My daughter’s Godmother is studying to be an MD, and has started her internship. Starting her internship coincided with her birthday, which meant that many of the presents she received were related to medicine. One of the gifts, which she gracefully allowed me to borrow before she read it was How Doctors Think, by Jerome Groopman, MD.

Groopman’s book covers one subject which I love: heuristics and bias. Heuristics are the stuff the practice of medicine is made of, which makes it a little strange that this isn’t always taught. The influence of the intuitive, fast, effortless System 1 thinking versus the slower, conscious, System 2 thinking is reasonably well known. System 1 allows us to unconsciously come to conclusions based on the information at hand, as Groopman says: “When you hear hoofbeats, think horses, not zebras.” The practice of medicine is such that most of the diseases encountered fit into a nice pattern, however it is also a burden which make cognitive bias possible. When a doctor sees nine patients who are suffering from flue symptoms, System 1 will quickly come to the conclusion that the diagnoses of the tenth patient with these symptoms is also flue, and will even ignore facts to the contrary.

If it looks like a duck, it walks like a duck, and it quacks like a duck, guess what? It’s a duck.

Taking the example of the series House you see that certain doctors who make suggestions during the differential diagnoses are prone to prefer a particular diagnoses, whether it is an auto immune disease, cancer, or psychological. The conscious mind (System 2) having found no fault in the choice that System 1 has made will defend the choice. As Groopman says in his book: “The doctor becomes increasingly convinced of the truth of his misjudgment, developing a psychological commitment to it. He becomes wedded to his distorted conclusion.”

When I realized that most of the occurrences of disease are evaluated based on bayesian inference of disease, and much like the Quants and their use of statistical arbitrage there are aberrations which can cause diagnostics to fail. While brushing up on the fundamentals of Bayesian probability I rediscovered the nitty-gritty of Markov chains, something in which I once had more than a passing interest. And came to the realization that to fundamentally diagnose a specific disease the sample rate, and thus the expensive tests, for specific markers should go up. Whether the first test confirms or denies a hypothesis System 1 takes this first as given, any further answer is seen as a deviation from the first “true” answer. Ockham’s razor doesn’t hold when the premise is reached based on incorrect data. Groopman calls this search satisfaction – you expected to find something found something so you stop searching rather than finishing your search.

When you hear hoofbeats, think horses, not zebras.

This means that in a simulation the sample rate may cause the diagnoses to become more accurate, additional samples with aberrant results in reality may not cause as large a shift in the accuracy of the diagnoses. And naturally the speed at which a result of a laboratory test is returned means that in worst cases the patient is dead before the result is known, which means that the only diagnostic tool which can be relied on is suffers from flaws.

Current medicine seems to be held back by the limitations of man, and although this can be improved upon the basic limitation of human beings means that even with the knowledge that humans are fallible, it is impossible to take the human out of the current equation therefore there is a three stop solution:

• communication
• critical reasoning
• compassion

Consider that there are ofter many unknowns with disease with the knowledge of the pitfalls apply critical reasoning to what you’re thinking. Communicate correctly with you doctor or patient, get it clear what the issue is, what the possible solutions could be. And show compassion, both doctor and patient rely on each other.

Image source:

I needed a way to be able to shamelessly plug the posts I recently bundled into the booklet “Write Something“. I want to build a list, and offering something which adds value for the subscriber is a good way to do this. There is a host of good material which you can use to help, so I won’t elaborate on that in this post.

I have a hosted WordPress.com blog, which means that I can’t run a local script to collect the mail addresses and mail them, so I turned to Google Docs’ Form functionality for the entry form, naturally I give them the option to download the booklet there, and I wanted to send the subscriber a message to thank them. In the Google tutorial: Simple Mail Merge they explain how to do a mail merge using the Script Editor. I wanted to go a little further and have it send a mail with thank you note and a link to each subscriber as soon as they filled in the form.

Using the tutorial and Script Editor, which uses javascript, I had a starting point. I wanted three changes:

1. send only the last mail address mail
2. customizable subject line
3. trigger mail

The first two changes where easily done by changing the example script. Rather than cycling through the spreadsheet with a for-loop I requested the last rowData. And I would be using A1 for the subject and A2 for the mail body, instead of using A1 for the body and having a hard code subject line.

function sendEmails() {
   var ss = SpreadsheetApp.getActiveSpreadsheet();
   var dataSheet = ss.getSheets()[0];
   var dataRange = dataSheet.getRange(2, 1, dataSheet.getMaxRows() - 1, 4);

   var templateSheet = ss.getSheets()[1];
   var emailTemplate = templateSheet.getRange("A2").getValue();

   objects = getRowsData(dataSheet, dataRange);

   var rowData = objects[objects.length-1];

   var emailSubject = templateSheet.getRange("A1").getValue();

   MailApp.sendEmail(rowData.mailAddress, emailSubject, emailTemplate);
}


For the last requirement I needed to use the Triggers functionality, which can be found in the menu. Select Current project’s triggers… and add a new trigger which should be run On form submit.

Image source: Search Engine People

I have a confession, I am a former software vendor, I’ve worked for software vendors as a consultant, and I’ve been guilt of delivering a solution which didn’t work as advertised. This is sadly an all too common occurrence which can be due to many things which I will not be discussing here. Here I will identify some of the common pitfalls that all vendors face, and what can be done to reduce and mitigate the risks these pose.

There are a number of pitfalls that a vendor can fall into when addressing the issue or the customer, Groopman calls^[1] these the 3 A’s:

• anchoring
• availability
• attribution

The Pitfalls

Your first instinctive reaction when being presented with an issue can be a compelling elegant simple solution and can often be right. And sometimes the solutions are completely wrong, and you can become increasingly convinced of the truth of this misjudgment, and developing a psychological commitment to it. You can become wedded to a distorted conclusion. This is anchoring, your opinion is like an anchor weighing you down. Also referred to as paradigm paralysis: the inability or refusal to see beyond the current models of thinking.

Errors of availability are also common to make, every other customer has this issue which you solve in a certain way and you simply apply Ockham’s razor to this customer. It is the simplest solution, they must also have this issue. This can mean that you ignore certain signals that don’t fit in your diagnosis, perhaps it is a simple issue and perhaps it’s a case of search satisfaction: you expected to find something, find something and stop searching rather than finishing your search.

Attribution can be as simple as believing that the customer is a complainer, and so it’s not as bad as they are saying. The argument that: “it’s a not a bug, it’s a feature” is also an attribution error.

The Solution

There are 3 easy solutions to resolve these pitfalls, these are the 3 Cs:

• communication
• critical reasoning
• compassion

Consider that there are ofter many unknowns with issues, so with the knowledge of the pitfalls apply critical reasoning to what you’re thinking. Communicate correctly with you customer, get it clear what the issue is, what the possible solutions will be, and if appropriate what the price is. And show compassion, they most probably rely on you and your software to get their job done. Which means that when it fails they can’t do their jobs.

1. How Doctors Think – Jerome Groopman, MD

Image source: Sebastian Fritzon

Recently there was some discussion on Klout, their influence calculation is unclear. Many people were unhappy with the fact that their Klout Score is a moving target. People who actually use the numbers generated by Klout to find the influencers they want to contact also have the issue that they don’t see what the results are of their contacts.

There are other options like Kred.ly or PeerIndex although they have not yet got the klout of Klout.

Kred.ly is an interesting option as the scoring is extremely transparent, with this transparency the system could be gamed. This would need collusion on quite a large scale.

PeerIndex is less transparent, although it gives more statistics and information on the date it uses to calculate authority and score. Roughly your PeerIndex is an average of your Authority + Activity + Audience. Unlike Kred.ly it doesn’t give numbers on individual social actions, although it does give more direct feedback it can’t be used to directly game the system.

What all of them suffer from is that they see authority stemming from one account, and neglect to see that power users – who use different channels to curate content for different audiences – may have their klout spread thinly over places that aren’t included like multiple Twitter, Google+ or FaceBook pages.

Image source: me

Last night’s Cinch about:

• HandPick.me
• TwitSprout
• Google Analytics
• Blogging
• WunderKit
• Social Media Job Trends
• and more…

Source: me

Image source: Cinch

Chris Brogan isn’t reinventing himself, and his project for 2012 Shhh! The Secret Show is certainly not a podcast.

So what is he doing?

There is not a new video show started by someone pretending to be me.

The thing is, podcasting isn’t exactly dead- it’s different than we all planned.
–Chris Brogan

His goal for this year seems to be learning a new skill, and sharing more. Everything from the interviews, mailbag and video promos is all raw and certainly not quality videography. He is starting with quality content, and taking the steps to reach – what I am assuming is his goal – a not so secret podcast.

Similar to my goal of the year, create a short not so secret podcast on the things which piqued my interest that week. For me doing what I want currently consists of:

1. Begin
2. Read
3. Record
4. Publish
5. Learn
6. Repeat

The next steps will include improving, more research and better audio.

Forget New Year’s resolutions! What are your goals? What steps will you take?

• Podcasting Isn’t Exactly Dead
• Get Smart About Podcasting

Image source: Chris Brogan

In 2008, and again early 2011, I wrote articles about the Social Networking Job Trends, again I checked the graph I’d included, continued to be updating and had shot over 1% of all the job postings on Indeed.com in December 2011. Perhaps these employers and sourcers should be reading Why I Will Never, Ever Hire A “Social Media Expert”:

Social media is just another facet of marketing and customer service.
Say it with me.

What else could this mean?

It’s obvious to me that this graph shows that Social Media as a term is winning ground over web2.0, which is lost from the mid 2011 high of 0.35%.

technorati tags: social, networking, jobs, business, work

Image source: zerojay, indeed

Some time after 530 and 510 BC after Pythagoras woven to Italy and had gathered his students he would established a strict routine for his students, being Pythagoras he paid particular attention to the hours they woke and slept. On rising his students were advised to repeat the following verses:

As soon as you awake, in order lay the actions to be done the coming day.

At nightfall they were told to recite:

Allow not sleep to close your eyes

Before reflecting on the following questions three times:

The actions of the day.
What deeds done well?
What not?
What left undone?

Source: The Golden Ratio: The Story of PHI – Mario Livio

Image source: zerojay

Last night’s Cinch about:

• MyPermissions.org
• kred.ly (me)
• CloudFlare and Google Analytics for WordPress.com

Source: me

Image source: Cinch

You can set up you DNS to point to cloudflare, although it’s far more powerful you can view this functionality as a High Availability proxy. Cloudflare then accepts the connections for http and requests the requested page from wordpress.com. This file is manipulated to inject the GA script into the site. There is NO need to perform any modifications on wordpress.com.

As it says in the blog:

Since CloudFlare is optimizing and delivering your site’s content to your visitors, it inserts the Google Analytics JavaScript tracking code in the proper place as your site’s visitors pass through our network. Your site now benefits from both WordPress.com site analytics and Google Analytics.

Source: Enabling Google Analytics on Your WordPress.com Blog

Image source: CloudFlare

I was playing with adding the Google +1 button to my blog and added the icon you see below this blog, then I realized by adding the following HTML block in the sidebar I can add a page button.

FYI

Image source: Google

Everybody tells you not to reinvent the wheel, and I am going to explain why everybody is wrong and you should start re-inventing. Programming paradigms and design patterns are the staple of all new programmers, and they enable everybody to communicate in a common language which can be easily understood when their rules are strictly adhered to. The issue is that beginner developers have cursory knowledge, expertise and familiarity with the design patterns they are required to implement.

A recent practical example a group of relatively inexperienced programmers with the Model-View-Controller paradigm found that the controller they were using didn’t make their life easier, so in some specific cases they deviated from this and implemented their own heuristics. This caused the underlying database to get more SQL queries that even Facebook reports it gets. At the point the website ground to a halt a simple investigation revealed that they bypassed the controller and model to access the database. Common heuristics would usually point to scaling vertically or horizontally.

If it looks like a duck, it walks like a duck, and it quacks like a duck, guess what? It’s a duck.

A Duck?

It is not always a duck. Current thinking is that common things are common, and common problems have common solutions. This isn’t always the case, Henry Ford summed it up best: “If I had asked people what they wanted,” he said, “they would have said a faster horse.” By living in the constraints of their knowledge when people hear hoofbeats, they think horses, not zebras. And “[w]hen faced with a result that doesn’t go according to plan, a series of perfectly effective short-term tactics are used until the desired outcome is achieved.”^[2] Some developers believe that once this hurdle has been taken all will be well, I can tell you the light at the end of the tunnel is an oncoming train.^[4]

When you are in a hole, stop digging! That is exactly how we got into the mess in the first place.

How do you stop digging?

You have become increasingly convinced of the truth of your misjudgment, developing a psychological commitment to it. You have become wedded to this distorted conclusion.^[1] Realizing this is your first victory. “In the material world, the unknown is a place of uncertainty and potential risk … [b]ut we make a mistake when we attribute the same qualities to the world of our thinking.”^[3] The second victory is having the courage to throw out everything you have done up to now, baby and bathwater.

“There is a wonderful story of a group of American car executives who went to Japan to see a Japanese assembly line. At the end of the line, the doors were put on the hinges, the same as in America. But something was missing. In the United States, a line worker would take a rubber mallet and tap the edges of the door to ensure that it fit perfectly. In Japan, that job didn’t seem to exist. Confused, the American auto executives asked at what point they made sure the door fit perfectly. Their Japanese guide looked at them and smiled sheepishly. “We make sure it fits when we design it.” In the Japanese auto plant, they didn’t examine the problem and accumulate data to figure out the best solution—they engineered the outcome they wanted from the beginning. If they didn’t achieve their desired outcome, they understood it was because of a decision they made at the start of the process.”^[2]

Clean Slate

Starting with a clean slate learn to question everything you know and are told, especially what I tell you. Learned heuristics can be good, but they are only as good as your teacher. You own experience is key to be able to implement anything. Having a prototype or an example can help you, and a prototype is only as good as the developer who wrote it. Don’t be afraid to start over rather than refactoring, there is little to lose and everything to gain by ignoring the old paradigm: “If it ain’t broke, don’t fix it.“

1. How Doctors Think – Jerome Groopman, MD
2. Start with Why – Simon Sinek
3. Effortless Evolution – Jamie Smart
4. Wall Street proverb

Image source: Sebastian Fritzon

Last year I was so happy to see this instant feedback for the toilets at Schiphol I thought about the ways in which I give instant feedback for a job done. I send the occasional Thank You card, and on occasion hand deliver them to the person in question. This is not instant. How can I give somebody instant feedback?

In a food service establishment, such as a café or restaurant it is customary to leave a tip, for shops this is not as customary and it still only allows the employee to see the appreciation for the service performed. Location based recommendations with a geolocation service, such as foursquare, is ideal although this is unlike a tip that it only promotes the establishment and there is no feedback loop within the establishment. Service cards or books, a mainstay of hotels and small catering services also don’t entirely cover it. And naturally this example has price as the prohibiting factor.

How would you get instant on- and offline?

Image source: me

Signals come from everywhere, they are tell us something about our environment. Whether it’s hot or cold, wet or dry, and painful or pleasant. These signals are rarely binary, there are gradients in the signals. And we have signals with which we aren’t dealing at that moment, which we’ll call noise in that instance. Feedback is also a signal, perhaps it causes a painful sensation or it causes a pleasant sensation. Whatever the sensation it causes that sensation too is another signal which we can choose to regard as noise.

In Test Driven Development we give a higher priority to creating controls which alert us with signals we consider negative, such as a unit test failing or a build failing, and race to improve this. Yet in our personal contacts we tend to give a higher priority to positive signals, and disregard or become angry about negative signals such as feedback. These are the signals we can use to improve ourselves, and in my experience there are few controls which alert us to this signal, it can be difficult to recognize them as information rather than as criticism. Jerome Groopman M.D. states that a doctor – like everybody else – can become “increasingly convinced of the truth of his misjudgment, developing a psychological commitment to it. He becomes wedded to his distorted conclusion.”^[1] Once the signal becomes corrupted it is difficult to interpret, and “[a] signal is only as good as your interpretation of it.”^[3]

1. Misinterpretation of valid signals can lead to extreme difficulties.
2. All it takes to solve a misinterpretation problem is insightful understanding.

In SCRUM and XP we use our Daily Stand Up, Paired Programming/Negotiation and Retrospective to help improve the functioning of the team, and as a free and open space to give feedback for the benefit of the team and team members. This creates feedback loops in which the results of the feedback become controls which can be used to verify the resulting actions. In our personal contacts there is not as much space for these feedback loops to be created, there is no daily SCRUM or pair situation, and there is certainly no retrospective.

“When faced with a result that doesn’t go according to plan, a series of perfectly effective short-term tactics are used until the desired outcome is achieved.”^[2] In development we sometimes choose to go for short term wins, this work well with inert systems which do not have many links in the process chain. For larger systems we usually ask ourselves: “[H]ow structurally sound are those solutions?”^[2] This is where heuristics can made life much easier, little shortcuts which can enable a developer to develop code more effectively, efficiently and reliably. Similar heuristics can be used in the personal context.

Groopman gives a good example: “During my training, I met a cardiologist who had a deserved reputation as one of the best in his field, not only a storehouse of knowledge but also a clinician with excellent judgment. He kept a log of all the mistakes he knew he had made over the decades, and at times revisited this compendium when trying to figure out a particularly difficult case. He was characterized by many of his colleagues as eccentric, an obsessive oddball. Only later did I realize his implicit message to us was to admit our mistakes to ourselves, then analyze them, and keep them accessible at all times if we wanted to be stellar clinicians.”^[1]

Unlike Groopman’s cardiologist I believe that achievements should be registered with failures, both are signals and information. Thomas Edison said: “I didn’t find a way to make a light bulb, I found a thousand ways how not to make one.” He documented the ways that didn’t work, just like the ways that did work. Edison rightly remarks that both need to be known. In the past peer review journals contained the failures, it was considered important to know what not to do, now they seem mostly to contain the successes. There is a reason that George Santayana quote: “Progress, far from consisting in change, depends on retentiveness. When change is absolute there remains no being to improve and no direction is set for possible improvement: and when experience is not retained, as among savages, infancy is perpetual. Those who cannot remember the past are condemned to repeat it.” is drilled into the minds of children when learning history, one can learn from one’s mistakes and successes only by registering them. These patterns can then be turned into you own shortcuts for life.

This can be the end, as it answers the question of recognizing signals. The issue is that it merely the answer to how to recognize the signals. What Sinek and Groopman call the WHAT and HOW, or Smart calls “The content of thought” and “The structure of thought.” It doesn’t address the WHY or “The nature of thought.” There are heuristics that don’t sit right, like having a 4GB memory footprint, or robbing a Peter to pay Paul as a shortcut to wealth. How structurally sound are those heuristics?

1. How Doctors Think – Jerome Groopman, MD
2. Start with Why – Simon Sinek
3. Effortless Evolution – Jamie Smart

Image source: Sebastian Fritzon

I was advised to read Simon Sinek’s book Start with Why by a social media guru who practically abandoned his – albeit limited to the Netherlands – stardom to pursue a position in a turning round a company who’s why was determined by governmental decree, and as such was fuzzy for customers and company. And I came to it with many preconceptions of cones and funnels, expecting it to be a Gladwellian book with limited practical application beyond creating awareness – which in some circles is already a Herculean task.

Sinek started by blowing my Anglo-American expectations out of the water by posing a question on the first page of the book. It acts as the first warning in the book to not take things at face value – the What and How – and go straight for the jugular: Inspiring with Why you are doing what you are doing. The nature of the thought is that our experience of the world is created “from the inside-out”^[1], understanding that the Golden Circle has Why at the centre and the How and What are just the physical manifestations of Why we do things.

As examples he uses Bill Gates, Steve Jobs, Martin Luther King, the Wright brothers and a host of others for whom we already know What they did and shows us How they did it by being inspired with a reason – their Why. The stories he tells and the way he tells them influenced me and my story, and my answer to Why.

What’s you Why?

1. Effortless Evolution – Jamie Smart

Image source: Amazon