It’s surprising to me that people would question that obesity would have a negative effect on the brain, because it has a negative effect on so many other bodily systems,” he says, adding, “why would the brain be spared?”
– Terry Davidson, director of the Center for Behavioral Neuroscience at American University in Washington, D.C, speaking to NPR about new research concerning obesity’s effects on memory.
These statues are not just stone and metal. They are not just innocent remembrances of a benign history. These monuments purposefully celebrate a fictional, sanitized Confederacy; ignoring the death, ignoring the enslavement, and the terror that it actually stood for.
After the Civil War, these statues were a part of that terrorism as much as a burning cross on someone’s lawn; they were erected purposefully to send a strong message to all who walked in their shadows about who was still in charge in this city.
…
Another friend asked me to consider these four monuments from the perspective of an African American mother or father trying to explain to their fifth-grade daughter who Robert E. Lee is and why he stands atop of our beautiful city. Can you do it?
Can you look into that young girl’s eyes and convince her that Robert E. Lee is there to encourage her? Do you think she will feel inspired and hopeful by that story? Do these monuments help her see a future with limitless potential? Have you ever thought that if her potential is limited, yours and mine are too?
That last line.
Alan Kay on Xerox’s culture back when it was killing it:
A few principles:
1. Visions not goals
2. Fund people not projects — the scientists find the problems not the funders. So, for many reasons, you have to have the best researchers.
3. Problem Finding — not just Problem Solving
4. Milestones not deadlines
5. It’s “baseball” not “golf” — batting .350 is very good in a high aspiration high risk area. Not getting a hit is not failure but the overhead for getting hits.
Doesn’t that sound so healthy and reasonable? Of course, it didn’t last: profit needs and fear can easily trump ingenuity, hard work, teamwork, and progress.
We don’t really fund scientists in the public sector; we fund projects. And outside of politically expedient “moonshots,” we’ve curbed our visions in favor of concrete achievable goals with deadlines.
Charlie Munger about self-improvement and solving problems:
Well the big ideas, I think you should be intelligent in improving yourself. You’re way better to take on a really big important idea that comes up all the time than some little tiny idea that you might not face. I always tried to grab the really big ideas in every discipline. Because, why piddle around with the little ones and ignore the big ones. Just all the big ideas in every discipline are just very, very, very useful. Frequently, the problem in front of you is solvable if you reach outside the discipline you’re in and the idea is just over the fence. But if you’re trained to stay within the fence you just won’t find it. I’ve done that so much in my life it’s almost embarrassing. And it makes me seem arrogant because I will frequently reach into the other fellows discipline and come up with an idea he misses. And when I was young it caused me terrible problems. People hated me. And I probably shouldn’t have been as brash as I was. And I probably wouldn’t be as brash as I am now. I haven’t completed my self-improvement process. But, it’s so much fun to get the right idea a little outside your own profession. So if you’re capable of doing it, by all means learn to do it. Even if you just want to learn it defensively.
I do not observe professional boundaries. My doctor constantly writes, PSA test, prostate specific antigen, and I just cross it out. And he says, ‘What the hell are you doing? Why are you doing this?’ And I say, ‘Well I don’t want to give you an opportunity to do something dumb. If I’ve got an unfixable cancer that’s growing fast in my prostate I’d like to find out 3 months in the future, not right now. And if I got one that’s growing slowly, I don’t want to encourage a doctor to do something dumb and intervene with it. So I just cross it out.’ Most people are not crossing out their doctor’s prescriptions, but I think I know better. I don’t know better about the complex treatments and so forth. But I know it’s unwise for me to have a PSA test. So I just cross it out. I’m always doing that kind of thing. And I recommend it to you when you get my age. Just go cross out that PSA test. Now the women I can’t help.
The famous 93-year-old partner of Warren Buffet probably doesn’t need to be giving medical advice, but he’s clearly still super sharp.
The forgotten half of the 10,000 hours to mastery popularized by Malcolm Gladwell, as argued by Alex Soojung-Kim Pang in Rest (emphasis mine):
“Deliberate practice,” they observed, “is an effortful activity that can be sustained only for a limited time each day.” Practice too little and you never become world-class. Practice too much, though, and you increase the odds of being struck down by injury, draining yourself mentally, or burning out. To succeed, students must “avoid exhaustion” and “limit practice to an amount from which they can completely recover on a daily or weekly basis.”
We should try to remember that we call it practicing medicine for a reason.
When people criticize or respond negatively to me, usually they’re responding to this character that they’re seeing on TV called Barack Obama, or the office of the presidency, or the White House and what that represents. So, you don’t take it personally. You understand that if people are angry that somehow the government is failing, than they are going to look to the guy who represents government.
Barack Obama talking with Ta-Nehisi Coates for The Atlantic.
This is of course not limited to elected officials. Every person can function as a representative of their organization or profession. It happens to doctors every day because healthcare is broken. It can even happen to the CEO of United Airlines.
Von Hippel offers two pieces of wisdom regarding self-deception: “My Machiavellian advice is this is a tool that works,” he says. “If you need to convince somebody of something, if your career or social success depends on persuasion, then the first person who needs to be [convinced] is yourself.” On the defensive side, he says, whenever anyone tries to convince you of something, think about what might be motivating that person. Even if he is not lying to you, he may be deceiving both you and himself.
From “Living a Lie” in Scientific American.
Recent pet peeve, of which many healthcare writers and physicians are guilty: using the incorrect article before an acronym.
Everyone knows that you use “a” before a consonant and “an” before a vowel. What people may not realize is that it’s not the spelling that matters of the following word but its pronunciation. The actual rule is to use “a” before a consonant sound and “an” before a vowel sound.
Correct:
A MICU admission
A HIPPA violation
Also correct:
An MRI
An HIV patient
I know it may look funny, and your word processor may punish you with a colored underline, and Clippy may scoff at you from his digital paper clip grave, but thems the rules.
Amidst desires for simultaneous growth, quality, profit, and patient satisfaction, the delivery of healthcare has gotten more…complicated. But the disconnect between the powers that be and the providers who actually work on the ground has turned work for big hospitals and institutions into something increasingly more like working for a big widget factory.
Spurred by rising costs, healthcare in the US has felt the need to “catch up” with the “best” business practices. Have more meetings. Look at more processes. More management. More managers for the managers we just hired.
A few bits from the intro to the forthcoming book, The Calm Company, on Signal v. Noise, the blog from 37Signals (the company behind the team management software Basecamp):
Work claws away at life. Life has become work’s leftovers. The doggy bag. The remnants. The scraps.
You’d think with all the hours people are putting in, and all the promises of tech’s flavor of the month, the load would be lessening. It’s not. It’s getting heavier.
Technology has been used to add capacity, not to improve workflow. As an example, MyChart is a great tool that allows patients to communicate with clinics and providers without calling repeatedly or making an appointment just for a routine refill or to answer a simple question. But you don’t get paid to answer MyChart messages. They’re added on to your workload. The more you’re willing to meet patients where they are and do things on MyChart, the more unpaid work you do and the more time and energy you lose. That’s a system flaw. This is part of why the average physician spends 1-2 hours at home charting daily. More uncompensated time.
Crazy companies all tend to be especially great at one thing: wasting. Wasting time, attention, money, energy.
The answer isn’t more hours, it’s less bullshit. Less waste, not more production. And far fewer things that induce distraction, always-on anxiety, and stress.
I am routinely impressed at how good healthcare systems are at wasting dollars to save cents. Skimping on cheap patient transporters so that highly paid specialists sit around waiting for the next case to start and then run overtime. Understaffing clinic nurses and MAs, leaving the physicians to deal with more phone triage and data entry. The money in some cases comes from different pots, which sometimes allows departments to seem more profitable or efficient than they really are.
Hospitals make changes like real enterprises do but mostly without the critical reflection to see if process improvements are actually improvements. We tokenize quality through small projects to avoid dealing with foundational infrastructural failures—because those are actually hard.
On-demand is for movies, TV shows, and podcasts, not for you. Your time isn’t an episode recalled when someone wants it at 10pm on a Saturday night, or every few minutes in the collection of conveyor belt chat room conversations you’re supposed to be following all day long.
I actually posted this excerpt once before, but I just finished Paul Kalanithi’s When Breath Becomes Air and was moved anew by his missive to his infant daughter:
When you come to one of the many moments in life when you must give an account of yourself, provide a ledger of what you have been, and done, and meant to the world, do not, I pray, discount that you filled a dying man’s days with a sated joy, a joy unknown to me in all my prior years, a joy that does not hunger for more and more, but rests, satisfied. In this time, right now, that is an enormous thing.
Earlier in the book, in conversations with his oncologist about coming to terms with how to spend his life with cancer, this entreaty comes up multiple times:
Find your values.
In his moving memoir (which doesn’t at all belittle fields like radiology), Kalanithi softly and compellingly argues that this is the key to how you live like you were dying.