Driving at Stable

A classic Jeff Bezos quotation:

I very frequently get the question: “What’s going to change in the next 10 years?” That’s a very interesting question.

I almost never get the question: “What’s not going to change in the next 10 years?” And I submit to you that that second question is actually the more important of the two.

You can build a business strategy around the things that are stable in time. In our retail business, we know that customers want low prices, and I know that’s going to be true 10 years from now. They want fast delivery; they want vast selection. It’s impossible to imagine a future 10 years from now where a customer comes up and says, “Jeff I love Amazon, I just wish the prices were a little higher.” Or, “I love Amazon, I just wish you’d deliver a little slower.” Impossible.

So we know the energy we put into these things today will still be paying off dividends for our customers 10 years from now. When you have something that you know is true, even over the long term, you can afford to put a lot of energy into it.”

I recently attended a “leadership” seminar about (radiology) healthcare ecosystems and change. As with all virtual events since early 2020, discussion of the Covid-19 pandemic played an outsized role, and the nature of complexity and change were much pontificated about.

But no one over the course of two days–no one–mentioned the stability of the core mission. The strategic analyses–such as explicit or implicit utilization of SWOT–were happy to focus on anticipation and interception of perceived changes and threats, but no one spared a breath for what they thought wouldn’t change. We talked about trends in corporatization and productivity metrics, group consolidation, encroachment by midlevels and other specialties, downward reimbursement pressure, the push for 24/7 subspecialty staff coverage, lifestyle and burnout, and AI and data science.

To be sure, these and all other big changes are important, but you also can’t lose sight of the underlying purpose of the business in all the pivoting.

What can we say about medicine that is not going to change in 10 years? What is our stability north star?

(Yes this is a rhetorical question cop-out.)

 

The Stress Heuristic

Cal Newport, author of the beloved Deep Work (among others), writing in The New Yorker.

…most workers who are fortunate enough to exert some control over their efforts—such as knowledge workers and small-business entrepreneurs—tend to avoid working way too much, but also tend to avoid working a reasonable amount. They instead exist in a liminal zone: a place where they toil, say, for the sake of fixing a specific number, twenty percent more than they really have time for. This extra twenty percent provides just enough overload to generate persistent stress—there’s always something that’s late, always a message that can’t wait until the next morning, always a nagging sense of irresponsibility during any moment of downtime. Yet the work remains below a level of unsustainable pain that would force a change.

If you’re a professor, or a mid-level executive, or a freelance consultant, you don’t have a supervisor handing you a detailed work order for the day. Instead, you’re likely bombarded with requests and questions and opportunities and invites that you try your best to triage. How do you decide when to say no? In the modern office context, stress has become a default heuristic. If you turn down a Zoom-meeting invitation, there’s a social-capital cost, as you’re causing some mild harm to a colleague and potentially signaling yourself to be uncoöperative or a loafer. But, if you feel sufficiently stressed about your workload, this cost might become acceptable: you feel confident that you are “busy,” and this provides psychological cover to skip the Zoom. The problem with the stress heuristic is that it doesn’t start reducing your workload until you already have too much to do. Like Parkinson’s naval bureaucracy, which expanded at a regular rate regardless of the size of the Navy, this stress-based self-regulation scheme ensures that you remain moderately overloaded regardless of how much work is actually pressing.

“The Stress Heuristic” is a great term for people’s default strategy for avoiding more work: being literally too busy for more work.

But while saying ‘no’ is easiest when saying ‘yes’ is impossible, it forces you to live without margin. And margin–space in your life for yourself, serendipity, and the chance to chase down things of interest–is where the magic happens.

Even for academics, consider the words of psychologist Amos Tversky (whose work with Daniel Kahneman yielded the Nobel-prize-winning Prospect Theory and the crazy popular book Thinking, Fast and Slow): “The secret to doing good research is always to be a little underemployed. You waste years by not being able to waste hours.”

Writing Makes It “True”

From “How to Leverage Language to Cultivate Your Creative Process” by Nicole He in Killscreen.

I had a concept in my mind—maybe I felt it emotionally, I had a feeling about what this thing is supposed to represent. Now what I’m saying makes it real. After that, I started responding to journalists the next morning. What blew my mind was this: the thing I wrote about my project became true about the project. Many of the things I would say, the lazier journalists would just copy and paste. Weirdly, seeing my own ideas in the media suddenly made them even more true—things about a project being about intimacy, about computers knowing more than we know about ourselves. All of this became true, because someone else was saying things about my project, but based on what I had said about my project.

There’s a lot to be said for putting in the effort of distilling a vague idea into a clear concept and writing it down (and, yes, maybe even sharing it). Not just for a specific project, but for you and your whole career.

There is power in storytelling, both internally and externally.

And, perhaps weirdest of all is that–on the whole–you get to define your own narrative.

Semiannual Social Media is Terrible PSA

Here’s a little exercise adapted from “You Really Need to Quit Twitter” in The Atlantic:

Step 1: Take the Simone Weil essay  “On the Abolition of All Political Parties” and replace the word “parties” with something that maybe shouldn’t exist, like social media:

The mere fact that social media exists today is not in itself sufficient a reason for us to preserve it. The only legitimate reason for preserving anything is its goodness. The evils of social media are all too evident; therefore, the problem that should be examined is this: Does it contain enough good to compensate for its evils and make its preservation desirable?

Step 2: (Oh well I still have my Twitter account).

The Limitations of Copy and Paste

From “To Kickstart a New Behavior, Copy and Paste” by Kathy Milkman, author of the new book, How to Change, which suggests the best way to master a new skill is to emulate the methods of someone successful.

Happily, it’s easy to turn yourself into a deliberate copy-and-paster. The next time you’re falling short of a goal, look to high-achieving peers for answers. If you’d like to get more sleep, a well-rested friend with a similar lifestyle may be able to help. If you’d like to commute on public transit, don’t just look up the train schedules—talk to a neighbor who’s already abandoned her car. You’re likely to go further faster if you find the person who’s already achieving what you want to achieve and copy and paste their tactics than if you simply let social forces influence you through osmosis.

Kinda maybe sorta.

There is a big, big difference between emulating psychosocial habits (like vegetarianism or fashion) or noncomplex skills (like a workable commute route or some forms of regular exercise) and achieving success in a skill-based habit like practicing medicine or playing an instrument.

For low-stakes or low-commitment behaviors, sure. It’s reasonable to try to save time and give yourself the boost of something that has worked for someone. Copy-paste saves you from analysis paralysis.

But copy and paste is also a guaranteed way to fully embrace survivorship bias. You don’t know if the people you are emulating succeeded because of their methods or despite them. You don’t know if those methods are optimal for you or if the most important aspects of said methods are even those which are externally visible or consciously retrievable from the expert.

A lot of people don’t know why they’re successful, and their attempts to craft a narrative about their successes are fiction.

And when it comes to experts instead of peers, one of the common difficulties for many is that it’s been so long since they’ve been a novice that they literally don’t know what it’s like anymore. Their memories of their early growth are fuzzy and often out-of-date to boot.

As we are back in the middle of USMLE Step season for the medical students among you, I am reminded of this post I wrote in 2014 about the Methods to Success Fallacy.