Author Archives: Raymond Yee

Wondrous snow according to Joyce

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Although I've lived in Berkeley for over 18 years, I still have a special fascination with snow. It doesn't take much for me to fall into some reverie about snow -- for it seems to symbolize a special time and place for me, maybe a time and place that actually never existed.

From Joyce's great short story The Dead:

A few light taps upon the pane made him turn to the window. It had begun to snow again. He watched sleepily the flakes, silver and dark, falling obliquely against the lamplight. The time had come for him to set out on his journey westward. Yes, the newspapers were right: snow was general all over Ireland. It was falling on every part of the dark central plain, on the treeless hills, falling softly upon the Bog of Allen and, farther westward, softly falling into the dark mutinous Shannon waves. It was falling, too, upon every part of the lonely churchyard on the hill where Michael Furey lay buried. It lay thickly drifted on the crooked crosses and headstones, on the spears of the little gate, on the barren thorns. His soul swooned slowly as he heard the snow falling faintly through the universe and faintly falling, like the descent of their last end, upon all the living and the dead.

Currently reading: Groopman’s How Doctors Think

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I just started reading Jerome Groopman's  How Doctors Think. 1st ed. Houghton Mifflin Company, 2007. . (1st ed. Houghton Mifflin Company, 2007.)     I remember with some fondness "Eyes Wide Open,"  an essay from 2007  in The New Yorker.   I picked this book up in hopes of learning how to better deal with doctors, a skill that would come in useful in both mundane and life and death situations.

From what I've gleaned so far, Groopman is focused on the type of misdiagnoses made by doctors, which he writes is dominated by cognitive errors:

In one study of misdiagnoses that caused serious harm to patients, some 80 percent could be accounted for by a cascade of cognitive errors, like the one in Anne Dodge's case, putting her into a narrow frame and ignoring information that contradicted a fixed notion.  Another study of one hundred incorrect diagnoses found that inadequate medical knowledge was the reason in only four instances.  The doctors didn't stumble because of their ignorance of clinical facts; rather, they missed diagnoses because they fell into cognitive traps.  Such errors produced a distressingly high rate of misdiagnosis. As many as 15 percent of all diagnoses are inaccurate, according to a 1995 report in which doctors assessed written descriptions of patient's symptoms and examined actors simulating patients with various diseases.  These findings match  classical research, based on autopsies, which shows that 10 percent to 15 percent of all diagnoses are wrong. (p. 24)

Presumably, I'll find out from Groopman how I as a patient can help steer my doctors away from cognitive pitfalls that might bring great harm to me and my loved ones.   That's what I get from:

Different doctors, as we will see in later chapters, achieve competency in remarkably similar ways, despite working in disparate fields.  Primarily, they recognize and remember their mistakes and misjudgments, and incorporate those memories into their thinking. Studies show that expertise is largely acquired not only by sustained practice but by receiving feedback that helps you understand your technical errors and misguided decisions. (p. 21)

Although reviews of this book have been extremely positive overall on amazon.com, I often turn to critical comments to get a sense of what the book is like. One I found particularly useful is Amazon.com: R. Albin's review of How Doctors Think:

Even more disappointing is Groopman's attitude towards the most serious effort to rectify this kind of problem, the evidence-based medicine movement. For example, Groopman makes several dismissive remarks about the introduction of Bayesian reasoning in diagnosis and management.

Let's see how well Groopman does with analyzing the role of evidence-based medicine

I might give youversion.com a try

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At the beginning of each new year I'm always drawn to  the practice of reading the Bible in a year through the help of a daily Bible reading plan.   I might try using YouVersion | 1 Year Bible Reading Plan -- though I am loath to put too many personal reflections into the Web application, not so much because of privacy concerns, but more because of data lock-in. In other words, I don't want all the writing I have stuck in  youversion.com. (Note: there is the promise of a public API in the new year.)

What to do about fat cats?

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Besides getting angry, what can one do in response to the outrageous behavior of irresponsible people in the financial services sector -- which was well dissected by Krugman in The Madoff Economy:

    The financial services industry has claimed an ever-growing share of the nation’s income over the past generation, making the people who run the industry incredibly rich. Yet, at this point, it looks as if much of the industry has been destroying value, not creating it. And it’s not just a matter of money: the vast riches achieved by those who managed other people’s money have had a corrupting effect on our society as a whole.

Is any way to get reform enacted to keep the Wall Street fat cats from driving the system off the cliff again, often still collecting bonuses they didn't deserve? Or am I just unfairly singling out bankers for something we all share collective responsibility? That's the argument put forth recently by Henry Blodget in The Atlantic Online Why Wall Street Always Blows It?:

    Who’s to blame for the current crisis? As usually happens after a crash, the search for scapegoats has been intense, and many contenders have emerged: Wall Street swindled us; predatory lenders sold us loans we couldn’t afford; the Securities and Exchange Commission fell asleep at the switch; Alan Greenspan kept interest rates low for too long; short-sellers spread negative rumors; “experts” gave us bad advice. More-introspective folks will add other explanations: we got greedy; we went nuts; we heard what we wanted to hear.All of these explanations have some truth to them. Predatory lenders did bamboozle some people into loans and houses they couldn’t afford. The SEC and other regulators did miss opportunities to curb some of the more egregious behavior. Alan Greenspan did keep interest rates too low for too long (and if you’re looking for the single biggest cause of the housing bubble, this is it). Some short-sellers did spread negative rumors. And, Lord knows, many of us got greedy, checked our brains at the door, and heard what we wanted to hear.

    But most bubbles are the product of more than just bad faith, or incompetence, or rank stupidity; the interaction of human psychology with a market economy practically ensures that they will form. In this sense, bubbles are perfectly rational—or at least they’re a rational and unavoidable by-product of capitalism (which, as Winston Churchill might have said, is the worst economic system on the planet except for all the others). Technology and circumstances change, but the human animal doesn’t. And markets are ultimately about people.

Should I stop dealing with banks? pull my money out of the stock market? treat bankers with disdain? How should I put my anger to productive use instead of just ranting against the fat cats who were supposed to know what they were doing?

Brooks on Gladwell in NYT

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An interesting coincidence this morning: as I was reading Malcolm Gladwell's new book Outliers, skimming through The New York Times and struggling to focus my attention on important things, I came across David Brooks' latest column on Gladwell and the topic of focus, which includes the following key excerpt:

    Most successful people begin with two beliefs: the future can be better than the present, and I have the power to make it so. They were often showered by good fortune, but relied at crucial moments upon achievements of individual will.Most successful people also have a phenomenal ability to consciously focus their attention. We know from experiments with subjects as diverse as obsessive-compulsive disorder sufferers and Buddhist monks that people who can self-consciously focus attention have the power to rewire their brains.

    Control of attention is the ultimate individual power. People who can do that are not prisoners of the stimuli around them. They can choose from the patterns in the world and lengthen their time horizons. This individual power leads to others. It leads to self-control, the ability to formulate strategies in order to resist impulses. If forced to choose, we would all rather our children be poor with self-control than rich without it.

    It leads to resilience, the ability to persevere with an idea even when all the influences in the world say it can’t be done. A common story among entrepreneurs is that people told them they were too stupid to do something, and they set out to prove the jerks wrong.

    It leads to creativity. Individuals who can focus attention have the ability to hold a subject or problem in their mind long enough to see it anew.

It should be noted that Gladwell argues that successful people are products of their environment to a greater degree than commonly acknowledged in Western society....