Bryan Vartabedian on the angry email:

The angry email is usually rooted in frustration over inefficiencies or some nagging problem that hasn’t been fixed. Ultimately, it’s about the fantasy of the willful imposition of change by the sender. […] The defining element of the angry email is that it’s ultimately regretted. Or it should be.

I’ve written thousands of angy emails in my head, a dozen or so on the computer, and sent zero to date. If there is a next one, I’ll write it in longhand.

Seth Godin on the amateur presenter:

If you’re called on to give a talk or presentation, the biggest trap to avoid is the most common: Decide that you need to be just like a professional presenter, but not quite as good. Being a 7 out of 10 at professional presenting is a mistake. Better to stay home and send a memo.

This is exactly what happened last month at that medical conference. Colleagues, please stop.

They are converting a modern office building into condos a few blocks down from my apartment, and by the looks of it they may as well have torn everything down and built it anew. I hope they will do that will all the brutalist federal garbage downtown, the FBI building first. Meanwhile, the late 19th-early 20th century townhouses scattered around DC have been switching seamlessly from commercial to residential and back for a hundred years now for little to no cost.

Optimization and scale: they work great, until they don’t. Just ask a salaried physician working for a conglomerate in the medical-industial complex, a large-scale operation which is being optimized to death (sadly not its own, but that of its component parts — patients and health care workers alike). All those large reptiles and mammals are extinct for a reason.

We discussed the problem of scale at the first RWRI I attended back in August 2020, the Beirut explosion still fresh in everyone’s mind. Less than a year later, a big ship blocked the Suez channel, as if to reinforce the message. I expect Nassim Taleb’s next book will have a chapter or three on the problem, even if “scale” doesn’t make it into the title.

What goes for biology, architecture, and logistics also goes for industry, and if there is one hyper-optimized massive-scale operation around, it’s Apple’s iPhone production. If and when its production chain comes toppling down, it will not be a black or a gray swan event, it will be snow-white, which is why I suspect (or, as an iPhone user, hope) they have contingencies.

And in practicing what I preach, I have slowly been transitioning away from GTD levels of hyper-productivity and into a 40,000 weeks mindset. Whether this is a sign of wisdom, experience, or just plain old age, well, who is to say? Why not all three?

The Benefits of Being a Young Mom:

My mom, who had me at 22, worked as a nanny for other people’s children when I was a baby, bringing me to work with her in St. Louis, where we were living so my dad could finish school. She had a few rules for kid-raising: no need to go to the doctor for most things (better to wait and see if a malady resolves on its own); a cardboard box from the garage makes for the most thrilling play; and babies can—and should—be brought practically anywhere.

I’m not a young mom, but I can vouch for the soundness of these rules. We did have our first child at an awfully young age for the East Coast (28–29!?)

When a project I have been putting off for 2 months gets done after 90 minutes of concerted effort, how should I feel: relieved or annoyed? Because right now it’s the latter.

This baby turned 11 years old a few weeks ago. Treasure the moments.

Nitin Khanna:

I love that Anne calls the very first draft of what writers write as “shitty first drafts”. I love it not because I write shitty first drafts and then better second drafts, but because I only write shitty first drafts, and then hit publish.

Which is exactly what I’m doing. Long live blogging!

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.