Book #2: Drive by Dan Pink

This one was a work-related read. We have a “leadership book club” in my residency program, wherein the Powers that Be select a book on corporate management type stuff to have us read and discuss. I think it fulfills some kind of “systems-based practice” type requirements. Or something.

OK so the premise of this book is that intrinsic motivations are as compelling as extrinsic rewards. That’s a Nobel Prize winning statement, right there. When choosing a field of study or a line of work, no one has EVER considered inherent interest in the subject. EVER. Dan Pink jazzes this up by calling it “Motivation 3.0″ (the original motivator being the caveman ethos of eat-mammoth-and-try-not-to-get-killed; and 2.0 being the carrot-and-stick model) and says that businesses should encourage employees to maximize intrinsic motivations instead of extrinsic rewards. Like, you know, salaries.

Happy slaves LOVE pickin’ cotton and banjo’ing! So much intrinsic motivation!

The book starts off with some psychology studies by Harlow (the man who did this to monkeys) on how people like solving puzzles, and if you pay them for solving puzzles, they lose interest, because then it’s about the money and not the cool Rubik’s cube. He then generalizes those findings, bizarrely, to the modern officespace, to say that corporations should pay people “the minimum necessary to live” (???) and instead focus attention on the trifecta of Motivation 3.0: autonomy, mastery, and purpose.

Look, that’s a valid enough point. If you are lucky enough to have a job that gives you a chance to succeed at all three things (and I do!), you’ll be more invested in the company, happier, and will be a more productive worker. But I think I am a very lucky exception … most people do not have the chance to have a job that allows them to achieve some sense of higher purpose. I have had jobs like that — janitorial work at the local library, transporting patients as a hospital volunteer, transcribing a paper dictionary into a computer. In my case there were all temporary high school / college positions, but there are lots and lots of people whose job, their everyday, pay-the-bills job, is some iteration of the above.

There are plenty of things that need done to keep things turning along. Bus drivers. Long distance truckers. Retail clerks. Cafeteria cooks. Street sweepers. Who is going to fulfill these roles during “20% time,” of which Pink makes a huuuuge deal. (Give your employees 20% of their paid time to do whatever they want. In my case, that time would be spent watching Netflix. Let’s be real.) Pink is very very optimistic when he thinks that everyone works in some sort of magical creative paradise all the time. I envision his “managerless company” as a sort of Lord of the Flies, wherein we all ritually slaughter Piggy on day three.

There are some interesting ideas in the first half of this book about creativity and puzzles and thinking outside the box. It starts to drag about halfway through, and loses its focus. The last 100 pages are a “toolkit” which basically rehash the whole book, in case you weren’t paying attention the first time around. Most frustratingly, he talks a big game about how important institutional culture is in promoting autonomy, mastery, and purpose, but he never once gives any practical tips on how to help encourage that.

Book #1: The Casual Vacancy

Oh my god, you guys. This book? Is good.Casual Vacancy, Wikimedia

Ignore the Amazon reviews. They are written by people who expected another Harry Potter book with TEH MAGICKS and were shocked / upset / generally kerfuffled that JK Rowling is not a one-trick pony.

(I liked the Harry Potter books a lot. But what was great about them was they were children’s lit written like adult lit, no punches pulled, no saccharine sentimentality. And what’s great about The Casual Vacancy is that it’s just … adult lit written like adult lit.)

The plot is straightforward: local council member dies abruptly, by-election is held to replace his seat. But the real strength of the novel is in the characters, drawn sharply and with an excellent eye. It reminds me in that way of Austen or even more of Middlemarch, but if Dorothea Brooke had a blog.

Perhaps it’s because I live in a relatively small city with similar class distinctions as fictional Pagford, but the characters, even the less likeable ones, were very real. Everyone knows a meddling Shirley, and middle-aged Samantha’s crush on a young musician is so common as to be almost a cliche. The teen characters are definitely the most well-rounded here and the most sympathetic, especially Krystal. Krystal’s heartbreaking. I can’t tell you why; just read.

Yes, it’s tragic and dark and the last few pages are like watching a slow inevitable explosion and you finish it in the middle of the night because you stayed up far too late and you just have to stare up at the ceiling. It’s a book with an impact even bigger than its tome-like size.

Apparently the BBC just did an adaptation starring Keeley Hawes, Michael Gambon, Julia McKenzie, which aired last month in the UK and will air here on the 12th of Never, because Masterpiece Bloody Theater would rather air their fifth Downton Abbey marathon than some new programming.  So if you are lucky enough to live in places where BBC player works, tell me, was it any good? Worth tracking down in the usual nefarious places on the internet, or give it a miss?

30 for 30

I went to my friend’s 30th birthday party this weekend. (When did we get so old?) She mentioned that she is doing a 30-for-30 thing this year, in her case hosting 30 events. Which … is a lot of events. I can’t even hardly get my stuff together to organize the residency retreat, let alone plan and host 30 parties in 365 days. The cleaning up alone would do me in!

But I really like the idea of commemorating a milestone year in a concrete way. You know what I think I can do, is read 30 books. I’m already partway there, thanks to a book club!

So here we go, 30 books (and reviews, of course) between now and Dec 31, 2014. Ready, set, read!

Patient letter

Dear Dr. [Scrivener],

Because of my chronic daily headache, I cannot get out of bed most days, so I cannot work and am now applying for disability. Can you fill out my paperwork?

Oh, and I need to reschedule my appointment with you next week because I’m going on vacation to the Caribbean. Even though I just told you I am bedbound and cannot work, I am still able to deal with airport security, cramped airline seats, and sitting out in the tropical sun sipping pina coladas on the beach. Can I get an early refill of Imitrex tho?

— Migraneur

Foul, fetid, fuming, foggy filthy….

I went up to Philadelphia last weekend for a wedding of a good friend of mine from medical school. The wedding itself was tons of fun — both the ceremony and the chance to catch up with our old med school crowd — but I confess I had ulterior motives. I’m thinking about applying to some programs there for fellowship, so it was a great excuse to try out the city in a non-pressured way.

Philly reminds me a lot more of Washington DC than NYC. By which I mean, it may be more liveable for me. You can see the sun so that’s good, I guess? I don’t know. It really breaks my heart to have to leave this town in a little over a year. As much as I complain sometimes about (non-existent) traffic, just spending the weekend in Philly reminded me of all the little annoyances of city living. Slush piles everywhere. Running errands on foot, especially hauling groceries several blocks or on public transport. Lack of greenery. People around ALL THE TIME. Better than NYC, but still, I was very happy, if a little exhausted, to come home.

More on patient satisfaction

The patient satisfaction forms I mentioned in the last post? Are making it to the residency program now, courtesy of JCAHO (I think).

We were each given a packet of forms, printed on hideously green paper with black type (who made these, the Wicked Witch of the West?) to hand out to our patients.

JCAHO’s coming! Quick, gel your hands!

The statements themselves are in size 10 italic font (great for our elderly patients! so readable!) and range from “My doctor introduces himself or herself” to “My doctor is sincere, trustworthy, and doesn’t keep information from me.” Patients have to rate the resident on a scale of 1-5.

No mention of other things like “My doctor seems competent.” or “My doctor can answer my questions or direct me to more information.” Medical knowledge, it seems, is somewhat irrelevant in this brave new world.

In non medical news, I’m currently reading Wolf Hall, by Hilary Mantel. It won a bazillion prizes when it came out, and it’s being made into a movie in the spring. It’s a tad introspective, but I do like it. Also slogging through The Martian, by Andy Weir, my book club’s official selection, which … it’s like a survival guide to being on Mars. There’s lots of info on how to generate oxygen from hydrazine. There’s lots of “Yay! It worked!” or “Boooo! The generator failed!” which makes Our Hero (TM) sound more like a pre-teen girl than a 30-something mechanical engineer.

Can’t get no

The clinics here do patient satisfaction forms, and periodically we get aggregate feedback emailed out. For the most part, this is a good thing — helps us understand issues with workflow, ease of scheduling appointments, all those things that as a doc we don’t have direct access to, but surely affects patients’ perceptions of our clinic and our overall competence.

Then sometimes we get gems like this:

HONESTLY some of the questions I answered I had to guess. I did not know how to answer them. I did not have the all the knowledge needed to answer them.

I don’t … I can’t even …. In what world do you blame the clinic for your own stupidity? And if you don’t understand the question because of jargon or something, just SAY SO.

On a bigger scale these stats (% positive reviews) are almost certainly being including in some sort of pen-pusher quality metric. It’s part of larger moves in Health Policy. In the private world, I hear physicians’ pay is being directly linked to patient satisfaction ratings, which seems like a great way to produce a community of candy-men and sycophants. In academia, departments with more satisfaction probably get more perks, or something. They keep promising us that we’ll move out of the basement one day, but with reviews like this …..