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Status Quo Bias

10.07.20 // Miscellany, Reading

From Machine, Platform, Crowd: Harnessing Our Digital Future by Andrew McAfee and Erik Brynjolfsson:

Research in many different fields points to the same conclusion: it’s exactly because incumbents are so proficient, knowledgeable, and caught up in the status quo that they are unable to see what’s coming, and the unrealized potential and likely evolution of the new technology.

This phenomenon has been described as the “curse of knowledge” and “status quo bias,” and it can affect even successful and well-managed companies.

There are a lot of bad actors in healthcare that I would love to see fall prey to the curse of knowledge.

When “value” became shorthand for “economic worth”

10.05.20 // Reading

From Doughnut Economics: Seven Ways to Think Like a 21st-Century Economist by Kate Raworth (emphasis mine):

Despite such misgivings from the twentieth century’s two most influential economists, the dominance of the economist’s perspective on the world has only spread, even into the language of public life. In hospitals and clinics worldwide, patients and doctors have been recast as customers and service-providers.

There may be no perfect frame waiting to be found, but, argues the cognitive linguist George Lakoff, it is absolutely essential to have a compelling alternative frame if the old one is ever to be debunked. Simply rebutting the dominant frame will, ironically, only serve to reinforce it. And without an alternative to offer, there is little chance of entering, let alone winning, the battle of ideas.

But when political economy was split up into political philosophy and economic science in the late nineteenth century, it opened up what the philosopher Michael Sandel has called a ‘moral vacancy’ at the heart of public policymaking. Today economists and politicians debate with confident ease in the name of economic efficiency, productivity and growth—as if those values were self-explanatory—while hesitating to speak of justice, fairness and rights. Talking about values and goals is a lost art waiting to be revived.

I love that.

And the example of healthcare I think is exactly right. Everything is a business—that’s unavoidable. It isn’t even a bad thing. Lose money and you won’t be in business very long. But not all businesses need to be organized with the primary purpose of optimizing productivity and growth.

Good patient care is inefficient. Talking to people—understanding their perspective and helping them become active participants in their health—takes time. A patient visit was never meant to be an assembly-line 15-minute med check.

It’s not that we should applaud or celebrate inefficiency. There is plenty of waste to trim in any enterprise. It’s that these ideas—efficiency, productivity, and growth—should be tools to achieve meaningful ends, not the primary endpoint. Measure what matters.

And if some of that extra “value” makes it to the actual workers? Much of our economy is predicated on individuals misallocating their income away from savings and away from optimizing their time:

As economist Tim Jackson deftly put it, we are ‘persuaded to spend money we don’t have on things we don’t need to make impressions that won’t last on people we don’t care about’.

Anger and Outrage: Features, Not Bugs

09.29.20 // Miscellany, Reading

From Cal Newport’s Digital Minimalism: Choosing a Focused Life in a Noisy World:

The techno-philosopher Jaron Lanier convincingly argues that the primacy of anger and outrage online is, in some sense, an unavoidable feature of the medium: In an open marketplace for attention, darker emotions attract more eyeballs than positive and constructive thoughts. For heavy internet users, repeated interaction with this darkness can become a source of draining negativity—a steep price that many don’t even realize they’re paying to support their compulsive connectivity.

Encountering this distressing collection of concerns—from the exhausting and addictive overuse of these tools, to their ability to reduce autonomy, decrease happiness, stoke darker instincts, and distract from more valuable activities—opened my eyes to the fraught relationship so many now maintain with the technologies that dominate our culture. It provided me, in other words, a much better understanding of what Andrew Sullivan meant when he lamented: “I used to be a human being.”

Doomscrolling is so insidiously toxic.

I am not a heavy social media user. I mainly use Twitter to make sure I interact with readers who use that medium and to share my newest articles. Since 2009, my main use of Twitter has been to publish other people’s tiny stories in Nanoism, an admittedly bizarre hobby and a largely one-way broadcast (@nanoism). I actively dislike Facebook.

And yet.

Sometimes I find myself scrolling and scrolling, clicking on a shared link to another depressing rantorial and then reading the awful comments from strangers on the internet who didn’t read the actual article acting out their respective caricatures. It all makes me wonder if humans are actually the creatures of morality and reason as argued by some philosophers. For most internet platforms, anger and outrage are features. Yelling at strangers on the internet is gold for companies that serve you targeted ads and profit from your attention. Everything is tailored for engagement.

One app I desperately needed when I was a student is Freedom, a service that allows you to block certain activities either on-demand or on a schedule. It would have saved me from a lot of my old internet demons. I should probably even turn it on more now, but I’m usually in a better place these days. Having young kids to soak up my time and attention has helped me hone my focus.

But Newport takes it a step further, and I think he’s right. It’s not enough to try to limit the damage of new technology or platforms on your life:

I’ve become convinced that what you need instead is a full-fledged philosophy of technology use, rooted in your deep values, that provides clear answers to the questions of what tools you should use and how you should use them and, equally important, enables you to confidently ignore everything else.

Many finance gurus talk about the need for all of us to have “Investor Policy Statements” or a “Written Financial Plan.” The reason being that if you don’t articulate a specific position, you may react inappropriately to the vagaries of life in a way that is counter to your goals. The plan keeps you honest and helps you deal with anxiety.

It makes sense to plot out “use criteria” so that you know if you should be incorporating the newest social media service that comes along and not just reactively picking something up because it’s popular.

Likewise, it makes even more sense to look critically at your use and see where the utility lies. You may not want to delete your Facebook profile or remove Instagram from your phone. Fine, right? But what—specifically—about using those services makes you happy, and what makes you angry, hurt, or jealous? And, knowing that, how can you structure some rules for engagement that can help you get what you want from the platform instead of letting it became just another automatic behavior?

 

Attention is a Gift

09.14.20 // Reading

From the highly readable Nobody Wants to Read Your Sh*t by Steven Pressfield:

You begin to understand that writing/reading is, above all, a transaction. The reader donates his time and attention, which are supremely valuable commodities. In return, you the writer must give him something worthy of his gift to you. When you understand that nobody wants to read your shit, you develop empathy.

Dear reader, I feel for you. Thanks as always.

Regarding persuasive nonfiction:

Here’s the wrong way:
1) Introduce the thesis (first three chapters).
2) Cite examples supporting the thesis (next hundred chapters).
3) Recap and sum up what you’ve presented so far (last five chapters).

In other words, “Tell ‘em what you’re gonna tell ‘em, tell ‘em, then tell ‘em what you’ve just told ‘em.”

This is salient advice, and it perfectly explains why every time I read self-help or one of these pop-psych “here’s how things really work” books it feels like the whole thing should have been a blog post or two.

 

Sociopaths need data too

09.01.20 // Miscellany, Reading

I just finished John Carreyrou’s Bad Blood: Secrets and Lies in a Silicon Valley Startup, about the fall of Elizabeth Holmes and Theranos, the Silicon Valley Unicorn that pretended to be a pioneer in laboratory testing but was really just a purveyor of bloated promises and outright lies.

A sociopath is often described as someone with little or no conscience. I’ll leave it to the psychologists to decide whether Holmes fits the clinical profile, but there’s no question that her moral compass was badly askew. I’m fairly certain she didn’t initially set out to defraud investors and put patients in harm’s way when she dropped out of Stanford fifteen years ago. By all accounts, she had a vision that she genuinely believed in and threw herself into realizing. But in her all-consuming quest to be the second coming of Steve Jobs amid the gold rush of the “unicorn” boom, there came a point when she stopped listening to sound advice and began to cut corners. Her ambition was voracious and it brooked no interference.

A 19-year-old with a couple of semesters of chemistry under her belt suddenly knows enough science and engineering to demolish the scientific state of the art and maybe even the laws of physics when it comes to fluid dynamics. Even the products themselves kept pivoting as her original ideas were clearly impossible with the current state of technology and the people she brought in to do the actual work rotated through.

It’s bonkers, and it’s so telling that almost everyone investing was a tech billionaire or silicon valley VC with no understanding of science. A cult of personality has no business in healthcare without data. This was Holmes describing the Theranos lab process:

A chemistry is performed so that a chemical reaction occurs and generates a signal from the chemical interaction with the sample, which is translated into a result, which is then reviewed by certified laboratory personnel.

If you heard this in a pitch meeting, would you think future of medicine or middle school book report?

I remember the news when Theranos imploded and I think a lot of people fully embraced the schadenfreude. But reading the detailed story was just so depressing. You shouldn’t be able to run a science company while hiding all the research and data. You know, all the sciency stuff. That’s literally not how science works.

How many thousands upon thousands of hours of smart folks’ time was wasted trying to duct tape vaporware when they could have been making a substantive contribution to their fields. How much money was flushed for someone’s ambition?

What I Read in 2019

12.31.19 // Reading

Continuing my tradition of posting my annual book diet, this year wasn’t nearly as good of a reading year as 2018. 2019 was (extremely?) busy with the birth of our baby daughter, the continued raising of our four-year-old son, my wife starting a solo private practice (that’s another post), and my first full year as an attending (and winning teacher of the year to boot!).

  1. Get Jiro! by Anthony Bourdain (weird)
  2. How to Talk So Little Kids Will Listen by Joanna Faber and Julie King (kids are ruthless)
  3. War of the Blink by Michael Nicoll and Yahgulanaas
  4. Anthem: The Graphic Novel by Ayn Rand
  5. Voice Lessons for Parents by Wendy Mogel
  6. Power Moves by Adam Grant
  7. Replay: The History of Videogames by Tristan Donovan (very interesting, at least if you’re me)
  8. Meet the Frugalwoods by Elizabeth Willard Thames
  9. Contact by Carl Sagan (classic)
  10. Heart: A History by Sandeep Jauhar (no Emperor of All Maladies, but pretty good)
  11. Junk by Les Bohem
  12. Company of One by Paul Jarvis (synopsis: there’s more to business than growth; something hospitals and academic centers would do well to remember)
  13. The Dispatcher by John Scalzi
  14. Black Crow, White Snow by Michael Livingston
  15. The Rule of One by Ashley and Leslie Saunders (near-future dystopia, but the twist is that the main characters are twins [and the authors are twins!]. The protagonists aren’t awesome athletes or killers, but it’s also not as good as [the first two books] of The Hunger Games or the [first two books] of Divergent.)
  16. The Rule of Many by Ashley and Leslie Saunders (the conclusion)
  17. Skyward by Brandon Sanderson (he’s better at fantasy, but still highly enjoyable YA light-sci-fi.)
  18. The Physician Philosopher’s Guide to Personal Finance by James Turner (reviewed here)
  19. Educated by Tara Westover (excellent memoir)
  20. The Yiddish Policemen’s Union by Michael Chabon (Chabon is my Jewish writer spirit animal.)
  21. The Vexed Generation by Scott Meyer (Magic 2.0 #6) (meh)
  22. Everything is F-cked by Mark Manson (though neither really treads new ground, his first book was much better and genuinely enjoyable. This one suffers from sequelitis.)
  23. Digital Minimalism by Cal Newport (Be thoughtful in how you use technology. Hint: Less is more. The weakest of his books, but still has enough meat to have warranted several blog posts.)
  24. Fall by Neal Stephenson (Long, good. What happens when people figure out how to live as digital avatars after death?)
  25. Chop Wood, Carry Water by Joshua Medcalf
  26. Space Force by Jeremy Robinson (hilarious, page-turning shoot ’em up thriller. I don’t laugh out loud very often, but I did a lot with this one. What happens if we create Trump’s Space Force,  everyone realizes how dumb it is, we cancel the program, and then immediately experience an alien invasion?)
  27. The Mage Fire War by L.E. Modesitt, Jr. (Sage of Recluce #21[!])
  28. Level Five by William Ledbetter
  29. Keep Going by Austin Kleon
  30. Bushido Online: War Games (#3) by Nikita Thorn (I’d never heard of let alone read a “LitRPG” book before this series, and I’ll probably never read another one. But I like this series! Yes, it’s silly. And yet.)
  31. Small Fry by Lisa Brennan-Jobs (A really good memoir; also, Jobs seems like a pretty not nice guy.)
  32. Make it Stick by Peter C. Brown (Probably the definitive book on modern learning science)
  33. The Toll by Neal Shusterman (Arc of a Scythe #3)
  34. The Others by Jeremy Robinson
  35. Indistractable by Nir Eyal (meh)
  36. Ultralearning by Scott Young (more anecdotal than #31)
  37. Strange Planet by Nathan W. Pyle (hands-down best thing on Instagram)

I think 2020 is going to be a good year. I already know what my first book is going to be.

Measles is the original measles vaccine

07.31.19 // Medicine, Reading

Measles is the original measles vaccine. It’s a natural method that’s been around for centuries. It was good enough for my mother and my mother’s mother and her mother before her.

Unlike synthetic vaccines, which are modified by scientists in underground labs to reduce their potency, measles is completely organic.

From “I’m vaccinating my child the natural way–with measles” in McSweeney’s.

This may be excellent satire, but it could just have easily been lifted from an actual blog written by an actual flesh-and-blood idiot.

What I read in 2018

01.06.19 // Reading

This is the fifth time I’ve published my book diet for the year (though admittedly a few days late). It’s a pretty eclectic mix this year, and I’m happy to report I did manage to squeeze in a few classics amidst my steady diet of not-so-classics. Not gonna lie, Gilgamesh (humankind’s earliest surviving written story) is kinda awesome. I did fail in my promise to myself to stop reading anything approaching pop-pseudo-psychology and self-help. I keep telling myself it’s because it’s background for all the writing on the topic I have planned, but it’s really a poor excuse.

This number is also totally inflated because I decided to include a few things from Audible that not only did I not “read” but aren’t exactly even books. Audible recently started giving members two free “Audible Originals” downloads every month, which are a combination of short books, plays, and…episodic treatments of a theme? Either way, they’re neat! (And audible is still offering two free books when you sign up.)

  1. The 4-Hour Workweek by Timothy Ferriss (This book is so frequently referenced and has generated so much copycat drivel that I’m shocked I hadn’t read the actual source before. Unfortunately, you can’t be a practicing physician in 4 hours a week, and most of the other insights I liked have remained unchanged since the time of the ancient Stoics.)
  2. The Doctors Guide to Smart Career Alternatives and Retirement by Cory S. Fawcett (I wouldn’t mind retiring to write books either; writing them while gainfully employed is hard work!)
  3. The Year of Living Danishly by Helen Russell (I wouldn’t want to live in Scandinavia, but I would like their social benefits please)
  4. Brevity: A Flash Fiction Handbook by David Galef (Nanoism and I get a shoutout and a couple of reprints in the final chapter, which is neat)
  5. So Good They Can’t Ignore You by Cal Newport (Along with Deep Work, Newport has written two of the least cringe-worthy entries in the productivity/self-help genre. I don’t regret reading either one.)
  6. American Sniper by Chris Kyle
  7. What I Talk about When I Talk about Running by Haruki Murakami
  8. SP4RX by Wren McDonald (‏One thing that I love about graphic novels is how different art styles can inform and reflect the story. Grabbing a random new one off the shelf is always fun when I take my son to the library)
  9. Can’t and Won’t (Stories) by Lydia Davis (it took me over a year reading this book in small chunks to get through it. Had high hopes, as I tend to enjoy (and of course publish) very short stories. Ultimately many of the shortest ones felt empty, while the longer ones generally felt somewhat plodding and maybe even indulgent?)
  10. Island by Aldous Huxley (a treatise on the benefits of Buddhism and magic mushrooms loosely masquerading as a story. Brave New World it is not.)
  11. Dockwood by Jon McNaught (beautiful, unique art, almost like a nearly silent film; very short graphic novel (really two graphic short stories) but so quietly depressing).
  12. Mooncop by Tom Gauld
  13. In Real Life by Cory Doctorow and Jen Wang
  14. How to Live a Good Life by Jonathan Fields (ugh. answer = buckets)
  15. Catch Me if You Can by Frank W. Abagnale (fascinating)
  16. Stephen Colbert’s Midnight Confessions (Weak. I did almost belly laugh once though. I also read it in Barnes and Noble for free, so well worth the price of admission).
  17. The Punch Escrow by Tal M. Klein (awesome near-future techno-romp)
  18. Spell or High Water by Scott Meyer (Magic 2.0 #2)
  19. First Man: Reimagining Matthew Henson by Simon Schwartz
  20. Buzz! by Ananth Panagariya and Tess Stone
  21. An Unwelcome Quest by Scott Meyer (Magic 2.0 #3)
  22. Fight and Flight by Scott Meyer (Magic 2.0 #4) (Ugh this was so weak compared to the first three.)
  23. Ikigai by Francesc Miralles and Hector Garcia (I told myself I wouldn’t buy any more terrible self-help Audible daily deals, but I’m a sucker for Japanese wisdom. This was really terrible but at least mercifully short)
  24. If On a Winter’s Night a Traveler by Italo Calvino (a unique trip, novels within novels *inception horn*)
  25. The Elements of Style by Strunk & White (I think this my third re-read)
  26. You’re Never Weird on the Internet (Almost) by Felicia Day
  27. The Machine Stops by E. M. Forster (published in 1909! probably the inspiration for WALL-E)
  28. Consciousness and the Brain by Stanislas Dehaene (not the fastest or easiest read, but a fascinating one nonetheless. His writing for a general audience is much more palatable than his papers from the 90s and early 2000s I read during one of my college seminars).
  29. The Time Machine by H. G. Wells
  30. Infinite by Jeremy Robinson (I thought this was an awesome sci-fi thriller thingie)
  31. See You in the Cosmos by Jack Cheng (highly recommended, particularly if you liked the Curious Incident)
  32. What Do You Care What Other People Think? by Richard P. Feynman
  33. Caves of Steel by Isaac Asimov (Robots #1)
  34. The Sky Below by Scott Parazynski
  35. The Naked Sun by Isaac Asimov (Robots #2)
  36. The Robots of Dawn by Isaac Asimov (Robots #3)
  37. You Do You by Sara Knight (her first book was far funnier and superior)
  38. Out of Spite, Out of Mind by Scott Meyer (Magic 2.0 #5)
  39. Gilgamesh: A New English Version by Stephen Mitchell
  40. The Stars My Destination by Alfred Bester (I read this so many years ago that it took me a few chapters to realize I’d already read it! A true science fiction classic)
  41. Andrea Vernon and the Corporation for Ultrahuman Protection by Alexander C. Kane (fun!)
  42. Outcasts of Order by L. E. Modesitt, Jr. (I don’t know if I’m just getting older, but the writing in this subseries is more repetitive and the characters more two-dimensional than I seem to remember. Nonetheless, Modesitt may always be my guilty pleasure.)
  43. Children of Time by Adrian Tchaikovsky (really good! Arthur C. Clarke Award winner)
  44. Edgedancer by Brandon Sanderson
  45. The Year of Less by Cait Flanders
  46. No Time to Spare by Ursula K. Le Guin
  47. Misbehaving by Richard Thaler
  48. Oathbringer by Brandon Sanderson (Stormlight Archive #3) (#4 please…)
  49. Harpoon: Inside the Covert War Against Terrorism’s Money Masters by Nitsana Darshan-Leitner
  50. Capital Gaines by Chip Gaines (If I could see deep inside myself, I’d still never know why I read this)
  51. Never Split the Difference by Chris Voss (This is an excellent [the best?] book on negotiating. Probably should be a must-read for every graduating resident)
  52. One Doctor by Brendan Reilly (This is a beautiful doctor memoir. It really is lovely. Reilly also deftly weaves in the frustrations and issues with the changes in the practice of American medicine deftly and with excellent perspective).
  53. You Need a Budget by Jesse Mecham (by the creator of the software of the same name)
  54. Bushido Online: The Battle Begins by Nikita Thorn (I can’t fully express how utterly silly and fun this book is. It’s a LitRPG. I didn’t know what a LitRPG was before, but it’s basically a book where the action and character development occurs like a roleplaying game. People have hitpoints. Gain abilities. Go on quests. It’s just so adorably goofy.)
  55. Bushido Online: Friends and Foes by Nikita Thorn
  56. The Coming Storm by Michael Lewis
  57. Girls and Boys by Dennis Kelly
  58. Thunderhead by Neal Shusterman (Arc of a Scythe #2)
  59. Boomerang by Michael Lewis
  60. Atomic Habits by James Clear
  61. Laid Waste by Julia Gfrorer
  62. “Surely You’re Joking, Mr. Feynman!” By Richard P. Feynman (I feel like if I had a spirit animal, it would have been Feynman.)
  63. This is Going to Hurt by Adam Kay (a diary version of the medical coming-of-age tale. You know the end before it starts, but it’s still a good ride with some laugh out loud funny bits. It was also neat to make sense of how training works in the UK)
  64. Twain’s Feast by Andrew Beahrs
  65. No Land’s Man by Aasif Mandvi
  66. The Impossible Fortress by Jason Rekulak
  67. I am Number Four by Pittacus Lore (not great even as far as super-powered YA goes, but when I discovered that Lore is a pen-name for a group of writers including literature’s greatest modern liar [James Frey], I was curious).
  68. Zero G by Dan Wells
  69. The 21 Irrefutable Laws of Leadership by John Maxwell (Why do I keep reading this tripe??)
  70. Victorian Secrets by Stephen Fry
  71. The Consuming Fire by John Scalzi (The Interdependency #2)(I really enjoyed this one. Has some echoes of Asimov’s Foundation but written with foul-mouthed contemporary style and pacing)
  72. Out of My Mind by Alan Arkin (um, this was odd and meh)
  73. Friday Night Lights by H. G. Bissinger

I’ve read some long books over the years, but Sanderson’s 1248-page epic Oathbringer was a monster.

I have so many unread books on the shelf it’s almost embarrassing (I practice the art of Tsundoku), and also I really want to finish writing book #4 this year—I need to get to work!

Big Update to Medical Student Loans

03.08.18 // Finance, Reading, Writing

In addition to publishing my “general audience” student loans book last week, I also pushed a pretty sizable update to the original doctor’s version last week.

Medical Student Loans has been revised for 2018 with a slew of small updates and a few new features, including expanded sections on the “married filing separately” loophole and its pitfalls and updates in the world of private refinancing for residents. On top of that, I’ve updated all numbers and figures for the 2018 tax year and made several bug fixes and clarifications throughout the text.

It remains a living document, so feedback is always welcome.

All new buyers will always receive the most recent version.

But, if you purchased the book previously, you can download the updated revision through the “Manage Your Content and Devices” on your Amazon account. Enjoy!

My newest book is Student Loans: A Comprehensive Guide

03.05.18 // Finance, Reading

I just released my third book. OK, it’s really more like my 2.5th book, because Student Loans: A Comprehensive Guide is a line-by-line reworking and expansion of my second book, Medical Student Loans: A Comprehensive Guide.

As with all of my longer projects, I drastically underestimated the amount of effort and time it would take to complete this task, as this book still took the better part of a year to complete.

Student Loans is temporarily exclusively available on the Kindle platform, and I’m running a free book promotion until the end of Friday.

So, if you are or will be a physician, read my other book; I wrote it just for you, and there’s nothing else like it.

If you’re anything else, please enjoy this new book (for free), and tell your friends who are in school, have been in school, or will be in school to get their free copy now (there’s nothing else like it).

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