Category Archives: Philosophy

Delivery vs. Content: Lectures and Scalability

A couple weeks ago, I was browsing through Tim Ferriss’s blog and began reading about a novel start-up incubator called Y Combinator. One of the chief founders, Paul Graham, is a pretty interesting guy. In his life, he’s spent significant time working as a programmer, painter, investor and, most importantly for me, essayist.  He could also lay a decent claim to having invented a little thing called the “web app.” So, you know, a pretty bright guy.  

He publishes a lot of his writing on his website and one piece in particular, titled “Writing and Speaking” caught my attention. The essay itself is worth reading, but his argument can be summed up this way: 

1. Any presentation is allotted a finite amount of preparation time. 
2. That time is split between developing content and practicing delivery. 
3. Consequently, well-polished speakers often have presentations poor in content
4. Similarly, those with the best content are often unimpressive speakers.  
5. Therefore, don’t focus on being a great speaker. Content always wins.  

At a glance, the first premise seems weak. Preparation for important presentations tends to balloon a la Parkinson’s law. However, Graham’s underlying premise, I think, is that it shouldn’t. Unless you want to talk for a living, you give lectures to support your main line of work, whether its research, software, clinical practice, or whatever else. This even applies, I would argue, to teaching, where large group lectures are given in hopes of developing a smaller subset of interested students (i.e. majors, graduate students, research assistants, sub-interns, etc).  

My disagreement with Graham lies more in his conclusion and, principally, in the particular context for which he tries to leverage it. As a Platonist, I understand his implicit critique of rhetoric. Great speakers are, by and large, great convincers.  But for all their persuasive power, they rarely instill much knowledge.  The problem is that acquiring knowledge of any kind is work.  A lot of work. And before people are willing to invest substantial effort into something, they need to be convinced that it’s important. Think of the early political career of Willie Stark in All the King’s Men. Or the meteoric rise of Barack Obama’s political career.  Rhetoric is important because knowledge rarely emerges directly from ignorance. First, you need to arrive at true belief and that, unfortunately, is a product of persuasion. And persuasion rarely relies on content.

Now, if you’re lecturing principally to a graduate seminar, things are different. Those in attendance are already educated in your field and convinced that the subject is important. But what if you’re in a giant lecture hall? The bigger the church, the less likely any particular audience member is already part of the choir. Consequently, most of them aren’t already invested. People who don’t care get bored fast. There’s something more interesting on Buzzfeed or Netflix. My rule of thumb: if you can’t introduce yourself to everyone at your talk and remember their names, persuasion is important. Same things goes for multiple iterations of the same talk. Pitching a hospital-wide quality improvement idea to the staff? Selling a high volume product? Trying to pick up people at bars? Delivery will eclipse content. But if you’re presenting to your CMO, selling someone an EMR or trying to find a life partner? Paul Graham is right.  There’s two “t”s in content. Cross both of them.  

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Becoming a doctor from philosophy

Clancy Martin recently published an article in the Atlantic titled “Playing with Plato,” in which he both reviews Rebecca Goldstein’s new book Plato at the Googleplex (which I have not read) and argues that the philosophical questions confronted by the historical philosophers are still relevant to modern day life (a point for which I have great sympathy). To me, however, the most interesting part of his article was the first sentence: 

“When I was 21, I was trying to decide whether to become a doctor or a philosophy professor.”

He goes on to explain that, during this process, he got two conflicting pieces of advice.  From his business-minded brother: “Be practical. Books are dangerous things. Just because it’s on paper, you think it’s true.” And from his “New Age guru” father: “Be a professor. You’ll never be rich, but you’ll be doing what you love: reading and writing. You get summers off. It’s a good life.” In the end, Martin followed his father’s advice and, by all accounts, has achieved a far bit of professional success.  

Understanding why I was fascinated by this brief introduction to Martin’s article requires a little background: when I was 22, I walked away from four years of undergraduate study (read: obsession) and an offer to attend a Ph.D. program in Boston to return to school and become a physician.  It wasn’t an easy choice. I suffered through more than one sleepless night. I sought a lot of advice. Much of it was in line with what Martin relays: “You’ll never find a job” versus “Do what makes you happy.”  In the end, I found that, unlike Martin, neither of these lines of reasoning was, well, reasonable.  

What eventually caused me to I walk away from academic philosophy was, ironically, philosophy itself. For me, books were indeed dangerous. But they didn’t ruin my sense of practicality and worldliness, as Martin’s brother feared. Rather, they shattered the idyllic vision I had of my career, lounging in the quad reading Spinoza and taking research trips to Greece. I imagined that what drove me was the possibility of changing young minds via the lectern and the pen. But the more I thought and the more I struggled, the more I realized that my motivation to enter academic philosophy was exactly as Martin’s father suggested: I wanted to spend my life reading and writing and I wanted someone to pay me for it.  Instead of being a noble pursuit, entering academic philosophy was the most selfish thing I could imagine doing. 

Why did this bother me so much? Most careers are chosen for selfish reasons; they offer money or power or respect or some other end. Time and time again, however, I returned Plato’s allegory of the cave and its enduring mystery: why, after climbing to the surface and seeing the beauty of the sun, would the philosopher return to the darkness of the cave and the danger of trying to free others? To me, this is similar to the great paradox of Buddhism: the quest for detachment from the worldly cycle of desire and suffering requires us to be moved with compassion for those around us.  

My mentor, Frank Harrison, helped me see that the answer, first, last and always, is love. The kind of love that drives us upwards towards Martin’s “eternal idea” should also drive us outwards towards our fellow man, who, in the words of Marcus Aurelius, “participate in the same intelligence and same portion of divinity” as we do. 

So why couldn’t my work with students and colleagues be my expression of this philosophical love? Because, by and large, they would be exactly like me: upper-middle class Caucasian males. Instead of practicing love for the other, I’d be practicing self-love under another name. Further, a long, hard look at academic philosophy lead me to conclude that being a philosophy professor and being a philosopher were distinct enterprises. Often, they can even be opposed. Recent events at the University of ColoradoNorthwestern and Miami have only reinforced my belief that modern academic philosophy is a troubled system.  

All this being said, I will not pretend for a moment that leaving philosophy for medicine was an act of self-immolation. The decision was difficult, but the human body is fascinating and medicine is challenging.  I find the work fulfilling and am consequently no martyr. But this, I would argue, is the great genius of the Greeks and, perhaps, the idea we should most strive to reclaim: serving yourself and serving others are not mutually exclusive, but rather walk together like two feet. In the end, I left academic philosophy because I believed that I would not be happy there. I believed that becoming a physician would make me a better, wiser person. And, trying my best to love wisdom, what other choice could I make?   

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Are doctors obligated to seek knowledge that has no medical benefit?

The New York Times published an article titled “A Life-Death Predictor Adds to a Cancer’s Strain” or, alternatively, “Genetic Test Changes Game in Cancer Prognosis.”  The piece is interesting on several levels, but, to me, serves to highlight an increasingly common ethical conundrum: are physicians obligated to seek knowledge that is available but has no possible medical benefit?

Most of us are familiar with the Schrödinger’s cat thought experiment (the basic setup: a cat is placed in a box, along with a device that has a 50/50 chance of killing it within the hour).  Suppose Schrödinger decided to actually carry out this experiment and you happen to be the veterinarian for the poor soul whose cat he borrowed.  Having been rushed to the scene by a distraught owner, you are faced with a choice: open the box and reveal the cat’s present state of health or wait and let the cat reveal itself by its eventual demands to be let free (or lack thereof).

Where my story runs parallel to real life: at the point of decision, Schrödinger’s veterinarian and the physician have no power over the patient’s outcome.  Their professional capacity as healer has been exhausted. The cat is either dead or alive.  The patient has Class 1 or Class 2 ocular melanoma (and its attendant mortality).  Until the proverbial box has been opened, however, neither state of affairs has quite come to pass.  The patient is neither doomed nor saved.  The physician stands as the portal of knowledge, holding the key that could dispel fear but also kill hope.

Typically, patients just want the good news.  In a perfect world, only patients with the treatable Class 1 melanoma would have the test performed.  Their Class 2 counterparts, on the other hand, would avoid it and preserve their hope until the end.  Unfortunately, this perfect world requires physicians with prescience (or an ethics “flexible” enough to perform the test without the patient’s knowledge).

What, then, of our imperfect world?  Is the possibility of relief worth the risk of a death sentence?  Further, what is the physician’s role in answering this question?  It is my belief that the option must be presented. The decision to know or not know is deeply personal.  Once he has stepped outside of his role as healer, the physician has no expert knowledge to justify any form of paternalism.  While he can serve as counselor, interpreter and friend, the physician has no right to decide if the possibility of finding a dead cat is worse than waiting next to a terrifyingly silent box.

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