Month: August 2019

A growing push to document surgeries with cameras in operating rooms

In each case, the families still don’t know the full story of what happened to their loved ones, due to lack of documentation and an inability to pursue a costly lawsuit.

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They are relatives of an estimated 400,000 people who die each year in the United States of preventable medical errors, the third-leading cause of death after heart disease and cancer. But the families say they could have known much more if cameras had been installed in the operating rooms, recording the actions and movements of the doctors and staffers involved.

They are enthusiastic supporters of a growing movement that is seeking to require hospitals and surgical suites to have video and audio recording capability. Now, a surgeon in Toronto has built a “black box” that synchronizes a patient’s physical data with video and audio recordings of an operation, enabling doctors to review their work the same way athletes watch video of their performances. And he said he has lined up two U.S. hospital systems to take part in the first testing of the system.

“If we don’t know what we’re doing wrong, we’ll never improve,” said Teodor Grantcharov, a professor of surgery at the University of Toronto. “This is what many other high-performance industries have been using for decades.”

A bill that would require cameras in every operating room in Wisconsin has been introduced in the state legislature, and supporters say that lawmakers in other states are closely watching the bill’s progress. The proposed legislation, known as the “Julie Ayer Rubenzer Law,” is named for a Wisconsin woman who died after she was given excessive amounts of propofol — the same anesthesic that killed singer Michael Jackson in 2009 — during breast-enhancement surgery.

Rubenzer’s brother, Wade Ayer, founded the National Organization for Medical Malpractice Victims and helped draft the Wisconsin bill, which is supported by patient-advocate groups around the country. Ayer said video and audio recordings can capture the reasons behind “adverse events,” as the medical industry terms them, and deter inept or simply bad behavior by medical personnel such as the anesthesiologist in suburban Washington who can be heard harshly criticizing her patient in an audio recording made by the patient. The physician was hit with a $500,000 jury verdict.

[Anesthesiologist trashes sedated patient — and it ends up costing her]

Currently, re-creating what went wrong in an operating room involves a mixture of memories and whatever notes were taken at the time or shortly afterward, a vague combination that vexes families trying to get to the truth about a failed procedure or a fatal complication. Recording surgeries “offers transparency, truth and accuracy,” Ayer said, “in collecting data for the medical record and testimony. It offers data and insight for medical boards and even prosecutors. It offers oversight and policing.”

The medical industry is treading cautiously. The American Hospital Association, the American Medical Association and the American College of Surgeons all declined to comment for this article. The AMA in 2005 adopted a policy on filming patients in health-care settings — it encouraged the practice for educational purposes — but focused on patient privacy and on filming only those who give their consent.

But the health-care industry has flexed its muscle where needed, sometimes driven by concerns about the effects that video recordings could have on medical malpractice lawsuits, as well as the cost of installing and maintaining complex recording systems. A bill in Massachusetts that would require hospitals to allow recording by a licensed videographer, at the patient’s expense, has repeatedly failed in recent years in the face of opposition from hospitals, according to news media reports.

In Wisconsin, Ayer said he has encountered opposition from the medical industry. But state Rep. Christine Sinicki, a Democrat, has pressed ahead with what would be the first law in the country to require cameras in operating rooms. “After hearing stories from families affected by malpractice,” Sinicki said in an interview, “a lot of people felt the way to rein this in and catch it is to record everything in the operating room.”

But there are “fantastic privacy issues” with cameras in operating rooms, not only with patients but also with doctors and staffers, according to Bruce Cranner, a medical malpractice defense lawyer in New Orleans who is a former chair of the Defense Research Institute’s Medical Liability and Health Care Law Committee. “Health-care providers have a justified right to be able to talk among themselves about a patient without fear that [they are] going to be second-guessed or overheard.”

Cranner also suggested that cameras would not necessarily capture the key parts of an operation, and that “we are going to have to have somebody explaining for the TV what’s going on, like PBS’s ‘Nova’. That’s not what medicine’s for; it’s not Hollywood.”

Ayer said Cranner is wrong. “They already have cameras in operating rooms,” he said. “That’s how they train medical students.” Although cameras may not always be conclusive on the finer points of a surgery, Ayer said, they would clearly show who was present during a procedure and when, details that often are at issue.

Ayer has also begun lobbying members of Congress in order to judge interest in a federal law regarding surgical cameras. He also is pushing for a national database of doctors who have had their licenses taken away after they made medical errors. The doctor whose actions killed Ayer’s sister had his license revoked in Florida but now practices in Pennsylvania, public records show.

Some advocates for operating-room cameras say the devices can only help. They add that tort reform in many states limits damages in malpractice cases, discouraging lawyers from taking on cases without clear-cut evidence — such as video.

“The medical records of what happened during surgery are often incomplete,” said John James of Patient Safety America, whose 19-year-old son died as a result of medical errors in Texas in 2002 and who authored a study that estimated that 400,000 people die of adverse medical events annually. “Cameras push us in the direction of the truth,” he said. “And if the surgical team knows they’re being videotaped, they’re going to do better.”

And that was the impetus for the University of Toronto’s Grantcharov to create a “black box” to record operations: improving surgeons’ performance. “The initial idea wasn’t to make it available to be used in the courts,” he said. “This is a way for our profession to reflect critically on what we do” and share knowledge industry-wide, not simply where cameras are being used.

He said that in one pilot project involving 54 procedures, there were adverse events in 38 of them, and 75 percent of the problems were not noticed by the surgical team. Using the video, audio and patient data from an operation can help surgeons learn from their mistakes, he said.

“In the majority of cases,” Grantcharov said, “the data will protect doctors in court. We will see a reduction of malpractice claims.” But he said that cameras and data must be rolled out carefully. “If it’s used for destructive purposes, the profession will shut it down. It’s a very delicate topic right now.”

The 2015 summer reading list for innovation junkies

In other cases, these books give you insights into the fields and disciplines — such as cybersecurity, space exploration and artificial intelligence — that are shaping the future of global innovation.

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_ “Who Gets What — and Why,” by Alvin E. Roth

Markets are part of our everyday life, whether it’s landing a vacation rental on Airbnb, bidding for an item on eBay, or finding your future life partner in the dating pool. Stanford professor Alvin E. Roth, the co-recipient of the 2012 Nobel Prize in Economics, explains the science of matchmaking and market design, pointing out how and why “matching markets” work. As Roth points out, these ideas about intelligent and effective market design are relevant for both business and government. Just another reminder that, for Silicon Valley start-ups, matchmaking should be top-of-mind when thinking about new products and new markets.

_”A Curious Mind,” by Brian Grazer and Charles Fishman

In addition to producing films such as “Apollo 13” and “A Beautiful Mind” (starring Russell Crowe as brilliant mathematician John Nash, who passed away in May), Hollywood filmmaker Brian Grazer was also the creative genius behind the Emmy-nominated “24” TV series. So what has inspired Grazer? It turns out that he’s a fan of weekly “curiosity conversations,” which are a way for him to find out more about subjects or people that he knows nothing about. Any innovator can learn from this approach — it’s not enough just to have deep domain knowledge, one also needs the ability to be inspired by ideas from a wide range of different disciplines.

_”Elon Musk: Tesla, SpaceX and the Quest for a Fantastic Future,” by Ashlee Vance

Elon Musk might just be the most famous innovator in America, if not the world, these days. If you want to get inside his head and see what makes him tick, this biography is a fascinating read. It turns out that Musk is just as driven and eccentric as you might expect him to be, working 23-hour days and reading up on Soviet rocket manuals in his spare time. Based on Musk’s unique experience starting companies such as Tesla and SpaceX, Vance suggests that he will come to be seen as an American innovation giant, in the mold of a Edison or Ford.

_”Work Rules! Insights from Inside Google That Will Transform How You Live and Lead,” by Laszlo Bock

While books about Google are not quite as unique as they used to be, this one comes from the head of Google’s People Operations. Laszlo Bock explains how Google goes about finding the best and the brightest employees and offers suggestions on how to make any workplace more innovative. (One important concept: Only hire people who are smarter than you, no matter how long it takes to find them.) These ideas can be used when trying to attract employees to a new start-up, or just trying to max out the creative throughput in your cubicle farm.

_”Future Crimes,” by Marc Goodman

Cybersecurity has emerged as an important issue — not just in the tech sector, but also as part of the evolving national security debate. Goodman, a former “futurist in residence at the FBI” and the founder of the Future Crimes Institute, takes you to the front lines of the cyber wars, showing how hackers are subjecting the world’s computers and information to constant attack. If you thought that cyberattacks by North Korea and China are isolated events, think again: there’s a vast, worldwide group of people who are using technology in ways you’d never expect, making all of us vulnerable. In some cases, software has become “crimeware.” In other cases, wearable devices could become the subject of attacks.

_ “Creative Schools,” by Ken Robinson

How will the schools of today prepare the innovators of tomorrow? There’s perhaps no one better on the planet to explain that than Sir Ken Robinson, one of the world’s preeminent experts on education and school creativity. He’s also the most-watched TED speaker in history. His TED video “Do Schools Kill Creativity?” has been watched nearly 34 million times on the TED website (and another 8 million times on YouTube), so it’s good to see that he’s back with more ideas about what he’s calling a “grassroots revolution” in school creativity.

_ “Beyond Measure: The Big Impact of Small Changes,” by Margaret Heffernan

Looking to introduce epic change and innovation in your company? You might be served by thinking in terms of innovation baby steps, says Margaret Heffernan. Small shifts, when well-executed, can have outsized results. That’s both instructive and inspiring — especially when trying to bring innovation to a large organization entrenched in the old ways of doing things. Watch Heffernan’s TED Talk on “Superchickens” — as she explains, trying to create a super company by staffing it entirely with “superchickens” could be a recipe for disaster. (Superchickens get to the top of the pecking order by pecking away everyone else.) In the same way, trying to create an innovative company by only focusing on super innovations may not turn out as planned.

_ “Sapiens: A Brief History of Humankind,” by Yuval Noah Harari

As you might guess, a “brief history” of humankind is not really all that brief — nearly 450 pages, with in-depth descriptions of biology, history and evolution. But it was a Mark Zuckerberg Book Club selection in June, and Israeli historian Yuval Noah Harari’s concept of a “Cognitive Revolution” for humankind is compelling. Cognitive adaptations during evolution — such as the embrace of language — have made humankind “the deadliest species in the annals of biology” as well as the most innovative. And there’s potentially more to come given humankind’s embrace of artificial intelligence and genetic engineering.

_ “Why Information Grows,” by Cesar Hidalgo

We may be drowning in a sea of informational complexity, but that’s okay, according to Hidalgo, a researcher at the MIT Media Lab who is often considered to be one of the most innovative people in the world. As Hidalgo explains, there’s an important correlation between information growth and economic growth, and between economic complexity and national competitiveness. The book builds on Hidalgo’s earlier work on “The Atlas of Economic Complexity,” which ranked national economies based on their “complexity,” not on their annual GDP or per capita income.

_ “The Martian,” by Andy Weir

Weir’s 2014 book, which has been described as “Robinson Crusoe in a space suit” will be hitting the big screens later this year as a Ridley Scott blockbuster starring Matt Damon as an American astronaut stranded on Mars. In much the same way as “Interstellar” launched public conversations about space exploration and the physics of deep space, it’s easy to see how “The Martian” could get people talking about Mars. In fact, NASA has been supportive of the book, seeing it as a way to build public support for additional Mars funding. As an added bonus, the book comes with a fascinating backstory, starting life as a series of self-published stories given away for free on the author’s personal Web site.

Basulto is a futurist and blogger based in New York City.

Reverse a historical injustice — literally. Give black voters a larger say.

Yet a year of protests over disparate law enforcement practices, a decade of particularly sharp income inequality and centuries of imparity in America show that racial reconciliation is impossible without some kind of broad-based, systemic reparations.

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Recognizing the original sin is simply not enough; we must also make moral and material amends for our nation’s treatment of African American citizens. But if a pecuniary answer can’t fix the structural disadvantage — and it can’t — what can?

Weighted voting.

Thanks to a compromise between Southern slaveholders who wanted enslaved blacks counted in the population, for the sake of boosting Southern congressional representation, and Northern whites who didn’t, the framers enshrined the three-fifths clause in the Constitution. This agreement set the census value of a slave as 60 percent of the value of a free person. Even after the 13th Amendment neutralized the political (and moral) compromise by abolishing slavery, Jim Crow laws, which contravened the right of equality guaranteed in the 14th Amendment, upheld the status quo. The just answer today is to invert that ratio. If black Americans were once counted as three-fifths of a person, let each African American voter now count as five-thirds.

Reparations in America have come to mean “free” money, so any serious discussion about them also mandates a discussion of how much — an exercise doomed to failure. Other ways of imagining reparations (as the spilled blood of more than half a million Union soldiers during the Civil War; as affirmative action in universities and workplaces; as subsidized education) don’t involve cash payments, but they also don’t do enough to combat the structural disadvantages black Americans face — disadvantages that have gone largely unaddressed by our legislative and executive branches.

That’s because the problem is almost unfathomably large. In a report titled “The Unfinished March,” the Economic Policy Institute found that school segregation, black unemployment, lack of access to fair housing and living wages, and abysmal African American household wealth remain at essentially the same levels of disparity today as they did in 1963, when the March on Washington occurred. Median household wealth today is $141,900 for whites and only $11,000 for blacks. Despite making up only 13 percent of the population, black Americans are 27 percent of those living at or below the poverty line; the white unemployment rate is 4.6 percent, while it’s 9.6 percent for blacks; during the housing bubble of the mid-2000s, 53 percent of blacks received high-cost mortgages, while only 18 percent of whites did; the black incarceration rate is 2,207 per 100,000, compared with the national rate of 707 per 100,000; nearly 3 in 4 black children today attend segregated schools; in many communities, blacks have poorer health outcomes and access to just half the social services of whites. The list goes on ad nauseam.

These are national issues that require policy solutions — and the political will to implement them, which clearly doesn’t yet exist. That’s why reparations should be apportioned in the exercise of a civic right (a duty, even) long denied to the descendants of the enslaved. A five-thirds compromise would imbue African Americans with a larger political voice that could be used to fight the structural discrimination expressed in housing, education, criminal justice and employment. Allowing black votes to count for 167 percent of everyone else’s would mean that 3 million African American votes would count as 5 million, substituting super-votes for the implausible idea of cash payments.

This weighted vote, coupled with an increasingly active black electorate that in 2012 had a higher voter participation rate than whites for the first time in history, would offer African Americans an outsize influence on national and state elections. Politicians, finally, would have to truly compete for the black vote, or a substantial share of it, to attain or remain in office. This would provide an incentive, even for purely self-interested politicians, to prioritize African American policy concerns and act on them, or face a loss at the polls.

True, the five-thirds notion is out of sync with the “one person, one vote” mantra the nation prides itself on. But the precise legal meaning of that phrase is still unclear, which is why the Supreme Court will review it next term in Evenwel v. Abbott. That case is about the basis for determining a district’s size: Should it be the total population or just the population of eligible voters? Currently, a district with a significant number of ineligible voters (children, undocumented immigrants, transient military personnel) counts those residents toward its population, thereby adding weight to the ballots of its eligible voters. (Naturally, districts with low numbers of such ineligible voters don’t appreciate their residents’ votes counting for less.)

Even the U.S. Senate, where Delaware has just as much say as California, intentionally belies the notion of strict representation as a means to protect the rights of the minority. In the House of Representatives, Montana has one member to speak for its entire population of 1 million people, while Rep. Jim Langevin, from Rhode Island’s 2nd Congressional District, has just 525,000 constituents. Our votes are already weighted.

What’s more, five-thirds has a redemptive, lyrical quality to it: The weighted portion of the vote could be interpreted as the voice of those who earned the right to the ballot but were unjustly silenced. Too sentimental? Fine. Economics and statistics could help assign the right value for proper weighting. The magnitude of the challenges and the corresponding solution could be taken up by Congress as a giant math problem, but in the end, racial reconciliation requires America to acknowledge a moral and political mandate to make black America whole.

This plan should be temporally limited in scope, since the point is not to permanently install a historical equivalence but to erase structural disadvantages. Weighted voting could be fixed to some predetermined period of years, say 24, which is only about a third of the number of years the three-fifths compromise was in place. This amount of time would include multiple presidential, congressional, state and local elections, as well as referenda. Each elected office, no matter its term, would face several elections, allowing their constituencies successive opportunities to hold their representatives accountable.

And then the problem of who exactly is eligible must be addressed. Would a biracial voter qualify? A black immigrant? And what exactly is an election official to do when Rachel Dolezal shows up to claim her five-thirds vote? The government shouldn’t be the sole arbiter of who gets to be black — nor flirt with archaic prescriptions such as the one-drop rule in determining a voter’s race. The most straightforward approach would be to limit access to weighted voting to those American-born citizens who have demonstrated through government documents, such as drivers’ licenses or birth certificates, that they identify, and are identified by others, as black or African American. There are bound to be instances where this approach is challenged, and one way to address the issue would be to model guidelines after the general requirements for establishing American Indian or Alaska Native ancestry as outlined by the Bureau of Indian Affairs, which involve establishing that a lineal ancestor belongs to a specific tribe and then producing vital records that document a relationship to that ancestor.

Granting reparations in this way would empower African Americans but gift nothing: Black voters would still have to claim their share of reparations at every election — a suitable settlement in a nation allergic to handouts. Weighted-vote reparations would require African Americans to register and turn out in order to achieve the desired impact on public policy. It would require sustained civic and political engagement.

Of course, weighted-vote reparations are only slightly more politically feasible than a multi-trillion-dollar payout. But we have to consider novel approaches to racial reconciliation — including apology, forgiveness and, yes, some kind of restitution — if we are serious about ridding the nation of barriers to opportunity and overcoming the racial discrimination woven into America’s fabric. If racism is the culprit, then dismantling it requires the same tools that constructed it.

Theodore R. Johnson is a career naval officer, former White House fellow and doctoral candidate in law and policy at Northeastern University.

GE’s death perk for Immelt: a $22 million life insurance benefit

GE paid $314,511 last year for Immelt’s two life insurance plans, the most for a CEO in the Standard & Poor’s 100 Index, according to data compiled by Bloomberg.

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It’s one of a shrinking number of companies offering coverage designed exclusively for top managers. On the lower end, JPMorgan Chase and Apple spent $101 and $2,520, respectively, on policies for CEOs Jamie Dimon and Tim Cook.

While many boards have scaled back executive perquisites after increased disclosure requirements and heightened scrutiny of pay practices, life insurance benefits — a ubiquitous part of estate planning for high-earning Americans because of the tax advantages — have received little attention.

Life insurance expenses are often lumped together with “an array of deferred compensation-related items, making it hard for investors to parse the details,” said Michael Pryce-Jones, director of corporate governance at CtW Investment Group, which advocates for pension funds that collectively manage $250 billion. “I don’t think it’s on the radar for shareholders in the way it should be.”

Executive insurance policies are reserved for a limited group of top leaders, a review of proxy filings shows. Last year, at least 10 companies in the S&P 100 Index offered their CEOs universal, or permanent, policies typically designed to last the insured’s lifetime. Some of the annual premiums go into investment accounts that can grow tax-free.

Immelt’s coverage includes two universal life insurance policies. One will pay two times his annual salary and bonus, which totaled $9.2 million last year, and the other provides a $3 million death benefit that’s grown 4 percent annually since he first enrolled, according to Fairfield, Connecticut-based GE’s most-recent proxy filing. GE, the world’s largest maker of jet engines and gas turbines, has spent more than $1.43 million on premiums for Immelt since he became CEO in 2001, according to data compiled by Bloomberg.

3M Co. paid $286,115 in premiums last year for CEO Inge Thulin’s executive life insurance, which has a death benefit of about $10.4 million, according to a proxy filing. Exxon Mobil’s Rex Tillerson and Honeywell International’s David Cote have accumulated benefits worth $11.5 million and $10 million in their executive life insurance plans, respectively.

“We provide our named executives with additional benefits that we believe are reasonable, competitive and consistent with the company’s overall executive compensation program,” Dominic McMullan, a spokesman for GE, said in an emailed statement.

Spokesmen for 3M, Exxon and Honeywell declined to comment.

Of the 51 companies in the S&P 100 that disclosed expenses for CEO life insurance premiums last year, JPMorgan spent the least. Dimon’s plan, which provides a maximum coverage of $100,000, is available to all benefit-eligible employees, according to a filing.

“Our compensation philosophy is to have a transparent and fair compensation program for senior executives with no special insurance, health or medical benefits,” Joseph Evangelisti, a spokesman for the largest U.S. bank, wrote in an email. “The board thought this was the most fair way to do it.”

Apple offers Cook the same insurance that’s available to all employees. Fred Sainz, an Apple spokesman, declined to comment beyond its proxy filing.

Companies must report perks given to any named executive officer if the annual aggregate value exceeds $10,000. Specific dollar amounts must be disclosed for all benefits that make up more than 10 percent of that sum or are worth more than $25,000.

While most Americans who buy policies do so to replace lost income after the death of a household breadwinner, the nation’s affluent often beef up their coverage to help heirs avoid fire- sales of assets to pay estate taxes.

The federal tax on estates worth more than $5.43 million is 40 percent. Including state levies, the government’s total share can approach 50 percent, an amount that can be difficult to pay for estates with significant assets tied up in illiquid holdings such as real estate, said Ivan Taback, a trusts and estates partner at law firm Skadden Arps Slate Meagher & Flom LLP.

“Oftentimes, they do not realize that their beneficiaries will have to come up with a massive check nine months after they die,” Taback said.

Beneficiaries of company-owned plans can collect death benefits tax-free as long as the insured doesn’t have a controlling stake in the company. To avoid having the death benefit included in the taxable estate, many people assign ownership of their privately purchased plans to irrevocable trusts, according to Parker Beauchamp, CEO of Inguard, a Wabash, Indiana-based insurance firm.

“Creating the liquidity to pay estate taxes can literally save the beneficiaries millions” if it can help preserve income-generating assets, said Beauchamp, who specializes in plans for clients with complex needs such as billionaires and professional athletes.

The share of Fortune 500 companies offering supplemental policies to their CEOs fell to fewer than 25 percent in 2013, down from 52 percent in 2008, according to a study by Towers Watson & Co., a human resource consulting firm. Bolstered compensation-disclosure rules and the implementation of advisory say-on-pay votes at annual meetings have fueled a retrenchment of company-provided perks, said Keir Gumbs, a partner at law firm Covington & Burling LLP.

Johnson & Johnson closed its executive life insurance program to new participants in January “in response to feedback and market data,” according to a March 11 filing. Exxon stopped giving the benefit to new executives in 2007. Firms including PepsiCo Inc. and Schlumberger Ltd. highlight in proxy filings that they don’t offer company-paid supplemental insurance policies to executives.

Spokesmen for the companies declined to comment.

Term policies, such as those provided to JPMorgan’s Dimon and Apple’s Cook, usually lapse when the covered employee leaves. GE’s Immelt and 3M’s Thulin are both covered by universal, or permanent, policies, which are more expensive.

While the premiums for term plans cover only the insurance, part of the annual cost for a permanent plan goes into an investment account. The balance grows and can be withdrawn free of taxes, making such policies attractive to some clients, Inguard’s Beauchamp said.

Both General Motors Co. CEO Mary Barra and Caterpillar Inc.’s Douglas Oberhelman have company-paid variable life insurance policies, permanent plans that can give owners control over how the cash value is invested, proxy filings show. Spokesmen for GM and Caterpillar declined to comment beyond the filings.

Variable plans that offer investment opportunities in hedge funds or private-equity funds have grown in popularity among affluent clients in recent years, said Joshua Husbands, a partner at Holland & Knight.

“These are the types of investments high-income folks would be making anyway — and now they’re available on a tax- preferential basis through an insurance policy,” Husbands said. “Life insurance isn’t just about the death benefit anymore.”

_ Margaret Collins and Brandon Kochkodin contributed from New York.

Google’s self-driving car offers smooth test ride

Myself and a herd of other journalists gather around and snap photos.

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A Google employee jokes that our hands will be cut off if we take photos inside the SUVs.

I’m assigned to car no. 2 and hop in the back. The first thing I do is buckle my seat belt. Two Google safety drivers get in the front seats to guide me through the experience. The one in the passenger seat balances a laptop that shows a real-time look at what the car’s sensors see around it.

A dumbed-down feed of the same data plays on a horizontal screen centered on the dashboard. Aside from that screen – and a gray box the size of a suitcase in the trunk – the interior looks like a typical SUV.

We start to pull away in manual mode. The driver demonstrates how easy it is to switch in and out of autonomous mode with a button on the steering wheel.

“You’re free to call for a disengage if you ever feel uncomfortable,” I’m told.

Our driver makes the first turn out of the parking lot on his own. Then the adventure begins.

A chime sounds. “Autodriving,” says a female voice over the car’s speakers.

The guy in the driver seat calmly rests his hands on his knees. I can’t see his feet, but he says they typically hover over the pedals in case he needs to brake to turn off autopilot. It hits home that the car is really driving itself when I hear the click of a turn signal and his hands haven’t moved.

We’re gently cruising down neighborhood streets behind Google X’s building. The roads are quiet and we don’t encounter any pedestrians. A bicycle looms ahead and we’re gaining on it. But the man turns left and we carry on, unaffected.

Things remain uneventful. I feel free of stress, like I might be riding with any trusted driver behind the wheel – until a curvy stretch of road. A car coming the opposite direction – at speeds that feel a bit fast for a side street – whips around the bend. The Google SUV brakes sharply and we come to a complete stop.

Did we need to brake? Putting myself in the car’s shoes (or should I say tires?), I probably would have slowed. But the complete stop seems like overkill given the open path on our side of the road. Our driver agrees and said it was the type of situation that would be logged and studied.

Google’s cars have been trained to be extremely conservative in unusual situations.

“They understand their own limitations,” said Dmitri Dolgov, principle engineer on Google’s self-driving car project, at a briefing later. “They understand that there’s something really crazy going on and they might not be able to make really good, confident predictions about the future. So they take a very conservative approach.”

Once the car passed us, we were quickly back on our way. Most of the side streets we traveled at about 15 mph.

Soon we would get a chance at faster roads.

We smoothly turn onto a main road and the SUV steadily accelerates to about 35 mph.

“Left lane change ahead,” calls out the computerized voice.

As an intersection nears, the turn signal clicks again, and soon we’re in the left-turn lane. The traffic light turns yellow, but the car doesn’t slam on the brakes. It feels like what any driver would do, given how close we are to making our turn.

During our turn – as we’re in the middle of the intersection – the Google SUV brakes for a momentary beat. After about half a second we’re quickly back on the gas and complete our turn.

So why the braking? As we made our turn, a car coming the opposite direction made a left from the middle lane, not the far left lane. I ask if that was what concerned the car. One of the Google test drivers pointed to a different car – one that had just turned right from the opposite direction – as the trigger.

Ultimately it was a minor hiccup and we still had time to complete the turn safely before our signal turned red. After a few more uneventful minutes on suburban roads, we looped back toward Google’s headquarters.

A few blocks away from Google I got another glimpse of the SUV’s cautious nature. A car, also with a stop sign, arrived at the intersection just after us. The Google car inched forward in two spurts. After a pause we drove through the intersection. We got through it fine, but slower than I expect most drivers would have. Soon we pull back in front of GoogleX’s building, a 14-minute ride in the books.

“Manual,” calls out the female voice as our driver took control again, and turned the car off.

If I was grading the SUV on our brief trek I would give it a B+. It wasn’t perfect driving, but safe and effective. Of course, our route wasn’t especially difficult. The real challenges come when pedestrians, inclement weather, construction sites and cyclists arrive.

Afterward I also had a chance to ride in Google’s prototype of a self-driving car. Because Google has two test drivers in vehicles at all times – and the prototype only seats two – I couldn’t ride it on public roads. So we had to settle for the experience of cruising around Google X’s rooftop.

The electric vehicle makes a distinct humming sound (notice it in the background here). I hopped in the passenger seat alongside another journalist. The interior – without a steering wheel or pedals – looks a lot like these photos I shared earlier in the year . The windshield isn’t glass, so some things look slightly distorted, as if looking through Plexiglas.

(On my way out I walked by another prototype – not part of Google’s demo day – that had a distinctly different interior, including a steering device that was mounted between the passengers and resembled a large metal ring.)

After we hit a “Go” button on the main console, and sat through a brief countdown, we were off on an automated course.

We looped around the roof at low speeds for 2 1/2 minutes, avoiding a pedestrian, a cyclist and a vehicle that Google positioned to showcase the car’s abilities. It handled each situation cautiously and effectively.

Google’s fleet of self-driving vehicles are covering between 10,000 and 15,000 miles a week. At the briefing, leaders of the project – including Google co-founder Sergey Brin – all raved about the improvements they’ve made of late.

A deadline of sorts continues to approach – the eldest son of Chris Urmson, director of the self-driving car project, turned 12 a couple weeks ago.

“In the U.S., you need a driver’s license in four years,” Urmson said. “And so our team is working really hard so he doesn’t have to.”