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The Doctor Won’t See You Now

Shouldn't you be at a meeting?

Shouldn’t you be at a meeting?

If you were to have major heart problem – acute myocardial infarction, heart failure, or cardiac arrest — which of the following conditions would you prefer?

Scenario A — the failure occurs during the heavily attended annual meeting of the American Heart Association when thousands of cardiologists are away from their offices or;

Scenario B — the failure occurs during a time when there are no national cardiology meetings and fewer cardiologists are away from their offices.

If you’re like me, you’ll probably pick Scenario B. If I go into cardiac arrest, I’d like to know that the best cardiologists are available nearby. If they’re off gallivanting at some meeting, they’re useless to me.

But we might be wrong. According to a study published in JAMA Internal Medicine (December 22, 2014), outcomes are generally better under Scenario A.

The study, led by Anupam B. Jena, looked at some 208,000 heart incidents that required hospitalization from 2002 to 2011. Of these, slightly more than 29,000 patients were hospitalized during national meetings. Almost 179,000 patients were hospitalized during times when no national meetings were in session.

And how did they fare? The study asked two key questions: 1) how many of these patients died within 30 days of the incident? and; 2) were there differences between the two groups? Here are the results:

  • Heart failure – statistically significant differences – 17.5% of heart failure patients in Scenario A died within 30 days versus 24.8% in Scenario B. The probability of this happening by chance is less than 0.1%.
  • Cardiac arrest — statistically significant differences – 59.1% of cardiac arrest patients in Scenario A died within 30 days versus 69.4% in Scenario B. The probability of this happening by chance is less than 1.0%.
  • Acute myocardial infarction – no statistically significant differences between the two groups. (There were differences but they may have been caused by chance).

The general conclusion: “High-risk patients with heart failure and cardiac arrest hospitalized in teaching hospitals had lower 30-day mortality when admitted during dates of national cardiology meetings.”

It’s an interesting study but how do we interpret it? Here are a few observations:

  • It’s not an experiment – we can only demonstrate cause-and-effect using an experimental method with random assignment. But that’s impossible in this case. The study certainly demonstrates a correlation but doesn’t tell us what caused what. We can make educated guesses, of course, but we have to remember that we’re guessing.
  • The differences are fairly small – we often misinterpret the meaning of “statistically significant”. It sounds like we found big differences between A and B; the differences, after all, are “significant”. But the term refers to probability not the degree of difference. In this case, we’re 99.9% sure that the differences in the heart failure groups were not caused by chance. Similarly, we’re 99% sure that the differences in the cardiac arrest groups were not caused by chance. But the differences themselves were fairly small.
  • The best guess is overtreatment – what causes these differences? The best guess seems to be that cardiologists – when they’re not off at some meeting – are “overly aggressive” in their treatments. The New York Times quotes Anupam Jena: “…we should not assume … that more is better. That may not be the case.” Remember, however, that this is just a guess. We haven’t proven that overtreatment is the culprit.

It’s a good study with interesting findings. But what should we do about them? Should cardiologists change their behavior based on this study? Translating a study’s findings into policies and protocols is a big jump. We’re moving from the scientific to the political. We need a heavy dose of critical thinking. What would you do?

Personal Branding In The Social Media Age

Rock climbing, biking, or violent crime?

How’s my brand?

When I was a teenager, my mother urged me to dress nicely because, “you do want to make a good impression, don’t you?” She even taught me how to iron my clothes so I could make a neatly pressed impression. (In fact, “pressing” clothes and making an “impression” derive from the same root). I remember asking her, “If it’s so important to make a good impression, why don’t you iron my clothes?” She answered with a smile: “It’s not that important”.

Mom also told me (repeatedly) that “you have only one chance to make a first impression.” She didn’t know it but she was speaking the language of personal branding. I’m often asked what personal branding means and I simply shrug and say, “it’s the impression you make”. We all make an impression on others, whether we intend to or not, and that impression is essentially our brand.

Another popular definition is that your personal brand is what other people say about you when you’re not around. Actually, I would distinguish between two different commentaries. When you’re not around, people can talk about what you do or who you are. The what-you-do stories are often interesting (“Did you hear what Travis did?”) but they’re not really your brand. Your brand consists of the who-you-are comments.

While the what-you-do stories can be lengthy, the who-you-are commentaries are usually quite brief – typically, 25 words or less. So your brand consists of the roughly 25 words that people speak about you when you’re not around. (This is a pretty good definition of a corporate brand as well).

If you care about your brand (some people don’t), you need to think about how to get the right words in place. My mother called it making an impression; today we call it managing your brand. But, really it’s the same thing. How do you get people to think of you in the way you want to be thought of?

One big difference between my mom’s era and today is the arrival of social media. In my mom’s day, making an impression typically meant meeting somebody face-to-face. Or it might have meant a good cover letter and resumé. (Mom was a great copy editor). Either way, it was personal.

Today, it’s not so personal. I can make a first impression on someone I’ve never met and never even heard of. Recruiters might look me up on LinkedIn. Friends of friends might see my Facebook page. Indeed, I hope that lots of people I don’t know will come to my website.

The other big difference from my mom’s era is the economy. My mother grew up in a manufacturing economy, where your skills were important. We’re now in a service economy, where your personality is important. As Tony Tulathimutte points out in The New Yorker, “Success in a service job … often involves getting people to see you as competent and likeable. … Now that what we have to offer in the service economy is ourselves, the rules of branding apply to us.”

So how do you make a good first impression these days? Think about the 25 words you want people to say about you and then work backwards. If you want people to say you’re intelligent, you better learn to write (and spell) well. If you want people to say you’re a good manager, then highlight your management expertise. As my mother used to say, “just remember to put your best foot forward”. Oh, and learn how to iron

Are You Happy? Hedonic or Eudaemonic?

I'm just peaking.


Research on happiness often distinguishes between two types: affective happiness and evaluative happiness. Affective happiness is how you’re feeling now and in the recent past. It’s fairly volatile and can rise or fall quickly. Evaluative happiness measures how happy you are with your life. It tends to be more stable.

Both types of happiness fit into a broader category generally known as the hedonic theory of happiness. This is essentially the pleasure principle – we seek pleasure and avoid pain. It’s fairly straightforward and is often considered the ultimate goal in theories of positive thinking.

But let’s think critically about this. Is pleasure really all there is to happiness? When you overcome obstacles in life, doesn’t that make you happy, even if the process is painful? Can you be happy simply by thinking positively and banishing negative thoughts? Indeed, can you truly banish negative thoughts and emotions?

These questions lead to a different theory of happiness that’s often known as the eudaemonic perspective. In Western thought, the concept originated with Aristotle. The basic idea is that we should lead an actively engaged life, colored by virtue and excellent character. It’s often compared to what Mihaly Csikszentmihalyi calls flow – when you’re completely immersed in what you’re doing. You harness your emotions toward a task and become completely absorbed by it.

When you’re fully engaged, negative thoughts may arise just as easily as positive thoughts. Rather than trying to suppress negative thoughts, you simply let them flow by. They’re part of who we are. In fact, they probably have some survival value. They can spur you to take action against an obstacle, do something unpleasant but necessary, or even just take your medicine.

Indeed, it may well be the case that trying to suppress negative thoughts causes us to have more of them rather than fewer. As Tori Rodriguez reports, a phenomenon called dream rebound may come into play. Researchers at the University of New South Wales divided participants into two groups. One group was asked to suppress a negative thought just before falling asleep. The other group did not try to suppress their thoughts. Those who tried to suppress their negative thoughts reported dreaming about it more frequently than those who didn’t. (Though it’s a different realm, this is similar to Jevon’s paradox).

In my experience, negative thinking produces a second-order effect. First, we have a negative thought. Second, we get wound up about having negative thoughts. OMG, am I a negative person? Why do I have such negativity?

In my opinion, the second-order effect is more damaging than the first. Of course we’re going to have negative thoughts. We can’t avoid them. In fact, they probably help us survive. The trick is to let them pass. As the Tibetans say, thinking is like writing on water. It goes away. Allowing negative thoughts to flow may not lead us to hedonic happiness but may very well stimulate eudaemonic happiness.

Verbal, Vocal, Visual – Body Language and You

Let me explain quantum mechanics.

Let me explain quantum mechanics.

A woman says to a man, “Oh, you’re such a brute.” What does she mean? Well, it depends. The words have meaning in themselves but the way they’re delivered also counts for something.

Let’s say that she delivers the line with an aggressive posture, a scowl on her face, and a harsh tone in her voice. Most of us would conclude that the man should take her words literally; she’s angry and the man should back off.

On the other hand, let’s say she delivers the same line with a smile on her face, a flirtatious giggle in her voice, and a soft, inviting posture. She uses the same words but delivers them in a very different way. Most people would conclude that she doesn’t mean for her words to be taken literally. What she does mean may not be crystal clear but it’s probably not the literal words she speaks. (By the way, I adapted this example from an excellent article in New Scientist).

This is what Albert Mehrabian, the father of the so-called 7%-38%-55% rule, was studying. Mehrabian was trying to identify how face-to-face communication actually transpires, especially when the words are ambiguous. He identified three basic components: 1) the words themselves; 2) tone of voice; and 3) body language, including facial expressions. These are often summarized as the three V’s – verbal, vocal, visual.

In ambiguous situations, especially when discussing feelings, how do you sort out what the other person means? Mehrabian calculated that the words themselves account for 7% of the meaning (from the perspective of the receiver). Tone-of-voice accounts for 38% of the meaning, and body language accounts for 55%. To determine whether you’re really a brute or not, you should probably pay less attention to what the woman says and more attention to how she says it. (For more on the multiple meanings of simple words, click here).

Mehrabian’s findings may be accurate in the very specific case of conveying feelings in face-to-face communication. Unfortunately, far too many “experts” have over-extrapolated the data and applied it to all communications. When you give a speech, for instance, they may claim that 93% of what the audience receives comes from tone-of-voice and body language.

If that were really true, then why speak at all? If 93% of meaning comes from non-verbal channels, a good mime should be able to deliver a speech just as well as you can. Indeed, if 93% of communication is non-verbal, then why do we bother to learn foreign languages?

Fortunately or unfortunately, even Marcel Marceau (pictured) can’t effectively deliver an information-laden speech without words. Words are important – use them wisely and use them sparingly. Body language is also important. The best advice on body language is simple: you should appear comfortable and confident to your audience. If you don’t, your audience will wonder what you’re hiding. If you do appear comfortable and confident, your audience will attend to your words – for much more than 7% of the meaning.

Computers Are Useless. They Only Give You Answers.

Questions and Answers signpostI’ve worked with some highly creative people during my career. I’ve also worked with very insightful thinkers, both in business and in academia. Oftentimes, the two skills overlap: creative people are also insightful thinkers and vice-versa. I’ve often wondered if creativity leads to insight or if insight leads to creativity. Lately, I’ve been thinking that there’s a third factor that produces both — the ability to ask useful questions.

Indeed, the title of today’s post is a quote from Pablo Picasso, who seemed both creative and insightful. His point — computers don’t help you ask questions … and questions are much more valuable than answers.

So, how do you ask good questions? Here are some tips from my experience augmented with suggestions by Shane Snow, Gary Lockwood, Penelope Trunk, and Peter Wood.

It’s not about you — too often, we ask long-winded questions designed to show our own knowledge and erudition. The point of asking a question is to gather information and insight. Be brief and don’t lead the witness.

You can contribute to a better answer — even if you ask a great question, you may not get a great answer. The response may wander both in time and logic, looping forward and backward. You can help the respondent by asking brief, clarifying questions. Don’t worry too much about interrupting; your respondent will likely appreciate your help.

Remember your who, what, where, when, how … and sometimes why — these words introduce open-ended questions that often result in more information and deeper insights. Be careful with why. Your respondent may become defensive.

Don’t go too narrow too soon — decision theory has a concept called premature commitment. We see a potential solution and start to pursue it while ignoring equally valid alternatives. It can happen in your questions as well. Start with broad questions to uncover all the alternatives. Then decide which one(s) to pursue.

Dumb questions are often the best — asking an (open-ended) question whose answer may seem obvious often uncovers unexpected insights. Even if you’re well versed in a subject, don’t assume you know the answer from the respondent’s perspective. He or she may have insights you know nothing about.

Be aware of your ambiguities — even simple, seemingly straightforward questions can be ambiguous. Your respondent may answer one question when you intended another. Here’s a simple example: what’s the tallest mountain in the world? There are two “correct” answers: Mt. Everest (if you measure from sea level) or Chimborazo (if you measure from the center of the earth). Which question is your respondent answering?

Think of parallel questions — I’m reading a Kinsey Millhone detective novel (U is for Undertow). One of the important questions Kinsey asks herself is, “why were the teenage boys burying a dog?” It gets her nowhere. But a slight tweak to the question — “Why were the boys burying a dog there?” — provides the insight that solves the mystery. (Reading detective novels is a good way to learn questioning techniques).

Clarify your terms — my sister is an entomologist. She knows that there’s a difference between a bug and an insect. I use the terms more or less interchangeably. If I ask her a question about bugs, she’ll answer it in the technical sense even though I mean it in the colloquial sense. We’re using the same word with two different meanings. It’s a good idea to ask, “When you talk about bugs, what do you mean?”

Think about how you answer questions — when you respond to questions, observe which ones are annoying and which ones lead to interesting insights. Stockpile the interesting ones for your own use.

Silence is golden — when speaking on the radio, I might say “over” to indicate that I’m finished speaking and it’s your turn. In normal conversation, we use body language and tone-of-voice to make the same transfer. Breaking the expected etiquette can lead to interesting insights. You ask a question. The respondent answers and turns it back to you. You remain silent. There’s an awkward pause and, often, the respondent continues the answer … in a less rehearsed and less controlled manner. Interesting tidbits may just spill out.

Don’t be too cleverPeter Wood probably says it best, “A few people have a gift for witty, memorable questions. You probably aren’t one of them. It doesn’t matter.  A concise, clear question is an important contribution in its own right”.





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