Archive for December 5th, 2008

batikdflyI don’t know whether my undergrads all ‘get’ what I am trying to teach them about portable intellectual tools — I want them to see that reasoning about science is not that different from other kinds of reasoning: it’s the types of data, the range of acceptable warrants, and the strength of the claims that differ.  Of course, I also want them to understand that reasonable people can disagree.  Not everyone thinks that way, nor do they expect their teachers/classmates to act on that assumption!

Several of the undergrads who initially worried I would spout and evangelize for liberal politics seem pleasantly surprised; they could make arguments, and I would make sure that everyone could see the structure of what was being stated, and how perspectives on very similar data could vary widely, based on assumptions or values that had been set long before any given argument [and I mean that in the technical, not emotional sense] began. The ice broke with one such student when I explained that it was perfectly fine to use articles about police technology [Tasers, bullet-proof vests, etc.] as examples of technology news.  I gave him some links to police-oriented websites I knew about, and he felt comfortable explaining that one of his absences was going to be for interviews for a local police force.  He’s got prior military service, and is older and quieter than most of the other students in the classroom; I think he’d make a good officer and I wish him well.

“It’s interesting,” he told my yesterday, when I asked how the testing and interviews had gone. “They don’t want gung-ho people, or people who build their lives around the force.  They want it to be a job, not a lifestyle. Get in there, do your job, go home at night.”

That reminds me a little of how some hospitals are trying to change the ways medical residents get their training — you do an allocated # of hours, and then you time out and go home, as opposed to following one patient’s care however long that might take, or struggling to stay awake for 72 hours.solarmalkiesmall

Now, I’ve heard that making residency more ‘humane’ in this way can compromise continuity of care, and perhaps eliminate an essential tempering process for new doctors.  I don’t have sufficient data to assess that.  [I’m sure there’s a little of the “I went through hell, and so will you” going on in the resistance as well.  Humans can justify all manner of trama if they associate it with an outcome of which they approve].  What jumps out at me now, though, is that the changes in hours is similar to what was described for that police force:  It’s a job, not a lifestyle.  I sense a potential problem here — if it’s already been established that we’re understaffed in the medical professions, is saying it’s a job like other jobs a good recruiting tool?  If there’s no love for the field, for the work, what recommends it other than a paycheck, and what makes even that enough when times are hard and red tape is binding your wrists?

There is data suggesting that many physicians are eager to retire or otherwise get out of patient care. There’s data suggesting that doctors are not recommending the path to their children, and that areas of great genuine need, such as primary care, geriatrics, and nephrology are not attracting candidates the way dermatology and plastic surgery are.  Some of this, it seems to me, is a side effect of saying medicine is a job, and not a vocation. [Yes, I do know that the HMO industry is a huge part of what makes any sort of medical practice unattractive to the sane.]

Let me do something of a K-turn here:  Maybe we do want some high-pressure activities to be jobs that people do, then leave behind and return to a different world. Police, soldiers, fire-fighters….front-line people.  Knowing that the stress has a predetermined end might help some people hold themselves together better, or help long-term planners see that what gets accomplished during one shift or cycle is something that will have to be maintained by others, rather than deciding that Carthago will damn sure be delendo est on their shift.  So they don’t have tot go in, guns blazing, with the expectation that it’s you and no-one else, and it doesn’t matter what’s left in your wake because we’ll only have to go this way once. [Sort of a corollary to “Be kind to those you meet while climbing the ladder, because you may have to climb back down again someday”].

I am musing here, and I can easily see where if someone is having an MI, you want folks to go in blazing.  If someone is bleeding, or getting stabbed in the street, etc. We don’t have a good enough system for determining what % of enthusiasm + what % of expertise gets the best long-term outcomes.

Hmmn.  I suspect some of my students frequently confuse enthusiasm with emotional committment.  That would explain many a short-term undergraduate romance, and a fair amount of “drama” I’ve endured over the years.

Here’s a comment about arguments of “ease” and “enthusiasm” from, of all people you probably didn’t expect me to cite, the Secretary of Defense, Dr. Robert Gates. He’s talking about preparing US defenses for the long term:

“… no one should ever neglect the psychological, cultural, political, and human dimensions of warfare. War is inevitably tragic, inefficient, and uncertain, and it is important to be skeptical of systems analyses, computer models, game theories, or doctrines that suggest otherwise. We should look askance at idealistic, triumphalist, or ethnocentric notions of future conflict that aspire to transcend the immutable principles and ugly realities of war, that imagine it is possible to cow, shock, or awe an enemy into submission, instead of tracking enemies down hilltop by hilltop, house by house, block by bloody block. As General William Tecumseh Sherman said, “Every attempt to make war easy and safe will result in humiliation and disaster.”

The whole essay is here.  No, I am not going to dwell upon how much of this he may have written; he’s a professor in his other life, and I’m actually more interested in knowing how much of this essay got written after the election, or if parts of it had been drafted, and were held back until he was re-selected for the job. Or maybe this is his application essay? 😉

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