books · PGY-3

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.

clinic · PGY-3

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 …..


The definition of quiet

You know what’s really annoying?

When you feel sick and miserable and haven’t had a decent night’s sleep in a week and just a little bit stressed about your upcoming pathology exam and general Life Issues, so you decide to go to the quiet study lounge instead of outside to the library, and you find that the study lounge has been overrun by a group of first-years who evidently don’t know what “quiet” means.

Here’s a hint, firsties.  “Quiet study lounge” means whispers.  Indoor voices.  When you walk across the hardwood floor in heels, people should look up.  If you want to have a study group, go next door to the former cafe that has been transformed into … group study space!  Shocking concept!

EDIT: A soul braver than I asked them to keep it down.  They gave her the dirtiest look, then glanced around and realized that everyone else was quiet.  Let’s see how long their relative silence lasts.