Saturday, November 30, 2019

"All truths are easy to understand..."

The scientist Galileo Galilei once said, "All truths are easy to understand once they are discovered; the point is to discover them."  The process of discovery requires, first and foremost, a certain level of intellectual curiosity.  To this end, another scientist, Max Planck, said, "Scientific discovery and scientific knowledge have been achieved only by those who have gone in pursuit of it without any practical purpose whatsoever in view."  In other words, at least according to Galileo and Planck, most major advances in science and technology have come when individuals seek to find new knowledge simply for the sake of learning new things. 

I have talked about Harvard Business School professor, Amy C. Edmondson in a number of previous blog posts.  She is perhaps best known for her work on the concept of psychological safety (see, for example, her most recent book entitled "The Fearless Organization").  What is less known about Dr. Edmondson is her early work as Chief Engineer for the architect and inventor Buckminster Fuller in the early 1980's.  Her first book, in fact, explained some of Fuller's contributions to the world of mathematics, architecture, and design called "A Fuller Explanation: The Synergetic Geometry of R. Buckminster Fuller" in "conventional language" that a lay person could understand.  On a whim, I checked her book out at the local public library and tried to read it.  To be honest, there was little in the book that I could understand, so I never finished it.

My point is this - and it's a point that I have made before on a number of occasions - we should read broadly outside our own individual specialties, if for no other reason than to exercise our brains and stretch the limits of our comprehension.  Imagine having the intellectual brainpower to not only understand a highly technical concept outside of your own discipline, but also to be able to write an entire book on the subject!  Most of us - including me - are a long way from being able to do that.  The important thing is that we continue to learn new things, even if outside our intellectual comfort zones.

With all of this in mind, I'd like to recommend a great book by the mathematician Leonard M. Wapner, called "The Pea and the Sun: A Mathematical Paradox".  Here's another book that I checked out from our public library that discusses another esoteric concept called the "Banach-Tarski Paradox".  Simply stated, the Banach-Tarski Paradox suggests that a solid ball can be broken up into as few as five pieces which can then be assembled back together again to form two equally sized solid balls!  The title of Wapner's book comes from a slightly different version of the Banach-Tarski Paradox that suggests that a small sphere, say a pea, can be cut into five different pieces and reassembled together to form a new, much larger sphere, say the size of the sun! 

It sounds really fantastic, and when I first learned of this paradox, my initial response was "Are you kidding me?!?!"  I won't spoil your fun and explain the paradox any further here.  Wapner does a great job explaining the paradox through brief sketches on the lives of several other famous mathematicians, including Georg Cantor, Kurt Gödel, Paul Cohen, and of course, Stefan Banach and Alfred Tarski.  Read the book and you will also find out about the so-called "Axiom of Choice" and Hilbert's Infinity Hotel.  The book can get heavy in parts, but I really enjoyed it, and I think you will too.

There is almost certain that I will never have an opportunity to use or even talk about the Banach-Tarski Paradox in my own line of work.  That's not the point.  Learning knowledge for knowledge's sake - that is what matters.  Even if you don't end up reading a book about making a sun out of the different pieces of a pea, please take the time to read something that you will likely never use in your professional life.  Just read to learn, and learn just for the sake of knowledge.  Trust me, you will be better for it.

Nothing good comes easy

I was traveling over the Thanksgiving holidays, so last week's post is a little late.  If I execute my plans successfully today, you will get two posts today and one tomorrow!  Yancey Strickler, the writer, entrepreneur, and Co-founder of Kickstarter recently posted a short essay on LinkedIn entitled "This is how long it takes to change the world".  His premise is that change happens very slowly.  Evidence from a number of different disciplines shows that what he calls significant change (which he defines as "significant shifts in values, beliefs, and behavior") takes about 30 years or so.  In other words, it takes the passing of at least one or two generations before significant change really catches on and people abandon "the way we've always done things around here."  Strickler uses two examples to prove his point - the story of Joseph Lister's introduction of the antiseptic method in surgery during the 19th century and the introduction of the 3-point shot in college and professional basketball. 

Strickler closes his essay with a wonderful quote from Amazon's Jeff Bezos that comes from his 2017 letter to Amazon shareholders:

A close friend recently decided to learn to do a perfect free-standing handstand.  No leaning against a wall.  Not for just a few seconds.  Instagram good.  She decided to start her journey by taking a handstand workshop at her yoga studio.  She then practiced for a while but wasn't getting the results she wanted.  So, she hired a handstand coach.  Yes, I know what you're thinking, but evidently this is an actual thing that exists.  In the very first lesson, the coach gave her some wonderful advice. 

"Most people," he said, "think that if they work hard, they should be able to master a handstand in about two weeks.  The reality is that is takes about six months of daily practice.  If you think you should be able to do it in two weeks, you're just going to end up quitting."

Unrealistic beliefs on scope - often hidden and undiscussed - kill high standards.  To achieve high standards yourself or as part of a team, you need to form and proactively communicate realistic beliefs about how hard something is going to be.

The lesson here is pretty clear.  Nothing good comes easy.  Change is hard - even if it doesn't take 30 years, meaningful change doesn't happen overnight.  And it takes hard work, persistence, and commitment.  We've grown accustomed to instant gratification in today's modern world.  The truth is that when it comes to significant, meaningful change, there is no such thing as instant gratification. 

As Strickler points out, "Change creates compound interest: some people changing means more people change.  Change is contagious.  A growing movement can seem to tip in favor of a new idea overnight.  But for the really big changes, "overnight" takes thirty years to arrive."

Sunday, November 24, 2019

“Fifty percent of physicians in the U.S. graduated in the bottom half of their medical school class...”

It's been a little crazy the past several days, so I have taken a brief hiatus from my blog.  I heard a statistic cited the other day by some television news reporter that seemed pretty obvious and maybe even a bit silly.  Apparently, fifty percent of all physicians in the United States graduated in the bottom half of their medical school class.  Really?!?!  I wonder if the television news reporter would be surprised to hear that fifty percent of all physicians in the United States graduated in the top half of their class.  Everywhere you look these days, someone is manipulating statistics to either make a statement or prove some point.  Unfortunately, you have to pay attention carefully so that you don't fall into their trap.

During the 2007 election campaign for New York City Mayor, Rudy Giuliani tried to make a point that his chances of surviving prostate cancer were much better because he lived in the United States rather than in England, which had "socialized medicine."  Giuliani stated, "My chance of surviving prostate cancer - and thank God, I was cured of it - in the United States?  Eighty-two percent.  My chance of surviving prostate cancer in England?  Only 44 percent under socialized medicine."  The New York City Mayor was trying to drive home the point that he was lucky to be living in New York, where his chance of surviving prostate cancer was almost twice as high had he been living in London, England.  The problem with his statement was that it was simply not true

According to Dr. Gerd Gigerenzer, former Director of the Center for Adaptive Behavior and Cognition at the Max Planck Institute for Human Development in Berlin, Germany, journalists and politicians aren't the only ones who misquote statistics.  Many physicians (and their patients) don't understand even the most basic concepts of statistics and probability (for a review, see a great article by Gigerenzer here).  So, where did Mayor Giuliani (and many physicians, journalists, and others too) go wrong with his prostate cancer statement?  Apparently Giuliani used data published in 2000 that showed that 49 British men per 100,000 were diagnosed with prostate cancer.  Of these, 28 men died within 5 years.  Similar published results from the United States showed that 136 American men per 100,000 were diagnosed with prostate cancer in 2000 (the number is higher because more screening is conducted in the U.S. compared to England).  Of these, 26 men died within 5 years.  If you use the statistics to calculate a percent survival at 5 years, you get about 82% survival for American men versus 42% survival for British men.  Unfortunately, this is absolutely incorrect.  You should not use incidence statistics to calculate percentage survival.  Giuliani, like so many journalists, politicians, and (unfortunately) physicians today, massaged the numbers to make a dramatic point.

My point is this.  We would all do well to go back and review some basic principles of statistics and probability.  Armed with this new knowledge of statistics and probability can be a powerful thing.  Now (well, at least learning more about statistics and probability), whenever you hear statistics reported on the television, radio, or Internet, you can take a moment to background check the facts.  Don't fall into the trap by accepting everything you hear.  There's a really good chance that what you hear isn't actually correct.

Thursday, November 14, 2019

"What's in a name?"

Gender equity is an incredibly important issue in health care (and in society at large, of course) today.  For example, there is evidence that (1) female physicians are paid less than male physicians (see "Do we need a National Women Physician's Day?"), (2) female physicians are more likely to be introduced by their first name rather than by "Doctor" and their last name (see "A Life of Privilege - part III", and (3) female physicians are less likely to serve in academic leadership (see a recently published study by my colleagues here).  In addition, one scientific study went so far as to suggest that women don't lead resuscitation teams as effectively as men (see "Do we need a National Women Physician's Day - one year later") because they are "inferior leaders" (a subsequently published study suggested otherwise, see "Word choice matters"). 

Women in health care today are subject to obvious forms of discrimination and prejudice.  For example, the New England Journal of Medicine published a study in the last two weeks that showed that nearly 2/3 of surgical residents in the United States reported discrimination based upon their self-identified gender and almost 20% reported being subjected to sexual harassment.  The women who reported being victims discrimination, abuse, and harassment were much more likely to report symptoms of burnout, depression, and thoughts of suicide.  Clearly we need to do a better job at addressing outright discrimination, prejudice, and harassment in our workplace.  Unfortunately, women are also victim to a less obvious form of gender discrimination known as implicit bias, and addressing this form of bias in the workplace will be more difficult, but undoubtedly equally as important.

If you don't understand what implicit bias is, perhaps I can help.  The aforementioned study looking at gender differences in resuscitation team leadership is a great example.  In this study, the authors suggested that women were more timid, reserved, and less direct compared to men, and as a result, the men made better leaders during the crisis situation of a resuscitation.  There is a widespread misperception that women are more timid and less aggressive than men. 

Just look at hurricanes.  Between 1950 and 2012, there were 94 Atlantic hurricanes that made landfall in the United States.  According to one study, hurricanes with a female name were far more deadlier than those that had a male name.  Consider that the selection of hurricane names are determined in advance before the start of the hurricane season.  If hurricanes with female names are deadlier than those with male names, this has occurred completely by chance (even when you factor in that US hurricanes were only given female names up until the 1970's), even after removing two of the most deadly hurricanes in American history, Hurricane Katrina (1,833 deaths in 2005) and Hurricane Audrey (416 deaths in 1957), which were both female names! 

Why are female hurricanes deadlier than male hurricanes (notably, the statistical analysis used in the study was somewhat controversial)?  The study investigators suggested that the reason has to do with the fact that men and women have different stereotypes.  Men are expected to be strong, competent, and aggressive, whereas women are expected to be timid, passive, and nice.  Multiple experiments conducted by the study investigators suggested that feminine- versus masculine-named hurricanes are perceived as less risky.  In other words, the general public associates male hurricanes with being more violent and dangerous than female hurricanes, so they are more likely to seek shelter or evacuate.  However, when a female hurricane comes along, the general public is less likely to take shelter or evacuate.  The risk of death is therefore increased due to greater exposure to the hurricane itself.

I hope you get my point.  I suspect that if you asked most of the individuals participating in the series of experiments in the hurricane study, they probably wouldn't think that they were biased in any way towards feminine-sounding hurricanes.  The fact remains, we likely are all subject to this kind of implicit bias.  How can we combat this form of bias?  It starts with the simple recognition that it exists.  "What's in a name" turns out to be more important than we think.

Sunday, November 10, 2019

"The last full measure of devotion"

I checked out a book the other day on the recommendation of a mentor, colleague, and friend. It’s called “Sacred Duty: A Soldier’s Tour at Arlington National Cemetery” and was written by U.S. Senator Tom Cotton. I am just getting started, but so far I would have to say that it’s an incredible read. If the rest of the book continues how it has started, I would highly recommend it. The book talks about the United States Army’s 3rd Infantry Regiment, “The Old Guard” which has been around since 1784 (it’s the oldest active-duty infantry regiment in the Army).  I've previously written about their story in my post "I raised a flag today".  The “Old Guard” is responsible for conducting all of the funerals at Arlington National Cemetery and guarding the Tombs of the Unknown Soldier. They are also responsible for guarding the White House. 

In the preface to the book, Cotton writes, “The Old Guard represents to the public what is best in our military, which itself represents what is best in us as a nation.” I fully understand that the military has had its share of problems over the years. Those of us who have served in uniform would be the first to admit that fact. However, whatever you may think about the military, there is something truly inspirational and powerful in the heart of a volunteer. There’s an old saying, I am not sure where it comes from or who said it, but it states, “The heart of a volunteer is not measured in size, but by the depth of the commitment to make a difference in the lives of others.” I can’t imagine any commitment being more profound than one that could very well require an individual to give “the last full measure of devotion.”

As President Lincoln said in his Gettysburg Address, “It is for us the living, rather, to be dedicated here to the unfinished work which they who fought here have thus far so nobly advanced…that we here highly resolve that these dead shall not have died in vain – that this nation, under God, shall have a new birth of freedom – and that government of the people, by the people, for the people, shall not perish from the earth.”

We have a lot to be thankful for today. We also have a lot of work before us. But tomorrow, November 11th, I hope that you will take the time to reflect on what it means to be an American, what it means to love your country, and what it means to be a patriot. And I hope you take the time to thank a veteran. For their service, for their commitment, for their courage. But most of all, for their love of country and dedication to make a difference in the lives of others.

Happy Veteran's Day to all who have served and continue to serve.  God Bless You.

Thursday, November 7, 2019

"The 7 C's of Success"

I think I've mentioned in the past that I subscribe to Ryan Holiday's daily blog post, "The Daily Stoic."  I don't like to copy other blog posts, but this one was really good.  The author, philosopher, and motivational speaker, Tom Morris was recently interviewed by Holiday, and he referred to something that he has called the "7 C's of Success."  Morris adapted them from the Stoic philosophers, Seneca and Marcus Aurelius.  Here they are for your consumption:

1. A clear CONCEPTION of what we want, a vivid vision, a goal clearly imagined.
2. A strong CONFIDENCE that we can attain that goal.
3. A focused CONCENTRATION on what it takes to reach our goal.
4. A stubborn CONSISTENCY in pursuing our vision.
5. An emotional COMMITMENT to the importance of what we're doing.
6. A good CHARACTER to guide us and keep us on a proper course.
7. A CAPACITY TO ENJOY the process along the way.

Not too bad, right?  It doesn't matter what you are trying to accomplish in your life, either personally or professionally.  These are the keys to success.  Success starts with a vision and a goal.  Commitment and hard work are absolutely crucial to achieve that goal.  Moral character will keep you focused on that goal and not on things that will distract you from achieving that goal.  And finally, having some fun while working hard is always a great thing.

Sunday, November 3, 2019

"Cool Runnings"

Imagine, if you will, what would happen if a group of athletes from a tropical island in the Caribbean Sea attempted to qualify for the Olympics in a sport that is usually only played during the winter season.  Well, this is actually what happened with the 1988 Jamaican bobsleigh team, which was the subject of the 1983 comedy film, "Cool Runnings" starring the late John Candy.  The film, like most movies, is largely fictionalized account of what actually happened at the 1988 Winter Olympics.  The team was recruited from the Jamaican Army and had no previous experience in the sport.  They did actually qualify for the 1988 Winter Olympics in the four-man bobsled event in Calgary, Alberta.  The team did not officially finish, as they lost control and crashed during their final run.  However, it was a great story and a great movie!


The story of the Jamaican bobsleigh team definitely violates all the major arguments in K. Anders Ericsson's theory of "deliberate practice" and the so-called "10,000 hour rule" popularized by the author Malcolm Gladwell in his book, Outliers.  Basically, Ericsson's "theory of deliberate practice" and Gladwell's "10,000 hour rule" suggest that the only way to develop deep expertise in something - say Olympic bobsledding - is through years and years of practice.  According to this line of thinking, the best way to develop Olympic caliber talent in a sport is to identify athletes early in their lives (i.e., when they are children) and have them focus on just that particular sport.  Based on this argument, there is no way that a bobsledding team from Jamaica could have ever qualified for the Winter Olympics.  They didn't have nearly enough experience.


Of course, there is a different theory as well.  As I have previously discussed, David Epstein wrote a fantastic book called Range: Why Generalists Triumph in a Specialized World that provides evidence completely counter to Ericsson's and Gladwell's argument.  As this line of evidence would recommend, the best way to develop deep expertise is to develop general skills and abilities and then specialize later in life in one particular area (see my previous post, "Be like the Renaissance").


There are other examples in the sports science literature that suggest that "late specialization" as discussed in Epstein's book is the absolute best approach.  For example, an unpublished retrospective review of Australian senior national athletes (the "best of the best") showed that 28% attained elite status within just 4 years of participating in their sport for the first time!  On average, these elite athletes had participated in three sports before ultimately deciding to focus on just one sport.  Based partly on these results, the Australian Institute of Sport (AIS) subsequently identified a small group of female athletes from sports  such as track (sprinters), surf life saving, and short track speed skating.  Just 14 months later, one of these athletes qualified for the Winter Olympics in the sport of skeleton.


These examples of so-called "late specialization" don't necessarily disprove the theory of deliberate practice.  Rather, the AIS example suggests that "deliberate practice" is simply a subset of something called "deliberate programming."  Here, athletes with innate talent (these athletes excelled in their previous sports) are identified from a greater pool of athletes and then undergo focused training ("late specialization") with access to high-quality coaches, trainers, and equipment.  In other words, identify athletes with generalized skills and talent and then expose them to intensive training and elite-level competitions, which is very similar to deliberate practice!


These are fascinating studies which certainly raise a lot of fascinating questions.  I can think of a few that are relevant to leadership.  Is it better that leaders have general knowledge in a wide range of areas ("mile wide, inch deep") and disciplines with significant managerial and leadership training and experience?  Or should leaders have deep technical knowledge and expertise ("mile deep, inch wide") in a particular focus area before entering management?  So far, I don't these questions have been definitively answered.  It's a great discussion - which side are you on?