Surgeons Should Not Look Like Surgeons

https://medium.com/incerto/surgeons-should-notlook-like-surgeons-23b0e2cf6d52#.8v2rgscza

89 78 9 years 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.

saxonklaxon2• 9 years 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• 9 years ago

Creative people apply creativity to all aspects of their life. I don't see it as a resource which must be rationed

Retric• 9 years 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.

nickthemagicman2• 9 years 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.

nolemurs4• 9 years 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• 9 years 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.

Robotbeat• 9 years 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• 9 years ago

And a surgeon needs to inspire confidence on both his patients and team

DelaneyM2• 9 years 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• 9 years 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

edblarney3• 9 years 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?

DelaneyM2• 9 years ago

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

in_cahoots2• 9 years 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.

travisjungroth3• 9 years 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_cahoots2• 9 years 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?

cjf1012• 9 years ago

While there may be overvaluation of appearance/social ability, it's likely exaggerated in this particular example.

Appearance and social ability in surgical teams are important because surgeons are also leaders and caregivers. These attributes will matter to the members of their team and their patients. Team members who believe in their leadership tend to be more effective. Patients who believe in their care have better recovery rates.

If you did find such an example, it would be worth finding out what they are doing in other areas to compensate for the lack of this attribute.

Kluny• 9 years ago

Success rates are themselves a flawed metric. Doctors who take on more difficult cases will have lower success rates, but their experience will be more valuable.

muninn_• 9 years ago

Well of course. You're giving us two identical (for this purpose) people and then saying one has something more desirable. Naturally, all else being equal, that person has a slight edge.

uremog• 9 years ago

The one with the bad image will have to be better at his job (95% success rate) to get hired as often.

Or he could fast talk his way into preference, or get a drinking buddy to hire him, or countless other ways that don't involve being better at his job.

libertymcateer• 9 years ago

When you have a highly overvalued attribute, that attribute becomes an indicator of overvaluation.

That is a hell of a leap. It is actually a strict logical fallacy, called affirming the consequent. https://en.wikipedia.org/wiki/Affirming_the_consequent

In other words this is a huge gap in your reasoning, it is claim - not a conclusion - that you are making and it is one that requires evidence. To put it another way: your argument is wholly conclusory and the only way to settle this argument is with evidence. It cannot be derived from first principle. There may be some instances where surface-level indicia (I can tell about the quality of a fabric pretty quickly, and it is typically indicative of good tailoring) are strongly correlated with quality and others where there is a low (a fresh paint job on a house) or even a potenitally inverse correlation (REALLY NICE ads for attorneys - located on bus stops).

But your blanket statement is just unsupported. I am not saying it is false - I am saying it is unsupported and you are jumping to a huge conclusion that does not follow logically, nor can it be proved to follow on the basis of logic alone.

golergka• 9 years ago

The vast majority of time we don't have all the information for making decisions. That's exactly why we use heuristics that are relying on some things being more or less statistically probable.

smallnamespace2• 9 years ago

I think the main problem with the article is that it's conclusions are covered by signalling theory [1][2] but the author seems blissfully unaware that this field exists.

A signal of quality is likely to be reliable if it's inherently expensive to produce and is correlated to the desired metric. A big peacock tail is a reliable indicator of the peacock's health, because to falsely grow a bigger tail than it should support would end up being detrimental for the peacock. Same with lion manes, college degrees, etc.

The author points out that there are metrics and signals that can be overvalued, and that's true, but the hospital example is a terrible one because fellow physicians have access to the true quality of a doctor. A surgeon with a good degree, expensive watch, and nice clothing will not fool his or her fellow doctors because they actually see how they operate in the theatre. If a doctor X tells me that surgeon Y is good (and I trust doctor X), then that's sufficient evidence because doctor X almost certainly knows better than me, and I can entirely skip the process of evaluating surgeon Y's sartorial choices myself.

Where the author's point makes more sense is addressing pop-culture indications of quality, which are more likely to be incorrect because the general public (or the media industry specifically) is not an expert in any given field.

You probably shouldn't hire an engineer simply based on ideas of what hackers look and talk like gleaned from Mr. Robot, but I think most people already knew that?

[1] https://en.wikipedia.org/wiki/Signalling_(economics)

[2] https://en.wikipedia.org/wiki/Signalling_theory

ci5er• 9 years ago

He's talking about iterative/cumulative asymmetric choice markets.

And signaling.

That's all.

EDIT: I almost didn't read the article because of your comment. That would have been a mistake.

nolemurs4• 9 years 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.

jstewartmobile2• 9 years 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.

nolemurs4• 9 years 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.

savanaly• 9 years 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.

scott_s• 9 years ago

It's also a model supported only by anecdote.

eplanit• 9 years ago

I agree. It's almost self parody: what appears to be a thoughtful and thorough exploration of the topic is really just a long winded restatement of that wisdom.

That said, maybe people can reconsider buying that next pair of hipster glasses[1].

1. https://www.google.com/search?q=hipster+glasses&espv=2&biw=1...

lisper3• 9 years 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.

BorgHunter• 9 years 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

lisper3• 9 years ago

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

hamrickdavid• 9 years ago

I believe he is referring to the Lindy effect.

https://en.wikipedia.org/wiki/Lindy_effect

lisper3• 9 years ago

Thanks for the pointer, but the passages in this piece still make no sense even in that context. (If you want to reply, let's merge this thread with https://news.ycombinator.com/item?id=13725124)

sjg0072• 9 years ago

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

For green lumber the hidden details that determine price (as exploited by the successful trader) are only apparent after some time (that exists after the knowledgeable guy exited the market via bankruptcy). The argument that is that these hidden details are fundamental to determining price so likely indicate a power-law distribution of remaining utility (basically if you've been successful for 50 years you will continue to be successful for another 50).

So oddly he says that past performance determines future success (until it doesn't).

You see this develop posthumously (Elvis) and also during their life time (the Bill Murray effect). He's been in so many comedies and successful movies and now a meme that basically his estate may always be (unless it's not and then his influence will be at his half life and decays exponentially).

You still need regeneration but the brands can endure Mickey Mouse, Winnie the Poo.

slg• 9 years 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• 9 years 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• 9 years 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• 9 years 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• 9 years ago

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

losteverything• 9 years 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• 9 years ago

edit: lmao

leroy_masochist2• 9 years ago

Taleb wrote the article

jstewartmobile2• 9 years ago

This guy is Nassim Taleb.

soneca• 9 years ago

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

chickenbane• 9 years 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.

mtdewcmu• 9 years 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• 9 years 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.

smallnamespace2• 9 years ago

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.

bbctol2• 9 years ago

IIRC, surgeons show an incredibly high rate of psychopathy and low empathy, while general practitioners show the opposite. Cutting people open is one part of medicine where you'll be much better off if you see the body as a problem to be solved rather than a person in need of understanding.

emcq• 9 years ago

One key predictor to patient outcomes is the experience of a surgeon. There are tons of papers pointing to how long the learning curve for a technique is. This isn't rolling the dice.

I don't want an overly confident surgeon. I want a surgeon who has my health in the best interests. If that means refusing a surgery they deem too risky then so be it.

aspinei• 9 years 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• 9 years 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• 9 years 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• 9 years 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• 9 years 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.

Surgeons Should Not Look Like Surgeons

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