One at a time




One at a time.

One day at a time. One run at a time. One mile at a time. One step at a time. Any task can overwhelm even the most talented, competent, and prepared individual if they try to do everything, all at once.

In a long distance race, thinking about every mile while standing at the start line is terrifying. Even more, standing at the edge of the water before a triathlon thinking about the swim, then the hours on the bike, then the many miles of running. Mentally, it is the stress of doing all three disciplines at the same time.

Occupations can be the same way. To become a physician or scientist many stages of training are required. If you want to do medicine and research, the problem is further compounded. Undergraduate education takes 4 years, a PhD or MD take around 4 years (or combined 7-9 years). Then comes at least 3 years of residency, often followed by 1-3 years of fellowship, and for the research minded, a 3-4 year post doctoral fellowship. It’s like graduating from your undergraduate work and realizing you have to repeat kindergarten through 12th grade all over again. Just writing all that down in one place is enough to elevate the stress levels. No one could finish that training by waking up every morning and counting down the days (The count at the end of undergraduate work would be something like 6,200 days left). Planning ahead but also taking each challenge as they come, not mentally all at once, is essential.

The same can be said for other life events. Launching into a responsible adulthood does not mean buying a car, getting a mortgage on a house, finding your life companion, starting a retirement account, and getting a salaried job all at once. It means gradually progressing towards the long term goal of independence.

So whether in a race, an occupation, or life in general, it is important to take the next step without fighting every battle and taking on every future challenge all at once.

“Do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own.” (Matthew 6:34)

This however, is often easier said than done.

Making decisions easy



Simplistically, making good decisions is rejecting the bad while acting upon the good. In many cases, rejecting the bad is almost a more difficult and continuous task than acting upon the good. For example, the decision to maintain a healthy diet certainly entails eating healthy foods. However most people struggle more with not eating junk food than with eating a salad here and there. The same can be said for spending. While it is easy to put away a set dollar amount every month for savings, it is much more difficult to constantly avoid spending throughout the whole month.

One attempt to help alcoholics avoid drinking is Antabuse, a drug that causes flushing, vomiting, and a host of other unpleasant side effects, if alcohol is consumed.  Those struggling with alcoholism often find it difficult to constantly say “no” to alcohol. Since it only takes a momentary lapse in resolve and the opportunities to drink occur incessantly all day, every day, the journey of sobriety is often fraught with relapses. The thinking behind Antabuse is that it takes the job of constantly saying “no” throughout the day and replaces it with a single “yes” decision to take the medication.

In the modern world, nearly every pleasure and temptation are available conveniently and constantly. Want a burger and side of fries? You’ll probably pass at least 3 or 4 places on your way home from work or school promising you just that. Want a sweet treat? There are aisles filled with just that at any number of grocery stores, corner stores, and gas stations within a few blocks of you home or office. Feel like something else? Amazon, Uber, or another delivery service will drop it off to you wherever you are. And that’s just food. Alcohol, entertainment, sex, and nearly anything else are available to everyone at any time, with minimal effort.


Creating a more simple and productive life must seek to make the good choices the easy and convenient choice. This means selecting a workout plan that is nearby or even at home. This means keeping foods close by that are healthy and making the less healthy foods a treat rather than a regular part of the diet. It is much easier to say no to several pints of ice cream once a week at the store than to avoid eating several of the delicious pints that are conveniently already sitting in your freezer. It may mean planning out meals, using tools to increase our productivity on our devices while limiting distractions, and pre specifying our budget each month.  It means establishing convenient times and methods of communication for keeping up with important relationships. It is a different type of intentionality. One that seeks to make good decisions easy and makes it convenient for us to ignore our vices.

Making cases to ourselves


Making a case is a valuable skill and an important part of developing as a person as well as working as part of a team. Making a case is a great way to get a new perspective and decide what idea is best within the marketplace of ideas. Although certainly not perfect, a debate between two genuine, curious people is an important way that we make progress. Making a case for yourself is also a key skill in pursuing new opportunities. When applying to medical school you make a case for yourself, presenting why you are going to be an excellent physician and a contributing member of the community. You are decidedly not presenting truth and hoping that the admissions committee sorts it out for you. Your personal statement is not a list of good and bad things you’ve done (best to leave that time you pushed Suzi into a puddle for your diary). Rather, it is a well crafted argument about your attributes. In general, making cases should be reserved for presenting to others where opposing cases and impartial observers can challenge these cases.

One problem I have had, and seen others have as well, is that we often confuse which one of these tasks we are doing. Instead of presenting our cases to others, we begin making cases to ourselves. As we like ourselves, and fancy that we are right the vast majority of the time, we tend to accept our cases without developing opposing arguments. For example, weighing whether to get a new bike can rapidly become making a case for buying a new bike. Deciding whether to workout or relax can become an argument for why you deserve the couch. Without anyone else in your head to oppose your case, you’ll certainly win every time. For minor things, like a new bike or a workout here and there this is barely even problematic. However in more important decisions this can be a huge blindspot. For example,  in deciding what stock to invest in you don’t want to make a case for one stock as much as to get to the truth of which stock might be most profitable in your given time frame. This means weighing both the good AND the bad. In deciding what house to buy, who to date, who to marry, what career to choose, how many kids to have, we must avoid making internal cases (this more closely resembles a delusion than a search for truth), and begin to weigh both sides. At least two sides to the case must be argued in good faith.

To quote Richard Feynman,

“The first principle is that you must not fool yourself, and you are the easiest person to fool.”

Information: Collecting and synthesizing


Computers have changed everything. We all know it. Most of the things that computers have changed have been changed for the better. Many of the fears that we had with the advent of computers have not come about (…yet). In the preface of one of the versions of the Divine Comedy by Dante Alighieri, the comment is made that in Dante’s age one could know everything that was known in the world. Whether this was empirically true of Dante’s age is hard to say, however the point is well taken. That is to say that collecting information about the world was the rate limiting step and a very useful attribute for an individual to have.

Fast forward to the modern age, there is far too much information for one person to know. Even within a single field, say biology or medicine, there is far too much for one person to take in. It is estimated that 1.5 million academic papers were published last year alone. To merely keep up with new knowledge is an insurmountable task, not even counting the enormous amount of information that already exists. Teachers or professors cannot principally teach facts. This is not a tradition of passing on an oral history from one generation to another. The vast number of facts on the internet make it so that professors who pass on facts will soon be obsolete. The job of the professor and indeed the job for all of us, is to learn how to synthesize information. This is taking in large amounts of data and reaching a conclusion from which actionable steps can be taken. Computers are currently stunningly bad at doing this type of thing. Creativity, that is developing an objective that is not predetermined, operating in a system where the rules are fungible, and recognizing opportunities between disciplines and between tasks, are all things with which increased computational power has not endowed computers. These are, for the near future at least, tasks for which humans are uniquely suited.

Although there is much discussion (ahem…debate) about where artificial intelligence will take us, there is consensus that artificial intelligence will be used, and is being used, to augment human abilities. Our role, both now and in the future, is not to accumulate information but synthesise information and to creatively solve problems and come up with new goals. It is, and will continue to be, a new way to do things, but one in which the benefits are enormous. You may remember from a previous post the fact that there are over 7,000 known diseases and many scientists estimate there could be double that number that actually exist. No human can keep that straight. That is a recipe for failure as a physician and a lot of missed diagnoses and opportunities in patients. Artificial intelligence augmenting physician knowledge and skills is the solution to this problem. The computational power and memory capabilities of artificial intelligence would keep the diseases, indications, complications, medications, and everything else straight. So why even need the physician at all? Precisely because of the weaknesses of computer based intelligence mentioned earlier. In medicine there are no set rules and no clearly defined goal. Each patient is different, has different baselines, and unique attributes. Further, there is no guarantee that there is only one solution or diagnosis to the puzzle. There may be (and often are) many different disease conditions and diagnoses all occurring at once. Obtaining information from the patient, tailoring their diagnosis and treatment to the individual, and ensuring that the patient as a whole is cared for will be the domain of the physician. Recalling large amounts of information, integrating the newest clinical trials, and identifying rare diseases will be the critical contribution of the machine.

But whether in medicine or any other field, the times have changed and so too has our role. Instead of collecting information we must synthesize information and use our creativity to solve practical problems.