2024 was a busy year for me (as all years feel busy, just as I suspect they do for literally everyone). Here on the site I did more quote-and-commentary posts and short asides, which I find enjoyable to write and share but also help me cover emotionally for fewer longer or more involved postings amidst the vagaries of life and also all the radiology job-related stuff I won’t shut up about. Every site like this has its seasons, and not every season results in the same frequency, length, or even writing quality (depending on the content, current events, and my shifting interests over time). That is the usually happy nature of a writing hobby instead of a writing job. That said, I’ve wanted to do another longer project for several years, and I naively thought 2024 was going to be the year that happened. It didn’t.

This year I would like to practice finishing, which is one of life’s most satisfying skills. I’m going to start that by finishing, polishing, and publishing a whole bunch of half-written drafts that I have accumulated over the past year. Even then, I have so many that will never see the light of day (especially those that were topical at one time but probably no longer helpful or insightful). I doubt any of these will blow any minds, but I hope some will be helpful for those smaller number of readers that will stumble upon them at the right time of their lives. Some are about medicine including radiology practice, radiology learning, and radiology training, but some are just derived from interesting things I’ve read over the past year or two that I’ve wanted to share. I’ll never, ever clean out my writing backlog, but I’d like to share some work over the coming months that I will define as complete in the sense that I’ve pressed publish.

I’ve tried to take heart from the overarching lesson of Four Thousand Weeks: this doesn’t matter. That doesn’t mean none of this is worth doing to me or has no value, but rather that—on a cosmic scale—there’s no reason to take myself too seriously. There are a few things I want to do this year writing-wise just because I (theoretically) can, so I think I will.

Regarding the future of writing (and thinking) in an AI-enabled world, from “Writes and Write-Nots” by Paul Graham:

The result will be a world divided into writes and write-nots. There will still be some people who can write. Some of us like it. But the middle ground between those who are good at writing and those who can’t write at all will disappear. Instead of good writers, ok writers, and people who can’t write, there will just be good writers and people who can’t write.

A very short essay, well worth the 2 minute read.

With improving AI tools, the progressive ease of information acquisition and low-effort good-enough “work” generation may be good for lots of things, but for actually internalizing the skills of deliberation, argumentation, and communication? Probably not so much.

In Show Your Work, Austin Kleon argues “the best way to get started on the path to sharing your work is to think about what you want to learn, and make a commitment to learning it in front of others.” That’s what I’ve been doing since 2009.

One downside of Showing Your Work is when the showing of the work is the only work you do. I never set out to be a blogger (cringey moniker that it is). Not that there’s anything wrong with this site (I think it’s pretty good?), but it’s undeniably the lower-hanging fruit that I’ve been doing for 15 years while mostly not writing the books and stories I originally intended to write. We could call it productive procrastination.

Now that’s not entirely fair, because it turns out that I also like whatever this is. I like writing short, I always have—I edited a nanofiction literary journal for 14 years for heaven’s sake—and I like curating, sharing, teaching people, helping others, and yes, even being a curmudgeon when the situation calls.

Kleon quotes David Foster Wallace, who said that good nonfiction was like watching “somebody reasonably bright but also reasonably average pay far closer attention and think at far more length about all sorts of different stuff than most of us have a chance to in our daily lives.” Which is I think is both generous and true.

So, I wish more people had websites, took the time to have a position or make something to share/teach, and then put it online.

For anyone considering graduating from transient social media reactions to starting a site to show their work, this gem from Clary Shirky:

The stupidest possible creative act is still a creative act. On the spectrum of creative work, the difference between the mediocre and the good is vast. Mediocrity is, however, still on the spectrum; you can move from mediocre to good in increments. The real gap is between doing nothing and doing something.

Medicine is, on the whole, underserved in the public sphere by its physicians. And the field of radiology, which has made up a significant fraction of my writing over recent years, certainly deserves more independent perspectives online than mine and a handful of others.

Don’t be scared to start small and reduce the barrier to entry for yourself. You can curate more than you generate, as old tech writer Jeff Jarvis advised: “Do what you do best and link to the rest.” (Last year I even added a smaller post-style microblog here to encourage myself to share more.)

I’ve enjoyed writing in my little corner of the internet and have no intention of stopping.

But, maybe there will be another book soon.

When I started the current iteration of this site in January 2009, I was also writing short fiction. In fact, one of my self-imposed creative writing projects was an exercise in the form of a daily tweet-sized story. Very strange, it’s true, but 2009 was a long time ago in internet years, and it seemed like a good idea at the time. Perhaps even odder, but I found this experiment so creatively fulfilling that I decided to do something that remains unique: a paying venue for literary Twitter fiction, self-contained stories in 140 characters or fewer. (For reference, this is so long ago that it predates the official retweet function, and to this day, most literary magazines do not pay writers for their stories.)

After 14 years of continuous publication, Nanoism remains by far the longest-running venue of its kind. This has been on the About page since day one:

We’re not just catering to the 21st-century attention span, we’re publishing flexible fiction: stories that you can read on your computer or cellphone, stories that fit in the cracks of your day.

Over the past fourteen years, we published 1000 standalone tweet-sized stories from 660 writers, multiple longer serials, ran contests to raise money for charity (judged by amazing writers like Ethan Canin and Robert Swartwood), been on NPR, and had stories featured in best short fiction anthologies and books on craft. Not a bad run.

It was a fun hobby and relatively well-suited to the preclinical/basic science years of medical school. But in the years since, through residency and fatherhood and the many wrinkles that make up a life, it was harder and harder to find the bandwidth to promote this art form, this venue, and the hundreds of writers I’ve published.

This is a small project (forgive the pun), but it took what I had just to keep it running week after week. I was remiss in rarely taking the time to submit stories for the many possible awards and anthologies that work like this can appear in (especially since they often did well!). But the fact is that even if the recognition were to start and stop with just my nomination, every writer who sits down to do the work, puts themselves out there, and hopes for the best deserves as much recognition as they can receive. And for that lack, I truly apologize.

I know that it seems silly to publish things so small and call them stories, but, sincerely, it was an honor and pleasure to read and share your work.

I’ve been writing online (“blogging”, cringe) for over 14 years now, and there can be a sometimes strange (and strained) relationship between writing-as-service and writing-as-expression. I’ve mostly written whatever I want, or at least whatever I thought had two or three of this magic combination:

• interesting to me
• would be helpful to other people
• either no one else was doing it or I had an individual (ideally unique) perspective

And yes, sometimes I just wrote whatever.

Over the years, this site has focused on a variety of topics until they’ve covered the ground I wanted to cover or exhausted my interest. I wrote a lot about studying in medical school (choosing books, approaching questions, etc) until I wasn’t interested anymore (not a great financial decision, but hey). I wrote a lot about approaching the residency selection process.

I wrote the book for the Texas JP exam because that test was a stupid hassle and no one had made what I thought should exist. So I did.

I wrote a lot about personal finance specifically for medical students and trainees and especially about student loans, mostly because content on student loans just did not exist at the time (I know, hard to believe). Now it does, and I felt I covered that sufficiently in the book, so I mostly moved on (also not a great financial decision, but hey). I’ll probably return to personal finance again in the future. I still have more to say, but I’d be kidding myself if I pretended even for a second that my opinions are particularly unique or interesting or that this space isn’t being adequately covered (frankly, it’s saturated; there’s plenty of content and almost infinite noise to wade through already).

I’ve written a lot about medical training, radiology, and various topical issues related to organized medicine like board certification (ABR I’m looking at you) or healthcare trends like private equity takeovers. People like these posts. I (still) like writing them. I genuinely think these issues aren’t talked about enough, even though my fly buzzing on the internet probably isn’t going to move the needle much.

I was going through my archives at the end of the year, and I noticed just how much of the writing that I thought was evergreen is slowly aging out. Posts that used to be perennial traffic drivers have eventually lost their mojo. A lot of that may be because “the blog is dead,” and some of it just that Google overall favors fresh content all things being equal (even if the classics are still fire, thank you very much). But some of it is because even things that don’t change quickly sometimes still change slowly. 14 years is a long time on the internet. I guess that’s both a testament to how long I’ve been doing this and also a little sad.

There has never been a shortage of things I’d like to write about. I could easily fill up my days writing full-time, and my collection of potential post ideas and article fragments is comically long. It only gets longer. I get a lot of topic requests, and they’re almost always things I’d be happy to write about given time. But there’s also that unavoidable truth that every yes to one thing is a no to another.

I’d like to have more of my writing be timeless. (Maybe it’s time to go back to fiction too?) We’ll see. I also want to keep being a resource for radiologists and other physician readers, but I also wouldn’t mind writing things that might be interesting to someone who doesn’t work in a hospital. Morgan Housel, who wrote the excellent Psychology of Money, tweeted:

I think “know your audience” can be dangerous advice for writers.

Write stuff you yourself find interesting and entertaining.

Writing for yourself is fun, and it shows. Writing for others is work, and it shows.

One perk of jumping around over time is that I haven’t had to worry too much about audience capture.

As for me, I want you to know this has been fun, and I hope that shows. Thanks for reading.

Anne Lamott from her lovely book on writing, Bird by Bird:

Writing has so much to give, so much to teach, so many surprises. That thing you had to force yourself to do—the actual act of writing—turns out to be the best part. It’s like discovering that while you thought you needed the tea ceremony for the caffeine, what you really needed was the tea ceremony. The act of writing turns out to be its own reward.”

I gave a talk about the benefits of writing last year at WCICON21. I didn’t know about this passage back then, but if I had, I would have included it at the beginning.

As the absurdly prolific Brandon Sanderson repeats in The Way of Kings as one of the ideals of the Knights Radiant: “Journey Before Destination.”

Process > outcome.

A reader asked me recently about starting a website, something that happens every so often and a topic I’ve written about before. And my answer in that post, which Lamott so beautifully captures, is that the writing has to be worth it in and of itself.

You think you want to teach others, get a following, sell something, or influence (as a verb). And of course you do! You’re human. I do too. But most people can’t just write for that and keep it going very long. Because while the output can be awesome, the outcome is unknowable. The process is the only guarantee.