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The Mare of Easttown 👍

The Mare of Easttown is the best dead-girl-in-a-sad-town TV show to come out of the US since Twin Peaks. To be clear, the 30-some years that separate them still have many good shows of the genre, but none were American. When they weren’t busy churning out the millionth iteration of CSI, Americans could only muster pale copies of what came out of Britain and Scandinavia, with characters and plots lifted wholesale and Northern European sentiments crammed oddly into New England toponyms.

The Mare takes its setting more seriously, and not just with flannel shirts, odd accents, and dozens of bottles of Yuengling and Rolling Rock drunk per episode. You quickly learn that the town is not all that bad: it has decent homes, an upscale college and high school, and a pretty good sense of community. It’s the people who are sad, each in their own way and for their own reasons, with the titular Marianne the saddest of them all, and the show mostly dedicated to exploring how and why this happened.

There is also a murder or two, some kidnappings, and an action scene that brought back some of the best moments of The Silence of the Lambs. A few of the cliffhangers were the murder mystery equivalent of a jump scare, but that can be forgotten because the show manages to pull off a successful double-twist ending that is both reasonable and unexpected.

Ultimately, if a show is good enough for Kate Winslet to be in, it’s more than good enough for me to watch.


The White Lotus 👍

Two parts lifestyle porn one part sociologic study of intergenerational struggle, with a smidgen of mystery to whet your appetite and make you think there is more there there than it actually is, though what is there is still pretty good if not exactly a Knives Out caliber of crime comedy.1

But oh my that soundtrack.


  1. And it is here that I realize I never wrote about Knives Out, which would have been the movie of the year had it not come out in 2019, a good year for movies in an otherwise mediocre decade. So here is my review: it is outstanding, go see it (👍). 


How I handle meetings (which most certainly is not how everyone should, but again, may be useful to some)

It is easier than ever to organize and attend a meeting, which should scare the living daylights out of anyone who doesn’t organize or attend meetings for a living. It used to be that only middle management had to deal with a series of 90-minute meetings all 15 minutes apart in which they had no specific role, which had no effect on their task list, and which left them no better off than they’d be if they had just read the minutes.

We are all middle management now.

My own experience with middle management was during chief residency and I learned quickly that the more administrative aspects of it just weren’t for me. But I also learned a few coping strategies, modified below for the video conferencing age.

  • A short ad-hoc meeting is better than a long email thread. Email is a brilliant technology, but it just wasn’t meant for frequent back and forth between any number of people. It always amazes me when someone sends an email with five direct recipients and ten more addresses cc’ed, and then expects to have a productive conversation. Pre-2020 the excuse would have been that everyone was too far apart to attend a meeting, whether in another time zone or in a different building on campus. No longer.1
  • A short standing meeting is even better than an ad-hoc one. Few things in any line of work need someone’s immediate and undivided attention. Issues can usually wait: if one project is on hold because a decision needs to be made, there will be others to work on. If they can wait a full week, why not batch them and bring them up with your boss/employees/co-workers/contractors at a weekly meeting. If they can’t wait for more than a day, make it into a short daily meeting held at a set time. We have these meetings all the time in medicine — we call them rounds, and they have worked well for more than a century.
  • Frequent short meetings are better than infrequent long ones. Setting one up used to be hard logistically: from booking the right sized room on time to making sure the timing works out for everyone — not to mention having to include a buffer for getting to the conference room and setting up AV. With that much overhead for a meeting of any length, of course the default was at least 60 minutes, if not a full hour and a half. Now even a 90-year-old can tap a link on their oversized phone to log onto that Zoom meeting while quarantining at home. The negligible cost of starting a meeting may mean they are more frequent, but it should also make them shorter. Much shorter.
  • One day full of meetings is better than all five weekdays broken up with just a few per day. When in meeting mode, it takes me at least 30 minutes to get my bearings back to doing other work. Mode switching is a fixed cost and it’s best done infrequently. I therefore have a day dedicated to meetings, and if I have any say whatsoever in when a meeting will be held I try to do it then.2 If you need to have a meeting on a different day, try to have it as a bookend — morning and afternoon rounds are a good example of this.
  • Finish off a meeting with a task list and the designated person(s) for each task. You will probably have missed something, but that’s OK since you’re still at the meeting and others can fill in the gaps. Send off that list as an email to all attendees. Congratulations: you are now the meeting’s Most Valuable Attendee. If the meeting ends without anyone being able to come up with a single task, it should not have taken place. This is an important lesson. Take note of whomever called the meeting and try to avoid attending their meetings in the future.3
  • Bonus tip: If you are setting up a one-on-one meeting with me, and you are the one sending out a calendar invite, do enter both of our names in the meeting title. I have too many meetings with myself on the calendar and it’s getting hard to keep track.4

If you liked this, you may also enjoy my lukewarm take on handling email.


  1. I believe Cal Newport wrote a whole book about this issue which is in my ever-growing To Read pile so this will remain just a belief for the foreseeable future. 

  2. Wednesdays. 

  3. This excludes staff meetings mandated by this or that accreditation agency, which turn into venting venues by design — though even then the tasks should be to set up smaller, more meaningful meetings to deal with concrete issues that may be brought up. 

  4. My default name for those kinds of meetings is just “Milos <-> Person 2“. 


Blogroll

I, for one, am glad that blogs are making a comeback. Here are a few I’ve been reading for at least a few months, many of them for years, some for decades.

Applied philosophers

The only true philosophers of our time.

The new scientists

People without major academic credentials who have interesting ideas about science.

The old scientists

People with major academic credentials and interesting ideas, something to teach, or both.

The ludites

People against modernity of one sort or another.

People doing their own thing

Unclassifiable but exhilarating.

Apple enthusiasts

Some tips, a few tricks, many opinions.

Finance-adjacent

Economists and investors, for the most part.

Journalist-cum-substackers

Former or current journalists who now earn some or all of their living by writing newsletters via Substack, which is slowly reinventing blogs (in the sense of reinventing the wheel, not actually making them better and in fact in many was making them much worse).

Company blogs

For when I really want to know when the next update is coming.


Notes from West Virginia

It was the middle of another heat dome week, but the morning was cool enough to require long sleeves. The grass — freshly cut, of course — was covered in dew. In less than 20 minutes one could see sitting on the front porch: several hummingbirds battling around a feeder, two deer grazing just off the gravel driveway, a wild turkey, a rabbit, several blue jays and cardinals; I half-expected Snow White to skip down the forest path and burst into song.

The Broadband internet in West Virginia is not great, but it’s not terrible either. Why are there only 2 million people in this state?


The Mitchells vs. The Machines 👍

Spider-verse meets Gravity falls, resulting in a completely unexpected delight that really is fun for the whole family. The animation is beautiful, the pace is fast, the humor earnest and often physical, and the story intentionally misses every opportunity for cynicism. The photogenic family next door with the perfect vacation photos really is that high-functioning, fit and smart.1 Friends are there to support you, not tease you. The world doesn’t make fun of weirdness, it embraces it.

So, even though it premiered on Netflix, this is not your ordinary Netflix feature-length animation; it is actually good. It is also a triumph of believable character motivation and well-executed action sequences over a coherent plot. Thankfully, humans put much more weight on the former.


  1. Some Eastern European cynicism is in order, though: given that these characters are voiced by John Legend and Chrissy Teigen, making them inauthentic frauds was never an option. 


Range — Why Generalists Triumph in a Specialized World

At the very beginning, David Epstein presents a dichotomy: there are the super-specialists, who decide early on in their lives who they are and what they want to be, and put all of their time and energy into improving a narrow set of skills that make them competitive in a tightly-regulated field such as professional sports; and then there are the generalists, who try out different things here and there, learning across disciplines and using that knowledge to solve difficult — “wicked”, the book calls them — problems that don’t fall neatly into any category, but which are more and more common in our modern world full of complexities.

The model super-specialist is Tiger Woods, who picked up his first golf club as a toddler and won his first tournament at age six. Compare and contrast with the model generalist, Roger Federer, who dabbled in 11 different sports1 before finally picking up the one that will make him famous at the ripe old age of (checks notes)… eight.

The rest is of the same cloth: light on arguments, heavy on emotion. The examples of hyper-specialization it gives are telling: oncologists specializing in cancer related to a single organ and interventional cardiologists.2 Never mind that to get to any medical subspecialty one needs to go through more than 20 years of not so specialized schooling, sample different professional careers in college, then sample different physician specialties in medical school, and not reach the subspecialty until their early thirties at best. When did the supposed generalist Roger Federer start playing tennis, again?

So, the term “specialist” gets thrown around a lot without being precisely defined. Is it the narrowness of one’s current field that makes them a specialist? Or is it the path they took to get there? Regardless, we do know what makes a generalist: meandering from field to field until you find your niche, which will, ideally, use some of the knowledge and skills gained through all of that meandering. If you start as a stocker at Walmart, then work as a florist, hair stylist, hand model for a watch company, and end up as a short order cook at McDonalds, well that’s not much of a generalist story. Flip these around so that your final job is something more glamorous and you are the master of your profession who uses the Walmart work ethic, florist’s sense of proportion and beauty, Mickey D’s sense of urgency, and a hand model’s way with wrist movements to create a work of coiffured art. It’s the narrative and Texas sharpshooter fallacies combined.

Their friends confirmation and survivor bias also show up. Each chapter has a few stories hand-picked to showcase how a “generalist” solves problems that the “specialists” were stumped with. The generalist’s life story is then picked apart to showcase their versatility, though some at first do not appear to be so versatile. There are, unfortunately, no counterfactuals, and no going over the specialists’ biographies which would — I am fairly confident — be strikingly similar to those of the generalists.

Looking back at a life, your own or someone else’s, is very much like stargazing. There are a few set pieces — a marriage here, a near-death experience there — but for the most part the events are devoid of much meaning until we give it to them by imputing a causal relationship to something that is important ex post. Epstein picks out situations where a failing team of “specialists” — let’s take him at his word that they are, for their biographies are not presented and we are left wondering whether they, too, worked the summers in their family’s farm or had a brother in the concrete business or some such — well, where that team of maybe-specialists is rescued by a certified (by Epstein) generalist who expresses their generalissimo-ness via a string of anecdotes, the stars in my overwrought stargazing analogy.

There is a story to be told about narrowness of focus and the importance of not being a fachidiot. Epstein comes tantalizingly close to framing the problem as it should be framed: that specialty narrow-mindedness — no matter how you got to it — is dangerous and makes you a bad specialist and a worse human. Yet there is no mention of this wonderful German word in the book’s hundreds of pages. That’s too bad: Fachidiocracy would have been a better title.


  1. Squash, skiing, wrestling, swimming, skateboarding, basketball, handball, tennis, table tennis, badminton, and soccer. 

  2. Apropos interventional cardiologists, Epstein attributes the massive overuse of stents for dubious indications to the said specialists “getting so used to treating chest pain with stents … that they do so reflexively”. And not because of financial incentives? Interesting. 


Clearing the PDF log jam

There is a crisis in medicine, but not the one you think:1

Reading primary literature is superior to press releases and tweets — it sounds so obvious, but not many physicians act on it. There no prizes to be won for not just following the KOLs2, nor do you save any time. Quite the opposite: instead of a promoted tweet about the me-too drug de jour falling into your lap, you need to find a way to identify what’s worth your time reading, and also find time to actually read it — not a small achievement, as highlighted by the above tweets.

But then what? Sure, there is profit at the end of the rainbow in the form of useful knowledge, but merely reading a PDF may not result in any knowledge at all, let alone knowledge you can use. Or, as the underpants gnomes would put it:

Step 1. Read PDFs; Step 2. ???; Step 3. PROFIT!

I too had a backlog of unread PDFs once, spent so much time organizing files and folders, using this and that program to store the metadata3, trying out plain paper, a Kindle, an iPad or two, thinking it is how I was reading them that mattered and oh if only I could find the perfect setting, under the shade of an old oak tree perhaps, with some peace and quiet, a pen in one hand and a cup of coffe in the other, well, then the unread pile would melt away and all would be good in the world.

But reading is easy, if what you read is useful, entertaining, or both. For most people without visual impairments or dyslexia, the log jam is at Step 2. We don’t want to read our pile of PDFs because, in most post-GME circumstances, there isn’t a clear goal to reading them (lest you have superhuman memory).5 This is particularly true early on in your carreer, when you have nothing to hang your hat on mentally, and few connections to make between what you are reading and what you already know. Sure, you don’t need to keep track of the articles you’ve read if the only reason for reading is to pan them on Twitter. You do, however, want to summarize what you’ve read and save it for future use, be it in a lecture, article, grant proposal or a blog post. So if and when you find a fairly obscure but potentially important fact about this or that cellular pathway in a supplemental figure from a CNS-adjacent journal, and you memorize the fact for later use, and then a year or so later you do use it to make a figure for the background section of a clinical trial protocol, well, what you do not want happening in that case is to spend hours of your life trying to retrace your steps and figure out the original source when a fellow asks where you got the data.4

I wouldn’t be admitting to all that if I didn’t think I’ve found a solution. A few years ago, I replaced the unsustainable routine of just-in-time literature reviews for whatever I needed done with a robust knowledge management system — a GTD®6 for ideas, if you will. It got to a point where I can read at least one article every day and skim a few more, get the useful information out and into my app of choice7, and have all the information I need to write an editorial like this in a morning or two.

As with most of the things I do it is too personal and Rube Goldberg-y to be of use to anyone else, but it started with a forum post and a book, and if you’d like to turn your plate full of PDFs into something more usable may I recommend that you start with one or both of those and see how it goes. Could it be any worse than what you’re doing now?


  1. And not only in medicine, of course. 

  2. Key Opinion Leaders, the influencers of medicine before influencer became a real noun. Note that unlike the influencers of social media KOLs don’t use the #sponsored hashtag, though there is a hashtag equivalent

  3. NB: if you write any sort of scholarly texts you will still need a reference manager, no matter what system of organizing PDFs themselves you choose. I recommend Zotero, lest your institution has a requirement for Endnote (which must have quite a salesforce, to so thoroughly insert their buggy, laggy, slob of a program into every academic crevice). 

  4. Yes, this has happened to me. We do have good fellows. 

  5. The clear exception here being board exam and MOC prep, where the goal is obvious and the sources of information are all spelled out. 

  6. © David Allen Co. 2001. It is a good system though 

  7. The app of choice before DEVONthink was Roam, which is a web service and a marvelous one at that, but unfortunately not much into encryption, privacy, and other things people dealing with confidential information like to have in the tools they use. 


Interstellar (2014) 👍

Interstellar is many things: a mediocre sci-fi story, a timely study of sociopathy, a schmaltzy meandering about love conquering space and time, an excellent showcase of near-future space engineering, and, sadly, a big budget Hollywood movie that grossly underestimates its audience. Foreshadowing is one thing, having one astronaut do the punch-a-hole-though-a-folded-piece-of-paper schtick to another while they are in space on their way to a wormhole as part of a billion dollar secret mission… Well, that’s a whole new level of cringe.1

Hollywood rears its head in many other places, most of all the needless addition of superficial suspense to things that don’t need added suspense. Because a father communicating with his estranged daughter through spacetime is not emotional enough, let’s also add a hick brother who doesn’t want her at the only place where communication is possible, and may kick her out at any moment. Decades are spent on trying to get humans off Earth, yet the big scientific breakthrough comes at the very last moments, as people are suffocating on the ground. While we are there: if the human civilization is capable of building a county-sized space habitat and the only problem is getting the thing off the ground, why not build it on Earth or under the sea, instead of using a few hundred frozen embryos as humanity’s only backup plan? But let’s not get into plot holes because, um, there are a few.

Which is to say that Interstellar is not an overwhelmingly good movie. The good, however, still outweighs the bad, especially for those willing to forgive all the pandering. The best of humanity is also the worst of it, and the best of American sci-fi in matters of technology also turns out to be some of the worst story-wise. So it goes…


  1. I have yet to see Tenet but from what I have heard about its convoluted and unknowable plot, it is Christopher Nolan’s reactive formation to the many comments about oversimplifying and over-explaining that followed Interstellar. For an ever better example of a reactive formation see La La Land as Damien Chazelle’s response to Birdman winning the best movie Oscar over Whiplash and giving the Academy what it wants: more cotton candy navel-gazing. Ironic that the attempt also failed to win, this time to a better opponent


Mulan (2020) 👎

There are too many things here that just don’t work: the acrobatics (cartoonish in a bad way), the believability (live action is less forgiving to cross-dressing, just ask Mrs. Doubtfire), and worst of all, the message, which comes straight from the Big State handbook of propaganda: a woman’s worth is in marriage and — maybe, under extraordinary circumstances — in her service to the country. Self-actualization is allowed, after much hemming and hawing, as long as you are actualizing yourself towards protecting the Empire.

Which is too bad, because the setup provided excellent opportunity for two badass female characters to unite against the common oppressor. Of course, uniting against anything would not have been received with open arms in Mulan’s intended market, said market working diligently towards exterminating threats foreign and domestic even as the movie was made.

One thing that did work was the matchmaker who really should get a show of her own. A Disney+ series of shorts with a match per episode, perhaps, culminating in helping Xianniang the witch find the man/woman/hawk of her life? Disney, you are welcome.

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