Want Healthcare LLC

Synthesis, systems, and relationships

February 17, 2014 at 12:09 PM Leave a comment

Recently I have been pondering whether my daughter should try to become a physician.  She’s expressed some interest, but remains undecided.  I am ambivalent about the prospect.

 

We overestimate things that have produced benefit in the past, and underestimate things that will produce benefit in the future.  I think that often, as I am coming to understand more and more that we are the product of emotional decision-making, and not rational decision-making. 

 

When I was growing up, there was no question that becoming a physician was a good thing to do.  I think that our parents were absolutely convinced that education was the way to a better financial living, and therefore of a happier life.  And indeed, I got a degree in medicine, and that improved my standard of living over theirs.  Whether that makes me happier or not, it’s hard to say.  I look at my 86 year old mother, and think that she looks pretty happy.   And indeed, she has lived a life that allows her to appreciate the relative economic security she now enjoys.  She has been dirt poor, living in New York’s Chinatown, next to the Bowery.  She experienced living with a rich physician uncle in her childhood, on a large estate.   And she experienced living in the middle class, as a draftsperson in the suburbs of Chicago.  She has seen the gamut, and I think it helps her be grateful for where she is today.

 

The research on wealth and happiness says that my mother did a lot for her happiness once she advanced from living hand to mouth in Chinatown to a lower middle class existence.  This happened for my family when my father took a job with a cousin in his laundry in Fort Wayne, Indiana.   The data say that once worrying about food, shelter, and clothing is no longer the prime concern, we rise in happiness.   But becoming more wealthy after that doesn’t seem to add much to our happiness.  

 

What does seem to make us happier is relationships and experiences.  This seems to be especially true when you combine the two, experiences that create and deepen relationships.  

 

Against this backdrop, I see my daughters’ generation as struggling to find the kinds of jobs that would allow them to exceed my standard of living, to enjoy an economic security comparable to my own, just as my parents invested in my education to better my economic security. 

 

But it seems that our economy is plateauing, from the booming growth that characterized the half century following World War II, to the Internet boom and bust, to the relative stagnation of the last ten years.  It is not surprising that this era of relative stagnation followed the Internet boom.  One of the major consequences of the increased productivity that came with computerization is the elimination of jobs that could be done by computers, faster and with near zero errors.  A whole class of jobs that dealt with the classification, storage, and recall of information was eliminated.  In the beginning, these jobs were obvious: filing clerks, typists, newspaper writers and editors.  Remember what my mother did in Chicago?  She was a draftsperson.  Ask anyone under 30 what that is, and you’ll get blank stares.  That job was obliterated by computer-added drafting (CAD).

 

But increasingly, other jobs that involve knowledge management are finding the same fate.  These include what we call professions now, ones that took advantage of knowledge scarcity and obscurity.   This includes attorneys, physicians, architects, professors, consultants, and others.  Any field that relied on years of training to store masses of information in the imperfect repository we call human memory is now under fire for the cost of that process and the imperfection of its recall.  Remember an obscure court decision that could bear on the current situation and bring it to bear in a lawsuit?  Google will do that in a millisecond, and recall it more perfectly than any human brain.   Cost to do that search?  Even calculating in a contribution to fixed cost, it’s pretty close to zero.  (This is why search is such a lucrative business: once you set up the infrastructure, marginal cost is almost zero, making marginal profit almost 100%.  It’s a highly scalable business.)  Search and recall is cheap.

 

Which brings me back to my daughters’ generation.  In my college days, most of the smart kids aspired to be doctors, lawyers, and professors.  But these days, the business advantage of acquiring the body of knowledge to enter any of these professions is eroding at a steady rate.  Watson, the IBM computer that became Jeopardy champion a few years ago, is now being purposed to practicing medicine.  While Martin Kohn, the scientist who is responsible for its development reassures us that it will simply be a tool that humans use to deliver better care, it seems highly likely that it will suggest better decisions than the unaided human doctor will be able to render alone.  So what is the marginal value of the human in this equation? 

 

 I think the answer to this may be in the emotional decision-making I talked about at the beginning of this piece.  Recent neuroscience tells us that our default mode is social.  From mirror neurons to the ventrolateral prefrontal cortex, we are hardwired to detect and react to other humans in our environment.  First we assess whether they are an outright threat, but then we do more subtle calculi, estimating what their motives are, and how we might either harmonize with or oppose those motives.  

 

This means that the professional roles I’ve talked about that rely on information storage will likely transition into information interpretation and counseling.  The first part of this is the incorporation of right-brain subtleties that might not be easily conveyable through data (although this domain may be shrinking because of Big Data); the second part is the building and maintenance of trust channels to through which the data flows.  In medicine we term this “the doctor-patient relationship”.   This is archaic as this dyad doesn’t begin to describe the complexity of this interaction, based in the future on terabytes of information.  

 

What are the implications of this for my daughters and their friends?

 

1. Professions as the royal road to prosperity will probably underperform.  If professions were a stock, we would probably be rating them as “underperform”, or likely to be worth less in the future relative to the broader market of jobs that currently exist.  The barriers to entry remain high and are getting higher (Google “average medical student debt”), and the marginal benefit of their certifications is diminishing (Google “percent of law graduates who get jobs requiring bar passage”).   Cost/benefit ratio is getting worse steadily.
2. Many of the middle class jobs that remain will require tech literacy.  I actually think that tech is the new English, a knowledge domain that underlies all other areas.  The ability to understand how tech makes your ideas known and your effort valuable to the market will be critical in this generation.  Even jobs that we think of as blue collar, like truck driving and heavy machinery operation, are now requiring some understanding of the computers that are increasingly built into those jobs.
3. Schumpeter’s creative destruction will require them to reinvent their value proposition every few years.  You say to-may-to, I say to-mah-to.   What you call proprietary knowledge, I call a market inefficiency waiting to be commoditized.  Remember when the iPhone was the “It Girl” of gadgets?  Now Apple’s stock is flattening out because of Google’s Android platform and the various manufacturers who are producing hardware to exploit it.  They in turn will be disrupted by someone else with a better mousetrap, say a neural interface device that will make touching icons just so first-decade-of-the-twenty-first-century.  The point here is that the cycle time of the destruction of perfectly good knowledge caches is shortening, so that obsolescence that used to take a generation takes a few years now.  So what makes us think that the ideas that we base our livings on are somehow so special that they won’t be disrupted in the same way?
4. If teamwork skills were a stock, it would be a “buy”.  The skills that come from a well-developed social brain will be increasingly important.  This is because being able to work in teams that match the complexity of the task/service experience required by purchasers will be more and more prized.  The machines have linked together vast amounts of left brain inputs, to draw inferences about very complex systems.  Now the challenge is to match that complexity in our social systems to improve outcomes.  Content knowledge?  Sure, still valuable.  But relative to relational skills that allow teams to perform at a high level, that latter are appreciating in value. 
5. If search and synthesis were a stock, it would also be a “buy”.  The ability to find the right dirt cheap content knowledge on the Web and then reassemble it in ways that bear on specific circumstances someone with money will pay you to understand, this will be big.  Recently I read a book that says that some people see numbers as colors, and have other unusual sensory experiences.  This is because they have connections in their brains the rest of us don’t have.  This variant is overrepresented in creative professions by a factor of eight.  Synthesis is the essence of creativity and innovation, and as translating ideas into reality becomes easier, the thinking of the ideas gets relatively more important.   

 

So how should this inform how we shape society going forward?  What it says to me is that the following skills are going to drive the next phase of our development: information recall and restructure, rather than information storage; teamwork skills vs. solitary production; and synthesis/creativity vs. static mental model care and maintenance. 

 

See the pattern?  All of the obsolete characteristics above are present in our current mental models of professions.  Think about the small group family medicine doc, hopelessly trying to keep up his knowledge with the unaided human brain, and working detached from a system of knowledge management.  That person works according to obsolete protocols, engages in little continuous learning, and uses a largely static knowledge base.  While they may work in teams, most of the time those teams aren’t about generating new and improved management systems continuously, they’re more likely unidirectional vehicles for physician knowledge implementation, knowledge that can be decades old. 

 

Medicine, law, and other professions based on information storage are in the process of changing to recognize the value they actually produce.  A good deal of that value has been eroded by the massive power of computing to make information storage and recall amazingly cheap.  What’s left will be about synthesis, systems, and relationships.  And if my daughter can be good at those things, then she can probably make any profession work for her.

 

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