Why Are There So Few Good Doctors?

One in ten is a generous estimate of medical professionals who are highly knowledgeable and passionate about their work.  This is based entirely on my own interactions with everything from surgeons, specialists, pediatricians, ER doctors, and more.

From a customer standpoint, this sucks.  A tepid box-checker is a poor vendor of any good or service, not just health.  When you get your car fixed, you want the guy who’s fascinated by the clunking noise and getting all House M.D. in his zeal to find and fix it.  You want the lifetime gearhead who dreams about pistons at night.  When it’s your body, you want the actual House M.D.

But you’re almost never going to get it.

Most medical professionals aren’t very sharp, interested, passionate, or eager.  Not trying to be rude, they just aren’t.  It’s almost always a lackluster if not downright crappy experience.  They aren’t thrilled by sleuthing the root cause behind the symptoms in your unique body.  They rattle off tons of drugs they haven’t studied that might dull the symptoms, classify you with a government/insurance approved code, order several useless tests, and blather some condescending thing about flu-shots or the latest seasonal scare.

I suspect the reasons for the disinterest in most medical professionals are several.

  1. They pursued the career for prestige, not intrinsic interest.
  2. Intrinsic interest was beaten out of them in the industrial schooling system.
  3. They are protected by a labyrinth of government regulations and monopoly status, so the incentive is to master the government game rather than master the craft, since the former is rewarded and the latter isn’t.
  4. They have grown intellectually arrogant and stagnant due to the universal respect and awe in which they are held by a credential-worshiping media and public.
  5. They were schooled in a “lump of dough” philosophy that treats problems and solutions in aggregate and plays down biological diversity while playing up one-size-fits all scientism.

It seems dentists, and especially chiropractors, have a much higher rate of deep interest in their field.  Midwives and doulas have a ridiculous, almost pathological love for their craft.

Not surprisingly, they have less of all of the above.  Their fields are less prestigious, less monopolized and cartelized with legal privilege, and they are less revered.  In the midwife/doula case, they almost never get reimbursed by insurance or recommended by the health industry, so they have to win and keep customers themselves like a self-respecting market participant.  They often face legal obstacles that make their practice borderline banned.  You’ve gotta be driven by a deep interest to persist in those cases.

Incentives matter more than anyone thinks.  The medical licensing regime is one of the more pernicious and pervasive elements of society.

You Realize Your Deepest Fear…and It’s Amazing

My son told me about a plot he created for a dystopian movie.  It involved dissidents being sent to a dreaded penal colony another planet away, never to interact with the home civilization again.   When they got there, they realized it wasn’t the hell they feared and fled from their whole lives, but a paradise filled with the best minds (the kind who would be banished from a despotic society).  Incidentally, the only way to discover paradise a planet away was to be captured and banished, since no one there had any way to inform others about what was waiting on the other side of the law.

It got me thinking about examples of similar expectational twists, when the most deeply dreaded outcome turns out to be better than anything you could’ve imagined.  Especially those where there is no way of knowing how good it can be until you do it.

Everyone fears the horror of a world without government support for education.  What if no one could afford to go to school?  Most assume hell, I think it would be delightful.  Our transition into unschooling was a microcosm of this realization.

Leaving your loved ones sounds terrifying to most.  What if you were uprooted from your hometown, leaving all friends, family, and network behind, forced to start fresh in a new city far away?  Few things are more amazing and valuable for personal growth.  In fact, the more you fear it, the more you probably need to do it.  And you can’t ever access what’s on the other side without biting the bullet and saying goodbye.

My son was convinced our new baby would ruin the balance in the family, taking his happiness with it.  He came home and met his baby brother and told me his months of stress were for naught.  Maybe that’s what inspired his plot.

I suspect death will be the ultimate plot twist of fear into wonder.  Guess I’ll have to wait and see.

“Unless You Are Like One of These…”

My daughter loves Moana.  We watched it again the other day.  I love the scene where the protagonist as a toddler walks right into the ocean after a seashell – something her cautious and fearful father would’ve never allowed.

The water parted.  She was in awe and playful, totally ignorant of the fact that toddling into the ocean is dangerous.  Her wide-eyed ignorance is the very thing that allowed her to experience the magic and power of her calling.  Had she known more, been better “educated”, she’d have never left the shore.

I often think about what I know now, four years in to building Praxis.  If I had known it back when I began, I never would have launched.  It would have been foolish.  I was nowhere near prepared to build what needed to be built.  My ignorance of the dangers of the journey turned out to be the most necessary asset.

You have to become like a little child to embark on the biggest adventures.

Greatness Is About More Than Results

Kobe and Shaq were dominant.  Three titles and every reason to believe more on the horizon.

But Shaq likes to have fun while Kobe wants to kill.  They didn’t get along.  Kobe wanted to win, but not as much as he wanted to win his way.  Kobe didn’t fight to keep Shaq around.  He let one of the greatest duos in basketball break up.  LA fans hated Kobe for it.  Everyone mocked him.  He didn’t care.

Winning was almost everything for Kobe. Winning his way was everything.

He cared not what anyone else thought.  He was willing to risk several more titles to be able to build and lead a team his way.  They sucked after Shaq left.  People jeered.  Kobe didn’t listen.  Instead, he climbed the mountain without the big man and willed LA to two more titles, Shaqless, and no question of who’s team it was and how it happened.

Selfish?  Maybe.  Short-sighted?  Perhaps.  Kobe doesn’t worry about that.  He focuses on what he wants.  The great ones don’t just get the results.  They live life on their terms, even when those terms decrease the odds of success.  They force success anyway.  They squeeze blood out of a stone.

That’s why I love Kobe.  I’d rather work the night shift at Wendy’s than have success on someone else’s terms.

Theoretical Man: Who Is This Poor Guy and When Can I Meet Him?

There’s no shortage of Facebook Warriors patrolling the web for things to dismiss.  Ironic, yes.  If it’s worthy of dismissal, why take the time to seek it out and publicly dismiss it?  Everyone has different emotional needs.

The most common dismissal tactic is appeal to Theoretical Man.  No one’s ever met him, but TM is the most amazing person imaginable.  His circumstances are so extenuating and full of nuance that nothing applies to him.  Ever.  Not gravity.  Not time.  Above all, not happiness or success or anything good.

You can find him if you post something simple like, “If you work harder, you can get more of what you want.”

Someone will come to the defense of TM in no time.  It will probably go something like, “This might not work for everyone.  Some people have real struggles.” (But it will probably be longer and accuse you of callousness toward TM).

TM is powerful in this way.  Anything that wouldn’t work for TM – which is everything – can be dismissed.  Very useful.

You and I have never personally known a single soul for whom the above aphorism wouldn’t apply, if charitably and commonsensically interpreted.  In your own life, you can think of several ways that working harder could result in you getting more of something you want.  You can think of zero real-life acquaintances for whom this is not true.

Not good enough.  The standard of evidence you should use (and you’d know this if you spent more time commenting on Facebook) is whether you can imagine any way in which the infinitely oppressed TM could possibly not turn into Warren Buffet tomorrow if he heeded the advice.

Spoiler: it won’t work for him.  Theoretical Man is tricky.

The point of the internet is to protect TM from any ideas that may benefit others.  It’s not fair to him, because he’s not capable of benefiting from anything himself.

Remember, if it won’t work for TM, it’s irresponsible for you to say it to anybody or try it yourself.

Success Doesn’t Require Understanding

In the market you can succeed without knowing why.

This is vexing to intellectual types.  They tend to have the opposite problem, because it’s equally possible to know why without succeeding.

A decent number of successful people are also intellectual and they do have deep understanding of why their product succeeds.  A small number of intellectual people are also successful, and therefore translate their understanding into practical success.

The market is a phenomenal process because it’s blind.  It doesn’t need you to show your work like a math teacher would.  It doesn’t even care if the answer matches the textbook, only if the answer is subjectively useful to enough people given the trade-offs.  That’s what makes it powerful.  Amazing things emerge when price signals communicate what’s working, even if everyone’s left to guess why it works.

Outside the market, especially in academic arenas, there is a demand to know why things work – or ought to work – with no corresponding demand that they actually do.  It results in much investigation into the nature of things that are dumb or impossible (communism, any theory of governance outside of a rational choice framework, and really anything – ideas or products – shielded from the market by subsidies or regulations.)

In the market, things need to work.  That’s priority number one.  It’s messy and full of experimentation and feedback.  Of course, you can’t be without theory whether you like it or not.  You need a theory for why something’s worth trying in the first place (it needn’t be correct to succeed), and you need theories for what the feedback means (again, not necessarily correct), but how people respond is the ultimate test for success.

Repeatable success is much harder and more rare.  I suspect those who can repeat success are those who not only do something well, but really understand why it worked and can replicate the underlying principles, or take the specific knowledge gained and use it for the next thing.

It’s easy to get stuck trying to understand why phenomena should work, and being frustrated when it doesn’t pan out.  But the market doesn’t care about should, only does.  It’s a good reminder to not relegate philosophy to thought experiments.

Stop Consuming and Start Creating

My son was frustrated with lack of originality in his drawings.  He said he used to find it easier to create new characters and worlds.  Now he’s in a rut making variations on popular worlds created by Nintendo, Marvel, and DC.

I told him with blogging and podcasting, I sometimes get sick of myself (hard to imagine, I know).  Sometimes I need a content fast.  A week without the books, podcasts, or blogs I normally consume.  The creative work gets a little harder at first, then easier and fresher.  Content fasts open new vistas.  I end them hungry for something totally different.  I might turn off a business podcast for a week and find myself craving some physics or history.

My son liked the idea and decided to try it and see if he could re-awaken originality in his creations.

The create to consume ratio

I’m a big fan of consuming new ideas, but it can be a crutch.  My friend Derek Magill recently shared a quote about an optimal 2:1 ratio for creating to consuming.  I don’t know if there’s a consistently optimal ratio, but I do know my rate of content consumption needs to be regulated or it will spiral into stagnation.

The best way I’ve found to nail the ratio is to let creation determine consumption.

If you think of consumption as an input needed prior to creating, you’re in a dangerous spot.  This framework will give you infinite excuses and you’ll bloat your brain with decreasingly effective stimuli.

Creation comes first

Commit to create and do it.  For me, the baseline is a new blog post per day.  When I’m doing that, I find my appetite for consumption regulates itself.  At times I get dry and need new ideas to mix with old ones and fuel creativity.  If creation is the priority, consumption ebbs and flows as needed.

I think this is the way humans naturally learn.  They create before they appeal to instruction manuals.  They test first, and study after failures drive them to better info.

Formal education treats ideas like physical goods.  Everything is divided into subjects, like raw materials in a factory, prepared, perfected, measured into the prescribed quantities, then combined into a final product as a last step.  It’s all resource gathering and prep work, with a tiny creative output at the 11th hour.

This ain’t no factory

Ideas aren’t like physical goods.  They aren’t scarce.  You can’t break them.  You can create an end product without setting up a sophisticated system of inputs first.  In fact, until you have created a product in your mind, you don’t know what inputs and processes are even needed.  Who would bulk up on raw materials and build a factory with no notion of what they wanted to produce?  That’s how school approaches learning.

I’ve referred to the natural process elsewhere as practice–>practice–>theory–>practice…

You try stuff first.  Create first.  Consume, study, and reflect in response to a felt need to improve the thing you’re trying to build, not as a preemptive info-cram.

I get better results and have more fun when I lead with creation.

“Will Your Kids Go to College?”

I’m always amused when someone says, “You talk a big game about college not being necessary, but I wonder what you’ll have your own kids do!?”

It reveals a fundamental ugliness at the heart of the problem I’m trying to help overcome. I won’t “have” my kids do anything. My kids will pursue what they want to pursue. They don’t need a “talking to”, or carrots and sticks or goading or pressure or shame or a savings fund to steer them to what I prefer.

It’s hard for me to imagine a scenario in which college wouldn’t be a waste of time, money, and creativity for them. But what I imagine isn’t what matters. It’s not my choice, it’s theirs. If they ask for my opinion, I’ll share it. If not, I wont. My kids will fail or succeed at their own dreams by their own efforts, not my engineering of their every decision.

Kids aren’t widgets to plug into a conveyor-belt ride towards your vicarious dreams.

(Oh, and if they apply to Praxis, they’ll face the same scrutiny from the review team as everyone else.)