medical residency

43 results back to index

pages: 52 words: 16,113

The Laws of Medicine: Field Notes From an Uncertain Science by Siddhartha Mukherjee


Atul Gawande, cognitive dissonance, medical residency, randomized controlled trial, retrograde motion, stem cell

In my recollection, I also read only one book that year—a slim paperback collection of essays titled The Youngest Science—but I read it as if it were a thousand books. It became one of the most profound influences on my life in medicine. .... The Youngest Science was subtitled Notes of a Medicine-Watcher and was about a medical residency in another age. Written by the physician, scientist, author, and occasional poet Lewis Thomas, it describes his tenure as a medical resident and intern in the 1930s. In 1937, having graduated from Harvard Medical School, Thomas began his internship at Boston City Hospital. It was a grueling initiation. “Rewarding might be the wrong word for it, for the salary was no money at all,” Thomas wrote. “A bedroom, board, and the laundering of one’s white uniform were provided by the hospital; the hours of work were all day, every day. . . .

In Harry Potter, that philosophical treatise disguised as a children’s book, a teacher of wizardry asks Hermione Granger, the young witch-in-training, whether she wishes to learn the Magical Laws to pursue a career in magic. “No,” says Granger. She wishes to learn the laws so that she can do some good in the world. For Granger, magical laws do not exist to perpetuate magic. They exist as tools to interpret the world. .... In the winter of 2000, during the first year of my medical residency, I lived in a one-room apartment facing a park, a few steps from the train station at Harvard Square. Lived is a euphemism. I was on call every third night at the hospital—awake the whole night, admitting patients to the medical wards, writing notes, performing procedures, or caring for the acutely ill in intensive care units. The next day—postcall—was usually spent in a dull haze on my futon, catching up on lost sleep.

Living creatures must, of course, obey the fundamental rules of physics and chemistry, but life often exists on the margins and in the interstices of these laws, bending them to their near-breaking limit. Even the elephant cannot violate the laws of thermodynamics—although its trunk, surely, must rank as one of the most peculiar means to move matter using energy. But does the “youngest science” have laws? It seems like an odd preoccupation now, but I spent much of my medical residency seeking the laws of medicine. The criteria were simple: a “law” had to distill some universal guiding principle of medicine into a statement of truth. The law could not be borrowed from biology or chemistry; it had to be specific to the practice of medicine. In 1978, in a mordantly acerbic book called The House of God, the writer Samuel Shem had proposed “thirteen laws of medicine” (an example: “Law 12: if the radiology resident and the intern both see a lesion on an X-ray, then the lesion cannot be there”).


pages: 282 words: 80,907

Who Gets What — and Why: The New Economics of Matchmaking and Market Design by Alvin E. Roth


Affordable Care Act / Obamacare, Airbnb, algorithmic trading, barriers to entry, Berlin Wall, bitcoin, Build a better mousetrap, centralized clearinghouse, computer age, crowdsourcing, deferred acceptance, desegregation, experimental economics, first-price auction, Flash crash, High speed trading, income inequality, Internet of things, invention of agriculture, invisible hand, Jean Tirole, law of one price, Lyft, market clearing, market design, medical residency, obamacare, proxy bid, road to serfdom, school choice, sealed-bid auction, second-price auction, second-price sealed-bid, Silicon Valley, spectrum auction, Spread Networks laid a new fibre optics cable between New York and Chicago, Steve Jobs, The Wealth of Nations by Adam Smith, two-sided market

Let’s just say they are doctors who look after your digestive system, and after you turn fifty, you’re supposed to visit them so they can look for early signs of colon cancer. To become a gastroenterologist, a doctor must participate in what’s called a fellowship, which takes place following his first job, or residency, after graduating from medical school. The market for medical residencies was the first unraveled market I studied. Today that market is no longer unraveled, and new doctors are matched to residencies during their last year of medical school, in a market that is thick, uncongested, and safe. (I’ll tell that story in chapter 8.) The medical residency that future gastroenterologists must complete is in the field of internal medicine and takes three years. So gastroenterology fellows could, in theory, be hired after they have three years of medical experience. Unfortunately, the unraveling of the fellowship market caused that hiring to creep back earlier and earlier, until first-year residents sometimes found themselves being interviewed for jobs that they might begin two years in the future.

See also regulation cheating and, 93–98 for college bowl games, 60–65 for judicial clerkships, 92–96 unraveling markets and, 68 Rural Hospitals Theorem, 149–50 safety of market participation, 11, 113–30 in auctions, 182–84, 186–87 clearinghouses and, 112 credit cards in, 23 early transactions and, 60–80 in gastroenterology fellowships, 76–78 information sharing and, 122–28 in Boston Public Schools, 122–28 in clearinghouses, 112 for kidney exchanges, 34, 36, 37, 47–49 market efficiency and, 119–21 for medical residencies, 137–43, 150–51 in New York City schools, 109–10, 112, 153–61 in Internet marketplaces, 105 in kidney exchanges, 34, 36, 47–49, 51–52 for medical residencies, 137–43 privacy and, 119–22 reputation and, 115–16 for restaurants, 220–22 same-sex marriage, 198–99 Scarf, Herb, 32–34 Scheibe, Peter, 38–39 Scheibe, Susan, 38–39 school matching, 8, 165–67 Boston Public Schools, 11, 122–28, 162–65 in China, 165–66 constraints in, 158–61 deferred acceptance algorithm in, 157–61 inequality of schools and, 166–67 New York City school system, 8, 106–10, 112, 122, 153–61 parent preferences in, 150–51 safety of sharing preferences in, 124–30, 153–54 unraveled markets in, 73–74 searches, 6 Securities and Exchange Commission, 85 self-control, 67–68, 74–78 judicial clerkships and, 91, 93–98 as solution to early transactions, 79–80, 135–36 self-interest, 52 sex trade, 114, 214–15 Shapley, Lloyd, 32–34, 141–43, 158 Shim, John, 86, 88, 239 Shmida, Avi, 13 shopping malls, 221 signals and signaling, 6, 169–92 in auctions, 180–89 cheap talk in, 176–77 in college admissions, 169, 170–73 costly, 177–89 of desirability, 178–79 of interest, 178–80 in Internet dating sites, 169, 175–77 in job markets, 173–75 opportunity cost of, 179–80 by restaurants, 181 simplicity, 11, 26–27 in commodity markets, 15–17 in communication, 169–92 in kidney exchanges, 51–52 in navigating the system, 124–26 slavery, 199–200, 201 slippery slope, 204 smartphones Internet market congestion and, 99–106 as marketplaces, 21–22 payment systems with, 24, 26–27 privacy and, 192 Smith, Adam, 7, 206–7 social media, 169 Sönmez, Tayfun, 8, 35, 37–38, 43–44 on Boston school choice, 126–28 Sotomayor, Marilda, 146 South Korea, 171 speed of transactions, 81–99 communication and, 99–106 congestion and, 99–112 in financial markets, 82–89 in judicial clerkships, 90–98 price-based competition vs., 85–88 telegraph and the cotton market, 89–90 Spread Networks, 83 stable outcomes, 139–43, 157–58 Standage, Tom, 89 standardization, 17–20, 22 Standard & Poor’s 500 (SPY), 82–89 Starbucks, 18, 19 Starzl, Thomas, 34 stockbrokers, 48 strategic decisions, 10–11 allowing time for, 92–93, 154 congestion and, 99–106 for judicial clerkships, 69–70, 92–98 on marriage, 70–74 in school matching, 124–30, 153–55, 161, 163–65 speed of information in, 89–90 StubHub, 104 Sugar Bowl, 62 surrogate babies, 201–2 taxi drivers, 114 telegraph, 89–90 thick markets, 8–9 Amazon, 21 for college bowl games, 63–64 for commodities, 17 congestion in, 9–10, 99–112 credit card, 23–24 differentiation in, 18–20 early transactions and, 57–80 early transactions in, 57–80 in financial markets, 82–89 for kidney transplants, 49–51 New York City school system, 107–10 platform changes and, 26–27 for restaurants, 217–20 self-reinforcing, 21 signaling in, 179 transaction speed in, 81–99 ticket re-sales, 104 timing of transactions in college bowl games, 59–65 congestion and, 80, 99–112 in Internet marketplaces, 101–6 Internet markets and, 20–26 market thickness and, 8–9 too fast, 81–99 too soon, 57–80 trading cycles, 32–41 transactions early, 57–80 monetization of, 202–5 protected, 198 time to evaluate, 9–11 timing of (See timing of transactions) trading cycles and, 32–41 trust in Boston Public Schools system, 123–28 at eBay, 117–19 gastroenterology fellowships and, 76–78 in Internet marketplaces, 105 in New York City school system, 108–10, 112 regulation and, 222–23 reliability and, 116 reputation and, 115–16 Uber, 103–4, 116 UberX, 104 United Network for Organ Sharing (UNOS), 50 University of Cincinnati Medical Center, 39–41 University of Oklahoma Sooners, 59 University of Pittsburgh, 34, 45, 174–75 University of Toledo Medical Center, 29–30 UNOS, 50 unraveled/unraveling markets.

This restriction in the candidate pool reduced the desirable diversity of fellows. What these directors didn’t appreciate—until they saw our results—was that this local hiring was happening to everyone. Only then did they all realize that their own problem was in fact market-wide. As you might imagine, that generated a lot of interest in hiring later. Muriel and I eventually helped them to plan a clearinghouse that operated later in the careers of medical residents, like the one that matched new doctors to residencies. But those same fellowship directors didn’t trust each other to cooperate and wait for the clearinghouse; they all worried that the others would continue to hire via early exploding offers. If they waited to take part in the clearinghouse, they feared all the best candidates would already be hired. This lack of trust threatened to keep everyone making early offers, just in case everyone else did—even when no one, or almost no one, wanted to.


pages: 250 words: 75,586

When the Air Hits Your Brain: Tales From Neurosurgery by Frank Vertosick


butterfly effect, double helix, index card, medical residency, random walk

A general surgery resident, still dressed in surgical scrubs and wearing blood-splattered shoe covers, was slamming his hips into a “Star Wars” pinball machine and cursing. In the back corner of the pizza parlor a table was crammed with medical residents dithering about some liver syndrome, their stethoscopes draped around their necks and their coat pockets jammed with standard-issue medical resident paraphenalia: the Washington Manual, index cards, photocopies of New England Journal articles, syringes. The pediatric residents were essentially medical residents with small teddy bears wrapped about their pastel-colored stethoscopes and an empathetic gaze permanently welded onto their faces. As we passed the table of medical residents, Gary glanced back at me and began scratching violently at the back of his right ear with his cupped hand, imitating a dog scratching a flea. This was his own personal code for internists.

Rushing to the room, we found a very aged but otherwise quite robust-looking gentleman reading the Wall Street Journal and sipping coffee. “Who called a cardiac arrest here?” angrily demanded the senior medical resident on the resuscitation team. “I didn’t call any cardiac arrest, young man; I simply asked the operator to send Dr. White to my room. My own internist isn’t worth a damn and people have been calling for this Dr. White character all morning. I felt he must be pretty damned good if he’s in so much demand.” Thankfully, the V.A. had no public-address system. The operator merely summoned the designated arrest team through their beepers. As a third-year student on the medicine rotation, I was assigned to the arrest team for the evening every other night. The team consisted of the senior medical resident, Kate; my intern, Jim; a fourth-year student, Pam; and me. At least once a night we answered the call of our whining arrest beepers.

Because neurosurgeons violate the brain’s natural barriers to infection, any postoperative fever in one of our patients may herald a bacterial meningitis. Fever in a post-op head case mandated a lumbar puncture, known to laymen as a “spinal tap,” so that some of the cerebrospinal fluid, or CSF, could be sent for a white cell count, glucose measurement, and bacteriological cultures. When we were busy, I would do ten to twelve LPs a day. Medical residents, in comparison, might do ten or twelve a year, while other specialties may do less than that in a career. By virtue of our experience and availability, we were the LP mavens of the health center. The procedure consists of turning a patient on his or her side, numbing a small patch of skin in the middle of the lower back, and plunging a six-inch-long needle into the spinal canal. (It’s best not to show the needle to the patient, I have discovered.)


pages: 262 words: 79,790

Final Exam: A Surgeon's Reflections on Mortality by Pauline W. Chen


medical residency, randomized controlled trial

They found that medical students had emotionally powerful reactions, even in the absence of a significant clinical relationship with the patient. Moreover, because of lack of discussion or emotional reaction from others around them, students often inferred that avoidance and continuing with work were appropriate coping reactions. Rhodes-Kropf et al., “Medical Students’ Reactions.” 27 But when I looked over at Bill to ask: In a recent survey, only one of forty-seven medical residents reported having had formal training either in medical school or during residency on how to determine death. Ferris et al., “When the Patient Dies.” Chapter 3 SEE ONE, DO ONE 28 Premedical students overwhelmingly believe: Chuck, “Do Premedical Students Know.” 29 “of all the professions”: Nuland, How We Die. 30 Attracted to medicine: Others have referred to this heightened anxiety over death among medical students and physicians and to the use of denial as a coping mechanism.

Unfortunately, many of these younger clinicians also experience these deaths in isolation. Jackson et al., “Powerful Patient Deaths”; Sullivan et al., “Status of Medical Education.” A substantial percentage of trainees do not discuss deaths with their attendings, and when they do, the education and the support they receive is inadequate. Redinbaugh et al., “Doctors’ Emotional Reactions”; Schwartz et al., “Medical Residents’ Perceptions.” Most residents instead tend to rely on talking with their peers, the other residents. Redinbaugh et al., “Doctors’ Emotional Reactions.” 33 we learn that many of them: In a recent survey of medical students, residents, and attendings on attitudes and experiences related to end-of-life care, researchers noted a large discrepancy in refusal rates. While only 8 percent of students and 13 percent of residents refused to answer the twenty-five-minute telephone survey, almost 50 percent of the faculty refused.

., “Morbidity and Mortality Conference.” 64 Internal medicine training programs: While M and M has traditionally been considered a surgical conference, the Accreditation Council for Graduate Medical Education has required this conference in internal medicine residency programs since 1983. Liu, “Error in Medicine.” Internal medicine educators, like surgeons, are also working to restructure and redefine the role of M and M in education. Orlander et al., “Learning from Error”; Orlander and Fincke, “Morbidity and Mortality Conference”; Pierluissi et al., “Discussion of Medical Errors”; Schwartz et al., “Medical Residents’ Perceptions.” Chapter 6 THE VISIBLE WOMAN 65 To do otherwise would be to admit: MacLeod wrote of doctors discussing such “turning points”: “[H]alf of the respondents wept as they recounted their stories…. The doctors seemed to lower their defensive barriers, and open themselves up to a personal vulnerability that remained alive, despite the passage of years.” MacLeod, “On Reflection.” 66 In 1992, as part of a lecture: Aoun, “Eye of the Storm.” 67 “had turned him into an emaciated, wheelchair-bound”: Ibid. 68 “It hit me violently that I had lost sight”: Ibid. 69 “The mystery was solved”: Lerner, “Ultimate Sacrifice.” 70 And on the day after his talk was published: Ibid. 71 I have read Hacib Aoun’s speech: Several physicians have written about becoming patients.


pages: 252 words: 73,131

The Inner Lives of Markets: How People Shape Them—And They Shape Us by Tim Sullivan


Airbnb, airport security, Al Roth, Andrei Shleifer, attribution theory, autonomous vehicles, barriers to entry, Brownian motion, centralized clearinghouse, clean water, conceptual framework, constrained optimization, continuous double auction, deferred acceptance, Donald Trump, Edward Glaeser, experimental subject, first-price auction, framing effect, frictionless, fundamental attribution error, George Akerlof, Goldman Sachs: Vampire Squid, helicopter parent, Internet of things, invisible hand, Isaac Newton, iterative process, Jean Tirole, Jeff Bezos, Johann Wolfgang von Goethe, John Nash: game theory, John von Neumann, Joseph Schumpeter, late fees, linear programming, Lyft, market clearing, market design, market friction, medical residency, multi-sided market, mutually assured destruction, Nash equilibrium, Occupy movement, Peter Thiel,, pez dispenser, pre–internet, price mechanism, price stability, prisoner's dilemma, profit motive, proxy bid, RAND corporation, ride hailing / ride sharing, Robert Shiller, Robert Shiller, Ronald Coase, school choice, school vouchers, sealed-bid auction, second-price auction, second-price sealed-bid, sharing economy, Silicon Valley, spectrum auction, Steve Jobs, Tacoma Narrows Bridge, technoutopianism, telemarketer, The Market for Lemons, The Wisdom of Crowds, Thomas Malthus, Thorstein Veblen, trade route, transaction costs, two-sided market, uranium enrichment, Vickrey auction, winner-take-all economy

But economists no longer limit themselves to money and pricing in thinking about how the wants and desires of individuals determine how resources (whether kidney beans, kidneys, or kids in a kindergarten class) are distributed. The very definition of what constitutes a market has changed. New forms of transacting are popping up not just on iTunes, Google, Uber, and e-commerce sites (although algorithms driven by economic theory of recent vintage lie under the hood of these websites). Economists have also changed the way we think about—among other things—how to match medical residents to hospitals or donor kidneys to dialysis patients, how governments sell broadband spectrum, and how donations are distributed among food banks across America. Economic Theory and You We wanted to tell the story of the sometimes complicated interactions that have landed us where we are today—surrounded by market interactions that have not only replaced grocery stores like Percy P.’s but also schools like Lincoln Elementary.

Recent work on two-sided markets like Uber or Google that sit between customers and drivers or between web searchers and advertisers has helped to guide the strategies of companies looking to build the next killer platform. We now even have market designers who have shifted from describing markets to shaping them to a desired image in an effort to address a particular problem, whether assigning students to the right schools or matching medical residents to hospitals. This isn’t an intellectual history of economics since World War II, nor are we aiming to be comprehensive in our coverage. Instead, we hope that our selective history of recent market insights and design can get us to a place where we can better confront our complicated and often fraught relationship with markets. Rather than react viscerally to them, we can be better informed on when markets actually work their magic—where, as we’ll see near the end of the book, they’ve have made the world far, far better despite some initial resistance.

It happened to the market for slots at sororities, too, which used to be reserved for college seniors, until popular girls started getting invitations to join at the start of their junior, then sophomore, then freshman year. (According to market design guru Al Roth, one theory holds that the term “fraternity/sorority rush,” which today describes the process by which sororities and fraternities recruit new members, comes from the frenzied competition among sororities to lock in new members.4) It’s what prompted medical residency programs to develop a centralized clearinghouse in the 1940s to fend off students receiving exploding offers before they were done with their intro to anatomy course. These allocation problems all now have centralized clearinghouses, many designed with the basic deferred acceptance algorithm as their foundations. But that’s really all that Gale and Shapley provided: a conceptual framework that market designers have, for several decades now, been applying, evaluating, and refining.


pages: 314 words: 101,034

Every Patient Tells a Story by Lisa Sanders


data acquisition, discovery of penicillin, high batting average, index card, medical residency, meta analysis, meta-analysis, natural language processing, pattern recognition, randomized controlled trial, Ronald Reagan

The missing end of our stethoscopes rested on the upper left side of the mannequin’s chest, a couple of inches below the clavicle, demonstrating where the sound we heard would be coming from, had this plastic dummy been a living patient. The tiny class sat silent. Despite the age and years of experience of most of the doctors, there was an awkward pause as we hesitated to answer—it was a moment straight out of sixth grade. I knew from my own years of teaching medical residents that it’s often hard to tell what that silence means. Is the question too hard? Or too easy? Both provoke the same uneasy hush. I still hadn’t recognized the heart sound and suspected that was true of the others as well. “All right. Don’t tell me what you think it is—we’ll get to that. Just describe the sound.” Obeso tried again. “First, when does it occur? Is it systolic or diastolic?” A normal heartbeat has two sounds separated by a very short period of what is usually silence—these two beats and the pause between them is known as systole (from the Greek word systole, which means contraction, so named by William Harvey when he first described the circular motion of the blood through the body in the seventeenth century).

But ultimately everyone takes it because that’s what you need to do to become a doctor. Has it done any good? It’s still too early to tell if the test has made any real difference in what doctors do, yet if my own institution is any example, then I suspect it’s having a tremendous impact on how doctors are trained—at least in medical school. Eric Holmboe now heads the department that evaluates medical residents at the American Board of Internal Medicine (ABIM), the organization that accredits doctors specializing in internal medicine. Until 2004 he was associate program director of the Primary Care Internal Medicine Residency Program at Yale. (That’s when he saw my patient Susan Sukhoo.) At a recent meeting of directors of clinical teaching from medical schools in the Northeast, Holmboe described Yale’s preparation for the clinical skills exam part of the USMLE.

“But there’s plenty of evidence that there were significant inadequacies in the way doctors took a history and performed a physical exam starting as early as the 1970s.” Eric wants to change all that. An energetic man in his forties with a rangy build, broad smile, and loping gait, he greeted me enthusiastically when I appeared at one of his workshops taking place in Boston. Eric is in charge of developing programs to shore up the physical exam training in medical residency programs for the American Board of Internal Medicine. One of the principal ways he does that is by teaching teachers how to teach. His focus is to convince teachers to actually watch residents as they examine their patients and then teach them how to fix what they find. “The way I was taught the physical exam was just crazy,” he told me. “No one ever watched me. How could they help me get better?


pages: 443 words: 153,085

The Intern Blues: The Timeless Classic About the Making of a Doctor by Robert Marion


Albert Einstein, medical malpractice, medical residency, place-making

In the critical care room, the crowd was gone; there were just a couple of nurses, removing all the lines and stuff, cleaning him up, getting ready to bag him, and there he was with his glazed corneas—yeah, he looked dead, all right. The medical resident came in and we talked about it for a minute. No one had said anything to the family yet. I told him I’d gotten the history from the mother. “Well, I guess you’re the only one who’s established rapport . . .” he said. Rapport? I spoke with the woman for five lousy minutes; that’s not exactly what I’d call establishing rapport. But I was elected. Other than me, nobody had even laid eyes on the woman. The medical resident said he’d come along with me. On the way back to the social work office, I stopped myself and thought, What the hell am I going to say to this woman? I knew she was totally unprepared for this.

I wish I had said it when I’d had the chance, but then that damned clerk had come in and had taken her out to register her. I should have booted him out, told him I was talking and that it was important, but I didn’t think to do that, so I didn’t get to prepare her in any way. Ah, maybe she didn’t want to know, maybe she would have been worse off had I tipped her off beforehand. Who knows? Anyway, there I was, sitting in front of her in the social work office, and the medical resident was standing behind me and there she was, looking at me, not having a clue what was going on. All I could think to say was, “I’m sorry, but I have to tell you, your son is dead.” She looked at me, her eyes bugged out, and she became completely hysterical. And the woman who was there with her also became completely hysterical. They began screaming in Spanish and wailing and throwing themselves around.

It’s the first of many horrendous and inhuman experiences to which house officers are exposed. In other professions, a person who wants a particular job submits an application and a résumé; the person goes on interviews, trying to convince the employer that he or she is right for the job; if the job is offered, the person has the right to accept it and begin work, or to reject it. But this system, good enough for American business, apparently is too simple for medical residency training. After all, there’s no torture involved. The search for the perfect internship begins early in the summer before the medical student’s fourth and final year of school. The student interested in pediatrics or internal medicine fills out as many as twenty applications for residency programs. He or she then spends a month interviewing at hospitals around the country, asking numerous questions of the house staff and attendings, trying to get a feel for the place.


pages: 234 words: 53,078

The Conservative Nanny State: How the Wealthy Use the Government to Stay Rich and Get Richer by Dean Baker


accounting loophole / creative accounting, affirmative action, Asian financial crisis, Bretton Woods, corporate governance, declining real wages, full employment, index fund, Jeff Bezos, medical malpractice, medical residency, offshore financial centre, price discrimination, risk tolerance

They would also be asking the trade negotiators from Mexico, India, or China what obstacles prevent them from sending hundreds of thousands of highly skilled professionals to the United States. This does not happen. In fact, the exact opposite happens. In 1997 Congress tightened the licensing rules for foreign doctors entering the country because of concerns by the American Medical Association and other doctors' organizations that the inflow of foreign doctors was driving down their salaries. As a result, the number of foreign medical residents allowed to enter the country each year was cut in half. 3 For some reason, the editorial boards, political pundits, and trade economists managed to completely ignore this protectionist measure, even though its impact dwarfed the impact of most of the "free trade" trade agreements that they have promoted so vigorously. If free trade in physicians brought doctors’ salaries down to European levels, the savings would be close to $100,000 per doctor, approximately $80 billion a year.

physicians, see "Caught in the Middle," Washington Post, March 19, 1996, "A.M.A. and Colleges Assert There is a Surfeit of Doctors," New York Times, March 1, 1997, and "U.S. to Pay Hospitals Not to Train Doctors, Easing Glut," New York Times, February 15, 1997. The success of the 1997 policy changes in restricting the inflow of foreign doctors was noted five years later. See “Fewer Foreign Doctors Seek U.S. Training,” Washington Post, September 4, 2002, and “Test Tied to Slip in Foreign Applicants for Medical Residences,” New York Times, September 4, 2002. 19 Most people probably do not realize that the protectionist barriers that keep out foreign professionals are actually quite extensive.4 This is in part due to efforts by proponents of the conservative nanny state to conceal the protectionist barriers that benefit professionals like themselves. When confronted on the issue, nanny state conservatives are likely to refer to Indian doctors or Chinese scientists they know as evidence that barriers to foreign professionals working in the United States do not exist.


pages: 197 words: 60,477

So Good They Can't Ignore You: Why Skills Trump Passion in the Quest for Work You Love by Cal Newport


Apple II, bounce rate, Byte Shop, Cal Newport, capital controls, cleantech, Community Supported Agriculture, deliberate practice, financial independence, follow your passion, Frank Gehry, job satisfaction, job-hopping, knowledge worker, Mason jar, medical residency, new economy, passive income, Paul Terrell, popular electronics, renewable energy credits, Results Only Work Environment, Richard Bolles, Richard Feynman, Richard Feynman, rolodex, Sand Hill Road, side project, Silicon Valley, Skype, Steve Jobs, Steve Wozniak, web application, winner-take-all economy

The more time you spend reading the research literature, the more it becomes clear: Giving people more control over what they do and how they do it increases their happiness, engagement, and sense of fulfillment. It’s no wonder, then, that when you flip through your mental Rolodex of dream jobs, control is often at the core of their appeal. Throughout Rule #3, for example, you’ll meet people in a variety of different fields who wielded control to create a working life they love. Among them is a freelance computer programmer who skips work to enjoy sunny days, a medical resident who took a two-year leave from his elite residency program to start a company, and a famous entrepreneur who gave away his millions and sold his possessions to embrace an unencumbered, globe-trotting existence. These examples all have great lives, and as you’ll learn, they all used control to create them. To summarize, if your goal is to love what you do, your first step is to acquire career capital.

“They really didn’t want a contractor,” she recalls, “but they didn’t have anyone else who could do this type of work, so they eventually had no choice but to agree.” The more I met people who successfully deployed control in their career, the more I heard similar tales of resistance from their employers, friends, and families. Another example is someone I’ll call Lewis, who is a resident in a well-known combined plastic surgery program, which is arguably the most competitive medical residency. Three years into his residency, he was starting to chafe under hospital bureaucracy. When I met him for coffee, he gave me a vivid example of the frustrations of life as a modern doctor. “I once received this patient in the ER who had his chest cut open because he had been stabbed in the heart,” he told me. “I’m on the gurney, massaging his heart with my hands as he’s brought into the operating room.


pages: 241 words: 75,516

The Paradox of Choice: Why More Is Less by Barry Schwartz


accounting loophole / creative accounting, attribution theory, Atul Gawande, availability heuristic, Cass Sunstein, Daniel Kahneman / Amos Tversky, endowment effect, framing effect, income per capita, job satisfaction, loss aversion, medical residency, mental accounting, Own Your Own Home, positional goods, price anchoring, psychological pricing, RAND corporation, Richard Thaler, science of happiness, The Wealth of Nations by Adam Smith

Researchers have known for years about the harmful effects of negative emotion on thinking and decision making. More recent evidence has shown that positive emotion has the opposite effect—when we are in a good mood, we think better. We consider more possibilities; we’re open to considerations that would otherwise not occur to us; we see subtle connections between pieces of information that we might otherwise miss. Something as trivial as a little gift of candy to medical residents improves the speed and accuracy of their diagnoses. In general, positive emotion enables us to broaden our understanding of what confronts us. This creates something of a paradox. We seem to do our best thinking when we’re feeling good. Complex decisions, involving multiple options with multiple features (like “Which job should I take?”) demand our best thinking. Yet those very decisions seem to induce in us emotional reactions that will impair our ability to do just the kind of thinking that is necessary.

It isn’t even the most important thing. But all other things being equal, it’s better to be happy than not. And happiness isn’t just about feeling good. Despite our romantic images of suffering geniuses who have enriched our civilization, creative by day and tormented by night, there is a growing body of evidence that people think more creatively and expansively when they’re happy than when they’re not. Giving medical residents a little bag of candy unexpectedly before they engage in a difficult differential diagnosis task improves both the speed and the accuracy of their diagnoses (you may want to keep this in mind the next time you visit your doctor). Happy people are more energetic and physically healthier than those who are not. And happiness adds about nine years to life expectancy. So even if you don’t think that happiness is such a big deal in itself, it seems to serve a useful instrumental function.


pages: 436 words: 123,488

Overdosed America: The Broken Promise of American Medicine by John Abramson


germ theory of disease, Louis Pasteur, medical malpractice, medical residency, meta analysis, meta-analysis, p-value, placebo effect, profit maximization, profit motive, RAND corporation, randomized controlled trial, stem cell, Thomas Kuhn: the structure of scientific revolutions

Wolfe, “Medical Education Services Suppliers: A Threat to Physician Education,” Health Research Group Report, Public Citizen, July 19, 2000. 121 $3 million to the prestigious Massachusetts General Hospital: Raja Mishra, “Deal May Tie MGH to Furor on Pain Pill,” Boston Globe, March 14, 2002. 121 George Annas, commented: Quoted ibid. 122 Permissible offerings: D. Grande and K. Volpp, “Cost and Quality of Industry-Sponsored Meals for Medical Residents,” Journal of the American Medical Association 290:1150–1151, 2003. 122 Alan Holmer, claims that the drug industry: A. F. Holmer, “Industry Strongly Supports Continuing Medical Education,” Journal of the American Medical Association 285:2012–2014, 2001. 123 review article published in JAMA: A. Wazna, op. cit. 123 gifts and meals start in medical school: “Drug-Company Influence on Medical Education in U.S.A. (Editorial),” The Lancet 356:781, 2000. 123 Eight out of 10 medical residents: M. A. Steinman, M. G. Shilpak, and S. J. McPhee. “Of Principles and Pens: Attitudes and Practices of Medicine House-staff Toward Pharmaceutical Industry Promotions,” Journal of the American Medical Association 110:551–557, 2001. 124 “Twisted together like the snake: R.

It first appears harmless enough: a textbook here, a penlight there, and progresses to stethoscopes and black bags, until eventually come nights ‘on the town’ at academic conventions and all-expenses-paid ‘educational symposia’ in lovely locales.” It doesn’t take long before doctors and drug reps are on a first-name basis. A 2001 study published in the American Journal of Medicine looked at residents’ interactions with drug salespeople and their opinions about accepting gifts and attending drug company–sponsored educational activities. Eight out of 10 medical residents saw the inclusion of such sponsored education and interaction with drug reps as “appropriate.” This shows how seamlessly drug company infomercials have become integrated into medical training, even in the very best medical centers, just as soft drink and snack machines gradually have become accepted as a normal part of the public school environment. The study commented on the “ubiquity of the [drug] industry’s presence” in the residents’ environment and on the lack of formal education for residents about the effect of relationships with drug industry salespeople.


pages: 1,294 words: 210,361

The Emperor of All Maladies: A Biography of Cancer by Siddhartha Mukherjee


Barry Marshall: ulcers, conceptual framework, discovery of penicillin, experimental subject, iterative process, life extension, Louis Pasteur, medical residency, meta analysis, meta-analysis, mouse model, New Journalism, phenotype, randomized controlled trial, scientific mainstream, Silicon Valley, social web, statistical model, stem cell, women in the workforce, éminence grise

“To me,” Goldstein wrote, “one of the most pathetic sights of all that I have seen is the little go-cart, with the little child, leg or arm tightly bandaged to hold needle in vein, and a tall IV pole with its burette. The combined effect is that of a boat with mast but no sail, helplessly drifting alone in a rough, uncharted sea.” Every evening, Farber came to the wards, forcefully driving his own sail-less boat through this rough and uncharted sea. He paused at each bed, taking notes and discussing the case, often barking out characteristically brusque instructions. A retinue followed him: medical residents, nurses, social workers, psychiatrists, nutritionists, and pharmacists. Cancer, he insisted, was a total disease—an illness that gripped patients not just physically, but psychically, socially, and emotionally. Only a multipronged, multidisciplinary attack would stand any chance of battling this disease. He called the concept “total care.” But despite all efforts at providing “total care,” death stalked the wards relentlessly.

“Li was accused of experimenting on people,” Freireich said. “But of course, all of us were experimenting. Tom [Frei] and Zubrod and the rest of them—we were all experimenters. To not experiment would mean to follow the old rules—to do absolutely nothing. Li wasn’t prepared to sit back and watch and do nothing. So he was fired for acting on his convictions, for doing something.” Freireich and Li had been medical residents together in Chicago. At the NCI, they had developed a kinship as two outcasts. When Freireich heard about Li’s dismissal, he immediately went over to Li’s house to console him, but Li was inconsolable. In a few months, he huffed off to New York, bound back for Memorial Sloan-Kettering. He never returned to the NCI. But the story had a final plot twist. As Li had predicted, with several additional doses of methotrexate, the hormone level that he had so compulsively trailed did finally vanish to zero.

But these efforts had reached a standstill. “We knew where Rb lived,” Weinberg recalled, “but we had no idea what Rb was.” Across the Charles River from Weinberg’s lab, Thad Dryja, an ophthalmologist-turned-geneticist, had also joined the hunt for Rb. Dryja’s laboratory was perched on the sixth floor of the Massachusetts Eye and Ear Infirmary—the Eyeball, as it was known colloquially among the medical residents. The ophthalmological infirmary was well-known for its clinical research on eye diseases, but was barely recognized for laboratory-based research. Weinberg’s Whitehead Institute boasted the power of the latest technologies, an army of machines that could sequence thousands of DNA samples and powerful fluorescent microscopes that could look down into the very heart of the cell. In contrast, the Eyeball, with its proud display of nineteenth-century eyeglasses and lenses in lacquered wooden vitrines, was almost self-indulgently anachronistic.


pages: 400 words: 94,847

Reinventing Discovery: The New Era of Networked Science by Michael Nielsen


Albert Einstein, augmented reality, barriers to entry, bioinformatics, Cass Sunstein, Climategate, Climatic Research Unit, conceptual framework, dark matter, discovery of DNA, double helix, Douglas Engelbart,, Erik Brynjolfsson, fault tolerance, Fellow of the Royal Society, Firefox, Freestyle chess, Galaxy Zoo, Internet Archive, invisible hand, Jane Jacobs, Jaron Lanier, Kevin Kelly, Magellanic Cloud, means of production, medical residency, Nicholas Carr, publish or perish, Richard Feynman, Richard Feynman, Richard Stallman, semantic web, Silicon Valley, Silicon Valley startup, Simon Singh, Skype, slashdot, social web, statistical model, Stephen Hawking, Stewart Brand, Ted Nelson, The Death and Life of Great American Cities, The Nature of the Firm, The Wisdom of Crowds, University of East Anglia, Vannevar Bush, Vernor Vinge

In 1996 another follow-up experiment was done, this time in a teaching hospital, asking groups to make medical diagnoses on the basis of video clips of patient interviews. Again, the information was partial: each person in the group saw only part of the video interview. The groups making the decisions included three people of different statuses a medical resident, an intern, and a student. Alarmingly, but perhaps not surprisingly, the groups paid much more attention to unique information held by the high-status medical resident. Unique information held by the interns and students was much more likely to be ignored. These and many other studies paint a bleak picture for collective intelligence. They show that groups often don’t do a good job of taking advantage of their collective knowledge. Instead, they focus on knowledge they hold in common, they focus on knowledge held by high-status members of the group, and they often ignore the knowledge of low-status members of the group.


pages: 313 words: 95,361

The Vast Unknown: America's First Ascent of Everest by Broughton Coburn


Berlin Wall, British Empire, colonial rule, cuban missile crisis, medical residency, mutually assured destruction, risk tolerance, Ronald Reagan, upwardly mobile

Another American Everest veteran, Dave Dingman, had been recruited for the 1966 team. Early that year Dingman had been drafted for service in Vietnam—an inconvenient development falling right in middle of his medical residency. Just before being shipped out, he received a mysterious phone call. “Dr. Dingman … Would you like to work for the government on a special project?” “Well, I’ve already been drafted,” he responded with wry resignation. “We can fix that,” said the caller, who claimed to be with the CIA. Dingman’s curiosity was piqued, and he returned to Baltimore for a meeting. He said that he’d consider the Nanda Devi mission, but only if the CIA interceded with the draft board and allowed him to complete his final year of medical residency. The agency agreed. Early in the summer of 1966, Langley phoned back, saying that they needed him in India right away. They signed him up and gave him an alias.


pages: 307 words: 94,069

Switch: How to Change Things When Change Is Hard by Chip Heath, Dan Heath


Atul Gawande, Cass Sunstein, clean water, cognitive dissonance, corporate social responsibility,, fundamental attribution error, impulse control, medical residency, Piper Alpha, placebo effect, publish or perish, Richard Thaler, shareholder value, Silicon Valley, Steve Jobs

In 1984, Libby Zion, an 18-year-old freshman at Bennington College, at home visiting her parents in Manhattan, died in a New York teaching hospital. She’d been given the wrong medication by a medical resident who’d been working for over 19 hours. Her death sparked an outcry over the excessive hours worked by medical interns. (Interns are first-year residents. They’ve completed three years of medical school and are beginning full-time work in hospitals.) Traditionally, interns have worked an astonishing 120 hours per week. The story of Libby Zion became the centerpiece of a campaign to limit the workweeks of medical residents. Almost two decades later, in 2003, Congress finally seemed ready to move. Then the American Council for Graduate Medical Education—which accredits medical schools—made an effort to preempt congressional legislation by requiring 80-hour workweeks for residents starting in July 2003.


pages: 385 words: 117,391

The Complete Thyroid Book by Kenneth Ain, M. Sara Rosenthal


follow your passion, medical residency, meta analysis, meta-analysis, place-making, placebo effect, Post-materialism, post-materialism, randomized controlled trial, upwardly mobile

The dean gave me permission to spend six weeks under the endocrinologist’s tutelage, and he introduced me to academic endocrinology, critical thinking, and the thyroid gland. As a new intern, my first intensive care patient was a comatose gentleman whose illness had defied understanding for three weeks. What a triumph for a new physician to diagnose myxedema (hypothyroid) coma and see my patient awaken after sufficient treatment with thyroid hormone! My interest in thyroid disease persisted and grew through medical residency and then blossomed under the mentorship of Dr. Samuel Refetoff at the University of Chicago during three years of an endocrinology fellowship. It progressed further during my time as a senior staff fellow working with Dr. Jacob Robbins at the National Institutes of Health, where I began to specialize in treating patients with thyroid cancer and continued my basic and clinical research on thyroid diseases.

The chapter will start with an overview of the thyroid hormone resistance syndrome and then touch upon four additional areas: pituitary or hypothalamic genetic disorders, genetic abnormalities in thyroid gland development, genetic defects in the production of thyroid hormone, and inherited abnormalities in thyroid hormone binding proteins in the blood. 241 P EOP LE I N SP ECIAL CI RCUMSTANCES Resistance to Thyroid Hormone (RTH) or Thyroid Hormone Resistance The story of resistance to thyroid hormone (RTH) started forty years ago with my (Ken) mentor, Dr. Samuel Refetoff. As an astute medical resident in a Los Angeles emergency room, he examined a six-year-old girl after she’d been in an automobile accident. This child had a goiter, bones that appeared to be those of a younger child (on x-ray exam), and was a deaf-mute. Such findings would typically make a physician suspect the child to have had severe hypothyroidism since birth; however, Dr. Refetoff was surprised to find that the test for thyroid hormone showed nearly four times the normal level in this child.


Is Everyone Hanging Out Without Me? (And Other Concerns) by Mindy Kaling


Berlin Wall, Burning Man, Donner party, East Village, illegal immigration, index card, medical residency, pre–internet, rent control, Saturday Night Live, Triangle Shirtwaist Factory

Going on and on in detail about how stressed out I am isn’t conversation. It’ll never lead anywhere. No one is going to say, “Wow, Mindy, you really have it especially bad. I have heard some stories of stress, but this just takes the cake.” This is entirely because my parents are immigrant professionals, and talking about one’s stress level was just totally outlandish to them. When I was three years old my mom was in the middle of her medical residency in Boston. She had been a practicing obstetrician and gynecologist in Nigeria, but in the United States she was required to do her residency all over again. She’d get up at 4:00 a.m. and prepare breakfast, lunch, and dinner for my brother and me, because she knew she wouldn’t be home in time to have dinner with us. Then she’d leave by 5:30 a.m. to start rounds at the hospital. My dad, an architect, had a contract for a building in New Haven, Connecticut, which was two hours and forty-five minutes away.


pages: 172 words: 54,066

The End of Loser Liberalism: Making Markets Progressive by Dean Baker


Asian financial crisis, banking crisis, Bernie Sanders, collateralized debt obligation, collective bargaining, corporate governance, currency manipulation / currency intervention, Doha Development Round, financial innovation, full employment, Home mortgage interest deduction, income inequality, inflation targeting, invisible hand, manufacturing employment, market clearing, market fundamentalism, medical residency, patent troll,, pirate software, price stability, quantitative easing, regulatory arbitrage, rent-seeking, Robert Shiller, Robert Shiller, Silicon Valley, too big to fail, transaction costs

The categories of professional workers who are most protected from international competition overlap hugely with the categories of workers who write and report the news, staff congressional offices, and teach at colleges and universities. They are the people who shape the debate over policy issues like trade. And they use their control over this debate to prevent the notion of increased international competition in professional services from entering public debate. In the mid-1990s there was a debate over efforts to tighten restrictions on the number of foreign medical residents entering the United States. The two sides in the debate were the physicians’ organizations, who contended that foreign-born doctors were driving down the wages of doctors born in the United States, and community health groups, who argued that foreign-born doctors were serving underserved areas like rural areas, places where native-born doctors did not want to practice.[75] Remarkably, no one was cited in this debate who gave the standard economists’ argument that increasing the number of qualified foreign-born doctors in the country would drive down the wages of native-born doctors.


pages: 281 words: 83,119

The Secret Female Hormone by Kathy C. Maupin, M.D.


clean water, medical residency, randomized controlled trial

Women lose testosterone ten years before men and have a tenth of the total testosterone men have throughout their reproductive lives. Sleepless in the OR The ability to work without sleep has historically been a requirement the medical profession placed on young physicians, despite their obvious loss of performance after the 12th hour of alertness. Only recently has lack of sleep been officially associated with poor quality work and mistakes made by doctors in training. Thankfully, medical residents currently in training have limits on their work hours, but most practicing physicians were trained in the old system when doctors considered the ability to stay awake a badge of honor. Unfortunately, this makes them less likely to consider a lack of sleep important. It is no wonder, then, that when patients complain of insomnia, their doctors often ignore their complaints. But insomnia is a risk factor for poor health and should be attended to and treated.


pages: 271 words: 82,159

David and Goliath: Underdogs, Misfits, and the Art of Battling Giants by Malcolm Gladwell


affirmative action, Berlin Wall, cuban missile crisis, Daniel Kahneman / Amos Tversky, delayed gratification, medical residency, Menlo Park, meta analysis, meta-analysis, RAND corporation, school choice, Silicon Valley

One colleague remembers his unforgettable first impression of Freireich: “a giant, in the back of the room, yelling and screaming on the phone.” Another remembers him as “completely irrepressible. He would say whatever came into his mind.” Over the course of his career, he would end up being fired seven times, the first time during his residency when he angrily defied the head nurse at Presbyterian Hospital in Chicago. One of his former coworkers remembers Freireich coming across a routine error made by one of his medical residents. A minor laboratory finding had been overlooked. “The patient died,” the doctor said. “It wasn’t because of the error. Jay screamed at him right there in the ward, in front of five or six doctors and nurses. He called him a murderer, and the guy broke down and cried.” Almost everything said about Freireich by his friends contains a “but.” I love him, but we nearly came to blows. I invited him to my house, but he insulted my wife.


pages: 246 words: 81,843

David and Goliath: The Triumph of the Underdog by Malcolm Gladwell


affirmative action, Berlin Wall, cuban missile crisis, Daniel Kahneman / Amos Tversky, delayed gratification, medical residency, Menlo Park, meta analysis, meta-analysis, RAND corporation, school choice, Silicon Valley

One colleague remembers his unforgettable first impression of Freireich: “a giant, in the back of the room, yelling and screaming on the phone.” Another remembers him as “completely irrepressible. He would say whatever came into his mind.” Over the course of his career, he would end up being fired seven times, the first time during his residency when he angrily defied the head nurse at Presbyterian Hospital in Chicago. One of his former coworkers remembers Freireich coming across a routine error made by one of his medical residents. A minor laboratory finding had been overlooked. “The patient died,” the doctor said. “It wasn’t because of the error. Jay screamed at him right there in the ward, in front of five or six doctors and nurses. He called him a murderer, and the guy broke down and cried.” Almost everything said about Freireich by his friends contains a “but.” I love him, but we nearly came to blows. I invited him to my house, but he insulted my wife.


pages: 230 words: 71,320

Outliers: The Story of Success by Malcolm Gladwell


affirmative action, Bill Gates: Altair 8800, computer age, medical residency, popular electronics, Silicon Valley, Steve Ballmer, Steve Jobs, union organizing, upwardly mobile, why are manhole covers round?

I tell her all about the day and what happened, and by the time we are finished, she is on the brink of sleeping, so that's probably around eleven-fifteen. Then I go to sleep, and the next morning we do it all over again. We are in the same room. But it's a huge bedroom and you can split it into two, and we have beds on other sides. Me and my mom are very close. She spoke in the matter-of-fact way of children who have no way of knowing how unusual their situation is. She had the hours of a lawyer trying to make partner, or of a medical resident. All that was missing were the dark circles under her eyes and a steaming cup of coffee, except that she was too young for either. “Sometimes I don't go to sleep when I'm supposed to,” Marita continued. “I go to sleep at, like, twelve o'clock, and the next afternoon, it will hit me. And I will doze off in class. But then I have to wake up because I have to get the information. I remember I was in one class, and I was dozing off and the teacher saw me and said, 'Can I talk to you after class?'


pages: 221 words: 68,880

Bikenomics: How Bicycling Can Save the Economy (Bicycle) by Elly Blue


2013 Report for America's Infrastructure - American Society of Civil Engineers - 19 March 2013, active transport: walking or cycling, American Society of Civil Engineers: Report Card, big-box store, car-free, hydraulic fracturing, if you build it, they will come, Jane Jacobs, job automation, Loma Prieta earthquake, medical residency, oil shale / tar sands, peak oil, Ponzi scheme, ride hailing / ride sharing, science of happiness, the built environment, urban renewal, women in the workforce, working poor, young professional

Meanwhile, the establishment is starting to open its eyes, to not just see but listen to and be led by these community bicycle movements. Their rise provides new opportunities for leadership—and proves the effectiveness of people riding together and using bicycles to change the shape of their own neighborhoods and communities. In 2009, Emily Finch was in her early thirties, living in the small town of Williamsport, Pennsylvania.161 Her husband was in his medical residency, and she was raising five children with another one on the way. She wasn’t happy. She knew that something in her life had to change, but she didn’t know what. One day an internet search turned up a picture of a bakfiets, a type of Dutch bicycle that literally means “box bike.” The bikes are nine feet long, weigh 100 pounds unloaded, cost $3,000, and come equipped with a hardwood box in the front with a bench for children.


pages: 240 words: 65,363

Think Like a Freak by Steven D. Levitt, Stephen J. Dubner


Albert Einstein, Anton Chekhov, autonomous vehicles, Barry Marshall: ulcers, call centre, Cass Sunstein, colonial rule, Edward Glaeser, food miles, Gary Taubes, income inequality, Internet Archive, Isaac Newton, medical residency, microbiome, prediction markets, randomized controlled trial, Richard Thaler, Scramble for Africa, self-driving car, Silicon Valley, Tony Hsieh, transatlantic slave trade, éminence grise

But the medical establishment was quick to point out the glaring flaw in this theory: How could bacteria possibly survive in the acidic cauldron of the stomach? And so the ulcer-treatment juggernaut rolled on. There wasn’t much of an incentive to find a cure—not, at least, by the people whose careers depended on the prevailing ulcer treatment. Fortunately the world is more diverse than that. In 1981, a young Australian medical resident named Barry Marshall was on the hunt for a research project. He had just taken up a rotation in the gastroenterology unit at Royal Perth Hospital, where a senior pathologist had stumbled onto a mystery. As Marshall later described it: “We’ve got 20 patients with bacteria in their stomach, where you shouldn’t have bacteria living because there’s too much acid.” The senior doctor, Robin Warren, was looking for a young researcher to help “find out what’s wrong with these people.”


pages: 998 words: 211,235

A Beautiful Mind by Sylvia Nasar


Al Roth, Albert Einstein, Andrew Wiles, Brownian motion, cognitive dissonance, Columbine, experimental economics, fear of failure, Henri Poincaré, invisible hand, Isaac Newton, John Conway, John Nash: game theory, John von Neumann, Kenneth Rogoff, linear programming, lone genius, market design, medical residency, Nash equilibrium, Norbert Wiener, Paul Erdős, prisoner's dilemma, RAND corporation, Ronald Coase, second-price auction, Silicon Valley, Simon Singh, spectrum auction, The Wealth of Nations by Adam Smith, Thorstein Veblen, upwardly mobile

• • • One Hundred Fifteen Mill Street, Belmont, Massachusetts, was, and still is, a verdant 240–acre expanse of rolling lawns and winding lanes and a scattering of buildings of old brick and ironwork nestled among majestic trees or perched airily on rises — a precise copy, that is to say, of a well-manicured New England college campus of late-nineteenth-century vintage.7 Many of its smaller buildings were designed to resemble the homes of wealthy Boston Brahmins — long the bulk of McLean’s clientele. A psychiatrist who reviewed the hospital for the American Psychiatric Association in the late 1940s recalled, “There were all these little two-story homes with suites — kitchen, living room, bedroom. They had suites for the cook, the maid, the chauffeur.”8 Upham House, a former medical resident recalled, had four corner suites per floor and on one of its floors all four patients turned out to be members of the Harvard Club! McLean was, as it still is, connected to Harvard Medical School. So many of the wealthy, intellectual, and famous came there — Sylvia Plath, Ray Charles, and Robert Lowell among them9 — that many people around Cambridge had come to think of it less as a mental hospital and more as a kind of sanatorium where high-strung poets, professors, and graduate students wound up for a special kind of R&R.

Stanton had been charged by McLean’s trustees in 1954 to modernize McLean.45 Before Stanton arrived in the early 1950s, as Kahne recalled, “The nurses were spending all their time classifying fur coats and writing thank you letters.” Moreover, patients spent most of the day lying in bed as if they were suffering from some physical ailment. Stanton hired a large number of nurses and psychiatrists, expanded the medical residency program, instituted an intensive psychotherapy program, and organized social, educational, and work activities. McLean’s treatment philosophy boiled down to the notion that “it was impossible to be social and crazy at the same time.”46 The staff was dedicated to encouraging all new patients, no matter what the diagnosis, to relate. Along with this “milieu” therapy, as it was called, intensive, five-day-a-week psychoanalysis was the main mode of treatment.47 Nobody thought of Thorazine as anything but an initial aid in preparing the way for psychotherapy.


pages: 304 words: 22,886

Nudge: Improving Decisions About Health, Wealth, and Happiness by Richard H. Thaler, Cass R. Sunstein


Al Roth, Albert Einstein, asset allocation, availability heuristic, call centre, Cass Sunstein, choice architecture, continuous integration, Daniel Kahneman / Amos Tversky, desegregation, diversification, diversified portfolio, endowment effect, equity premium, feminist movement, framing effect, full employment, George Akerlof, index fund, invisible hand, late fees, libertarian paternalism, loss aversion, Mahatma Gandhi, Mason jar, medical malpractice, medical residency, mental accounting, meta analysis, meta-analysis, Milgram experiment, pension reform, presumed consent, profit maximization, rent-seeking, Richard Thaler, risk tolerance, Robert Shiller, Robert Shiller, Saturday Night Live, school choice, school vouchers, transaction costs, Vanguard fund, Zipcar

The Boston system is still in place around the country, though not in Boston. In 2003 a group of economists led by Al Roth at Harvard pointed out these problems to initially skeptical Boston school administrators. After letting the economists poke around in the internal data, the administrators became convinced of their system’s flaws.6 In response, they adopted the economists’ new strategy-proof choice mechanism, based on one used to match hospitals and medical residents. IMPROVING SCHOOL CHOICES The mechanism does not penalize parents who are unsophisticated about the choice process, allowing them to spend time visiting schools and seeing teachers, rather than estimating the level of competition to get into each school. In return, administrators do not have to guess about parents’ true preferences so that the policy can be adjusted properly based on future feedback.


pages: 319 words: 89,477

The Power of Pull: How Small Moves, Smartly Made, Can Set Big Things in Motion by John Hagel Iii, John Seely Brown


Albert Einstein, Andrew Keen, barriers to entry, Black Swan, business process, call centre, Clayton Christensen, cleantech, cloud computing, corporate governance, Elon Musk,, future of work, game design, George Gilder, Isaac Newton, job satisfaction, knowledge economy, knowledge worker, loose coupling, Louis Pasteur, Malcom McLean invented shipping containers, Maui Hawaii, medical residency, Network effects, packet switching, pattern recognition, pre–internet, profit motive, recommendation engine, Ronald Coase, shareholder value, Silicon Valley, Skype, smart transportation, software as a service, supply-chain management, The Nature of the Firm, too big to fail, trade liberalization, transaction costs

Or imagine trying to perform brain surgery after having read all the books you can find on the subject. The books are the explicit knowledge telling you what to do—which is eminently necessary—but knowing how to perform this kind of surgery critically depends on an extended apprenticeship process in which tacit knowledge gets communicated through observation and participation on the periphery of these operations. That’s the whole raison d’être of apprenticeship, including the medical residency: learning by doing under supervision. Another example of tacit knowledge in action is brewing beer. A brewer recently explained to us how he moved from using kits in the early 1990s to following recipes shortly thereafter, while keep logs of the process. Then he started tinkering with the recipes (still taking notes), experimenting with different mixes of hops, yeast, and so on, still carefully noting the process and the results.


pages: 317 words: 84,400

Automate This: How Algorithms Came to Rule Our World by Christopher Steiner


23andMe, Ada Lovelace, airport security, Al Roth, algorithmic trading, backtesting, big-box store, Black-Scholes formula, call centre, cloud computing, collateralized debt obligation, Credit Default Swap, credit default swaps / collateralized debt obligations, delta neutral, Donald Trump, Douglas Hofstadter, dumpster diving, Flash crash, Gödel, Escher, Bach, High speed trading, Howard Rheingold, index fund, Isaac Newton, John Maynard Keynes: technological unemployment, knowledge economy, late fees, Mark Zuckerberg, market bubble, medical residency, Narrative Science, PageRank, pattern recognition, Paul Graham, prediction markets, quantitative hedge fund, Renaissance Technologies, ride hailing / ride sharing, risk tolerance, Sergey Aleynikov, side project, Silicon Valley, Skype, speech recognition, Spread Networks laid a new fibre optics cable between New York and Chicago, transaction costs, upwardly mobile, Watson beat the top human players on Jeopardy!, Y Combinator

., 217–18 McCartney, Paul, 104, 105, 107 “In My Life” claimed by, 110–11 as math savant, 103 McCready, Mike, 78–83, 85–89 McGuire, Terry, 145, 168–72, 174–76 machine-learning algorithms, 79, 100 Magnetar Capital, 3–4, 10 Mahler, Gustav, 98 Major Market Index, 40, 41 Making of a Fly, The (Lawrence), prices of, 1–2 Malyshev, Mikhail, 190 management consultants, 189 margin, trading with, 51 market cap, price swings and, 49 market makers: bids and offers by, 35–36 Peterffy as, 31, 35–36, 38, 51 market risk, 66 Maroon 5, 85 Marseille, 147, 149 Marshall, Andrew, 140 Martin, George, 108–10 Martin, Max (Martin Sandberg), 88–89 math: behind algorithms, 6, 53 education in, 218–20 mathematicians: algorithms and, 6, 71 online, 53 on Wall Street, 13, 23, 24, 27, 71, 179, 185, 201–3 Mattingly, Ken, 167 MBAs: eLoyalty’s experience with, 187 Peterffy’s refusal to hire, 47 MDCT scans, 154 measurement errors, distribution of, 63 medical algorithms, 54, 146 in diagnosis and testing, 151–56, 216 in organ sharing, 147–51 patient data and home monitoring in, 158–59 physicians’ practice and, 156–62 medical residencies, game theory and matching for, 147 medicine, evidence-based, 156 Mehta, Puneet, 200, 201 melodies, 82, 87, 93 Mercer, Robert, 178–80 Merrill Lynch, 191, 192, 200 Messiah, 68 metal: trading of, 27 volatility of, 22 MGM, 135 Miami University, 91 Michigan, 201 Michigan, University of, 136 Microsoft, 67, 124, 209 microwaves, 124 Midas (algorithm), 134 Miller, Andre, 143 mind-reading bots, 178, 181–83 Minneapolis, Minn., 192–93 minor-league statistics, baseball, 141 MIT, 24, 73, 128, 160, 179, 188, 217 Mocatta & Goldsmid, 20 Mocatta Group, 20, 21–25, 31 model building, predictive, 63 modifiers, 71 Boolean, 72–73 Mojo magazine, 110 Moneyball (Lewis), 141 money markets, 214 money streams, present value of future, 57 Montalenti, Andrew, 200–201 Morgan Stanley, 116, 128, 186, 191, 200–201, 204 mortgage-backed securities, 203 mortgages, 57 defaults on, 65 quantitative, 202 subprime, 65, 202, 216 Mosaic, 116 movies, algorithms and, 75–76 Mozart, Wolfgang Amadeus, 77, 89, 90, 91, 96 MP3 sharing, 83 M Resort Spa, sports betting at, 133–35 Mubarak, Hosni, 140 Muller, Peter, 128 music, 214 algorithms in creation of, 76–77, 89–103 decoding Beatles’, 70, 103–11 disruptors in, 102–3 homogenization or variety in, 88–89 outliers in, 102 predictive algorithms for success of, 77–89 Music X-Ray, 86–87 Musikalisches Würfelspiel, 91 mutual funds, 50 MyCityWay, 200 Najarian, John A., 119 Naples, 121 Napoleon I, emperor of France, 121 Napster, 81 Narrative Science, 218 NASA: Houston mission control of, 166, 175 predictive science at, 61, 164, 165–72, 174–77, 180, 194 Nasdaq, 177 algorithm dominance of, 49 Peterffy and, 11–17, 32, 42, 47–48, 185 terminals of, 14–17, 42 trading method at, 14 National Heart, Lung, and Blood Institute, 159 Nationsbank, Chicago Research and Trading Group bought by, 46 NBA, 142–43 Neanderthals, human crossbreeding with, 161 Nebraska, 79–80, 85 Netflix, 112, 207 Netherlands, 121 Netscape, 116, 188 Nevermind, 102 New England Patriots, 134 New Jersey, 115, 116 Newsweek, 126 Newton, Isaac, 57, 58, 59, 64, 65 New York, N.Y., 122, 130, 192, 201–2, 206 communication between markets in Chicago and, 42, 113–18, 123–24 financial markets in, 20, 198 high school matching algorithm in, 147–48 McCready’s move to, 85 Mocatta’s headquarters in, 26 Peterffy’s arrival in, 19 tech startups in, 210 New York Commodities Exchange (NYCE), 26 New Yorker, 156 New York Giants, 134 New York Knicks, 143 New York magazine, 34 New York State, health department of, 160 New York Stock Exchange (NYSE), 3, 38–40, 44–45, 49, 83, 123, 184–85 New York Times, 123, 158 New York University, 37, 132, 136, 201, 202 New Zealand, 77, 100, 191 Nietzsche, Friedrich, 69 Nirvana, 102 Nixon, Richard M., 140, 165 Nobel Prize, 23, 106 North Carolina, 48, 204 Northwestern University, 145, 186 Kellogg School of Management at, 10 Novak, Ben, 77–79, 83, 85, 86 NSA, 137 NuclearPhynance, 124 nuclear power, 139 nuclear weapons, in Iran, 137, 138–39 number theory, 65 numerals: Arabic-Indian, 56 Roman, 56 NYSE composite index, 40, 41 Oakland Athletics, 141 Obama, Barack, 46, 218–19 Occupy Wall Street, 210 O’Connor & Associates, 40, 46 OEX, see S&P 100 index Ohio, 91 oil prices, 54 OkCupid, 144–45 Olivetti home computers, 27 opera, 92, 93, 95 Operation Match, 144 opinions-driven people, 173, 174, 175 OptionMonster, 119 option prices, probability and statistics in, 27 options: Black-Scholes formula and, 23 call, 21–22 commodities, 22 definition of, 21 pricing of, 22 put, 22 options contracts, 30 options trading, 36 algorithms in, 22–23, 24, 114–15 Oregon, University of, 96–97 organ donor networks: algorithms in, 149–51, 152, 214 game theory in, 147–49 oscilloscopes, 32 Outkast, 102 outliers, 63 musical, 102 outputs, algorithmic, 54 Pacific Exchange, 40 Page, Larry, 213 PageRank, 213–14 pairs matching, 148–51 pairs trading, 31 Pakistan, 191 Pandora, 6–7, 83 Papanikolaou, Georgios, 153 Pap tests, 152, 153–54 Parham, Peter, 161 Paris, 56, 59, 121 Paris Stock Exchange, 122, 201 partial differential equations, 23 Pascal, Blaise, 59, 66–67 pathologists, 153 patient data, real-time, 158–59 patterns, in music, 89, 93, 96 Patterson, Nick, 160–61 PayPal, 188 PCs, Quotron data for, 33, 37, 39 pecking orders, social, 212–14 Pennsylvania, 115, 116 Pennsylvania, University of, 49 pension funds, 202 Pentagon, 168, 144 Perry, Katy, 89 Persia, 54 Peru, 91 Peterffy, Thomas: ambitions of, 27 on AMEX, 28–38 automated trading by, 41–42, 47–48, 113, 116 background and early career of, 18–20 Correlator algorithm of, 42–45 early handheld computers developed by, 36–39, 41, 44–45 earnings of, 17, 37, 46, 48, 51 fear that algorithms have gone too far by, 51 hackers hired by, 24–27 independence retained by, 46–47 on index funds, 41–46 at Interactive Brokers, 47–48 as market maker, 31, 35–36, 38, 51 at Mocatta, 20–28, 31 Nasdaq and, 11–18, 32, 42, 47–48, 185 new technology innovated by, 15–16 options trading algorithm of, 22–23, 24 as outsider, 31–32 profit guidelines of, 29 as programmer, 12, 15–16, 17, 20–21, 26–27, 38, 48, 62 Quotron hack of, 32–35 stock options algorithm as goal of, 27 Timber Hill trading operation of, see Timber Hill traders eliminated by, 12–18 trading floor methods of, 28–34 trading instincts of, 18, 26 World Trade Center offices of, 11, 39, 42, 43, 44 Petty, Tom, 84 pharmaceutical companies, 146, 155, 186 pharmacists, automation and, 154–56 Philips, 159 philosophy, Leibniz on, 57 phone lines: cross-country, 41 dedicated, 39, 42 phones, cell, 124–25 phosphate levels, 162 Physicians’ Desk Reference (PDR), 146 physicists, 62, 157 algorithms and, 6 on Wall Street, 14, 37, 119, 185, 190, 207 pianos, 108–9 Pincus, Mark, 206 Pisa, 56 pitch, 82, 93, 106 Pittsburgh International Airport, security algorithm at, 136 Pittsburgh Pirates, 141 Pius II, Pope, 69 Plimpton, George, 141–42 pneumonia, 158 poetry, composed by algorithm, 100–101 poker, 127–28 algorithms for, 129–35, 147, 150 Poland, 69, 91 Polyphonic HMI, 77–79, 82–83, 85 predictive algorithms, 54, 61, 62–65 prescriptions, mistakes with, 151, 155–56 present value, of future money streams, 57 pressure, thriving under, 169–70 prime numbers, general distribution pattern of, 65 probability theory, 66–68 in option prices, 27 problem solving, cooperative, 145 Procter & Gamble, 3 programmers: Cope as, 92–93 at eLoyalty, 182–83 Peterffy as, 12, 15–16, 17, 20–21, 26–27, 38, 48, 62 on Wall Street, 13, 14, 24, 46, 47, 53, 188, 191, 203, 207 programming, 188 education for, 218–20 learning, 9–10 simple algorithms in, 54 Progress Energy, 48 Project TACT (Technical Automated Compatibility Testing), 144 proprietary code, 190 proprietary trading, algorithmic, 184 Prussia, 69, 121 PSE, 40 pseudocholinesterase deficiency, 160 psychiatry, 163, 171 psychology, 178 Pu, Yihao, 190 Pulitzer Prize, 97 Purdue University, 170, 172 put options, 22, 43–45 Pythagorean algorithm, 64 quadratic equations, 63, 65 quants (quantitative analysts), 6, 46, 124, 133, 198, 200, 202–3, 204, 205 Leibniz as, 60 Wall Street’s monopoly on, 183, 190, 191, 192 Queen’s College, 72 quizzes, and OkCupid’s algorithms, 145 Quotron machine, 32–35, 37 Rachmaninoff, Sergei, 91, 96 Radiohead, 86 radiologists, 154 radio transmitters, in trading, 39, 41 railroad rights-of-way, 115–17 reactions-based people, 173–74, 195 ReadyForZero, 207 real estate, 192 on Redfin, 207 recruitment, of math and engineering students, 24 Redfin, 192, 206–7, 210 reflections-driven people, 173, 174, 182 refraction, indexes of, 15 regression analysis, 62 Relativity Technologies, 189 Renaissance Technologies, 160, 179–80, 207–8 Medallion Fund of, 207–8 retirement, 50, 214 Reuter, Paul Julius, 122 Rhode Island hold ‘em poker, 131 rhythms, 82, 86, 87, 89 Richmond, Va., 95 Richmond Times-Dispatch, 95 rickets, 162 ride sharing, algorithm for, 130 riffs, 86 Riker, William H., 136 Ritchie, Joe, 40, 46 Rochester, N.Y., 154 Rolling Stones, 86 Rondo, Rajon, 143 Ross, Robert, 143–44 Roth, Al, 147–49 Rothschild, Nathan, 121–22 Royal Society, London, 59 RSB40, 143 runners, 39, 122 Russia, 69, 193 intelligence of, 136 Russian debt default of 1998, 64 Rutgers University, 144 Ryan, Lee, 79 Saint Petersburg Academy of Sciences, 69 Sam Goody, 83 Sandberg, Martin (Max Martin), 88–89 Sandholm, Tuomas: organ donor matching algorithm of, 147–51 poker algorithm of, 128–33, 147, 150 S&P 100 index, 40–41 S&P 500 index, 40–41, 51, 114–15, 218 Santa Cruz, Calif., 90, 95, 99 satellites, 60 Savage Beast, 83 Saverin, Eduardo, 199 Scholes, Myron, 23, 62, 105–6 schools, matching algorithm for, 147–48 Schubert, Franz, 98 Schwartz, Pepper, 144 science, education in, 139–40, 218–20 scientists, on Wall Street, 46, 186 Scott, Riley, 9 scripts, algorithms for writing, 76 Seattle, Wash., 192, 207 securities, 113, 114–15 mortgage-backed, 203 options on, 21 Securities and Exchange Commission (SEC), 185 semiconductors, 60, 186 sentence structure, 62 Sequoia Capital, 158 Seven Bridges of Königsberg, 69, 111 Shannon, Claude, 73–74 Shuruppak, 55 Silicon Valley, 53, 81, 90, 116, 188, 189, 215 hackers in, 8 resurgence of, 198–211, 216 Y Combinator program in, 9, 207 silver, 27 Simons, James, 179–80, 208, 219 Simpson, O.


pages: 316 words: 91,969

Gray Lady Down: What the Decline and Fall of the New York Times Means for America by William McGowan


affirmative action, Affordable Care Act / Obamacare, corporate governance, David Brooks, East Village, friendly fire, haute couture, illegal immigration, immigration reform, medical residency, New Journalism, obamacare, payday loans, postnationalism / post nation state, pre–internet, uranium enrichment, young professional

Was he a self-radicalized “lone wolf” or part of a wider plot set in motion by an unseen Islamist fifth column in the Army? And whether his actions reflected personal pathology, religious extremism, or both together, how had he come to be commissioned as a highly trained U.S. Army medical officer, and promoted to the rank of major just six months earlier? The Washington Post intensified these questions by reporting that when Hasan was a medical resident in psychiatry at Walter Reed Army Hospital, he gave a PowerPoint presentation not on a medical topic but on “The Koranic World View As It Relates to Muslims in the U.S. Military.” He included the comment, “It’s getting harder and harder for Muslims in the service to morally justify being in a military that seems constantly engaged against fellow Muslims,” and presented some basics of Islamic thought and teaching, such as: “We [Muslims] love death more then [sic] you love life!”


pages: 422 words: 104,457

Dragnet Nation: A Quest for Privacy, Security, and Freedom in a World of Relentless Surveillance by Julia Angwin


AltaVista, Ayatollah Khomeini, barriers to entry, bitcoin, Chelsea Manning, clean water, crowdsourcing, cuban missile crisis, data is the new oil, David Graeber, Debian, Edward Snowden, Filter Bubble, Firefox, GnuPG, Google Chrome, Google Glasses, informal economy, Jacob Appelbaum, Julian Assange, market bubble, market design, medical residency, meta analysis, meta-analysis, mutually assured destruction, prediction markets, price discrimination, randomized controlled trial, RFID, Robert Shiller, Ronald Reagan, security theater, Silicon Valley, Silicon Valley startup, Skype, smart meter, Steven Levy, Upton Sinclair, WikiLeaks, Y2K, Zimmermann PGP

Jabber is run by volunteers who struggle to defend it against repeated hack attacks while running on donated computers. Off-the-Record is a volunteer project led by founder Ian Goldberg, who is now a professor at the University of Waterloo. Adium is an open source project led by Evan Schoenberg. There wasn’t much information about him on the website, so I called him up. It turned out he was an ophthalmologist finishing his fourth year of medical residency. He started Adium in college and had been trying to keep it up. “I thought when I went to medical school I was going to make the transition—I would hand the reins over to someone else,” Schoenberg told me. (He had time to talk because it was a quiet day at the hospital.) “But there was never anyone with programming experience who seemed to want to get involved in leadership.” And so Adium languished.


pages: 301 words: 86,278

Women and Autoimmune Disease by Robert G. Lahita


medical residency, stem cell, Yogi Berra

A compendium of papers on this important disease written by Dr. Hughes’s friends and colleagues. This is for the professional. Ronald Asherson, ed., The Antiphospholipid Syndrome (London: Elsevier Press, 2002). The textbook for this illness, edited for the professional. � The Immune System C. Janeway, P. Travers, M. Walport, and M. Shlomchik, Immunobiology, 5th ed. (New York: Garland Publications, 2001). This is the book that I use to teach medical residents and young physicians about basic immunology. It is a bit complicated but will be worth it for the very enthusiastic reader. The figures are terrific. � Vasculitis and the Circulation E. Ball and S. Louis Bridges Jr., eds., Vasculitis (New York: Oxford University Press, 2001). This is a comprehensive review of this very difficult topic. Issues of diagnosis, treatment, and pathogenesis of the disease are discussed.


pages: 292 words: 94,324

How Doctors Think by Jerome Groopman


affirmative action, Atul Gawande, Daniel Kahneman / Amos Tversky, deliberate practice, fear of failure, framing effect, index card, iterative process, medical malpractice, medical residency, Menlo Park, pattern recognition, placebo effect, stem cell, theory of mind

Gandhi concluded that the majority of serious errors that led to malpractice claims were cognitive in nature; see "Missed and delayed diagnoses in the ambulatory setting: A study of closed malpractice claims," Annals of Internal Medicine 145 (2006), pp. 488–496. Mark Graber presented a study of one hundred misdiagnoses highlighting the high frequency of cognitive pitfalls in "Diagnostic error in internal medicine," Archives of Internal Medicine 165 (2005), pp. 1493–1499. Studies of the use of computers to improve diagnosis have shown relatively small benefits, primarily among students rather than medical residents or attending physicians. In some instances the "computer consultation" was detrimental and caused the clinician to latch on to a misdiagnosis: Charles P. Friedman et al., "Enhancement of clinicians' diagnostic reasoning by computer-based consultation: A multiple study of 2 systems," JAMA 282 (1999), pp. 1851–1856. 1. Flesh-and-Blood Decision-Making Robert Hamm's comments can be found in his chapter "Clinical intuition and clinical analysis: Expertise and the cognitive continuum," in Professional Judgment: A Reader in Clinical Decision Making, ed.


pages: 336 words: 113,519

The Undoing Project: A Friendship That Changed Our Minds by Michael Lewis


Albert Einstein, availability heuristic, Cass Sunstein, choice architecture, complexity theory, Daniel Kahneman / Amos Tversky, Donald Trump, Douglas Hofstadter, endowment effect, feminist movement, framing effect, hindsight bias, John von Neumann, loss aversion, medical residency, Menlo Park, Murray Gell-Mann, Nate Silver, New Journalism, Richard Thaler, Saturday Night Live, statistical model, Walter Mischel, Yom Kippur War

But Redelmeier kept to himself any heretical thoughts he harbored as a young medical student. He had never felt the impulse to question authority or flout convention, and had no talent for either. “I was never shocked and disappointed before in my life,” he said. “I was always very obedient. Law-abiding. I vote in all elections. I show up at every university staff meeting. I’ve never had an altercation with the police.” In 1985, he was accepted as a medical resident at the Stanford University hospital. At Stanford he began, haltingly, to voice his professional skepticism. One night during his second year, he was manning the intensive care unit and was assigned to keep a young man alive long enough to harvest his organs. (The American euphemism—“harvesting”—sounded strange to his ears. In Canada they called it “organ retrieval.”) His brain-dead patient was a twenty-one-year-old who had wrapped his motorcycle around a tree.


pages: 264 words: 90,379

Blink: The Power of Thinking Without Thinking by Malcolm Gladwell


affirmative action, airport security, Albert Einstein, complexity theory, David Brooks, East Village, haute couture, Kevin Kelly, medical malpractice, medical residency, Menlo Park, new economy, pattern recognition, phenotype, Ronald Reagan, Silicon Valley, Stephen Hawking, theory of mind, young professional

So when it comes to chest pain, doctors gather as much information as they can, and then they make an estimate. The problem with that estimate, though, is that it isn’t very accurate. One of the things Reilly did early in his campaign at Cook, for instance, was to put together twenty perfectly typical case histories of people with chest pain and give the histories to a group of doctors—cardiologists, internists, emergency room docs, and medical residents—people, in other words, who had lots of experience making estimates about chest pain. The point was to see how much agreement there was about who among the twenty cases was actually having a heart attack. What Reilly found was that there really wasn’t any agreement at all. The answers were all over the map. The same patient might be sent home by one doctor and checked into intensive care by another.


pages: 346 words: 92,984

The Lucky Years: How to Thrive in the Brave New World of Health by David B. Agus


3D printing, active transport: walking or cycling, Affordable Care Act / Obamacare, Albert Einstein, butterfly effect, clean water, cognitive dissonance, crowdsourcing, Danny Hillis, Drosophila, Edward Lorenz: Chaos theory,, epigenetics, Kickstarter, medical residency, meta analysis, meta-analysis, microbiome, microcredit, mouse model, Murray Gell-Mann, New Journalism, pattern recognition, personalized medicine, phenotype, placebo effect, publish or perish, randomized controlled trial, risk tolerance, statistical model, stem cell, Steve Jobs, Thomas Malthus, wikimedia commons

And Osler was as much renowned for his practical jokes as he was for his doctoring and teaching. In fact, “Osleriana”—language from his written works—still appears frequently in the Journal of the American Medical Association, as a reminder of his wise and common tidbits. Perhaps Osler’s greatest contribution to medicine and to health care in general was to require that students learn by example—from seeing and talking to real patients. He established the first medical residency program, an idea that would eventually spread across the Western world and become the main system by which teaching hospitals operate. Even today, when you walk into a teaching hospital, much of the medical staff is composed of doctors in training. Osler also initiated another tradition in medical school by getting his students to the bedside early in their training. Rather than spend the majority of their time sitting in a lecture taking notes, third-year students mastered how to take patient histories, perform physicals, and order lab tests to examine various bodily fluids.


pages: 265 words: 93,231

The Big Short: Inside the Doomsday Machine by Michael Lewis


Asperger Syndrome, asset-backed security, collateralized debt obligation, Credit Default Swap, credit default swaps / collateralized debt obligations, diversified portfolio, facts on the ground, financial innovation, fixed income, forensic accounting, Gordon Gekko, high net worth, housing crisis, illegal immigration, income inequality, index fund, interest rate swap, London Interbank Offered Rate, Long Term Capital Management, medical residency, moral hazard, mortgage debt,, Ponzi scheme, Potemkin village, quantitative trading / quantitative finance, short selling, Silicon Valley, too big to fail, value at risk, Vanguard fund

I am asking myself that question all the time, and never have I felt like I should be thinking that way more than now. No way we should be down 5% this year just in mortgage CDSs." To his Goldman Sachs saleswoman, he wrote, "I think I am short housing but am I not, because CDSs are criminal?" When, a few months later, Goldman Sachs announced it was setting aside $542,000 per employee for the 2006 bonus pool, he wrote again: "As a former gas station attendant, parking lot attendant, medical resident and current Goldman Sachs screwee, I am offended." In the middle of 2006, he began to hear of other money managers who wanted to make the same bet he did. A few actually called and asked for his help. "I had all these people telling me I needed to get out of this trade," he said. "And I was looking at these other people and thinking how lucky they were to be able to get into this trade." If the market had been at all rational it would have blown up long before.


pages: 487 words: 151,810

The Social Animal: The Hidden Sources of Love, Character, and Achievement by David Brooks


Albert Einstein, asset allocation, Atul Gawande, Bernie Madoff, business process, Cass Sunstein, choice architecture, clean water, Daniel Kahneman / Amos Tversky, David Brooks, delayed gratification, deliberate practice, disintermediation, Donald Trump, Douglas Hofstadter, Emanuel Derman,, fear of failure, financial deregulation, financial independence, Flynn Effect, George Akerlof, Henri Poincaré, hiring and firing, impulse control, invisible hand, Joseph Schumpeter, labor-force participation, loss aversion, medical residency, meta analysis, meta-analysis, Monroe Doctrine, Richard Thaler, risk tolerance, Robert Shiller, Robert Shiller, school vouchers, six sigma, Steve Jobs, Steven Pinker, the scientific method, The Spirit Level, The Wealth of Nations by Adam Smith, Thorstein Veblen, transaction costs, Walter Mischel, young professional

They lent each other money, drove each other to the airport, helped each other load U-Hauls and generally provided all the services that people from an extended family might provide for one another in a more traditional society. Harold was sure that his group was filled with the most talented proto-geniuses that had ever been assembled. One of them was a singer-songwriter, another was doing her medical residency, a third did art and graphic design. Even the ones who had boring jobs had interesting sidelights—hot-air ballooning, extreme sports, or great potential as a future contestant on Jeopardy!. There was an unofficial ban against Groupcest, dating within the group. But an exception was made if the couple involved got really serious about each other. The Group conversations were the most exhilarating part of Harold’s life at this time.


pages: 542 words: 132,010

The Science of Fear: How the Culture of Fear Manipulates Your Brain by Daniel Gardner


Atul Gawande, availability heuristic, Black Swan, Cass Sunstein, citizen journalism, cognitive bias, cognitive dissonance, Columbine, correlation does not imply causation, Daniel Kahneman / Amos Tversky, David Brooks, Doomsday Clock, feminist movement, haute couture, hindsight bias, illegal immigration, medical residency, Mikhail Gorbachev, millennium bug, mutually assured destruction, nuclear winter, placebo effect, Ralph Nader, RAND corporation, Ronald Reagan, Stephen Hawking, Steven Levy, Steven Pinker, the scientific method, Tunguska event, uranium enrichment, Y2K, young professional

We also have to recognize that the brain that is doing this careful thinking is subject to the foibles of psychology. This is actually more difficult than it sounds. Psychologists have found that people not only accept the idea that other people’s thinking may be biased, they tend to overestimate the extent of that bias. But almost everyone resists the notion that their own thinking may also be biased. One survey of medical residents, for example, found that 61 percent said they were not influenced by gifts from drug company salespeople, but only 16 percent said the same of other physicians. It’s as if each of us recognizes that to err is human, but, happily for us, we are not human. But even if we accept that we, too, are human, coping with the brain’s biases is not easy. Researchers have tried to “debias” thinking by explaining to people what biases are and how they influence us, but that doesn’t work.


pages: 404 words: 124,705

The Village Effect: How Face-To-Face Contact Can Make Us Healthier, Happier, and Smarter by Susan Pinker


Atul Gawande, Bernie Madoff, call centre, cognitive dissonance, David Brooks, delayed gratification, Edward Glaeser, epigenetics, Erik Brynjolfsson, estate planning, facts on the ground, game design, happiness index / gross national happiness, indoor plumbing, invisible hand, Mark Zuckerberg, medical residency, Menlo Park, meta analysis, meta-analysis, neurotypical, Occupy movement, place-making, Ponzi scheme, Ralph Waldo Emerson, randomized controlled trial, Ray Oldenburg, Silicon Valley, Skype, Steven Pinker, The Great Good Place, The Wisdom of Crowds, theory of mind, Tony Hsieh, urban planning, Yogi Berra

Franklin Nathaniel Daniel Buchman, one of AA’s missionary founders put it, “confession as a prerequisite to change,” not to mention a social responsibility to experience a “change that must change others.”51 Overbearing zealots though they were, these self-control missionaries were right about one thing: when it comes to changing human habits around consumption, social pressure—especially from people you admire—works. The Real God of 12-Step In January 2009, the New York Times Magazine ran a profile of Dr. Drew Pinsky, an addictions specialist and the star of the reality TV shows Sober House and Celebrity Rehab with Dr. Drew. Pinsky’s decision to pursue addiction medicine as a career—his “burning bush moment,” as he called it—came while he was a medical resident providing care to recovering alcoholics and addicts at a Pasadena hospital. “I watched these people—these young people—go from dying to better than they ever knew they could be. And I was like, ‘Whoa.’ In medicine you go from dying to chronically ill. You don’t go from dying to better than you ever knew you could be. That just doesn’t happen,” he said. Pinsky soon evolved into the camera-ready therapist who could challenge, on air, the hidden demons of celebrity substance abusers like Rodney King and Heidi Fleiss, which earned him their public gratitude and the moniker “the God of 12-step.”


pages: 413 words: 119,587

Machines of Loving Grace: The Quest for Common Ground Between Humans and Robots by John Markoff


A Declaration of the Independence of Cyberspace, AI winter, airport security, Apple II, artificial general intelligence, augmented reality, autonomous vehicles, Baxter: Rethink Robotics, Bill Duvall, bioinformatics, Brewster Kahle, Burning Man, call centre, cellular automata, Chris Urmson, Claude Shannon: information theory, Clayton Christensen, clean water, cloud computing, collective bargaining, computer age, computer vision, crowdsourcing, Danny Hillis, DARPA: Urban Challenge, data acquisition, Dean Kamen, deskilling, don't be evil, Douglas Engelbart, Douglas Hofstadter, Dynabook, Edward Snowden, Elon Musk, Erik Brynjolfsson, factory automation, From Mathematics to the Technologies of Life and Death, future of work, Galaxy Zoo, Google Glasses, Google X / Alphabet X, Grace Hopper, Gödel, Escher, Bach, Hacker Ethic, haute couture, hive mind, hypertext link, indoor plumbing, industrial robot, information retrieval, Internet Archive, Internet of things, invention of the wheel, Jacques de Vaucanson, Jaron Lanier, Jeff Bezos, job automation, John Conway, John Maynard Keynes: Economic Possibilities for our Grandchildren, John Maynard Keynes: technological unemployment, John von Neumann, Kevin Kelly, knowledge worker, Kodak vs Instagram, labor-force participation, loose coupling, Mark Zuckerberg, Marshall McLuhan, medical residency, Menlo Park, Mother of all demos, natural language processing, new economy, Norbert Wiener, PageRank, pattern recognition, pre–internet, RAND corporation, Ray Kurzweil, Richard Stallman, Robert Gordon, Rodney Brooks, Sand Hill Road, Second Machine Age, self-driving car, semantic web, shareholder value, side project, Silicon Valley, Silicon Valley startup, Singularitarianism, skunkworks, Skype, social software, speech recognition, stealth mode startup, Stephen Hawking, Steve Ballmer, Steve Jobs, Steve Wozniak, Steven Levy, Stewart Brand, strong AI, superintelligent machines, technological singularity, Ted Nelson, telemarketer, telepresence, telepresence robot, Tenerife airport disaster, The Coming Technological Singularity, the medium is the message, Thorstein Veblen, Turing test, Vannevar Bush, Vernor Vinge, Watson beat the top human players on Jeopardy!, Whole Earth Catalog, William Shockley: the traitorous eight

“His facts are almost always wrong; his insight into programming is so poor that he classifies as impossible programs a beginner could write; and his logical insensitivity allows him to take his inability to imagine how a particular algorithm can be carried out, as reason to believe no algorithm can achieve the desired purpose.”14 Winograd would eventually break completely with Papert, but this would not happen for many years. He came to Stanford as a professor in 1973, when his wife, a physician, accepted an offer as a medical resident in the Bay Area. It was just two years after Intel had introduced the first commercial 4004 microprocessor chip, and trade journalist Don Hoefler settled on “Silicon Valley U.S.A.” as shorthand for the region in his newsletter Microelectronics News. Winograd continued to work for several years on the problem of machine understanding of natural language very much in the original tradition of SHRDLU.


pages: 309 words: 114,984

The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age by Robert Wachter


Affordable Care Act / Obamacare, AI winter, Airbnb, Atul Gawande, Captain Sullenberger Hudson, Checklist Manifesto, Clayton Christensen, collapse of Lehman Brothers, computer age, crowdsourcing, deskilling,, Erik Brynjolfsson, everywhere but in the productivity statistics, Firefox, Frank Levy and Richard Murnane: The New Division of Labor, Google Glasses, Ignaz Semmelweis: hand washing, Internet of things, job satisfaction, Joseph Schumpeter, knowledge worker, medical malpractice, medical residency, Menlo Park, minimum viable product, natural language processing, Network effects, Nicholas Carr, obamacare, pattern recognition, personalized medicine,, Productivity paradox, Ralph Nader, RAND corporation, Second Machine Age, self-driving car, Silicon Valley, Silicon Valley startup, six sigma, Skype, Snapchat, software as a service, Steve Jobs, Steven Levy, the payments system, The Wisdom of Crowds, Toyota Production System, Uber for X, Watson beat the top human players on Jeopardy!, Yogi Berra

But over the past five years, tens of billions of dollars of federal incentive payments have helped increase the adoption of electronic health records by hospitals and doctors’ offices from about 10 percent to about 70 percent. When it comes to technology, we’ve been like a car stuck in a ditch whose spinning tires suddenly gain purchase, so accustomed to staying still that we were totally unprepared for that first lurch forward. When I was a medical resident in the 1980s, my colleagues and I performed a daily ritual that we called “checking the shoebox.” All of our patients’ blood test results came back on flimsy slips that were filed, in rough alphabetical order, in a shoebox on a small card table outside the clinical laboratory. This system, like so many others in medicine, was wildly error-prone. Moreover, all the things you’d want your physician to be able to do with laboratory results—trend them over time; communicate them to other doctors, patients, or families; be reminded to adjust doses of relevant medications—were pipe dreams.


pages: 654 words: 191,864

Thinking, Fast and Slow by Daniel Kahneman


Albert Einstein, Atul Gawande, availability heuristic, Black Swan, Cass Sunstein, Checklist Manifesto, choice architecture, cognitive bias, complexity theory, correlation coefficient, correlation does not imply causation, Daniel Kahneman / Amos Tversky, delayed gratification, demand response, endowment effect, experimental economics, experimental subject, Exxon Valdez, feminist movement, framing effect, hindsight bias, index card, job satisfaction, John von Neumann, libertarian paternalism, loss aversion, medical residency, mental accounting, meta analysis, meta-analysis, nudge unit, pattern recognition, pre–internet, price anchoring, quantitative trading / quantitative finance, random walk, Richard Thaler, risk tolerance, Ronald Reagan, The Chicago School, The Wisdom of Crowds, transaction costs, union organizing, Walter Mischel, Yom Kippur War

Until the anesthesiologist Virginia Apgar intervened in 1953, physicians and midwives used their clinical judgment to determine whether a baby was in distress. Different practitioners focused on different cues. Some watched for breathing problems while others monitored how soon the baby cried. Without a standardized procedure, danger signs were often missed, and many newborn infants died. One day over breakfast, a medical resident asked how Dr. Apgar would make a systematic assessment of a newborn. “That’s easy,” she replied. “You would do it like this.” Apgar jotted down five variables (heart rate, respiration, reflex, muscle tone, and color) and three scores (0, 1, or 2, depending on the robustness of each sign). Realizing that she might have made a breakequthrough that any delivery room could implement, Apgar began rating infants by this rule one minute after they were born.


pages: 2,045 words: 566,714

J.K. Lasser's Your Income Tax by J K Lasser Institute


Affordable Care Act / Obamacare, airline deregulation, asset allocation, collective bargaining, distributed generation, employer provided health coverage, estate planning, Home mortgage interest deduction, medical malpractice, medical residency, mortgage debt, mortgage tax deduction, passive income, Ponzi scheme, profit motive, rent control, telemarketer, transaction costs, urban renewal, zero-coupon bond

Where these services are furnished by the employer and their value is deducted from your salary, the amount deducted is excluded from taxable wages on Form W-2. But if you pay for the utilities yourself, you may not exclude their cost from your income. - - - - - - - - - - Caution Housing as Job Requirement If housing is provided to some employees with a certain job and not others, the IRS may hold that the lodging is not a condition of employment. For example, the IRS taxed medical residents on the value of hospital lodging where other residents lived in their own apartments. - - - - - - - - - - EXAMPLE Tyrone Jones is employed at a construction project at a remote job site. His pay is $1,500 a week. Because there are no accessible places near the site for food and lodging, the employer furnishes meals and lodging for which it charges $400 a week, which is taken out of Jones’s pay.