Creative Doctoring

Listening to my former students who ended up with MD degrees, there are negotiations in the medical profession, especially in large settings, which sound remarkably the same as any blue-collar labor negotiations. How many days off? Which hours for work? And so on. These are even issues that are negotiated up front during the hiring process.

Not too surprisingly, this situation means that (on average) the attending physicians who work in the evenings do not necessarily have the same profile as those who work during the day.

The demands from the greater fraction of sleeping people, in the evenings, are also less (just board a long-haul transoceanic flight that leaves in the afternoon or early evening – the cabin turns into a flying dormitory within moments after the refuse from that first, quickly-served meal is collected).

There are places in a hospital where circadian rhythm rest cycles do not matter: the Emergency Room, for one, and the Intensive Care Unit, for another.

Improving care in the ICU by coaxing senior physicians to take the evening shift is a challenge in doctoring.

The ICU is an interesting place, in addition, because the bulk of the information comes from electronic monitors, and these data are used to make strategic choices for treatment, often with an overriding sense of urgency.

I recently learned of an interesting solution to this situation (and the fact that this solution exists tells you that it is, in fact, considered a problem).

That solution? Find a comparable hospital in a time zone that is 12 hours away, in a reasonably interesting and attractive part of the world, and let the attending physician serve 8-12 months at this location, where the day shift locally equals the night shift back home.

Does being on-call and hooked up by distance, for a more experienced and senior physician, compensate for the day/night difference when that same person will never be serving the night shift back home?

Currently, data are being collected about this, but there is at least one large academic hospital that I just learned about (no, not the one where I am) that has been trying this out for a while. The other location is in a large city along the coast of Western Australia.

At first the idea struck me as just weird, but changed my mind within a few hours.


Learning to Play a Rigged Game

Mark Evanier works in the television and movie business. He tells this joke when he gives The Speech to some would-be creative artist.

A man arrives in a strange city. He wanders around and eventually finds his way to a local tavern where folks crowd around a roulette wheel to gamble. He pulls some cash from his pocket and joins in.

After a while, a waitress wanders up to him and whispers, “The wheel’s crooked.”

“Thanks,” he says. But he doesn’t quit.

A few minutes later, the waitress notices him still losing money at the table. She sidles back up to him and again whispers, “Didn’t you hear me? The wheel’s crooked!”

“I know,” he says as he lays down another bet and promptly loses again.

The waitress is baffled. “Then why are you still playing?” she asks.

The man replies, “It’s the only wheel in town.”

Evanier has a four-point moral to The Speech.
(1) The system is not fair.
(2) It’s never going to be fair.
(3) You have two choices: Play under the system, as it is, or get out.
(4) If it should happen to pay off, it pays off big.

Coppola, B. P. “Learning to Play a Rigged Game” The National Teaching and Learning Forum, 2000, 9(2), 6-9.

Woodbock Printing

Humans have been stamping and pressing patterns into objects for a long time. Patterns or seals pressed into clay date back thousands of years, and hammering ingots of metal into patterns as coins appears to have started around 600-700 BCE.

Fragments of carved woodblocks used to print patterns onto silk date to about 200 CE, in Asia. Wood-based paper emerges in China around this same time (200 BCE – 200 CE), and using a carved woodblock to press out the pages of a book dates to about 650-700 CE, in the reproduction of Buddhist scripture.

The technology is simple. Regardless of your medium, parts of a solid, level surface carry ink, which is transferred onto the surface of paper by stamping or pressing.

Although moveable type (ca. 1050) enabled printing of Western languages, with the rich combination of a finite set of letters into infinite words, the pictographic Eastern languages remained more suited to carving out an entire page uniquely, as opposed to carving and sorting, indexing and storing thousands of characters.

The printing press emerges in the mid-1400s, and using carved wooden blocks as the source of impressions was common for a hundred years, until the long era of etching on metal (1500-1800) prior to lithography and offset printing.

Woodblock printing for books and artwork persisted in Asia through the late 1800s, before the era of photo-reproduction changed the world of printing.

Here is an 1853 Japanese woodblock printing plate that I own. 
This is a hard wood block carved on both sides. The printing area is 17.4 x 27 cm (6 7/8 x 10 5/8 inch), with an overall size of the woodblock of 19.2 x 40.5 cm (7 1/2 x 15 7/8 inch), with a thickness of 1.3 cm (1/2 inch). It weighs 720 g (1.6 pounds).

The provenance on this is solidly good because the book is well known. Here is the impression from this plate.

The book title is Enmi Jizokyo Wakun Zue (Sutra of Life-extending Jizo Bodhisattva with Japanese Annotation and Illustration) in 3 volumes; and these are pages 25 and 26 of Volume 2. It was printed by Bokuko and released in September 1853 by the bookseller Haruhoshi Do in Osaka. The editor and commentator was Yomogimuro Aritune, and the illustration artist was Matsukawa Hanzan (1818-1882). The scripture itself was first published in print form around 15thcentury in Japan, and this specimen is one of the first with illustrations and Japanese annotation.

Ksitigarbha is one of the four most important Bodhisattva of East Asian Buddhism, and one of the most loved figures in Japan (called O-Jizo Sama by children in Japan). Many scriptures attributed to him were translated from Sanskrit in China around 700 CE. This particular scripture (Enmi Jizokyo) was claimed to be translated by Amoghavajra (705 – 774), a highly revered Indian monk who spent most of his life in the court of Tang dynasty China.

It begins with a passage claimed to be spoken by the Buddha himself. The scriptures might actually have been originated in Japan since there are certain passages that are uniquely Japanese (e.g., mentioned the legendary Tengu – a heavenly dog). It was very popular with the Samurai of Kamakura period (11th – 12th century) and popular with people of East Asia ever since.

This woodblock printing plate contains one of the important passages with its entire annotation and its companion illustration. The pronunciation of each character was indicated by Hiragana.

It can be translated roughly as: Jizo Bodhisattva is such that he can exhibit his body in variety of forms and would like to save all the souls from all the Six Worlds (including the hell). The annotation included detailed explanation of each word and a story of two Samurai (rich and poor) of Kamakura period with the illustration showing one praying with the Jizo Bodhisattva appeared to him in person.

The other side of the block looks like this.

And the impression from this side looks like this.

Hundreds of thousands of book pages and images were printed in Japan from the period of about 1710-1875.

Still today, you can see the monks at the Sera Monastery, in Tibet, printing scripture, to be sold as souvenirs, from woodblocks. Here are some pictures I took of a monk working at the Sera in 2008, nearby to a storage wall for the woodblocks.

Mirror Birthday

Mirror Birthday should be a thing.

Reflect your  lifetime backwards to get perspective on what those years mean.

This year is a fun one for a chemist. I’m 60, so go to my birth year (1957) and look backwards by 60 years to see what was going on in 1897.

1897: the year electrons were discovered, and Dow Chemical was founded

1957: electrons and Dow Chemical were as old as I am right now

And also, the pencil sharpener was patented, as well as the movie projector; the first internal combustion submarine sailed, Bram Stoker’s “Dracula” was published; and Oscar Wilde was released from the Gaol Prison.

The Art of The Steal (Again)

Ren Jingwen, a man in Xi’an, China, who spent over 40 years collecting ancient artifacts, and particularly things related to “Ox Culture,” built his own museum in Xi’an. The birth of new China (October 1, 1949) was in the year of the Ox, and 2009 was the hugely important 60th birthday of China and the year he planned for this museum to open, displaying his collection to the public. This museum opened on September 12, 2009.

Here is a run-down about the museum

I just happened to be  with an alum group that month, and had arrived in China on September 17; we got to Xi’an on Sept 21-23. The provincial museum was closed on the day we were supposed to go, in preparation for the October 1 celebrations, and our guide had heard about this new private museum, so we went. Here is a link to my full set of pictures.

This place was not only physically magnificent, but the collection (and I have seen a few Chinese history museums) was at least as good if not better, in many of his items, that I have ever seen… examples that I had only seen broken and repaired, he would have five pristine versions of them.

He was there that day, and took us around – I am pretty we were the first foreigners, and among the first visitors ever.

Apparently, creating this palatial and privately held museum and putting on this display – EVEN though it was all in deference to the country and the culture – was too much for the provincial government, who decided they needed the land, and demolished the museum and parsed some of the collection to three smaller museums.

I am so upset to hear about this! It sets my social justice neuron to firing when you mess with art. I have a super-special sense of privilege to have seen this place during its short lifetime.

And if you are smirking and telling yourself that “this is China, and this could never happen in the United States,” then you do not know about the story of the ca. $25B (B!Barnes Collection in Philadelphia, and I urge you to watch “The Art of the Steal” (2009) sometime. There is a copy on YouTube.

Risky Business

I was at dinner with some of my graduating seniors a few weeks ago, and they were recounting an elementary Astronomy course that they had taken this year (as seniors, to fulfill science elective credit) in which their stories about the course were (1) only thinking about it on the day before the exams and (2) that the exams (and thereby the course objectives) were lists of memorized information. Even at that, in the few days that had passed, the number of the Jovian moons that they could recall was already going down.

I asked the question: can it possibly be worth tuition and time to memorize lists of stuff that one could call up on a Wikipedia page on one’s phone in about as much time as it takes to read this sentence?

Recent reports about proposed changes to the Harvard and Duke University general education programs have been brutally honest about something I think we rediscover generation after generation, namely, that many “general education” courses are worthless. When I was in school, we certainly had versions of science courses that are still know by names such as “Rocks for Jocks” and “Physics for Poets.”

Faculty committees at both Harvard and Duke are convinced that the core values of the Liberal Arts education need to be resuscitated.

I have no argument with that position at all. But in the reports, you also read this:

How do we combine this structure with a robust pass-fail policy to further promote academic experimentation? What student mentoring structure will need to be in place to promote a deliberative engagement with the curriculum and ensure students embrace and meet expectations? How will this be financed? What other academic support structures may be necessary?

These statements drive me nuts because they are not much more than the latest version of what makes “Rocks for Jocks” such a bad idea, namely, that students are not actually being given the opportunity to make a mistake – a bad choice – and then learn how to deal with it and/or make the best of it.

What is particularly surprising is that nearly everyone embraces the conceptual value of “learning from failure,” yet we have systematically reduced the ability for students to make mistakes – or when we do, we anticipate it and then minimize the potential consequences.

“How do we ensure that students embrace and meet expectations?” is really asking “How to we ensure that students do not make a mistake?” My reply: let them.

“A robust pass-fail policy to promote academic experimentation” is really saying “A system of consequence where risk is actually mitigated.” My idea: it is not actually risky business when you swaddle a student in bubble wrap and fill the world with warnings and safety nets.

Professors are embracing “gamification” because they will tell you it promotes risk-taking, when I believe it does exactly the opposite because the actual risk has been removed.

And almost everyone has mindlessly embraced a world full with “custom tailored or adaptive” recommendation about what you should do or buy or watch based on the analytics. Why is it seen as positive to remove the opportunity to discover something?

Full disclosure: I took one course in college as pass-fail. As a chemistry major also interested in art, I took my first drawing class pass-fail. I was not taking a risk; I was mitigating it. I engaged the course, and I would have gotten an “A” (as it turns out), but I was playing it safe. My professor was quite disappointed when I said I was taking the course pass-fail, and I did not understand why for a long time. But his message was not lost on me, and I took three other drawing classes for a grade and never exercised the pass-fail option again.

Did I approach these latter courses more seriously? I honestly cannot say. Frankly, I was too good of a student in the first place. I would like to think that the choices I made – turning to academic advisors as the last resort, because I wanted to figure things out on my own, and often going for the instructors that others warned against – were statements of my willingness to take actual risks, make decisions, and work out challenges that crept up along the way.

I never quite thought about it before, but it really ought to be called the “pass” option. How many students who take “pass-fail” ever actually fail?

It is sometimes true (and reasonable) that you get the idea that you have made a horrid mistake within the first moments of making a decision, and the best decision can be to bail out. Learning how to detect a real disaster as opposed to over-reacting to a challenge is also a useful skill to have. I was a dual chemistry and physics major for about one week, which lasted as long as it took to take one hour of the first third-term physics course. I ran like the wind because I was able to evaluate the situation and make a decision.

Somewhere along the way, getting less than an “A” grade, regardless of what you learn (or not) has become a risk, thanks to the imagined consequences, often including the complete melt-down of one’s professional future prospects.

The real risk, perhaps, is that we are not providing the kinds of experiences with decision-making, failure, and recovery that are necessary for the educated person to have, while they are in school, where the real consequences are not learning how to cope with real life.

And in real life, in which many things are (in fact) “pass-fail,” the “fail” carries actual consequence.

I fell off the turnip truck a long, long time ago (Part III)

Previously… this point about reporting percentages.

In a recent essay, UCSB’s Robert Samuels began “Now that more than 75 percent of the instructors teaching in higher education in the United States do not have tenure, it is important to think about how the political climate might affect those vulnerable teachers.” And throughout the first paragraph, these instructors are (as are we all, apparently) being “threatened” and how these teachers are in “an especially vulnerable position because they lack any type of academic freedom or shared governance rights… they are a class without representation… [they have] precarious employment, which is spreading all over the world… [creating] professional insecurity and helps to feed the power of the growing management class.”

Whew. I am glad he got all of that off of his chest in the first paragraph. It is impossible to tell, from these multiple theses, that the point of his essay is to not use student evaluations to assess teacher performance.

I am sympathetic with his implication (or my inference), which rejects the consumerist mentality that has overwhelmed education in that last few decades, although I am more inclined to blame the faculty for being asleep at the switch, too readily giving up their responsibilities for governance, thereby letting the management class (including the lawyers) swoop ever so vulture-like into the void.

OK, OK. It is easy to get carried away when writing about these topics.

And I am always cautious about the claim of anyone lacking any type of academic freedom, because “academic freedom” has recently been overblown as a license to say or do anything without consequence. Indeed, if anything, academic discourse has been more restricted by internal policing than by external forces, it seems to me.

Samuels begins his essay with a percentage statistic. Did you notice that?

It has been common, for the last decade or so, for editorialists to at least imply that tenure track jobs have been lost and replaced by a growing class of non-tenure track faculty. The real picture, as you might suspect, is not so clear-cut.

Samuels rightly links to the dramatic graphical data (above) from the AAUP (American Association of University Professors), 1975-2011, which records the steady decline of the percentage of full-time tenure and tenure-track faculty as changing from 45.1% to 24.1%, and the part-time faculty as rising from 24.0% to 41.3%. The “75%” in the AAUP numbers needs to be attenuated somewhat from the get-go, given that graduate student instructors (TAs) are included in the ranks of the “75%,” but that percentage is nearly constant over this time period (20.5% to 19.3%).

Diving a little more deeply, there are two things to keep in mind to understand the “75%” and the percent changes shown here.

First, the number of students in higher education over this time grew substantially, from 8.6M (1970) to 11.1M (1975) to 14.3M (1995) to 21.0M (2011). In 2011, there were almost a many students in 2-year programs (7.5M) as there were in all of higher education in 1970.

What increase in the instructional workforce will result when the population of students doubles, and who is going to handle this teaching demand?

Second, and interestingly enough, the total instructional staff, including graduate student instructors, grew by 136% (remarkably, perhaps, tracking the enrollment increase since 1970). The number of tenured faculty increased by 36% (227K to 308K individuals), and the number of tenure track faculty increased 8% (126K to 136K). The number of full-time non-tenure track faculty, which was lower in 1975 (81K) has grown to 284K, a 250% increase), and the number of part-time faculty, which was 188K in 1975, has grown to 761K (305% increase).

So we have one of those situations, again, where you get to tell the story you want to tell to make your point. Both of the following statements are equally correct.

From 1975-2011, in US higher education…

… the fraction of tenured/tenure track faculty members has reduced by 45%.

… the number of tenured/tenure track faculty members has increased by 26%.

Maybe it is too much to follow, but I would have been happier if people such as Samuels would give me a bit more to go on when they decide to make a point with numbers such as these.

Now that more than 75 percent of the instructors teaching in higher education in the United States do not have tenure…

From 1975-2011, the increase in instructional ranks (136%) is comparable with overall increase in student enrollment (100%) in US higher education. While the absolute number of tenured/tenure track faculty members has increased modestly (30%), the fraction of instructors who are not tenured (or tenure-able), including graduate students, has increased from 55% to 75%, representing an increase from 430,000 to 1,140,000 individuals in the workforce.

I fell off the turnip truck a long, long time ago (Part II)

Previously, off the end of the truck… this.

Here is a description of someone’s history of giving: “Your charitable donations have gone up 100% compared with 10 years ago.”

Here is another description of someone’s history of giving: “Your charitable donations have gone down by 50% compared with 10 years ago.”

If you were a university fund-raising officer, which of these ‘someone’s would you rather target for that alumni dinner with the Dean?

On the surface of it, it seems pretty clear cut.

But it is not.

And every day (every day), the thinking person needs to filter the motivation of every author who presents or posts an idea. And particularly when they are quoting numbers, because we automatically, subconsciously, tend to regard numbers as clear and objective evidence without the intrinsic ambiguity that natural language can present.

But it is not that clear or objective. Keep  my two statements about those charitable donations in mind.

Ten years ago, when you were earning $50,000 a year, you made $5000 in charitable donations, which was 10% of your income. This year, you donated $10,000 from your $200,000 earnings, which was 5% of your income.

Turns out there are not two ‘someone’s in my original scenarios, and those seemingly contradictory statements are simultaneously true.

$5000 ten years ago; $10,000 this year; this means:

“Your charitable donations have gone up 100% compared with 10 years ago.”

10% of your salary ten years ago; 5% of your salary this year; this means:

“Your charitable donations have gone down by 50% compared with 10 years ago.”

Relative measurements (high, low, more, less, warm, cool…) all require additional absolute information (the point of reference) to understand them. Always think about that when people talk in percentage change.

I fell off the turnip truck a long, long time ago (Part I)

I was having a periodic annoyance with my home wireless system that was increasing in frequency, so I got onto the chat line for the company to report it. Turns out I needed an equipment upgrade, which took about 45 minutes to figure out.

As that was being ordered and set up, the kind person at the other end of the chat pulled out the standard company playbook.

“While we are waiting, I noticed your current service, and I think you can definitely get more for less money. Would you like to hear about it?”

I fell off the turnip truck a long, long time ago. So there was only one reply to give.

“I assume this is a promotion that reverts to a higher price after a while. What is the deal, how long does it last, and what does the cost go up to at the end?”


“Let me get that information. Hang on.”

Bottom line: for more service (some of which was interesting), I would pay about $30 less per month for a year, compared with now, then $10 less for another year, then it would be $15 more thereafter. That was a pretty easy calculation. 12 x $40 in reduction is $480 relative to what I am paying now, which would offset 32 months at the higher price. So that is more service at the same cost for 5 years. Not that bad, and the increased services looked good. So I agreed. Five years is next to forever; I might get run over by a turnip truck by then.

And it came packaged with phone service, which means -$60/month by cancelling the current service into the house.

There was a two-part online contract to sign to authorize the new service. And, I read it, which is another part of the lesson here (after understanding that you do not get something for nothing).

As it turns out, their contract read that the lower price ($30/month savings) was in effect for all 24 months, not 12, and it looked like the final price at the end of the promotion was not +$15, but -$10, from what I am paying now.

Maybe you can get something for nothing.

So I signed it and sent my chat buddy the authorization. Once that was confirmed, I pointed out the discrepancy.

“Before we end, I do have one more question…”

What I got back was a non-answer… a cut-and-paste repetition of the numbers from before, an uninformed answer.

Big mistake.

So I dug in through two rounds of this stonewalling, and finally got the person’s attention.

“I just signed a contract and here is what it says (quote/unquote). I know what you told me, and I even agreed to it. But now I have another thing that contradicts it. That is a discrepancy and needs to be resolved.”

“Hang on. I need to check with someone.”

Stonewall wall.

Rinse and repeat.

“Hang on. I need to check with someone else.”

“Sure, no problem.”

“Sorry for the misunderstanding. Yes, the lower rate is in effect for 24 months and the total price at the end of that time is lower than what you are paying now.”

“Thanks. Can I have the confirmation number and the chat reference for our conversation today?”

“Sure, no problem.”