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Stuff [Aug. 23rd, 2012|01:53 am]
Scott
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Sometimes I feel like I'll be a failure unless I'm good at everything. Then I remember that no one's good at everything, and all you can do is the best you can, and I feel better. Then I meet someone who really is good at everything, and it's super annoying.

The psychiatrist mentoring me, Dr. H, is good at everything. When psychotics who believe they are God quote the Bible at him, he quotes the Bible back, and he knows it better than they do ("I made a point to study all world religions because they're so important in these people's lives"). When drug addicts talk about making their own crystal meth, he points out flaws in their manufacturing techniques ("I've treated so many meth-heads by now that by this point I know more about it than they do"). When a nurse was trying to puzzle out a patient who kept lying about his sleep habits, Dr. H told her five ways to test if someone's really sleeping ("I used to work nights in a sleep laboratory.") Whatever his patients' trade - plumber, welder, mechanic - he quizzes them on domain-relevant knowledge, then afterwards declares whether or not they're good at their jobs, which is of course relevant to their psychological health. ("My brother's a master plumber, I repair vintage Buicks as a hobby, and I just thought I'd learn welding because you never know when something might need to be welded.")

He gets results, too. Someone will come in, screaming and flailing about, shouting that all psychiatrists are quacks and we can't make him stay here and he'll sic his lawyers on us. Five minutes with Dr. H and he's calmed down. Ten minutes and he's agreed to treatment. A week and he's crying thanking him for changing his life and saying that agreeing to come to the hospital was the best decision he ever made.

I asked him about the effectiveness of his drug rehab program. He said that 99% of the addicts he treats are drug free after one year. I expressed some doubt, and found some studies of a bunch of programs, none of which had above a greater than 35% success rate. "None of those programs," he said dismissively. "Here, we do it right."

Doing it right involves knowing everything. He assigned one of the doctors under him a "homework" project of going into the local liquor store and learning the differences - price, alcohol content, et cetera - between every brand on the shelf ("Your alcoholic patients will trust you if you know that information.") He himself can discuss everything from the history of the 19th-century Opium Wars to amusing facts about narcotics. Did you know that heroin was originally invented (and marketed!) as a cure for morphine addiction? That part of the stigma against methadone comes from people incorrectly believing that its trade name (Dolophin) was a reference to Adolf Hitler?

After a particularly difficult patient confessed during morning rounds that Dr. H was the only psychiatrist who had ever understood him, one of the residents just sort of stared at him and asked "How do you do it all the time?" Dr. H just shrugged and said "I'm the best there is. It's that simple." And he meant it, not in a boasting way but as a simple statement of fact.

When people complain that doctors are basically just technicians with good memories, and not really professionals who require any particular skill or creativity or intelligence, I think instead of people like Dr. H. He is a type. There are doctors like him at every hospital and in every specialty. It's not always obvious who they are from a patient perspective, but if you know them well you can pick them out pretty quickly (my father is another from the same mold). It is a personality type I have never seen outside medicine - there are genius scientists, and genius politicians, and geniuses in a lot of places, but it's a different kind of genius. The doctor who knows everything, knows she knows everything, and manages to combine reassuring arrogance with a reassuring humanity is a sort of person I just don't find anywhere else.

I was hoping I would learn how to be that way in medical school, but last time I checked I was still fallible (though I might be wrong about that). I'm starting to think my best bet is one of those occult rituals where you eat someone's heart to gain their powers. Working thirty-five years in the same hospital like Dr. H did might also work, but eating someone's heart sounds much simpler.
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Comments:
[User Picture]From: mountainkiss
2012-08-23 07:19 am (UTC)
Okay, so I know very little about this so this comment might be rubbish. But I would guess that one of the most important factors in becoming that good a doctor would be that his or her job would be the most important thing in their life (or quite likely the only important thing in their life), and all their attention would be devoted towards becoming a better and better doctor. Is that true of you? It seems that there are a lot of other things that are also important to you and take your attention.
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[User Picture]From: squid314
2012-08-25 03:42 am (UTC)
Well, Dr. H is also the president of the National Old Car Restorer Association or something like that, but your point is well-taken and I have been worrying about that myself.
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[User Picture]From: little_ribbit
2012-08-26 02:35 am (UTC)
My guess is actually in the other direction, that only a small part of his attention was devoted to only being a doctor. It sounds like he's at least 60, which is a long time to build up that kind of knowledge. His particular style of being the best at everything tells me that he's also genuinely curious about almost everything (or can trick himself into being curious). If you spend decades being curious about everything, you're going to learn a hell of a lot.

It also sounds like he has learned to channel that natural curiosity in useful ways that aren't strictly limited to his field. The following is entirely hypothetical, but after 20 or 30 years of implementation, you'd be incredibly knowledgeable about many, many topics:

If you look at the top 10 or 20 professions represented by your clients, you can put together a good homework list of things you should study. You would look at each profession and figure out what kind of schooling or training is required, what their most common professional tasks are, common pitfalls and mistakes, and what kinds of people do really well in each field. You might even find that you want to pursue one of them, such that you become a serious hobbyist (restoring cars, etc), and you could certainly speak about each one intelligently. Then if you look at the most common afflictions your patients suffer from, like certain types of substance abuse, you can use those as a starting point for new research. Instead of just looking at treatments and presentation of symptoms, you'd do your best to examine what's actually most relevant to each of them or what they will frequently deal with day to day. His homework assignment of looking up every type of alcohol in a liquor store is a very good example, as is a deep knowledge of methamphetamine synthesis. If you treat a lot of suicidal individuals, you might start looking at everyday objects and situations in terms of their potential lethality. And so on.

I suppose my best suggestion is actually that you should not worry about being this awesome, at least not any time soon. You have a really wide range of interests, only some of which are medical, and a very interesting way of expressing them. If you can channel some of your curiosity into learning the minutia that is common to many of your patients' lives, you could find yourself coming across as being just as impressive as Dr. H is, eventually.
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[User Picture]From: mindstalk
2012-09-03 01:51 pm (UTC)
Yeah, broad interests + good memory + lots of time spent adds up to impressive. I'm not that old or that focused, but I've spent most of my free time reading and get a fair bit of "you know everything" or "you're one of the smartest people I know"[1][2].

[1] People commonly confuse knowledge and intelligence. Or maybe talking fast in big sentences and intelligence.
[2] Followed one time by "so how can you be so lazy?" "My intelligence lets me get away with being lazy" was the obvious reply I didn't say.
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[User Picture]From: mercureal
2012-08-23 07:38 am (UTC)
I just want to off-topic comment that I notice you've adopted feminine pronouns for the general case, and I appreciate that.
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[User Picture]From: squid314
2012-08-25 03:42 am (UTC)
It seems to get me about 50% fewer unpleasant remarks than any of the other available options.
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[User Picture]From: avanti_90
2012-08-23 07:58 am (UTC)
Are you implying that you want to murder Dr. H in an occult ritual and eat his heart? If so, Dr. H will certainly know more about occult rituals than you, correct the placement of your magic circles and pentagrams, and then reverse the flow of magical energy so that he destroys you and consumes your powers instead.
Hmm. Maybe this is how he does it?
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[User Picture]From: ikadell
2012-08-23 07:53 pm (UTC)
And then later people would ask him: how do you know so many details about the inner geography of Ireland and what made you read Harry Potter and the Methods of Rationality, and he would innocently respond: "Well, my wife is from Ireland and she likes to talk about it, and I stumbled upon this Harry Potter thing by mistake in the internet, when looking for the movie tickets, and finished it it one night"...
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[User Picture]From: nancylebov
2012-08-23 10:35 am (UTC)
Have you tried asking Dr. H how he does it?
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[User Picture]From: cakoluchiam
2012-08-24 09:23 am (UTC)
That's so crazy it just might work!
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From: (Anonymous)
2012-08-24 05:11 pm (UTC)
It probably won't. Our [high school equivalent]'s headmaster had an impossible memory of names. He knew *everyone's* name at a school with 1500 students. So I asked him how he does it, and he answered that it was important to him that the students not feel anonymous and exchangeable. Some motivation like that might actually be necessary, but I doubt that this is largely a motivation problem.
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[User Picture]From: squid314
2012-08-25 03:44 am (UTC)
I'm going to ask him for a list of recommended reading when I leave, especially as geared toward working with patients and being a good doctor and things more general than pharmacology textbooks. This seems like the most likely way to gain his powers, since I doubt it's anything he could fit in a sentence.
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[User Picture]From: nancylebov
2012-09-02 09:34 pm (UTC)
Probably, though I'm curious about how he remembers so much so easily. It might be Hermione's answer (approximate, from memory) of paying attention.

Edited at 2012-09-02 11:36 pm (UTC)
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[User Picture]From: celandine13
2012-08-23 11:35 am (UTC)
There are some professions where, behind layers of posturing and angling for position, behind all the people who do it for the wrong reasons, there's a core that really is a sacred calling. I always instinctively got that science was like that, but I've only recently started to appreciate that it's true of medicine as well. A real doctor is a DOCTOR.

I'm sure you'll be one someday.
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[User Picture]From: marycatelli
2012-08-23 12:43 pm (UTC)
Heroin was tragic. About one in -- ten thousand, hundred thousand (I forget exactly) people can not get addicted to heroin. The researchers were searching for a non-addictive substitute for morphine, and all their test subjects fit in that group. Something like a dozen of them.

Sometimes you really beat the odds. Alas.
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[User Picture]From: gwern branwen
2012-08-23 05:30 pm (UTC)
Really? I've never heard of that before. Sauce?

---

> The doctor who knows everything, knows she knows everything, and manages to combine reassuring arrogance with a reassuring humanity is a sort of person I just don't find anywhere else.

Have you run into very many top witch doctors or shamans?
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[User Picture]From: marycatelli
2012-08-24 12:39 am (UTC)
It was from an editoral by the late John W. Campbell, I don't know his source.
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[User Picture]From: mindstalk
2012-08-24 04:15 am (UTC)
Unfortunately JWC himself is not a reliable source...
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[User Picture]From: gwern branwen
2012-08-25 03:14 pm (UTC)
Indeed: http://en.wikipedia.org/wiki/John_W._Campbell#Editorials_and_opinions
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[User Picture]From: squid314
2012-08-25 03:53 am (UTC)
Even if it was only 1/1000, the probability of a dozen randomly selected people all belonging to that group is about 1/10^36. If a million events happen every second, then one event with 1/10^36 probability should happen approximately once every 700 sextillion years - or, in other words, about once every fifty trillion lifespans of the Universe.

I think it's more likely that your source is misinformed.
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[User Picture]From: gwern branwen
2012-08-25 03:17 pm (UTC)
I'd point out that it's not quite that unlikely; as the psychologists say, the null hypothesis is always false, there is always substantial covariance. Maybe this supposed heroin resistance was hereditary and the sampling of control groups was being done from a concentrated & contaminated population, or perhaps it was connected to dopaminergic stuff which could manifest in all sorts of ways (greater conscientiousness in signing up for medical trials?). That sort of thing.
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[User Picture]From: eyelessgame
2012-08-23 02:55 pm (UTC)
Obviously, the thing to do is to ask Dr. H whether eating a heart would work. He'll know, of course, whether it does.
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From: gjm11
2012-08-23 08:51 pm (UTC)
A doctor, or The Doctor?
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[User Picture]From: maniakes
2012-08-23 09:04 pm (UTC)
I approve of this message.
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[User Picture]From: jannytruant
2012-08-24 12:35 am (UTC)
(head explodes)
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[User Picture]From: marycatelli
2012-08-24 12:40 am (UTC)
But then you would have to ask which one, or whether you need both.
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[User Picture]From: squid314
2012-08-25 03:58 am (UTC)
Well, he's black, and given some of the fuss around Martha Jones I don't think the networks would let The Doctor be black...although they're welcome to prove me wrong.
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