Giving advice and selling can’t be the same thing.
Nassim Taleb, pithily summarizing a lot of problems. For example, the core problem of much of the financial planning industry.
Giving advice and selling can’t be the same thing.
Nassim Taleb, pithily summarizing a lot of problems. For example, the core problem of much of the financial planning industry.
This is a brief adjunct to my post on using Autohotkey in Radiology (which basically every radiologist should be doing, by the way). I include it here not because I expect many people to run into the same problem I did but rather because it’s a good example of the not-so-challenging troubleshooting that we shouldn’t be scared to do in our quest for a better workflow. I’m a novice and that’s okay! We can still do cool stuff!
In that post, I mentioned an example script I made to streamline launching patient charts in Epic from PACS at home since our automatic integration doesn’t work remotely.
One thing I didn’t describe in that post is an annoying quirk for activating Epic because it runs through Citrix. Since Citrix is weird, and there are presumably multiple servers that can run Epic, the window title of our Epic actually changes with each login. Therefore, the usual static name-matching technique we use to activate Powerscribe, Chrome, or other typical apps doesn’t work.
In our system, Epic always has a title like “ecpprd2/prdapp01” or “ecpprd3/prdapp04”—but the numbers always shift around.
For a while, I used a workaround:
WinActivate, ahk_exe WFICA32.EXE
…which is the name of the Epic/Citrix program .exe file running on my PC, and as long as only one Citrix application was open at the time, it worked (I had to make sure to close an MModal application that auto-launched with it, but otherwise it was fine). Recently, my hospital started using some useless AI tool that cannot be closed, which broke my script.
The workaround one of my colleagues figured out is to change the AHK TitleMatchMode of that specific hotkey to recognize “regular expressions” (a “RegEx” is a sequence of characters that specifies a pattern of text to match).
SetTitleMatchMode RegEx
Then we can use WinActivate with a few modifiers to recognize an unchanging portion of the window title. In our example above, where the title always contains ecpprd or prdapp, we can use the following to select the EPIC window:
WinActivate i)^ecpprd
In this example, the “i” modifier allows case-insensitive search, and the carat (^) limits the string to the beginning of the window title. You can read more about regular expressions in AKH here.
In reality, if I had just explained my problem to any of the popular LLMs, I’m confident they would have given me the answer. They absolutely excel at this. The rapidly approaching agentic era will allow for some very easy, very powerful scripting in the very near future even if commercial products lag behind.
There’s a common first-things-first productivity parable of the rocks and the jar. It goes like this:
Imagine you have an empty jar that represents your life, and you have different sizes of rocks that represent different priorities and commitments. The big rocks represent the most important things in life, like your family and health. Medium rocks would be secondary priorities like intermediate career goals, social commitments—other worthwhile but less crucial activities. And finally, the small rocks and sand represent the minor daily tasks, distractions, and time-fillers that can easily consume our attention.
The thrust: If you fill your jar with sand and small rocks first, you won’t have room for the big rocks. But if you put the big rocks in first, then the medium rocks, the sand will filter down into the spaces between them—and everything fits.
From Oliver Burkeman’s Four Thousand Weeks: Time Management for Mortals:
Here the story ends—but it’s a lie. The smug teacher is being dishonest. He has rigged his demonstration by bringing only a few big rocks into the classroom, knowing they’ll all fit into the jar. The real problem of time management today, though, isn’t that we’re bad at prioritizing the big rocks. It’s that there are too many rocks—and most of them are never making it anywhere near that jar. The critical question isn’t how to differentiate between activities that matter and those that don’t, but what to do when far too many things feel at least somewhat important, and therefore arguably qualify as big rocks.
That tracks.
The Art of Creative Neglect Principle number one is to pay yourself first when it comes to time. I’m borrowing this phrasing from the graphic novelist and creativity coach Jessica Abel, who borrowed it in turn from the world of personal finance, where it’s long been an article of faith because it works.
Abel saw that her only viable option was to claim time instead—to just start drawing, for an hour or two, every day, and to accept the consequences, even if those included neglecting other activities she sincerely valued. “If you don’t save a bit of your time for you, now, out of every week,” as she puts it, “there is no moment in the future when you’ll magically be done with everything and have loads of free time.”
From both of these passages, my takeaway is that we can’t hope it actually choose all the rocks in some cohesive way. Avoid some of the useless filler sand, sure. But, maybe, don’t wait and just choose a rock sometimes:
Thinking in terms of “paying yourself first” transforms these one-off tips into a philosophy of life, at the core of which lies this simple insight: if you plan to spend some of your four thousand weeks doing what matters most to you, then at some point you’re just going to have to start doing it.
The easy trap is the too many coals in the fire:
The second principle is to limit your work in progress. Perhaps the most appealing way to resist the truth about your finite time is to initiate a large number of projects at once; that way, you get to feel as though you’re keeping plenty of irons in the fire and making progress on all fronts. Instead, what usually ends up happening is that you make progress on no fronts—because each time a project starts to feel difficult, or frightening, or boring, you can bounce off to a different one instead. You get to preserve your sense of being in control of things, but at the cost of never finishing anything important.
I’m trying to work through a backlog of abandoned work, but at this point my inability to focus, attend, and limit possibilities is a core character flaw.
From “The how we need now: A capacity agenda for 2025 and beyond,” published by the Niskanen Center think tank.
What are the forces making the government so slow? The first of those dysfunctions is what Nicholas Bagley of the University of Michigan calls the “procedure fetish,” and we dub the bureaucratic anxiety cycle. Anxiety about legitimacy and accountability drives critics to demand, and bureaucrats to seek refuge behind, more and more layers of procedure that show things have been done “by the book.” But all that procedure further erodes both legitimacy and accountability by overburdening the bureaucracy, reducing its ability to deliver meaningful outcomes.
In the addition to the government, tell me this doesn’t summarize every large company you’ve ever dealt with, especially any that deal in a high-regulation industry like healthcare.
They go on to flesh out the “Cascade of Rigidity” with a helpful infographic:
Well-intentioned laws and regulations become increasingly inflexible and counterproductive as they evolve toward implementation. The authors argue part of the solution is shifting focus:
The revised system must shift its emphasis from compliance to meeting mission needs. This means power to make decisions must shift from compliance personnel to the people closest to the work.
The vicious cycle of growing bureaucracy and procedural bloat requires a reversion to our ultimate goals: a need to serve the mission and not its own machinery.
“This means power to make decisions must shift from compliance personnel to the people closest to the work.”
No easy feat.
Old advice from Andy Grove, former CEO of Intel (back when Intel was killing it), from a 2007 Esquire interview:
Not all problems have a technological answer, but when they do, that is the more lasting solution.
The problem, as anyone who has used an EHR or any other enterprise software, is that the problem being solved (e.g. optimal billing) may itself create a wealth of downstream problems (e.g. frustrating, inefficient healthcare).
Satisfaction doesn’t come in moments but in periods of time.
Beware the arrival fallacy.
Success breeds complacency. Complacency breeds failure. Only the paranoid survive.
This is ironic in that post-Grove Intel entirely missed the boat on mobile an increasing fraction of everyone’s devices utilize the ARM architecture.
It’s also so painfully clear that this manifests in the lack of institutional and cultural knowledge that plagues schools, organizations, and the government. We rest on the status quo when it works until it doesn’t.
But the problems compound when we then forget the parts that got us there in the first place in our desire for improvement.
Sometimes inefficiency is a critical piece of the puzzle (like we saw with Covid supply chain issues). Other times, we are unaware of the lessons from the past and miss the negative externalities of our panicked interventions.
Profits are the lifeblood of enterprise. Don’t let anyone tell you different.
We have to live in the world as it is.
There’s never enough time.
I signed up for my Threads and my Bluesky accounts in addition to OG Twitter/X or even LinkedIn a while back but never started really using them (@benwhitemd across the board, links above–give me a follow?). I’ve now set those up so that I can more easily share tweets of new blog posts across all platforms to account for reader preference (and I even added the cute little logos to my sidebar here).
From “People systematically overlook subtractive changes,” published in Nature back in 2021:
Participants were less likely to identify advantageous subtractive changes when the task did not (versus did) cue them to consider subtraction, when they had only one opportunity (versus several) to recognize the shortcomings of an additive search strategy or when they were under a higher (versus lower) cognitive load. Defaulting to searches for additive changes may be one reason that people struggle to mitigate overburdened schedules, institutional red tape, and damaging effects on the planet.
In so many cases, the easiest, cheapest solution to a problem is to simplify. It’s just so hard to remember/realize/acknowledge that—especially at an organizational or regulatory level—without skin in the game.
Bill Watterson, who created the best comic strip of all time (Calvin and Hobbes), gave the commencement address at Kenyon College back in 1990, which he titled, “Some Thoughts on the Real Word by One Who Glimpsed It and Fled“:
It’s surprising how hard we’ll work when the work is done just for ourselves. And with all due respect to John Stuart Mill, maybe utilitarianism is overrated. If I’ve learned one thing from being a cartoonist, it’s how important playing is to creativity and happiness. My job is essentially to come up with 365 ideas a year. If you ever want to find out just how uninteresting you really are, get a job where the quality and frequency of your thoughts determine your livelihood. I’ve found that the only way I can keep writing every day, year after year, is to let my mind wander into new territories. To do that, I’ve had to cultivate a kind of mental playfulness.
I love that line: “If you ever want to find out just how uninteresting you really are, get a job where the quality and frequency of your thoughts determine your livelihood.” Of course, Watterson had the constraints he placed on himself by his chosen medium. I don’t know if it’s easier or harder long term to do permutations pivoting around a central premise or to bounce from thing to thing as you tire and exhaust the low hanging fruit of its potential. I think they’re probably both really hard.
We’re not really taught how to recreate constructively. We need to do more than find diversions; we need to restore and expand ourselves. Our idea of relaxing is all too often to plop down in front of the television set and let its pandering idiocy liquefy our brains. Shutting off the thought process is not rejuvenating; the mind is like a car battery-it recharges by running.You may be surprised to find how quickly daily routine and the demands of “just getting by” absorb your waking hours. You may be surprised matters of habit rather than thought and inquiry. You may be surprised to find how quickly you start to see your life in terms of other people’s expectations rather than issues. You may be surprised to find out how quickly reading a good book sounds like a luxury.
I was traveling for a talk the other day and this came up with someone in the audience. I make time for the writing and the projects and the teaching/mentoring and everything else because that’s the variety that makes the more routine, potentially tedious stuff tolerable.
Yes, time management is impossible, but it doesn’t mean I wouldn’t fill more precious time with garbage if I wasn’t trying to be deliberate.
Creating a life that reflects your values and satisfies your soul is a rare achievement. In a culture that relentlessly promotes avarice and excess as the good life, a person happy doing his own work is usually considered an eccentric, if not a subversive. Ambition is only understood if it’s to rise to the top of some imaginary ladder of success. Someone who takes an undemanding job because it affords him the time to pursue other interests and activities is considered a flake. A person who abandons a career in order to stay home and raise children is considered not to be living up to his potential-as if a job title and salary are the sole measure of human worth.
You’ll be told in a hundred ways, some subtle and some not, to keep climbing, and never be satisfied with where you are, who you are, and what you’re doing. There are a million ways to sell yourself out, and I guarantee you’ll hear about them.
To invent your own life’s meaning is not easy, but it’s still allowed, and I think you’ll be happier for the trouble.
Some passages on what makes a job “good” from The Happiness Hypothesis by Jonathan Haidt:
Psychologists have referred to this basic need as a need for competence, industry, or mastery. [Psychologist Robert] White called it the “effectance motive,” which he defined as the need or drive to develop competence through interacting with and controlling one’s environment. Effectance is almost as basic a need as food and water, yet it is not a deficit need, like hunger, that is satisfied and then disappears for a few hours. Rather, White said, effectance is a constant presence in our lives: Dealing with the environment means carrying on a continuing transaction which gradually changes one’s relation to the environment. Because there is no consummatory climax, satisfaction has to be seen as lying in a considerable series of transactions, in a trend of behavior rather than a goal that is achieved.
This reflects the importance of developing the craftsman mentality.
The effectance motive helps explain the progress principle: We get more pleasure from making progress toward our goals than we do from achieving them because, as Shakespeare said, “Joy’s soul lies in the doing.”
Believing the opposite was coined as “the arrival fallacy” by psychologist Tal Ben-Shahar, who wrote the best-selling Happier. (As in: I’ll finally be happy when I finish that big exam or project. No, when I graduate! Or get that promotion! No, when I retire!)
Contrast the effectance motive with the many narrowly defined clock-in clock-out closely supervised jobs that limit personal choices:
In 1964, the sociologists Melvin Kohn and Carmi Schooler surveyed 3,100 American men about their jobs and found that the key to understanding which jobs were satisfying was what they called “occupational self direction.” Men who were closely supervised in jobs of low complexity and much routine showed the highest degree of alienation (feeling powerless, dissatisfied, and separated from the work). Men who had more latitude in deciding how they approached work that was varied and challenging tended to enjoy their work much more. When workers had occupational self-direction, their work was often satisfying.
My profession of radiology can easily fall into this trap in the wrong environment. You have to carve out ways to take ownership of both the process and product.
It’s an incredible privilege to work at a place and live in a country that is willing to set aside money to answer these existential questions. I heard a phrase the other week, existential humility, and I really liked that. We’re this complex life form that has evolved over billions of years to the point where we can ask these questions — and yet we’re perhaps not the only ones in the universe. And if we could know that for certain, that would be humbling in the most wonderful possible way.
– Astronomer Vanessa Bailey in Dave Eggers’ “The Searchers,” a profile on NASA’s Jet Propulsion Lab.