Efficient Communication Saves Lives…

While many medical professionals spend their days juggling patients and insurance companies (and more!), they are also expected to keep up with the latest research. Research that might save lives and improve quality of lives are obviously important, but what about the integration of new or novel data?

Change in the medical world takes years. Possibly decades. This passage from Atul Gawande’s The Checklist Manifesto speaks to the difficulty and delay in adoption of new or novel data derived from research:

     Sometimes, though, failures are investigated. We learn better ways of doing things. And then what happens? Well, the findings might turn up in a course or seminar, or they might make it into a professional journal or a textbook. In ideal circumstances, we issue some inch-thick set of guidelines or a declaration of standards. But getting the word out is far from assured, and incorporating the changes often takes years.

One Study in medicine, for example, examined the aftermath of nine different major treatment discoveries such as the finding that the pneumococus vaccine protects not only children but also adults from respiratory infections, one of our most common killers. On average, the study reported, it took doctors SEVENTEEN YEARS to adopt the new treatments for at least half of American patients.

What experts like Dan Boorman have recognized is that the reason for the delay is not usually laziness or unwillingness. The reason is more often that the necessary knowledge has not been translated into a simple, usable, and systematic form. If the only thing people did in aviation was issue dense, pages-long bulletins for every new finding that might affect the safe operation of airplanes – well, it would be like subjecting pilots to the same data deluge of almost 700,000 medical journal articles per year that clinicians must contend with. The information would be unmanageable.

(Emphasis mine)

While we cannot deny the importance of medical research, it is just as (maybe even more) important that the information is structured into an actionable architecture for efficient practicality.

@Cinema_Air

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On Complaining, Pain, and What to NOT Focus On…

The following excerpt from The Tim Ferriss Show where Tim interviews Tracy DiNunzio is fantastic!

Tracy DiNunzio: Yeah, I tried like complaining and being bitter. It didn’t
work. It was just terrible and I was definitely bitter. I
definitely went through my ups and downs. Okay, so
Stephen Hawking actually has the best quote on this and
also the best like legitimate story of, you know, has the
right to complain probably more than anybody. He says
that when you complain nobody wants to help you and it’s
like the simplest thing and so plainly spoken. Only he
could really say that brutal honest truth, but it’s true, right?

If you spend your time focusing on the things that are
wrong and then that’s what you express and you
projection to people you know, you don’t become a
source of growth for people, you become a source of
destruction for people. That draws like more
destructiveness. I think that because that was how it felt
for me when I was thinking about how I was in pain and
talking about how I was in pain, it started a momentum
that went in a negative direction in my life. At one point, I
would say, I don’t know, probably in like 2006-2007, I just

decided to, it’s kind of like Tim Ferriss challenge, but I
didn’t know you then. But, I put myself on like almost a
complaining diet, where I said like, “Not only am I not
going to say anything negative about the situation I’m in,
but I’m not going to let myself think anything negative
about it.” This coincided with, I had lost feeling in my feet
because of the surgeries, so I don’t have any feeling in
my feet, so I have to keep my eyes open when I walk.

At the time, I was reading about how plastic the brain is
when it comes to filling in the gaps where you’re losing
information and starting to understand just scientifically
how plastic the brain is, I thought, “Well, I refuse to have
negative thought and I only let myself have a positive
thought, eventually that’s going to change my brain, I
don’t know how long it’s going to take thought.” It took a
long time and I wasn’t perfect at it, but I definitely feel like
… Not only did replacing those thoughts helped me start
moving my life in a better direction, where I wasn’t
obsessing about what was wrong and I was just thinking
about what was right, it also made me not feel physical
pain as much, which is very liberating and kind of
necessary if you want to do anything because if you’re in
pain, it’s really hard to do anything else but feel it.

You know probably more about this than I do the way that
the body processes pain and how pain is in a way just a
thought. Yeah, I did this experiment where I tried to
control my thoughts for some time. It just started things in
the right direction. It doesn’t mean that everything is
always good. I definitely have days where I am still like,
“This sucks, I wish I just had like normal feet and could
go, run around and not think about all the little things that

I have to think about.” But for the most part, I just don’t
think about it anymore.

Pair the Interview with this blog post by Tim: The 21-day No Complaint Experiment

@Cinema_Air

My Morning Routine

This is something that has interested me for at least the last year. How can I optimize my day so that I feel productive by the end of the day?

Morning rituals have been a popular topic in the last year or so, and it was my first exploration. I’ve found my preferred waking time lies around 2 hours before I have to leave the house. What I choose to do with these 2 hours is, essentially, my morning routine. The following is a list of my attempts to fill these 2 hours in order to optimize my day starting from when I first wake up.

1. Block off the internet. This was my first attempt at altering my morning routine. At face value it is seems very simple, but in practice it can get a bit tricky. Here’s the rule: no social media, email, or internet before 10AM.

2. Read or Write. The first 30-45min might just be the best time to work on that book you wanted to start (or finish). You could also spend this time exercising your idea muscle by trying to come up with 10 new ideas every morning. This, just like everything, else is hardest at first, but after a few days or a couple weeks you’ll be surprised at the connections you can make. If 10 new ideas are too much, then do not settle for less than 5.

3. Liquids. There’s something about rituals that provide a sense of structure and framework to think (about anything). This isn’t new to you; in fact, you probably do this already. What do you do when you’re stressed? Exercise? Sleep? Watch TV? Grab that pint of ice cream? These are routines that you’ve created for yourself without intentionally fostering an end result. So why not create a routine intentionally? A morning routine of making tea or coffee, or simply making breakfast fits the bill.

4. Shower. Not everyone prefers morning showers, but if you are, then consider the James Bond shower. This just involves taking your usual warm/hot shower, followed by a minute or two of cold shower. How cold? As cold as you can tolerate. Ease into it. You’ll be more awake than you thought you could be at this hour of the day.

5. Clothes. Will-power is limited. Minimize decision-making in the morning by doing one of two things: 1. wear the same clothes every day (like a uniform), or 2. decide what you’re going to wear before you go to bed. This step should not involve having to decide which shirt, socks, shoes, etc. to put on in the morning.

Mea Culpa: I haven’t stuck to this 5 step routine as consistently as I hoped I would, but I can say that having some routine puts your day on the right track from the start. You might include other activities in your routine; maybe running, exercise, yoga, meditation. Whatever you chose, it should probably be something that you want to do in order to become the person you’ve always wanted to become.

What’s your morning routine?

@Cinema_Air

Deliberate Practice

Michael Mauboussin (from Think Twice) on Deliberate Practice:

Let me emphasize one point. I suggested that people become experts by using deliberate practice to train their experiential systems. Deliberate practice has a very specific meaning: it includes activities designed to improve performance, has repeatable tasks, incorporates high-quality feedback, and is not much fun. Most people – even alleged experts – do not come close to satisfying the conditions of deliberate practice and, accordingly, do not develop the necessary abilities for reliable intuition.

@Cinema_Air

The Inside-Outside View to Better Decision-making

Decision-making isn’t always the easiest thing in the world. While many errors may seem obvious in hindsight, they’re rarely as crystal clear during the decision-making process. Even worse, we have a tough time imagining the opposing view. As Michael Mauboussin states in his book Think Twice, we have “a tendency to favor the inside view over the outside view.” He goes on to explain,

An inside view considers a problem by focusing on the specific task and by using information that is close at hand, and makes predictions based on that narrow and uniques set of inputs. These inputs may include anecdotal evidence and fallacious perceptions. This is the approach that most people use in building models of the future and is indeed common for all forms of planning.

Compare that with The Outside View:

The outside view asks if there are similar situations that can provide a statistical basis for making a decision. Rather than seeing a problem as unique, the outside view wants to know if others have faced comparable problems and, if so, what happened. The outside view is an unnatural way to think, precisely because it forces people to set aside all the cherished information they have gathered…. The outside view can often create a very valuable reality check for decision makers.

He goes on to list three illusions that lead one to the inside view: the Illusion of Superiority (I’m better than them), the Illusion of Optimism (that’ll never happen to me), and the Illusion of Control (I can make this happen). Obvious question: “How can we get better at adopting The Outside View?”

Mauboussin pulls from Kahneman and Tversky, and distills their 5 step process into 4 steps.

  1. Select a reference class: “Find a group of situations, or a reference class, that is broad enough to be statistically significant but narrow enough to be useful in analyzing the decision that you face. The task is generally as much art as science, and is certainly trickier for problems that few people have dealt with before. But for decisions that are common – even if they are not common for you – identifying a reference class is straightforward.”
  2. Assess the distribution of outcomes: “Once you have a reference class, take a close look at the rate of success and failure…. Two other issues worth mentioning. The statistical rate of success and failure must be reasonably stable over time for a reference class to be valid. If the properties of the system change, drawing inference from past data can be misleading…. Also keep an eye out for systems where small perturbations can lead to large-scale change. Since cause and effect are difficult to pin down in these systems, drawing on past experiences is more difficult.”
  3. Make a prediction: “With the data from your reference class in had, including an awareness of the distribution of outcomes, you are in a position to make a forecast. The idea is to estimate you chances of success and failure…. Sometimes when you find the right reference class, you can see the success rate is not very high. So to improve your chance of success, you have to do something different that everyone else.”
  4. Assess the reliability of your prediction and fine-tune: “How good we are at making decisions depends  a great deal on what we are trying to predict. Weather forecasters, for instance, do a pretty good job of predicting what the temperature will be tomorrow. Book publishers, on the other hand, are poor at picking winners, with the exception of those books from a handful of best-selling authors. The worse the record of successful prediction is, the more you should adjust your prediction toward the mean (or other relevant statistical measure). When cause and effect is clear, you can have more confidence in your forecast.”

The more probabilistic the context, the better these step will work. Now you know how to take The Outside View to increase the odds of a better decision.

The main lesson from the inside-outside view is that while decision makers tend to dwell on uniqueness, the best decisions often derive from sameness. – Mauboussin

— @Cinema_Air