The Negativity Tendency

Hans Rosling gave an amazingly popular TED talk back in 2006 (and many other popular talks since). You may have seen it. It’s the one showing recent human progress by following counties over time as a series of bubbles. It’s not all rosy, but it shows us how counterintuitive reality can be compared with our usually grimmer assumptions. One could summarize: things can be bad but still be improving. Trajectories matter.

In his follow-up book, Factfulness, Rosling discusses the fact that almost all “news” by definition is bad news. His helpful grounding suggestion: When you hear bad news, ask yourself if similar good news would be able to reach you.

* * *

In healthcare, M&M is full of bad outcomes. Do you hear about the patients who recover uneventfully in the hospital? Not really. Do people gossip about the patients who go home after surgery with well-healed incisions? No, they do not. As a radiologist, I only hear about my misses. About once a year, someone congratulates me on a good catch, and usually, that’s coming from another radiologist who read the follow-up.

As an attending evaluating my residents’ overnight work, I have to grade every change. We have grades for verbiage changes, incidental additions, small relevant misses, and big emergent misses. There’s nothing forcing me to tell my residents that I recognize the great job they’re doing tackling a large volume of complex cases. Most of what they see is negative feedback, even though that parade of bad news doesn’t really tell them an accurate story about the work they’re doing.

When I was a resident, my program had a separate grade for doing an amazing job. You could receive a coveted “1” on the 1-4 scale for crushing a subtle case, performing at a subspecialty level, etc. 1’s were rare.

One evening as I logged in for another shift, I was reviewing my grades from the night before and I saw I’d received a 1. Exhaustion aside, I was always excited when I earned a 1. The comment said, “Everyone deserves a 1 every now and again, so here’s yours.” I didn’t know how to parse that cryptic statement, so I clicked on the link to see the case.

It was a completely normal head CT in a young patient.

I hadn’t changed a word of the template.

* * *

We learn medicine through the slow accumulation of emotional microtrauma. As an educator, it takes special effort to try to really teach through praise and positive reinforcement; usually the vague “great jobs” show up on end-of-rotation evaluations. I’ll be the first to admit I’m too far on the curmudgeon spectrum.

Yes, feedback–even negative feedback–is a critical component of the learning process. But, when you’re beating yourself up about your mistakes and questioning your skills/growth, you also need to ask yourself:

What are the odds that I’m receiving the true positive side of the same coin?

The answer is you’re probably not.

Things can be bad and still be improving. Trajectories matter.

You can still have a lot to learn and a long way to go and still be doing a great job.

On Building

Highlights from Build: An Unorthodox Guide to Making Things Worth Making by Tony Fadell (who led the teams for the iPod, iPhone, and Nest Learning Thermostat):

On the need to divide decisions into two main camps, data-driven or opinion-driven:

Data-driven: You can acquire, study, and debate facts and numbers that will allow you to be fairly confident in your choice. These decisions are relatively easy to make and defend and most people on the team can agree on the answer.

Opinion-driven: You have to follow your gut and your vision for what you want to do, without the benefit of sufficient data to guide you or back you up. These decisions are always hard and always questioned-after all, everyone has an opinion.

Every decision has elements of data and opinion, but they are ultimately driven by one or the other. Sometimes you have to double down on the data; other times you have to look at all the data and then trust your gut. And trusting your gut is incredibly scary. Many people don’t have either a good gut instinct to follow or the faith in themselves to follow it. It takes time to develop that trust. So they try to turn an opinion-driven business decision into a data-driven one. But data can’t solve an opinion-based problem. So no matter how much data you get, it will always be inconclusive. This leads to analysis paralysis-death by overthinking.

“Data can’t solve an opinion-based problem” is a core problem of the universe.

And the problems are worse when you can find a way to shirk responsibility for making those decisions:

But we fell into the same trap as everyone else. We were wowed by the consultants, excited by the numbers. And we quickly became far too reliant on them: everyone wanted data so they wouldn’t have to make decisions themselves. Instead of moving forward with a design, you’d hear, “Well, let’s just test it.? Nobody wanted to take responsibility for what they were making.

So you’d run the test. And then run it again. On Monday the customer panel would pick option X. On Friday, the same group would go with option Y. Meanwhile, we were paying millions of dollars to consultants who took a month and a half to put their own slant on everything.

The data wasn’t a guide. At best, it was a crutch. At worst, cement shoes. It was analysis paralysis.

“Design by committee” is an adjunct to the crutch of data, where there is no vision for the product and no responsibility for the outcome. I see this in medical schools, residency programs, and medical centers of all varieties. So many meetings to discuss so many dashboards. The analytic tools have become robust, so we are awash in numbers and react by massaging our processes to push various metrics in the right direction, often with no regard to second-order effects.

We so often seem locked into a rearranging deck chair approach to problem-solving instead of designing from first principles to make better products and achieve better outcomes.

On being a doofus:

I remember we had a huge all-hands meeting at Apple once these meetings would only happen two, maybe three times a year. And a guy stands up during the Q&A and starts asking Steve Jobs why he didn’t get a raise or a good review. Steve looks at him in stunned disbelief and says, “I can tell you why. Because you’re asking this question in front of ten thousand people.”

On quitting:

Anyone who’s ever stuck with a job they hated knows the feeling.

Every meeting, every pointless project, every hour stretches on and on. You don’t respect your manager, you roll your eyes at the mission, you stagger out the door at the end of the day exhausted, dragging yourself home to complain to family and friends until they’re as miserable as you are. It is time and energy and health and joy that disappear from your life forever. But hey, that title, that stature, that money it’s worth it all, right?

(He’s asking a rhetorical question.)

The threat of leaving may be enough to push your company to get serious and make whatever change you’re asking for. But it might not. Quitting should never be a negotiating tactic it should be the very last card you play.
So before you quit, you’d better have a story. A good, credible, and factual one. You’ll need to have a rationale for why you left.

And you’ll need one for why you want to join whatever company you’re heading to next. These should be two very different narratives. You’ll need them for the interview, but also for yourself to make sure you’ve really thought things through. And to make sure you’re making the right choice for the next job.

The last part I think is sometimes underappreciated. You don’t just quit from something. Until you retire, you’re also quitting to something.

I wrote a brief article last year on evaluating jobs, where I referenced a 2020 study that showed 41% of radiologists had changed jobs in the past 4 years. I bet it’s even higher now given the current market. Lots of folks are quitting. The question is, are they learning from their experiences?

On the benefits of integrating old and young people:

The best teams are multigenerational Nest employed twenty-year-olds and seventy-year-olds. Experienced people have a wealth of wisdom that they can pass on to the next generation and young people can push back against long-held assumptions. They can often see the opportunity that lies in accomplishing difficult things, while experienced people see only the difficulty.

The generational conflict is real, and it’s often amazing to see in person how easily both groups generously weigh only their own strengths.

Rules to Live By

Summarized from the epilogue of Humankind: A Hopeful History by Rutger Bregman, itself a pretty compelling read that summarizes the real world flaws and scholarship foibles of most negative philosophical and psychological research about man’s beastly nature (e.g. Machiavelli, Lord of the Flies, the Stanford Prison Experiment, etc) and instead argues that we are, on the whole, decent.

No. 1: When in doubt, assume the best
No. 2: Think in win-win scenarios
No. 3: Ask more questions
No. 4: Temper your empathy, train your compassion
No. 5: Try to understand the other, even if you don’t get where they are coming from.
No. 6: Love your own as others love their own.
No. 7: Avoid the news
No. 8: Don’t punch Nazis
No. 9: Come out of the closet: Don’t be ashamed to do good
No. 10: Be realistic

“Don’t punch Nazis” absolutely requires some context/explanation, but I don’t want the ruin the great story it derives from.

What I Read in 2022

2022 was the ninth(!) year that I’ve kept track of my book consumption. I’m still trying to get better at capturing even just some brief thoughts/impressions about what I read (especially the fiction, which sometimes fades from memory almost as fast as I can read it). I still read most of my nonfiction on my Kindle (or on the kindle app on my phone) because of the very handy highlight feature. A fraction of those highlights typically then find their way into my digital brain archive and some eventually become posts on this very site.

Prior years here: 2021, 2020201920182017201620152014.

  1. Atomic Habits (I’ve gone through this best-selling-in-whole-world book as a centering routine for the New Year a few times now)
  2. The Almanack of Naval Ravikant (some decent lines/ideas, my favorites are in this post)
  3. Appleseed by Matt Bell (environmental speculative fiction, a sprawling epic with well-crafted prose; Mr. Bell very nicely rejected a short story I wrote for his literary journal back in 2010)
  4. The Lies of Locke Lamora by Scott Lynch (Ocean’s Eleven meets epic fantasy; these books are awesome, and one of the unusual parts of these stories is that while this world has magic, the main characters are just blokes equally out of their element in dealing with it).
  5. Red Seas Under Red Skies by Scott Lynch (Gentleman Bastards #2)
  6. Republic of Thieves by Scott Lynch (Gentleman Bastards #3)
  7. The Poppy War by RF Kuang (way younger than me so we didn’t overlap, but Kuang apparently went to my high school)
  8. Termination Shock by Neal Stephenson (Stephenson, who first coined the term metaverse, writes super engaging sprawing near future speculative fiction. This is climate-related and just great)
  9. The Fifth Season (Broken Earth Trilogy #1) by NK Jemisin (2016 Hugo Award winner, gosh this is so good. May also be the only book where a partial second-person perspective totally works)
  10. Pangea Online: Death and Axes by SL Rowland
  11. Pangea Online: Magic and Mayhem by SL Rowland
  12. Pangea Online: Vials and Tribulations by SL Rowland
  13. Girl Logic by Iliza Shlesinger (my wife bought this but Iliza is probably now the most famous person I sorta knew growing up. She was a few years ahead of me in high school and probably even briefly knew my name at the time).
  14. Forward Collection edited by Blake Crouch
  15. The Obelisk Gate (Broken Earth Trilogy #2) by NK Jemisin
  16. The Stone Sky (Broken Earth Trilogy #3) by NK Jemisin (Again, very original. Not always the most fun read but a great story and incredible world-building).
  17. Stories of Your Life and Others by Ted Chiang (the title story is the mind-bender that gave rise to the movie Arrival)
  18. Exhalation by Ted Chiang (the newer collection of this award-winning writer of speculative short fiction, also unusually thoughtful)
  19. The Dragon Republic (Poppy War Trilogy #2) by RF Kuang
  20. Robot Dreams by Sara Varon
  21. Just Keep Buying by Nick Maggiuli (data-driven personal finance, some takeaways here)
  22. The Burning God (Poppy War Trilogy #3) by RF Kuang
  23. Lock In by John Scalzi (a master of the short, snappy, snarky, sci-fi thriller)
  24. Head On by John Scalzi (a sequel, but both are totally stand-alone)
  25. He Who Fights with Monsters by Travis Deverell (yes, it’s silly LitRPG, but the protagonist this time is Australian.)
  26. He Who Fights with Monsters 2 by Travis Deverell
  27. He Who Fights with Monsters 3 by Travis Deverell
  28. He Who Fights with Monsters 4 by Travis Deverell
  29. He Who Fights with Monsters 5 by Travis Deverell
  30. He Who Fights with Monsters 6 by Travis Deverell
  31. The Kaiju Preservation Society by John Scalzi (light, funny, enjoyable; though not as funny as Red Shirts)
  32. Wabi Sabi by Beth Kempton
  33. Warrior of Light by Paulo Coelho (I really liked The Alchemist. This was a bland platitude companion, 100% not worth it).
  34. The Cat Who Saved Books by Sosuke Natsukawa
  35. Man’s Search for Meaning by Viktor Frankl
  36. The Simple Path to Wealth by JL Collins
  37. Sufficiently Advanced Magic (Arcane Ascension #1) by Andrew Rowe (Meh. Magic system and plot, not so bad. Characters and writing, pretty painful even for YA.)
  38. On the Shoulders of Titans (Arcane Ascension #2) by Andrew Rowe
  39. The Torch that Ignites the Stars (Arcane Ascension #3) by Andrew Rowe
  40. Consider This by Chuck Palahniuk (Writing advice from the author of Fight Club among others; this was really good writing about writing).
  41. Good Omens by Neil Gaiman and Terry Pratchett (two of fantasy’s greats, working together in a way distinct from either alone)
  42. Jade City (Green Bone Saga #1) by Fonda Lee (Winner of the World Fantasy Award. The world-building is a bit a slow burn but this series ended up being exceptionally good.)
  43. Four Thousand Weeks by Oliver Burkeman (Refreshing “time management” that reads like happy nihilism)
  44. The Lion Tracker’s Guide to Life by Boyd Varty (briefly quoted here)
  45. Jade War (Green Bone Saga #2) by Fonda Lee
  46. Pacchi Festival (Bushido Online #4) by Nikita Thorn
  47. The Order by Jeremy Robinson (I didn’t get how Robinson was trying to pull together all of his stand-alone novels into a giant universe with a whole bunch of crossovers at first, but it’s working surprisingly well).
  48. Reckoning (The Beginning After the End #9) by TurtleMe
  49. Building a Second Brain by Tiago Forte (nothing convinced me to change my current workflow)
  50. Jade Legacy (Green Bone Saga #3) by Fonda Lee
  51. He Who Fights with Monsters 7 by Travis Deverell
  52. Rules for a Knight by Ethan Hawke
  53. Babel by RF Kuang (This was a singular book, nothing else quite like it)
  54. Dawnshard by Brandon Sanderson (Stormlight novella)
  55. The Android’s Dream by John Scalzi (I can see how the author who wrote this amusing book would go on to write the excellent Interdependency Trilogy)
  56. Unsouled by Will Wight (Cradle #1) (More progression fantasy)
  57. Soulsmith by Will Wight (Cradle #2)
  58. Blackflame by Will Wight (Cradle #3)
  59. Skysworn by Will Wight (Cradle #4)
  60. Ghostwater by Will Wight (Cradle #5)
  61. Underlord by Will Wight (Cradle #6)
  62. Uncrowned by Will Wight (Cradle #7)
  63. Wintersteel by Will Wight (Cradle #8)
  64. Bloodline by Will Wight (Cradle #9)
  65. Reaper by Will Wight (Cradle #10)
  66. Dreadgod by Will Wight (Cradle #11)
  67. Gilded Ghost (Ripple System #3) by Kyle Kirrin
  68. Agent to the Stars by John Scalzi
  69. Old Man’s War by John Scalzi
  70. The Doors of Eden by Adrian Tchaikovsky
  71. Throne of the Crescent Moon by Saladin Ahmed (Arabian Nights-esque fantasy. I’ve been meaning to read my copy of this ever since I published one of Ahmed’s stories in Nanoism, which was subsequently a finalist for the annual Best Small Fictions Anthology.
  72. Gallant by VE Schwab (Schwab is a great and very-bestselling writer. This ghost story reminds me a bit more of Neil Gaiman’s work.)
  73. The Black Prism (Lightbringer #1) by Brent Weeks (at first I wasn’t sold on the magic system/world-building but I was wrong. This series is great).
  74. The Blinding Knife (Lightbringer #2) by Brent Weeks
  75. The Broken Eye (Lightbringer #3) by Brent Weeks
  76. The Blood Mirror (Lightbringer #4) by Brent Weeks
  77. The Burning White (Lightbringer #5) by Brent Weeks (a rare satisfying series conclusion!)
  78. Farmer in the Sky by Robert Heinlein (some of these classic sci-fi books really haven’t aged well)
  79. Methuselah’s Children by Robert Heinlein
  80. He Who Fights with Monsters 8 by Travis Deverell
  81. The Lost Metal (Mistborn era two, #4, the conclusion) by Brandon Sanderson (Honestly fell kinda flat? The whole second arc just isn’t as good as the first, and I’ll admit I find the overall Cosmere integration slow burn to be mostly frustrating at this point)
  82. Noise by Daniel Kahneman (I’ll be quoting this book in more posts, but here’s a taste)
  83. Khaos by Jeremy Robinson (the penultimate volume in the Infinite timeline)


My son is getting older, so in addition to me reading to him, he also now reads a ton to himself, and sometimes I read a book or two in the series he’s currently enjoying or to introduce him to a new one:

  1. The rest of this Pokémon box set
  2. No One Returns from the Enchanted Forest by Robin Robinson
  3. Caveboy Dave by Aaron Reynolds and Phil McAndrew
  4. Sunken Tower by Tait Howard
  5. Some of the Wings of Fire graphic novel renditions by Tui T. Sutherland (talking dragons!)
  6. Boulder Brothers Mo and Jo by Sarah Lynn
  7. Cat Kid Comic Club Perspectives by Dav Pilkey
  8. Lightfall: The Girl & the Galdurian (Lightfall #1) by Tim Probert (such a beautiful art style; this was great)
  9. Lightfall: Shadow of the Bird (Lightfall #2) by Tim Probert
  10. Portions of the Minecraft Woodsword Chronicles by Nick Eliopulos
  11. Star Knights by Kay Davault (also a really cute standalone graphic novel)
  12. All five of the 5 Worlds graphic novels by Mark Siegel (which were awesome, he loved these)
  13. The first two books in the classic Chronicles of Narnia series by CS Lewis, which I kept in great condition from childhood for just this purpose!
  14. Several entries in the Amulet series by Kazu Kibuishi, which he thought were super epic. Fantastic art.

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.