It’s Always Your Fault

I came across this brief article (“It’s Always Your Fault“) from 2016 by DHH, who–among other things–was the creator of the web application framework Ruby on Rails and co-founder of Basecamp/37Signals:

There’s a system in place that caused this to happen, and you’re part of that system. Shit never happens in a vacuum. The vast majority of it is a predictable consequence of the way things are. Even if it was “just somebody’s fault”, others put or kept that person there.

The goal is to change the system, and to change the system, you have to change its parts. Have the courage to start with yourself. Absorb as much blame and responsibility you can for what happened, and hopefully some of that introspection will rub off on the other parts of the system. But even if it doesn’t, you’ve still done your bit to improve matters.

In Medicine, we seem to oscillate between blame-game individual-at-fault finger-pointing and Just Culture the-system-is-the-problem.

It’s true we shouldn’t go around punishing people who are trying to learn and doing their best, and equally true that we need to always be looking to address system flaws. It’s also critical to keep in mind how many people working in healthcare are second victims of those mistakes, which prevents healthy introspection in favor of guilty misery.

But I also found his point just a little refreshing. As usual, it’s not either/or, it’s both.


Losing the Track is Part of Tracking

From The Lion Tracker’s Guide To Life by Boyd Varty:

You must train yourself to see what you are looking for.

Perhaps the most concise description of radiology training.

“I don’t know where we are going but I know exactly how to get there,” he says.

Process > outcome.

I think of all the people I have spoken to who have said, “When I know exactly what the next thing is, I will make a move.” I think of all the people whom I have taught to track who froze when they lost the track, wanting to be certain of the right path forward before they would move. Trackers try things. The tracker on a lost track enters a process of rediscovery that is fluid. He relies on a process of elimination, inquiry, confirmation; a process of discovery and feedback. He enters a ritual of focused attention. As paradoxical as it sounds, going down a path and not finding a track is part of finding the track.

Uncertainty is part of life, but a search pattern helps.

Coffee at Work

The coffee at work has been—for most locations of my training and attending career—terrible. From the burnt “Parks and Coffee” drip sitting for hours on the hot plate during residency to the cheapest K-cups at the imaging center. It doesn’t matter what sweetener or creamer you might add, it was rare to finish the cup once it was cold enough to taste. I’m not a coffee snob. I’m really more of a pragmatist. I don’t have the time or inclination for a long ritual even when working from home let alone the desire to do anything elaborate at work. Walking to the hospital Starbucks is slow and expensive. It’s a treat on the way for an early call shift morning but not something I enjoy doing routinely.

One of my residents shared Cometeer with me. It’s a variation on a coffee subscription (which is itself a variation on the incredible number of subscriptions available these days). I generally don’t like these sorts of things (who wants to remember to pause or cancel?), but I enjoyed the one I tried at work so I gave it a try.

The twist is that it’s a small recyclable cup of liquid-nitrogen flash-frozen coffee concentrate. Add your liquid of choice, hot to the frozen puck or cold after thawing, and you have instant coffee that isn’t, well, instant coffee. I predominantly use it as an espresso shot equivalent for making ice lattes, and for this purpose, it is effective and efficient. And it’s easy to slip in my bag and use on-site. On the enjoyment scale, I put it way above Starbucks’ regular iced coffee and just underneath their shaken iced espresso.



I honestly don’t know if I will continue to subscribe in the future, because it’s not the cheapest. You can cancel at any time and thankfully it’s also easy to spread out deliveries and pause them for months, because there’s no way I would want tons of coffee piling up in my freezer at any given time. I just don’t drink that much. With a $25 new member coupon, the per cup cost is $1.20 per pod (just a bit more than Nespresso pods) and cheaper than what I get at the coffee shop (but also more expensive than nothing, free tea, or the burnt brown caffeinated sludge otherwise available).

So, if you happen to be in the market for a new caffeine source and are interested in trying something new, you can try Cometeer and get $25 off (and subsidize my coffee consumption by the same amount!). Note that this is not a sponsored post; I just wouldn’t mind having cheaper coffee in the future. Also, note that I have literally never done a post like this in this site’s 13-year history. And finally, note that I can only use one referral bonus per order, so alas no matter how many of you choose to buy some I won’t be getting any coffee for free.

Physician Survey Signup Bonuses

Survey company offerings vary a lot by level of training and specialty, but several do offer bonuses to all comers for signing up (or when you attempt a survey or two):

I maintain an up-to-date list of healthcare survey companies here. Some of those links are also referrals that help support this site–so if signing up meets your needs/desires, thank you for supporting my writing.

On the long list for second place

It was a nice surprise to see over my busy call long weekend that I was nominated as a semifinalist for Aunt Minnie’s “most effective radiology educator” this year.

Or something like that:


As always, thanks for reading.