Gross and Net:

• No matter your income, you can judge a prospective purchase by how much work you would have to perform to buy it. Thoreau said “the price of anything is how much life you exchange for it.” 
• Well something you might not consider is the gross versus net issue. Imagine you want to buy something that costs three hours of work. Don’t forget that (depending on your tax bracket) you would have to actually work 4 or even 5 hours to bring home the gross amount required to buy that good or service. Not to mention the time spent driving. 
• With this in mind, you can see how much more efficient and powerful it is to not buy thingsthan to work more(saving versus increasing income). Not buying that 3 hour item is actually saving you 5 or 6 hours of your time. Think about this the next time you are making a not so essential purchase. 
• The exception is books. You should always buy books. Remember Erasmus: “When I get a little money I buy books, and if any is left, I buy food and clothes.”

Burn a Little More:

• Great pieceby Siddartha Mukherjee reflecting on burnout in medicine. He tells the stories of his anatomy group members from medical school. They seem to all be thriving in academics, possibly because they pursued “powerful, autonomous interests” in “peculiar medical niches.” 
• He covers the main causes of job dissatisfaction: lack of autonomy, lack of meaning, and in medicine, bureaucracy and paperwork, time at work, lack of respect. Something that typically increases satisfaction is development of mastery. The anatomy group members delved deeper, achieving mastery of their own little pieces of medicine. 
• Though he never mentions it, his “burning a little more” approach paints physicians as antifragile. Doctors can be like candles – extinguished by a little bit of wind. But if we become more resilient, we can be energized by the wind, like fire.  

Abiding:

• Somehow, no prior newsletter has referenced the movie The Big Lebowski. If you haven’t seen it, leave your room / family / surgical case right now and go watch it. A theater dud that years later became a cult classic, Lebowski has very dedicated fans around the world. Louisville, KY was home to the first Lebowski Fest in 2002. 
• If you don’t love the movie on the first time through, give it another shot, new stuff will come to light. If you don’t get the humor, then obviously you’re not a golfer. If you don’t even try, you are entering a world of pain. Am I wrong?
• Check out this interviewwith Jeff Bridges, John Goodman, and Steve Buschemi from last week, looking back on the movie after 20 years. Thanks Derrick Fowler for the recommendation.

Influence:

• Robert Cialdiniis a professor of marketing, business and psychology who studied (often undercover) the practices of “compliance professionals,” ie. people trying to sell us stuff. 
• First he explained the contrast principle. Whereby you might be more likely to buy something for $20 after being shown something that costs $100. 
• He broke the remaining tactics down into 6 main principles. Reciprocation. Commitment / Consistency. Social Proof. Liking. Authority. Scarcity. All of these tactics exploit the very human tendency to take cognitive short cuts to make decisions. 
• The Commitment / Consistency chapter had several interesting examples. One especially powerful one is the ubiquity of hazing / initiation rituals. Humans cannot seem to eradicate even the very cruel ones. One quote from researchers: “Persons who go through a great deal of trouble or pain to attain something tend to value it more highly.” Think of fraternities, boot camp, and of course medical school and residency. The end result could certainly be very valuable, but we tend to value the outcome state even higher if we worked hard to get it. The argument is that the loyalty that follows these rituals allows participants to remain consistent in the professed commitment. And people often value being consistent more being right (“flip-flopping” politicians).

Quote:

“Civilization advances by extending the number of operations we can perform without thinking about them.”

– Alfred North Whitehead