As I compare best practice software development to best practice project management…I can’t help but think that many of the scrum approaches would be well suited to business product development in a way that Gantt charts and Microsoft Project never really seem able to pull off in the real world.

Anyone use scrum outside of software?

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John Wooden: a consummate teacher and wonderful human being.  Thank you Coach for reminding us that true success is about each of us achieving our potential, and that our life’s path is enjoying the journey paced by the cornerstones of industriousness and enthusiasm.

Wooden's Pyramid of Success

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This is post 3 in a series highlighting my journey from physician to consultant to entrepreneur

I write this in a period of reflection — when I try to figure out what’s next for me as I reflect on my career to date.  My calling is the fixing of our broken health system.  However, as but one individual, how to do so in a way that allows me to build something of immediate value while taking care of my family is a complex challenge.  My goal is writing this is to help highlight my somewhat strange career path, as I’ve been contacted by a number of physicians at all stages of their careers.

While applying for medical school, my goal was to be a preventive medicine pediatrician: I wanted to keep kids healthy and make sure they never got sick.  This perspective, even in interviews for medical school, got me in trouble…great doctors were supposed to be tremendous diagnosticians with ability to memorize vast facts and prescription/ procedure options.  I never really understood why…for me the challenge was in understanding how to change basic behaviors early…so the bread and butter things that impacted the majority of people either occurred later or never.  I questioned the impact of the things we spent 80% of our time on…and needless to say it didn’t make me popular in an environment where people were conditioned to jump through professional hoop after professional hoop.

It all crystallized for me in a few places:

1. I had a pediatric orthopedic surgery rotation with a bunch of “SCFE” kids.  SCFE stands for Slipped Capital Femoral Epiphysis.  Basically, these kids were so fat (and they were a bit more than “husky”, that their growth plates attaching the ball (in socket) part of the hip bone with the leg part of the hip bones cracked…and needed to be pinned to keep the kid’s leg in place.  What I saw was extraordinary technology to get the leg pinned and some followup with rehab.  What I didn’t see was any effort to get the kid’s weight under control (it is horrifying to see that a 12 year old is on the verge of type II diabetes)…although they did note they would put them on insulin if they tipped into diabetes.  I was pretty disgusted with how doctors were trained to view the world.
2. I had a 5 yr old 110 pound girl (and no, that’s not a typo) on an ENT rotation in for a tonsillectomy to clear airway so she could breathe.  The ENT was executed beautifully.  The child’s health?  That was someone else’s concern…surgeons must move on to their next case once a patient comes off the table.  When I bothered to try and figure out in my busted Spanish what was going on, it all made sense.  The child was 110 pounds and had no teeth because her parents thought soda was better for her than water.  This was the moment I decided I didn’t want to practice in a system that defines success in a way where the patient may not have survived.
3. I came across the book “Demanding Medical Excellence” by Michael Millensen.  This was my first concrete exposure to the inanity of a health system where better results (on a cost-plus basis) often equate to a bankrupt organization.  The need to change business models in health to reward EFFECTIVENESS vs. EXPENSIVE ACTION dawned and me…and has become the cause to which I’ve dedicated my career.

Late in my 3rd year, I decided not to apply to residency.  It came with much heartache and second-guessing at the time, but while doors closed others have opened that have led to a passionate-filled and interesting start to my career…

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HTC Incredible now shipping 5/21

Update: Verizon cancelled my order via email and now I’m in the queue until early June.  Had anyone done less to try to keep the customer happy than the big wireless providers?

_________________

Just ordered my HTC Incredible from Verizon Wireless.  Been blown away by the great reviews and a quick trial in the Verizon store (alas, I played with the demo version a few minutes too long…the last one in the store was sold to the person in front of me in line…argh!)

Now, unfortunately, the stores still don’t seem to be getting any and the online version won’t be available until 5/21.  I had been hoping to sneak into a batch going to the stores ahead of the old 5/14 ship date.  Apparently this has backfired.  Decided to bite the bullet and just order online…I’ve had my blackberry since late 2006, so nothing’s really going to change that much in the next couple weeks.

Looking forward to finally being able to take pictures and access the internet off my phone!

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This is post 2 in a series highlighting my journey from physician to consultant to entrepreneur

I write this in a period of reflection — when I try to figure out what’s next for me as I reflect on my career to date.  My calling is the fixing of our broken health system.  However, as but one individual, how to do so in a way that allows me to build something of immediate value while taking care of my family is a complex challenge.  My goal is writing this is to help highlight my somewhat strange career path, as I’ve been contacted by a number of physicians at all stages of their careers.

Having been admitted to medical school, I now was immersed deep into the more academic curriculum of the first two years.  I have to admit I was tremendously disappointed.

Don’t get me wrong, I loved the clinical piece of medicine.  Interacting with patients (even in our limited pre-clinical years) was an amazing process.  Donning the white coat opened up a whole new world of access into the deepest, most intimate details of a person’s life.  The tradeoff was the dimming of your own empathetic humanity…the role required that those deep details be used to drive medical diagnoses and services and a filter of “doctor” screen all normal human impulses and reactions.  This perspective would truly change my life and enforce the importance of time in generating enough of a rapport and relationship to really be able to help someone.

The academic/ science side was a different story.  What I thought would be an experience that built upon the dynamic understanding of physiology combined with how to achieve great results in real patients in the health system…instead was a flood of didactic memorization based on the deep (and largely irrelevant) details of our professors’ research.  There seemed to be a great focus on breadth in detail…providing a slurry of facts and figures without the focus on building a high-level framework that would serve as our foundation in medicine.  In an era where most of these details were available on my palm pilot, when they were relevant to anything I was doing, I found incredibly frustrating and largely a waste of time.  Where I wanted discussion and debate, I found a premium placed on memorizing what my elders told me…and substantial challenges at the points where I thought that the literature pointed to plausible alternatives to what I heard in class (e.g., my early suspicions that “mature” tissues like nerves and muscles could regenerate based on satellite cells and latent stem cells).  My love for science and probing mind had become a liability in the two year sprint through the basic sciences…and how I was frustrated by the intellectual challenges of science turning into brute memorization of things I didn’t quite believe.

What had happened was that the explosion of science had translated into a desire to cover all of life sciences, rather than to focus on the skills and evaluation frameworks that would ensure that we were lifelong scholars we could evaluate all of that research relevant to our patients.  As a happenstance of fate, our class of supposedly 150 at USC School of Medicine had somehow accepted our admits in a way well outside the bell curve.  We ended up with 180+ in our class, 2/3 men.  This meant that our lectures had to be videotaped and broadcast into a satellite room.  This provided me the opportunity to study instead of waste my time in class, read the textbooks and literature and go deep in areas of interest, while still being able to review lectures that I wanted to play back.  I became a virtual student…and memorized enough of what I was told to pass my pass/fail first couple of years.

What did I do with that extra time?  I focused on a few things…I spent a fair bit of time volunteering in the emergency room and I pursued a deeper understanding of how health care worked…not the scientific part but the people part.  This would be the element that would change my life and move me away from my initial calling in prevention-oriented pediatrics…but that will come in the next installment…

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The last few weeks, I’ve been sitting a lot…and finding that I really miss moving around more, but that its hard to do in a smaller office.

This brings me back to earlier dreams of a “treadmill desk” or even an “adjustable height desk”…something so I’m able to change positions and get the blood flowing a bit more.  My focus is as much on channeling unproductive energy (currently expressed as moving around to get a snack or drink) and turning it into energy that moves my work along…as it is also burning the calories so I can lose some weight.

Current hypothesis is that a treadmill desk would help me take off at least 10 pounds over a 3 month period.

Its very hard to buy right now…but there are a few options available.  Here’s what I’m looking for:

• Adjustable height desk: looking hard at TreadDesk and the Geekdesk Mini .  I’ve ruled out hospital bed tables, as they seem a little flimsy and still considering either a bookcase shell or a drafting table as cheaper alternatives
• Treadmill: Here I’m really not sure if I should get a standard treadmill and take off the arms or if I should go with a more dedicated model.  Given my smaller desk constraint (my space is <50 inches wide) I either need a treadmill I can easily move or something I can put a chair/ stool on top of.

I’ll post a followup with what I’ve decided on and how the experience goes.

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Chef Jose Andres is a chef who loves to play with his food. It was great to watch his passion combining food and science into the molecular gastronomy movement.

One quote I pulled away from this was something similar to Jaime Oliver…chefs take care of maybe 1-3% of food that people eat. To really make a difference, we need to figure out how to help make the other 97% of meals both nutritious and delicious.

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This is post 1 in a series highlighting my journey from physician to consultant to entrepreneur

I write this in a period of reflection — when I try to figure out what’s next for me as I reflect on my career to date.  My calling is the fixing of our broken health system.  However, as but one individual, how to do so in a way that allows me to build something of immediate value while taking care of my family is a complex challenge.  My goal is writing this is to help highlight my somewhat strange career path, as I’ve been contacted by a number of physicians at all stages of their careers. My professional journey started with the choice of physiological sciences as my undergraduate major at UCLA.  Physiology taught me a number of things — most importantly the concept of homeostasis

:

Homeostasis (from Greek: ὅμοιος, homoios, “similar”; and ἵστημι, histēmi, “standing still”; defined by Claude Bernard and later by Walter Bradford Cannon in 1929 + 1932^[1]) is the property of a system, either open or closed, that regulates its internal environment and tends to maintain a stable, constant condition. Typically used to refer to a living organism, the concept came from that of milieu interieur that was created by Claude Bernard and published in 1865. Multiple dynamic equilibrium adjustment and regulation mechanisms make homeostasis possible.

Physiology activated a dynamic understanding of life in my engineer-oriented brain.  Where other fields point toward magic bullets: specific molecular targets, solve-all frameworks, etc; my training and orientation focused on how complex pathways interacted in a dance…and that all of the players needed to be aligned in what they were trying to accomplish to achieve change without triggering massive unintended consequences.  This education helped me understand that if there are multiple moving parts trying to keep things within ranges, then magic bullets were unlikely to work…you need to make sure solutions took into account how the rest of the players in your system would react to changes made.

Little did I know that this would be an amazingly helpful perspective as I looked at getting things done in the business world. UCLA was an amazing education for me.  As a member of the honors collegium, I learned to spend time with my professors and get the messy view of science that never really seemed to emerge in the classroom or from textbooks.  What I learned about science was:

• It’s an ongoing debate. You have to understand both the favored explanations and leading alternatives to really understand what your options might be
• It’s driven by consensus and politics.  When your grant funding is determined by peer review, you’re less likely to be asking for money for things that challenge the beliefs of your peers.  Hence scientific research is more often incremental than disruptive due to our current grant processes
• Just because its published doesn’t mean its right.  Things written in textbooks often don’t make sense due to internal contradictions.  Understanding to spot inconsistencies in theories is where you’ll really understand what’s going on and where new opportunities exist.  In addition, many things reported in the literature contain errors that no one ever bothers to check…but then are cited across the literature because the headline sounds nice.
• Statistical significance is not the same as real-world significance. Massive numbers of papers are published from data passing the statistical significance filter.  When you analyze the real world implications in terms of meaningful change for individuals or populations, its often underwhelming.
• Literature omits those things that went wrong. Nobody writes up papers detailing their failed experiments.  They repeat them or throw them away.  Therefore anything written up will have a bias toward displaying positive results that may not exist in a more objective environment

Making a commitment to write again, on 3 ongoing topics:
1) Innovation: I’m writing a book called “Innovation in the Crowd” and ask for your help in clarifying the thinking as I write it
2) Small business: My wife and I have opened a bakery and wine bar in Santa Monica, Bite Bar & Bakery, and I’ll share my experiences in the food industry. If you’re in the area, we hope you’ll come by and say hello!
3) Health care: I’m involved in a mix of consulting and building my healthcare startup to improve consumer’s feeling of Health Assurance through informed decision-making. Look forward to discussing the topics that emerge.