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A Glimpse at the Coming Metaverse

11.05.21 // Miscellany

Ben Thompson of Stratechery talking about why he’s becoming more bullish on virtual reality than augmented reality during an interview with Mark Zuckerberg about the Metaverse:

I do have to say, the last couple of years, particularly the COVID era, has changed my perspective a little bit as there does seem to be more and more of sort of a bifurcation between your online reality and your offline reality. It’s something I wrote about in the context of work, where people call it working from home, but I actually think that’s a misnomer: it’s actually working online, and you can work online from anywhere but when you go online, you’re in a different place cognitively speaking than you are when you’re at home or playing with your kids, or you’re seeing your friends or whatever it might be.

I get to work from home sometimes, but I think there is a key nuance here. One of the hardest things about working online from home is that the people around you don’t want or feel like you are somewhere else, cognitively speaking. Frankly, getting to that other cognitive place in the first place can be quite difficult when surrounded by the context of all the non-work things around you.

Does a future where you can slip further into the internet make it easier or harder to be productive online?

Well, it depends on how you define productivity. In the interview, Zuckerberg claims that fostering human connection is his life’s work. He then goes on to freely admit that ruining meaningful unadulterated human connection is a “killer use case”:

Although I do think that for augmented reality, for example, one of the killer use cases is basically going to be you’re going to have glasses and you’re going to have something like EMG on your wrist and you’re going to be able to have a message thread going on when you’re in the middle of a meeting or doing something else and no one else is even going to notice. Think about what we’ve had over the last couple of years during the pandemic where everyone’s been on Zoom, and one of the things that I’ve found very productive is you can have side channel conversations or chat threads going while you’re having the main meeting. I actually think that would be a pretty useful thing to be able to have in real life too where basically you’re having a physical conversation or you’re coming together, but you can also receive incoming messages without having to take out your phone or look at your watch and even respond quickly in a way that’s discreet and private. So I think that there are going to be those use cases. I think that there are going to be easier ways to get in and out of experiences where you’re experiencing that deep sense of presence.

The problem with social media on cell phones is that your kids, friends, and colleagues know you are being rude and self-absorbed when you ignore them. The problem—of course!—is not the behavior and our inability to be fully present in our interactions. The problem is being so transparent in informing others that they are insufficiently interesting to hold our full attention.

This is the promise of the coming metaverse.

Driving at Stable

09.23.21 // Medicine, Miscellany

A classic Jeff Bezos quotation:

I very frequently get the question: “What’s going to change in the next 10 years?” That’s a very interesting question.

I almost never get the question: “What’s not going to change in the next 10 years?” And I submit to you that that second question is actually the more important of the two.

You can build a business strategy around the things that are stable in time. In our retail business, we know that customers want low prices, and I know that’s going to be true 10 years from now. They want fast delivery; they want vast selection. It’s impossible to imagine a future 10 years from now where a customer comes up and says, “Jeff I love Amazon, I just wish the prices were a little higher.” Or, “I love Amazon, I just wish you’d deliver a little slower.” Impossible.

So we know the energy we put into these things today will still be paying off dividends for our customers 10 years from now. When you have something that you know is true, even over the long term, you can afford to put a lot of energy into it.”

I recently attended a “leadership” seminar about (radiology) healthcare ecosystems and change. As with all virtual events since early 2020, discussion of the Covid-19 pandemic played an outsized role, and the nature of complexity and change were much pontificated about.

But no one over the course of two days—no one—mentioned the stability of the core mission. The strategic analyses—such as explicit or implicit utilization of SWOT—were happy to focus on anticipation and interception of perceived changes and threats, but no one spared a breath for what they thought wouldn’t change. We talked about trends in corporatization and productivity metrics, group consolidation, encroachment by midlevels and other specialties, downward reimbursement pressure, the push for 24/7 subspecialty staff coverage, lifestyle and burnout, and AI and data science.

To be sure, these and all other big changes are important, but you also can’t lose sight of the underlying purpose of the business in all the pivoting.

What can we say about medicine that is not going to change in 10 years? What is our stability north star?

(Yes this is a rhetorical question cop-out.)

 

The Stress Heuristic

09.09.21 // Miscellany

Cal Newport, author of the beloved Deep Work (among others), writing in The New Yorker.

…most workers who are fortunate enough to exert some control over their efforts—such as knowledge workers and small-business entrepreneurs—tend to avoid working way too much, but also tend to avoid working a reasonable amount. They instead exist in a liminal zone: a place where they toil, say, for the sake of fixing a specific number, twenty percent more than they really have time for. This extra twenty percent provides just enough overload to generate persistent stress—there’s always something that’s late, always a message that can’t wait until the next morning, always a nagging sense of irresponsibility during any moment of downtime. Yet the work remains below a level of unsustainable pain that would force a change.

…

If you’re a professor, or a mid-level executive, or a freelance consultant, you don’t have a supervisor handing you a detailed work order for the day. Instead, you’re likely bombarded with requests and questions and opportunities and invites that you try your best to triage. How do you decide when to say no? In the modern office context, stress has become a default heuristic. If you turn down a Zoom-meeting invitation, there’s a social-capital cost, as you’re causing some mild harm to a colleague and potentially signaling yourself to be uncoöperative or a loafer. But, if you feel sufficiently stressed about your workload, this cost might become acceptable: you feel confident that you are “busy,” and this provides psychological cover to skip the Zoom. The problem with the stress heuristic is that it doesn’t start reducing your workload until you already have too much to do. Like Parkinson’s naval bureaucracy, which expanded at a regular rate regardless of the size of the Navy, this stress-based self-regulation scheme ensures that you remain moderately overloaded regardless of how much work is actually pressing.

“The Stress Heuristic” is a great term for people’s default strategy for avoiding more work: being literally too busy for more work.

But while saying ‘no’ is easiest when saying ‘yes’ is impossible, it forces you to live without margin. And margin—space in your life for yourself, serendipity, and the chance to chase down things of interest—is where the magic happens.

Even for academics, consider the words of psychologist Amos Tversky (whose work with Daniel Kahneman yielded the Nobel-prize-winning Prospect Theory and the crazy popular book Thinking, Fast and Slow): “The secret to doing good research is always to be a little underemployed. You waste years by not being able to waste hours.”

Writing Makes It “True”

08.30.21 // Miscellany, Writing

From “How to Leverage Language to Cultivate Your Creative Process” by Nicole He in Killscreen.

I had a concept in my mind—maybe I felt it emotionally, I had a feeling about what this thing is supposed to represent. Now what I’m saying makes it real. After that, I started responding to journalists the next morning. What blew my mind was this: the thing I wrote about my project became true about the project. Many of the things I would say, the lazier journalists would just copy and paste. Weirdly, seeing my own ideas in the media suddenly made them even more true—things about a project being about intimacy, about computers knowing more than we know about ourselves. All of this became true, because someone else was saying things about my project, but based on what I had said about my project.

There’s a lot to be said for putting in the effort of distilling a vague idea into a clear concept and writing it down (and, yes, maybe even sharing it). Not just for a specific project, but for you and your whole career.

There is power in storytelling, both internally and externally.

And, perhaps weirdest of all is that—on the whole—you get to define your own narrative.

Semiannual Social Media is Terrible PSA

07.08.21 // Miscellany

Here’s a little exercise adapted from “You Really Need to Quit Twitter” in The Atlantic:

Step 1: Take the Simone Weil essay  “On the Abolition of All Political Parties” and replace the word “parties” with something that maybe shouldn’t exist, like social media:

The mere fact that social media exists today is not in itself sufficient a reason for us to preserve it. The only legitimate reason for preserving anything is its goodness. The evils of social media are all too evident; therefore, the problem that should be examined is this: Does it contain enough good to compensate for its evils and make its preservation desirable?

Step 2: (Oh well I still have my Twitter account).

The Limitations of Copy and Paste

06.17.21 // Medicine, Miscellany

From “To Kickstart a New Behavior, Copy and Paste” by Kathy Milkman, author of the new book, How to Change, which suggests the best way to master a new skill is to emulate the methods of someone successful.

Happily, it’s easy to turn yourself into a deliberate copy-and-paster. The next time you’re falling short of a goal, look to high-achieving peers for answers. If you’d like to get more sleep, a well-rested friend with a similar lifestyle may be able to help. If you’d like to commute on public transit, don’t just look up the train schedules—talk to a neighbor who’s already abandoned her car. You’re likely to go further faster if you find the person who’s already achieving what you want to achieve and copy and paste their tactics than if you simply let social forces influence you through osmosis.

Kinda maybe sorta.

There is a big, big difference between emulating psychosocial habits (like vegetarianism or fashion) or noncomplex skills (like a workable commute route or some forms of regular exercise) and achieving success in a skill-based habit like practicing medicine or playing an instrument.

For low-stakes or low-commitment behaviors, sure. It’s reasonable to try to save time and give yourself the boost of something that has worked for someone. Copy-paste saves you from analysis paralysis.

But copy and paste is also a guaranteed way to fully embrace survivorship bias. You don’t know if the people you are emulating succeeded because of their methods or despite them. You don’t know if those methods are optimal for you or if the most important aspects of said methods are even those which are externally visible or consciously retrievable from the expert.

A lot of people don’t know why they’re successful, and their attempts to craft a narrative about their successes are fiction.

And when it comes to experts instead of peers, one of the common difficulties for many is that it’s been so long since they’ve been a novice that they literally don’t know what it’s like anymore. Their memories of their early growth are fuzzy and often out-of-date to boot.

As we are back in the middle of USMLE Step season for the medical students among you, I am reminded of this post I wrote in 2014 about the Methods to Success Fallacy.

Underwriting is Noisy

05.18.21 // Miscellany

An example a brief essay “Bias Is a Big Problem. But So Is ‘Noise.” about noise and decision-making in the NYT by Daniel Kahneman and his co-authors in support of their new book Noise: A Flaw in Human Judgement:

Consider another noisy system, this time in the private sector. In 2015, we conducted a study of underwriters in a large insurance company. Forty-eight underwriters were shown realistic summaries of risks to which they assigned premiums, just as they did in their jobs.

How much of a difference would you expect to find between the premium values that two competent underwriters assigned to the same risk? Executives in the insurance company said they expected about a 10 percent difference. But the typical difference we found between two underwriters was an astonishing 55 percent of their average premium—more than five times as large as the executives had expected.

This is why you don’t buy an insurance policy from a captive agent; you purchase through an independent agent who can get quotes from multiple companies. Every decision is subject to bias and noise, and they are separate and independent problems (i.e. both inaccurate and imprecise).

The easiest way to push both in your favor is through multiple independent attempts.

Student loan debt predicts burnout

05.14.21 // Miscellany, Radiology

From “Predictors Between the Subcomponents of Burnout Among Radiology Trainees” by Le et al. in JACR.

 

 

In summary:

Debt level < $200,000 was associated with lower [emotional exhaustion] scores among upper-level trainees and was the only predictor of burnout that significantly affected multiple years of training.

I suspect there is a dose-response above that debt level as well.

Uncertainty breeds despair. Make sure you develop a student loan action plan.

Regulatory controls and not-so-free markets

04.26.21 // Miscellany

Not just doctors but all sorts of students and professionals scrambled to figure out how to deal with their high-stakes exam during the pandemic. Lawyers were no exception. Some states had new lawyers take the bar remotely. But a few states just got rid of it altogether and allowed diplomas from accredited schools to stand on their own.

NPR’s Planet Money, “Most People Can’t Afford Legal Help. 1 Reformer Wants To Change That” is an interesting quick discussion of slowly changing legal regulations that has plenty of parallels with medicine:

The National Conference of Bar Examiners, which helps states administer the bar, argues that the bar remains important in protecting the public. “Every high-stakes profession, including engineering, medicine, aviation, and others, relies on licensure to ensure that practitioners meet minimum standards of fundamental competency, and the practice of law is no exception,” the organization said in a statement.

But Gillian Hadfield, a law professor and economist at the University of Toronto, argues there’s no evidence that the bar actually protects the public. She thinks not only it is time we reevaluate use of the bar exam — it’s time to completely revamp how we regulate the practice of law in the United States.

The bar exam, she says, is one part of a broader system that raises the cost of legal services and contributes to an “access to justice crisis” in the United States. “My estimate is well over 80% of Americans who need legal help can’t get it because it’s too expensive,” Hadfield says. “And the main reason for that is a crazy regulatory system. The bar exam is part of that.”

…

It’s kinda like cafe baristas getting control of the coffee market by using the regulatory system to prevent restaurants, Keurig machines, and gas stations from providing you coffee. They’re like, “It’s for your safety! You could get burned or poisoned! The coffee will be worse!” Meanwhile, a cup of coffee costs $20.

The Support Page

01.24.21 // Miscellany

It’s one of those things I probably should have done around a decade ago, but last week I put up a “support” page. As I don’t run any ads and the vast majority of my writing is unmonetized, this site is largely a labor of love (and I’m happy with that).

But…

I also talk to enough folks who want to support my efforts that it’s silly for me to make that challenging.

So while the page does include a way to directly send me money, it’s mostly a collection of the active affiliate arrangements I have, which are easy ways to get someone else (Amazon, educational products, physician survey companies, etc) to provide me with financial support at no cost to you if/when such things meet your needs (and usually with a reader discount).

Also, please feel free to ignore it entirely.

Regardless, I will continue to accept virtual high fives, which remain my primary currency.

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