Atomic Habits

Atomic Habits was apparently the very best-selling book of 2021.

I don’t re-read books often, but James Clear’s entry is short and tactical, and it makes for a nice “get your head in the game” reset prior to a new effort (such as new year’s resolutions if that’s something you typically enjoy planning and then not doing).

Clear isn’t a scientist, but he did a nice job summarizing the work of others, particularly Charles Duhigg’s The Power of Habit and BJ Fogg’s Tiny Habits (though the latter’s popular book came later). It’s an example, like Yuval Harari’s wildly popular Sapiens, that synthesis, packaging, and storytelling are all considered valuable and certainly rewarded by the market (much more so than rigor).

Clear had a pretty solid newsletter for many years prior to the book, so he put in the time to generate some great quotes.

My two favorites:

You do not rise to the level of your goals. You fall to the level of your systems.

Every action you take is a vote for the type of person you wish to become.

I love the idea of identity-based habits. People love goals and are obsessed with outcomes. But not hitting your goals isn’t always a failure, and outcomes are often not within your locus of control. The inversion here we are affirming is of course the classic, “it’s the journey, not the destination.”

Habits are an effort to be the kind of person we want to be–internal validation–and not focused on outcomes that might happen as a result–external validation. That identity is more who we are and less exactly what we do.

From a post about residency interviews last year:

So much of your identity feels tied to your success in school, the match, and your developing career as a physician. But internal validation is always superior to external validation. You don’t and can’t control outcomes. You–at best–control yourself and your approach.

Perhaps we would do better to think of ourselves foremost as listeners or healers and less as a specific role like trauma surgeon or dermatologist.

What I Read in 2021

It turns out that this was the eighth year that I’ve kept track of at least the book-reading fraction of my entertainment consumption. It’s a practice I encourage, especially if you can jot down a few notes to yourself about your thoughts afterward (I read most of my nonfiction on my Kindle because of the very handy highlight feature, which helps). A fraction of those highlights typically then find their way into my digital brain archive and some eventually become posts on this very site. That and a new daily note habit are part of my ongoing fight against the forgetting curve.

Prior years here: 2020, 2019, 2018, 2017, 2016, 2015, 2014.

  1. Atomic Habits by James Clear (re-read this for pandemic new year inspiration)
  2. The Math of Life and Death by Kit Yates (I’ve long wished people were generally numerate, especially after reading the book Innumeracy in college. This pandemic has only made that desire stronger.)
  3. Derelict by Dean Henegar (This is a sub-subgenre of LitRPG called DungeonCore, where the main character is a sentient dungeon. This wasn’t very good, but the genre itself is sorta weirdly engaging, as if a tower defense game were a novel with lots of internal monologue.)
  4. Derelict #2 by Dean Henegar
  5. A Promised Land by Barack Obama (Obama is a good writer.)
  6. Quit like a Woman by Holly Whitaker (Alcohol culture is pretty toxic.)
  7. How I Built This by Guy Raz (origin stories of some modern unicorn companies. Honestly less interesting than I thought it would be.)
  8. Weird by Olga Khazan (also much less interesting than I thought it would be.)
  9. Exo Hunter by Jeremy Robinson (Everything this guy writes is a fast-paced romp. He has the page-turner plotting down to a science. This is one of the worst but still perfectly enjoyable.)
  10. Vagabonds by Hao Jingfang translated by Kevin Liu  (The Dispossessed [a Le Guin class] as if written by twenty-something year Chinese man writing in Mandarin in 20xx.)
  11. Happier by Tal Ben-Shahar
  12. God’s Eye Awakening by Aleron Kong (new series based on The Land; we’ll see…)
  13. On Writers and Writing by Margaret Atwood (meh, as far as writing about writing goes, I much prefer Ursula K Le Guin’s and Stephen King’s entries)
  14. Life Reset (#1) by Shemer Kuznits (another LitRPG, yes, but in this one, the main character is a monster, so there)
  15. Life Reset: EvP (#2) by Shemer Kuznits
  16. Life Reset: Hobnobbing (#3) by Shemer Kuznits
  17. Life Reset: Human Resource (#4) by Shemer Kuznits
  18. Life Reset: Conquest (#5) by Shemer Kuznits
  19. Infinite 2 by Jeremy Robinson (solid, but honestly Infinite [1] was probably better off on its own. That was a seriously fun book.)
  20. Range by David Epstein (If you ever feel frustrated that we’re all hamsters spending more and more time learning about less and less, this is the book for you)
  21. The Hobbit by JRR Tolkein (thought I’d return to the classic)
  22. Project Hail Mary by Andy Weir (super duper enjoyable book. This [not Artemis] is the real spiritual sequel to The Martian.)
  23. How to Take Smart Notes by Sonke Ahrens (the most academic of the recent takes on the Zetellkasten system of creating a repository of personal knowledge like those facilitated by recent apps including RoamResearch and Obsidian. It is also very repetitive and dry).
  24. World Tree Online (#1) by EA Hooper (enjoyable LitRPG; also nice that it’s a trilogy with an actual ending!)
  25. Demon Lord (#2) by EA Hooper
  26. World Tree’s End (#3) by EA Hooper
  27. Backable by Suneel Gupta (written by the brother of the much more famous Sanjay Gupta; meh; made it into some posts about medicine here and residency interviews here.)
  28. Adventures in Opting Out by Cait Flanders (thought this might be fun as a quick sequel to her first book, but it mostly wasn’t)
  29. The Emergency Mind by Dan Dworkis MD PhD (A book of mental models for decision making in high-stress situations [e.g. an emergency department]. Dan was actually the older brother of a close friend growing up. Super smart dude. Brief post here.)
  30. Israel by Noa Tishby (a very accessible whirlwind tour)
  31. Talking to Strangers by Malcolm Gladwell (It’s refreshing how willing Gladwell is to take the flip side of the coin he popularized in Blink. Brief post here.)
  32. Andrea Vernon and the Superhero Industrial Complex (#2) by Alexander C. Kane (not as good as the original)
  33. Vanishing Fleece by Clara Parkes (a story about modern American textiles; I find these types of memoir-ish deep dives to be oddly interesting. I knew nothing about yarn–until now.)
  34. The Practice by Seth Godin (truly half-baked)
  35. Ascension (The Beginning After the End #8) by TurtleMe
  36. Metropolitan by Walter Jon Williams (The world-building and characters in this book are extremely vivid.)
  37. City on Fire (#2 of 2) by Walter Jon Williams
  38. The Midnight Library by Matt Haig (This is one of those books that became extremely popular. I get why given the world we live in, but ultimately perhaps too tidy, dry, and predictable.)
  39. The Mayor of Noobtown by Ryan Rimmel
  40. The Village of Noobtown (Noobtown #2) by Ryan Rimmel
  41. Castle of the Noobs (Noobtown #3) by Ryan Rimmel
  42. Dungeons and Noobs (Noobtown #4) by Ryan Rimmel
  43. Noon Game Plus (Noobtown #5) by Ryan Rimmel
  44. The Blade Itself (First Law #1) by Joe Abercrombie (often held up as the best example of Grimdark Fantasy. This was really, really good in addition to being brutal.)
  45. Before They Are Hanged (First Law #2) by Joe Abercrombie
  46. The Last Argument of Kings (First Law #3) by Joe Abercrombie
  47. The Hundred Thousand Kingdoms (The Inheritance Trilogy #1) by NK Jemisin (I’m still not sure how I feel about this series.)
  48. The Broken Kingdoms (The Inheritance Trilogy #2) by NK Jemisin
  49. The Kingdom of Gods (The Inheritance Trilogy #3) by NK Jemisin
  50. The Awakened Kingdom (The Inheritance “Trilogy” #4) by NK Jemisin
  51. Mirrorworld by Jeremy Robinson
  52. Red Shirts by John Scalzi (Hugo Award winner; such a great sci-fi subversion; breaks the fourth wall and then beyond)
  53. The Amazing Adventures of Kavalier and Clay by Michael Chabon (a novel set primarily in the golden age of comics. Won the Pulitzer Prize and has been on my shelf to read for a decade. Truly excellent. Chabon is a master.)
  54. Shadeslinger (Ripple System #1) by Kyle Kirrin (I think this is really the last new LitRPG series I expose myself to for a while. All of these LitRPG series are essentially examples of a subgenre called Progression Fantasy, essentially stories focused on character growth like the shonen-style of anime that’s been popular for the past 30 or so years, and–in that way–they’re addictive and soothing at the same time, a balm for the mind in these troubled times.)
  55. Life Reset: Salvation (#6) by Shemer Kuznits (another series concluded!)
  56. The Hospital by Brian Alexander (a depressing tale of modern healthcare and small-town decline through the lens of a midwestern community hospital. Brief post here.)
  57. Everyday Vitality by Samantha Boardman
  58. What Happened to You? By Oprah Winfrey and Bruce D Perry MD Phd
  59. Greenlights by Matthew McConaughey (some interesting stories but almost painfully self-indulgent)
  60. Taste by Stanley Tucci (warning: will make you desperately want really good Italian food)
  61. Keep Sharp by Sanjay Gupta (synopsis: exercise, eat right, and don’t retire)
  62. Cytonic by Brandon Sanderson (Skyward #3)
  63. Will by Will Smith (even more interesting stories but even more self-indulgent)
  64. Black Sand Baron by Kyle Kirrin (Ripple System #2)
  65. The End of Craving by Mark Schatzker (I really found The Dorito Effect interesting as a look at modern food science, the flavorings industry, etc. I honestly don’t have the background to evaluate the claims this book makes about food additives. Could all be raving pseudoscience for all I know. I can at least recommend his first book. But clearly, in the words of Michael Pollan, “eat [real] food, not too much, mostly plants” would be better for all of us.)
  66. The Invisible Life of Addie LaRue by VE Schwab (This was enjoyable, with echoes of The Time Traveler’s Wife. I preferred the Shades of Magic, but VE Schwab is a solid writer.)
  67. Crying in H Mart by Michelle Zauner (though this is supposed to be a moving memoir about acculturation, assimilation, family, food, and loss, it mostly made me want to head to our local H Mart to re-stock my freezer and pantry because it’s been a while.)

I didn’t do a very good job keeping track of what I read to my son, but here are some of the chapter books and graphic novels:

  1. We eventually finished the 27-volume Magic Treehouse series and read the first five or so of the sequel Merlin Missions.
  2. Yeti Files by Kevin Sherry
  3. Cat Kid Comic Club by Dav Pilkey
  4. Rowley Jefferson’s Awesome Friendly Spooky Stories by Jeff Kinney
  5. The Magician’s Nephew by C.S. Lewis (I would really like to continue reading Narnia with him, but he’s more interested in Pokemon and Lego at the moment…)
  6. The Forbidden Power (Lego Nexo Knights: Knights Academy #1) by Max Brallier (honestly far better than it deserved to be)
  7. Glitch by Sarah Graley
  8. The first two volumes in this Pokemon novelization box set, which we are enjoying, um, asymmetrically.

Shallow versus Deep. Prolific versus Profound.

From Rest: Why You Get More Done When You Work Less:

We see work and rest as binaries. Even more problematic, we think of rest as simply the absence of work, not as something that stands on its own or has its own qualities. Rest is merely a negative space in a life defined by toil and ambition and accomplishment. When we define ourselves by our work, by our dedication and effectiveness and willingness to go the extra mile, then it’s easy to see rest as the negation of all those things. If your work is your self, when you cease to work, you cease to exist.

What fraction of doctors (and miscellaneous business workaholics) do you think still believe rest is for the weak and that the ability to slog and hustle is not just good but truly enviable?

Second, most scientists assumed that long hours were necessary to produce great work and that “an avalanche of lectures, articles, and books” would loosen some profound insight. This was one reason they willingly accepted a world of faster science: they believed it would make their own science better. But this was a style of work, Ramón y Cajal argued, that led to asking only shallow, easily answered questions rather than hard, fundamental ones. It created the appearance of profundity and feelings of productivity but did not lead to substantial discoveries. Choosing to be prolific, he contended, meant closing off the possibility of doing great work.

Just like many jobs are bullshit jobs, much of our research is bullshit research. If we reward volume, we disincentive depth.

As Vinay Prasad was quoted in the Atlantic, “Many papers serve no purpose, advance no agenda, may not be correct, make no sense, and are poorly read. But they are required for promotion.”

When we treat workaholics as heroes, we express a belief that labor rather than contemplation is the wellspring of great ideas and that the success of individuals and companies is a measure of their long hours.

And this is one of the tough parts about almost everything written about deep work, rest, the power of no, when to say yes, and everything else in the modern business/productivity/self-improvement genre. The approaches just don’t apply very well out-of-the-box to service workers.

Doctors are primarily service workers. If we work more hours, we see more patients. While there is almost certainly a diminishing return in terms of quality care, there is no diminishing return for billing. A doctor generates more RVUs when they have more clinical hours, and that means more profits for their handlers (until someone burns out and quits).

William Osler advised students that “four or five hours daily it is not much to ask” to devote to their studies, “but one day must tell another, one week certify another, one month bear witness to another of the same story.” A few hours haphazardly spent and giant bursts of effort were both equally fruitless; it was necessary to combine focus and routine. (He lived what he preached: one fellow student recalled that in his habits Osler was “more regular and systematic than words can say.”)

Cramming is bad. Overwork is bad. A reasonable concerted effort over a long period of time is good.

Studying 4-5 hours a day was apparently a reasonable amount to Osler’s sensibility. Olser, if you recall, founded the first residency training program at Johns Hopkins.

Do you remember when the heads of the NBME and FSMB suggested in 2019 that a pass/fail USMLE Step 1 would be bad because students might take the decreased pressure as an opportunity to watch Netflix? Because I do.

Focus on the drive, not the distraction

NYT Columnist David Brooks writing about “The Art of Focus” back in 2014:

If you want to win the war for attention, don’t try to say ‘no’ to the trivial distractions you find on the information smorgasbord; try to say ‘yes’ to the subject that arouses a terrifying longing, and let the terrifying longing crowd out everything else.

There are whole books written about The Power of No, but I wouldn’t discount how our environments shape our behavior. Whether or not willpower is muscle or decision fatigue is real, there are plenty of data to show that making suboptimal activities harder improves outcomes in a variety of contexts.

I can tell you, for example, that the proximity of a Panera to one of the imaging centers I work at is not helping me make good lunch choices (bread bowls are my kryptonite).

But Brooks does reframe the classic “If you do what you love, you’ll never work a day in your life” adage to make it more approachable.

I think “find your passion” is generally terrible meaningless advice in most circumstances. If you have one, great. But if you don’t, it’s not exactly straightforward to meditate for a few minutes, analyze your innermost desires, and manifest your calling.

However, there’s also no denying that having a “pull” to do something (say, teaching others or writing) is the antidote to other less impactful activities. If you are drawn to something that matches your desired identity and goals, then it automatically makes it easier to avoid the “trivial distractions.”

As in, it’s easier to focus when you don’t want to escape the thing you’re trying to do.

Residency and the Craftsman Mentality

From Cal Newport’s excellent Deep Work: Rules for Focused Success in a Distracted World:

Whether you’re a writer, marketer, consultant, or lawyer: Your work is craft, and if you hone your ability and apply it with respect and care, then like the skilled wheelwright you can generate meaning in the daily efforts of your professional life.

You don’t need a rarified job; you need instead a rarified approach to your work.

Let’s add “physician” to Newport’s list.

One of the more disheartening aspects of medical school is the siloing of medical specialties such that different breeds of doctors appear to compete in the hospital and medical students come away with the idea that one specialty should spark passion in their hearts (and that they will be professionally unhappy if they then don’t match into that one specialty).

It doesn’t have to be this way.

The satisfaction of professional growth and a job well done can transcend specialty choice. If the results of the match weren’t what you wanted, apply yourself to developing a craftsmen’s mentality. Get good at what you do, take pride in it, and passion can follow.