Review: Death’s End

Death's End
Death’s End by Liu Cixin

My rating: 5 of 5 stars

I did not believe the reviews. Three-Body was a terrific book, but reviewers said that book 2 was better, and then book 3 was even better. Well, believe it.

I was enthralled by the Three Body Problem. Celestial mechanics, virtual reality gaming done right, alien interaction over galactic distances, political upheaval, insoluble problems pulled together into a tight narrative.

I boggled at Dark Forest. Description of the principles of Cosmic Sociology (no kidding! I loved this construct and its corollary ideas), the suspicions across light-years. Just so well constructed and told.

And, now Death’s End. The author broadens his view to illustrate his point “The Universe is big, but Life is bigger.” And another point, that older civilizations end up using the laws of physics as weapons. What?!? Suffice it to say, the narratives set up in the previous books are kicked up another notch. Moreover, the author creates 3 compelling fairy-tales that are not only terrific stories in themselves, but completely crucial to the larger story-arc. This is my new favorite trilogy of all time.

What are you waiting for? Go read it.

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Review: The Power of Habit: Why We Do What We Do in Life and Business

The Power of Habit: Why We Do What We Do in Life and Business
The Power of Habit: Why We Do What We Do in Life and Business by Charles Duhigg

My rating: 5 of 5 stars

I read lots of what I call “popular psychology” books, the way I used to devour “popular science” magazines when younger. I find the intricate and contradictory patterns of the mind even more interesting than the latest scientific or technological breakthroughs. Having numerous habits that I wish I could change, and, as importantly, having numerous colleagues, and perhaps most importantly, patients who have habits I wish I could influence positively, I was eager for the anticipated advice.

Duhigg writes clearly and compellingly. He stocks the chapters with story after dissected story of how habits can change at an individual, small group, or large corporate or even national level.

This main tenet is the sequence of links between CUE-BEHAVIOR-REWARD, and how even our best conscious intentions are overwhelmed with the subtle, insistent, irresistable patterns in this habit-sequence. Want fries and a drink with that burger? That TV remote and barcalounger calling to you at the end of a long day? The gym too far away AGAIN?

He finds fault with those (like me) who believe that IT’S JUST WILLPOWER. No, it’s not. Habit will win every time (in the long run). His idea, at the individual level, is that it’s worth taking stock of the habit you’re interested in changing (say, getting enough sleep at night), and determining, really what the cue (it’s 11pm and quiet in the house) and the reward (now I can finally think, and read!) are. Then, it’s a matter of retaining the reward and figuring out what other behavior can sustainably be substituted: audible books to listen in the car? turning off your screens in the evening and reading for 2 hours? carving out 2 hours some other time in the day?

Furthermore, his insights on strong ties, weak ties, sense of community, obligation, make this more than just a self-help book.

CMIO’s take? This one clearly demands a re-reading. I’m going to use this to analyze my own habits, and see which of my behaviors I can hack. Furthermore, I’m wondering if, as a physician, I can create concrete new habits and rewards for my patients, whether’s there’s a simple formula, or whether that work is so much more self-driven, so much harder, as it seems to be.

It’s no longer adequate to tell patients “just go get some exercise”. Now its time to discuss: what is the cue-behavior-reward of exercise? Cue: get home from work. Behavior: sit down, turn on TV, Reward: relax and enjoy the evening. However, there are those who, once started on an exercise habit, find the behavior: exercise leading to its own reward: feeling better about yourself.

But, how to get over the hump of change? Some other mini-reward for 30 days to establish the new habit and start feeling the new reward? Using a calendar and marker? Perhaps a prescription from the doctor taped to the fridge with checkboxes to complete? A doctors fake-pill bottle of minty tic tacs that you can take daily AFTER exercise, and then we count the pills together at the end of 30 days? There’s something powerful here for all of us.

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Review: Dark Matter

Dark Matter
Dark Matter by Blake Crouch

My rating: 5 of 5 stars

Some books slink onto the bookshelf and lay there for months or years. Some books keep popping up insistently until you say “FINE” and buy it, just to shut up the voice in your head. This is one of the latter. I saw this on my feed, highly recommended among my friends on Goodreads, and finally(!) as a first-ever flyer for “Book Club” near the restrooms in my building in Academic Office One at work. A Sci-fi book for nerdy academic physicians and their staff?

Once I picked up this book, I couldn’t put it down. Sure, the Spielberg-like, idyllic family life for the protagonist, check. The “gotta go out for just a minute” (don’t do it!), check. The inevitable “event” that upends the world for the protagonist, check. Sure, I’ve read (and maybe some of you, following me on this blog?) about the Hero’s Journey at the root of so many stories, and maybe, with my new eyes, I was anticipating some of the next steps.


Sometimes an author pulls you along, and then starts unwinding some big ideas. Okay, maybe the title “Dark Matter” should have been a giveaway. Maybe the first chapters, as the protagonist’s grogginess wears off, seemed to telegraph the author’s hidden intentions.

But then, as my favorite sci-fi books do, the author shifts it into a higher gear and starts spinning a terrific yarn: a tale of hard choices, yearning, “what-if’s”, superpositions, love, Schroedinger’s cat(?), and nape-of-the-neck Spidey-sense tinglers. Any book that includes the phrase: “that person will decohere the quantum state” is okay in my book. Especially if it makes total sense when you get to that point in the narrative.

CMIO’s take? There are times in our lives that we wished we did something differently, and wonder if things would have turned out differently, at work, at home, whether we would be happier, wouldn’t we have fewer regrets, if only…

I suggest: live your life in the present. This present. This one, where you have to read this amazing, thoughtful, science-fiction-isn’t-even-as-weird-as-real-science book, ‘cuz I’m not gonna spoil it for you.

BONUS ROUND: Book club at work was hilarious and fun. Met with staffers at the academic center, all of whom had interesting backgrounds, found very different points of the book to be fascinating, and we had a great exchange. Why don’t we have more book clubs at work? We should.

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Review: We Are Legion (We Are Bob)

We Are Legion (We Are Bob)
We Are Legion (We Are Bob) by Dennis E. Taylor

My rating: 5 of 5 stars

Not all Sci-fi books are BIG idea, massive-world-building enterprises, clearly researched and diagrammed to the infinite detail, to sustain disbelief over multiple volumes (I’m talking to you: Foundation, and The Expanse, and Three Body Problem, and Quicksilver, and anything by Alastair Reynolds). This one doesn’t take itself seriously, AND YET is a rollicking read, full of laugh-out-loud moments, and then chin-scratching “hmm” moments. Reminiscent of Ender’s Game and Hitchhiker’s Guide in tone and action.

CMIO’s take? If you get the chance to “freeze” your head after a massive accident, AND someone offers you the chance to be the brains behind a Von Neumann probe that can self-replicate and explore the universe? Do it.

Seriously, it is not necessarily good to have a team of “yes-men” to rubber-stamp your actions; instead, a team of those with common strategic goals, with varied expertise and opinions (see: Wisdom of Crowds by Surowiecki) that is most likely to succeed.

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Review: Houston, We Have a Narrative: Why Science Needs Story

Houston, We Have a Narrative: Why Science Needs Story
Houston, We Have a Narrative: Why Science Needs Story by Randy Olson

My rating: 5 of 5 stars

So many scientists and doctors I know are terrific at science, and SO impressively smart. Kudos to their years of training, discipline, self-sacrifice. And yet … many (perhaps most) have no idea how to tell a story. In fact, “telling stories” is often construed as lying, or at the very least, being unscientific, and not “evidence-based.”

It is a terrible tragedy, therefore, as the Internet echo chamber relentlessly promotes those who can write a tagline, a teaser, a STORY (autism and vaccines, anyone?), and those scientists and researchers with deep knowledge and expertise, have no effective training to fight back, and are drowned out in the hue and cry.

Michaelangelo said: “I saw the angel in the marble, and I carved until I set him free.”

Reminiscent of the great artist, this book laid out 3 techniques to help me see the narrative inside our lengthy, cluttered, many-faceted, detail-oriented scientific pursuits. This book was written by a dissatisfied, tenured Marine Biologist, who quit his job to go be a screenwriter in Hollywood. Screenwriters, he says, are the “working class storytellers of our age.”

CMIO’s take: I thoroughly enjoyed and devoured this book, and now, like the ageless Hero described by Joseph Campbell, and with the aid of such books as this, I will face my personal limitations, and transform myself in order to face and overcome my challenges.

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STEMpathy, via Thomas Friedman, and Sean the teacher

Automation is coming for the American worker.

I have been bothered by our recent election, with all its swirling issues. However, one aspect swirling out of this maelstrom, is the dissatisfaction of Americans put out of work with globalization, and the technological acceleration based on Moore’s law. Much has been made of the President’s claim that he brought Carrier jobs back from overseas.

Much has ALSO been written that the massive forces of “off-shoring” of jobs is NOT just a redistribution to countries with lower-cost labor, BUT ALSO a continuing acceleration of technology and automation. Bringing jobs back is but a brief speed-bump along the way to losing the jobs again to robots and computers.

As a parent, how are we to advise our younglings as they prepare to head out into the world? If globalization and Moore’s law are contributing to the destabilization of our visions of the future, how can we see clearly enough to help them choose wisely?

Tom Friedman’s latest book, “Thank you for being late” is a thoughtful, broadly researched, multi-cultural, geopolitical, economist’s answer to this question. And one of his answers to this question is:


Although, to be fair, a google search on the term first shows a WordPress blog by an insightful 5th grade science teacher: 

that appears to predate Mr. Friedman’s best-selling tome. Thank you Sean.

Nevertheless, I love this term. STEMpathy encompasses two ideas. The first is, that having a solid understanding of Science, Technology, Engineering and Math is a requisite foundation for the coming age of scientifically- and computationally-based Age of Acceleration. AND YET, STEM skills are insufficient to survive into this future, for as computation power doubles every 18 months and costs continue to fall, the capabilities of robotics and automation, powered by machine learning, are sure to outstrip almost all human occupations, from manual labor to highly technical and cognitive fields, including (gasp) MEDICINE.

What is a high-school or college student to do? Friedman notes, and I agree, that obtaining a solid college (and for some, post-college) education would set one up for a lifelong career in some respectable field. No more. Now, one would be lucky to complete a college degree, that might lead to one’s FIRST job for a few years, but that as the speed of change increases, one must learn to find employment as jobs change and entire categories of jobs collapse, or are born.

So, what skill(s) might future-proof a youngling over the coming decades?

This is the second part of the STEMpathy idea: the combination of a solid grounding in rigorous STEM scientific thinking WITH exceptional skills in EMPATHY, communication, human connection. In my experience, this combination of skills rarely occurs “in the wild” and must be explicitly learned. This is the double-whammy of left-brained logical, numerical thinking, combined with right-brained words, story, art, connection, that is so hard to find in one individual.

And perhaps the most hopeful note, is that empathy, communication, and human connection, unlike the mythology that “you’re either born with it or not” is NOT TRUE. In our organization, we have incorporated several Communications and Empathy courses into the curriculum for medical students, residents, and more recently, our academic faculty. For example, our recent Communications Workshop that I teach (more on this in a future post) is from the Institute for Healthcare Excellence. One set of skills taught includes the acronym PEARLS (partnership, empathy, acknowledgement, respect, legalization, support). These are discrete skills that can be practiced, learned, and mastered.

My bet, is that STEMpathy is useful now, and is one way to future-proof yourself, and the next generation. Be safe out there!

Review: Patients Come Second: Leading Change by Changing the Way You Lead

Patients Come Second: Leading Change by Changing the Way You Lead
Patients Come Second: Leading Change by Changing the Way You Lead by Paul Spiegelman

My rating: 3 of 5 stars

I wanted to like this book more. The provocative title says a lot. However, the point could have been made with fewer words. Moreover, I looked forward to real-life examples to illustrate this idea, and was disappointed.

In brief, the authors claim that over-focusing on the customer (or in healthcare, the patient), although wonderful on the surface, can be twisted into ununtentional results. Shall we, as physicians, chase after the increasingly important “patient satisfaction” metric at the cost of, say, antibiotic overprescribing? “Oh, so you’ve had a cough for a day, and you’d like some antibiotics?” It is indeed easy, and quick, to say “Sure, here you go” and get back on track with an over-scheduled clinic day, and be assured of a higher patient satisfaction rating. Who would rather spend the 5-10 minutes to discuss the patient’s root concerns, explain the risks of overprescribing, and grit the teeth anticipating the inevitable “I drove all the way over, paid my co-pay, and THE NERVE of that doctor to withhold my necessary antibiotics” and resulting low patient satisfaction score.


Yes, this is not news to any practicing physicians. Yes, we know we’re being pinched from all sides. Yes, there is too much ‘fat’ in the US healthcare system and something has to be done. Yes, Obamacare did some great things and also did not do enough. Yes, we need to listen to our patients and ensure we do the best for every one of them. Yes, we need to treat our physicians better, so that they can step back from the brink of burnout, of retirement, of leaving medicine in disgust, of suicide. Yes, this book is a call-to-arms.

No, its not as helpful as it could have been. There’s less substance than the pages would indicate.

CMIO’s take? This book is more valuable for the shocking title and its use in conversation and leadership meetings, than it is for its actual content.

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Review: Stargirl

Stargirl by Jerry Spinelli

My rating: 4 of 5 stars

My teenaged daughter handed this book to me with a smile, stating that I might enjoy it. She’s almost always right. For some reason I do enjoy YA fiction. Is it the yearning? The optimism? The world view that “anything is possible, but its just so HARD for me right now?”

Nevertheless, this was a fun, quick read. Not perhaps in the same category as “The Fault in our Stars” but a solid rollercoaster of a read. Stargirl is a fanciful embodiment of Richard Feynman’s “What do you care what other people think?” Playing ukulele, dressing up, oblivious to the stares of others, Stargirl is both attractive and repulsive to the high-school mindset. Interesting to read it as an adult, with perspective. I’m looking forward to reading the sequel.

My favorite quote of the book:
“Like so many of Archie’s words, they seemed not to enter through my ears but to settle on my skin, there to burrow like tiny eggs awaiting the rain of my maturity, when they would hatch and I at last would understand.”

CMIO’s take? The pressure of conformity, of habit, is comforting, lulling, deadening. Sometimes it takes an extrovert or an unexpected event to shake us out of our doldrums and open our eyes again.

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Review: The One Thing: The Surprisingly Simple Truth Behind Extraordinary Results

The One Thing: The Surprisingly Simple Truth Behind Extraordinary Results
The One Thing: The Surprisingly Simple Truth Behind Extraordinary Results by Gary Keller

My rating: 5 of 5 stars

So, is it realistic to clear 4 hours of your work day EVERY DAY to work on your ONE THING? Yes, I agree, not going to happen, even if Gary Keller tells you to. However, it is inspiring to read about new ways of working, new ways of structuring the day, the week, the month, to think about focus. Given the 17 priorities I’m working on now, and my many colleagues with highly variant concerns and demands, I completely understand where this book comes from and its audacious goal.

I also know, from my recent work on APSO notes (inverting the SOAP progress note written by doctors, to place the Assessment and Plan at the top of the note, for easier reading and understanding by all), and making this change (highly resisted, because IT’S DIFFERENT AND UNFAMILIAR) throughout the 3000 doctors at our hospital system, that this was my primary focus for years, until it was achieved as a universal standard. Focus does have its benefits. When I look back on my career, it is NOT the hundreds of smaller projects, or the hundreds of thousands of emails I crafted or responded to, it is not the ‘crucial conversations’ I had with individual docs and patients that maybe moved their beliefs and attitudes very slightly. Instead, I look back at BIG projects that were HARD, and where we accomplished something as a team, as an organization.

CMIO’s take: In hindsight, it was the unintentional “One Thing” attitude that put these projects over the top. Perhaps I could learn from my past, of the projects never reaching fruition, and the few that did, and allow the “One Thing” more of an influence in what I do. Highly recommended as a book.

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Review: Steal Like an Artist: 10 Things Nobody Told You About Being Creative

Steal Like an Artist: 10 Things Nobody Told You About Being Creative
Steal Like an Artist: 10 Things Nobody Told You About Being Creative by Austin Kleon
My rating: 5 of 5 stars

This is a fun read. If you’re human, you are creative. This book gives you permission to open your arms, in big scribbled words, to something new, and not let your frontal cortex shut it down as “stupid, anyway.”

Austin unlocks the fun hidden deeply in your teenaged soul, suppressed by years of schooling and working. If you have 10 dollars and a free hour, read this book. Such an easy way to get a new perspective on creativity, enjoyment, and life. As a CMIO, my take is: many folks at my work desperately need to read this book.

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