Slim pickings high up on the ladder

From Nobel laureate economist Richard Thaler’s Misbehaving: The Making of Behavioral Economics:

A competitive labor market does do a pretty good job of channeling people into jobs that suit them. But ironically, this logic may become less compelling as we move up the managerial ladder. All economists are at least pretty good at economics, but many who are chosen to be department chair fail miserably at that job. This is the famous Peter Principle: people keep getting promoted until they reach their level of incompetence.

I wrote an article called Academic Medicine and the Peter Principle back in 2019, and the mismatch between merit for admission, merit for promotion, and skill at a given position explains so much about so many rudderless institutions.

Feynman’s Wish

As we near the end of the residency interview season, a choice quotation from “Surely You’re Joking, Mr. Feynman!”: Adventures of a Curious Character:

So I have just one wish for you—the good luck to be somewhere where you are free to maintain the kind of integrity I have described, and where you do not feel forced by a need to maintain your position in the organization, or financial support, or so on, to lose your integrity. May you have that freedom.

This is Going to Hurt

From the original UK version of Adam Kay’s This is Going to Hurt: Secret Diaries of a Medical Resident:

Asked to review a patient in labour ward triage and repeat a PV as the midwife is uncertain of her findings. Her findings were of cephalic presentation with cervix 1 cm dilated. My findings are of breech presentation, cervix 6 cm dilated. I explain to mum that baby is bottom-down and the safest thing to do is to deliver by caesarean section. I don’t explain to mum which part of the baby the midwife has just stuck her finger in to 1 cm dilatation.

Good medical humor is rare.

Carving out a Creative Routine

From Keep Going: 10 Ways to Stay Creative in Good Times and Bad by Austin Kleon:

In his book Daily Rituals, Mason Currey catalogs the daily routines of 161 creative individuals: when they woke up, when they worked, what they ate, what they drank, how they procrastinated, and more. It’s a wild collage of human behavior. Reading about the habits of writers alone is like visiting a human zoo. Kafka scribbled into the night while his family slept. Plath wrote in the morning before her children woke up. Balzac slugged fifty cups of coffee a day. Goethe sniffed rotten apples. Steinbeck had to sharpen twelve pencils before starting his work.

It’s undeniably fun to read about the routines and rituals of creative people, but what becomes clear after a while is that there is no perfect, universal routine for creative work. “One’s daily routine is a highly idiosyncratic collection of compromises, neuroses, and superstitions,” Currey writes, “built up through trial and error and subject to a variety of external conditions.” You can’t just borrow your favorite artist’s daily routine and expect it to work for you. Everyone’s day is full of different obligations—jobs, families, social lives—and every creative person has a different temperament.

I’m not always sure that what I do here qualifies as creative work, but it’s so easy to fall into the jealousy trap looking at the routine of a full-time professional creative. It’s not hard to read a book like Cal Newport’s excellent Deep Work and think, yeah, that’s how you do it–if you’re an academic or knowledge worker.

I’m an academic physician working in a private practice. When you break it down transactionally, I trade time for money and then do a whole bunch of unpaid work on top that helps give my job extra meaning.

I’m a dad and a husband.

And that’s why it’s so much easier to have an amateur’s mindset instead of a professional’s: to do something because you like it or when the stars align.

But I’ve also found that I do better work and find more satisfaction in the work when it’s part of a routine (i.e. a modified professional mindset). My routine just isn’t one that involves long uninterrupted periods of deep work or a cabin in the woods.

I think the key is carving out a habit–or maybe a better word is a pattern–that allows you to fold in your avocations in a way that allows for regularity despite dominant competing obligations, recharges your battery, and still results in enough forward progress on your larger projects (if you have them) as to not be demoralizing (and it’s actually that last part that’s the hardest).

Productive Procrastination

From Indistractable: How to Control Your Attention and Choose Your Life:

I discovered that living the life we want requires not only doing the right things; it also requires we stop doing the wrong things that take us off track.

If distraction costs us time, then time management is pain management.

That’s a catchy line.

Being okay in your skin, being okay within your own mind is part of it. We reach for the phone because it’s easier.

There’s a lot of navel-gazing writing about how you should just stand in the grocery line and be mindful: to find space in that brief time to just be.

And that sounds so nice.

But…I also start a lot of drafts in those in-between moments. I haven’t conquered being alone with my thoughts, and maybe I never will. But at least I’ve practiced sublimating them into something I consider meaningful.

If you’ve ever chewed over something in your mind that you did, or that someone did to you, or over something that you don’t have but wanted, over and over again, seemingly unable to stop thinking about it, you’ve experienced what psychologists call rumination. This “passive comparison of one’s current situation with some unachieved standard” can manifest in self-critical thoughts such as, “Why can’t I handle things better?”

But there’s the rub.

I’m not sure it’s really possible to avoid the rumination and bad habit loops without dealing with that pain management directly. I see a lot of workaholics that are good at doing things but not so good at just being alive, and perhaps our work-focused, over-scheduled, and outcome/comparison-focused society is at least partially to blame.

Certainly, the resume-fluffing requirements we place on students for competitive colleges, graduate schools, and jobs like medical residencies are teaching those lessons early enough at young enough ages that we’re likely still susceptible to making them part of our personalities.