Monthly Archives: November 2014

The Gorilla Detection Exercises at Dawn – A Theory of Radiology Nightfloat

As a rite of passage as well as part of the regular work schedules of a radiologist, a resident trainee must take on the role of independent interpretation for exams that come into the hospital at night.  I happen to work at a place where attending backup is readily available by phone, but an attending radiologist is not in-house at night.  This provides an abundance of learning opportunities.

After finishing one week of radiology night duties as one of two trainees, I’ve begun to think how the progression of the night always seem to follow some pattern, and what that means for a radiologist trainee on call.


First, it’s probably useful to introduce the concept of a pareto-efficient curve. The curve explains the relationship between two desirable but partially mutually exclusive qualities.  For example, a radiologist wants to be very fast at interpreting studies.  A radiologist also wants to provide very high quality interpretations.  Alas, we cannot do both at the maximal capacity.  One might imagine the relationship between the two to look like this:


Standard pareto-efficiency curve

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Do More or Better – But Usually Can’t Do Both

Today’s world provides us with tools that make humans more capable than ever. Writers who used to make elaborate trips to exotic locations to gleam material for the next espionage thriller while talking to their book agent on the landline with expensive long distance fees can now do the research at their computers while setting up an Amazon self-publishing account.  Radiologists who used to be at the mercy of transcriptionists to translate their verbal stutters into fluent medical poetry days later now generate reports within minutes using voice recognition technology.

These are empowering tools, putting the ability to affect outcome directly in the hand of those holding the highest stakes.  In general terms, it makes sense that with advancements in technology, professionals can now (1) do the same amount of work with better quality, or (2) do more work at the same quality.

Unfortunately,  inadvertently what happens is we tend to be expected to accomplish more and do better (occasionally one also expects to feel less tired at the end of it!) Business school professors would teach that technology advances push the entire pareto-efficient frontier forward.  That is, assuming that you are already working at your absolutely most efficient way such that any improvement in speed will automatically have a quality tradeoff, then adapting a new technology may change the nature of the curve such that you can now move both “up” and “to the right.”  The truth is, I am so rarely pareto-efficient in the first place that if a new technology can somehow land me onto my existing frontier, it was well worth the cost.  And while technology like this, this, and this don’t literally breaking any frontiers, they do have the added benefit of putting productivity in my conscious thought and – at least temporarily – make me healthier and more productive.

Back when Xerox invented the mouse

Xerox PARC, founded in the 1960s, was among the most cutting edge research group of its time.  On December 9, 1968, Douglas Englebart famously showcased a set of inventions that set the vision for the future of computing.  In a world when everything ran on a black and white screen with punch cards and command lines, he showcased live video conferencing, real-time document editing, and something called a graphical user interface.

In the center of all of this technology was a simple box-with-a-ball device that came to be known as the mouse, which then promptly spent the next 11 years in obscurity, discussed only by the geekiest pioneers in technology.  Continue reading