So far so good. If the first month is anything to go by, I will have the 2022 reading list licked by September.
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.
Squash, skiing, wrestling, swimming, skateboarding, basketball, handball, tennis, table tennis, badminton, and soccer. ↩
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. ↩
Yes, real life is messy, yes, there is more stupidity than evil in the world, and no, there are no billionaire/vampire/reptile cabals running the show behind the curtains (if only). Yet individual humans do have needs, and some of those needs are secret, and when meeting a secret need involves more than one person, when each of those persons is tasked with keeping their role a secret, and when that role is exacting revenge, well then, you have a genuine conspiracy.
There have been many conspiracies in my lifetime, most of them having to do with Serbian politics: the conspiracy by the heads of Serbia and Croatia to break up Yugoslavia; the conspiracy by parts of the Serbian surveillance apparatus to overthrow Slobodan Milošević; the conspiracy by the Serbian mafia-political complex to assasinate the prime minister; the conspiracy by parties yet unknown to hide the numbers of Serbian Covid-19 victims… You cannot fault the average Serb for seeing conspiracies everywhere, and you can empathise at least a tiny bit for being sceptical of masks, vaccines, the existence of the virus itself.
The last time the average American was exposed to a big conspiracy that was named as such was in 1974, and it was so bungled and comically inept that you cannot fault them for thinking conspiracies are relegated to history books. This is what Ryan Holiday suggests in his book, while unravelling the conspiracy by Peter Thiel to secretly bankroll civil lawsuits against Gawker Media until they are bankrupt. But is this true? After all, weren’t Purdue Pharma, Ferguson PD, the 25th amendment gang, and the Capitol insurrectionists, to name a few, all involved in more or less successful conspiracies?
“The idea of a conspiracy,” Thiel is quoted saying in the book, “is linked with intentionality, with planning, working towards longer-term goals. In a world where you don’t have conspiracies maybe also those things disappear.” Holiday adds: “The truth is that Gawker already believed we lived in that world. And so do far too many people.”
I object to that evaluation of my fellow humans, because most people are well aware of the fact that we do indeed live in a world full of conspiracies. If the last few years have taught us anything, it is that people over-read them. But they are conspiracies perpetrated by multinational corporations, rouge state officials, the actual states, and, Holiday’s book now tells us, condescending billionaires.
I started the decade childless and am ending it with three, so I have missed most of the 2010s’ pop culture. This includes the entire Transformers franchise and most of the Marvel Cinematic Universe (so, not much missed then?)
Movies and music were better in the 2000s, but oh what time to watch TV and follow tennis. It’s too early to judge the books (though it’s telling that my favorite was originally written in 2008).
The next time someone asks me about books to read before residency, I will direct them here. You don’t have to be a medical trainee to benefit from these, but that period of anxious anticipation between match day and orientation is perfect for buffing your attributes.
What better way to start learning about learning than by reading a book about reading books?
The Farnam Street blog has a nice outline of the book’s main ideas. The same establishment is now hocking a $200 course on the same topic. It’s probably good, but at $10 the source material is slightly more affordable.
The first few months you will be neck-deep in scut work no matter what you do. After that, though, you will have to juggle patient care, research, didactics, fellowship/career planning, and piles of administrative drek—and that’s just inside the hospital. At the very least, this book will help you make time for laundry (and maybe some reading).
Superficially, similar knowledge to what is in these 400+ pages can be found in a few Wikipedia entries. But you would miss out on the how and why cognitive biases and heuristics are so important. Medicine and research are bias-driven endeavors, and not understanding them is not knowing real-world medicine.
Only three? Yes. If anything, the two and a half months between mid-March and July 1st won’t be enough to read them all with the attention they deserve. But you should try.
After skimming through the fifth long-form article about the increase in bite-sized consumable writing made for the short-attention-span—-dare I say “millennial”—-crowd, I became scared for my own tenacity. Would the 15-year-old me, the one who had read the LotR cover to cover, be horrified by this balding humunculus with twice the age and—-if you’d believe the articles—-half the attention span?
No, he would not. I can write that with confidence of a man who has just burned through the first two Dark Tower books exclusively while riding the subway. Get in at Union Station, actually sit down to read at Gallery Place, blink and I’m done with a chapter or two and arriving at Bethesda.
Stephen King is a hell of a writer, you see, and most of what you can find online—-this blog post included—-is derivative crap at worst, well-written nonsense at best. My brain jumping from text to text was its way of saying Dude, why are you punishing me with this drivel? Just get us a good book. So I did, and the percieved length of my metro commute has decreased by two orders of magnitude. Which is a convoluted way of saying that time flies when you’re having fun1.
But if you’ve never read a book in your life and are now devouring Buzzfeed like a horsefly in a manure factory—-sorry, there is no help. It is you.
See above re: quality of online writing. ↩
NIH orientation started today. My commute is 90-plus minutes each way, and the first four months are mostly inpatient. I will have to wait until retirement for another run like this.