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Comment by dpatru | Hacker News Reader

Reminds me of a passage from Philip Greenspun's article, How to Become as Rich as Bill Gates, http://philip.greenspun.com/bg/:

When I arrived at MIT as a first-year graduate student in electrical engineering and computer science, I asked a professor for help with a research problem. He said "The reason that you've having trouble is that you don't know anything and you're not working very hard." A friend of mine was a surgery resident at Johns Hopkins. He complained to one of his teachers that he was having trouble concentrating because he'd been up all night for several nights in a row. The professor replied "Oh... does your pussy hurt?" According to Business Week, Jack Welch "encouraged near-brutal candor in the meetings he held [at GE]".

The bottom line: self-esteem is great but beware of creating a cozy home for unproductive people with bad ideas.

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Perhaps this is a tangent, but the notion of ...creating a cozy home for unproductive people... resonated with something I learned from a kiteboard instructor, of all people:

When I was learning to kiteboard I was out one day for a couple hours, had a good session and decided I was ready to get out of the water. I wasn't exhausted, but I was getting tired.

My instructor came speeding up next to me and asked me what I was doing. I explained I was getting tired and wanted to head in. He tossed his really nice new kiteboard my way, told me to give him the old beat up kiteboard I was riding and to go back out. I was reluctant but he pushed me and I caved in. My session went from good to great, and I think my kiteboarding skills improved more in that extra hour than in many of the days prior.

Later that night I was telling my instructor how well I did on the newer board and how I had been ready to give up for the day. He told me "Sometimes you just have to push yourself that extra 5%, even when you think you can't." That statement has been a guiding principle throughout my life ever since.

Any time I feel like I'm in too much in my comfort zone, not challenging myself to learn new things, or feel I'm incapable of doing something, I remember my kiteboarder's adage and try to push myself just a little bit more. So far it seems to have worked well.

I don't think your two stories are the same thing. The MIT professor was being blunt, but not rude, and providing helpful advice (if not in a pleasant form). The medical professor was being rude to the point of abuse, and was not being helpful so much as an enforcer of the insane culture of medical training that causes residents to have to stay up for several nights in a row in the first place. (IIRC, sleep deprivation has been shown to lead to increased medical errors.)

> (IIRC, sleep deprivation has been shown to lead to increased medical errors.)

It has[1]. However, it's not as cut-and-dried as it might seem at first. Decreased hours for physicians lead to more handoffs between physicians, and each handoff is a potential source of error[2].

Therefore, a proper balance between hours and handoffs, as well as new institutional practices, are required to bring patient safety to an optimal level.

[1]: http://sumerdoc.blogspot.com/2006/04/sleep-deprivation-leads...

[2]: http://www.boston.com/news/health/blog/2008/09/hazards_of_ha...

A friend of mine made it to the end of a medical degree then switched to finance and is doing really well (a natural).

When people ask why he "wasted" all those years of a medical degree his response was simple:

"yeh it felt like a waste at first; especially as I knew for a large part of it I wouldnt ever be a doctor. But then I realised how far it was pushing me to my limits. I learnt much more about myself than I did about medicine"

He's in his mid twenties and easily the most successful person amongst his peers.

> The professor replied "Oh... does your pussy hurt?"

The funny thing about this is that I'll bet if that resident socked that professor in the face, the 'tough guy' routine would drop pretty quickly. In any case, I don't think that trying to turn Med School into boot-camp is necessarily the right thing to do. If all those students take after that professor I shudder to think of what their bedside manor would be like:

  Patient: The pain is coming back again. Can I have some morphine?
  Doctor: Suck it up maggot! Are you crying for your mommy again?

Thomas Sowell told a similar tale about himself as an undergrad at Harvard. He had transferred from Howard, and was on the way to flunking out do to poor work habits. Some quotes from p.118 fo his "A Personal Odyssey" (hardcover):

"My work at Howard was a further handicap, for that experience gave me no inkling of the kind of time and effort required at Harvard, and in fact lulled me into a false sense of security. I thought I was being a conscientious student, so I was shocked one day when Nort [his roommate] suddenly said to me:

"Tom, when are you going to stop goofing off and get some work done?"

"Goofing off! I didn't know what he was talking about. But I learned the hard way when the mid-term grades came out."

This was about 1956. He pulled his shit together and graduated magna cum laude.

WTF: I do not certainly see any value in torturing oneself.

If you're working too hard and bragging about it, good chance that you aren't performing terribly well and, certainly, rather inefficiently

Especially if you're doing things like operating on people:-/ No restoring from backups, or rolling back to the latest working version if you fuck up.

That's the exact reason they push interns beyond breaking point. My friend regularly made silly, dangerous mistakes when tired - every time he did a serious dressing down ensued.

Because he was an intern a qualified doctor always double checked him so none of the mistakes were enacted. But he learned his limits and how far it was safe to go.

People put their lives in the hands of doctors; they are under pressure, overworked and often have a tiny margin for error. Knowing your limits is one of the most important aspects.

This is the reason usually only the brightest and hardest workers at school make the grade to become a doctor. Not because of their smarts - but because they can concentrate and focus on a task and achieve highly on it in a consistent way, even under pressure.

What you say is logical, but doesn't quite square with the macho attitude described in the other comment. If you're tired and you realize you're going to do stupid stuff - that you're past your limit, you've learned that lesson, it sounds like.

Providing a safe environment in which to learn how to recognize that you aren't performing at your best is wonderful; it's hard to simulate the other conditions that give suboptimal results, but lack of sleep gives a good cross-section of drowsy, distracted, over-caffeinated, agitated, etc.

Still this can be arranged as a well-defined test instead of humiliation crapfest.

Everything can be.

No, it can't. I am doing research on medical robotics/robotic analogs for surgical practice. Psychologically you can't create the same feelings when the people know it is fake.

Ok, but when it's real and people tell you that they're beyond their limit, in some fields, pushing further is a bad idea. Piloting, mountaineering and surgery come to mind immediately.

I think the real point is that, when people don't know their limits, they might think that they're somewhere below where they really are, rather than somewhere above. If the person's output is still great and they aren't making any mistakes, don't let them quit; keep pushing until they actually start to falter. After doing that a few times in relatively safe environments, you can be sure they'll actually know when to say stop, rather than trusting an uncalibrated instrument (their opinion of themselves.)

I agree that knowing your limit it part of medical school training, but it's also about practicing how to work effectively and safely when you pass that limit. Many doctors will eventually have to perform very long surgeries often over 12 hours of intense concentration with no breaks. Overworking medical students for long shift helps to prepare them for the occasions when they have to perform and have no one to pass the patient off to and no one to closely monitor their work.

FWIW, I've read that the reason for pushing interns beyond their physical limits is simply money, not teaching or building character. It's cheaper to work them ridiculous hours than to hire enough people to do the job well.

Working sleep-deprived for long periods of time doesn't really teach you anything after the first couple weeks. It just lowers your efficiency and increases your error rate. In software development, that causes you to waste time. In medicine, that causes, er, iatrogenic death, or something like that.

http://en.wikipedia.org/wiki/Libby_Zion_law#Libby_Zion.27s_d...

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