medical residency

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The Ethical Algorithm: The Science of Socially Aware Algorithm Design by Michael Kearns, Aaron Roth

23andMe, affirmative action, algorithmic trading, Alvin Roth, Bayesian statistics, bitcoin, cloud computing, computer vision, crowdsourcing, Edward Snowden, Elon Musk, Filter Bubble, general-purpose programming language, Google Chrome, ImageNet competition, Lyft, medical residency, Nash equilibrium, Netflix Prize, p-value, Pareto efficiency, performance metric, personalized medicine, pre–internet, profit motive, quantitative trading / quantitative finance, RAND corporation, recommendation engine, replication crisis, ride hailing / ride sharing, Robert Bork, Ronald Coase, self-driving car, short selling, sorting algorithm, speech recognition, statistical model, Stephen Hawking, superintelligent machines, telemarketer, Turing machine, two-sided market, Vilfredo Pareto

One such setting is broadly known as matching markets in economics. While this phrase may bring to mind dating apps like Coffee Meets Bagel, matching markets are usually found in much more formal scenarios in which we want to pair up individuals with each other, or individuals with institutions. One long-standing application area is medical residency hiring, in which the approach we’ll describe is implemented as the National Resident Matching Program (NRMP, affectionately known as “The Match”). The basic problem formulation is as follows. Candidates for medical residencies each have an individual ranking of potential programs. For example, suppose the candidates Elaine and Saeed have the following ranked list of residencies (ignore the annotating characters for now, which we discuss shortly): Elaine Saeed Harvard Cornell Johns Hopkins UC San Diego @ UC San Diego & Harvard # Baylor Johns Hopkins Based on application materials and interviews, the schools of course also have their own ranked lists of candidates, such as: Harvard UC San Diego Saeed # Roger Elaine Saeed @ Roger Elaine & Gwyneth Mary So this is a two-sided market—candidates and hospitals—and there are also capacity constraints, because each candidate can of course take only one residency, and each hospital can only take a limited number of residents (which for simplicity we’ll assume is also just one).

First, regardless of the preferences, everyone gets matched (if there are equal number of men and women, and they don’t deem any of their potential partners as absolutely unacceptable; for instance, every medical student wants to do a residency no matter what). Second, the matching computed by the algorithm is stable in the sense we described above. Algorithms generalizing to the cases where there are unequal numbers of men and women (or students and medical schools), or where one side of the market can accept more than one partner (as in medical residencies), also exist. These algorithms are in widespread practical use, including in assigning actual medical residencies and other competitive admissions settings, such as matching students to public high schools and matching pledges to sororities in universities. (In contrast, US undergraduate college admissions are generally done in a much more haphazard fashion, giving rise to experiments in admissions office gamesmanship such as early decision, early action, requiring standardized tests or not, additional essays, and the like—all to the exhaustion and frustration of applicants and their parents.)

We can view the blood type and biology of a donor as a form of “preferences” over recipients—a donor “prefers” to donate to compatible recipients, and not to incompatible ones. Similarly, a recipient prefers to receive a transplant from a compatible donor. While there are many details that make this problem more complicated than medical residency matching, there are again practical, scalable algorithms that maximize the efficiency of the solution found, where here efficiency means maximizing the total number of compatible transplants that occur globally—ideally across all hospitals, not just within a single one. For his algorithmic and game-theoretic insights on this problem (and the others we have mentioned, including the medical residency match) and his efforts to convince the medical community and hospitals that it was worth the effort to pool their transplant donors, recipients and data, Alvin Roth was awarded the 2012 Nobel Prize in economics—along with the aforementioned Lloyd Shapley, whose early work initiated the era of algorithmic matching.


pages: 52 words: 16,113

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

Atul Gawande, cognitive dissonance, Johannes Kepler, medical residency, randomized controlled trial, retrograde motion, stem cell, Thomas Bayes

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, Chuck Templeton: OpenTable:, commoditize, computer age, computerized markets, 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, uber lyft, undersea cable

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, zero-sum game

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: 263 words: 78,433

What Doctors Feel: How Emotions Affect the Practice of Medicine by Danielle Ofri

affirmative action, delayed gratification, facts on the ground, job satisfaction, lateral thinking, longitudinal study, medical malpractice, medical residency, RAND corporation

I looked up and made a vague indication that I was running the code. There was an embarrassing moment as the fellow and I instantly recognized each other—Mitchell had been in my medical-school class. We’d spent the first two years of school together, even traveled in the same circle of friends. But because of the years I’d taken to do my PhD, he’d completed his training before me and was now a senior cardiology fellow while I was a third-year medical resident. It was evident that if he hadn’t known me from med-school days he would have dressed down the medical consult for not running the code more aggressively. He bit back his comment, sidled over to me, and leaned in to look at the EKG. “Peaked T waves, hyperkalemia,” he announced clearly, though not derisively—an act of humanity that allowed me a modicum of dignity. “Let’s get some calcium,” he said, “an amp of bicarb, D50 and insulin.”

They’d gotten a verbal report from someone in the ER that “psych had cleared the patient,” and they gave the same report to me. No one had taken the time—or had the time—to read the actual note to see that further monitoring was recommended, that the patient was still considered suicidal. Seeing the resident walk by, though, shot an idea into my head. I called Mount Sinai back and asked for the page operator. “This is Dr. Ofri,” I said, corralling some authoritative heft into my voice. “Please page the admitting medical resident for me.” The operator didn’t say a word or even ask if I was a Mount Sinai doctor; she simply patched through what must have been her 1,357th page of the day. Thirty seconds later a young voice was on the line. I quickly explained that I was a medical attending at Bellevue and that we’d transferred a patient to Mount Sinai this evening. I just needed to confirm that he’d arrived. The resident paused and I could hear clicking on a keyboard.

DKA is one of those rare, gratifying conditions in which a patient arrives in extremis and, with the deft handling of insulin, is readily cured. I felt a surge of pride as we watched our patient gain consciousness, get cranky, and then demand double meal portions. Our patient’s glucose returned to normal. With palpable triumph, I handed a “d/c insulin drip” order to the nurse. I was officially declaring our patient cured. The nurse took the order from me while passing a bottle of saline to another medical resident. “Do you want to give an injection of long-acting insulin before stopping the drip?” she asked me as the clerk pressed two more charts in her direction. I thought for a moment. Why would I want to use the sledgehammer of long-acting insulin after eight hours of our meticulous adjustments with the insulin drip? “No,” I said, turning to my intern, capitalizing on the teaching moment. “If we push him overboard with long-acting insulin, it’ll be stuck in his system for hours, and his sugar could bottom out.


pages: 262 words: 79,790

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

longitudinal study, 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

"Robert Solow", Airbnb, airport security, Al Roth, Alvin Roth, Andrei Shleifer, attribution theory, autonomous vehicles, barriers to entry, Brownian motion, business cycle, buy and hold, centralized clearinghouse, Chuck Templeton: OpenTable:, clean water, conceptual framework, constrained optimization, continuous double auction, creative destruction, deferred acceptance, Donald Trump, Edward Glaeser, experimental subject, first-price auction, framing effect, frictionless, fundamental attribution error, George Akerlof, Goldman Sachs: Vampire Squid, Gunnar Myrdal, helicopter parent, information asymmetry, 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, Kenneth Arrow, late fees, linear programming, Lyft, market clearing, market design, market friction, medical residency, multi-sided market, mutually assured destruction, Nash equilibrium, Occupy movement, Pareto efficiency, Paul Samuelson, Peter Thiel, pets.com, 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, uber lyft, uranium enrichment, Vickrey auction, Vilfredo Pareto, 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, Pepto Bismol, 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: 277 words: 88,539

Singular Intimacies: Becoming a Doctor at Bellevue by Danielle Ofri

index card, medical residency, placebo effect, union organizing

It was apparently difficult for FMGs to gain positions at larger medical centers. Later on I learned that if it weren’t for the FMGs, there would be almost no medical care in small community hospitals in most of America, but no one ever mentioned that. Miguel had been raised in upper-middle class Venezuela. He’d attended private Catholic schools and the most prestigious college and medical school. He’d completed an entire medical residency in South America but was now repeating it in New York in order to apply to competitive American cardiology fellowships. For him, life in the hospital was old-hat. Nothing fazed or unnerved him, which was a relief to me, for whom everything was a potential land mine. He enjoyed sharing his knowledge and never minded when the other members of the team made fun of his throaty accent. He was more well-read in European and American literature than I was, and he was as likely to expound upon Flaubert as he was upon hypokalemia.

There was even someone from legal affairs. There were so many levels of hierarchy in the room that I couldn’t keep track of who feared whom the most. The case summary was gripped in my right hand, a cup of coffee in my left. Only a few drops spilled onto the typed sheets as I squirmed into my seat under the weight of their stares. I wasn’t the only person who had made the error, but as medical consult—the senior medical resident—I’d been in charge. Well, since this was University Hospital, the attending was really in charge, so I guess he’d be at the top of the lawsuit. And there were all those consultants on the case, too. But it’s always the resident who gets flayed for the screwups. Residents are cheap labor for the private attendings. We carry out their orders, do all their scut, but have little say in the important medical decisions like we do at Bellevue.

“Last Wednesday he was admitted to University Hospital with symptoms of nausea, vomiting, and dizziness. His admission labs were within normal limits. On Thursday, endoscopy showed esophageal strictures. On Friday he underwent successful balloon dilatation of the strictures. By Saturday the patient was already able to swallow soft foods.” I was medical consult at UH that weekend. As the senior medical resident I was responsible for all the interns and residents on call. I had to handle all admissions and transfers, and of course any codes. I was irritable just having to be there—I preferred to work at Bellevue. Maybe Bellevue didn’t have as many amenities, but at least we residents got to make all the decisions about patient care. At UH we had to ask the attendings permission for every little thing.


pages: 332 words: 97,325

The Launch Pad: Inside Y Combinator, Silicon Valley's Most Exclusive School for Startups by Randall Stross

affirmative action, Airbnb, AltaVista, always be closing, Amazon Mechanical Turk, Amazon Web Services, barriers to entry, Ben Horowitz, Burning Man, business cycle, California gold rush, call centre, cloud computing, crowdsourcing, don't be evil, Elon Musk, high net worth, index fund, inventory management, John Markoff, Justin.tv, Lean Startup, Marc Andreessen, Mark Zuckerberg, medical residency, Menlo Park, Minecraft, minimum viable product, Paul Buchheit, Paul Graham, Peter Thiel, QR code, Richard Feynman, Richard Florida, ride hailing / ride sharing, Sam Altman, Sand Hill Road, side project, Silicon Valley, Silicon Valley startup, Skype, social graph, software is eating the world, South of Market, San Francisco, speech recognition, Stanford marshmallow experiment, Startup school, stealth mode startup, Steve Jobs, Steve Wozniak, Steven Levy, TaskRabbit, transaction costs, Y Combinator

Ballinger says he is excited about this idea because he worked on detecting keyword spam at Google, and Tan has worked on related problems, too. Ballinger is concerned, though, that fewer than a thousand Web sites host discussion forums whose scale is large enough to need the service. This would seem to limit the potential size of the startup. Another idea they are considering is medical resident scheduling. “Do you know how it works? OK, at the beginning of the year, the head resident puts together a schedule of all the rotations medical residents do. Each one has a specialty—” “How did you arrive at that idea?” Taggar asks. “We know a lot of doctors. Jason has been on the phone with like ten to fifteen different doctors. I heard about it ’cause my doctor friends are always complaining that this is a huge issue—” Taggar attempts to steer the conversation away from this idea and back to the first one.

Because it means they’re not desperate for it.” The spam detection idea is looking better. Ballinger says one company that they spoke with said it would be willing to pay annually the equivalent of “two engineers’ salaries” for this service, because it was contemplating having two software engineers work on the spam problem full-time. “That’s pretty encouraging,” says Taggar. Ballinger and Tan are not yet ready to give up medical resident scheduling, however. “The adjacent thing is emergency room scheduling,” says Ballinger. “Happens monthly. And there are a lot more ERs than residency programs.” Taggar still is not enthusiastic. “Of the ideas we’ve talked about so far, the spam idea sounds interesting to me because it’s something you guys have a background in, it’s something that someone has told you they would pay you for.


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, business cycle, corporate governance, declining real wages, full employment, index fund, Jeff Bezos, medical malpractice, medical residency, money market fund, offshore financial centre, price discrimination, risk tolerance, spread of share-ownership

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, business cycle, Byte Shop, Cal Newport, capital controls, cleantech, Community Supported Agriculture, deliberate practice, financial independence, follow your passion, Frank Gehry, information asymmetry, 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, 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: 442 words: 127,300

Why We Sleep: Unlocking the Power of Sleep and Dreams by Matthew Walker

A. Roger Ekirch, active measures, clockwatching, Dmitri Mendeleev, Donald Trump, Exxon Valdez, impulse control, lifelogging, longitudinal study, medical residency, meta analysis, meta-analysis, microbiome, mouse model, orbital mechanics / astrodynamics, placebo effect, RAND corporation, Ronald Reagan, the scientific method

This is because the revised rule (at the time of writing this book) has only been applied to those in their first year of training, and not to those in later years of a medical residency. Why? Because the Accreditation Council for Graduate Medical Education—the elite board of high-powered physicians that dictates the American residency training structure—stated that data proving the dangers of insufficient sleep had only been gathered in residents in their first year of the program. As a result, they felt there was no evidence to justify a change for residents in years two to five—as if getting past the twelve-month point in a medical residency program magically confers immunity against the biological and psychological effects of sleep deprivation—effects that these same individuals had previously been so provably vulnerable to just months before.

Residents working a thirty-hour-straight shift will commit 36 percent more serious medical errors, such as prescribing the wrong dose of a drug or leaving a surgical implement inside of a patient, compared with those working sixteen hours or less. Additionally, after a thirty-hour shift without sleep, residents make a whopping 460 percent more diagnostic mistakes in the intensive care unit than when well rested after enough sleep. Throughout the course of their residency, one in five medical residents will make a sleepless-related medical error that causes significant, liable harm to a patient. One in twenty residents will kill a patient due to a lack of sleep. Since there are over 100,000 residents currently in training in US medical programs, this means that many hundreds of people—sons, daughters, husbands, wives, grandparents, brothers, sisters—are needlessly losing their lives every year because residents are not allowed to get the sleep they need.


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, publication bias, RAND corporation, randomized controlled trial, selective serotonin reuptake inhibitor (SSRI), 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: 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, hedonic treadmill, income per capita, job satisfaction, loss aversion, medical residency, mental accounting, Own Your Own Home, Pareto efficiency, 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: 266 words: 77,045

The Bend of the World: A Novel by Jacob Bacharach

Burning Man, haute couture, helicopter parent, Isaac Newton, medical residency, phenotype, quantitative easing, too big to fail, trade route, young professional

I liked my mother, loved her, even, but it was always best to talk to her with one’s psychic armor on or, if that wasn’t combat-ready, with a strong dose of one’s psychic anesthetic. I lived on the third floor of a converted Victorian near Friendship Avenue. The rest of the poor house, like all the other defiled old houses on my street, had long since given up its grace to cheap drywall and particleboard kitchens. An endless stream of undergraduates and itinerant hipsters and drag queens and the occasional medical residents, lured by the online promise of unbelievable (really, unbelievable) rent and a few photographs of the admittedly charming exterior as well as the wide blond floorboards and arched dormer windows that were, in fact, in my apartment alone and in no way representative of any of the others, signed leases sight unseen, arrived, and swiftly departed, paying the neat penalty of three months’ rent (security deposit, first and last month) to get the fuck out of those shitholes.

I could not recall when I’d begun to think this way. I pulled out my phone and entered the listing number from the sign on the real estate company’s website. It occurred to me that I had, or I would soon have, enough money to buy the place. Six units, I thought. You could turn that into income. The Mexicans could do the whole thing for twenty, thirty K. And not a shitty job. But still, a reasonable price point. Mid-level. Appropriate for a medical resident or an arts admin or something. An actual and essential function for the world I’d made. 26 After lunch, I met Julian at his other gym in East Liberty and we played racquetball for an hour. I’d considered canceling; it seemed absurd to play before going to a funeral; but then, phone in hand, finger about to tap Julian’s number, I thought, Well, what the fuck, it would be even weirder to cancel because of a funeral, as if a dead woman could be insulted that your attention was elsewhere and otherwise, as if an as-yet-unascended soul could be fooled by the artifice of grieving in excess of the grief one actually felt, as if, having already spent the morning in a jail and contemplating a future livelihood bought with my blood money bribe, it would be anything less than entirely absurd to sit in my apartment trying to be, of all things, appropriate.


pages: 287 words: 82,576

The Complacent Class: The Self-Defeating Quest for the American Dream by Tyler Cowen

affirmative action, Affordable Care Act / Obamacare, Airbnb, Alvin Roth, assortative mating, Bernie Sanders, Black Swan, business climate, business cycle, circulation of elites, clean water, David Graeber, declining real wages, deindustrialization, desegregation, Donald Trump, drone strike, East Village, Elon Musk, Ferguson, Missouri, Francis Fukuyama: the end of history, gig economy, Google Glasses, Hyman Minsky, Hyperloop, income inequality, intangible asset, Internet of things, inventory management, knowledge worker, labor-force participation, low skilled workers, Marc Andreessen, Mark Zuckerberg, medical residency, meta analysis, meta-analysis, obamacare, offshore financial centre, Paul Samuelson, Peter Thiel, purchasing power parity, Richard Florida, security theater, sharing economy, Silicon Valley, Silicon Valley ideology, Skype, South China Sea, Steven Pinker, Stuxnet, The Great Moderation, The Rise and Fall of American Growth, total factor productivity, Tyler Cowen: Great Stagnation, upwardly mobile, Vilfredo Pareto, working-age population, World Values Survey

Alvin Roth, an experimental economist now at Stanford University, won a Nobel Prize in part for using economic theory to come up with better algorithms for matching, and these methods are supposed to be robust across many realms in a quite general sense. His Nobel Prize was an especially deserved one, as it reflects the spirit of our times more than was recognized in 2012, the year he won. Some of Roth’s work focused on the allocation of doctors to medical residencies, which is fundamentally a problem of matching. At some point in the process of becoming a full-fledged doctor, candidates apply for resident appointments, but there are many candidates and many available places for service, and not everyone can get his or her top choice of venue or doctor. Given this complexity, what is the most efficient way to decide which candidates should be paired with which slots?

Roth came up with a scheme that asks both doctors and hospitals to present their rank orderings. His algorithm then uses this information to make the best possible allocation of doctors across residencies. Roth’s matching algorithm now governs the national system of slot allocation. It’s better for doctors and hospitals, and probably better for patients too, because happier doctors probably means higher-quality performance. Roth’s algorithms for matching are not just for medical residencies. Many colleges and universities, when they receive a new class of freshmen and must allocate them to dorms and roommates, draw on Roth’s ideas to elicit preference rankings and then use mathematics to perform the optimal pairings. Again, not everyone can get his or her first choice, but the better matching makes as many students as happy as possible. In that context, better connections can mean more lasting friendships or business connections across an entire lifetime.


pages: 295 words: 82,786

The Harm in Asking: My Clumsy Encounters With the Human Race by Sara Barron

Burning Man, Columbine, East Village, medical residency

The first thing I noticed about Dr. Dean was that Dr. Dean was very handsome. He had hair that looked plucked from a Ken doll, and his shoulders were so, like, erotically broad I’d have licked my way across them if given the chance. Dr. Dean was the director of the hospital’s orthopedics department, and this meant that wherever he went—whenever he went there—a gaggle of medical residents trailed along behind. These medical residents were also very handsome. I hadn’t known I had a thing for doctors, but now I realized this was only because I’d never seen a slew of handsome ones together. The cumulative effect suggested I’d died and gone to Vegas heaven, to a place where the showgirls were not showgirls at all, but rather Harvard-educated, scrubs-clad show-boys. Except, of course, they weren’t. They were not Vegas show-boys, and I was not in Vegas heaven.


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, Joan Didion, life extension, longitudinal study, Louis Pasteur, medical residency, meta analysis, meta-analysis, mouse model, New Journalism, phenotype, randomized controlled trial, Robert Mercer, scientific mainstream, Silicon Valley, social web, statistical model, stem cell, women in the workforce, Year of Magical Thinking, 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: 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: 289 words: 87,137

What Patients Say, What Doctors Hear by Danielle Ofri

big-box store, Columbine, Daniel Kahneman / Amos Tversky, medical residency, meta analysis, meta-analysis, Nelson Mandela, placebo effect, randomized controlled trial, stem cell

The treatment has to score better than placebo, otherwise it’s deemed useless. But outside of research, placebo has been viewed with suspicion. Using placebos in actual clinical medicine is considered shady, if not downright unethical. But communication plays an enormous role in placebo and the eschewal of using placebo in treatment is starting to ease. I had occasion to employ a placebo one night during my second year of medical residency, though even to this day I’m not sure whether I did the right thing. It was well past midnight on the AIDS ward at Bellevue Hospital in New York City, at a time when this ward was overflowing with patients. Despite the late hour, the nurses and doctors were still rushing about at full speed, as the admissions continued to surge in, each more feverish and emaciated than the previous. But even the AIDS ward eventually quieted down for the night.

Telling patients the truth about errors, even about near misses, is, of course, the right thing to do. Every doctor would say that this is the ethically correct course of action. But I know from brutal experience that this is far from easy. It was during a long night on call—we were probably up to our eighth or ninth admission that day, but my intern and I had long since given up counting. I was midway through my medical residency at Bellevue and was already a seasoned survivalist; you had to be, otherwise you’d drown in the overwhelming pummel of admissions that streamed in from the ER, day and night. This admission was a classic eye-roller: a nursing home patient with dementia, sent to our hospital for altered mental status. When you were juggling patients with bleeding ulcers, acute heart failure, fulminant septicemia, raging diabetic infections, and multidrug overdoses, it was hard to get worked up about a demented nonagenarian who someone thought was looking perhaps a wee bit more demented that day.


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, en.wikipedia.org, fundamental attribution error, impulse control, longitudinal study, 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: 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, Donald Knuth, double helix, Douglas Engelbart, Douglas Engelbart, en.wikipedia.org, Erik Brynjolfsson, fault tolerance, Fellow of the Royal Society, Firefox, Freestyle chess, Galaxy Zoo, Internet Archive, invisible hand, Jane Jacobs, Jaron Lanier, Johannes Kepler, Kevin Kelly, Magellanic Cloud, means of production, medical residency, Nicholas Carr, P = NP, publish or perish, Richard Feynman, Richard Stallman, selection bias, semantic web, Silicon Valley, Silicon Valley startup, Simon Singh, Skype, slashdot, social intelligence, 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: 424 words: 114,905

Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again by Eric Topol

23andMe, Affordable Care Act / Obamacare, AI winter, Alan Turing: On Computable Numbers, with an Application to the Entscheidungsproblem, artificial general intelligence, augmented reality, autonomous vehicles, bioinformatics, blockchain, cloud computing, cognitive bias, Colonization of Mars, computer age, computer vision, conceptual framework, creative destruction, crowdsourcing, Daniel Kahneman / Amos Tversky, dark matter, David Brooks, digital twin, Elon Musk, en.wikipedia.org, epigenetics, Erik Brynjolfsson, fault tolerance, George Santayana, Google Glasses, ImageNet competition, Jeff Bezos, job automation, job satisfaction, Joi Ito, Mark Zuckerberg, medical residency, meta analysis, meta-analysis, microbiome, natural language processing, new economy, Nicholas Carr, nudge unit, pattern recognition, performance metric, personalized medicine, phenotype, placebo effect, randomized controlled trial, recommendation engine, Rubik’s Cube, Sam Altman, self-driving car, Silicon Valley, speech recognition, Stephen Hawking, text mining, the scientific method, Tim Cook: Apple, War on Poverty, Watson beat the top human players on Jeopardy!, working-age population

We quickly came to the realization that the esophageal varices were secondary to end-stage liver disease. A man who had been perfectly healthy for ninety years all of a sudden was in a coma with a rotted liver. He was receiving no intravenous or nutritional support, but he was receiving lactulose enemas to reduce his blood ammonia level from the liver failure. His prognosis for any meaningful recovery was nil, and the attending doctor and the medical residents suggested that we make him a do-not-resuscitate order. Arrangements were made over the next few days for him to come to our house with hospice support, so he could die at home. Late on a Sunday night, the night before we were to take my father-in-law home to die, my wife and daughter went to visit him. They both had been taught “healing touch” and, as an expression of their deep love, spent a few hours talking to him and administering this spiritual treatment as he lay comatose.

Given the importance of empathy for improving physician performance and psychosocial outcomes, it’s vital to know whether empathy can be nurtured—or destroyed. Zak Kelm and his colleagues undertook a major analysis of sixty-four studies, ten of which they considered to be rigorously designed; in general, the studies showed that empathy can be cultivated among physicians.24 Unfortunately, empathy scores decline during medical training, as empathy is challenged by the practice environment. As David Scales, a medical resident, noted, practitioners lack the time to care for patients as the doctors hope and patients deserve, with physicians blaming “the time pressure created by a billing system that promotes quantity of patients seen over quality, the lack of control over the chaotic work environment, and endless time spent on administrative tasks.”25 We also know that medical professionals generally have low scores on empathy quotient (EQ) tests.


pages: 405 words: 112,470

Together by Vivek H. Murthy, M.D.

Airbnb, call centre, cognitive bias, coronavirus, COVID-19, Covid-19, crowdsourcing, gig economy, income inequality, index card, longitudinal study, Lyft, Mahatma Gandhi, medical residency, meta analysis, meta-analysis, moral hazard, Nelson Mandela, Ralph Waldo Emerson, randomized controlled trial, rent control, ride hailing / ride sharing, Ronald Reagan, sharing economy, Silicon Valley, Silicon Valley startup, Skype, Snapchat, social intelligence, stem cell, twin studies, Uber and Lyft, uber lyft

My pockets were overflowing with tools, including a stethoscope, ophthalmoscope, tuning fork, reflex hammer, Pocket Medicine handbook, three black ballpoint pens, blank index cards for recording patient details, a list of phone numbers for key hospital services, and laminated cards filled with algorithms for everything from cardiac resuscitation to the treatment of diabetic ketoacidosis. Yet none of those cards and manuals mentioned the most common ailment I was about to encounter among my patients. In the days ahead, as I went on bedside rounds with my team of medical residents and senior physicians, I focused my attention on getting the right diagnosis and prescribing the right medications, treatments, and tests. It was overwhelming at times, but as the months wore on, I got more and more comfortable managing common illnesses like diabetes and cancer and unusual ones that I had only read about in textbooks. As I slowly ascended the steep learning curve of medical training, I began to notice other aspects of the people I was caring for, including their social lives—or lack thereof.

Yet despite all the innovation, technology, and resources that promise to make modern life easier, I found myself thinking I’d rather have the strong community that this man was describing. Family close by and neighbors who were like family. I’d take the traditional solution over the modern-world solution of community-for-hire any day. This encounter reminded me fondly of another Ethiopian family I’d met during my first year as a medical resident. I received a page one Saturday afternoon to evaluate a patient with advanced liver failure due to hepatitis C, acquired through a blood transfusion many years earlier. Checking her chart on my way to the hospital’s main patient tower, I read that Mrs. Bekele was in the final stages of her illness. At this point, no treatment could cure her, and she had come to terms with that. She’d been admitted for comfort care, meaning that she was being maintained on a morphine drip and other medicines to relieve symptoms such as nausea and pain.


pages: 676 words: 203,386

The Platinum Age of Television: From I Love Lucy to the Walking Dead, How TV Became Terrific by David Bianculli

affirmative action, Albert Einstein, Alistair Cooke, Berlin Wall, Bernie Sanders, cuban missile crisis, desegregation, Donald Trump, Downton Abbey, feminist movement, friendly fire, global village, Mark Zuckerberg, medical residency, period drama, pre–internet, Ronald Reagan, Saturday Night Live, Steve Jobs, trickle-down economics, unpaid internship

“I think the first thing I learned, which is maybe the best thing,” Kelley says of his days with Bochco on L.A. Law, “was just never underestimate the intelligence of the audience. There are a lot of studio and network executives that will preach just the opposite.” In 1989, Bochco invited Kelley to co-create, and collaborate on, another series, ABC’s Doogie Howser, M.D. comedy-drama, starring a teenage Neil Patrick Harris as a young prodigy medical resident. When I interviewed Bochco, I mentioned I planned to classify Doogie, in my history of quality TV, under the medical show genre, but he disagreed with me, saying he considered it first and foremost a family drama. And he should know, so I reclassified it. “The medical aspects of it was the sort of organizing element of it, no question,” Bochco allows. “But the concept, to me, was most interesting as a notion of ‘How does a prodigy still manage to be a kid when he or she is possessed of some kind of prodigious ability?’

Even its most prominent characters could die suddenly or have their lives changed significantly, and that refers to the doctors and nurses as well as the patients. Not only did one doctor become a serial rapist, but another, Morse’s Dr. Morrison, was a rape victim himself, taken hostage and brutalized while tending to male patients at a local prison. (Fontana’s dry run, perhaps, for the brutality of Oz.) Regular characters died suddenly, committed suicide, became clinically depressed, lost their medical residencies, or suffered razor slashes to the face. One doctor, Mark Harmon’s Bobby Caldwell, became the first prominent TV character to contract AIDS, and that wasn’t the first time St. Elsewhere had explored that particular subject matter. A story line in 1983, involving a secretly gay politician who tested positive for HIV, was the first mention and depiction of the AIDS virus on prime-time dramatic television.

— The next batch of prominent medical shows were genre benders, dealing with medicine in more unorthodox settings or styles than the straightforward medical series. ABC’s China Beach (1988–91), set near the front lines during the Vietnam War, was, like CBS’s M*A*S*H, as much a war series as a medical one and is discussed there instead. ABC’s Doogie Howser, M.D. (1989–93), starring Neil Patrick Harris as a teenage medical resident, is split between scenes at the hospital and scenes at home, but the creator Steven Bochco says he considers the show, first and foremost, a family comedy-drama. CBS’s Northern Exposure (1990–95), from the early St. Elsewhere producers Joshua Brand and John Falsey, was about a New York doctor repaying his massive student loan debt by tending to the citizens of a small town in Alaska but was much more about the townspeople than the medicine.


pages: 150 words: 45,389

When Breath Becomes Air by Paul Kalanithi, Abraham Verghese

coherent worldview, delayed gratification, medical residency, scientific worldview, Silicon Valley, stem cell

This was unlike the usual nausea of chemotherapy, which washed over you like a wave and, like a wave, could be ridden. I began uncontrollably vomiting green bile, its chalky taste distinct from stomach acid. This was from deep in my gut. I would not be going to graduation, after all. I needed IV fluids to avoid dehydration, so Lucy drove me to the emergency department and rehydration began. The vomiting gave way to diarrhea. The medical resident, Brad, and I chatted amicably, and I relayed my medical history, covering all my medications, and we ended up discussing advances in molecular therapies, especially Tarceva, which I was still taking. The medical plan was simple: keep me hydrated with intravenous fluids until I could drink enough by mouth. That evening, I was admitted to a hospital room. But when the nurse reviewed my medication list, I noticed Tarceva was not on it.


pages: 436 words: 131,430

House of God by Samuel Shem

affirmative action, index card, lateral thinking, medical residency, MITM: man-in-the-middle, Norman Mailer, placebo effect

To turn cruelty to compassion is a great alchemy of life. You see, the world is so finely balanced that small actions can have tremendous effects—one person can make a difference. Our ten-year-old did, and is continuing to do so. To all, my gratitude. Samuel Shem, M.D., Ph.D. October 15, I. FRANCE Life's like a penis: When it's soft you can't beat it; When it's hard you get screwed. —The Fat Man, Medical Resident in the House of God 1 Except for her sunglasses, Berry is naked. Even now, on vacation in France with my internship year barely warm in its grave, I can't see her bodily imperfections. I love her breasts, the way they change when she lies flat, on her stomach, on her back, and then when she stands, and walks. And dances. Oh, how I love her breasts when she dances. Cooper's ligaments suspend the breasts.

When I'd told her I'd be taking a year off, she'd said, "That's OK, I'll be your patient when you get back." No. She'd be dead. It was hard, too hard. I went through my last Clinic taking deep breaths to keep back the tears. Mae, my black Witness, concerned about my puffing, asked, "Oh Doctuh Bass, you ain't done caught my asthma from me, has you?" When I'd told people I was thinking of going into psychiatry, many were surprised. … NOT GOING ON IN YOUR MEDICAL RESIDENCY?! YOU PROMISED THEM! HOW WILL IT LOOK ON YOUR RECORD? RECONSIDER! I AM AMAZED!… My father. For the first time, he'd been nudged out of his conjunctions. But then, calming himself again, he embraced his grammar, he embraced his son, and went on: … I can't understand your taking a year off and it is a waste of a potential year's income. I'm amazed at your going into psychiatry and it seems a waste of your talent.


pages: 520 words: 134,627

Unacceptable: Privilege, Deceit & the Making of the College Admissions Scandal by Melissa Korn, Jennifer Levitz

"side hustle", affirmative action, barriers to entry, blockchain, call centre, Donald Trump, Gordon Gekko, helicopter parent, high net worth, Jeffrey Epstein, Maui Hawaii, medical residency, Menlo Park, performance metric, rolodex, Ronald Reagan, Sand Hill Road, Saturday Night Live, side project, Silicon Valley, Snapchat, stealth mode startup, Steve Jobs, telemarketer, Thorstein Veblen, unpaid internship, upwardly mobile, yield management, young professional, zero-sum game

Lamb, who would go on to become a U.S. congressman representing a western Pennsylvania district, had just come out of the Marine Corps and was used to being around very hardworking, disciplined people. The two clicked. After graduating from Harvard and then Columbia Law School, Rosen worked as an assistant district attorney in Manhattan and then clerked for a federal judge in the Southern District of New York before jumping to the private firm of Richards Kibbe & Orbe, where he became a point person on complex securities cases. When his wife landed a medical residency spot in Pittsburgh, he could’ve stayed in lucrative private practice. But government service had an allure, and he became a federal prosecutor there, focused on drug cases, navigating gritty distributors, informants, and wiretaps. His peers saw him as notably tenacious with an unusual ability to laugh at himself. Rosen cycled to the office in a suit, even in the winter, and always seemed itching to dive in, despite whatever misadventure he’d had on the way in.

Hooper believed the couple had been under the impression that going to the West Hollywood test site was beneficial for students who needed special testing arrangements, such as extra time. He said their son had for years received such allowances for a legitimate medical issue. The couple traveled with the teen and even turned the visit into a fun family weekend, visiting Gregory Colburn’s old stomping grounds of West Hollywood, where he lived while doing his medical residency at UCLA, Hooper said. The teen brought his pencils and packed his lunch like his peers. But according to Hooper, the couple had no idea that Singer’s corrupt proctor would be there, or that he would take the test from their son at the end and fix his answers. The Colburns, Hooper said, “thought it was all legit.” * * * • • • TO BE ONE DEFENSE LAWYER standing against the full power of the federal government takes more than skill.


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, business cycle, 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, pets.com, 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: 385 words: 117,391

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

active measures, follow your passion, medical residency, meta analysis, meta-analysis, place-making, placebo effect, 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.


We Are the Nerds: The Birth and Tumultuous Life of Reddit, the Internet's Culture Laboratory by Christine Lagorio-Chafkin

4chan, Airbnb, Amazon Web Services, Bernie Sanders, big-box store, bitcoin, blockchain, Brewster Kahle, Burning Man, crowdsourcing, cryptocurrency, David Heinemeier Hansson, Donald Trump, East Village, game design, Golden Gate Park, hiring and firing, Internet Archive, Jacob Appelbaum, Jeff Bezos, jimmy wales, Joi Ito, Justin.tv, Kickstarter, Lean Startup, Lyft, Marc Andreessen, Mark Zuckerberg, medical residency, minimum viable product, natural language processing, Paul Buchheit, Paul Graham, paypal mafia, Peter Thiel, plutocrats, Plutocrats, QR code, recommendation engine, RFID, rolodex, Ruby on Rails, Sam Altman, Sand Hill Road, Saturday Night Live, self-driving car, semantic web, side project, Silicon Valley, Silicon Valley ideology, Silicon Valley startup, slashdot, Snapchat, social web, South of Market, San Francisco, Startup school, Stephen Hawking, Steve Jobs, Steve Wozniak, technoutopianism, uber lyft, web application, WikiLeaks, Y Combinator

Goldstein couldn’t believe his luck. Huffman had become a minor legend for having created Reddit, and he could easily have raised funding from a venture capital firm for any idea he’d wanted. Instead, he partnered with a virtually unknown twenty-two-year-old, on an idea whose premise he’d deemed unsound. Over the following weeks they made plans. They’d move together to wherever Katie Huffman’s medical residency required that Huffman relocate after her graduation. They’d live together, and they’d code the site together. Nervously, Goldstein decided he’d need to approach Huffman again. Before they started work in earnest, they should divide responsibilities. He knew he wanted to handle business growth, and that Huffman was the superior hacker. He wanted to be CEO. It was his idea, after all. Gingerly, he approached the topic of roles.

Do you want to be CEO?” Goldstein hesitated. “Uh, yeah.” “It’s yours,” Huffman said. He’d been there, done that. He didn’t need to do it again. After a flight out to the Bay Area to meet with Paul Graham, they decided to join the next Y Combinator class that summer, out in California. Goldstein flew to San Francisco the day after he graduated MIT. Fortuitously, Katie Huffman got accepted to a medical residency there, so Steve Huffman came out, too. His Virginia respite was over. Over the course of eighty-five days that summer, they created their travel startup, which they dubbed Hipmunk, like chipmunk without the C. The Ones That Got Away Apple Inc.’s App Store had debuted to much fanfare in July 2008. As the iPhone became ubiquitous, so did apps tailor-made for its iOS operating system.


pages: 194 words: 57,925

The Heartfulness Way: Heart-Based Meditations for Spiritual Transformation by Kamlesh D. Patel, Joshua Pollock

financial independence, Lao Tzu, medical residency, Richard Feynman

Role of the Guru Conclusion Afterword Experience Heartfulness Glossary Foreword My parents were born and raised in India, where they met and fell in love while in medical school. However, they dreamed of a different life for themselves and their future family, and so upon graduating from medical school, they bravely moved to the United States. I was born a few years after that as part of the first generation of ethnically Indian Hindus raised in the United States. When my parents moved to the United States, they were still young medical residents. But in just a few short years, they went from new immigrants struggling to support themselves to new physicians struggling to support not only themselves, but also their children, their siblings, and their parents. Through their extraordinary work ethic and dedication to family, my parents eventually flourished in their careers, and I grew up as the direct beneficiary of their American Dream, enjoying the many privileges and resources that they worked so hard to attain.


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, Everything should be made as simple as possible, food miles, Gary Taubes, income inequality, Internet Archive, Isaac Newton, medical residency, Metcalfe’s law, 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: 230 words: 71,320

Outliers: The Story of Success by Malcolm Gladwell

affirmative action, Bill Gates: Altair 8800, computer age, corporate raider, crew resource management, medical residency, old-boy network, Pearl River Delta, 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, Boris Johnson, business cycle, car-free, hydraulic fracturing, if you build it, they will come, Induced demand, 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: 237 words: 74,109

Uncanny Valley: A Memoir by Anna Wiener

autonomous vehicles, back-to-the-land, basic income, blockchain, Burning Man, call centre, charter city, cloud computing, cognitive bias, cognitive dissonance, commoditize, crowdsourcing, cryptocurrency, Extropian, future of work, Golden Gate Park, housing crisis, Jane Jacobs, job automation, knowledge worker, Lean Startup, means of production, medical residency, new economy, New Urbanism, passive income, pull request, rent control, ride hailing / ride sharing, Sand Hill Road, self-driving car, sharing economy, side project, Silicon Valley, Silicon Valley startup, social web, South of Market, San Francisco, special economic zone, technoutopianism, telepresence, telepresence robot, union organizing, universal basic income, unpaid internship, urban planning, urban renewal, women in the workforce, Y2K, young professional

In the other direction was Valencia Street, a living diorama of late-stage gentrification: third-wave-coffee shops selling paleo lattes, juice bars hawking turmeric shots, waifish Australians clutching branded paper bags from spartan boutiques. The apartment was cozy and welcoming, full of strange artifacts: an upright piano with the hammers exposed, a headless mannequin covered in hand-drawn hieroglyphs. In the bathroom, a small line of half-melted havdalah candles lined the edge of the tub. The third roommate was a medical resident who kept impossible hours, appearing only occasionally to make generous pots of oatmeal or host men’s circles in the living room. It seemed like the sort of place where the roommates would share towels, laying claim to whichever smelled least like mildew, and it was. I loved being there. That fall, Noah was experimenting with larger-format communal living and had sublet his room to start a collective in Berkeley.


pages: 224 words: 74,599

Confessions of a Surgeon: The Good, the Bad, and the Complicated...Life Behind the O.R. Doors by Paul A. Ruggieri

fear of failure, job satisfaction, medical malpractice, medical residency

Libby Zion’s death exposed the exhaustive pressures and lack of supervision that were the norm in many training programs, both of which increased the potential for serious mistakes, and led to reforms including the number of hours residents could work continuously without sleep. Libby’s death ultimately closed the door on residencies rooted in the old way of thinking: “Survive no matter what the circumstances.” Initially, in the late 1980s, the reforms instituted in New York first trickled into the medical residencies only. It wasn’t until the publication of the landmark paper To Err Is Human—which concluded that 44,000 to 98,000 people died in hospitals each year from medical errors—that these reforms found their way to the surgical teaching programs in this country as well. In July 2003, all surgical residencies in this country changed, for better or worse, depending on whom you talk to. I was a product of the old school of training, taking whatever fatigue, abuse, and work came my way.


pages: 272 words: 78,876

Heart: A History by Sandeep Jauhar

blue-collar work, clean water, correlation does not imply causation, Honoré de Balzac, John Snow's cholera map, mass immigration, medical residency, placebo effect, publish or perish, Rubik’s Cube, selection bias, stem cell, the scientific method

Nowadays, most stents used in the United States are coated with rapamycin or a similar drug, which has nearly eliminated in-stent scarring. From a self-surgery in a tiny operating room in Eberswalde, Germany, cardiac catheterization has been transformed into a hugely profitable, multibillion-dollar industry. Unfortunately, Gruentzig never got a chance to witness this revolution. He and his second wife, a medical resident, died on October 27, 1985, when the private plane he was piloting crashed in a storm in rural Georgia. He was forty-six years old. That year was a tragic one for interventional cardiology. Smoking caught up with the field’s heroes. Mason Sones died of metastatic lung cancer; Charles Dotter, ironically, of complications of coronary bypass surgery. *Obstructive plaque can stimulate “collateral circulation,” or the formation of new blood vessels.


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, commoditize, Credit Default Swap, credit default swaps / collateralized debt obligations, delta neutral, Donald Trump, Douglas Hofstadter, dumpster diving, Flash crash, G4S, Gödel, Escher, Bach, High speed trading, Howard Rheingold, index fund, Isaac Newton, John Markoff, John Maynard Keynes: technological unemployment, knowledge economy, late fees, Marc Andreessen, Mark Zuckerberg, market bubble, medical residency, money market fund, Myron Scholes, Narrative Science, PageRank, pattern recognition, Paul Graham, Pierre-Simon Laplace, prediction markets, quantitative hedge fund, Renaissance Technologies, ride hailing / ride sharing, risk tolerance, Robert Mercer, 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 Parse.ly, 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 Perfectmatch.com, 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: 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, mass incarceration, 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: 403 words: 87,035

The New Geography of Jobs by Enrico Moretti

assortative mating, Bill Gates: Altair 8800, business climate, call centre, cleantech, cloud computing, corporate raider, creative destruction, desegregation, Edward Glaeser, financial innovation, global village, hiring and firing, income inequality, industrial cluster, Jane Jacobs, Jeff Bezos, Joseph Schumpeter, knowledge economy, labor-force participation, low skilled workers, manufacturing employment, Mark Zuckerberg, mass immigration, medical residency, Menlo Park, new economy, peer-to-peer lending, Peter Thiel, Productivity paradox, Richard Florida, Sand Hill Road, Silicon Valley, Skype, special economic zone, Startup school, Steve Jobs, Steve Wozniak, thinkpad, Tyler Cowen: Great Stagnation, Wall-E, Y Combinator, zero-sum game

Overall, limiting the number of unskilled immigrants is unlikely to have major negative effects for natives, but limiting the number of skilled immigrants could have significant negative effects, especially for our low-skilled workers. Recent research by Jennifer Hunt identifies which kind of highly skilled immigrant is most likely to bring benefits to American natives. Using a detailed sample of college-educated immigrants, she found that those who arrived as postdoctoral fellows and medical residents have been most successful in generating original research and patents and vastly outperform natives. By contrast, immigrants who arrived thanks to a family member who was already in the United States perform at the same level as natives. It is in America’s self-interest to radically reform its immigration policy to favor immigrants with college degrees, master’s degrees, and PhDs. Right now, 60 percent of the students in American engineering schools are foreign-born, but when these individuals graduate, they often find it difficult to stay in the United States.


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: 998 words: 211,235

A Beautiful Mind by Sylvia Nasar

"Robert Solow", Al Roth, Albert Einstein, Andrew Wiles, Brownian motion, business cycle, cognitive dissonance, Columbine, experimental economics, fear of failure, Gunnar Myrdal, Henri Poincaré, invisible hand, Isaac Newton, John Conway, John Nash: game theory, John von Neumann, Kenneth Arrow, Kenneth Rogoff, linear programming, lone genius, longitudinal study, market design, medical residency, Nash equilibrium, Norbert Wiener, Paul Erdős, Paul Samuelson, 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, zero-sum game

• • • 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: 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, commoditize, corporate governance, creative destruction, disruptive innovation, Elon Musk, en.wikipedia.org, future of work, game design, George Gilder, intangible asset, Isaac Newton, job satisfaction, Joi Ito, knowledge economy, knowledge worker, loose coupling, Louis Pasteur, Malcom McLean invented shipping containers, Maui Hawaii, medical residency, Network effects, old-boy network, packet switching, pattern recognition, peer-to-peer, 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, the new new thing, 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: 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, different worldview, East Village, friendly fire, haute couture, illegal immigration, immigration reform, liberation theology, medical residency, New Journalism, obamacare, payday loans, postnationalism / post nation state, pre–internet, uranium enrichment, yellow journalism, 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: 301 words: 86,278

Women and Autoimmune Disease by Robert G. Lahita

medical residency, stem cell, the new new thing, 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: 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, John Meriwether, London Interbank Offered Rate, Long Term Capital Management, medical residency, money market fund, moral hazard, mortgage debt, pets.com, Ponzi scheme, Potemkin village, quantitative trading / quantitative finance, Robert Bork, short selling, Silicon Valley, the new new thing, too big to fail, value at risk, Vanguard fund, zero-sum game

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: 302 words: 92,546

Overdiagnosed: Making People Sick in the Pursuit of Health by H. Gilbert Welch, Lisa M. Schwartz, Steven Woloshin

23andMe, double helix, Google Earth, invisible hand, life extension, longitudinal study, mandelbrot fractal, medical residency, meta analysis, meta-analysis, phenotype, placebo effect, randomized controlled trial, Ronald Reagan, The Wealth of Nations by Adam Smith

The investigators wanted to see if early diagnosis and treatment of asymptomatic abnormalities could prevent sudden death in the year following the heart attack. Although the investigators envisioned that monitoring would eventually be done at patients’ homes, the study was initiated in the hospital in order to standardize the process. A heart attack patient who was doing well and was ready to be discharged was first sent to a special unit and attached to a small heart monitor. The job of responding to the monitor’s findings fell to the medical residents like me. It drove us nuts. The patients were well, but their monitors were always going off. It seemed as though every one of them had an abnormality. And we were treating them. We were constantly adjusting medications to try to find the right drug and the right dose to make the rhythm normal. Occasionally, it seemed as though what we were doing was working. But more often, our efforts didn’t seem to make any difference.


pages: 325 words: 92,622

The Girl in the Road by Monica Byrne

medical residency, stem cell, undersea cable, uranium enrichment

He said, I’m a self-respecting Indian man. So I asked him to tell me more about himself. About his country. About what India was like. His feelings on Eritrea (“Let them be”). How many languages he spoke (five: Malayalam, Hindi, Tamil, Kannada, English). How old he was (twenty-one, one year older than me). How he liked Ethiopia (“fascinating”). Where else he’d been in Ethiopia (only Ambo so far, on a trip with the other medical residents, to bathe in the hot springs). What caste he belonged to (Brahmin mother, on her father’s side; Kshatriya father). What kind of music he liked. He liked Ethiopian jazz. He had real vinyl records and a record player, brought all the way from India in a trunk. He’d been combing the stores for pre-Derg records. Most had already been bought by foreign dealers who then sold them to collectors abroad for huge sums of money, but he’d found six so far.


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, lateral thinking, 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: 346 words: 92,984

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

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, en.wikipedia.org, epigenetics, Kickstarter, longitudinal study, 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: 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, lateral thinking, medical malpractice, medical residency, Menlo Park, Nelson Mandela, 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: 290 words: 87,549

The Airbnb Story: How Three Ordinary Guys Disrupted an Industry, Made Billions...and Created Plenty of Controversy by Leigh Gallagher

Airbnb, Amazon Web Services, barriers to entry, Ben Horowitz, Bernie Sanders, cloud computing, crowdsourcing, don't be evil, Donald Trump, East Village, Elon Musk, housing crisis, iterative process, Jeff Bezos, Jony Ive, Justin.tv, Lyft, Marc Andreessen, Mark Zuckerberg, medical residency, Menlo Park, Network effects, Paul Buchheit, Paul Graham, performance metric, Peter Thiel, RFID, Sam Altman, Sand Hill Road, Saturday Night Live, sharing economy, side project, Silicon Valley, Silicon Valley startup, South of Market, San Francisco, Startup school, Steve Jobs, TaskRabbit, the payments system, Tony Hsieh, Travis Kalanick, uber lyft, Y Combinator, yield management

(It would be significant for Sequoia, too: that $585,000 investment is, as of this writing, worth roughly $4.5 billion.) A few other things fell into place. Blecharczyk had told his fiancée, Elizabeth Morey, he’d be back in three months to start their life together in Boston. But on the same day Chesky, Gebbia, and Blecharczyk got their term sheet, Morey learned she’d been matched at Stanford’s Lucile Packard Children’s Hospital for her medical residency. Blecharczyk could make a go of the start-up, and Morey would move out to San Francisco. Over the next few months, the groundwork they had laid in New York continued to pay off. By August, their twenty to thirty bookings a day had hit seventy bookings a day. They started to get attention for quirkier listings, like treehouses, igloos, and tepees. With the Sequoia funding, they started paying themselves an annual salary—$60,000 each, which felt almost gluttonous after their days of milkless bowls of cereal.


pages: 420 words: 98,309

Mistakes Were Made (But Not by Me): Why We Justify Foolish Beliefs, Bad Decisions, and Hurtful Acts by Carol Tavris, Elliot Aronson

Ayatollah Khomeini, cognitive dissonance, cuban missile crisis, desegregation, Donald Trump, false memory syndrome, fear of failure, Lao Tzu, longitudinal study, medical malpractice, medical residency, meta analysis, meta-analysis, Milgram experiment, moral panic, Nelson Mandela, placebo effect, psychological pricing, Richard Feynman, Ronald Reagan, social intelligence, telemarketer, the scientific method, trade route, transcontinental railway, Watson beat the top human players on Jeopardy!

With a small donation ... and perhaps the purchase of a charming, overpriced edition of the Bhagavad Gita. Were the travelers aware of the power of reciprocity to affect their behavior? Not at all. But once reciprocity kicks in, self-justification will follow: "I've always wanted a copy of the Bhagavad Gita; what is it, exactly?" The power of the flower is unconscious. "It's only a flower," the traveler says. "It's only a pizza," the medical resident says. "It's only a small donation that we need to have this educational symposium," the physician says. Yet the power of the flower is one reason that the amount of contact doctors have with pharmaceutical representatives is positively correlated with the cost of the drugs the doctors later prescribe. "That rep has been awfully persuasive about that new drug; I might as well try it; my patients might do well on it."


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, fixed income, 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, money market fund, pension reform, presumed consent, price discrimination, profit maximization, rent-seeking, Richard Thaler, Right to Buy, 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. 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. Nudging High Schoolers Toward College Good choice architecture doesn’t need to originate with a wonkish professor and a powerful computer algorithm.


pages: 351 words: 101,051

Also Human: The Inner Lives of Doctors by Caroline Elton

Alvin Roth, fear of failure, feminist movement, job satisfaction, Kickstarter, longitudinal study, medical residency, meta analysis, meta-analysis, Rubik’s Cube, women in the workforce

What this resident is describing here is a catastrophic erosion of empathy; in the end she changed specialty because she didn’t want to respond to her patients in this way. If this resident was a lone example it would be a personal problem for that doctor, and for her patients. But the situation is much more worrying than that. A recent systematic review concluded that nine out of eleven studies of medical students, and six out of seven studies of medical residents, reported a consistent decline in empathy as training progressed. Some of the reasons given for this finding include sleep deprivation, excessive workload, mistreatment by superiors, and lack of positive role models. In other words, the environment in which doctors work has a significant impact on their capacity to respond empathically to patients. Unfortunately, Ellen’s response to Vartika and Suzy’s unsympathetic treatment of some of the inpatients on the ward are far from unique.


How to Survive a Plague: The Inside Story of How Citizens and Science Tamed AIDS by David France

affirmative action, Albert Einstein, Berlin Wall, Donald Trump, East Village, estate planning, facts on the ground, global pandemic, Live Aid, medical residency, placebo effect, Ronald Reagan, sensible shoes, trickle-down economics

“Even if we find a causative virus or other agent, it will be considerable time, probably years, before we can develop a vaccine or some strategy to eradicate it. We are in for a long haul.” He fell silent for a time, moved by the hush in the room. But he wanted to end on an optimistic note. “You’re showing great leadership,” he said reassuringly. “Epidemics come and epidemics go. Keep calm and don’t be too upset.” Almost immediately after he descended the stairway, one of the young physicians touched his arm, introducing himself as chief medical resident at the NYU Medical Center. He spoke in the lyrical cadence of a native Georgian. He hailed from Columbia, a city two hours east of the CDC headquarters. “I’ve had PCP,” he said. Every available statistic counted his life expectancy to be a few months. Curran thought what an idiot he was to tell these people to keep calm. Before returning to Atlanta the following morning, Curran paid a visit to the office of Dan William, whom he first met in the late 1970s.

I’m afraid there is no known treatment. All we can do is try to keep you hydrated and see what happens. Your body will either handle it or…” She patted him on the leg and smiled. He had six to eighteen months of life left to enjoy, she told him. She pulled a business card out of her lab coat. “Here’s the number of Dr. Stuart Nichols. He’s starting a support group,” she said. “I think you should go—if you beat this bout.” A medical resident followed her into his room and coaxed out of Callen the details of his life to include in a case report for the CDC. In poetry and lyrics, and occasional short stories, Callen had sometimes looked back at his long history of sexual exploration, which began at age seventeen. This was the first time he made that journey with a calculator. He arrived at a figure by estimating the number of men he might have sex with on an average day, times seven average days a week, times fifty-two weeks a year, times the ten-year span of his active sexual life.


The Last Best Cure: My Quest to Awaken the Healing Parts of My Brain and Get Back My Body, My Joy, a Nd My Life by Donna Jackson Nakazawa

back-to-the-land, epigenetics, index card, longitudinal study, medical residency, meta analysis, meta-analysis, mouse model, place-making, placebo effect, randomized controlled trial, stem cell

Before that, she spent most of her time working in innercity Manhattan, getting her start in medicine working with women and children suffering from human immunodeficiency virus (HIV)—in Harlem. She walks the hard path with patients, incorporating the best that traditional medicine has to offer with alternative practices many patients have never tried or even heard of before. Although she has only been at Hopkins for a year, all second-year medical residents are already required to do an outpatient rotation in integrative medicine with RowlandSeymour. Her practice is full, and her wait list long. “You’ve been through a great deal in a relatively short period of time,” she says. She looks up at me. Her brown eyes are penetrating and bright behind wire-rimmed glasses. Her shoulder-length hair, pulled back tight from her forehead into a ponytail, springs wildly free once past the confines of the elastic band that contains it.


pages: 403 words: 106,707

Endure: Mind, Body, and the Curiously Elastic Limits of Human Performance by Alex Hutchinson

airport security, animal electricity, experimental subject, Fellow of the Royal Society, Frederick Winslow Taylor, glass ceiling, Iridium satellite, medical residency, meta analysis, meta-analysis, placebo effect, randomized controlled trial, Sand Hill Road, Silicon Valley, Silicon Valley startup, Stanford marshmallow experiment, technoutopianism, Walter Mischel

Giant screens in front of me are flashing detailed statistics about Kipchoge’s run, but my mind is drifting away from punditry. I want to slip out of the booth and get back down to the side of the track—to feel the crackling tension in the assembled crowd, to hear the rasp of Kipchoge’s breath as he runs past, and to look into his eyes as he pushes deeper into the unknown. In 1991, Michael Joyner, an ex-collegiate runner from the University of Arizona who was completing a medical residency at the Mayo Clinic in Minnesota, proposed a provocative thought experiment. The limits of endurance running, according to physiologists, could be quantified with three parameters: aerobic capacity, also known as VO2max, which is analogous to the size of a car’s engine; running economy, which is an efficiency measure like gas mileage; and lactate threshold, which dictates how much of your engine’s power you can sustain for long periods of time.


pages: 406 words: 109,794

Range: Why Generalists Triumph in a Specialized World by David Epstein

Airbnb, Albert Einstein, Apple's 1984 Super Bowl advert, Atul Gawande, Checklist Manifesto, Claude Shannon: information theory, Clayton Christensen, clockwork universe, cognitive bias, correlation does not imply causation, Daniel Kahneman / Amos Tversky, deliberate practice, Exxon Valdez, Flynn Effect, Freestyle chess, functional fixedness, game design, Isaac Newton, Johannes Kepler, knowledge economy, lateral thinking, longitudinal study, Louis Pasteur, Mark Zuckerberg, medical residency, meta analysis, meta-analysis, Mikhail Gorbachev, Nelson Mandela, Netflix Prize, pattern recognition, Paul Graham, precision agriculture, prediction markets, premature optimization, pre–internet, random walk, randomized controlled trial, retrograde motion, Richard Feynman, Richard Feynman: Challenger O-ring, Silicon Valley, Stanford marshmallow experiment, Steve Jobs, Steve Wozniak, Steven Pinker, Walter Mischel, Watson beat the top human players on Jeopardy!, Y Combinator, young professional

Life expectancy in countries at the biomedical cutting edge, like the United Kingdom and the United States, recently declined after decades of improvement. The flu annually kills hundreds of thousands of people worldwide while humanity fights it with a cumbersomely produced vaccine from the 1940s. Casadevall’s mother is ninety-three, and on five medications that were available when he was a medical resident in the 1980s. “Two of them are older than I am,” he said, and two others are barely younger. “I cannot believe we can’t do better.” He paused for a moment, tilted his head, and leaned forward. “If you write an interdisciplinary grant proposal, it goes to people who are really, really specialized in A or B, and maybe if you’re lucky they have the capacity to see the connections at the interface of A and B,” he told me.


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, Chuck Templeton: OpenTable:, 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, John Markoff, Julian Assange, Marc Andreessen, market bubble, market design, medical residency, meta analysis, meta-analysis, mutually assured destruction, Panopticon Jeremy Bentham, 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, zero-sum game, 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: 309 words: 114,984

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

"Robert Solow", activist fund / activist shareholder / activist investor, Affordable Care Act / Obamacare, AI winter, Airbnb, Atul Gawande, Captain Sullenberger Hudson, Checklist Manifesto, Chuck Templeton: OpenTable:, Clayton Christensen, collapse of Lehman Brothers, computer age, creative destruction, crowdsourcing, deskilling, disruptive innovation, en.wikipedia.org, 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, Kickstarter, knowledge worker, lifelogging, medical malpractice, medical residency, Menlo Park, minimum viable product, natural language processing, Network effects, Nicholas Carr, obamacare, pattern recognition, peer-to-peer, personalized medicine, pets.com, 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, Thomas Bayes, Toyota Production System, Uber for X, US Airways Flight 1549, 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: 385 words: 118,901

Black Edge: Inside Information, Dirty Money, and the Quest to Bring Down the Most Wanted Man on Wall Street by Sheelah Kolhatkar

Bernie Madoff, Donald Trump, family office, fear of failure, financial deregulation, hiring and firing, income inequality, light touch regulation, locking in a profit, margin call, medical residency, mortgage debt, p-value, pets.com, Ponzi scheme, rent control, Ronald Reagan, short selling, Silicon Valley, Skype, The Predators' Ball

Right there in his own driveway, Martoma fainted. CHAPTER 11 UNDEFEATABLE Like many people who immigrate to America from faraway places, Mathew Martoma’s parents dreamed of what their children might eventually achieve there. They had especially high expectations for their firstborn son, whom they named Ajai Mathew Mariamdani Thomas. Martoma’s mother, Lizzie Thomas, was a twenty-six-year-old medical resident in Michigan when he was born, in 1974. Both she and Martoma’s father, Bobby Martoma, were Christians from Kerala, located in India’s tropical south. Bobby emigrated in 1964 at age nineteen to study mechanical engineering in the United States; after graduating from Howard University, he took a job as an engineer with the Ford Motor Company in Michigan. When Martoma was a toddler, the family moved to Florida.


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, Kenneth Arrow, loss aversion, medical residency, Menlo Park, Murray Gell-Mann, Nate Silver, New Journalism, Paul Samuelson, Richard Thaler, Saturday Night Live, Stanford marshmallow experiment, statistical model, the new new thing, Thomas Bayes, 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.


Mbs: The Rise to Power of Mohammed Bin Salman by Ben Hubbard

Ayatollah Khomeini, bitcoin, Donald Trump, Jeff Bezos, knowledge economy, Mark Zuckerberg, medical residency, megacity, Mohammed Bouazizi, RAND corporation, ride hailing / ride sharing, Rosa Parks, Rubik’s Cube, Silicon Valley, Snapchat, Steve Jobs, Tim Cook: Apple, urban planning, WikiLeaks, women in the workforce, Yom Kippur War

The Saudi Foreign Ministry accused Canada of “blatant interference in the internal affairs” of Saudi Arabia, gave the Canadian ambassador to Riyadh twenty-four hours to leave, and threatened to freeze trade and investment. It canceled flights by the Saudi national airline to Canada; pulled the Saudi ambassador from Ottawa; and announced the withdrawal of Saudi students from Canadian universities. That upended the lives of thousands of students, including about eight hundred doing medical residencies at Canadian hospitals. The Saudi Foreign Ministry even raised the specter of a tit-for-tat response, saying that further criticism would give the kingdom the right to interfere in Canada’s domestic affairs. The kingdom rallied its media to demonize Canadians, hosting commentators on air who claimed that Canada persecuted women and airing a montage about “the worst Canadian prisons,” saying they had terrible food and medical care, and that 75 percent of prisoners had died before trial between 2015 and 2017, a hugely dubious claim.


pages: 413 words: 119,587

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

"Robert Solow", A Declaration of the Independence of Cyberspace, AI winter, airport security, Apple II, artificial general intelligence, Asilomar, augmented reality, autonomous vehicles, basic income, 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 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, Gunnar Myrdal, 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 Markoff, 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, Marc Andreessen, Mark Zuckerberg, Marshall McLuhan, medical residency, Menlo Park, Mitch Kapor, 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, zero-sum game

“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: 404 words: 124,705

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

assortative mating, 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, Kickstarter, longitudinal study, Mark Zuckerberg, medical residency, Menlo Park, meta analysis, meta-analysis, neurotypical, Occupy movement, old-boy network, place-making, Ponzi scheme, Ralph Waldo Emerson, randomized controlled trial, Ray Oldenburg, Silicon Valley, Skype, social intelligence, Stanford marshmallow experiment, 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: 441 words: 124,798

Dopesick: Dealers, Doctors, and the Drug Company That Addicted America by Beth Macy

Affordable Care Act / Obamacare, centre right, crack epidemic, deindustrialization, Donald Trump, invisible hand, labor-force participation, mandatory minimum, mass incarceration, McMansion, medical residency, meta analysis, meta-analysis, obamacare, offshore financial centre, RAND corporation, rent-seeking, single-payer health, urban renewal, War on Poverty, working poor

A chain-smoking doctor in Bland, Virginia, was so blatantly in favor of graft that she posted a signup sheet in her office, soliciting reps to sponsor her daughter’s upcoming birthday party at Carowinds, an amusement park—and one (not a Purdue rep) did. She even accepted cartons of cigarettes emblazoned with a sticker for Celexa, the antidepressant manufactured by Forest Laboratories: another gift from another clever rep. * Steve Huff was in medical residency training in the mid-1990s when he sampled his first taste of pharmaceutical swag—and not just by way of stickers, golf balls, and pens adorned with drug company names. “We were impressionable young doctors, fresh meat with a lifetime of prescribing ahead, and they flocked to us,” he told me. “They took us golfing. It was standard to have a free lunch most days of the week because the drug companies were always buying, then you’d have a short educational seminar going on [about their drugs] while you ate.”


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, Intergovernmental Panel on Climate Change (IPCC), lateral thinking, mandatory minimum, medical residency, Mikhail Gorbachev, millennium bug, moral panic, mutually assured destruction, nuclear winter, placebo effect, Ralph Nader, RAND corporation, Ronald Reagan, social intelligence, 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: 487 words: 151,810

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

Albert Einstein, asset allocation, assortative mating, Atul Gawande, Bernie Madoff, business process, Cass Sunstein, choice architecture, clean water, creative destruction, Daniel Kahneman / Amos Tversky, David Brooks, delayed gratification, deliberate practice, disintermediation, Donald Trump, Douglas Hofstadter, Emanuel Derman, en.wikipedia.org, 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, longitudinal study, loss aversion, medical residency, meta analysis, meta-analysis, Monroe Doctrine, Paul Samuelson, Richard Thaler, risk tolerance, Robert Shiller, Robert Shiller, school vouchers, six sigma, social intelligence, Stanford marshmallow experiment, 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: 649 words: 172,080

Hunting in the Shadows: The Pursuit of Al Qa'ida Since 9/11: The Pursuit of Al Qa'ida Since 9/11 by Seth G. Jones

airport security, battle of ideas, defense in depth, drone strike, Google Earth, index card, Khyber Pass, medical residency, Murray Gell-Mann, RAND corporation, Saturday Night Live, Silicon Valley, trade route, WikiLeaks

Take Afghanistan: by 2007, U.S. forces were supporting a government in which 82 percent of Afghans had confidence in President Hamid Karzai, only 5 percent supported Taliban forces, and a striking 71 percent supported U.S. military forces in the country.85 Iraq was more controversial because of the U.S. invasion, though by 2007 Nouri al-Maliki had taken over as prime minister and was fighting an increasingly unpopular al Qa’ida in Iraq. Still, the perception that the wars were “against Muslims” persisted. During Hasan’s medical residency and postresidency fellowship, his superiors and colleagues observed his views becoming increasingly radical. Witnesses reported that Hasan openly supported many of the principles of violent Islamist extremism in class and in written academic papers.86 In the last month of his residency at Walter Reed, he fulfilled an academic requirement for graduation to make a scholarly presentation on psychiatric issues by giving an off-topic lecture on violent Islamic extremism.


pages: 519 words: 169,973

My Own Country: A Doctor's Story of a Town and Its People in the Age of AIDS by Abraham Verghese

index card, Mason jar, medical residency

Astute diagnosis was rewarded by a return to perfect health. Death from infection used to be common on bone-marrow-transplant wards and on leukemia wards. Now, he pointed out, with newer, more powerful antibiotics, better diagnostic tools, and a new understanding of immunology, ID physicians were getting the upper hand. But I also had a selfish reason for picking infectious diseases. Most medical residents flocked to cardiology or gastroenterology or pulmonary medicine—specialties rich in invasive procedures (and therefore very lucrative). Fellowships in these areas were very competitive. Unlike the internship year (where foreign graduates were in much demand and were critical to the survival of many inner-city hospitals), both foreign and American medical graduates were competing for the limited number of fellowship slots across the country.


pages: 575 words: 171,599

The Billionaire's Apprentice: The Rise of the Indian-American Elite and the Fall of the Galleon Hedge Fund by Anita Raghavan

airport security, Asian financial crisis, asset allocation, Bernie Madoff, British Empire, business intelligence, collapse of Lehman Brothers, collateralized debt obligation, corporate governance, delayed gratification, estate planning, Etonian, glass ceiling, high net worth, kremlinology, locking in a profit, Long Term Capital Management, Marc Andreessen, mass immigration, McMansion, medical residency, Menlo Park, new economy, old-boy network, Ponzi scheme, risk tolerance, rolodex, Ronald Reagan, short selling, Silicon Valley, sovereign wealth fund, stem cell, technology bubble, too big to fail

Back then, jobs on Main Street (manufacturing, retailing, energy), not Wall Street (trading and banking), were the traditional path to prosperity for MBAs. The markets wheezed and sputtered in the late 1960s, so much so that by mid-1973, when Gupta’s Harvard class was set to graduate, the risk to stock investors of the three I’s—interest rates, inflation, and the impeachment of President Richard Nixon—had risen exponentially. Harvard MBAs angled to land “residencies,” much like medical residencies, at big, prestigious companies such as US Steel, 3M, Procter & Gamble, and General Mills. The traditional career path for the men—mostly white men and very few women or men of color—who came of MBA age in the 1970s was to start at the bottom of the corporate ladder and work to the top. Getting an MBA from Harvard allowed one to skip a slew of steps and offered the possibility of a country-club lifestyle after graduation.


pages: 520 words: 164,834

Bill Marriott: Success Is Never Final--His Life and the Decisions That Built a Hotel Empire by Dale van Atta

Berlin Wall, Charles Lindbergh, clean water, collective bargaining, corporate raider, Deng Xiaoping, Donald Trump, dumpster diving, financial innovation, hiring and firing, index card, indoor plumbing, Kickstarter, Maui Hawaii, medical residency, Menlo Park, Mikhail Gorbachev, mortgage debt, profit motive, Robert Bork, Ronald Reagan, shareholder value, short selling, urban renewal

Kirklin opened up her heart, he found that she had only two defects instead of the predicted four. He worked efficiently to repair them. Many open-heart patients in the 1960s who survived surgery died in the days immediately following the operation. On the second night, Bill and Donna received a terrible phone call in their hotel room. Debbie was not doing well, and might not make it. “We were on our knees all night praying that she might be spared,” Bill recalled. The medical resident who had been assigned to stay was fortunately there when her heart went into fibrillation. He used CPR and drugs to revive her. He shakily confided to Bill the next day that Debbie appeared to have died for two or three minutes. Neither of her parents knew for more than a decade that Debbie had had an out-of-body experience. It was profound and real to her, but she did not feel comfortable sharing it until Dr.


pages: 654 words: 191,864

Thinking, Fast and Slow by Daniel Kahneman

Albert Einstein, Atul Gawande, availability heuristic, Bayesian statistics, 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, hedonic treadmill, hindsight bias, index card, information asymmetry, job satisfaction, John von Neumann, Kenneth Arrow, libertarian paternalism, loss aversion, medical residency, mental accounting, meta analysis, meta-analysis, nudge unit, pattern recognition, Paul Samuelson, pre–internet, price anchoring, quantitative trading / quantitative finance, random walk, Richard Thaler, risk tolerance, Robert Metcalfe, Ronald Reagan, Shai Danziger, Supply of New York City Cabdrivers, The Chicago School, The Wisdom of Crowds, Thomas Bayes, 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: 824 words: 218,333

The Gene: An Intimate History by Siddhartha Mukherjee

Albert Einstein, Alfred Russel Wallace, All science is either physics or stamp collecting, Any sufficiently advanced technology is indistinguishable from magic, Asilomar, Asilomar Conference on Recombinant DNA, Benoit Mandelbrot, butterfly effect, dark matter, discovery of DNA, double helix, Drosophila, epigenetics, Ernest Rutherford, experimental subject, Internet Archive, invisible hand, Isaac Newton, longitudinal study, medical residency, moral hazard, mouse model, New Journalism, out of africa, phenotype, Pierre-Simon Laplace, Ponzi scheme, Ralph Waldo Emerson, Scientific racism, stem cell, The Bell Curve by Richard Herrnstein and Charles Murray, Thomas Malthus, twin studies

That year, a young dentistry student named Walter Noel presented to his doctor in Chicago with an acute anemic crisis, accompanied by the characteristic chest and bone pain. Noel was from the Caribbean, of West African descent, and had suffered several such episodes over the prior years. Having ruled out a heart attack, the cardiologist, James Herrick, assigned the case rather casually to a medical resident named Ernest Irons. Acting on a whim, Irons decided to look at Noel’s blood under the microscope. Irons found a bewildering alteration. Normal red blood cells are shaped like flattened disks—a shape that allows them to be stacked atop each other, and thus move smoothly through networks of arteries and capillaries and veins, bringing oxygen to the liver, heart, and brain. In Noel’s blood, the cells had morphed, mysteriously, into shriveled, scythe-shaped crescents—“sickle cells,” as Irons later described them.


pages: 740 words: 227,963

The Warmth of Other Suns: The Epic Story of America's Great Migration by Isabel Wilkerson

anti-communist, Berlin Wall, California gold rush, card file, desegregation, Gunnar Myrdal, index card, indoor plumbing, invisible hand, labor-force participation, Mason jar, mass immigration, medical residency, Rosa Parks, strikebreaker, trade route, traveling salesman, union organizing, white flight, Works Progress Administration

LOUIS and Pershing climbed on board with his suitcase in his hand and his back propped straight as if he were stepping onto the Queen Mary and going to France. He dusted the folds of his tweed suit and headed down the central aisle of the bus in search of a seat. The bus was not going to take him to the Big North of southern dreams but to a modest city in a border state where his brother was serving out his medical residency, and well enough out of the South. He scanned the aisle to find a place for himself. His eye caught the wooden shingle with the metal prongs on the bottom, the shingle that said COLORED on one side and WHITE on the other. It was set into holes at the top of a seat back toward the latter half of the bus. He didn’t like seeing it, but he knew to expect it. He took a seat behind the wooden shingle and looked out the window at the view.


pages: 976 words: 235,576

The Meritocracy Trap: How America's Foundational Myth Feeds Inequality, Dismantles the Middle Class, and Devours the Elite by Daniel Markovits

"Robert Solow", 8-hour work day, activist fund / activist shareholder / activist investor, affirmative action, Anton Chekhov, asset-backed security, assortative mating, basic income, Bernie Sanders, big-box store, business cycle, capital asset pricing model, Capital in the Twenty-First Century by Thomas Piketty, carried interest, collateralized debt obligation, collective bargaining, computer age, corporate governance, corporate raider, crony capitalism, David Brooks, deskilling, Detroit bankruptcy, disruptive innovation, Donald Trump, Edward Glaeser, Emanuel Derman, equity premium, European colonialism, everywhere but in the productivity statistics, fear of failure, financial innovation, financial intermediation, fixed income, Ford paid five dollars a day, Frederick Winslow Taylor, full employment, future of work, gender pay gap, George Akerlof, Gini coefficient, glass ceiling, helicopter parent, high net worth, hiring and firing, income inequality, industrial robot, interchangeable parts, invention of agriculture, Jaron Lanier, Jeff Bezos, job automation, job satisfaction, John Maynard Keynes: Economic Possibilities for our Grandchildren, knowledge economy, knowledge worker, Kodak vs Instagram, labor-force participation, longitudinal study, low skilled workers, manufacturing employment, Mark Zuckerberg, Martin Wolf, mass incarceration, medical residency, minimum wage unemployment, Myron Scholes, Nate Silver, New Economic Geography, new economy, offshore financial centre, Paul Samuelson, payday loans, plutocrats, Plutocrats, Plutonomy: Buying Luxury, Explaining Global Imbalances, precariat, purchasing power parity, rent-seeking, Richard Florida, Robert Gordon, Robert Shiller, Robert Shiller, Ronald Reagan, savings glut, school choice, shareholder value, Silicon Valley, Simon Kuznets, six sigma, Skype, stakhanovite, stem cell, Steve Jobs, supply-chain management, telemarketer, The Bell Curve by Richard Herrnstein and Charles Murray, Thomas Davenport, Thorstein Veblen, too big to fail, total factor productivity, transaction costs, traveling salesman, universal basic income, unpaid internship, Vanguard fund, War on Poverty, Winter of Discontent, women in the workforce, working poor, young professional, zero-sum game

According to the survey, “62% of high-earning individuals work more than 50 hours a week, 35% work more than 60 hours a week, and 10% work more than 80 hours a week.” Nearly a quarter of the highest earners surveyed qualified for the Review’s most extreme job classification and worked “even more punishing” hours: “The majority of them (56%) work 70 hours or more a week, and 9% work 100 hours or more.” Elite professionals have also ratcheted up their work hours. Medical residents now work such long hours that the Accreditation Council for Graduate Medical Education has sought, with limited success, to restrict them to eighty working hours per week, averaged across four weeks. Lawyers’ hours are similarly extreme. For example, between 1984 and 1990 the percentage of lawyers working over fifty-five hours per week more than tripled, and the share working more than two hundred hours per month increased by nearly half.


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, business cycle, collective bargaining, distributed generation, employer provided health coverage, estate planning, Home mortgage interest deduction, intangible asset, medical malpractice, medical residency, money market fund, mortgage debt, mortgage tax deduction, passive income, Ponzi scheme, profit motive, rent control, Right to Buy, 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.


pages: 1,845 words: 567,850

J.K. Lasser's Your Income Tax 2014 by J. K. Lasser

Affordable Care Act / Obamacare, airline deregulation, asset allocation, business cycle, collective bargaining, distributed generation, employer provided health coverage, estate planning, Home mortgage interest deduction, intangible asset, medical malpractice, medical residency, mortgage debt, mortgage tax deduction, obamacare, passive income, Ponzi scheme, profit motive, rent control, Right to Buy, 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.


J.K. Lasser's Your Income Tax 2016: For Preparing Your 2015 Tax Return by J. K. Lasser Institute

Affordable Care Act / Obamacare, airline deregulation, asset allocation, business cycle, collective bargaining, distributed generation, employer provided health coverage, estate planning, Home mortgage interest deduction, intangible asset, medical malpractice, medical residency, mortgage debt, mortgage tax deduction, passive income, Ponzi scheme, profit motive, rent control, Right to Buy, 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. Jones reports only the net amount he receives’$1,100 a week.