behavioral economics lesson

courtesy of Continental Airlines.

Imagine you have a 3pm flight from Las Vegas to New York that arrives at midnight. You arrive early with a friend who has a 1pm flight that gets in at 9:30. That sounds soooooo much earlier. You approach the lady at the ticket counter and ask her if you can fly standby on the 1pm flight.

She says that there are six people in front of you on the standby list. Would you like to add your name? Sure you would. She says that there is a $50 fee to switch flights, but that if you aren’t accepted as a standby and end up on your originally scheduled flight, credit card is not charged. Is that okay?

What do you say? Reasonable deal?

All right now consider a different scenario. You approach the lady at the ticket counter and ask her if you can fly standby on the 1pm flight.

She says yes, but it will cost you $50 to change the flight.

Is it worth it?

Interesting, eh?

an exercise in prejudice

Amtrak service from Ardmore, Pennsylvania to Penn Station in Manhattan first stops at 30th Street Station in Philadelphia, where about half the passengers get off, then makes stops at a series of small stations in New Jersey, before arriving at its terminus two hours later.

Amtrak cars seat two passengers on each side of the center aisle. Like everyone else traveling alone, I want to have a set of two seats to myself. There are some small number of solo travelers who would prefer to sit next to someone; these are of course the travelers to avoid being near at all costs.

If there are no sets of vacant seats, I must choose whom to sit next to. I must make this choice as I walk down the center aisle. There may be fellow travelers in front of me, making the same decision, on whose leftovers I must feed, and behind me, who will feed on my leftovers. The more people behind me, the less able I am to linger in one spot to consider my options, though veterans utilize carefully orchestrated stall tactics to buy an extra moment, such as switching a large piece of luggage from one hand to another or, in a related maneuver, accidentally having a wayward luggage strap get caught on an armrest. In general, however, I have about three seconds to assess each pair of passengers as they appear on either side before me: 1.5 seconds per person.

I must make this decision in 1.5 seconds, with a paucity of information. I see what each candidate looks like, hear what they’re saying if they happen to be saying anything, and occasionally catch a scent. No touching or tasting is allowed, and I cannot ask any questions. In 1.5 seconds I must decide based almost entirely on prejudice, preconception, and bias.

If I can’t sit alone, I want to avoid sitting next to someone who will try to talk to me. I want to avoid sitting next to someone who takes up too much space, someone who will eat, talk on the phone, pass gas, or steal my wallet. I want to avoid sitting next to someone who smells bad, or might start to perspire if the train stops, or will whip out a portable DVD player and start watching a movie, because I know that will distract me.

If I can’t sit alone, what I really want is to sit next to someone who will get off at the first stop, 30th Street Station, so that I can have the set of two seats to myself for the remainder of the trip. Coming to a decision based on these goals would be difficult enough in 1.5 seconds if it weren’t that my prejudices tell me that the kind of person I otherwise wouldn’t want to sit next to is also the kind of person who is likely to get off at 30th Street Station. So complicated, this world we live in.


A nubyte is the word you get when one or both of your hands are misplaced on the keyboard. Comes from typing minute when your right hand is shifted to the left. phEMxy is the nubyte generated from typing pharmacy when your left hand is shifted to the left.

compassion switch

This weekend I accompanied Rodney to meet his long lost cousins at a not otherwise notable restaurant near Lincoln Center. Very few options for food in that area at midnight; my expectations were low. Famished, we walked in and stood with that vacant look on our faces that says as loudly as possible that we’d like to be seated. We were approached by a small, odd-looking middle-aged gentleman in restaurant uniform. He spoke with a mild stutter and it required more effort than normal to explain to him that we wanted a table for seven, but I was focused on the menus we had ferociously grabbed off the counter. At that moment, the closest we could get to eating was reviewing the menu, imagining what each dish would taste like. This was surprisingly satisfying; I would rate it just below savoring the aroma of something delicious on the list of things almost as satisfying as eating when you’re very hungry.

Anyway, regarding the middle aged, stuttering, mildly dense guy, with what little of my attention wasn’t occupied by menu porn, I figured he was drunk or distracted. We sat down, and I was surrounded by people I didn’t know but was expected to talk to. An overly bubbly dominican girl started chatting with me, and I remember looking at her and being unable to focus on the conversation out of hunger: as she spoke, she turned into a steak, like in those bugs bunny cartoons when two castaways are stranded on a desert island.

Finally a very thin, mildly disheveled lady in her fifties approached and asked us if she could take our drink orders. I replied that I would like a shrimp quesadilla and a steak and cheese sandwich. Not a drink, for sure, but she looked at me as though I was speaking an exotic language. Now, with the hunger and all, I’m starting to get frustrated. As if I hadn’t said anything, she asks the table again if she can take our drink orders. Other people start ordering drinks, and she starts writing them down, but it’s taking her two and three tries for every order, I wonder if she’s reading lips or something and also wonder if I’m going perish before I get any food. Ultimately she serves the drinks and I ask her if I can order food, and it took a few moments but, yes I can. I again request a shrimp quesadilla and a steak and cheese sandwich, no tomato. She doesn’t get it. I look at Rodney, what on earth is going on. I point on the menu and raise my voice, she’s slowly beginning to comprehend but not fast enough for my appetite which now dominates all other emotion and reason. After what seemed like 45 minutes she gets my order down on her pad, and I’m incredibly annoyed, almost angry.

Rodney’s turn to order, and he’s straining to get the message across as well, what the fuck is wrong with this woman? Fortunately Rodney works with at-risk teenagers and is able to relate to her better, but still, his gorgeous locks of hair have lost their usual bounce – an early sign of patience being stretched. After she finishes with Rodney, she turns back to me, stares at me for a second, as if trying to remember something, and then asks me if she can take my order, and I am struck with a realization so thick and heavy that I might have just done a belly-flop off the high dive, the wind actually knocked out of me. This woman is mentally disabled, and so is the stuttering dude. This restaurant hires mentally disabled workers.

It took a few moments for the concept to sink in, but what happened next was even more remarkable: every thread of frustration evaporated. Instantly. In a matter of seconds I was living in an entirely different brain. Her incompetence didn’t bother me in the slightest; in fact her inadequacies as a server, which I was just enumerating in my head for a letter to the manager I was possibly going to a write, suddenly seemed like virtues. 20 minutes to process the word quesadilla? Fine. Not just fine, amazing. This disabled woman was doing a job that fully functional people find challenging. And the owner of the restaurant, who hires these people? God damn hero. I no longer cared when or if I got my food. In the end I left a generous tip.

I have encounters every day with people who frustrate me. For my work, I am charged with helping people deal with problems they often brought on themselves through vice and shortsightedness, and it is precisely these people who are the least grateful for my help and often frankly hostile, even when I’m trying hard to be nice. And sometimes it is really hard for me to be nice. Why can’t I harness the compassion switch that flipped in that restaurant? Take the compassion I felt for quesadilla lady and apply it to the world at large? Everyone’s disabled in their own way, right? Is this how jesus felt? Endless compassion? What a guy.

While our waitress was away working on our drink orders, Rodney, who lives in Montreal, flagged down the stuttering dude and pointed to soup du jour on the menu. What is the soup du jour, he asked. Stuttering dude looked at him and assumed a face that said, oh good, I can answer that question. In his most helpful voice, he replied, “It’s the soup of the day.”

gadget to action

Most of us have a daily or weekly routine, and incorporated within that routine is a priority structure. This structure is often not recognized, and I think we benefit from making it explicit, which is why I write about it. Overlying the priority structure is our needs hierarchy, which stipulates that we will take care of the basics (sleep, eat, shave, earn an income) before we work on higher level activities (socialize, create, contemplate). Of course how much time we spend on the basics and on the higher pursuits depends on our priority structure.

The intersection of our routine and our priority structure generates a pattern of accomplishment in the following way: On a day-to-day basis, we move through our priorities, starting with the base and moving up, and at some point we run out of time. Because most of us have developed predictable (if implicit) priority structures, and because our routine tends to be, well, routine, there is a line in our priority structure below which the elements reliably get done, and above which elements reliably don’t get done–day after day, week after week. The irony is that activities that often fall just above the accomplishment line are A Tasks, which are most likely to result in long term improvements in our quality of life. Our challenge is to optimize our priority structure and to raise our accomplishment line.

I went camping this weekend, and joked that I prefer camping equipment to camping, and that I only go camping so I can use my camping equipment. This joke was in my favorite style of humor, which is stating a truth as plainly as possible, so that it’s perceived as a joke. This particular truth-joke, however, reveals an important strategy, which is that purchasing something cool inspires us to use it. Expensive camping equipment is lame, but camping is one of those things that I dread doing but always appreciate having done after it’s over, so if purchasing expensive camping equipment pushes camping below the accomplishment line, it’s an excellent use of money. This is gadget to action.

Gadget to action is why Mac users do so much more cool shit on their computers than PC users; Mac programs are fun and make you want to use them. I once designed a 3-year research project because it would have given me a reason to use a supercool Mac app.

I want to read more. Should I buy the Kindle?

happy slow minutes

We can all agree that time is our most valuable resource, miles ahead of money, love, power, even bacon. Day to day, we struggle to cram it all in, we take on enough commitments to push us just beyond our capacity. This is why it is so hard to be punctual: our internal secretary is optimistic.

In a larger sense, life is short, and among the most unsettling aspects of getting older is that as each moment passes, each moment represents a smaller fraction of our memorable lives, so that time passes more quickly as we age. A twelve year old’s summer is a sizable chunk of her life and seems to go on forever; the 42 year old feels on labor day that she just finished clearing the driveway of snow.

If time is precious, we benefit from a longer life, so it makes sense to do things like eat well and exercise. But all time is not equally valuable, in fact, time is only valuable insofar as we are happy during that time. We only want to maximize our number of happy minutes, so what to do if you hate eating well and exercising? It makes no sense to take steps to prolong your life if those steps diminish your happiness.

Further complicating the issue is the unfortunate tendency of happiness to actually destroy time. The happier we are during any given minute, the quicker that minute passes. What good is a lifetime of bliss that goes by so quickly we don’t notice it? Not much better than a lifetime of misery that never ends. We therefore want not only as many minutes as possible, but happy minutes, and not only happy minutes, but happy, slow minutes.

Most of us feel happiest when we’re busy, but busy doesn’t just use up time, it also destroys time in the way that happy destroys time. This is getting confusing.

One way we try to increase our enjoyment of any given minute is to consume cultural media. Music, books, magazines, newspapers, television, cinema, theater, the visual arts, and then the internet, which intersects and expands on all of these in all sorts of ways. We benefit from living in a time and place where we have access to an infinite reservoir of media that we would enjoy consuming, and our challenge, given the few minutes we have in the day and on earth, is to consume the media that makes for the (slowest) happiest minutes. Luckily, humanity has generated so much fantastic cultural media that it would take a lifetime just to consume the classics, and what a life that would be.

But we tend not to consume the classics. We buy and download the latest bestsellers, trendiest bands, blockbuster movies, and news of the day. This is illogical. Why would we spend our precious minutes consuming a new release when we could benefit from the sieve of time and generations of judgment to select for us the best media and consume that? Why is this week’s New Yorker so much more appealing than last week’s? Our consumption instincts encourage us to gulp down the fire hose of hot off the press, when we could be leisurely sipping from the media that has, through its demonstrated excellence, made its way downstream. The issue is not only that new doesn’t deserve the high status we are conditioned to give it; trying to drink from a fire hose is really busy, and busy destroys time. Furthermore, the current current widens as you try to swim in it–keeping up with one blog leads to two, newsfeeds lead to more newsfeeds–it’s not only never-ending, it’s viral. And exhausting. This is why so many report that they are much happier now that they’ve unplugged the internet from their homes.

During our unhappy minutes, we feel guilty for being unhappy, as we rich inhabitants of rich nations have nothing to complain about. We bathe ourselves in perspective checks when we’re down, and don’t hesitate to splash some on our complaining friends. Your boss won’t give you another week of vacation? That’s terrible. Have a look at this kid, his parents and siblings were just slaughtered before his eyes. And he has HIV.

Nobody would choose to wish for food, shelter and safety rather than an extra week’s vacation. But the assumption underlying perspective checks is that people wishing for food, shelter and safety are worse off than people wishing for another week’s vacation. It is certainly true that people who struggle to satisfy their basic needs try to move to a “better” station in life, but what if their instincts mislead them? Every station has its struggles, the question is whose happiness is more abridged by his struggles. Who is more unhappy: the cold, hungry homeless man or the lonely, directionless college grad?

I suspect that the higher we rise on Maslow’s hierarchy of needs, the more deeply our happiness is abridged by our struggles. Like all of you, I was born near the top of the hierarchy, so this conclusion seems convenient and self-serving. But my job not only puts me in contact with people from all over the hierarchy, but mandates that I assess their problems and their response to their problems. My conclusion is that though there are lots of unhappy homeless people, to reach the most horrible depths of misery, you have to be liberated from the need to find a place to sleep.

No doubt, however, that every cold, hungry homeless man would trade places with the lonely, directionless college grad and none of the college grads would prefer to walk in the homeless man’s shoes (if he has shoes). Perhaps it’s somehow better to be unhappy, higher on the hierarchy of needs than happy and lower on the hierarchy. Is it better to be an unhappy human or a happy pig? Maybe happier isn’t better after all. This is getting confusing.


1. Every once in a while, sit and do nothing for a few hours. Stare and think. Or don’t even do that.
2. Stop trying to keep up with the latest of everything. Take a vacation from blogs and news–they’re not going anywhere. Don’t consume the newest stuff, consume the best stuff.
3. Keep perspective checks in perspective. You might be worse off than it seems.
4. Find religion. None of the above applies to the lucky ones who can fool themselves into believing in some sort of cosmic karma, afterlife, or reincarnation. For the rest of us, the prospect of dying is unsettling. Consider, however, the prospect of never dying. It’s a horrifying thought. Why get out of bed if today is just one in an eternal series of days? Life derives its value from its finiteness. Take comfort in your mortality.

rooting for the underdog

It’s been cold lately, and no one is complaining. At first glance this is positively shocking, because everyone loves talking about the weather, and everyone loves complaining, so when inclement weather provides us the conversational shelter afforded by griping about the cold, it’s hard to resist. But no one is complaining.

When humanoids evolved the ability to reflect, their first conscious thoughts likely involved the feeling that they are at the mercy of the weather. Entire religions were constructed to address the impotence of man in the face of the elements. It is impossible to spend time in an extreme climate and not at least transiently be scared shitless of your utter helplessness at the hands of the environment. Edmund Hillary, who died this month, was the hero of a generation because he represented a victory of man over nature.

Suddenly, however, it is man who has become the aggressor. The perception that we are headed for a global warming Armageddon has become a political, media, and industrial circus. In the period of five years, the issue has moved from the scientific and activist fringe to affect everyone capable of having a conversation. We watch the reports of heat waves, declining crop yields, and drowning polar bears, and shake our heads, ashamed of ourselves.

I walked outside into 16 degree cold last week, and thought to myself, you go girl. For the first time in history, mother nature is the underdog.


Jeff Kline recently developed a tool that emergency doctors can use to evaluate patients with pulmonary embolism, which I was writing about, except that I couldn’t remember if his name is Kline or Klein. He speaks with a southern accent, and there aren’t too many jews with southern accents, so I suspected Kline, but wanted to be sure. What’s the fastest strategy to get at this information? I could pull up one of his papers, or I could search the staff directory at his hospital, or page through a textbook on pulmonary embolism. Or I could find out the same way I find out everything else, in less than five seconds: google.

Googlevoting came to me in a burst of inspiration when I was torn between humorous and humerus; I know one is funny and one is a bone in your arm, but can never remember which is which. Spellchecker counts them both as correct, but I know the funny one is used way more often than the in your arm one, so I plugged them both into google.

humerus: 776,000 results
humorous: 20,100,000 results

Funny bone, that humerus. But what about Jeff Kline/Klein? There are untold numbers of people with both spellings, and the winning vote will go to the Jeff Kline/Klein with the most recognition, which probably isn’t the guy who’s made a career of studying blood clots. No problem.

“jeff klein” “pulmonary embolism”: 9 results
“jeff kline” “pulmonary embolism”: 79 results

Other tough problems easily solved by Googlevoting include:

here, here! / hear, hear!
naval orange / navel orange
steel myself / steal myself
whoa, horsey / woe is me

But Gvoting isn’t just for homonyms; nor is it just for homos. Google makes quick work of strange proper names, also not correctable by spellcheckers, like my favorite band this week, Bigushkin. Or is it Begushkin? Just punch in Bigushkin and you get,

Did you mean: Begushkin

Why yes, yes I did.

incremental camouflage

My neighbor, in the year 2002, had a front door completely unadorned except for a small piece of paper, on which something was handwritten in Russian. It took me a few months to ask him what it meant because I didn’t want to be nosy.

“Don’t overfeed the dogs.”

Trying not to laugh and trying to respond to this without insulting his dogs, I asked him if the sign worked.

“No. I don’t see it.”

Incremental camouflage is the way something that is always in the same place becomes invisible over time. On my desk is a mousepad that looks like an Arabian rug that I use not as a mousepad but as decoration, and on it I put the things that I need to take with me when I leave the house: wallet, keys, watch, phone, handkerchief, hospital ID. I routinely, routinely leave something sitting on my little desk rug when I leave my apartment. I come back in and there it is, sitting there, plain as day. I didn’t see it.

We are frustrated by incremental camouflage when the LOSE WEIGHT sticker that we post on the fridge doesn’t prevent us from opening the fridge, but this phenomenon can be harnessed to our advantage. I keep the most-used cards in my wallet arranged in a particular order, so that when one of the cards is gone, the inside of the wallet looks all wrong and I notice it immediately.

My new job is performed almost entirely on a computer, in a chaotic environment with dozens of computer terminals around, where everyone uses the same computer application to do their charting. A frequently inconvenient and sometimes dangerous situation arises when Bob, charting patient Smith on one of these computers, gets called away to do something, and then Matt sits down and starts charting patient Jones on the computer that Bob was on, thinking that he’s logged in as Matt charting patient Jones, but in fact the application is still logged in under Bob. Twenty minutes later patient Smith receives a medication intended for patient Jones.

The way that many vendors deal with this problem is to log the user out after some brief period of inactivity, but this just pisses everyone off as they have to log in 50 times per shift. I suggest that we force each user to choose a picture from a palette of pictures, each user assigned to a unique picture. That picture, for example a blue bear or a mauve mushroom, appears in the toolbar at all times. After a few weeks, the mauve mushroom in Matt’s toolbar becomes invisible to Matt, but when he accidentally sits down at a computer logged in as Bob, Matt’s mauve mushroom is now Bob blue bear, and that difference will scream at him (though he may not know it) and he will immediately recognize he sat down in the wrong chair. Error reduction through fun pictures.

valentine’s day

[written in February 2001]

[names have been changed]

Sarah Goldstein was in my high school class and is now a year in front of me here [in med school]. She recently got married thank god and is now Sarah Steingold. During her second year, she started the Southwestern Jewish Alliance, which is now defunct. That same year she served as the editor of The Murmur, a quarterly newspaper designed to serve as a humorous outlet for medical students. At that time I had just moved to Dallas, and submitted a witty and intelligent criticism of the first week of medical school that she, without asking me, modified before including it in the paper. She expunged all the funny spicy parts and replaced them with hackneyed jokes, and introduced GRAMMATICAL MISTAKES. I sent her an email she probably never received because her internet-watch software picked up all the curse words and deleted the message before it got to her unblemished eyes.

This morning, she made everyone on the medicine 2a team (eight of us) brownies for valentine’s day. Later on in the morning I asked her what she was doing with her husband to celebrate the occasion and she told me with a self-satisfied look that she does not celebrate valentine’s day. I took the bait and asked why. Though I was blinded by the light reflecting off the Hebrew letters on her necklace that spell her name, I am sure she gave me a look of disgust as she said, “It’s Saint Valentine’s day, Reuben.”

An hour later I was waiting with Sarah, another student, and two residents as several members of the team were visiting a patient with tuberculosis. Somehow the hospital hallway conversation made its way to hot dogs and Dr. Vorth mentioned that though he is not jewish he has always eaten Hebrew National hot dogs. Sarah quickly pointed out that Hebrew National hot dogs are in fact not kosher. I should have known better, but I told her that they are widely consumed in kosher households, presumably because they say “kosher” on the package. She replied by telling me that Hebrew National has numerous documented instances of Kashrut violations and that no one who really keeps Kosher would allow anything made by Hebrew National into their home. It has been years since I have felt the masturbatory condescending slobber of this type of orthodox jew, and I should have known better, but I told her that everyone keeps kosher in their own way. To this she replied, with arms flailing, that you can not be pregnant in your own way, that you either keep kosher or you don’t.

When considering how to strangle someone, I recommend the Littmann Cardiology III stethoscope. Its single-shaft design won’t get caught up in your victim’s hair, and the diaphragm serves as a great handle for extra leverage. It’s the perfect length for most necks, and, when you’re finished, you can use it to confidently verify the absence of breath sounds.