Programming, meet medicine
John Siracusa is a programmer. Merlin Man is a lifehack guru-cum-internet personality. If you are in a medical field, there is no particular reason you would know them.
They co-host a podcast that modestly has themselves as the subject matter. It is one of the best new podcasts this year, second only to CGP Grey’s (though with Road Work coming out this week, it may be a three-way tie). In this week’s episode, Siracusa had this to say about programmers (link to the audio here—it sounds better than it reads):
Plenty of people can espouse information telling some younger programmer “make sure you always call ‘srand’ before you call ‘rand’”, and they can easily tell you “don’t listen to that guy, you should not call ‘srand’ before you call ‘rand’”.
Neither one of them really understands it, because they can’t explain it. If that young programmer is saying “But why? But why? Why? How do these things work together? Explain it to me.” and they realize “Oh, I can’t explain it. All I have is this…"—it’s not a cargo cult, but it’s more like—“I have this practice that I’ve learned through supposed bitter experience that if I didn’t do this one time and something didn’t work, then I did do it, then it did work.” Very often in programming you can sort of learn that way where basically “I tried this one thing and it didn’t work, or this bug happened, then (I did) this other thing, and the bug was fixed”, and come away from that with a rule, or a heuristic, or something you think is an unwritten law without actually understanding the underlying…
Remind you of anything? In medicine, “cargo cult” is exactly
the term I would use. Programming’s saving grace is that it is a finite
system created by humans, and—at least in theory—knowable. The human
body is as black a box as it ever was—the only difference between now
and the 1800s being a stronger flashlight.
So, programming clearly shares this with medicine: most of its practitioners don’t have a firm grasp of what they are doing, and don’t understand the underlying principles of their craft. Why, then, do we fool ourselves that adding programmers' idiosyncracies to physicians' by the way of electronic medical records, clinical decision support systems, and ultimately AI-run e-doctors, will somehow “fix” medicine instead of making it bad in a different way?
On medical euphemisms
Observe George Carlin discussing how euphemisms are invading the English language:
I first heard a version of this years ago, back in Serbia, while I was still a med student. It hadn’t left much of an impression, but I can imagine myself nodding my head and thinking ha ha, yes, stupid Americans, ruining their own language, or something comparably obnoxious.
Well, I’ve, erm, matured since then. True, some euphemisms now inspire rage instead of vague amusement, like my two favorites:
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“I just wanted to let you know” instead of “I’m telling you”, and its relatives “Please let me know”, and “Thank you for letting me know”. Physicians are particularly fond of this, for we are the gatekeepers of knowledge, and the only reason you know something is because we are letting you. Don’t worry though, it’s not just you, we say that to each other all the time.
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“I don’t feel comfortable doing xyz” instead of “I don’t want to do xyz”, as mentioned here.
Most of them, though—particularly ones we use with patients—have a good reason to exist. The Radiolab segment which inspired this post made fun of “making someone comfortable” being used for dying ICU patients. Instead of… what, exactly? Euthanasia? There is a difference between giving someone drugs usualy meant for comfort—opioids, primarily—in order to kill them, and giving them opioids for pain and comfort knowing it may shorten their life.
Then there are turns of phrase used because they are euphemisms. “You should get your affairs in order”, “your time is becoming limited”, “at this point we should concentrate on quality of life, not quantity” are all ways of saying “I don’t know when you’ll die, but it will be soon, so start planning the funeral”. I am sure Mr. Carlin would appreciate getting it straight, but not every patient is as stoic. We can easily be more blunt if asked to do so, but you cannot un-hit a patient with a sledgehammer like that. So the default is to err on the side of softness.
Then again, most of the euphemisms we use with patients also make us more comfortable with the sitation. What I wrote above may then just be my rationalizing it away with a convenient it’s-best-for-the-patient mantra. In truth—to use another common phrase—euphemisitis is a multifactorial condition (as in, I have no idea what the reasons are, but it’s probably a little bit of everything).
Down the vim rabithole
Spending two hours each day on the train, offline and without distractions, gives me an excuse to go down various rabbit holes that a couple of months ago I would’ve thought nothing but time wasters. Starting to read the Dark Tower series—I’m almost done with the Gunslinger—is one of them. Re-learning vim—if dabbling with it in high school 15 years ago counts as having learned it—is another.
This episode of the Technical Difficulties podcast is what started it, followed by a blog post or two on the perfect setup. Now, I may or may not continue using vim as my primary writting tool—I would have to figure out how to integrate it into my workflow—but several things I picked up will always be useful:
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git is an amazing tool for tracking changes that researchers should use more
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don’t blindly edit stuff—dotfiles in this particular case—on your computer without understanding what those edits mean
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Solarized should be your default color theme for anything
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use your macro/keyboard shortcut app of choice (mine is Keyboard Maestro, you can just as easily—but not as prettily—use Better Touch Tools) to quickly position windows into quadrants, halves, thirds, etc.
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there might not be much difference between bash and zsh if you are a beginner, but zsh has the cool customizable prompts
Yes, I am writing this in vim, previewing and exporting in Marked, then posting it manually to Squarespace. The only thing standing between me and a fancy-pants static website engine powering this blog is there being no internet access on MARC trains, and me being too cheap to get a $20-a-month personal hotspot from Sprint. That is probably for the best.
A podcast a day
Fun fact: The average Maryland to DC commute is the second longest in the US, right after New York. I should know. Mine will be 90+ minutes, come July 1st. Last week, while I was finishing paperwork at my new employer’s Bethesda offices, the looks people gave me went from incredulity to pity on seeing the Baltimore address on my driver’s license and hearing my explanation that no, since my wife is still at Sinai and usually just walks to work, we won’t move. It’s better for me to take one for the team, I’d say, than have both of us suffer hellish beltway traffic from some midway point.
I could write an essay on how taking one for the team is not entirely true, but the title of this post says “podcast”, and it’s already the second paragraph, so here is my point: My commute will be long. I will need to fill that time with something. Sometimes, that will be strangers talking into my ear about things I don’t understand. Here is my list of strangers, carefully curated after ten years of listening.
Monday: Mac Power Users
Comes out every Monday morning, like clockwork. Great for learning about new hardware, productivity apps, etc. but podcasts are not the best medium for going into the minutia of somebody’s workflow.
Tuesday: Back to Work
Go read this. Having Merlin Mann talk for an hour all by himself would be good enough, but Dan Benjamin—the other half of BTW—is the best podcast host in the business. By using a simple formula, it is easy to mathematically prove that their show is the best podcast ever created.
The first 30 or so minutes are laden with inside jokes and obscure references, but even that is fun after you are several episodes in.
Wednesday: Wait, wait…
It airs each Saturday, but I like alliteration, and there is nothing else good on Wednesdays. I was in Chicago once while it was being taped, but was too late to get a ticket. Now that Carl Kasell is retiring, it’s unlikely I’ll ever be at a live show. So it goes…
Thursday: The Talk Show
Daring Fireball is a better blog than TTS is a podcast—John Gruber and some of his guests tend to ramble—but you can get good insights on baseball and bourbon.
Friday: ATP
One word: Siracusa. There are two other co-hosts, whose main job is not to screw up too badly. They do it well.
Saturday: The Alton Browncast
The John Siracusa-slash-Bret Terpstra of food. Yes, Alton Brown is a national treasure.
The Sunday potpourri
This is the time for irregular shows, or ones that don’t always have something of interest. In order of preference:
- Radiolab • Fact: this is the best radio show ever created, and an even better podcast.
- The Incomparable • For geeks, by geeks. Or is it nerds?
- This American Life • Any co-production with Planet Money is a must-listen. Otherwise formulaic.
- Systematic • Hit-and-miss, though usually a hit.
- Technical Difficulties • A tech DYI show with show notes better than some books.
- CMD+Space • I only listen to it when an interesting guest is on, which is once every couple of months.
- The Pen Addict • A podcast about pens.
- JOP podcast • The only oncology podcast worth listening to; the medical podcast landscape is dreary.
Two podcasts, three doctors, one good show
In the last two months, two of my must-listen podcasts, Systematic and Mac Power User, have had medical professionals on as guests. I don’t usually listen to medical podcasts—Twitter and saved PubMed searches are big enough firehoses—so I thought it would be interesting to hear how my more experienced colleagues use technology. Two of the three episodes were underwhelming, one was stellar.
It started with Brett Terprstra and Dr. Pamela Peeke on Systematic. She has several books targeted towards lay public, and the episode went in the same vein—broad advice on nutrition, well-being, etc. I cringed more than once, but that was to be expected—public health information relies on overplaying the risks and simplifying facts to the point of absurdity. Much like weather forecasts. The one thing I could agree with was how important meditation can be, as mindful meditation might decrease physician burnout. Negative points for not mentioning Mindfulness in Plain English as essential reading, though I haven’t read Dr. Peeke’s own recommendation, The Miracle of Mindfulness.
I had higher hopes for Episode 169 of MPU, since Katie Floyd’s and David Sparks’s guest, Dr. Jeffrey Taekman, has an excellent productivity blog. Alas, McSparky spent more than half of the show being fascinated by the minutiae of what doctors do. Which is better than what followed—long periods of uncomfortable silence while the unprepared guest clicked through every app in his menu bar to see if there is anything worth mentioning. OK, it was not total silence. You could hear Katie fuming in the background. There wasn’t.
Then another episode of Systematic came on, with Dr. Don Schaffner, a microbiologist. PhD, not MD. Wonder if that explains why the show was better. It was outstanding. Brett was a better interviewer than David, and avoided getting too side-tracked by his guest’s interesting work. But ultimately, the show was good because Dr. Schaffner had useful tips and app recommendations that did not simply regurgitate the latest round of MPU/Mactories/Macdrifter/etc. sponsors. His paper review workflow gave me several ideas I will work on during the holiday downtime. He also suggested a promising contender in my quest to find headphones that will survive more than 8-12 months of intensive use.
One more thing for me to do during the downtime: promote Zotero. Between the developers fumbling Papers 3 and Mendeley being taken over by an evil corporation, Zotero coupled with a few extensions is the best reference manager on any platform. Coming in 2014.