I attended an interesting talk at UCLA by physicians and authors Jerome Groopman and wife Pamela Hartzband. It was called "When Experts Disagree: The Art of Medical Decision Making." It looks like you can watch a video of a similar talk they did at another school online. The talk is related to their book Your Medical Mind.
Pamela studied at Harvard Medical School and did her residency in endocrinology at UCLA. She is now a physician educator and author. Jerome did college and med school at Columbia, residency at Mass Gen, and fellowship at UCLA in hematology and oncology. He's now a staff writer for The New Yorker and author of 5 books. He's done extensive research on HIV and cancer and has about 400 publications. Nice.
My notes and takeaways from the talk are below.
Thesis: When you understand why the experts disagree, you can make better medical decisions.
Conflicting expert opinions in news (looking at same research study results)
Take or not take Vitamin D
Mammogram check protocol
Putting a number on utility
Linear scale from 0-1 (0 = death, 1 = perfect health)
Time trade off (how much time to give up to not have side effect)
Standard gamble (estimate odds you'd take to avoid some outcome vs. chance it might kill you immediately)
All 3 methods flawed cognitively
Can't predict future life
People adapt, med conditions not static
Self-reported quality of life not objective
In britain, blindness is rated 0.5 (reduces life 50%)
In US, much higher (blindness not as bad)
Daniel Kahneman gave address recently to med analysts
Classic way of measuring utility like measuring the ether
Textbooks not giving answers
Sir William Osler: listen to the patient, he'll tell you the answer
They interviewed many patients to come up with mindsets.
2 mindsets of people when diagnosed
Maximalist: be proactive, do everything and more
Minimalist: minimize medications
2 mindsets of medication orientation
Naturalism orientation: prefer those extracted from herb (60% of population)
Tech orientation: prefer those synthesized in lab using latest tech
2 mindsets when taking pills
Believers: confident about cure
Doubters: think treatment worse than disease
There's a medical risk calculator online they mentioned
Baseline risk of disease/bad event from your case might be really low (like 1%) vs. message pharma ad says like "med will reduce risk by 30%" (look at absolute risk and risk difference rather than relative)
Availability: effect of stories that stay in mind; overestimating likelihood of similar event; when you hear a story, go back to the #s
Framing: 10% of side effect sounds different from 90% of no side effect; physicians just as susceptible
Drug ads: for every $1000 spent, 24 new rx's written
Use stories and #s
#s framed in most positive way (risk reduced 30% [not 30% of 1%])
Dartmouth study found that drug ads make med seem 10X better than really is
Insurance company ads contribute
"Right outcome" is false hope
Controversies around expert opinions
Expert committee disagreements
Their medical mindsets:
Eastern European Jewish tradition
Docs on pedestal
Docs heroes like presidents
Sci/tech honored, anything natural was throwback to village life
He is maximalist, believer, and tech orientation: every med and procedure means better health
1st child in family
Parents were ahead of curve on exercise
She is minimalist doubter
The gray zone
No one right answer for everyone
Patient can ask what would you do; not best way to decide.
Watch and wait vs. surgery yesterday
End of life
Advance directives: 50% of people change minds and choose differently from what wrote (because can't forecast future in circumstances that aren't experienced AND because can't predict all scenarios); experts have formulas for when medicine at end of life is futile, but they don't work in real world because can't identify those who will survive with good life quality
Surrogate decision making: go back to the mindsets
Patient mindset: first understand this
Numbers: look to see how apply to the individual
Stories: Daniel Gilbert research on estimating outcome utility best done by talking to someone who had the outcome
When patient knows his/her medical mind, can communicate this to their doc and better explain risk/benefit
Does take time between physician and patient
People aren't automobiles on assembly line; takes time
Studies available online to anyone; doc's role changing from providing info to interpreting info
Patients like understanding where they fit into #s
Patient doesn't have to match mindset w/ doc; doc needs to know how to talk to any mindset
Healthcare reform and economics have insurance companies rating docs and dinging them when patients not complying
50% of medical studies/guidelines overturned in 5 years; 23% in 1 year
Step back and just acknowledge that often don't have good data
instead, government panel just does sweeping regulation that isn't right
Presenting relative risk is allowed but misguides
Merits and costs of drug ads:
Public service announcement vs. hypnotic suggestion/persuasion
Can better restrict how present info
Quality/outcome approaches have failed
Hard to quantity
Those things that matter aren't quantifiable; what's quantifiable doesn't matter
EHR won't save $80B; not as much duplication of tests as claimed
Adds extra costs and time waste from restricted methods of data entry
Problems with metrics-based/pay-for-performance med: creates incentives to meet metrics and not patient care end goal
Checklists good for surgery, procedures, infection decreases but less for medicine
Insurance companies are businesses, not about saving lives or helping you get "right" outcome
Healthcare costs going up because now we have more people living longer.
I recently attend a UX design event at UCLA, which included a presentation by Joselle Ho, Creative Director and Co-Founder of Miso Media, a music education company that got its start in mobile in 2008. It was a fun event as we got to hear Joselle's thoughts on design, and then a panel of judges critiqued some screenshots of real designs others were working on. Below are some of my notes and takeaways
UI != UX
Focus on user's wants, assumptions, emotions.
Design for main use case, bury functionality.
Every excess click reduces engagement 90%.
Replacing "Sign up" with "Learn more" increases sign-ups 350%.
What you say matters.
When you say it matters.
Animations make a big difference (continuity and breaks).
Outside pages need to communicate 2 things: why and how.
Login/Sign up/Help in upper right corner
Call to action must pop out when you squint.
Photo-based navigation preferred over text in studies
Discovery of activity in app: make it a widget, reduce the content amount, make it like a ticker
"ppl who added XYZ also added ABC"notification indicator in menu bar
Blueprint for iPad
Keynote (has hotspot/click targets)
Explainer video as sole thing in homepage: not great
I'm excited about having graduated on Friday from UCLA Anderson. Our commencement speech was entertaining and inspirational, and I wanted to share the top 10 list that Guy Kawasaki shared with us.
Guy shares alma maters with me (Stanford followed by UCLA Anderson), so I identified with him immediately. He was the chief evangelist at Apple and author of ten books (two of which I've read and really enjoyed: Enchantment and The Art of the Start).
You can watch his speech in the video above, and my notes are below.
Guy's Top 10 Practical Tips for Succeeding
1. Aspire to jump to the next curve.
Instead of working on a better sameness
2. Don't worry, be crappy.
When you're on the next curve, it's time to ship.
Ship and then test.
3. Never ask people to do something you wouldn't do.
Whether it's asking customers or employees
Importance of ethics
4. Obey the absolutes.
There's a hard line between right and wrong.
5. Default to yes.
Always thinking "how can I help others?"
6. Drop everything when your boss asks you to do something.
Make your boss or wife look good.
7. Become a baker not an eater.
For baker's, life's not a zero sum game.
8. Hire people better than you.
A people hire A people. B people hire C people (and so on).
Hire people better than you to prevent a "bozo explosion."
(See my notes on the book Who.)
9. Change your mind.
It's a sign of intelligence.
Steve Jobs changed his mind all the time (and convinced you he was right before and after).
10. 10/20/30 rule of PowerPoint
Optimal slides: 10
Optimal time: 20 minutes
Optimal font size: 30
Figure out oldest person in room and divide age by 2 and that is the font size.
11. Suck it up
Need to pay dues.
Do the dirty job.
12. Have children.
True success is happiness in life.
Children are his greatest joy in life.
Nothing came close in his life in joy.