiting, work is slowly coming in”…in other words, there is no work, sit tight and eventually there will be some.  The other option is that the QManager will find another account and have me begin work on that.  This can be a frustrating process as new accounts mean reading through pages and pages of instructions about what the client (hospital) expects.

There is so much variation from client to client. For example:

  • Some want their headings in bold, all caps while some want them in bold mixed case while others want all caps, but no bold.
  • Allergies in caps or not, bold or not.
  • Number all lists.  Don’t number lists.  Only number medications.
  • Patient names allowed in the report.  Patient names not allowed in the report.
  • Remember Dr. So and So; he wants to make up his own rules which you need to remember too.

You are expected to study these rules and remember them (or have notes everywhere as reminders!).   This is something that is done for every hospital or clinic you type for.  I currently have 4 hospitals I type for….so 4 sets of rules to keep straight.  You might type 3 reports for 1 hospital, then 2 for a different hospital, back to the first hospital for 1 report, onto a different hospital for 2…so you have to keep all these rules for all these different clients straight. So, sometimes I would rather be out of work and not typing than wading through trying to learn all these new rules for a temporary account.

One of the big downsides of being a transcriptionist is that we are only paid for those lines produced which means the time you spend studying those client expectations, time spent reading emails from your supervisor, time spent researching medication doses or unfamiliar terms or the name of the taco joint in St. Louis, Missouri the doctor mentions that the patient works at….all the time you spend doing any of these things you are not compensated for. The time spent waiting to see if any work comes into your queue isn’t compensated for, either (I know of one company that will pay you for up to 15 minutes of out of work time per day; not very helpful if you are out of work for 2, 3 or 4 hours!).

How many other professions are there where you are expected to report to work on time and not get paid if when you get there they have no work available for you to do?  This policy seems like a real injustice to me, but it is the norm in the medical transcription field.

Some companies require that you stay near your computer and “keep checking back” throughout our shift for work.  Some employers offer “flex time.” If you come to work and there is none available you can request flex time.   This is helpful in a way as you can then go do something else for a while and work again later in the day when there is work available again.

But what if your schedule isn’t flexible?  I’m currently caring for my elderly mother who needs my full attention during the day…I get up early in the morning to work, before she is up.  If there is no work I don’t have the ability to come back 3 or 4 hours later to see if there is some available.  The result?  No pay for the hours lost.  This can make budgeting difficult and this lack of having a consistent dependable income is one of the biggest problems that I see for the medical transcriptionist.

There is another practice in the medical transcription field which I really don’t understand or like, because it means two transcriptionists with equal skills can be earning very different income based on the accounts they are doing and the rules of those accounts.

Let me explain.  We are paid by lines…so for example for every 65-character line we might be paid 8 cents for typing or 4 cents for editing.  I recently had been working at one company where my accounts were all straight typing, which I loved!  I had one account which had many macros (pre-typed text you can copy and paste into the report; this only takes seconds, but you get credit for all those lines just as if you had typed them) and it also had text often plugged right into the report, so before you typed anything at all you might already have 30 or 40 lines to your credit.  Other accounts never did this, so my line counts were always much lower when I worked on those accounts.

There are also varying rules for each account regarding how many blanks you can leave.   The transcription companies put a lot of weight on how many blanks you leave and it counts against you if you send in too many reports with blanks.  The problem comes when one account might allow you to have 3 blanks in a report and not send it in for corrections while another account allows no blanks.  So it’s harder for the medical transcriptionist on the account with zero blanks to keep her submission rate low than it is for the transcriptionist on the other account, but there are no allowances for this (at least not at any companies I’ve worked for).  Since this is often tied to the amount of money you make it really can be more of a situation where luck of the draw (which account you are on) determines your paycheck more than how good a transcriptionist you are or how hard you are working.

One company I know of will reduce your line rate to a mere 7 cents per line for straight transcription if you send more than 5% of your reports to QC for corrections.  Many times these submissions are not the transcriptionist’s fault.  I have had to send in reports when there was no dictation, the attending physician’s name was not dictated, or some other similar situation which couldn’t be avoided…these reports counted against the QC submission rate and can result in a significant decrease in pay.  All rewards for 100% accuracy and high line counts disappear if the QC submission rate is deemed too high.   We are always told not to guess, to flag anything we are unsure of – but if we do it just one too many times we can pay for it, literally.

I actually had this happen to me (I went from 11 cents a line to 7 cents a line) because I was 0.1% over the quota for that pay period…and I know that I had 2 reports during that time that were no dictations; it was almost certainly one of those reports that caused me to exceed the limit and lose several hundred dollars in pay that pay period.

I am writing this article not to discourage anyone from becoming a medical transcriptionist, because there are some positives things about this career, but there are also many downsides and I hope this article helps you go into it with your eyes wide open.  The charge for tuition to learn transcription is significant and learning this trade also requires substantial investment of time.

I went into this profession expecting to make very good wages and be appreciated for producing quality work.  Neither has happened, in nearly 12 years as a transcriptionist.  One of these days I will go back to school and finish my degree and get a better job.  But for now, I type on.

If you choose this profession I wish you well.  I hope you are one of the fortunate ones who can find a company that rewards your efforts and skill appropriately.

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Infographic: How Childhood Trauma Affects Adult Life

I believe that childhood trauma has a significant and formative impact on who we become as adults. The impact can be mitigated by a supportive community during and following the trauma, but such support seems to be the exception rather than the rule. In adulthood we can work to heal the wounds trauma inflicted upon us in childhood, but in my experience, there is always a scar that aches and perhaps tears at times.

The danger when talking about the effects of childhood trauma on adult life is two-fold: (1) We may assume of ourselves that we are inferior to others and (2) others may assume that we are inferior to them.

It is true that we may be changed by what we have experienced, but that  sword is double-edged – we may be hobbled in one area, yet ahead in another. One of these days I need to read Wayne Muller’s Legacy of the Heart: The Spiritual Advantages of a Painful Childhood as I suspect he will flesh this thesis out in detail.

Example: During my childhood there was the necessity of separating emotions from actions. This has resulted in a struggle in adulthood to feel, experience, and express my emotions – both negative and positive. Yet the strength that has grown out of this trauma is my ability to remain reasonable within difficult situations. This allows me to function well during a crisis in which action is required or in conflict where I am able to remain calm in the midst of being (verbally) assaulted.[1]

With this danger acknowledged, and with the hope that others will recognize the strength within their wounds and the strength of others in their wounds, here is the infographic “The Impact of Childhood Trauma on Adult Disorders”:

 

 

Infographic Depicting the Impact of Childhood Trauma on Adult Disorders

 

  1. [1]At the same time, my ability to do so doesn’t mean that I should always do so. There is a cost I pay for such restraint and it manifests itself after the conflict is over, often physiologically. Now I choose when I use this ability and when I don’t – knowing the cost.↩
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Floating in a Sensory Deprivation Chamber: Personal Recollection.

Strange

Float Tank Path FinderAfter watching The Perfect Storm[1] I became a commercial fishing deckhand in Alaska for a summer.[2]

After watching some episodes of Fringe (see also Amazon) and Altered States (see also Amazon) I decided I wanted to experience a sensory deprivation chamber.

What do these two scenarios have in common? My interest was sparked by the stories – stories which, to many, cause fear or aversion.

I have theories as to why I am this way (attracted to, rather than repelled by), but I’ll leave those for another time…

Sensory Deprivation

The cultural knowledge of sensory deprivation chambers / isolation tanks is generally sourced in their portrayal on the recent TV show Fringe, a pseudo-X-Files.[3] Unfortunately, I couldn’t find an image or a clip which does justice to the horrifying nature of the lead character’s (Olivia) experience in the chamber.

Luckily, the 1980 classic Altered States‘ trailer[4] is quite adequate in portraying the horror common in media depictions:

But what is it like to actually be in a sensory deprivation chamber?

Serene Dreams

These days you can find sensory deprivation chambers in stand-alone businesses or at spas spread around the country.  You’ll rarely hear them referred to as sensory deprivation chambers, instead you’ll hear of flotation therapy, or perhaps in medical or academic circles Restricted Environmental Stimulation Therapy (REST).

I went to a stand-alone (no other services like massage, facials, etc. offered) in Kearny (northern) NJ called Serene Dreams. It wasn’t a big building and (I think) there were two entrance doors. I tried the first, I have no idea what the second led to. This brought me into their waiting/reception area. It was cramped – a single couch and two bar chairs provided the seating. I was handed a small stack of papers to read and sign. The papers were the usual disclaimers regarding liability for bodily harm but they also included the somewhat unusual disclaimer for psychological injury.

After a few minutes I was led through a door into a long, wide hallway. There were two rooms on my left along the hallway, but these were both occupied, so I was led around the corner into their third (and last) room. The room looks like a high-end bathroom. There is a beautiful large shower with a gazillion different settings, a sink, and then a large white pod with water inside and a lid that closes.

Unfortunately these rooms do not include a toilet, which would seem ideal seeing one is about to spend an extended period of time floating in water and having a full bladder would be most unpleasant.

The door was shut and I was left alone. The procedure indicates that one first shower so as not to bring anything into the pod with you (the water is purified between each consumer), one can use provided vaseline to cover over any cuts, and there are ear plugs – which you’ll really want to use.

Once the shower is over you can enter the pod. Inside the pod you have a few items. First there is a large button that allows you to control the lighting. These pods aren’t strictly for sensory deprivation, apparently many use them with the lights on.  Secondly there is a help call button that you can press if you are in need of assistance. Finally, there is a bottle of fresh water to use if you get the pod’s water in your eyes.

Why would one need regular water while laying in a body of water? Because the water in the pod is loaded with epsom salt – so much that it causes your body to float. Get that into your eyes and it will sting (yes, I know from firsthand experience).

I climbed into the pod and closed the lid on top of me.[5] I laid down and began to float in the water and then I turned off the lights. It was pitch black. I couldn’t see anything, I knew I was inside a pod, resting in a body of water – but there was nothing to feel, nothing to see.

As I laid there I became aware of some of my bodily problem spots. My right knee was aching, one of my fingers on my right hand as well. The lack of external sensory input was causing me to feel more intensely my aches and pains. Over time these pains faded away and I floated.

They played soft music for the first ten minutes, so I knew when ten minutes had passed – but after that all was silence – there was no way to know the time. So, I laid there, and laid there, and laid there some more.

My brain wasn’t busy – somewhat surprisingly. Nor did I feel tired, I just floated. The water was body temperature, but half my body was above the surface and every once in a while it would feel a little chilly. As time passed the air became stuffy. It hadn’t occurred to me beforehand, but I realized in order not to cause sensation, they wouldn’t be able to pump fresh air into the pod (or if they did, it wasn’t at a speed that could replace the old air with new). I wondered how long one could stay in the pod before suffocating – obviously much longer than the hour I was scheduled for.[6]

Sometimes it felt like time was dragging on. “How much longer?” I would wonder. At the end of the hour the music started again, informing me that there was only ten minutes remaining. I was surprised – could that much time have passed already? It is a weird feeling to be in the absolute dark with no reference to time – one feels almost simultaneously that a dreadfully long period of time is passing and at the same time that it has been only a few brief moments.

When the music stopped I turned on the light, opened the pod, and took another shower. The second shower is to wash all the epsom salt off your body. If you didn’t take a shower you’d look like you were covered with chalk dust after drying for a minute or two…not to mention that if you got the water in your ears there is the small possibility that they could form into crystals and cause ear pain.

I made my way down the long hallway back to the waiting area[7]. Plunked down my credit card and had a nice chat with the receptionist who informed me about how Mugwort’s Tea before bed has helped her to remember her dreams. Hmmm, I might have to try that.

Not That Scary?

No, it wasn’t that scary. So are the portrayals in film completely unreal? Not exactly. In the film portrayals the individuals are almost always dosed with psychoactive drugs such as LSD or mescaline. In addition the individuals tend to spend a much more extended period of time within the sensory deprivation tank.

Was I Happy?

Sure, I was happy. I had done something I’d wanted to do for some years now and I hadn’t panicked or grown so bored I quit. I had spent an hour alone with my own brain and hadn’t gone crazy – which is something of an achievement.

I’ll admit, I hoped for more. I hoped I would fall asleep and have a vivid dream I could process.[8] I didn’t think I had fallen asleep, but when I got home I had a pain in my tongue and it was a little bloody. I have bruxism, which means I grind my teeth in my sleep. Unfortunately, this also means I bite my tongue in my sleep[9] so it seems I may have fallen asleep at least briefly. Still, the sleep wasn’t what I was after – it was the dream.

That said, if I want more out of it I will have to do it for a more extended period of time. Will I do it again for a more extended period? I’m unsure. I’m ADD[10] and laying still for an hour is a challenge for me, laying still for longer seems at the least extremely boring and perhaps edging into torture…but I might.

There is some science indicating that flotation therapy is helpful in chronic pain and muscle relaxation – and I felt some of that. Portions of my body stopped aching, but I think I’d need to be a regular to see any lasting results.

Minor Positive Criticism

I have only a few minor criticisms of the location I utilized (Serene Dreams in Kearny NJ).

  • It would have been really great to have a toilet in the room.
  • The pod wasn’t quite big enough for me. I would occasionally drift into the walls. This wasn’t a major issue, but it did decrease the sensory deprivation experience.
  • I think I may have gone into the pod backwards (feet where my head should have been). This is probably a me problem…

Concluding Thoughts

Flotation therapy isn’t scary at all. Sensory Deprivation is a bit more testing – the pitch blackness and silence may get to some – probably would get to me over a longer period of time. To experience a more interesting psychological experience once would probably have to increase the length of the session significantly or, as the forefathers of this technology did (see Dr. John C. Lilly for example), utilize psychoactive drugs…ummm, okay, scratch that second idea.

  1. [1]Other materials had primed me, this was just the tipping point. I had previously loved Richard Dana’s Two Years Before the Mast and Louis L’Amour’s Education of a Wandering Man.↩
  2. [2]I was a salmon set-net commercial deckhand in Ninilchik. This is not nearly as dangerous as the scenarios portrayed in The Perfect Storm or Deadliest Catch.↩
  3. [3]I had hoped Fringe would be a satisfactory replacement to the X-Files (also Amazon) and at the get-go it appeared to be…but once it became evident that the story arc was becoming one dimensional by focusing on a mega-arc of parallel dimensions, I became disappointed and stopped watching. Monsters of the week episodes had always been my favorite part of the X-Files – which managed to keep an overarching myth without succumbing to it.↩
  4. [4]The depiction in Fringe was at least in part inspired by Altered States portrayal.↩
  5. [5]If you are claustrophobic, this may not be for you – luckily, if you aren’t going for sensory deprivation, you would just leave the lid open.↩
  6. [6]After some further research, I’m fairly certain that the pod was circulating air, it just wasn’t enough to prevent the staleness.↩
  7. [7]The lights were dampened and it was a somewhat more foreboding environment, if I had been coming in instead of going out, I might have felt a spooked.↩
  8. [8]I’m not a fan of DREAM INTERPRETATION but I am a fan of dream interpretation. I mean, I believe that sometimes there are overarching themes which spread across dreams which can be insightful to us, but I’m not a fan of attempting to deconstruct every portion of the dream and assign it meaning. I assume that if my brain really wants to tell me something, it will say it repeatedly (and this has been my experience).↩
  9. [9]I wear a bruxism guard most nights to prevent this↩
  10. [10]ADD not ADHD. I don’t have the hyperactive component.↩
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Fluidstance and the Thief

Occasionally folks reach out to me with a product or service they would like for me to review – Fluidstance was one of said companies. They told me they were shipping me The Level so I could put it through its paces. I eagerly anticipated its arrival…and I waited for it…and I waited some more.

As time passed I figured they must have decided not to send me The Level after all…maybe they decided my blog wasn’t getting enough traffic, maybe they had run out of units to send out to bloggers. I was giving up hope.

Then I received a followup email asking how things were going with The Level. I was confused. Wait, you sent me The Level? When? FedEx delivery confirmation shows that the package was successfully left on my doorstep nearly a month ago. Gahh!

Photo of legs standing on Fluidstance The Level

This is the first time I have ever had mail stolen off my front porch (at least that I am aware of) and it sucks. I was really looking forward to giving The Level a try.

I find my knees begin to hurt after a period of standing at my desk and I have to revert to sitting and I hoped that using The Level might allow me to spend longer periods at a time standing.

So, it sucks for me, but it also sucks for Fluidstance, since they sent me a moderately expensive product for review and I can’t review it because someone stole it.

As a poor substitute, I’ve compiled some resources together below to help those who are interested in learning more about The Level do so.

Gahhh! I just went through the first forty results in Google for “fluidstance” to garner the above reviews and now I am even more disappointed than before. Without exception, every one of the reviews I found in those first forty results where positive!

“But Dave, you should have Google ‘fluidstance review’, that would have given you better results.” You are so right, so I did and found the following:

Well, no, those additional reviews don’t make me feel any better about having mine stolen before I ever laid eyes on it.

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Soylent 2.0: A Better Meal Replacement?

A Little Background

I enjoy eating sometimes but oftentimes it is more of a chore. Unfortunately, eating is a necessity if I want to be healthy, energetic, productive.

Soylent 2.0 being poured into a glass.
Photo of Soylent 2.0 from official Soylent site.

I’ve written about Soylent, a meal replacement drink, in the past here and here. I’ve tried other meal replacement drinks like RAW Meal and Shakeology (also here and there, and up there and down here).

I’ve written about and regularly consume Ensure, I don’t care that I’m not the target audience.

When Soylent started out (and when I first began consuming it) it was a powder which one mixed with water and then added some bottled oils to. It only took two or three minutes to make a days worth and I thought it tasted decent – much less grainy than either RAW Meal or Shakeology – but much more grainy than Ensure.

I Try 2.0

Recently Soylent announced and then began shipping Soylent 2.0 – which comes bottled similar to Ensure. Now there is no prep time, just take a bottle out of the fridge. I purchased my first twelve pack and have consumed them all. I’ve now upped my order to 24 monthly, which will cover almost one meal a day. I expect, if I continue to like it, I will up my order to perhaps 48 bottles/mo., which would make almost two a day.

While I didn’t have a problem with the old Soylent’s taste, the new Soylent is significantly better. It tastes and has the texture of almond milk.

At first I thought I would need to mix something with it to drink it with great consistency and I tried some chocolate syrup as well as some V8 juice – the latter worked rather well. But as I have continued to drink it I find my taste buds developing more and more of a liking for it and I don’t see myself needing to mix anything else into it.

Why Else I Like Soylent

Besides Soylent providing me an alternative to meals there are a number of other techie reasons I like them.

First, their recipe is open source and this has resulted in a cottage industry producing similar products. I’m a huge fan of open source.

Second, they provide release notes with each version as well as providing detailed blog posts about why they do what they do and when problems arise. I am especially fond of the latter.

Third, they are constantly iterating on Soylent. 2.0 is great, but I’m sure 2.1 will be better!

But Dave…

“But Dave, this can’t be as good for you as eating real, organic food for meals.”

You are absolutely correct – thing is, I don’t eat real, organic food for meals. Soylent is a healthier alternative to a lot of the standard American diet / standard Dave diet. So, while not perfection, it is a step in the right direction…

And I won’t stop eating real food altogether. In fact, I may eat healthier the rest of the time b/c I am drinking Soylent. I always feel so time constricted – so much more I want to accomplish in a day than I can – if I feel a little less time constricted I may be more willing to invest in a meal (no promises, but hey, it’s possible!).

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What You Didn’t Know About Canceling Your Health Insurance Through Healthcare.gov

I recently moved into a new part-time position which then became a full-time position and thereupon provided benefits including health insurance. Up until that point Sheila and I had been being hit with fairly large insurance premiums every month, so I was quick to call the insurance provider and request cancellation.

I was surprised when they told me that I’d have to contact Healthcare.gov to cancel my policy. Annoying, but not the end of the world and my guess is it is an accountability measure to ensure that insurance companies don’t cancel policies of individuals without their consent.

I called Healthcare.gov (1-800-318-2596) and asked to cancel my plan effective the 19th of June. I was assured this would be done. Great! I figured I’d have a nice partial refund check sent to me in a few weeks time.

I did receive mail from the insurance company – but it wasn’t the check I had been expecting. Instead I received a bill for July’s premium.

I called Healthcare.gov back and was informed that there was a thirty-day period between when they received a cancellation and when they submitted it to the insurance company. I balked. Thirty days? This should happen (and technologically is feasible) instantaneously!

I pushed back a bit and when they stood firm I acquiesced on one condition – they provide me with documentation of the thirty-day period. At this point I was given a case worker and then I waited to hear anything. Eventually I did hear – they had rolled back my insurance cancellation date to June 30th. This meant I no longer owed the insurance company anything but also that I would not receive a refund.

Today I called in again and was told that there was a 14 day waiting period. That they were sorry I hadn’t been told this before I canceled.

I again request documentation for this new shorter period. They suggested there might be some on the website…I found it: Cancel your Marketplace plan.

I could have canceled 14 days before the actual date I wanted the cancellation to occur if I had known about this 14 day period. I’m sure this may have been tucked away in some long-winded legalese that I reviewed at some juncture or another. I’m not happy about it, but it is a real policy.

Screenshot of cancellation policy for Healthcare.gov
Here is a screenshot of the cancellation policy as found on Healthcare.gov

The reason I share all this is to hopefully help others avoid losing out on premium refunds or being billed after their desired cancellation date.

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Subscription Snacks: Graze vs. NatureBox

I like subscriptions. My razors are by subscription, for a while my toothbrushes were by subscription. I’ve also subscribed to Soylent in the past and plan to again once 2.0 is released in October.

So what about snacks? Recently both Graze and Nature Box provided me the opportunity to try one of their boxes free.[1]

I’ve had three boxes of Graze now and just received my fourth. I’ve received one box of Nature Box. Here are my thoughts…

NatureBox

My box included Strawberry Lemonade Fruit Stars, Sweet Kettle Crunch, Honey Crunch Crisps, Whole Wheat Vanilla Animal Cookies, and Mini Cocoa Belgian Waffles. This would normally cost $19.95.

Picture of Strawberry Lemonade Fruit Stars
Nature Box’s Strawberry Lemonade Fruit Stars

I loved the fruit stars and kettle crunch. I really enjoyed the animal cookies and waffles. The honey crunch crisps are good, but not my favorite.

The size of the portions are significantly larger than those provided by Graze – and this was actually a problem for me. I’m not the best with portion control, so I like single servings of snacks – that way I can better gauge and control the amount of a snack I’m eating.

In addition, some of the snacks were just too good. The fruit stars and kettle crunch I could easily eat in a single sitting.

I guess what I am saying is, their food is great – but for me personally it isn’t optimal. I am looking for foods that satisfy with fairly small portions and that are divided into single portions.[2]

At first glance one gets a little shock from the pricing. $20 for a few smallish bags of snacks? But if we do a little math we find it isn’t that bad. There are five snacks, so each snack is $4 and each snack has four or five servings, so you are looking at around $1 per serving – the same as you’d pay for a candy bar…but Nature Box offers half the calories and better nutrition.

Graze

There was a problem with my original order with Graze. Somehow I got (and was charged for) a second box before I ever received the first free one. Graze was cool about it though and refunded me for the second box.

Photo of Graze's Fruit and Seed Flapjacks
Graze’s Fruit and Seed Flapjacks

My first box included triple berry smoothie, herby bread basket, honeycomb flapjack, and chili & honey almonds (no longer available). These were all tasty and several of them were quite satisfactory as far as satiating effect.

My second box had jalapeno fiesta, fruit & seed flapjack, hot cross yum, and salsa corn chips.

It was the second box that actually really caught my attention – primarily because of the ingredients. For example, the Fruit & Seed Flapjack contains rolled oats, dried apricots, dried dates, sunflower seeds, raisins, currants, and pumpkin seeds and were delicious!

In my third box I received sesame garlic crunch, vanilla almond granola topper, iced cinnamon bun, and hickory smoked bbq – again, all great tasting!

Again I was impressed by the nutritional quality. My Sesame Garlic Crunch contained canola oil, sesame seeds, oat bran, dried garlic, steamed jasmine rice, soy sauce, and so on. Meanwhile my Vanilla Almond Granola Topper included almonds, pumpkin seeds, barley, coconut, cinnamon, and so on.

This box was seriously about perfect for me as far as being satiating and nutritious. I could list the ingredients from the other items, but you’d just get bored (ohh wait, you already did? sorry!).

I haven’t had a chance to dive into my current and fourth box, but I’m looking forward to it and expect that I will enjoy it as much as the previous ones.

Ohh, and did I mention that while the portions are smaller the price is less $12 for eight single serving snacks – that works out to $1.50 per snack.

Concluding Thoughts

Both Nature Box and Graze make great products and either can be a great fit for you. In my specific use case I’m leaning heavily towards Graze. I like the satiating quality of their snacks (Nature Box probably has more satiating snacks I haven’t explored, but Graze seems to just come with them), the nutritional value, and most importantly – the single serving packaging.

For many years of my life I would have considered this an unconscionable amount of money to pay for snacks…it was still hard for me to shell out this much for a relatively small amount of food (I could buy 12 boxes of Good & Plenties for this same amount!) but I’ve decided that it is a wise investment.

While it may be more expensive it helps me consume less overall and improves the nutrition of what I do eat. I figure, in the long run, the decreased cost in medical expenses will even out for the increased cost.

If you want to get a free Graze box, use this link. Or you can enter the reward code DAVEM6YKP while ordering.

  1. [1]This wasn’t a special offer made to me personally, rather I received coupons or otherwise saw ads, etc. for free boxes.↩
  2. [2]I’ve thought about getting larger supplies and breaking them down into single serving bags for myself, but for various reasons, including the psychological research that indicates we have a finite amount of willpower, I have decided against that approach.↩
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The Adjustable Standing Desk I Chose

I’ve wanted a height adjustable, sit / stand desk forever. Yes, literally, forever.

In 2012 I wrote an extensive survey of the sit/stand desk field of products and two years later when I still didn’t have a sit/stand desk I updated and expanded my already extensive survey.

Then I never told you about the desk I actually ended up with (thanks to my wonderful wife, Sheila). Well, I’m about to right that wrong.

I ended up purchasing a MultiTable ModTable. Yeah, that is a mouthful…and unfortunately, they don’t own the modtable domain, so go to multitable.com.

I chose to go with ModTable because

  1. Their prices are about as low as you can go for a real, true height adjustable desk.
  2. The reviews I found about the company’s desks were favorable.
  3. They offered a hand crank model.

Wait, I went with a hand crank model? Yup. I thought about going electric and while it was tempting I decided that a hand crank would probably last me many times longer.

This is my ModTable in sitting position.
This is my ModTable in sitting position. Click on the image to see a much larger image of the same.

The hand crank is a simple mechanical mechanism, unlikely to break – whereas electronic components almost always break down eventually. I have hopes that I’ll still be using this desk ten, even twenty years from now.

Because I want to be a hobo (of sorts) someday I went with a Medium top (24″ x 48″) so that it could fit into a travel trailer, etc. without too much trouble.

I splurged and bought a CPU holder ($100). I initially bought a Belkin keyboard and mouse tray through Amazon, but ran into some trouble getting it to adjust correctly (may have been a broken model or may have been my lack of mechanical skill) and returned it. I’ve planned on getting the keyboard/mouse tray from ModTable but just never got around to it.

Even if the Belkin had worked, it would have been a hack job. The metal crossbeam runs under the middle of the desk and most mouse/keyboard trays are made to have their track run vertically and the crossbeam sits firmly astride its desired path.

This is my ModTable in standing position. Note that it is still significantly lower than its maximum height [insert short joke here].
This is my ModTable in standing position. Note that it is still significantly lower than its maximum height [insert short joke here].

I did not buy the monitor arms. They were attractive but I opted instead for monitors that were height adjustable in and of themselves – which have worked out quite nicely.

I’m supremely happy with the table. The components all seem to be high quality. My only thoughts for improvement are as follows:

  1. Is the central crossbeam necessary? Could there be a model without it?
  2. The manual crank sticks out a bit and is easy to walk into. You can pull it out so that it isn’t in the way, but then you have to put it back in…which is a very minor annoyance, but if there was a way for the handle to fold under the unit, out of the way, that would be amazing.
  3. Could it go a little lower? I’m on the vertically challenged end of the spectrum and technically the height of the table top is still a little too high for me ergonomically….if I ever get around to getting the keyboard/mouse tray that will drop it to the correct height, but, still, it’d be nice to go down to say 25 in?

As far as any suggestions to those who may be considering buying a ModTable themselves, here are my thoughts:

  1. If you aren’t planning on living/working in tightly constrained quarters, splurge for the larger top size.
  2. Make sure to install the CPU holder far off to the side, otherwise you’ll be kicking it when you are sitting down.
  3. Splurge for the CPU holder and the keyboard/mouse tray off the bat.

Let me conclude by talking about expense. I’m used to owning used desks or pressed board desks – the kind you can pick up fairly inexpensively from Walmart, Target, or Ikea. ModTable is inexpensive compared to other height adjustable desks, but it is still expensive for those of us who frequent thrift stores for our furniture needs.

I heard (I think it was over at Lifehacker) that one should invest one’s money where one spends one time – which makes a lot of sense. Spend money on what you use most in life – a bed, a desk, a car, etc. For me and many like me, a desk is one of those things and the extra expense is worthwhile for our comfort as well as for our health.

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Soylent: A Viable Meal Alternative?

The Journey to Soylent

On June 27th, 2013 I began anticipating Soylent, talking about Soylent, impatiently waiting for Soylent to become available. I signed up for a week’s supply of Soylent on June 10th and it arrived on July 22nd.

A picture of my box of soylent...and of course, my feet, b/c I'm talented with cameras like that.
A picture of my box of soylent…and of course, my feet, b/c I’m talented with cameras like that.

Inside was a long sheet with instructions…I’m not a fan of the big sheet…What am I supposed to do with this? Unless I hang it on my way there is no easy way to store it.

The awkwardly long Soylent instructions.
The awkwardly long Soylent instructions.

You can click on the above image to see how long the instructions really where, but it would have consumed too much space on the page for me to embed the image here.

Next we had the bags of Soylent and the bottles of oil. You can see a picture below.

What came in the first Soylent box I received - instructions, oils, and soylent.
What came in the first Soylent box I received – instructions, oils, and soylent.

Theoretically, I should have received a package before this one with my welcome pack – which was to include a stainless steel measuring cup and an airtight pitcher as pictured below:

Stainless steel measuring cup from Soylent.
Stainless steel measuring cup from Soylent.

 

The Soylent pitcher - yes, it is BPA free.
The Soylent pitcher – yes, it is BPA free. Ohh, and mine doesn’t look like this, the main body is clear, the handle and lid are green, and it is entirely unbranded by Soylent…I think there is a name of some other company on top…

But I hadn’t and I didn’t for quite some time. I attempted using some of my own implements to make Soylent but had mixed successes. If this was what Soylent tasted like, I wasn’t going to stick with it. After a few tries I decided I would just wait until my welcome package came.

Ohh, and yes, I sent an email reporting the missing welcome package on the 23rd and of course received the usual automated reply the same day. It would be August 9th before I would receive a reply from Soylent and then to be informed that “I have forwarded your concern to our shipping department…” Then silence. Finally, on August 18th I received an email informing me that my starter kit was on its way.

Okay, that is a pretty ridiculous wait…the organizational side of Soylent has been extremely underwhelming…I’m not sure all of what happened behind the scenes, but, honestly, I don’t care that much if Soylent is good and works and if they learn from their mistakes – which, it seems (I hope), they are doing.

On a side note, the disorganization worked out to my advantage as I received a second shipment of Soylent by accident and when I asked what I should do with it they told me to keep it. I was pretty happy about that (though I feel bad for folks who ordered far before me and way more and still have not received their Soylent).

But How About It, Is It Good?

Now that you have heard about the nightmare of procuring my Soylent, lets talk about Soylent itself. It is a very fine mix and comes in bags that each contain three meals. I found trying to make Soylent in smaller portions to be a hassle – not only because of measurements and so on but because the powder is so fine that it puffs up into the air and lands everywhere while scooping.[1]

In any case, I moved to making a whole packet at a time and it was so much easier. Okay, I know for those of you who cook, you are rolling your eyes – and yes, in the distant past I did sometimes cook – but the whole point of Soylent is to save time and improve nutrition.

Making Soylent was now simple – pour in the powder, add a bottle of oil, and then fill the rest of the pitcher with water. Screw on the air-tight cap[2] and shake for around sixty seconds. Place in the refrigerator, remove when ready to consume, shake for five to ten seconds, then pour yourself a glass and enjoy.

Soylent tastes a bit like a milk shake. It has a pleasant flavor, though one I can’t place. Compared to any other powdered drink (Shakeology, RAW Meal), the “graininess” is almost non-existent.

It tastes good, the texture is good, and its easy to make – sweet! Another surprising and positive note is that it uses water not milk or a milk substitute and yet tastes better than Shakeology with (in my case) almond milk! Seriously, if you didn’t see the batch mixed, you’d swear it had to have a dairy base.

So, I like my Soylent and I intend on continuing to consume it. Right now I average two meals a day of Soylent and one meal elsewise. I allow myself to eat whatever I desire for that third meal – but my cravings for unhealthy foods seem to have lessened somewhat (not completely).

Should you get Soylent? Sure. Just be prepared to wait a bit. I think organizationally they are getting there, but with the delays initially as well as the huge demand, and then the ongoing demand for resupplies, it is going to be a while before Soylent is working smoothly.

A Few Importantish Notes

It Goes Bad

One of the great things about Soylent is that it lasts forever (hyperbole) in powder form. Something I didn’t realize until I received my Soylent is that once it has been mixed with water it needs to be consumed within two days. Apparently due to the nutrient richness of the drink, even while being refrigerated bacteria multiply quickly. I would like to know more about the health implications of this.

I oftentimes eat food far past its expiration date – especially dairy alternatives (almond milk, soy milk) and don’t have any problem…so I’d probably ignore this warning except after posting on the forums I learned that the bacteria make the taste go bad quickly – so its not just filled with bacteria, it tastes nasty too.

Still, I’ve been consuming Soylent over a two to may three day period and haven’t experienced issues thus far…and making it in this size batch saves me from measuring, etc.

Don’t Forget The Oils!

Each time you use a bag of Soylent you are supposed to add the oils as well – which provide some important aspects of Soylent’s nutrition. Being ADD, I have on occasion forgotten to put the bottles into the Soylent. This doesn’t bother me, but it is a dilemma – what am I supposed to do with these bottles of oil?

Flatulence

There was a lot of discussion of increased flatulence when using Soylent which, it is hypothesized, is caused by the bacteria in our stomachs not knowing how to handle nutritional food and the replacement of some of these bacteria with better bacteria that do consume this food.

I had no intention of mentioning flatulence, b/c I really don’t like talking about it. I was never a fart guy joker…but I must mention it, b/c it radically increases flatulence and it smells horrific.

This goes away after a few days – but my recommendation – start Soylent when you aren’t spending a lot of time with people…and please, give your spouse a break and sleep on the couch…or at least let them sleep on the couch.

What Now?

My plan at this juncture is to continue Soylent 2x daily long-term. We’ll see if I grow sick of the taste…which is very possible.

I haven’t noticed any huge changes in my health, but that may come with time. I also am hoping to get my blood drawn and analyzed every quarter by WellnessFX so I can monitor my health, especially vitamin levels, but that hasn’t happened yet.

Wrapping It Up

Soylent is great – I’m exceptionally pleased with the product itself. The company has some work to do – and seems to be doing it. I haven’t noticed any amazing positive health effects, but I’m hoping over time it works positively. I’ll provide future updates as I’ve been on it longer and can analyze how I respond to the taste with continued consumption and whether I see any health changes positive or negative.

  1. [1]The reason I wanted to do smaller servings was b/c Soylent goes bad after it is made and I wasn’t sure I could consume an entire package of Soylent quickly enough.↩
  2. [2]I discovered it isn’t really, really, really air-tight. I didn’t have room to put the pitcher standing up in my refrigerator (it is a mini) so I put it on its side – this worked a few times, but eventually it began to leak.↩