Ben White

Productive Procrastination

01.04.21 // Miscellany, Reading

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.

What I Read in 2020

12.31.20 // Reading

I said at the end of my 2019 reading list that I thought 2020 was “going to be a good year.”

Well.

I did, however, manage to read some books.

I also said last year that I’d discovered an absurdly dorky subgenre called LitRPG (basically fantasy novels crossed with role-playing games) and that I probably wouldn’t ever read any again other than the one series I stumbled on. Well, I lied. I read a lot of them, because full-throated absurdist escapism is what I needed this year (this is a no-judgment zone, thank you).

Since my son turned five and we started reading chapter books together, I’ve included a separate list of those at the bottom.

  1. The Boy, the Mole, the Fox, and the Horse by Charlie Mackesy (this was a mega-bestselling award-winning illustrated story-ish thing. I read it myself, and then I read it to my son. I enjoyed reading it to him more because it’s full of morals and nice thoughts and stuff and it has pretty pictures).
  2. Calypso by David Sedaris (who really does write excellent personal essays)
  3. The Minimalist Way by Erica Layne (meh)
  4. The Beginning After the End by TurtleMe (this reads like a YA shonen anime novelization but not necessarily in a bad way)
  5. The Calculating Stars by Mary Robinette Kowal (Lady Astronaut #1. Winner of the Hugo and Nebula awards. Excellent alternate history following the story of the first female astronaut in an Earth where an asteroid impact spurs humanity to ramp up space exploration in the 1950s)
  6. Starsight by Brandon Sanderson (Skyward #2)
  7. The Med School Survival Kit by Wendall Cole MD
  8. The Odyssey by Homer and Emily Wilson (this such a seamlessly modern-feeling translation. Kudos to Wilson).
  9. Dear Girls by Ali Wong (Ali Wong is very funny)
  10. New Heights by TurtleMe (The Beginning After the End #2)
  11. Becoming Fates by TurtleMe (The Beginning After the End #3)
  12. Horizon’s Edge by TurtleMe (The Beginning After the End #4)
  13. Why We Sleep by Matthew Walker
  14. The Last Emperox by John Scalzi (The Interdependency #3; this was a very enjoyable space opera trilogy)
  15. The Children of Hurin by J.R.R Tolkien (kinda)
  16. Seveneves by Neal Stephenson (the scope of this story is bonkers huge)
  17. Maybe You Should Talk to Someone by Lori Gottlieb
  18. Ascend Online by Luke Chmilenko (this is pure LitRPG, and the cover art is atrocious)
  19. Hell to Pay by Luke Chmilenko (Ascend Online #2)
  20. Legacy of the Fallen by Luke Chmilenko (Ascend Online #3)
  21. How to Defeat a Demon King in Ten Easy Steps by Andrew Rowe (adorable little novella, basically a subverted Zelda and Dragon Quest mashup/love letter. I found the subverted tropes amusing.)
  22. The Things You Can See Only When You Slow Down by Haemin Sunim
  23. Convergence by TurtleMe (The Beginning After the End #5)
  24. The Happiness Project by Gretchen Rubin
  25. The Land: Founding by Aleron Kong (A physician and author of a very (the most?) popular LitRPG saga, an Audible 2018 customer favorite; Chaos Seeds #1)
  26. The Land: Forging by Aleron Kong (Chaos Seeds #2)
  27. The Land: Alliances by Aleron Kong (Chaos Seeds #3)
  28. The Land: Catacombs by Aleron Kong (Chaos Seeds #4)
  29. The Land: Swarm by Aleron Kong (Chaos Seeds #5)
  30. The Land: Raiders by Aleron Kong (Chaos Seeds #6)
  31. The Land: Predators by Aleron Kong (Chaos Seeds #7)
  32. The Land: Monsters by Aleron Kong (Chaos Seeds #8; by this point in the series, we’ve gradually but now pretty firmly devolved into the grinding halt of the overall plot in favor of increasingly complex and tedious player statistics and points distribution. Literally nothing happened in this book.)
  33. Trigor by Tom Merritt (Pilot X #2; pretty enjoyable, though the first was better.)
  34. NPC by Jeremy Robinson (it’s no Space Force)
  35. White Fragility by Robin Diangelo
  36. Notes of a Crocodile by Qiu Miaojin
  37. The Art of Living by Thich Nhat Hanh
  38. How to be an Antiracist by Ibram X. Kendi
  39. Together by Vivek H. Murthy (he seems like a true aspirational model of a physician)
  40. Will Save the Galaxy for Food by Yahtzee Croshaw
  41. Transcendence by TurtleMe (The Beginning After the End #6)
  42. Doctor’s Orders by Tania M. Jenkins (reviewed here)
  43. The Plot Against America by Philip Roth (an alternate history where FDR loses the 1940 election to aviator Charles Lindbergh; currently an HBO series)
  44. WCI Bootcamp by James Dahle (more thorough and updated relative to his first book, which I still think he should go back and lightly revise).
  45. Bad Blood by John Carreyrou (the tale of the rise and fall of Theranos. What an absurd story and a stark illustration of the business world we live in. Discussed briefly here)
  46. Ham on Rye by Charles Bukowski
  47. Nobody Wants to Read Your Sh*t by Steven Pressfield (impressively concise, which is apt given the subject matter)
  48. The Psychology of Money by Morgan Housel (possibly the best non-technical book on money currently available)
  49. How to Fight a Hydra by Josh Kaufman (the extended metaphor gets a little tired if you ask me)
  50. How the Internet Happened by Brian McCullough (parts of this book felt like reading a history of my childhood)
  51. Reamde by Neal Stephenson (I read this after Fall, which is sort of a loose sequel, but it was almost more fun that way for some reason)
  52. The Circle by Dave Eggers (I never saw the movie with Tom Hanks and Emma Watson, but this is a chilling novel)
  53. Joy at Work by Marie Kondo and Scott Sonenshein (I really just had to know if being happy at work meant cleaning your desk and canceling all meetings that don’t spark joy)
  54. The Reluctant Adventures of Fletcher Connolly on the Interstellar Railroad Vol. 1: Skint Idjit by FR Savage
  55. The Reluctant Adventures of Fletcher Connolly on the Interstellar Railroad Vol. 2: Intergalactic Bogtrotter by FR Savage
  56. The Reluctant Adventures of Fletcher Connolly on the Interstellar Railroad Vol. 3: Banjaxed Ceili by FR Savage
  57. The Reluctant Adventures of Fletcher Connolly on the Interstellar Railroad Vol. 4: Supermassive Blackguard by FR Savage
  58. Is This Anything? by Jerry Seinfeld
  59. Girl, Wash Your Face by Rachel Hollis (I’m always curious about the #1 NYT bestselling things that get recommended to my wife)
  60. Girl, Stop Apologizing by Rachel Hollis
  61. Didn’t See That Coming by Rachel Hollis
  62. Divergence by TurtleMe (The Beginning After the End #7)
  63. Children of Ruin by Adrian Tchaikovsky (sequel to amazing and unique award-winning Children of Time)
  64. The War of Art by Steven Pressfield (this is one of those books referenced a lot, but I found his newer book [#40 above] to be much, much more enjoyable).
  65. Looking Within by Cullen Ruff
  66. Tiny Habits by BJ Fogg
  67. The Fated Sky by Mary Robinette Kowal (Lady Astronaut #2)
  68. Recursion by Blake Crouch (this is going be a Netflix movie, and I bet it’s going to end up really neat)
  69. Glory to the Brave by Luke Chmilenko (Ascend Online #4)
  70. 2001: A Space Odyssey (does this count as a classic?) by Arthur C. Clarke
  71. Ready Player Two by Ernest Cline (other than the devastating pandemic, this is a solid #2 for the most disappointing part of 2020)
  72. Rhythm of War by Brandon Sanderson (Stormlight Archive #4; I’ve enjoyed everything I’ve read from Sanderson, but I think his wild success has resulted in a book here that’s too long (1200+ pages! More than 500,000 words!), had too much filler, and fell back on some really irritating tired character tropes. A firmer editorial hand would have done so much for this, and I’m not sure any other fantasy author writing today other than Martin would have gotten away with it. I will still absolutely read the fifth and final book in the series, which from the publisher’s perspective is probably all that matters.)

 

What I read to my son:

  1. The Fantastic Mr. Fox by Roald Dahl (We actually bought this big Roald Dahl box set and made some good progress through it. I’d forgotten just how weird Dahl’s books were).
  2. The Chocolate Touch by Patrick Skene Catling
  3. The Magic Treehouse #1-15 (these are pretty short, he’s a big fan, and we just got 16-29 in the mail).
  4. Cat Wings by Ursula K. Le Guin (a four-part series for young children by one of my very favorite authors)
  5. Cat Wings Return by Ursula K. Le Guin
  6. Wonderful Alexander and the Catwings by Ursula K. Le Guin
  7. Jane on Her Own by Ursula K. Le Guin (Catwings #4)
  8. Jedi Academy by Jeffrey Brown (This series is actually three trilogies, though for some reason the current box set is only books 1-7. These are absolutely delightful, especially the first series by Brown, which was genuinely clever and so much more pleasurable to read as an adult than most children’s books)
  9. Jedi Academy: Return of the Padawan by Jeffrey Brown
  10. Jedi Academy: The Phantom Bully by Jeffrey Brown
  11. Jedi Academy: A New Class by Jarrett J. Krosoczka
  12. Jedi Academy: The Forces Oversleeps by Jarrett J. Krosoczka
  13. Jedi Academy: The Principal Strikes Back by Jarrett J. Krosoczka
  14. Jedi Academy: Revenge of the Sis by Jarrett J. Krosoczka
  15. Jedi Academy: Attack of the Furball by Jarrett J. Krosoczka
  16. Jedi Academy: At Last, Jedi by Jarrett J. Krosoczka
  17. Esio Trot by Roald Dahl
  18. The BFG by Roald Dahl
  19. The Magic Finger by Roald Dahl
  20. The Giraffe And The Pelly And Me by Roald Dahl
  21. George’s Marvellous Medicine by Roald Dahl
  22. The Twits by Roald Dahl
  23. Billy And The Minpins by Roald Dahl
  24. Danny the Champion of the World by Roald Dahl
  25. James and the Giant Peach by Roald Dahl
  26. Charlie and the Chocolate Factory by Roald Dahl
  27. Charlie and the Great Glass Elevator by Roald Dahl
  28. Rowley Jefferson’s Awesome Friendly Adventure by Jeff Kinney (author of the Diary of A Wimpy Kid books)

Learning & The Transfer Problem

12.09.20 // Medicine, Reading

There’s a classic quote that gets attributed to a whole bunch of people, and it goes like this:

“In theory, there is no difference between theory and practice. But in practice, there is.”

This is the transfer problem, and it’s a real thorn for how we learn (and especially how we learn to perform in high-stakes roles like medicine).

When a medical student says, “I know all the information and can explain it but I just don’t do well on the multiple-choice test,” this is the transfer problem at work.

When someone else can do well on the multiple-choice test but can’t apply their knowledge to actually helping patients, that’s the transfer problem too.

The more different the learning methods are from the evaluation, the harder it can be to succeed. The more different the learning and evaluation methods are from the real-life goal, the less useful they are.

Here are some passages from Ultralearning: Master Hard Skills, Outsmart the Competition, and Accelerate Your Career:

Given a century of research showing the difficulties of transfer along with proposed solutions that have failed to provide lasting results, any student must take seriously the notion that transferring what has been learned between very different contexts and situations will be treacherous.

The answer is that learning directly is hard. It is often more frustrating, challenging, and intense than reading a book or sitting through a lecture. But this very difficulty creates a potent source of competitive advantage.

The best way to prepare for taking a high-stakes multiple-choice exam is to do lots of multiple-choice questions (e.g. How to Study for Step 1). The best to learn to do a procedure (other than actually doing the procedure) is to do a good simulation of said procedure.

If you can judge yourself only on how much you improve at the overall task, it can lead to a situation in which your improvement slows down because you will be getting worse at the overall task while becoming better at a specific component of it.

This is the treacherous problem of stagnant or decreasing qbank performance during dedicated review for some students. More time to trying to memorize low-yield minutia or shore up knowledge gaps doesn’t always yield upfront measurable gains. But, that doesn’t mean that when once again incorporated into a broader approach and after refreshing your core knowledge against the forgetting curve that it won’t ultimately yield results.

This practice of starting too hard and learning prerequisites as they are needed can be frustrating, but it saves a lot of time

Sometimes it’s best to just dive in because you’ll rapidly figure out exactly what you need to know.

I agree with this, and it argues for the early incorporation of question-based learning. This is actually how I learned pathology, by slogging through the question book and largely ignoring the larger text.

Human beings don’t have the ability to know with certainty how well they’ve learned something. Instead, we need to rely on clues from our experience of studying to give us a feeling about how well we’re doing. These so-called judgments of learning (JOLs) are based, in part, on how fluently we can process something. If the learning task feels easy and smooth, we are more likely to believe we’ve learned it. If the task feels like a struggle, we’ll feel we haven’t learned it yet.

No pain, no gain.

Imaging is the great equalizer

11.27.20 // Radiology, Reading

Imaging is the great equalizer. When we look deep into ourselves from the vantage of this fundamental level, with exterior barriers and labels removed, we just might just see ourselves, other people, and our lives in a whole new light.

From Dr. Cullen Ruff’s Looking Within: Understanding Ourselves through Human Imaging, currently an Amazon Black Friday deal for a whopping $0.99 on Kindle.

When I see patients these days, it’s usually because I’m about to put a needle somewhere, but Ruff is old enough that he has decades of stories from an era where radiologists got (relatively speaking) a lot more patient facetime.

And yet, what a strange job we have, bypassing everything externally visible to study people’s insides.

To be home is to be known

11.16.20 // Reading

If anyone was looking for a summary of a core problem in American society, from former Surgeon General Dr. Vivek H. Murthy’s lovely book, Together: The Healing Power of Human Connection in a Sometimes Lonely World:

While loneliness engenders despair and ever more isolation, togetherness raises optimism and creativity. When people feel they belong to one another, their lives are stronger, richer, and more joyful.

And yet, the values that dominate modern culture instead elevate the narrative of the rugged individualist and the pursuit of self-determination.

To be at home is to be known. It is to be loved for who you are. It is to share a sense of common ground, common interests, pursuits, and values with others who truly care about you.

In community after community, I met lonely people who felt homeless even though they had a roof over their heads.

And, when people are desperate for community, the ones most emotionally convenient or accepting may not be ones that provide meaningful uplift.

Communities that focus on us vs. them distinctions, scapegoating, and villainization aren’t about bringing people together. They’re about frustration and fear.

Tomorrow is a new day

11.11.20 // Reading

Finish every day and be done with it. You have done what you could; some blunders and absurdities no doubt crept in; forget them as soon as you can. Tomorrow is a new day; you shall begin it well and serenely, and with too high a spirit to be cumbered with your old nonsense.

—Ralph Waldo Emerson, in an 1854 letter to his daughter.

It’s my birthday today, and this is something I think about when considering my relentlessly increasing age.

The best day for a new positive change is always today. But we’re very fallible human beings and I’ve been stress eating for about six months, so barring that, let’s not discount tomorrow either.

Bigger isn’t always better

10.19.20 // Reading

From Company of One: Why Staying Small Is the Next Big Thing for Business by Paul Jarvis:

I like reading things that are not about medicine and seeing what lessons cross domains and apply. The premise of Jarvis’ book is that growth for growth’s sake is a terrible business model for many businesses and especially the many people that run them. It’s okay to be big, but any decision to grow the enterprise should be an active choice considering all factors and not just the default MO taken from the recent start-up culture of silicon valley.

My wife left her employed university position last year to start a solo private practice, and it’s been wonderful. It’s not hard to see how there are so many downsides to being part of large company or expanding your own business too much. On the former, no control. On the latter, so much time managing the machine that it’s easy to completely lose track of why you started the practice and what you liked about it.

But here are four passages that also resonated with me as a physician and educator:

Miles Kington, a British journalist, reportedly said that “knowledge is knowing that a tomato is a fruit. Wisdom is not putting it in a fruit salad.” We should never assume that having an abundance of knowledge is the same as having an abundance of wisdom.

This is the problem with equating performance on a knowledge assessment like a high-stakes multiple-choice examination with real-life competence. Knowledge is important, but it doesn’t mean you can perform in your field.

More isn’t better—better is better. There are advantages to putting in the time and effort to master a skill, but there’s also a great need for balance.

“More isn’t better” is a real truism for so many things in our world. We should question whenever something or someone simply wants more of us: more hours, more years of training, more free labor, more notches on the CV belt. It’s not necessarily that the “more” is inherently bad—it almost never is—but that doesn’t mean it’s worth it.

Sukhvinder Obhi, a neuroscientist at McMaster University, coined the term “power paradox” to describe what happens when we gain power through leadership: we subsequently lose some of the capabilities we needed to gain it in the first place—such as empathy, self-awareness, transparency, and gratitude.

The power paradox explains much of the bullying we see within strict hierarchies: how excrement rolls downhill from the top of a poorly-run organization all the way to the youngest least experienced students who are just doing their impressionable best to insulate themselves from the worst of indoctrination as they grow.

[Cal Newport, author of So Good They Can’t Ignore You] believes that we need to be craftspeople, focused on getting better and better at how we use our skills, in order to be valuable to our company and its customers. The craftsperson mind-set keeps you focused on what you can offer the world; the passion mind-set focuses instead on what the world can offer you.

There are some people who in life (or medical school), are confident they know exactly what they want. They are passionate about dermatology and orthopedic surgery. That’s great.

But I don’t think there’s anything wrong with the rest of the world, those who simply don’t know or seem to be missing that “passion.” I agree with Newport that passion is something you can grow through competence and the craftsmen mentality. There are no perfect jobs or fields. There are good and bad aspects to everything, and suggesting otherwise drives so much anxiety in the specialty and residency-selection process.

Success has more to do with you, your goals, and your perspective than it does with exactly what box you place yourself in.

 

What Money Buys

10.14.20 // Finance, Reading

From How to Think About Money by Jonathan Clements:

First and foremost, money buys time and autonomy. Secondarily, it buys experiences. Last, and least, it buys stuff, and more often than not, the stuff we buy makes us miserable.

Most people live their lives with these in the opposite order, but Clements is absolutely right.

You don’t have to be a FIRE-fanatic to realize that setting up your professional life, spending, and saving to optimize for number one is the winning strategy.

Simple Sabotage

10.12.20 // Miscellany, Reading

Simple Sabotage: A Modern Field Manual for Detecting and Rooting Out Everyday Behaviors That Undermine Your Workplace is a book inspired by a real World War II CIA field manual called “Simple Sabotage” that was written to help “guide ordinary citizens, who may not have agreed with their country’s wartime policies towards the US, to destabilize their governments by taking disruptive action.” You can read the declassified original document at that link.

It’s short and fascinating and much of it is timeless. Operationally, it functions as a “how-not-to” for creating an efficient organization. The CIA’s top 3 takeaways:

1. Managers and Supervisors: To lower morale and production, be pleasant to inefficient workers; give them undeserved promotions. Discriminate against efficient workers; complain unjustly about their work.

2. Employees: Work slowly. Think of ways to increase the number of movements needed to do your job: use a light hammer instead of a heavy one; try to make a small wrench do instead of a big one.

3. Organizations and Conferences: When possible, refer all matters to committees, for “further study and consideration.” Attempt to make the committees as large and bureaucratic as possible. Hold conferences when there is more critical work to be done.

These points were once felt to be a great way to sabotage Nazi Germany, but they seem to have been voluntarily taken up by most modern American businesses.

A good example from the book is the “obedient saboteur,” someone who—by doing exactly what he’s told to do—is actually making things worse:

This problem can be particularly acute in organizations with a culture of “continuous improvement.” Continuous improvement is a business philosophy created by W. Edwards Deming in the mid-twentieth century. This philosophy thinks of processes as systems and holds that if each component of the system constantly tries to both increase quality and reduce costs, efficiency and success will follow. But taken to an extreme, even continuous improvement can lead to sabotage.

One company we know had a call center manager driving his team to move from an average pickup speed of 1.4 rings to 1.2 rings. The division head asked, “How often do callers abandon us after only 1.4 rings?” “Almost never,” he was told. “Virtually no callers who actually intended to call us hang up before the third ring.” Yet the call center manager persisted in trying to ensure that all calls were answered more quickly each year. Why? Because getting the phones answered quickly was his job—by definition, quicker was better. He never thought to question whether he had crossed the threshold where process had overridden outcome. He had become one of the Obedient Saboteurs. If you asked him why he was trying to lower pickup times, he would tell you that faster pickup means improved customer experience. That’s true—but the threshold is three rings. Once you get below three rings, faster pickup times don’t continue to improve the customer’s experience anymore.

The problem we see, time after time, is that nobody bothers to go back and tell the call center managers of the world to go continuously improve something else.

To keep this kind of sabotage out of your group, step back and conduct a formal review of any continuous improvement programs you have in place. If they aren’t relevant anymore, pull the plug.

Also see: measure what matters.

To fight back, ask yourself:

What is the stupidest rule or process we have around here?

What are the three biggest obstacles you face in doing your job?

If you could rewrite or change one process or procedure, what would it be and why?

A lot of quality improvement isn’t real:

It’s adding clutter. It’s replacing content with process.

We should be just as ruthless when evaluating quality measures and metrics as we are with the fail points that inspire them.