Comments on: Cutting Off the Long Tail http://sufficientscruples.com/blog/2006/08/08/349/ Bioethics, healthcare policy, and related issues. Tue, 07 Feb 2012 04:49:07 +0000 hourly 1 http://wordpress.org/?v=3.3.1 By: DB’s Medical Rants » Blog Archive » Long tail, practice time, education time http://sufficientscruples.com/blog/2006/08/08/349/comment-page-1/#comment-14029 DB’s Medical Rants » Blog Archive » Long tail, practice time, education time Thu, 10 Aug 2006 14:31:26 +0000 http://sufficientscruples.com/blog/2006/08/08/349/#comment-14029 [...] Our challenge, as physicians, is to know when we no longer reside in the “short head” of the above curve, i.e., when we have to consider the “long tail”. I believe that long tail excellence requires two factors, adequate time for thinking and adequate time for learning. Earlier this week, another blog commented on this problem - Cutting Off the Long Tail. The author wondered whether: The problem with long-tail events is that they are difficult or impossible to prepare for. Assuming these are the sorts of things that require prepration and training (for instance, studying up on medical diagnoses and stockpiling supplies to treat them - as opposed to merely stocking books in a bookstore which any clerk can then sell) you can’t make ready for all possible long-tail events because there are simply too many possible ones, of which only a few will actually occur to you personally. Doctors must concentrate on the diagnoses they are likely to see; it is humanly impossible for them to learn everything necessary about every possible one they could see. (There is a line in William Nolen’s celebrated The Making of a Surgeon in which he comes out with some obscure diagnosis for a difficult case, and the attending physician tells him “Learn all you can about appendicitis, Nolen, and leave the dum-dum fever to the experts.”) [...] [...] Our challenge, as physicians, is to know when we no longer reside in the “short head” of the above curve, i.e., when we have to consider the “long tail”. I believe that long tail excellence requires two factors, adequate time for thinking and adequate time for learning. Earlier this week, another blog commented on this problem – Cutting Off the Long Tail. The author wondered whether: The problem with long-tail events is that they are difficult or impossible to prepare for. Assuming these are the sorts of things that require prepration and training (for instance, studying up on medical diagnoses and stockpiling supplies to treat them – as opposed to merely stocking books in a bookstore which any clerk can then sell) you can’t make ready for all possible long-tail events because there are simply too many possible ones, of which only a few will actually occur to you personally. Doctors must concentrate on the diagnoses they are likely to see; it is humanly impossible for them to learn everything necessary about every possible one they could see. (There is a line in William Nolen’s celebrated The Making of a Surgeon in which he comes out with some obscure diagnosis for a difficult case, and the attending physician tells him “Learn all you can about appendicitis, Nolen, and leave the dum-dum fever to the experts.”) [...]

]]> By: Dan http://sufficientscruples.com/blog/2006/08/08/349/comment-page-1/#comment-13976 Dan Thu, 10 Aug 2006 05:33:26 +0000 http://sufficientscruples.com/blog/2006/08/08/349/#comment-13976 This seems to pertain directly to your last post about disabilities: Blue, and more pointedly Ballastexistenz, are showing that normals operate in everyday life by observing a few salient features and operating on the assuption that the usual case that fits those features is the correct one. In the case of somebody in a wheel chair, the salient features are a passable guide to behavior (duh, they can't walk), but in the case of a mental deficiency, particularly an emotional one, the salient features turn out to be a fairly poor guide to behavior (Somebody who shows no sympathy to human feeling can be modelled either as (a) incapable of detecting data that's obvious to others or (b) not valuing other humans as people.) Ballastexistenz goes on at some length to explain that others do a very poor job of modelling her mental structure. Surely, this is an indication that her mental structure is very unusual, not that several thousand years of evolution have been bad at matching typcial human mental hardware to... typical human mental hardware. Blue's commentor That Girl notes quite correctly that a perceptible problem is much easier for the observer to handle, since the observer can then actually react to the problem meaningfully. Perhaps now that the handicapped are no longer being institutionalized so much, the average person will have the same dilemma as what you describe here: the modal case is not the mean case, and poor performance is the mathematical requirement. This seems to pertain directly to your last post about disabilities: Blue, and more pointedly Ballastexistenz, are showing that normals operate in everyday life by observing a few salient features and operating on the assuption that the usual case that fits those features is the correct one.

In the case of somebody in a wheel chair, the salient features are a passable guide to behavior (duh, they can’t walk), but in the case of a mental deficiency, particularly an emotional one, the salient features turn out to be a fairly poor guide to behavior (Somebody who shows no sympathy to human feeling can be modelled either as (a) incapable of detecting data that’s obvious to others or (b) not valuing other humans as people.)

Ballastexistenz goes on at some length to explain that others do a very poor job of modelling her mental structure. Surely, this is an indication that her mental structure is very unusual, not that several thousand years of evolution have been bad at matching typcial human mental hardware to… typical human mental hardware.

Blue’s commentor That Girl notes quite correctly that a perceptible problem is much easier for the observer to handle, since the observer can then actually react to the problem meaningfully. Perhaps now that the handicapped are no longer being institutionalized so much, the average person will have the same dilemma as what you describe here: the modal case is not the mean case, and poor performance is the mathematical requirement.

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