Algorithms

A few years ago, I crossed paths with an orthopedic spine surgeon who came to be known as "Dr Algorithm." This guy. The images showed major bony changes, nerve impingement, and various misalignments in the spine of the subject. Packaged with a precipitating injury over a decade old, and multiple rounds of steroid injections and physical therapy already attempted over the intervening years, one might imagine he would have some other answer. Alas, he is, as his well-earned nickname implies, married to The Algorithm. He asserted steroid injections and physical therapy were the miracle cure for 90% of "his" patients, and he would not go to surgery until all those options has been exhausted under his supervision. Somehow he had the magic technique, and no previous attempts at injections and PT could possibly have lived up to his particular and special skill.

I only met this man once. It was enough times. Suffice to say the so afflicted patient has since had surgery. With a different surgeon.

Which brings us to today.

 I had a follow-up appointment with the civilian doctor (well, technically seeing the PA) I got referred to about my knee pain. On my first visit, he declared my knee pain must be the result of muscle imbalance. I suggested the level and type of activity I engage in made this conclusion seem unlikely. But, the x-rays were clean, and there was no changing his mind. He wanted me to do PT.

Now that I've had a few sessions of PT, the knee pain is not better. If anything, it's worse. And I had to go around with the physical therapist about some of those exercises, too. At least he was a nice guy and seemed to recognize there's something more to it than inner thigh muscles being weaker than outer thigh muscles or the other way around.

Anyway. I got in to see the PA. He walked in and his first question was about blood work he'd ordered. I told him I hadn't done it, because I realized all the arthritis I have ever had is secondary to other injuries and I don't have any of the conditions he wanted the test for. He got a little snippy and said he "didn't know that." I told him well, now you do.

Have I ever mentioned I'm not an easy patient?

Next he asked "how many PT sessions we have had."

To which I responded, well, *we* haven't had any, but *I* have done 6.

Yes, I really am that petty.

So after all of that, and not making any friends, he's ordering MRIs. Which should have been done 2 months ago. But of course it was not. Because, although he's not as open about it, this place is just as slave to The Algorithm as the surgeon I detailed above. X-rays are clean, the pain must be due to this other, evidently relatively common muscle imbalance. Don't listen to what the patient does. Don't test strength. Don't contemplate there may be more under the surface. Not until The Algorithm has been satisfied. 

But this post isn't ultimately about knees or spines or the surgeons who treat them. It's not even about the medical algorithms we all encounter.

This is really about that other algorithm we're all subjected to, on the daily basis. The algorithm which oversees social media.

Recently, Facebook has been increasingly unhappy with me. Mostly it is unhappy with me because I have a cat named Ugly and they think I'm bullying him. I have to carefully word any post including Ugly, because Facebook will legit remove it for "bullying or hate speech" if I get it wrong.

This would be amusing if I weren't seeing others posting perfectly innocent content and having it removed. An author I follow, Jim Wright, recently had a picture removed for "violation of community standards; it was a picture of a bee, captioned "a bee." Shadow-banning has been a thing, wherein a poster's content reaches very few people, as it's being hidden. I've demonstrated this on my own page, by having someone else post exactly what I did, words and images, in the same group, and they get responses, while mine is not seen.

Particularly after hearing things like this RadioLab episode I've been increasingly disenchanted by the whole Facebook experience. The algorithm has serious problems.

And y'know what? I'm kinda tired of it. I'm tired of how Facebook and most of social media works. I'm tired of bumping up against the algorithm because of pictures of a happy orange tabby cat. I like to get a little deeper into things. Facebook demands pithy and short content. The pressure to make posts amusing or otherwise entertaining is more than I'm willing to put up with.

So, while I'm not leaving social media, I'm going to spend more effort and energy on blogging. I like this format. I can write out long and (at least to me) interesting pieces. If I end up talking to myself, well, that's fine. More often than not, I seem to be talking to myself on Facebook, too. At least here I find myself more entertaining.