10 ms·

Surgeons Should Not Look Like Surgeons

89 points by jstewartmobile 10y ago

nickthemagicman 10y ago
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 10y ago
  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.
  - nartam11 10y ago
    Creative people apply creativity to all aspects of their life. I don't see it as a resource which must be rationed
  - Retric 10y ago
    Looking the part takes less effort than you might think. One study showed that men who shave spend the same amount of time in the bathroom as men who don't on average despite the fact shaving takes time.
    - oh_sigh 10y ago
      The key would be asking if their resultant hygiene or other important metrics are equivalent I could save time in the bathroom by not washing my hands, but I'd rather not.
  - nickthemagicman 10y ago
    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 10y ago
      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.
- nolemurs 10y ago
  > I would venture to say there's no correlation between how someone looks and how someone performs. I would argue that if someone looks the part, then they can be successful with a lower level of skill, and so they have less incentive to really be as good. My impression is that people generally, and doctors in particular, are quite lazy and generally aim to only be as good at a thing as they need to to get what they want, so the guy who looks the part is likely to be less competent. There will be exceptions obviously, but I know that if I meet someone who puts a lot of effort into appearances, my presumption is not that he does this because he is incredibly hard working and just puts more energy into everything. In my experience that's not usually the explanation.
  - jschwartzi 10y ago
    Another explanation is that people who "look the part" do so as a way to signal that they take good care of themselves, and by extension anyone that they might be entangled with.
    - nolemurs 10y ago
      Absolutely. I would guess that's the most common reason for people to look the part. I can't really tell if you're agreeing or disagreeing with what I said!
- Robotbeat 10y ago
  Right, that would be a good argument IF we were talking about a bunch of random people whose rank is completely unknown, and in fact this sort of heuristic is the usual, common sense one that leads to the situation we're describing (and that can be exploited). The KEY information here is that they're at the same rank. That means the slob has had to overcome people using the heuristic you've just described in order to reach the same rank, probably through being an objectively better surgeon.
- walshemj 10y ago
  And a surgeon needs to inspire confidence on both his patients and team
DelaneyM 10y ago
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. :)
- V-2 10y ago
  Also within the job itself, overengineering (a typical vice of intermediate level coders) is the root of, well, much evil. A programmer myself, I couldn't help but thinking about mammoth frameworks and architecture fads as I read the article
- edblarney 10y ago
  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 10y ago
    No bankers, but we do have a rather dapper gentleman pushing (over?) sixty. One of my strongest leads.
deleted 10y ago
[deleted]
in_cahoots 10y ago
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 10y ago
  > 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 10y ago
    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?
nolemurs 10y ago
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.
- jstewartmobile 10y ago
  I don't know... usually when Taleb's being boorish to the point of putting the book down, he'll lay down a "Black Swan" of insight that makes it all worthwhile.
  - nolemurs 10y ago
    You know, I read through the whole article. I even agreed with pretty much all of it. I didn't run into anything I found particularly insightful. Actually, I kind of feel like the reasoning in this article can be profitably applied to Taleb's own image management.
    - sjg007 10y ago
      I mean this is the contrarian mindset which if we believe in startup land is how you find success. Models for success: find some niche and grow it (kind of a contradiction); develop some new technology; or X is broken; copy X from market A and paste in market B (where X is not).
    - bbctol 10y ago
      In a weird way, that's sort of the reason to read Taleb. It's about 90% posturing and sophist bullshit and 10% legitimate insight, but at least the insight is "90% of the time intellectuals are just posturing and spouting sophist bullshit." Maybe he's making some meta-demonstration, though more likely he's just really self-unaware, but I've still found it worth reading enough until you realize why you can discount most of it.
- savanaly 10y ago
  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.
lisper 10y ago
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.
- deleted 10y ago
  [deleted]
- BorgHunter 10y ago
  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 10y ago
    Thanks for the pointer, but the passages in this piece still make no sense even in that context.
    - ABCLAW 10y ago
      Taleb is saying that the surgeon being a surgeon itself is the measure of his quality in the same manner that Lindy prescribes that age is a marker for stability. The fact that he continues to be a surgeon provides you with information about his fitness as a surgeon. In the face of poor appearance, his existence as a surgeon provides you information about his quality.
    - leroy_masochist 10y ago
      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.
slg 10y ago
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.
sverige 10y ago
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.
SamBam 10y ago
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..."
chubot 10y ago
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.
JohnJamesRambo 10y ago
You shouldn't judge a surgeon on looks at all. There are actual surgical stats you can use to judge surgeons.
losteverything 10y ago
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 10y ago
edit: lmao
- leroy_masochist 10y ago
  Taleb wrote the article
- jstewartmobile 10y ago
  This guy is Nassim Taleb.
soneca 10y ago
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
chickenbane 10y ago
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.
- deleted 10y ago
  [deleted]
- mtdewcmu 10y ago
  >> 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. Essentially, a sociopath. I think this sheds some light on the paradox of Ben Carson.
- ISL 10y ago
  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.
aspinei 10y ago
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.
Illniyar 10y ago
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.
matt_morgan 10y ago
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.
stephencanon 10y ago
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.
fuzzfactor 10y ago
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.

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 10y ago
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.
- nartam11 10y ago
  Creative people apply creativity to all aspects of their life. I don't see it as a resource which must be rationed
- Retric 10y ago
  Looking the part takes less effort than you might think. One study showed that men who shave spend the same amount of time in the bathroom as men who don't on average despite the fact shaving takes time.
  - oh_sigh 10y ago
    The key would be asking if their resultant hygiene or other important metrics are equivalent I could save time in the bathroom by not washing my hands, but I'd rather not.
- nickthemagicman 10y ago
  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 10y ago
    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.
nolemurs 10y ago
> I would venture to say there's no correlation between how someone looks and how someone performs. I would argue that if someone looks the part, then they can be successful with a lower level of skill, and so they have less incentive to really be as good. My impression is that people generally, and doctors in particular, are quite lazy and generally aim to only be as good at a thing as they need to to get what they want, so the guy who looks the part is likely to be less competent. There will be exceptions obviously, but I know that if I meet someone who puts a lot of effort into appearances, my presumption is not that he does this because he is incredibly hard working and just puts more energy into everything. In my experience that's not usually the explanation.
- jschwartzi 10y ago
  Another explanation is that people who "look the part" do so as a way to signal that they take good care of themselves, and by extension anyone that they might be entangled with.
  - nolemurs 10y ago
    Absolutely. I would guess that's the most common reason for people to look the part. I can't really tell if you're agreeing or disagreeing with what I said!
Robotbeat 10y ago
Right, that would be a good argument IF we were talking about a bunch of random people whose rank is completely unknown, and in fact this sort of heuristic is the usual, common sense one that leads to the situation we're describing (and that can be exploited). The KEY information here is that they're at the same rank. That means the slob has had to overcome people using the heuristic you've just described in order to reach the same rank, probably through being an objectively better surgeon.
walshemj 10y ago
And a surgeon needs to inspire confidence on both his patients and team

DelaneyM 10y ago

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. :)

V-2 10y ago
Also within the job itself, overengineering (a typical vice of intermediate level coders) is the root of, well, much evil. A programmer myself, I couldn't help but thinking about mammoth frameworks and architecture fads as I read the article
edblarney 10y ago
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 10y ago
  No bankers, but we do have a rather dapper gentleman pushing (over?) sixty. One of my strongest leads.

deleted 10y ago

[deleted]

in_cahoots 10y ago

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 10y ago
> 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 10y ago
  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?

nolemurs 10y ago

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.

jstewartmobile 10y ago
I don't know... usually when Taleb's being boorish to the point of putting the book down, he'll lay down a "Black Swan" of insight that makes it all worthwhile.
- nolemurs 10y ago
  You know, I read through the whole article. I even agreed with pretty much all of it. I didn't run into anything I found particularly insightful. Actually, I kind of feel like the reasoning in this article can be profitably applied to Taleb's own image management.
  - sjg007 10y ago
    I mean this is the contrarian mindset which if we believe in startup land is how you find success. Models for success: find some niche and grow it (kind of a contradiction); develop some new technology; or X is broken; copy X from market A and paste in market B (where X is not).
  - bbctol 10y ago
    In a weird way, that's sort of the reason to read Taleb. It's about 90% posturing and sophist bullshit and 10% legitimate insight, but at least the insight is "90% of the time intellectuals are just posturing and spouting sophist bullshit." Maybe he's making some meta-demonstration, though more likely he's just really self-unaware, but I've still found it worth reading enough until you realize why you can discount most of it.
savanaly 10y ago
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.

lisper 10y ago

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.

deleted 10y ago
[deleted]
BorgHunter 10y ago
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 10y ago
  Thanks for the pointer, but the passages in this piece still make no sense even in that context.
  - ABCLAW 10y ago
    Taleb is saying that the surgeon being a surgeon itself is the measure of his quality in the same manner that Lindy prescribes that age is a marker for stability. The fact that he continues to be a surgeon provides you with information about his fitness as a surgeon. In the face of poor appearance, his existence as a surgeon provides you information about his quality.
  - leroy_masochist 10y ago
    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.

slg 10y ago

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.

sverige 10y ago

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.

SamBam 10y ago

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..."

chubot 10y ago

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.

JohnJamesRambo 10y ago

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

losteverything 10y ago

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 10y ago

edit: lmao

leroy_masochist 10y ago
Taleb wrote the article
jstewartmobile 10y ago
This guy is Nassim Taleb.

soneca 10y ago

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

chickenbane 10y ago

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.

deleted 10y ago
[deleted]
mtdewcmu 10y ago
>> 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. Essentially, a sociopath. I think this sheds some light on the paradox of Ben Carson.
ISL 10y ago
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.

aspinei 10y ago

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.

Illniyar 10y ago

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.

matt_morgan 10y ago

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.

stephencanon 10y ago

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.

fuzzfactor 10y ago

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.