Ben White

From “Physicians Get Addicted Too,” an Atlantic story about opiates and addiction in West Virginia:

“I made pizza deliveries where I used to make house calls,” Ortenzio said. “I delivered pizzas to people who were former patients. They felt very uncomfortable, felt sorry for me.” But, he said, “it didn’t bother me. I was in a much better place.”

Ortenzio eventually left pizza delivery. But the way he told me the story, the job was an important step in his recovery: Every pie he delivered liberated him. He was free of the lies he’d told his colleagues, his family, and himself to hide his addiction. He liked hearing kids screaming “The pizza guy’s here!” when he knocked on the door. “You make people happy,” he said. “That was what I liked about being a doctor.”

// 05.02.19

Genetics, the environment, adversity, and perseverance—all in this short documentary from The Atlantic:

// 04.05.19

Kosher(ish)

11.19.18 // Miscellany

Some of you may have noticed that things have been a little bit quieter than usual around here. While I’m still writing (and have plenty more in store), my attention was divided recently on a new passion project my wife and I just launched.

It’s called Kosher(ish), and it’s basically the first part of a new Jewish lifestyle brand and blog. Because why not? Also, because there aren’t enough fun things for us to dress our son in for the holidays, and Hanukkah isn’t the only one that deserves a t-shirt or some paper goods!

(We only have a few items for this 2018/5779 Hanukkah season, but if you’re in the market, time is running out to receive your order for the holiday.)

It’s not easy to balance a dinosaur-and-train-loving three-year-old, this sprawling website, a half-finished book, a new job, and a new venture! In the meantime, I have some exciting news about my student loans books coming soon and a bunch of great posts to close out the year.

Most of all, thanks as always for reading.

How to start a website

10.29.18 // Miscellany, Writing

Despite the widely publicized demise of the blog, personal websites continue to exist, and writers like myself continue to publish them. I’ve also received a steady stream of requests for background information and approaches to maintaining a “successful” long-running website over the past decade, so here are my thoughts. What follows is most definitely my (long) personal opinion and is not necessarily prescriptive:

Motivation and Content

While most people have questions about the mechanics of choosing a platform and maintaining a website, those are ultimately the easier problems to solve. The content is ultimately the critical challenge.

You have to enjoy the writing, and you need to either pick a niche you really like or give yourself the flexibility to adapt. If your goal is traffic and money, you’ve probably already lost.

The vast majority of new personal websites (i.e. blogs) are abandoned within months.

There are a lot of reasons for the high blog mortality rate, but one of the ones I think people don’t anticipate is pigeonholing yourself into a niche that is overly narrow or unsustainable. When you choose doctoreatinghealthy.wordpress.com or howIgotthroughmedschool.blogspot.com (not real sites, I think?), what do you do when you’re tired of posting about steel cut oats or graduate? How can your site grow with your interests?

Of course, the flip side is that you also need to find your voice. Just rewriting things other people have already said won’t keep you interested for long and probably won’t bring a lot of readers either.

Platform and Hosting

It’s worth discussing both what software you’ll use for your site and what hosting you’ll need vs. purchase at the same time because neither choice lives in a vacuum. The most important question that determines what suits your needs is the level of control you want. There are good fully-hosted turnkey solutions that allow you to create a website with minimal fuss and no technical skill and just get to writing. And then there are DIY options that require a bit more effort up front but leave you with the power to change every detail of your site and take it to new directions in the future.

You don’t need to learn to code to design and run a website anymore, no matter which avenue or platform you choose.

Several years ago, I would have recommended that anyone serious about running a website use WordPress.org and set up their own hosting. WordPress is a CMS (content management system) that can basically do anything and runs almost every site on the internet. It’s great, it’s easy to use, and it’s free.

The turnkey options were too inflexible to create what I would have considered a “good” site. You could always tell who was using an out-of-the-box platform or design with the handful of near-universal themes, the laziness of the free wordpress.com URL, the bylines that would say “posted by Admin” on every single post (of a single author blog). It was depressing. With everyone posting more and more on Facebook and Twitter, no wonder people thought blogging was dead.

Over the past few years, advances among web platforms coupled with a general trend toward clean, minimalist design have really leveled the field.

Options

For web hosting, there are plenty of options. I have always used Dreamhost, which has one-click WordPress installation with automatic upgrades and a simple backend. You can purchase and manage new URLs and host multiple sites on the same cheap plan. I’ve paid $7 a month to host multiple sites with unlimited bandwidth and storage for over a decade and serviced millions of hits with basically 100% site uptime.

You can sign up here for a year of unlimited hosting for a few bucks a month. Unlimited means unlimited websites, storage, traffic, email, etc. You’ll also get a free domain registration thrown. You’ll also have an optional free SSL certificate (that you’ll need if you ever want to sell anything). It’s an awesome deal that I took advantage of over a decade ago, and I’ve never looked back.

Bluehost is another common WordPress host. You’ll hear about them on basically every “how to start a website post” because they are a solid webhost that also happens to offer a really popular affiliate program. While their program doesn’t include a reader discount, their packages are often a couple dollars cheaper than Dreamhost. Both companies offer various tiers of server upgrades if you find your site grows and you need more power.

If you don’t use the WordPress.org platform, you basically won’t need to pay for separate hosting, because the other reasonable options are full-service and the hosting comes included. One easy solution is to use WordPress.com (either for basically free or upgraded to a better plan as you need it), which is the commercial arm of the free WordPress CMS software: less control but more support. Personally, if I wasn’t into DIY, I’d pick Squarespace, which is a reasonably priced CMS with an excellent interface and nice clean themes. If you want to start a low-fuss online store, then go for Shopify.

Whatever you choose, just pay enough so that you don’t have lame corporate branding on it (like you often see with Wix sites). If you don’t take yourself seriously, why should anyone else?

URLs

Buy a real URL, even if you haven’t started yet or are not sure if blogging is for you. It costs about ten bucks a year. If that seems too steep, then you aren’t taking the idea of writing seriously. Please just buy a real URL, preferably .com (but .net or .org or probably .co is fine).

Every paid hosting option, whether WordPress via Dreamhost or Bluehost, Squarespace, etc will throw in a new domain registration if you sign up for a hosting package. Two birds with one stone, no excuses.

Part of running a successful site is being searchable and navigable. Your URL should be easy and memorable, and every post and page you write should be available at the same spot FOREVER. You aren’t going to build up link-juice from search engines by having crufty gross super-long URLs that you’ll need to completely change in a few months or years when you finally get serious. I know it’s not free, but again, if taking your project seriously isn’t worth forgoing a coffee or two a month, then why are you even contemplating it.

More Thoughts on Content

Far be it for me to give advice on what you (or anyone else) should write about. I write a poorly monetized personal website that meanders around a variety of topics including medicine, technology, writing, and personal finance, and it’s changed a fair bit over the past decade.

That far-ranging scope and the permission I’ve given myself to convert the questions and quests of my journey in medicine (and, to a lesser extent, writing and indie publishing) are what have kept me coming back to write for an audience of strangers here year after year.

On the flip side, a narrow scope may get you a more laser-targeted audience. If you want to make money, a narrow niche is much easier to sell to advertisers, pivot into a monetizable newsletter, or to target with upsells like the gazillions of overpriced e-courses you’ve seen cropping up online.

If it’s part of a business for which you might be willing to pay for traffic, a well-carved niche will also be easier to target for ads to attract the right kind of visitor and get a return on those sketchy sponsored Facebook posts.

But a narrow scope is also the fastest way to find yourself spinning the same handful of ideas into repetitive permutations and fluffy listicles. This–along with depression about having no traffic–is why so many people abandon their blogs. Most sites never make it to their one year anniversary.

I was happy to write about medical school stuff for a number of years. And I still do so on occasion when I think I have something valuable to add, but as I get more and more removed from that time of my life, it would be hard to imagine continuing to write here if the site was something that had “med school” somewhere in the title or where I felt constrained to stay on topic. However, starting from scratch with a new site or totally rebranding instead of just iterating and evolving would also be lame.

Now that’s in part the difference between starting a personal blog and a true business. If the primary goal is to make money, then sure, you can try to build up an audience and credibility while you have the energy and then later on try to sustain or grow the enterprise by bringing in outside writers, publishing lots of guest posts, etc. Just be aware that most people with this goal fail, and again–I can’t stress this enough–you should want to write.

Frequency & Activity

Many people try to drive traffic by publishing frequently. It is indeed true that search engines like to see a well-maintained, active site. And, it’s also true that if you post everything you publish to social media, you will likely get a greater number of clicks, and those clicks may even be a critical driver of the traffic you do see.

But that pressure results in a lot of people writing a lot of things that even they don’t care about. I don’t personally want to write the same thing more than once or twice, and it would be a debilitating killjoy to feel compelled to churn out trite, Madlib-like combinatorial garbage, throwing it against the wall week in and week out and hoping it sticks.

In my experience, organic search traffic comes from “high-quality” writing, especially that which gets linked to from reputable websites. I’ve never attempted to see if listicles perform well in the medical education niche, and frankly, I’m happy to remain ignorant.

Topical vs. Evergreen

Most personal sites probably function best at the outset when a significant portion of the posts are evergreen (meaning they stay relevant over the course of years). Current events and commentary are fun and keep things fresh, but the effort required to stay topical typically exceeds the staying power of the writing. When you have a lot of readers like Kottke.org or Daring Fireball, high-volume posting and topical commentary are basically the whole point. But for most people who are starting out writing part-time, your topical writing has no staying power and is mostly lost in the ether of the Internet. Make sure to take your time to write at least some really helpful stuff. Topical writing is more fun when you have an audience.

I believe that there is an inherent tension between writing for a periodical website like many blogs and writing to communicate ideas. Most informational sites should be generating content like a serialized novel, a larger overarching work split into manageable chunks and small sections. Instead, most sites meander through the same topics again and again like a pendulum swinging through the center. Where does a reader start? Why should a reader keep reading?

If you’ve ever read Lifehacker, you’ve seen this firsthand: the staff writers will often post the same hacks almost verbatim, apparently not even realizing that they’ve posted the same exact thing on multiple occasions before. Big successful websites do this and get away with it because even lame posts get clicks and clicks mean money.

You can do that too, of course, but if the goal is to build something you both enjoy doing and can be proud of, I’d argue for quality over quantity.

If you do end up writing an unruly tangle of posts about the same thing, then it becomes even more important to have strong site design/organization/navigation as well as to assemble your greatest hits into easy-to-find lists that help new readers really “get” what you have to offer. (Note: I’m 100% guilty of not following this advice.)

Good luck!

I think the internet is better off with more people owning their own content and maintaining their own presence online. Ceding our collective voices to Facebook has sped up the pace and volume of discussion, but it definitely has not made the world a better place.

I’m always happy to help.

The Hit Points

08.13.18 // Miscellany

Starting in 2003, my secret work/study music has mostly been comprised of hundreds of wonderfully creative arrangements of video game music, largely thanks to a website called OverClocked Remix, which has been steadily curating a massive collection of high-quality pieces for almost 20 years.

Which brings me to this stellar bluegrass rendition of a theme from a Kirby game (that I haven’t played):

My son wants to listen to this song on repeat in the car on the way to school literally every day.

Check out The Hit Points’ complete new album CD for free on their bandcamp. Every piece isn’t a standout, but the overall effort is still just delightful. If you can recognize Guile’s theme from Street Fighter II from your childhood, you’ll immediately agree that it was meant to be played this way.

Workflowy redesign

08.04.18 // Miscellany, Writing

This is some niche dorky stuff for a Saturday night, but I’m excited: My digital brain, Workflowy, just got a modern redesign.

For those who don’t know, Workflowy is a totally free (with very optional paid options) outliner/todolist/organizer that allows you to have infinitely nested arbitrarily large outlines/lists. If that doesn’t make sense, just try it. It’s ridiculously simple but very powerful. I even wrote the bulk of my last book in it.

The main downside for me has been that Workflowy’s design has been stuck in yesteryear. I’ve been spoiled by a number of elegant writing environments over the past few years, and I actually do think the extra zen makes a difference. This new design is, as expected, super simple, but the clean lines and font crispen up the experience just enough. Well done!

If you’ve already given Workflowy a try, you can activate the new beta design through the options page here. Now they just need to update the iPhone app!

Alto’s Odyssey

02.27.18 // Miscellany

The sequel to my favorite iOS game came out last week. Alto’s Adventure, which came out in 2015, was a snow-boarding-themed endless runner that has remained the iPhone’s best meditation app for several years.

I’ve been playing the new sequel Alto’s Odyssey since it came out last week, and it builds on the original to deliver an outstanding sequel. It’s sandboarding instead of snowboarding, so the ambiance is freshened, and there are several new gameplay elements including bouncing hot air balloons and canyon wall-grinding. But most of all, there is still an incredible attention to detail with countless little design touches that are, frankly, delightful coupled with another fantastic relaxing soundtrack. It’s awesome.

Focused Nonchalance

02.22.18 // Medicine, Miscellany

Focused nonchalance is, I believe, the ideal attitude to cultivate when preparing for and taking a high-stakes exam.

While much much easier said than done, the goal of attitudinal preparation is to strive for a state of flow when answering multiple-choice questions: focused and potentially even joyful as you take an exam, marshaling all of your cognitive resources without falling prey to anxiety and self-doubt.

Flow, the now widely-known phenomenon akin to being in “the zone,” was first described in the 90s by the prominent psychologist Mihaly Csikszentmihalyi in Flow: The Psychology of Optimal Experience:

In normal life, we keep interrupting what we do with doubts and questions. ‘Why am I doing this? Should I perhaps be doing something else?’ Repeatedly we question the necessity of our actions, and evaluate critically the reasons for carrying them out. But in flow there is no need to reflect, because the action carries us forward as if by magic.

While the optimal experience and apparent effortlessness of flow as it is most popularly described is probably out of reach for most students taking a multiple-choice test, my point in this discussion is to state firmly that achieving focused nonchalance or even a flow state is not dependent on your actual test-taking skills and prowess or the fraction of questions you get right easily but is instead a reflection of your attitude and preparation. (Don’t get me wrong, if you always do well on exams and are a natural narcissist, this will likely all come easier). Csikszentmihalyi never argued that flow necessarily meant you were doing awesome; even in the title, he suggests that flow leads to an optimal experience. Nonetheless, that optimal experience goes a long way on a long and stressful examination.

 

Hitting the Wall

Many people who put in a considerable study effort eventually hit a score wall or plateau where more and more effort seems to yield minimal or even worsening score results.

Your specific goal, whatever it is, is awesome and I hope you achieve it, but you also need to realize that goals are only helpful as a means of motivation, not something to tie your entire self-worth into. Otherwise, the wall is crippling. A friend’s performance, peoples’ forum posts—absolutely none of that matters.

Putting aside the reality that people presumably do have a natural maximum performance range and the fact that the tendency to focus on learning fringe esoterica is unlikely to pay dividends test by test, I think a significant fraction of the mutable wall comes from two places: overthinking and fatigue.

 

Overthinking

Overthinking a question is a symptom of underconfidence. When you overthink and question yourself it’s because on some level you believe that you are insufficiently prepared to determine which facts are critical within the information provided to derive a correct answer. Therefore you start searching for hidden clues to avoid making a “silly” mistake. This is approaching the question from a position of weakness instead of strength.

The solution is to believe that at any point you are as prepared as you can reasonably be and that you should use the skills you have at that moment to answer to the best of your actual ability. Going hunting or dowsing for tricks isn’t going to help you if you don’t really know what it is you’re looking for.

The components of a question that matter to you only matter because you actually know what to do with them and what they signify. If you change your answer from what you would otherwise pick due to a hunch, you’re guessing. If you want or need to guess that’s fine, everyone does with some frequency, but then guess happily and move on. However, changing what you believe is the best answer just because you wonder if some detail might make a difference but aren’t sure is unlikely to consistently lead to better results.

Overthinking and dumb mistakes are actually two sides of the same coin: one tends to happen when you try to prevent the other. So you oscillate back and forth, even from question to question within a single block. When you check your answers, either in a tutor mode scenario or at the end of a block, the questions you get wrong are a head-slapping frustration-fest instead of learning opportunities.

This frustration is (naturally) compounded by being emotionally invested in your performance. This is why you need to believe that you’re going to do as well as you can. Agony helps no one.

When you’re stumped by a question, the answer isn’t to be sad or angry at yourself. The response should be, “Ah, here’s one of those irritating questions that I’m designed to get wrong. Time to narrow down as much as possible, guess, and move on.” Even if you know that you used to know the answer, you’re still human.

Your job isn’t to get the all the questions right; that’s an outcome you can’t control. Your actual job is to take each question individually, apply your knowledge and reasoning to it, and pick what you feel is the most likely answer.

 

Guess. Guess again. Guess better.

Sometimes you will need to guess. When you’re down to two choices, try to see if one answer might feel more right. Often, you will like one answer better but won’t be able to “rule out” a second choice. This second choice sometimes seems like it could be correct. Most high stakes exams including the USMLE use a “single best answer” format. This means that other answers don’t all have to be wrong, just that one of them stands out as better (i.e. “the best”). You don’t technically have to know the right answer, you just have to pick it.

Medical school sadly may not contribute very much to your 10,000 hours toward becoming a great doctor as Malcolm Gladwell popularized in Outliers. But it does give you a lot of mileage on the goal of being a great MCQ test taker.

So, the ability to instinctively and comfortably guess the correct choice is another reason to do tons and tons of practice questions from a reputable source. You can develop your innate question sense by practicing and practicing. Using low-budget or alternative questions can be a bit dangerous, as some of these resources over-test minutia or try to trick you in ways that are not typical of the real USMLE.

 

There’s wrong, and then there’s wrong

I remember that when I’d get questions wrong on UWorld, a lot of the time I would say, “oh wait, that doesn’t count, I knew that one.” But the fact is that there is more than one way to get a question wrong. Most people think of really being “wrong” when they’re totally clueless, but that typically makes up a minority of cases. Many times you will actually know (or tell yourself you “know”) the fact being tested even when you get it wrong in question format. Doing questions means continuing to pair up facts with answers, and it takes time.

One of the difficulties many of my former students had with studying through questions is that getting questions wrong is demoralizing. Again, the bottom line is that when you’re studying over the long term with UW or any qbank, your goal isn’t to get questions right; your goal is to learn. There’s almost as much to learn from the questions you answer correctly as the ones you get wrong.

 

Building the Routine

As you get closer to game day, however, the need for simulation outshines the learning benefit of savoring each question in a pressure-free study session between looking at Instagram stories. Taking several blocks in succession and not being able to check answers or take large breaks is mentally different than normal studying. The difficult questions wear on you, shake your confidence, and, psychologically, it’s hard to maintain peak performance and concentration. What you want is to achieve Flow but what you are is nervous and miserable (even on a practice NBME).

Athletes train in similar circumstances as their competitions so that they don’t get nervous on game day. Wholehearted simulation is key. I am generally a huge proponent of tutor mode, but this does mean that as you get closer to test day you want to fix your habits and strain your test muscles so that the big day is just another day:

Two weeks out at the minimum is when you want to get your sleep and other habits in line, preferably four. But being mindful of your daily practices should start now. In the final two weeks you’ll need to start doing test mode and doing two or three block chunks in a row so that you get used to working long stretches.

Never forget that the real thing can really feel terrible. It’s long and you never get any positive reinforcement. The questions you had to guess on will weigh heavily in your mind. This is all test psychology. How it feels doesn’t actually need to matter; chances are you are doing exactly as well as you normally do, and that’s what you need to tell yourself as you go through the day to make that true.

Remember, the goal is focused nonchalance. Don’t forget: “this test is a poorly constructed hurdle” is a better mindset than “this test determines my future.”

Concussion Protocol

02.02.18 // Miscellany

Shaun King reacting to Josh Begley’s short reverse-highlight reel “Concussion Protocol” in The Intercept:

It’s not a headache. It’s not “getting your bell rung.” You don’t have a bell. It’s a traumatic brain injury.

iPhone X: First Impressions

11.12.17 // Miscellany

Background:

I generally try to spend money deliberately, particularly when it comes to what might be considered “nonessential” purposes. This year that included the iPhone X.

Our son is two and a half, so the main reason I’ve been upgrading my phone annually the past few years is to have the very best smartphone camera possible. My wife has the iPhone 7 and (until last week) I had the 7 Plus. The increased quality of the plus (particularly portrait mode, but also low-light performance and even macro) was so substantial that when we’re out and about we would almost exclusively use my phone for photos. The best camera—the saying goes—is the one you have with you, so the premium to capture my son’s moments has been the primary motivator.

(It’s snowing!)

Also, I like shiny things. And it was also my birthday.

I also do what I imagine is a surprising amount of my writing on my iPhone. I dictated the majority of my second book as well as large portions of my blog posts (including parts of this one) using Siri. I even do a fair amount my typing on the phone directly with my handy Bluetooth keyboard and Ulysses. All in all, I consider having a great phone to be a worthy business expense (obviously, I’m still trying to justify myself).

Design & Screen:

I’m ambivalent about the notch. The speaker, selfie camera, and sensors have to go somewhere. Perhaps one day they can be embedded in the screen, but overall I don’t find it as galling as some reviewers have. My main pet peeve is that so far a lot of apps haven’t been updated to make use of the unusual “ears” or rounded corners on the display. Updated apps will often show the clock on the left and wifi/cell signal/battery indicators on the top. Older apps just pretend all that space isn’t really there leaving a black bar at the top and bottom as if it were the size of a regular iPhone 7/8. Over time this will improve, but I’m not sure how well cross-platform apps or the many apps that are essentially webpage viewers will be able to accommodate the new design.

The new OLED screen is really nice. It’s beautiful, bright, and for some reason, almost a little more paper-like and less fatiguing when reading text on a white background.

Face ID:

Touch ID is better, but Face ID works as advertised (mostly). It works in light and dark, with or with my glasses or even sunglasses. It’s marginally slower than Touch ID but not enough to make a difference in most situations, and the change in notifications mostly makes up for it. Now notifications are private on the unlock screen, only showing the app but not the content/message itself until unlocked by Face ID. Then you can tap the notification to go straight into the app, which is a clever little improvement. Elegant.

My main fail point is when lying down or holding the phone at an exaggerated angle it often won’t engage. I haven’t figured exactly how much face the phone needs to see but my experience has been variable (generally poor) in these situations. Bedtime is not a great time for Face ID. I also had a cold recently and if I coughed or made an odd face while trying to unlock it would also fail (it was a bad cold; this was happening more than you’d expect). Chewing also causes it to fail.

My other irritating corner case pet peeve is that Face ID is terrible for using your phone on a table or desk. With Touch ID, you could keep your phone on the table and unlock it with your index finger, never having to pick it up to look at alerts etc. With the X, you either have to hit the side button and loom over the phone to unlocked it or pick it up.

Camera:

In my limited usage thus far, the main difference for me between the 7 Plus and X has the speed of portrait mode (in addition to the new portrait lighting effects). The problem with fast moving toddlers is that sometimes the lag of portrait mode means losing the best moment by the time the photo is actually taken. It’s almost as fast as a regular photo now, though I have noticed some serious auto-focus glitches with close up portrait mode, which I hope will be resolved soon.

I rarely use the front-facing camera, so I haven’t taken any decent front-facing portrait mode photos yet, though it does work as advertised.

Overall:

I like it. Like every new iPhone I’ve purchased over the past six or so years, the iPhone X is the “best” phone I’ve ever had. But it’s still (just) a magical glass brick. Face ID is still mildly irritating and forces a number of unwelcome behavioral changes, and the bugs are annoying. The X’s design is nice but I think most Apple customers would be better off just sticking with the iPhone 8 Plus for this iteration.