"...you're welcome"
By Timothy A. Robieson
Delivered to The Chicago Literary Club
April 5, 1993
The clinical use of the computer, in the dental setting, came as
a pleasant surprise to me about two years ago.
I had gotten out of dental college just
in time to not have to learn
how to their computer system and I have sort of been running away from
computers ever since. It has been twenty four years since my first really
"close encounter" with automated data processing, but like the proverbial
fish, I got caught this time only because I opened my mouth at the wrong
time.
When I was growing up, the familiar I.B.M. card was used for keeping
track of virtually everything. Even tax refunds and government paychecks
came printed on those crisp and official I.B.M. cards. Very neat looking
things with a beveled corner on the upper left and rows of seemingly
random but perfectly punched rectangular holes. Strength, efficiency and
the U.S. Government seemed to affirm the sacredness of those three
letters, I.B.M. Most cards were printed with the admonishment, do not
fold, spindle or mutilate this card.
In the pre60's environment no one I knew would
have considered
violating that sort of pristine and authoritative data processing
document. J. Edger Hover, I.B.M. and the U.S. Government held great
weight with all us patriotic citizens of the post war Eisenhower era.
Then came the
irreverent era of the 60's. The lid came off and I
don't think ever be put back on. I remember laughing myself silly when a
comedian joked that whenever he came across a data processing punch card,
he always mutilated it in some subtle way. A little punch, a bend or
staple hole. Whatever was necessary so that the card would be rejected by
the automatic processor. That way he and his accounts would always get
the personalized individual attention that he deserved. I never had the
guts to try that out. Compliance through fear, an I.R.S. and government
tool that works.
Computers have a way of blind siding you. They come out of no
where, just all of the sudden and you're at their mercy!
I got sucked into my first, rather formidable, encounter with
an industrial sized data processing monster aboard the U.S.S. ENTERPRISE
in 1969. My training in the Navy at that time made me an Operating Room
Technician. My usual haunt was the surgical suite adjacent to Sick Bay.I
liked the job and the few perks that went with it. But when our aircraft
carrier pulled in to the dry dock at Portsmouth, Virginia, the operating
room schedule went to zylch. This was due mainly because our ship's
surgeon was transferred to a shore based hospital and I became what is
known as "an extra body." With no one for me to serve in my O.R. Tech
capacity the Medical Service Corps. administrators looked around to find
something for me to do.
I got sent down the passageway to work with the nuclear
power
technicians in what is called The Radiation Health Protection Office.
This position was totally void of perks! The job involved the radiation
monitoring of all crew members who had any exposure to radiation. My new
job was to develop x-ray films that came out of each crew members film
badge. Every person has to wear a photo I.D. film badge if they do any
work in the nuclear power and/or nuclear weapons spaces.
From this Radiation Health Protection office, my new home, once a
year a report of the doses of every individual who wore a film badge on
the ship had to be made to Admiral H.Rickover. He is known
affectionately as the "father of the nuclear navy". Since I was just an
extra lukewarm warm body only recently transplanted from my spacious
air-conditioned operating room and lounge, I did not have a clue about
this report to Admiral Rickover.
Aboard a ship the size of the Enterprise a full compliment of
sailors and marines numbers over 5,000 souls. The probability of my
having a face to face dialogue of any kind with the ships captain is
remote. However with my formerly scrubbed and antiseptic hands now
sloshing x-ray films in their final rinse water bath, I did come face to
face with Captain Peterson. His regal countenance cast a disarmingly
casual pose at the "dutch door" of our small office. I registered nothing
but dull surprise when his request to see this report was verbally passed
to me by the nuclear power technicians with whom I worked. I knew nothing
of what he requested. My vacant expression was not making him very happy
and he was quickly gone with his Marine Corps entourage in tow.
My education in the matter was swift and I found myself in the
ships data processing center. Loaded down with 20 pounds of punch cards
on which needed to be re-punched the appropriate radiation dosages for
several hundred sailors, I surveyed my dilemma.
Buzz, buzz, clickity, clickity, click, bang, bang, buzz, click,
buzz, click. I delicately approached a keypunch machine and began my "on
the job training" doing "Data Entry". Each persons film badge had an
associated punch card with that individuals name on it. I had no idea
what other information was already punched on those cards. It set me
back several hard weeks worth of work when I eventually did find out
what useless information was already punched in.
Entering the data should not have been too intense or
difficult. An individuals card would slide through the keypunch machine
and I would type the dosages they received on the correct lines. My first
day went well and the job seemed pretty straight forward. Next day
however, things got a lot busier in the data processing room. The only
keypunch machines available for me to use was ones that did not print
while they punched. That meant that every letter and number I punch had
to be perfect. The smell of machine oil and clatter of the massive
computer printer and the umpteen keypunching machines graced my new
"Operating room" environment.
Over the course of my days at the keypunch machines
I was at the
non-printing keypunchers about 25 percent of the time.
When I finally finished this
huge deck of punch cards, they were put
into the reader/ printer to make my report. This machine was like an
industrial sized loom. It stretched some 10 feet across. Extra wide
Z-folded white and green stripped computer paper was loaded into this
machine from behind. The huge sheets were printed on with typewriter like
keys that were arranged the full length of this wide paper and they all
struck at once. Each key must have had the full alphanumeric compliment
of characters because they would strike the line all at one time. I
quickly got over my marveling at the mechanics of this monster when I saw
what kind of report was being generated by my several hundred punch
cards.
The pre-imprinted data that was already on the cards before I came
got the job was total chaos. Add to that the mumbo jumbo that I punched
on them while using the non-printing keypunch machines and the scope of
my task went through the roof (overhead that is).
Weeks later, when the job at length
was completed, I was one happy
operating room technician. To be finished with computers and also with
the Navy a few short weeks later.
My next personal brush with this technology had a
far happier
ending. Out in civilian land I went back to college and then after two
years of undergraduate work was admitted to the College of Dentistry of
the University of Illinois.
In our sophomore year there were some rumblings about every
dental students clinical requirements each being kept track of by
computer.
Those rumblings got louder and louder but the deed was not done
until I was a senior in Dental College. The underclassmen and instructors
had to attend seminars and sessions in order to become familiar with the
punch cards and data input documents. I cringed as I watched students
and teachers alike #2 penciling their way through the new system.
Mountains of that great green stripped report paper loomed out of my
past with near crippling anxiety.
I graduated just in time to escape those machines. I felt like
Steve McQueen must have in his dramatic jump over the prison camps barbed
wire on his motorcycle in the movie "The Great Escape". Graduating from
dental college was all the sweeter for me because of that timing.
Times have changed and computers are doing things in the 1990's
that relegate all of my data processing experience and understanding to
the archives. Those really the dark ages.
So vastly different is the current technology
that a reasonable case
can be made for the probability of its really being of extraterrestrial
origin.
An appreciation for what a computer might do for me in my line of
work was slow in coming. I am still new at the computer business and I am
finding out what a mixed blessing it is.
Voice operated computers are here. I have been using one in my
dental office for two years now. It is not what you probably think, I
actually use it in my treatment room with a patient in the chair. It
doesn't drill any teeth for me but it does a fabulous job of entering
clinical data by voice with a hands off head mounted microphone. Data
entry is confirmed automatically since the machine parrots back what ever
I say. And like any good parrot it repeats back some things that I don't
say. But in so doing I can verbally correct it's error since I heard it
out loud.
It has been over two years since my first fateful encounter with
something called,"Victor Voice Chart". I was innocently walking through
the Chicago Dental Society's exhibition area at the yearly Mid-winter
convention. Miniature television cameras and computers were being pushed
by several manufacturers. They looked nice, were high priced and I wasn't
even considering buying anything. I casually told my wife that I probably
wouldn't buy a computer until they made one with which you could just
talk. That was the sound of a fish opening his mouth for the hook. I was
sure that that comment would insulate me from making a computer purchase
for another decade.
I was just two aisles away from Avanti Systems,International.
Their "Victor Voice Chart" was being demonstrated and I had named my
poison.
A skillful dentist, with a microphone clamped to his temples,
was reading clinical data through that microphone into a personal
computer. This data was the usual type of dental conditions that are
common to all dentists examinations. That being missing teeth, fillings,
bridges, crowns and periodontal defects. The computer was repeating the
words he spoke as it registered the information on a beautiful
multicolored television display. As I listened to him answer someone
else's questions, I wondered if the costs of this marvel would ever be
within my reach. Then if that wasn't enough there was a color printer
that traced out an accurate duplication of the computers screen image on
paper in full color. With this system, clinical data can be conveniently
stored and meaningful color copies of a persons dental conditions can be
made.
As one might expect at a dental convention where there is a lot
of expensive equipment for sale, special financing was available and I
became almost instantly automated with a my own "Victor Voice Chart"
voice recognition computer system.
To thus be able to convert volumes of boring,
meaningless
dentalese into beautiful and understandable pictures for patients to see
was more than I could have hoped to do. Visualize if you will these 8+" x
11" full color, detailed dental charts, listing patients gum disease,
broken fillings and missing teeth. These to be given to the patient to
take home and display to their spouse and probably hang on the front of
their refrigerators with my complimentary oversized tooth magnets.
What a motivator
it is for people to see such a tangible,
colorful representation of their deteriorating dental conditions. With MY
name address and phone number in the margin, these charts as good as an
8+" x 11" business card!
The system itself looks no different than any personal
computer in any other office that one might see. It has a keyboard,
monitor and central computer processing unit where you insert the floppy
disks. In fact most computers can be used as a voice operated system with
the addition of a voice circuit board, microphone hook up and the proper
programming instructions.
One of the features that attracted me to this voice
technology
was that it worked so well side by side with the more usual word
processing, spreadsheet and office type of programs.
Again I confess that I am new at
this computer process, and I
know I am not alone in being new, this after all is a revolution. And it
is also another case in which misery loves company. There have been more
than one session of the blind leading the blind in my office as I have
encountered programing and equipment problems. And speaking of companies,
when it comes to finally getting a computer, the number of computers and
companies that sell them is legion.
I happened to move my office a few years ago and
I was pleased
with the new location being near a major highway intersection. This is
what I expected to be a good landmark for my patients to orient
themselves when coming to my new office for their next visit. I wasn't
long at the new office before I discovered that the real landmark in my
area, that so many people were familiar with, was ELECTEK. The major
computer store across the street. Cross streets work O.K., but nearly
everyone knows ELECTEK's location.
A few weeks after the convention my
computer system arrived at
the office. And as they say at the Olympic meets, let the games begin!
The instructions and installation took about three hours. The main
difficulty with the introduction was that afterward I had no idea how
much I didn't know yet. I knew there would be a lot to learn, but I know
now that the learning process continues infinitely. New computers and
something called components as well updated programs to run on them fill
countless catalogues and computer magazines. And they are all constantly
being updated, duplicated or outmoded.
In fact one of the major discomforts in
getting computerized is
the complete assurance that no matter how much money you spend and how
careful you are at selection your system, in six months it will not be as
good or as fast as the new models. In sixteen months your system will be
yesterday's technology. In sixty months you will be embarrassed to even
admit that you ever owned one so inefficient so and slow.
Any way, once the personal
computer had found its way in to my
life, I found it was another thing with which it is easy to become
frustrated. I like predictability and most times my computer system is
predictable. When something doesn't flow like I expected it to, then I
have reason to get up tight.
One important principle that I follow that helps to keep
me from
immense frustration is to not ask the question "why". I don't ask why the
computer does this or that. I should assume that if something wrong
happened it is my fault. I just relax and do the operation over again and
try to be more careful. If it fails again, I stop and read my manual. In
computing circles manual is pronounced "documentation".
The keyboard is the main
entry point for most data to go into the
computer. Each of the keys send specific electrical signals to the
system. These keys serve double purpose sometimes when used in
conjunction with and "Alt" key.
My system is "fitted" with a voice board that takes
electric
signals from a microphone and converts certain word patterns to keystroke
signals. When the "Voice Chart" recognizes a word pattern, it registers
it and with a synthesized voice, repeats it back for confirmation.
When my system is
not in use I keep the microphone on a hook
behind me. Extraneous vibrations are often picked up by the microphone as
I bump the counter or cabinets. Every now and then if the microphone is
turned on it will register and say something. It likes to say eight. A
bump on the counter will sometimes get me an eight response. To keep from
this annoyance and possible confusion I can turn the microphone off.
Very
humorously sometimes when the microphone is on and the voice
board is "listening" it will respond out of the blue with a
"...you're welcome! I have had patients happily chide me with comments to
the effect that "It sounds like your computer has an attitude". In
addition to the unexpected verbal out put, my programming has both male
and female voices. This has led to one patient to observe that my
computer is sexist because the female voice seemed to do more work than
the male voice.
To make these dramatically appealing color dental charts, my
system employes a Paint jet printer. Alas, that poor thing is an orphan.
In the race to build equipment that is faster, better, and cheaper,
some models do not find a wide enough acceptance quickly enough to be
come one of the standards. My printer is just non standard enough to not
work with some of the more generic
software programs. For example: when installing a software program that
needs to utilize a printer, the program will list a number of the widely
used printers for which it has the proper interfacing instructions. I
have used at lest three different programs that do not list my Paint Jet
printer. It still makes good dental charts and that is what I bought it
for and someday I will get a second printer that all other programs will
recognize.
Computer literacy is a concept which strikes fear into the hearts
of many people, even well educated people. I have felt this "angst" many
times when in the presence of those technosnobs whose entire
conversations at length revolve around their cascading torrents of
technobabble. Now I am ashamed to admit it, but to paraphrase one of our
frequently quoted presidents, Ich bin ein technosnob. I too am now
guilty of subverting many opportunities for meaningful fellowship into
microchip chatter and disk talk. The first assumption very quickly is
that everyone listening understands what you are talking about. The
second assumption is that if some of those present don't understand then
that is their problem.
Much of the technobabble is kind of amusing. I think my favorite
is the acronym W.Y.S.I.W.Y.G. Sometimes you have W.Y.S.I.W.Y.G. and some
times not W.Y.S.I.W.Y.G.. This is an acronym for What You See Is What You
Get. I believe it relates to what ever is displayed on the monitors
screen is what you will get printed out on paper. I imagine I like the
sound of it because it reminds me of my childhood and Uncle Wiggley.
I think
W.Y.S.I.W.Y.G. may also relate well to buying computer
systems.
It can be difficult for the uninitiated like myself to know precisely
what I am getting just by looking. There are more options and varieties
of hardware available for computing than you can believe.
The average beginner like
myself will buy an "off the shelf" or
"turn key" system. What you get looks like a ivory colored box with a
keyboard and a television set.It turns out to be considerably more. By
that I mean there are poor quality keyboards out there. There are
technically superior keyboards for sale too.
The data storage disk, or hard disk, is a
separate component that
can be triple A quality or grade Z. It can store data fast and give it
back out at a snails pace.
The circuit board that makes a color monitor work can be
of any
degree of quality from good to ho hum.
The pitch of the T.V. screen can be clear or
fuzzy.
Clearly W.Y.S.I.W.Y.G. may not be what you think you are
getting.
Now that I know somewhat about what is available I have the
dilemma which boat owners call two foot-itis. That is always looking to
upgrade to the next size larger boat.
For me it will be the next faster processing chip.
The greater
disk storage space. Faster speed of computing and ultimately, yes, more
prestige among other technosnobs.
When I finally do manage to purchase my next
"upgrade", there
will be an absolute blossoming of my self image. I will reload the half a
dozen software packages which I had to remove from my smaller hard disk
to make room for my literary club papers and other vital video games.
I think will
have to be somewhat complacent about my current
system a few more months perhaps a year or so. That is until dear Hillery
sorts out what she wants to do to healthcare providers.
I truly do enjoy being able to
do word processing for all sorts
of writing on my computer.
Among them: Inventory control. Purchasing dental
supplies
is a breeze with my telephone hook up.
I utilize a computer facsimile system which
sends data and
receives messages over the phone lines.
When my children visit the office they run
programs to tutor
themselves in Spanish, Algebra, Frogger and PacMan.
I wonder what kind of systems
and programs will my children be
sharing with their kids?
Part of the trauma of getting into computers is creating
change.
I remember a story my father told me about an accountant that
kept books for a manufacturing company where he worked. This accountant
had reluctantly agreed to computerize his books but he never could bring
himself to really trust the computer. In the end he was found to be
secretly keeping a regular set of books on paper and doing double the
work because he just couldn't let the old way go.
I think a little wariness about what a
computer can and can't do
is a good thing. Computers are mechanical devices that have moving parts
and are subject to breaking down. As I get more and more accustomed to
relying upon my computer, I know what a mess I will be in when it
eventually does break. Who hasn't been inconvenienced by a computer
glych, malfunction or interruption? Even if you don't own or operate a
system, the government on all levels and their agencies have each of us
in their data banks. We're at the mercy of an errant keystroke or botched
programs from any of them.
Of course this talk of computer breakdowns brings up the
subject
of computer viruses.
Biologically viruses live and multiply within the framework of a
living host.
Electronically speaking, viruses do not live. They are cleverly
written program instructions which can be maliciously placed in totally
unrelated good and valuable programs. These cleverly hidden virus
programs can create everything from mild humor to absolute chaos.
A small virus
program can instruct your personal computer to
Format your main data storage disk. This Format instruction erases all
data that you have placed on it. On Michaelangelo birthday last year a
fairly widespread virus which they named the "Michaelangelo Virus" caused
unsuspecting computer operators to sit powerlessly as they watched their
computers format all the data on their storage disks into oblivion.
Another, more
complicated, virus puts on a little show for you
while it destroys your data. Imagine typing a letter to someone and as
you read over what you have written, individual letters begin to randomly
fall off the screen. The "D" in Dear comes unglued and tumbles to the
bottom of the screen only to be then followed by the comma after the
name. Then an e and an m and then several s's cascade snowflake like down
on top of an quickly growing pile of useless alphabet soup.
There are now virus
detecting programs to help protect the
storage disk and its data. Doing what is call a "data back up" is also
helpful to keep from completely loosing valuable information.
Preventing your system from becoming infected is not 100% possible but
there are things that make virus contamination less likely.
One of the things that
personal computers do best is to copy
data. Copying complex and expensive computer programs costs virtually
nothing and can be done in minutes. So much good software is on the
market and in the business environment that it is common place for people
to "share" their copy of this or that with someone who doesn't have that
particular program. Never mind that that is a violation both of copyright
laws and of good moral judgement.
The temptation is strong and a lot of "shared"
software is loaded
onto peoples personal computers.
Consider now the virus factor. When the desire for
a certain
software package is so strong, there will be people who will help meet
the need by making "bootlegged" copies of it to sell to whomever they
will. Only in some instances, lurking somewhere in the boiler plate and
programing instructions, somewhere that only the computer experts can
find, is a virus program. The damage and havoc certain to be caused by
this virus will make one wish that they had spent more money. Only by
using authorized and legal copies of programs on ones computer system can
they do what is best to prevent virus contamination of their valuable
data base.
There is a reasonable possibility that these sophisticated and
damaging virus programs have actually been created and disseminated in
order to discourage the use of stolen or unauthorized copies of programs.
It works for me. I have had offers from people to copy this or that
program for my own use. It is a moral issue, and if the program is good
and I can use it, then the author and its creators deserve their
royalties. And they should be inspired to continue development of quality
software.
I think those who write creative viruses should be acknowledged
too. It seems like their product should fit into some form of socially
acceptable form.
How about a computer virus that would redirect junk mail and
return it to its sender? Or do the same thing for nuisance telephone
calls.
How about a "full disclosure" virus that would not allow
government accountants to lump multitudes of questionable expenditures
under vague headings.
Let's have a legislative consistency virus that won't allow non
related amendments to be attached one to another.
Think about that a moment. We
may have just discovered the
genesis for the computer virus. I can describe a computer virus as a
noxious little amendment, which no one in their right mind would swallow,
which is tacked onto a very good and desirable program that everyone
wants. Bingo! Legislative virus. That is officially sanctioned
contamination of legislation by "riders".
From Mike Edelhart/PC Computing/August
1992 issue magazine here
is a humorous sampling of some pretend viruses:
The Boris Yeltsin Virus - It reformats your drive and alters your PC's
basic operating principles every ten minutes, making it completely
inoperative. Meanwhile, an onscreen message begs you to be patient and
wait 90 days for results.
The Warren Commission Virus - It won't allow you to open any of your
files for 75 years.
The Michael Jorden Virus - It slam dunks your PC 40 times every 60
minutes, never the same way twice.
The National Enquirer Virus - It incessantly scans your files for
evidence that you are cross-dressing, have been abducted by aliens, or
are secretly dating Princess Di.
The Teenage Virus- You can get your PC to do what you want, but only
after an interminable argument that leaves you feeling horribly guilty.
The Pat Buchanan Virus- It shifts all screen output to the extreme right.
The Bill Clinton Virus - This virus mutates from region to region; we're
not sure exactly what it does. Appears to mate with other viruses at
random.
The Jerry Brown Virus - It blanks your screen, then incessantly flashes
an 800 number.
The David Duke Virus - It makes your screen go totally white.
The Spike Lee Virus - It makes your screen go totally black.
The Jesse Jackson Virus- Your screen becomes a beautiful rainbow, but
your PC can't accomplish anything.
The Paul Tsongas Virus- Suddenly, your PC becomes incredibly drab and
boring.
The Mario Cuomo Virus- Should it attack your system or should it leave
your system alone? This virus can't seem to decide what to do, but and
onscreen message says it withholds the right to destroy all your files at
a later date.
Enough about viruses.
I have around one thousand patients names, addresses, home & work
phone numbers. Clinical data for hundreds of examinations, newspaper
articles, club papers, personal letters, business correspondence,
inventory lists, various assorted programs and games loaded onto my
personal computer.
The time it has taken to load all that stuff in and the time that
it would take to key it in again would be very great. This brings me to
the first cosmic law of computers. Data that is destroyed can not be
recreated easily. Data can be copied very easily and that is call backing
up. As once was said by a contributing Graduate student to another PC
magazine article:
Woe befalls those who operate PCs on insufficient sleep or while taking
prescription cough medicine. PCs should be considered heavy machinery.
-Graduate student
It is rarely the cause of a computer virus which blasts vast
quantities of valuable data to the nether world. Most usually it is an
inadvertent flick of a finger that sweeps away the wrong files.
As in "Haste Makes Waste" nothing can waste faster than some errant and
unadvised key strokes. If you're not sure what you are doing it is like
tip toeing through a mine field. A Secretary- admonishes from experience:
When the computer prompts you, "Are you sure?" ponder the question for a
moment.
Most good programs have a highly technical menu selection called
"UNDO". Undo covers a multitude of goofs but it usually only covers the
very last keystroke or command.
As we get familiar with our computer systems we
get faster and
quickly out run the ability of the Undo command to save us because we
have moved more than a single keystroke past our goof before we noticed.
To quote an other:A Network supervisor-
Sooner or later most users of PCs learn just enough to become dangerous.
Of course it is overcoming the danger that we find life's
greatest rewards.
I wanted to write this paper as an encouragement to people like
me who stood on the sidelines. Go ahead jump in and get your feet wet. If
you even learned to type with just two fingers, this new technology just
brought almost all typists back to that same level. There are twice as
many goofy keys as any typewriter so that everyone has to hunt and peck.
To be sure,
as we venture into the technologies of the future, we
are at the mercy of technical support personnel. But there is great news
here. There are tons of people who will assist you in person or over the
telephone and get you past those mine fields into absolute verdant fields
of clover.
This is a risk worth taking!
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