How Do You Solve Your Maze?

Envision a mouse trying to solve a maze for a piece of cheese, and he has to decide which way to turn at the first cross-section. He takes a look at the three possible routes, thinks for a bit, then turns a sharp left and ran. In a complex labyrinth, the mouse would most likely reach a dead-end by blind guessing.

A regular mouse might get confused (where’s my cheese?!). A smart mouse might think “well that’s all wasted effort, let’s start over” and start again from the beginning. But a smarter mouse might try to backtrack as little as possible, by going back to the nearest intersection and making a different turn.

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Do Your Research Before Doing Your Research

Recently I had an idea.  Something just clicked when I least expected it – of course!  Why didn’t I ever thought of that before?  A simple research question.  A simple way to answer it.  Helpful contribution to knowledge.  I began to assemble the idea by writing it down, into outlines and paragraphs, thinking through all the possibilities.

Then it occurred to me to use PubMed.  It turns out that although I didn’t “ever thought of that before,” someone else clearly did.   It was a good paper.  So there was that.

Every now and then we all stumble upon an idea so good, so exciting, so cool that we want to pursue it and make it our life’s goal – a research focus, a project, a new company.

Just be careful that someone else might have had that epiphany too.  Last year. Find out what happened to that idea before starting yours.

Be a humble impostor

There is such thing as the impostor syndrome, in high-powered institutions when students and trainees hear their inner voices tell them that they are a fraud, that the admissions office made a mistake.  And the worst of it – on the next test, the truth will be revealed, and everyone will find out.

You might not be an impostor, but you also might be working among very smart people.  If you are as lucky as I am, you would have the occasional opportunity to be the dumbest person around.

I say lucky because once you realize that you work with a the world’s smartest people and trust that you still belong, you will have the humility to become a little bit more like them and the confidence to believe you can.

Is your niche too narrow? Too wide? It doesn’t matter.

Academics care about being in a niche.  A person only has 24 hours a day and 7 days a week.  It’s practically impossible to be the world expert in everything.

Some days I worry that my interest in informatics is too narrow.  So tell me again, why wouldn’t anyone just hire either a dedicated radiologist or a dedicated informaticist?  What’s the point of you?

Some days I worry my niche is too broad. Because that’s basically all of radiology, you dimwit!  That inner voice in my head would scream.   How can you expect to understand all of what makes my profession tick, all the intricacies behind every segmentation algorithm, every big-data challenge, every line of code?  Give it up.

And then there are days when I spend 8 hours doing something I want to do, and the day feels 20 minutes long.  Days when I feel tired but satisfied, proud to have made those career choices.

These are the days when that voice doesn’t speak.

 

Measure Differently to Think Differently

Credit: Innovation by Boegh, licensed by Creative Commons

There are many forms of innovations.  Sometimes medical innovation is nanotechnology, molecular imaging, high-precision targeted therapy, or 3D-printed prosthetic, which are advancements whose adaptation rate are limited by the rate of research.  This is a good thing.

And then, there exists technology that has become commonplace in every other industry but is still considered “innovation” in medicine due to their glacial adaptation rates in hospitals and clinics.  Case in point: When was the last time you saw a pager that doesn’t belong to a healthcare provider?

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Before the End of the Day

Radiology Education

Credit: arztsamui from freedigitalphotos.net

 

“Before the end of the day,” a staff radiologist placed a gentle but firm hand placed on my shoulder a few months into my first year in residency, “we should talk about your report.”  I felt a dull tugging in my stomach, worried that something had gone seriously wrong – an incorrect diagnosis, a poorly phrased finding, an embarrassing lapse in voice recognition leaving out the “no” in front of “evidence of cancer.”  Maybe I was completely off-base, having seen a finding that did not exist and perhaps called it “highly suspicious.”  Maybe the ordering physician called my attending on her personal cell phone to complain.

Maybe it was the patient who called.

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Stop Using Tablets/Phones/Computers before You Go to Bed!

According to some smart Harvard people, anyway.

Because evolution never expected humans to develop ways to produce light, our bodies are wired to assume that nightfall is all dark.  A December 2014 study from PNAS states that the light from a back-lit computer screen degrades sleep hygiene from a hormonal level. 
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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.

Pareto-Efficient

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:

pec1

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