Welcome! I’m an MD and haven’t yet figured out why there are so few of us here, given the importance of rationality for medical decision making. It’s interesting that at least in my country there is zero training in cognitive biases in the curriculum.
I have the Irish equivalent of an MD; “Medical Bachelor, Bachelor of Surgery, Bachelor of the Art of Obstetrics”. This unwieldy degree puts me in fairly decent company on Less Wrong.
I may be generalizing from a sample of one, but my impression is that medicine selects out rationalists for the following reasons:
(1) The human body is an incompletely understood highly complex system; the consequences of manipulating any of the components can generally not be predicted from an understanding of the overall system. Medicine therefore necessarily has to rely heavily on memorization (at least until we get algorithms that take care of the memorization)
(2) A large component of successful practice of medicine is the ability to play the socially expected part of a doctor.
(3) From a financial perspective, medical school is a junk investment after you consider the opportunity costs. Consider the years in training, the number of hours worked, the high stakes and high pressure, the possibility of being sued etc. For mainstream society, this idea sounds almost contrarian, so rationalists may be more likely to recognize it.
--
My story may be relevant here: I was a middling medical student; I did well in those of the pre-clinical courses that did not rely too heavily on memorization, but barely scraped by in many of the clinical rotations. I never had any real passion for medicine, and this was certainly reflected in my performance.
When I worked as an intern physician, I realized that my map of the human body was insufficiently detailed to confidently make clinical decisions; I still wonder whether my classmates were better at absorbing knowledge that I had missed out on, or if they are just better at exuding confidence under uncertainty.
I now work in a very subspecialized area of medical research that is better aligned with rational thinking; I essentially try to apply modern ideas about causal inference to comparative effectiveness research and medical decision making. I was genuinely surprised to find that I could perform at the top level at Harvard, substantially outperforming people who were in a different league from me in terms of their performance in medical school. I am not sure whether this says something about the importance of being genuinely motivated, or if it is a matter of different cognitive personalities.
In retrospect, I am happy with where this path has taken me, but I can’t help but wonder if there was a shorter path to get here. If I could talk to my 18-year old self, I certainly would have told him to stay far away from medicine.
I don’t think medicine is a junk investment when you consider the opportunity cost, at least in the US.
Consider my sister, a fairly median medical school graduate in the US. After 4 years of medical school (plus her undergrad) she graduated with 150k in debt (at 6% or so). She then did a residency for 3 years making 50k a year, give or take. After that she became an attending with a starting salary of $220k. At younger than 30, she was in the top 4% of salaries in the US.
The opportunity cost is maybe ~45k*4 years, 180k + direct cost of 150k or so.. So $330k “lost to training,” however 35+ years of making 100k a year more than some alternative version that didn’t do medical school. Depending on investment and loan decisions by 5 years out you’ve recouped your investment.
Now, if you don’t like medicine and hate the work, you’ve probably damned yourself to doing it anyway. Paying back that much loan is going to be tough working in any other job. But that is a different story than opportunity cost.
Thanks hyporational ! It is exactly same here. Cognitive biases, heuristics, or even Bayes Theorem (normative decision making) is not really taught here.
Also I once argued against some pseudoscientific treatment (in mental illnesses) and my arguments were completely ignored by 200 people because of argumentum ad hominem and attribute substitution (who looks like he is right vs. looking the actual arguments). Most people dont know what is a good argument or how to think about the propability of a statement.
Interesting points Anders_H, I have to think about those littlebit.
We were taught bayes in the form of predictive values, but this was pretty cursory. Challenging the medical professors’ competence publicly isn’t a smart move careerwise, unless they happen to be exceptionally rational and principled, unfortunately. There’s a time to shut up and multiply, and a time to bend to the will of the elders :)
One day when I was a junior medical student, a very important Boston surgeon visited the school and delivered a great treatise on a large number of patients who had undergone successful operations for vascular reconstruction.
At the end of the lecture, a young student at the back of the room timidly asked, “Do you have any controls?” Well, the great surgeon drew himself up to his full height, hit the desk, and said, “Do you mean did I not operate on half the patients?” The hall grew very quiet then. The voice at the back of the room very hesitantly replied, “Yes, that’s what I had in mind.” Then the visitor’s fist really came down as he thundered, “Of course not. That would have doomed half of them to their death.
”God, it was quiet then, and one could scarcely hear the small voice ask, “Which half?”
Yep :) You are definetely right career wise. Problem for me was the 200 other people who will absorb completely wrong idea of how the mind works if I wont say anything. Primum non nocere.
But yeah, this was 4 years ago anyway...just wanted to mention it as an anecdote of bad general reasoning and biases :)
Huh. My experience is somewhat similar to yours in the sense that I never was a big fan of memorization, and I’m glad that I could outsource some parts of the process to Anki. I also seem to outperform my peers in complex situations where ready made decision algorithms are not available, and outperformed them in the few courses in medschool that were not heavy on memorization. The complex situations obviously don’t benefit from bayes too much, but they benefit from understanding the relevant cognitive biases.
The medical degree is a financial jackpot here in Finland, since I was actually paid for studying, and landed in one of the top 3 best paying professions in the country straight out of medschool. Money attracts every type, and the selection process doesn’t especially favor rationalists, who happen to be rare. It just baffles me how the need for rationality doesn’t become self evident for med students in the process of becoming a doctor, not to mention after that.
how the need for rationality doesn’t become self evident for med students in the process of becoming a doctor,
Is it just a matter of terminology? I would guess that all med students will agree that they should be able to make a correct diagnosis (where correct = corresponding to the underlying reality) and then prescribe appropriate treatment (where appropriate = effective in achieving goals set for this patient).
Whatever the terminology, they should make the connection between the process of decision making and the science of decision making, which they don’t seem to do. Medicine is like this isolated bubble where every insight must come from the medical community itself.
I found overcoming bias and became a rationalist during med school. Finding the blog was purely accidental, although I recognized the need for understanding my thinking, so I’m not sure what form this need would have taken given a slightly different circumstance.
Welcome! I’m an MD and haven’t yet figured out why there are so few of us here, given the importance of rationality for medical decision making. It’s interesting that at least in my country there is zero training in cognitive biases in the curriculum.
I have the Irish equivalent of an MD; “Medical Bachelor, Bachelor of Surgery, Bachelor of the Art of Obstetrics”. This unwieldy degree puts me in fairly decent company on Less Wrong.
I may be generalizing from a sample of one, but my impression is that medicine selects out rationalists for the following reasons:
(1) The human body is an incompletely understood highly complex system; the consequences of manipulating any of the components can generally not be predicted from an understanding of the overall system. Medicine therefore necessarily has to rely heavily on memorization (at least until we get algorithms that take care of the memorization)
(2) A large component of successful practice of medicine is the ability to play the socially expected part of a doctor.
(3) From a financial perspective, medical school is a junk investment after you consider the opportunity costs. Consider the years in training, the number of hours worked, the high stakes and high pressure, the possibility of being sued etc. For mainstream society, this idea sounds almost contrarian, so rationalists may be more likely to recognize it.
--
My story may be relevant here: I was a middling medical student; I did well in those of the pre-clinical courses that did not rely too heavily on memorization, but barely scraped by in many of the clinical rotations. I never had any real passion for medicine, and this was certainly reflected in my performance.
When I worked as an intern physician, I realized that my map of the human body was insufficiently detailed to confidently make clinical decisions; I still wonder whether my classmates were better at absorbing knowledge that I had missed out on, or if they are just better at exuding confidence under uncertainty.
I now work in a very subspecialized area of medical research that is better aligned with rational thinking; I essentially try to apply modern ideas about causal inference to comparative effectiveness research and medical decision making. I was genuinely surprised to find that I could perform at the top level at Harvard, substantially outperforming people who were in a different league from me in terms of their performance in medical school. I am not sure whether this says something about the importance of being genuinely motivated, or if it is a matter of different cognitive personalities.
In retrospect, I am happy with where this path has taken me, but I can’t help but wonder if there was a shorter path to get here. If I could talk to my 18-year old self, I certainly would have told him to stay far away from medicine.
I don’t think medicine is a junk investment when you consider the opportunity cost, at least in the US.
Consider my sister, a fairly median medical school graduate in the US. After 4 years of medical school (plus her undergrad) she graduated with 150k in debt (at 6% or so). She then did a residency for 3 years making 50k a year, give or take. After that she became an attending with a starting salary of $220k. At younger than 30, she was in the top 4% of salaries in the US.
The opportunity cost is maybe ~45k*4 years, 180k + direct cost of 150k or so.. So $330k “lost to training,” however 35+ years of making 100k a year more than some alternative version that didn’t do medical school. Depending on investment and loan decisions by 5 years out you’ve recouped your investment.
Now, if you don’t like medicine and hate the work, you’ve probably damned yourself to doing it anyway. Paying back that much loan is going to be tough working in any other job. But that is a different story than opportunity cost.
Thanks hyporational ! It is exactly same here. Cognitive biases, heuristics, or even Bayes Theorem (normative decision making) is not really taught here.
Also I once argued against some pseudoscientific treatment (in mental illnesses) and my arguments were completely ignored by 200 people because of argumentum ad hominem and attribute substitution (who looks like he is right vs. looking the actual arguments). Most people dont know what is a good argument or how to think about the propability of a statement.
Interesting points Anders_H, I have to think about those littlebit.
We were taught bayes in the form of predictive values, but this was pretty cursory. Challenging the medical professors’ competence publicly isn’t a smart move careerwise, unless they happen to be exceptionally rational and principled, unfortunately. There’s a time to shut up and multiply, and a time to bend to the will of the elders :)
Reminds me of:
Yep :) You are definetely right career wise. Problem for me was the 200 other people who will absorb completely wrong idea of how the mind works if I wont say anything. Primum non nocere.
But yeah, this was 4 years ago anyway...just wanted to mention it as an anecdote of bad general reasoning and biases :)
Huh. My experience is somewhat similar to yours in the sense that I never was a big fan of memorization, and I’m glad that I could outsource some parts of the process to Anki. I also seem to outperform my peers in complex situations where ready made decision algorithms are not available, and outperformed them in the few courses in medschool that were not heavy on memorization. The complex situations obviously don’t benefit from bayes too much, but they benefit from understanding the relevant cognitive biases.
The medical degree is a financial jackpot here in Finland, since I was actually paid for studying, and landed in one of the top 3 best paying professions in the country straight out of medschool. Money attracts every type, and the selection process doesn’t especially favor rationalists, who happen to be rare. It just baffles me how the need for rationality doesn’t become self evident for med students in the process of becoming a doctor, not to mention after that.
Is it just a matter of terminology? I would guess that all med students will agree that they should be able to make a correct diagnosis (where correct = corresponding to the underlying reality) and then prescribe appropriate treatment (where appropriate = effective in achieving goals set for this patient).
Whatever the terminology, they should make the connection between the process of decision making and the science of decision making, which they don’t seem to do. Medicine is like this isolated bubble where every insight must come from the medical community itself.
I found overcoming bias and became a rationalist during med school. Finding the blog was purely accidental, although I recognized the need for understanding my thinking, so I’m not sure what form this need would have taken given a slightly different circumstance.