“Skin In The Game”

[deleted1111261]

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Many, many people on this board have mentioned this book.

I’m a fiction reader, but knew I had to get to this book.

It, perhaps imperfectly, but pretty damn accurately, explains what the f*ck has happened to our specialty.

Thank you for bringing his work to my attention. I plan on finishing “Incerto” by summer’s end.

 

[taserlaser]

Quote about administration is dead on. I should also look for this book… once I’m done reading ”The Silo” series.

 

[elementaryschooleconomics]

I was talking to an administrator on Monday who was telling me a story about something unrelated to work (what the kids used to call...watercooler talk, I think, back in the before times).

In this story, there was a part where this administrator intentionally did not come to our hospital for medical care, and indicated the choice was made because of concerns over the quality of the medicine. This was just a small footnote in the bigger story.

Now, this admin and I have gotten into some disagreements about what metrics we should care about, as in, what is indicative of "quality".

I think we should care about things like "how many of the patients we treat die of cancer", whereas admin thinks "how quickly can a patient have an appointment after the referral phone call" is the better thing to care about.

This story completely short-circuited my brain. I can't stop thinking about it.

But yeah...it's because of skin in the game...or not. Maybe I can finally stop thinking about this story tonight as I try to fall asleep.

 

[Chartreuse Wombat]

Many, many people on this board have mentioned this book.

I’m a fiction reader, but knew I had to get to this book.

It, perhaps imperfectly, but pretty damn accurately, explains what the f*ck has happened to our specialty.

Thank you for bringing his work to my attention. I plan on finishing “Incerto” by summer’s end.

Fooled by Randomness is also worthwhile. Taleb is idiosyncratic to be sure but compelling

 

[Chartreuse Wombat]

Fooled by Randomness is also worthwhile. Taleb is idiosyncratic to be sure but compelling

If you really want to go down the administrative rabbit hole read Burnham's classic "The Managerial Revolution". Marc Andreesen is great on this topic. Managerialism replaces capitalism. Same reason no one washes a rental car. Ownership

 

[BobbyHeenan]

This book should be required reading for anyone in med school.

I don't particularly like Taleb on twitter, but these books (Skin in the Game and the Incerto series) are amazing. They really do explain the current issues in our field.

Below not necessarily directly related to rad onc, but it surely captured some professors I had in undergrad/med school that seemed oblivious to things going on outside of campus.

 

[grenz]

It must be really disheartening to read stuff like that in the humanities. At least some of the research in medicine will improve/prolong peoples’ lives.

 

[fiji128]

It must be really disheartening to read stuff like that in the humanities. At least some of the research in medicine will improve/prolong peoples’ lives.

Signed; "Safe Zone Ally!" Can't make that stuff up!

 

[NotMattSpraker]

This book should be required reading for anyone in med school.

I don't particularly like Taleb on twitter, but these books (Skin in the Game and the Incerto series) are amazing. They really do explain the current issues in our field.

Below not necessarily directly related to rad onc, but it surely captured some professors I had in undergrad/med school that seemed oblivious to things going on outside of campus.

Haha I think this is directly related to Rad Onc.

 

[thecarbonionangle]

The worst part of academia is definitely the petty narcissists referenced above. Of course, you find them in PP but it seems to be particularly enriched in “academics”. The politics and brown nosing can be gag inducing.

 

[RickyScott]

Can’t believe no one has brought up the iyi (idiot yet intellectual)

 

[deleted1111261]

IYI are the soul of our field.

 

[thecarbonionangle]

This is a bigger issue than just our field but i think about this sometime. How can we as a society measure intelligence in better ways. How many times have we met people who are supposedly “smart” as in they can blow the MCAT/STEP out of water yet a 10 min conversation with that individual leaves you vastly unimpressed by their lack of common sense, EQ, “street smart”, etc. there are many people like that in our field and i think it hurts us. The focus on “pedigree” led us to have many of these people in our field.

 

[Fpg1245]

This is a bigger issue than just our field but i think about this sometime. How can we as a society measure intelligence in better ways. How many times have we met people who are supposedly “smart” as in they can blow the MCAT/STEP out of water yet a 10 min conversation with that individual leaves you vastly unimpressed by their lack of common sense, EQ, “street smart”, etc. there are many people like that in our field and i think it hurts us. The focus on “pedigree” led us to have many of these people in our field.

We don’t need another rain man in my practice.

 

[RickyScott]

This is a bigger issue than just our field but i think about this sometime. How can we as a society measure intelligence in better ways. How many times have we met people who are supposedly “smart” as in they can blow the MCAT/STEP out of water yet a 10 min conversation with that individual leaves you vastly unimpressed by their lack of common sense, EQ, “street smart”, etc. there are many people like that in our field and i think it hurts us. The focus on “pedigree” led us to have many of these people in our field.

You can certainly measure practical intelligence/judgement just on the basis of applying to radonc in the past several years. Unless you soaped in out of desperation and now got your sht together, you are probably damaged goods.

 

[thecarbonionangle]

You can certainly measure practical intelligence/judgement just on the basis of applying to radonc in the past several years. Unless you soaped in out of desperation and now got your sht together, you are probably damaged goods.

The people who know the entire list of concerns and have concluded to ignore advice will suffer the consequences of their own arrogance or the consequences of being deceived by “academic leaders” who are telling people all is well and the future has never been brighter. I do think some people are being lied to and misguided. There is a special place in the hellpit for people who take advantage of vulnerable unmatched students at these institutions who have no way to asses the field’s health and funnel them into their hellpit programs.
The field now soaps in almost 30 spots a year and the collective wisdom/sagacity/perspicacity of the “intelligentsia” is basically nothing to see here, and we are doing quite well and on the rebound.

 

[sloh]

This is a bigger issue than just our field but i think about this sometime. How can we as a society measure intelligence in better ways. How many times have we met people who are supposedly “smart” as in they can blow the MCAT/STEP out of water yet a 10 min conversation with that individual leaves you vastly unimpressed by their lack of common sense, EQ, “street smart”, etc. there are many people like that in our field and i think it hurts us. The focus on “pedigree” led us to have many of these people in our field.

Need higher IQ to make cunning career decisions. Oh you can do well on boards? You can follow simple directions and some moderately complex reasoning spoonfed to you.

 

[sirspamalot]

Those of us who have left the rat race can only shake our heads and wonder, when will everyone see the Emperor has no clothes (or #) ?

 

[theradiator]

Many, many people on this board have mentioned this book.

I’m a fiction reader, but knew I had to get to this book.

It, perhaps imperfectly, but pretty damn accurately, explains what the f*ck has happened to our specialty.

Thank you for bringing his work to my attention. I plan on finishing “Incerto” by summer’s end.

Great book recommendation. No question the Black Swan guy is a genius and an independent thinker. Sad that the consolidation of medicine and the rise of administration and onerous regulations in radiation oncology will only exacerbate the problems highlighted in this treatise.

But, when radiation is mentioned, of course it is placed in a highly negative light in a 'more realistic' but non-sensical hypothetical scenario of laryngeal cancer??? We are used to being a punching bag, the Roger Dangerfield of medical specialties. Page 64 of the physical book for those scoring at home.

 

[Pointless]

I bought this book and am trying to read it but man... this guy is all over the place as an author. I find many of the examples that he provides to support his points either directly contradict the point he is trying to make or are just plain irrelevant. The above quote is a good example. Dude is out of his depth in a lot of ways.

So far, however, there have been some great and profound one-liners in there that really do make you think. It is the other 99% of the book that is confounding to me.

 

[deleted1111261]

I agree with you about specific points and about the radiation example. Out of his element.

My interest and excitement is the overall worldview. Elites, bad science, ignoring common sense. Like when something works in practice, not in theory - go with it. But, people don’t.

But very reasonable points and he’s not a “good writer” or story teller like kahnemann or gladwell

 

[deleted1111261]

Tho, if you switch it to prostate cancer

I think the second malignancy argument makes some sense.

Some (not all) of us are anxious giving RT to a 50 year old with intermediate risk bc of future malignancy risk.

 

[Pointless]

The basic premise, that people who make decisions but aren't directly affected by the outcomes of their terrible decision-making are the cause of much of the dysfunction in our society, feels quite true. One of those things that you kind of implicitly knew but never spelled it out. This book drives that point home and so, in that sense, is a very impactful read (even if poorly written). Thanks for the recommendation.

 

[temujim]

The very definition of IYI.

But, when radiation is mentioned, of course it is placed in a highly negative light in a 'more realistic' but non-sensical hypothetical scenario of laryngeal cancer??? We are used to being a punching bag, the Roger Dangerfield of medical specialties. Page 64 of the physical book for those scoring at home.

 

[deleted1111261]

Planet Money episode on “Nudges” - about researchers falsifying data about the efficacy of nudges to change behavior.

(Relevance: Taleb hates this theory)

 

[BobbyHeenan]

View attachment 374271

The very definition of IYI.

I don't agree with some of his covid takes but that pic as I recall was pre vaccination era.

I give a lot of grace to the decision making and risk aversive odd behaviors in 2020 versus 2023 as it relates to living in a COVID world.

The basic premise, that people who make decisions but aren't directly affected by the outcomes of their terrible decision-making are the cause of much of the dysfunction in our society, feels quite true. One of those things that you kind of implicitly knew but never spelled it out. This book drives that point home and so, in that sense, is a very impactful read (even if poorly written). Thanks for the recommendation.

Absolutely. This book explains this IMO better than anything I've ever read. That is the take home.