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Monday, December 25, 2017

Booked up for the holidays

Trying to get back on pace with my reading tempo. Been hobbled most of the year with my daughter's illness.

Lots of great stuff.

In particular, the Rachel Pearson book has my rapt attention. Underachiever with MD (Peds) and PhD (Medical Humanities) degrees. Now in residence at UW Harborview Medical Center in Seattle.

Check this out, a summary of her UTMB Doctoral dissertation::

Objectivity is an epistemological virtue that physicians aspire to embody in our practice. Historians and philosophers have pointed out that objectivity is culturally specific: it varies with time, place, and profession. In pre-clinical training, physicians learn to honor a scientific version of objectivity, in which the self is understood primarily as a potential source of error and “scientific selves” seeks to eradicate the pernicious influence of the self from scientific data. In practice, however, this research identifies that medical objectivity is distinct from scientific objectivity. This dissertation examines memoirs of medical training to understand how physician trainees learn, experience, and use objectivity. Medical objectivity is defined herein as attitude within medical epistemology that serves physicians’ attempt to structure clinical knowledge as scientific knowledge. It is situated (within the bodies and selves of physicians and medical trainees), dynamically subjective (insofar as it both changes people and changes according to the people who embody it), structured by narratives (such as narratives of race and narratives of self), and learned. The objective/objectifying gaze is an epistemological technique that serves a limited but crucial role in medical objectivity. The devaluation and attempted eradication of the self that inheres in an idealized “scientific objectivity” persists in medical providers’ narratives of self, within the objective/objectifying gaze, and in the experiences of clinical detachment and aequanimitas. Medicine’s appeal to social authority relies in part on the perception that we are “scientific.” However, medical objectivity is best understood as a subjectively situated and narratively structured attitude that serves (and, in some cases, disserves) medicine: a science-using, moral practice. Truly embracing medical objectivity as a subjective and narrative practice can both alleviate trainee discomfort and improve care. Not only can our narratives be fruitfully examined and challenged, but also we can harness subjectivity (including our discomfort, our joy, and our narratives of self) as a tool to improve the quality of care we provide.
I really want to read her dissertation.

UPDATE: I finished Rachel's book. Utterly compelling. Five stars. I put it right up there with Ann Neumans's The Good Death.

I am always interested in books that shed light on "clinical cognition" and the lives of clinicians. e.g., see my prior post "Nurses and doctors in the trenches." Also a big fan of Dr. Danielle Ofri. See my "House calls, STAT!" See also my post on "Slow Medicine," "God's Hotel."

Below, I finished this book. Very good.

Dug it. Although, for a book claiming to have "launched the Lean Startup revolution," there is precisely nothing in it going explicitly to Lean methodology practices. Putting the "customer discovery / customer development" processes ahead of the "product development process," yeah, I get all that (and, charitably, it's foundational to a Lean philosophy, in many ways a direct descendant of Deming). But, no discussion of key topics such as "PDSA," "Value Stream," "Gemba," "Kaizen," "the 5 S's,", "A3," "Fishbone Diagram," etc.

I kept getting a recurrent feeling: "yeah, this is largely good old MBA (albeit PDSA-iterative) SWOT analysis stuff."  I'll have more to say about this one in a bit.

Other stuff in play:

And, off-topic, but intrinsically interesting to me (bought this in hardcover),

Below, not yet released, but coming in January:

Found out about this one via an article on its topic in The Atlantic.

I hope everyone has a happy and safe holiday season.


Update: I got two hardcover books for Christmas from my dear sister Carole.


Then there's this:

Ran across a reference to this book over at Naked Capitalism, "Cognitive Economics: How Self-Organization and Collective Intelligence Works."
Cognitive Economics
The more detailed study of apparently self-organizing groups points toward what could be called a cognitive economics: the view of thought as involving inputs and outputs, costs and trade-offs. This perspective is now familiar in the evolutionary analysis of the human brain that has studied how the advantages of an energy-hungry brain, which uses a quarter of all energy compared to a tenth in most other species, outweighed the costs (including the costs of a prolonged childhood, as children are born long before they’re ready to survive on their own, partly an effect of their large head size).

Within a group or organization, similar economic considerations play their part. Too much thought, or too much of the wrong kind of thought, can be costly. A tribe that sits around dreaming up ever more elaborate myths may be easy pickings for a neighboring one more focused on making spears. A city made up only of monks and theologians will be too. A company transfixed by endless strategy reviews will be beaten in the marketplace by another business focused on making a better product.

Every thought means another thought is unthought. So we need to understand intelligence as bounded by constraints. Cognition, memory, and imagination depend on scarce resources. They can be grown through use and exercise, and amplified by technologies. But they are never limitless...
Some of this is obviously going to point to "AI." Stay tuned.


More to come...

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