
Surgeons Should Not Look Like Surgeons - jstewartmobile
https://medium.com/incerto/surgeons-should-notlook-like-surgeons-23b0e2cf6d52#.8v2rgscza
======
in_cahoots
This is the sort of sophmoric 'conventional wisdom 2.0' that's no more
effective than the conventional wisdom it aims to replace. The thesis is
basically, "most people think / act / look like X, therefore the opposite is
more valuable."

That guy who looks and sounds like a doctor may have paid his own way through
college. Maybe he went to speech therapy to overcome a stutter. Maybe he works
out regularly and follows a good diet because he truly believes in the
advantages of a healthy lifestyle and he knows how hard it is for his patients
to do the same.

The point is, the vast majority of the time we don't have any way of judging
how much a person has had to overcome just by looking at their appearance.
It's not that we're drawing the wrong conclusion from the metric, it's the
metric itself that's broken.

~~~
travisjungroth
> it's the metric itself that's broken.

That's the point. When a metric is broken, you can exploit its defects.

Let's say you have two surgeons applying for a job. One has the image down,
one does not. Both have a 90% success rate in their surgery. The one with the
better image will get hired more often. The one with the bad image will have
to be better at his job (95% success rate) to get hired as often.

When you have a highly overvalued attribute, that attribute becomes an
indicator of overvaluation. Meaning, it's a negative indicator of true value.
The article applies this rule to "image".

If I told you that startups with a name that started with an "S" got 10x the
early valuation compared to other companies, would you ever invest in a
company that started with an "S"? Hopefully not. The startup may be good, but
the odds are lower it would ever live up to its hype.

~~~
in_cahoots
I agree with you in theory, but in real life there is nothing that is that
quantifiable. What you are proposing is similar to video game stats -- if a
character has 10 points to allocate, putting some in charisma necessarily
means taking some out of intelligence.

In real life, I have no way of knowing which doctor is better at his job. The
only metric I have to go off of is the degree and board certifications, and
yet this article discounts those entirely in favor of the other guy. To use
bedside manner as a metric instead of appearance, most of the brusque, rude
doctors I know are just jerks, not real-life versions of Dr. House.

Adjusting for the relaxed standards of computer programming, proportionally I
know just as many mediocre unconventional ones as I do mediocre conventional
ones. The comments in this very thread suggest that the one with the worse
image will get closer attention by many (though obviously not all) hiring
managers just because of his/her appearance. So why should I believe the
unkempt programmer was hired because he was more talented, and not because
some other person just _assumed_ he was?

~~~
travisjungroth
> What you are proposing is similar to video game stats -- if a character has
> 10 points to allocate, putting some in charisma necessarily means taking
> some out of intelligence.

It seems similar, but it's really not the same. There's a comment in this
thread suggesting if a surgeon spends more time fitting in, that means they
have less time and energy to spend on being a surgeon. I totally disagree with
this.

I don't believe there's some finite amount of energy (that you could call
willpower or character points) that's somewhat consistent across people and
you only get to spend in certain ways.

To keep overusing the surgeon analogy: let's pretend New York surgeons suck
compared to Boston surgeons. For every measurable metric, Boston surgeons are
better on average. Everyone knows this. Accent becomes a reasonable indicator
of skill.

You go to a top-tier hospital in a different state. Everyone there is great at
their job. You meet two doctors. One has a Boston accent (indicator of skill)
and one has a New York accent (indicator of lower skill).

The suggestion of this article is to look at the New York doctor and think
"What's so great about this guy that even while walking around with something
that every single person is going to judge him for, he still made it all the
way to a top-tier hospital? He must be damn good at his job to make it this
far."

An attribute can be an indicator of value. But, if it is overvalued, it
becomes an indicator of overvaluation.

When people are discriminated against but still successful, the discrimination
criteria becomes an indicator of skill.

Shit, call it the Jackie Robinson Effect. When no one wants you around, when
you don't look the part, you have to be damn good at your job to keep it.

I'm guessing here, but I'd bet money that in the first few years of
desegregating baseball, the average black player in the MLB was way better
than the average white player. They had to be amazing to get a spot. Being
black in the MLB was an indicator of value. Now that those pressures aren't
the same, I'd bet they're equivalent and being black in the MLB isn't an
indicator of skill.

~~~
logfromblammo
Clearly, I cannot choose the wine in front of me.

But you would have counted on this, so I cannot choose the wine in front of
you.

------
chickenbane
My eyes started to glaze over this piece, but dating a surgeon really opened
my eyes to their very exclusive profession.

First of all - forget about the tech industry, surgeons are overwhelmingly
male. It's obviously a tough path to get there, and takes a huge toll on you
when you get there (eg., their divorce rate is pretty high). This made me
realize simply the scenario of Gray's Anatomy - some hospital with like eight
female surgeons - is ridiculous.

Now, all doctors have a God complex, but the surgeons take the cake. They deal
with tons of death and save countless lives. My gf fiercely defended this -
her point was you want a surgeon who doesn't think twice about huge terrible
bloody trauma, people freaking out and intense pressure. You want a surgeon
who will be bold, roll the dice and do what needs to be done. I've helped
build pretty important systems that affect many lives, but certainly nothing
close to that kind of immediacy.

Finally, and this is going totally off topic now, but I also saw how terribly
confusing the state of American health costs are. We lived in a big city, and
doctors did rotations among the hospitals in the area. The _same_ doctors
would be doing the _same_ procedures and patients in different hospitals would
be billed hugely different amounts. Of course that has many secondary impacts;
maybe you get a nicer facility, a room to yourself, certainly (and maybe as
importantly) the demeanor of the nurses attending you would be much nicer.

~~~
ISL
I do not want a bold surgeon.

I want a surgeon who is well-trained, well-rested, aware of and working within
her circle of competence, working with a communicative support team, and using
a clear defense-in-depth strategy against error. In such an environment, doing
what needs to be done is more certain.

~~~
smallnamespace
Surgery, or _cutting other people open deliberately_ is instinctively
difficult for people, even after they rationally evaluated that it 'needs to
be done'.

Being able to bring oneself do X is not the same as knowing X needs to be
done.

In that case, a quality like 'boldness' might help the surgeon execute
successfully, rather than shrink away instinctively, if you define 'boldness'
as being willing to make on-the-fly, risky, life-changing decisions when the
need calls for it and then follow through. Most people are either not able to
do this well, or deliberately choose _not_ to work in an environment where it
is called for.

This same sort of calculus weighs in any profession that is in same way
already inherently unpleasant, such as being a soldier, a fireman, or a spy.

~~~
projektfu
I disagree. The hesitant feeling goes away in first year anatomy. Many doctors
do not become surgeons because they prefer another field, don't have the
scores, don't have the personality that gets recommendations from surgery
preceptors, don't want the long residency with bad hours, or were simply
unlucky and didn't match.

~~~
edblarney
"The hesitant feeling goes away in first year anatomy. "

Surely 'first year anatomy' is not the same thing as a bloody mess on the
table, alarms going off, a frantic staff, and someone about to die in front of
you unless you _do something_ that happens to be fairly close to _the right
thing_.

I didn't study medicine, but I was in the Army, and I confess that a degree of
slightly irrational hubris is necessary in some situations.

Surely, we would all prefer our surgeons to be calm, team-oriented and
thoughtful in front of us, but I think the situational dynamics just don't
apply well to that. Also, people can be all of those things and 'bold'.

Admittedly, 'bold' may not be the right word.

If there is a word for someone who can be called upon to think clearly and 'do
what is necessary' in a complex, high-stress scenario ... well than that.

~~~
projektfu
In the army, any combat staff with a rank of sergeant or better should have
what it takes to be calm in that situation. That's why there are residencies.
One of my mentors would chuckle during an intense situation and say "pit
sweat!" Another would say "all bleeding stops eventually...". With students,
the nurses are often keeping it cool until the student calms down. Many people
can learn to stay calm.

------
SamBam
Somehow I thought this was going to be more like the barber question.

" _There are only two barbers in town. One is neatly trimmed, smooth shaven,
professional, and is sweeping up after his last customer. The other has a wild
appearance, terribly-cut hair, his shop is messy and has no customers. Which
do you go to?_ "

I wasn't quite sure how it would work with surgeons, though... " _One has
perfectly-sutured incisions all over his body, the other has organs flopping
out..._ "

------
slg
I think a better real world example than the hypothetical surgeons is seen in
sports. Look at the first several players break the color barrier in Major
League Baseball. Of course you have Jackie Robinson as the first. But among
the next few after him were Ernie Banks and Willie Mays. There was a decent
bet that if you saw a black ball player in the early to mid 1950s he was an
all time great simply because they were the only ones who could overcome the
racism that was keeping others out.

------
nolemurs
I totally agree with the core sentiment here, but I'm not sure this long-
winded and moderately pretentious rant conveys much beyond "don't judge a book
by it's cover." I would encourage others to skip the long read.

~~~
savanaly
It conveys more than "don't judge a book by its cover." It is making the
stronger point that not only are people who are unkempt in their appearance
just as likely to be good at their job, they're more likely to be good at
their job. He explains a model that this prediction falls out of: where there
is competition between professionals and they can either get their status
through expertise, superficial preening, or some combination thereof. Most
people think those two traits go hand in hand but he's making the point that
due to competition they might be anti-correlated.

~~~
scott_s
It's also a model supported only by anecdote.

~~~
peeters
And then even anecdotally counters his own point by saying Trump's behavior as
president is somehow to his credit. As if it's all a matter of theatrics and
perception, and not what he's actually done.

------
DelaneyM
People who don't "look" like typical programmers always deserve a second look.

This is the one hiring maxim which has never steered me wrong, and also
provided a very diverse (and really fun!) development team. :)

~~~
edblarney
That's odd, because I always thought developers should look a little 'off'.

I generally dress well. Like a business guy. To overcome prejudice, I would
wear sandals to my interviews.

I wouldn't care to get a job in software today, but being a little older, and
dressing the way I do, I doubt anyone would overlook their conventions and
hire me!

But I'm grateful you're doing it.

Maybe you have some devs that look like bankers on your team?

~~~
DelaneyM
No bankers, but we do have a rather dapper gentleman pushing (over?) sixty.
One of my strongest leads.

------
nickthemagicman
A counter argument is that someone who looks more like a surgeon cares more
about his profession, pays more attention to details, and is therefore more
likely to do a good job.

Either way it's completely anecdotal. I would venture to say there's no
correlation between how someone looks and how someone performs.

~~~
saxonklaxon
It takes creativity and effort to look the part. It takes creativity and
effort to be normal. Which means _less_ creativity has been applied elsewhere
like to something important.

~~~
nickthemagicman
Yeah but on a scale of "1 to Surgeon" how much creativity is really traded off
in how someone dresses?

14 years of schooling vs 30 min on the internet?

I'd say the effort trade off is statistically insignificant.

~~~
saxonklaxon
Good point. However cargo-culting other surgeons subtly and fashionably and
well enough to fool promotion committees into overlooking mediocre performance
might take more creativity than you think. For one thing surgeons are
intelligent, status-oriented, complicated creatures. It's not just about
picking the right clothing. Not giving the game away by your demeanour may
require that you fool _yourself_ too. Such narcissism might take a herculean
effort to maintain because your ideas about yourself are connected to other,
more objective, ideas. You might have to organise professional conferences and
get involved in _politics_ , which always take a psychological toll. If your
attention is on the wrong things this could indicate that privately you don't
believe your surgical performance is up to much or that it can be improved.
Which may turn out to be a self-fulfilling prophecy.

------
chubot
_You don’t create a firm by creating a firm; nor do you do science by doing
science._

I read this as Paul Graham's point that startups should not "play house".
They're both saying that creating a company isn't about getting funding,
hiring people, having a website and a logo, etc. It's about making something
that people want, which can start in any number of ways that might not look
like a company.

------
Illniyar
Maybe that unprofessional looking doctor is actually the son of a rich
benefactor and got the job because of his connections.

Maybe he kept with appearances until he got tenure and now he's slacking
because no one can fire him.

Maybe the hospital was short on staff and took anyone willing to apply at the
time.

Or a hundred other reasons why, if you can choose a doctor, do research on
them, if you dont have time, pick one by virtue of conversation, if you can't
do either, you are just trying to make a pattern out of randomness.

------
lisper
The (capitalized) word "Lindy" appears exactly twice in this piece:

"The idea is Lindy compatible."

"In any activity, hidden details are only revealed via Lindy-style
experience."

Having read the whole piece and done some web searches I still have no idea
what this could possibly mean.

~~~
BorgHunter
Taleb is likely referring to the Lindy effect, which he also referenced in his
book, The Black Swan.

[https://en.wikipedia.org/wiki/Lindy_effect](https://en.wikipedia.org/wiki/Lindy_effect)

~~~
lisper
Thanks for the pointer, but the passages in this piece still make no sense
even in that context.

~~~
leroy_masochist
Here's my best effort at explaining:

The Lindy effect describes cases in which real-life outcomes get better as one
progresses down the "bad odds axis". For example, a 95-year-old selected at
random from the general population might have a higher likelihood of being
alive one year from now than an 80-year-old selected at random -- e.g., due to
fact that living 95-year-olds tend to be people with good genetics who make
healthy life decisions [0].

Taleb is somewhat sloppily trying to tie this phenomenon to the broad
assertion that the relative aptitude of two given individuals at any given
pursuit is often counterintuitive to first impressions. This ties into Taleb's
favorite argument, which he predictably makes in a slightly different way with
each new book or essay: what is often rewarded by society / companies / etc is
the appearance of being good at something, rather than actually being good at
it, and the pursuit of being perceived as good at something is not only not
helpful to being better at it, but often actively counterproductive to said
task....but if you ignore people's perceptions about what it means to be
excellent, and "put skin in the game" by focusing on being excellent rather
than cultivating that perception, you will be less susceptible to unforeseen
bad events ("black swans").

[0] This very well may not be statistically true, just trying to put forth an
illustrative example.

------
sverige
My only rebuttal to this somewhat rambling piece is that my heart surgeon
looked and acted very much like I expected a heart surgeon to look and act,
and he did a great job. I found out later that he's one of the top-rated
cardiac surgeons in the US, and that many cardiac surgeons come to this
hospital just to study under him.

But in support of the thesis, this _hospital_ is not located where one might
expect one of the top three heart hospitals to be located.

------
JohnJamesRambo
You shouldn't judge a surgeon on looks at all. There are actual surgical stats
you can use to judge surgeons.

------
fuzzfactor
A brain surgeon is like a hairdresser because there are only so many heads you
can work on over a lifetime using only your own two hands.

Only some surgeons can be full time lifesavers, some hairdressers however can
be full time media production savers.

Either way, for someone in the top performance bracket who is truly saving the
day with each head they work on, more energy professionally devoted to clients
which would otherwise be expended on their own superficial appearance and
gratuitious recognition-seeking can only be a good thing for the clients
themselves.

The best could possibly be expected to not appear very much like the well-
known Hollywood stereotypes or not be fashionable themselves at all very
often.

------
soneca
The Red Sneakers Effect: Inferring Status and Competence from Signals of
Nonconformity:
[http://www.hbs.edu/faculty/Pages/item.aspx?num=45809](http://www.hbs.edu/faculty/Pages/item.aspx?num=45809)

------
stephencanon
What immediately jumps out at me is that both hypothetical surgeons described
are men; patients consistently assume that my wife (neurosurgeon) is a nurse,
and that the tall man in his 50's (a PA) is the surgeon. She doesn't even
bother correcting them most of the time, it's not worth the effort.

I would say that if you have no other information, pick the female (and
preferably minority) surgeon. I know a lot of excellent white male surgeons,
but within my circle of acquaintances, a randomly selected woman is
unquestionably a better option than a randomly selected man.

------
matt_morgan
Let's all start with the assumption that both of the surgeons are men, shall
we?

I don't mean to be flip. This is an article about assumptions and yet it makes
one it shouldn't.

------
aspinei
This kind of reasoning is valid in an idealistic, meritocratic society where
the standing of a doctor is mostly established by track record and skills. In
a corrupt society or a hospital with an unethical management, this may simply
not be the case.

------
losteverything
After just having Doogie Howser as an orhtopeadic surgeon I would take him
again. For the simple reason of high tech recency. So what his hair was not
perfect

------
oculusthrift
edit: lmao

~~~
leroy_masochist
Taleb wrote the article

