Charlie Munger understands the unintended consequences of screening

Charlie Munger about self-improvement and solving problems:

Well the big ideas, I think you should be intelligent in improving yourself.  You’re way better to take on a really big important idea that comes up all the time than some little tiny idea that you might not face.  I always tried to grab the really big ideas in every discipline.  Because, why piddle around with the little ones and ignore the big ones.  Just all the big ideas in every discipline are just very, very, very useful.  Frequently, the problem in front of you is solvable if you reach outside the discipline you’re in and the idea is just over the fence.  But if you’re trained to stay within the fence you just won’t find it.  I’ve done that so much in my life it’s almost embarrassing.  And it makes me seem arrogant because I will frequently reach into the other fellows discipline and come up with an idea he misses.  And when I was young it caused me terrible problems.  People hated me.  And I probably shouldn’t have been as brash as I was.  And I probably wouldn’t be as brash as I am now.  I haven’t completed my self-improvement process.  But, it’s so much fun to get the right idea a little outside your own profession.  So if you’re capable of doing it, by all means learn to do it.  Even if you just want to learn it defensively.

I do not observe professional boundaries.  My doctor constantly writes, PSA test, prostate specific antigen, and I just cross it out. And he says, ‘What the hell are you doing?  Why are you doing this?’  And I say, ‘Well I don’t want to give you an opportunity to do something dumb.  If I’ve got an unfixable cancer that’s growing fast in my prostate I’d like to find out 3 months in the future, not right now.  And if I got one that’s growing slowly, I don’t want to encourage a doctor to do something dumb and intervene with it.  So I just cross it out.’  Most people are not crossing out their doctor’s prescriptions, but I think I know better. I don’t know better about the complex treatments and so forth.  But I know it’s unwise for me to have a PSA test.  So I just cross it out.  I’m always doing that kind of thing.  And I recommend it to you when you get my age.  Just go cross out that PSA test.  Now the women I can’t help.

The famous 93-year-old partner of Warren Buffet probably doesn’t need to be giving medical advice, but he’s clearly still super sharp.

The missing piece: “deliberate rest”

The forgotten half of the 10,000 hours to mastery popularized by Malcolm Gladwell, as argued by Alex Soojung-Kim Pang in Rest (emphasis mine):

“Deliberate practice,” they observed, “is an effortful activity that can be sustained only for a limited time each day.” Practice too little and you never become world-class. Practice too much, though, and you increase the odds of being struck down by injury, draining yourself mentally, or burning out. To succeed, students must “avoid exhaustion” and “limit practice to an amount from which they can completely recover on a daily or weekly basis.”

We should try to remember that we call it practicing medicine for a reason.

Excerpted in Nautilus.

When people are angry

When people criticize or respond negatively to me, usually they’re responding to this character that they’re seeing on TV called Barack Obama, or the office of the presidency, or the White House and what that represents. So, you don’t take it personally. You understand that if people are angry that somehow the government is failing, than they are going to look to the guy who represents government.

Barack Obama talking with Ta-Nehisi Coates for The Atlantic.

This is of course not limited to elected officials. Every person can function as a representative of their organization or profession. It happens to doctors every day because healthcare is broken. It can even happen to the CEO of United Airlines.

Self Deception: a tool that works

Von Hippel offers two pieces of wisdom regarding self-deception: “My Machiavellian advice is this is a tool that works,” he says. “If you need to convince somebody of something, if your career or social success depends on persuasion, then the first person who needs to be [convinced] is yourself.” On the defensive side, he says, whenever anyone tries to convince you of something, think about what might be motivating that person. Even if he is not lying to you, he may be deceiving both you and himself.

From “Living a Lie” in Scientific American.

Articles before Acronyms

Recent pet peeve, of which many healthcare writers and physicians are guilty: using the incorrect article before an acronym.

Everyone knows that you use “a” before a consonant and “an” before a vowel. What people may not realize is that it’s not the spelling that matters of the following word but its pronunciation. The actual rule is to use “a” before a consonant sound and “an” before a vowel sound.

Correct:
A MICU admission
A HIPPA violation

Also correct:
An MRI
An HIV patient

I know it may look funny, and your word processor may punish you with a colored underline, and Clippy may scoff at you from his digital paper clip grave, but thems the rules.