Patrick McKenzie on X:

I hate to sound intellectually vacuous but choose to get more done. At the relevant margins, get more done. Life : culture / peers will routinely tell you it is OK to get less done and you should politely insist on getting more done. The amount of doneness you get is not fixed.

I have been thinking along these lines ever since reading, some dozen years ago, an article about a particularly successful cystic fibrosis center, whose outcomes were an order of magnitude better than average. This was before any new drugs or promising trials were available, and the only reason why they were so much better was that they did more of everything: more frequent follow-up, more intensive manual therapy, more changes to treatment regimen with subtle changes in condition, less complacency.

Nowhere is this more evident than on the inpatient service. It is incredibly easy to coast with reflexive and defensive medicine, putting out small fires like hospital-acquired infections or patient falls, passing on the buck to the next team, shrugging your shoulders about that 60-year-old with questionable CHF (or is it COPD/asthma) exacerbation who is not following the script and doesn’t seem to be getting any better despite being treated for everything. Patients hang around a bit longer, suffer a bit more iatrogenesis, die a bit sooner, not enough for it to be obvious in any particular case but just enough for the outcomes to be worse in aggregate.

Make no mistake: this is how many (most?) American hospitals operate, for the simple reason that there simply aren’t enough doctors and nurses around for the level of attention sick patients with many active complex disorders deserve. But doing more is the American ethos (see the X-post above); not being able to provide more focused care, we dig into the seemingly infinite supply of more drugs, more procedures, more iatrogenesis to which to expose patients, making their condition all the more complex.

Outside of medicine, this is also the difference you can see in “good” and “bad” (for collaboration) institutions: good ones throw water at embers before they become a fire, communicate more frequently and openly, do not leave documents for review “for after the long weekend”. They do more; or rather, each individual there does more and does not pass on the buck to forces unknown which are beyond their control (and the bigger the institution is, the more numerous and more complacent those forces are; incredible how that works). The not-so-good institutions also do more: of emailing, usually, to tell you that something can’t be done.

So yes, choose to get more done, and also make sure you are doing more of the right thing.

The five or so regulars readers of this blog may have noticed a pattern of promises made and not kept of things I will, may, or should discuss at some future, unspecified point. These were usually somewhere in the margin notes, but sometimes I would end with a cliffhanger. The topics included mental models, notable microblogs, and ABIM’s financial shenenigans; in my head, the list was significantly longer, and the items expanded into 1,000+ word posts that would be a slog to reference, a nightmare to edit, and which no one would ultimately read.

Up until last year, whatever I thought about those topics would stay in my head, waiting for the stars to align and for the Gods of chaos and time Also known as my children. to smile upon their humble servant. Which is a net good for the reading public — who needs to read the unbaked thoughts of an oncologist? — but as Cory Doctorow wrote, having one’s thoughts written down is good practice both for developing them and for future reference. I was, in a way, depriving my future self of the benefit of knowing how big of a fool my past self was.

But ever since learning of the micro.blog/MarsEdit combination This is Miraz Jordan’s brief YouTube introduction to the two; 15 minutes of time well spent if you have even a tiny bit of interest., I’ve maintained a daily log of thoughts, readings, viewings, and writings. The low friction of the tools begs for scattered non-sequiturs and word salads — think of an unkempt Obsidian database — but the semi-social veneer that micro.blog provides tempers my worst instincts and makes the posts better overall for everyone exposed, including my future self. Sure, those longer texts still don’t get written — although, just watch this one grow! — but for personal use the snippets are even more valuable (and easier to skim).

Not everyone should be a capital-b Blogger — or have a gated newsletter for that matter — but many more people could benefit from a small-p personal blog of the commonplace type. The reason I bristle at overproduced “content” and at statements that anyone who writes must give it their all, strive to perfect everything they write above the 80%-done good-enough-for-government-work standard that is close to my heart, is that they create the wrong impression of what blogging could/should/would be if it hadn’t been for the Huffington Posts and the Gawkers of the peak-blog internet that equated blogging with monetization. And also why I took an initial dislike of The Curator’s Code despite its obvious usefulness. Why should personal blogging be standardized? It’s Personal!

And if you want to find some of these to read, for instruction, inspiration, or just plain enjoyment? Outside of the great micro.blog blogs — check out the Discover page for a daily sampling — there is Dave Winer’s scripting.com, John Naughton’s Memex, Ian Betteridge’s Technovia, Reader John’s Tipsy Teetotaler, Jerry Coyne’s Why Evolution is True, and oh so many more.

I am reasonably quick at making decisions, and people occasionally ask me for input when they need to make theirs. This is either when they have already decided — and there are good and not so good ways of soliciting feedback then, but that is for a different time — or when they haven’t a clue about what to do. This latter situation is usually because:

• The problem is not clear (“I am unhappy at my job, please help.")
• The problem is clear but the options are not (yet) well-defined (“I am medical student who wants to be involved in clinical trials, please help.")
• Both the problem and the options are clear, but the correct choice is not (“I have 4 good job offers with different salaries, geographic locations, and prospects for advancement, please help.")

My favorite part of the process, and the part I consider the most difficult, is defining the problem, figuring out the options, and mapping out — to the extent possible — the Markov chain for each; i.e. the first two items on the list. But once you do that, shouldn’t the choice be clear? Well, for some (many?) apparently not!

Wild problems aside, ⊕ This is admittedly a very big aside, but most issues people ask me about are not, in fact, wild, just ill-defined. once you know the choices and their consequences, shouldn’t it be easy to pick the one that fits best with your priorities?

Well, not unless you rank them! Which is so banal I’m a bit embarrassed to waste even two minutes of your time for it, but seriously, for every 10 people I ask about their top priority (singular), nine will start giving me an unordered list of them, and start hemming and hawing about my follow-up, which is to pick just one. Because there can be only one: it’s right there in the name! And if only one choice fits, well, there you have it! If there are several, you go down your ordered list one by one and prune.

Of course, it is not always that easy. But the decisions people get paralyzed about are seldom in the Sophie’s Choice category; and for those that are, there are usually many more degrees of freedom to reframe the problem, the choices, or both, than poor Sophie had. For everything else, the choice is difficult because people haven’t figured out the priority, i.e. what they actually want.

NB: the list of priorities can be all-encompassing (“values”, but remember, at the end of the day it’s really just one “value”) or context-specific (“first, do no (net) harm” for doctors, etc.) I am sure there are whole industries ready to sell you their lists of priorities, or, um, empower you to make your own. I am by nature skeptical of anyone who too readily shares theirs. Caveat lector, as they say.

Tim Harford writes about productivity:

There are so many things one could be doing at any particular moment, and so many variables — where you are, how much energy you have, whether you’re being interrupted — that the whole exercise can feel like a game of five-dimensional chess that frequently leaves even the most skilled and seasoned players bewildered by an unexpected move.

This was such a great description that I had to share it. His advice, drawn heavily from GTD, is:

1. Look ahead (i.e. do weekly reviews)
2. Clarify
3. Be content (Oliver Burkmean style)

💯, as the kids would say.

These were supposed to be Notes from a 6-hour trip to Boston, but mechanical issues delayed the inbound flight by 4 of the 6 hours, and since this included the 90 minutes during which I was supposed to talk (for 20 minutes) answer questions (10), and attend a panel (30), the lecture had to be pre-recorded and the questions will have to wait another day. So anyway:

• Despite the delay, I have to give kudos to JetBlue. I am not their frequent traveller — though that is now likely to change — and my status with them is “Group F”, yet they refunded the entire trip without fees and gave additional credit for the inconvenience. The gate staff was on top of reshuffling people with connections to different flights and they handled some heated situations with poise. Granted, I may have been more heated myself had the trip been higher stakes, but had it been higher stakes I would not have had such a tight itinerary. Hurray for risk management.
• The stakes are not high because I was able to pre-record and send out the talk as soon as I realized I would not make it there on time. Now, could things have gone better? Yes: using AirPods to record over the background airport noise led to less than ideal audio, and a few times I had to yell over a person who decided to take a phone call right next to me, but hey, it’s a free airport, I hope we had annoyed each other equally.
• Speaking of sound quality, of course there is a study that shows that poor audio quality leads to distrust (sponsored by Shure, by any chance?). The original article had some 200 of Amazon’s “mechanical Turks” — what a charming way to describe low-wage digital labor — listen to manipulated and clear NPR recordings and grade them by how trustworthy they were. Now, this rhymes so much with the now-debunked study of illegible text leading to better retention due to increased focus that I’ll decide to throw all of it onto the ever-growing pile of things that just don’t matter, and will keep telling myself that my sub-$100 Samson is more than enough, if I just used it more.
• But anyway, it is a good idea in general to pre-record your talks — maybe during a practice session? — and save the best take for cases like this. It will also help you get rid of ticks both verbal and facial which you won’t even notice until you see yourself speak. Nowadays even PowerPoint has built-in recording.
• And if you didn’t come here via the homepage and/or RSS, do have a quick look at the good and the ugly of Washington National airport, DMV’s premiere flight cancelation destination.

Ages ago, back when this was a Squarspace blog, I had a snippet that automatically added Amazon affiliate links to posts. No one ever clicked, until now.

This morning, I found in my inbox a gift card with my Amazon Associates payment, for the amount of…

$0.49. It’s a start!

🗃️ The analogue dashboard is working better than expected! This is how it started.

I love that micro.blog hosts blogs as static websites. But if I were ever to need a non-blog static website, FastMail would be my number 1, 2, 3… host of choice. They’ve managed my email for a decade and have been nothing but outstanding. ↬This day’s portion

Infrastructure Saturdays continue with some minor tweaks to the link underlining, which should reduce visual clutter. I have also spent an unreasonable amount of time moving the infinity symbol a few pixels down. Point of diminishing returns reached!

I vaguely remember learning about The Curator’s Code from Marco Arment’s blog and sharing his lack of enthusiasm: I still don’t quite grasp the difference between “via” (ᔥ per the Code) and “hat tip” (↬). But 10 years later, why not give it a shot? ↬Tedium.