“Working here makes us better humans”

A daily thought from Leandro Herrero:

I have had a brilliant two day meeting with a brilliant client. One aspect of my
work with organizations that I truly enjoy is to help craft the ‘Behavioural DNA’ that shapes the culture of the company. This is a set of actionable behaviours that must be universal, from the CEO to the MRO (Mail Room Officer). They also need to pass the ‘new hire test’: would you put that list in front of a prospect employee and say ‘This is us’?

There was one ‘aspirational’ sentence that I put to the test: ‘Working here makes us better human beings’.

It was met with scepticism by the large group in the meeting, initially mainly manifested through body language including the, difficult to describe, cynical smiles. The rationalists in the group jumped in hard to ‘corporatize’ the sentence. ‘Do you mean better professionals?’ The long discussion had started. Or, perhaps, ‘do you mean…’ – and here the full blown corporate Academy of Language – from anything to do with skills, talent management, empowerment to being better managers, being better leaders, and so on.

‘No, I mean better human beings. Period!’- I pushed back. Silence.

Next stage was the litany of adjectives coming form the collective mental thesaurus: fluffy, fuzzy, soft, vague…

I felt compelled to reframe the question: ‘OK, so who is against working in a place that makes you inhuman? Everybody. OK, ‘ So who is against working in a place that makes you more human? Nobody. But still the defensive smiling.

It went on for a while until the group, ‘organically’, by the collective hearing of pros and cons, turned 180 degrees until everybody agreed that ‘Working in a place that makes you a better human being’ was actually very neat. But – there was a but – ‘Our leadership team wont like it. They will say that its fluffy, fuzzy, soft etc… In the words of the group, it was not ‘them’ anymore who had a problem, it was the infamous ‘they’.

The “difficult to describe” cynical smiles are familiar…. indeed I am sure I have perpetrated such smiles more than once myself!

Medicine can be a dehumanising profession, sometimes literally. Dehumanising in both ways – patients, especially some categories of patient, colleagues, but also we ourselves. Of course, the rationalist part of us can pick apart what “better humans” means…


Marcus Aurelius: reflection good enough for an emperor but is it good enough for medicine?

Sati Heer-Stavert very kindly asked my permission to link to the paper I wrote a while back on Marcus Aurelius, stoicism and reflective practice – here is the post that has resulted which I am very impressed by! Certainly Sati has provided an excellent framework to prompt students and learners to reflect on what reflection means and what the obstacles to it are….


Reflection is an important part of training, appraisal and revalidation for doctors based in the UK. However, for many doctors the very thought of reflection can cause feelings of frustration, non-engagement or even rejection. Where did we go wrong?

Learning objectives

1. Consider the definition of reflection used in medicine

2. Understand how reflection can be assessed

3. Encourage you to read Meditations by Marcus Aurelius

Oh no! A patient has complained about your refusal to supply antibiotics for a cold. Wow! This would make a really good entry in your learning portfolio:

“That men of a certain type should behave as they do is inevitable. To wish it otherwise were to wish the fig-tree would not yield its juice. In any case, remember that in a very little while both you and he will be dead, and your very names will quickly be forgotten.”

You have to respond to…

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In Space, No One Can Hear You Snore

Amazon Alexa informed me, as one of its “crazy facts” available on request, that astronauts do not snore because in zero gravity their airways do not collapse.

Sounds good, and plausible, but is it true? I decided to fact check Crazy Fact on this. And obviously one factchecks Alexa via Google.

First port of call was this 2008 piece, which informed me that :

Research on two space flights found some interesting sleep statistics. A 2001 study [1] conducted found that five astronauts actually stopped snoring completely while in space. As well, some who had suffered episodes of stopping breathing, called sleep apnea, had none when they were in space.

This was a breakthrough. They had proveN that gravity was indeed necessary to constrict the airflow, aggravate the throat and cause the vibrations along the soft palate and uvula. No gravity made it easier to breathe. Oddly they also learned that astronauts sleep fewer hours and use sleeps medications to assist them in sleeping.

An earlier study was done in 1998 aboard the shuttle Columbia to see how astronauts sleep in the artificial environment of a space shuttle. The result surprised many scientists and sleep specialists when microphones picked up snores from the crew. They were surprised because the feeling was that astronauts likely breathed less.

This led me to David Dinges who has the cool title “chief of the division of Sleep and Chronobiology and director of the Unit for Experimental Psychiatry in the Perelman School of Medicine at the University of Pennsylvania” and this 2001 editorial from the American Journal of Respiratory and Critical Care Medicine:

An excellent example of the latter outcome
is the investigation by Elliott and colleagues in this issue
of the American Journal of Respiratory and Critical Care Medicine
(pp. 478–485) (1). They recorded respiration and sleep
physiology in healthy astronauts during two National Aeronautics
and Space Administration (NASA) space shuttle flights
and compared these recordings to those made when subjects
were Earth-bound before and after flight. They found that microgravity
was associated with marked reductions in sleep-disordered
breathing, in time spent snoring, in arousals during
sleep, in respiratory rate during presleep waking, and in heart
rate during both presleep waking and slow wave sleep. The results
highlight not only the relative importance of gravity in
ventilatory mechanics during sleep, but also reveal that within
physically fit subjects there is a covariation between upper airway
resistance, snoring, and the likelihood of respiratoryrelated
arousals during sleep. It suggests Earth’s gravity has a
key role both in upper airway resistance and obstruction, and
in the relationship of these factors to arousals during sleep

So next to the paper “Microgravity Reduces Sleep Disorder Breathing in Humans” by Elliot and colleagues in that journal. Abstract:

To understand the factors that alter sleep quality in space, we
studied the effect of spaceflight on sleep-disordered breathing.
We analyzed 77 8-h, full polysomnographic recordings (PSGs)
from five healthy subjects before spaceflight, on four occasions
per subject during either a 16- or 9-d space shuttle mission and
shortly after return to earth. Microgravity was associated with a
55% reduction in the apnea–hypopnea index (AHI), which decreased
from a preflight value of 8.3 1.6 to 3.4 0.8 events/h
inflight. This reduction in AHI was accompanied by a virtual elimination
of snoring, which fell from 16.5 3.0% of total sleep time
preflight to 0.7 0.5% inflight. Electroencephalogram (EEG)
arousals also decreased in microgravity (by 19%), and this decrease
was almost entirely a consequence of the reduction in respiratory-related
arousals, which fell from 5.5 1.2 arousals/h
preflight to 1.8 0.6 inflight. Postflight there was a return to near
or slightly above preflight levels in these variables. We conclude
that sleep quality during spaceflight is not degraded by sleep-disordered
breathing. This is the first direct demonstration that gravity
plays a dominant role in the generation of apneas, hypopneas,
and snoring in healthy subjects.


All five subjects in this study showed some degree of snoring
from mild to moderate during preflight PSGs. Time spent
snoring ranged from 2.8 to 32.6% of the total sleep time. In
microgravity, snoring was almost completely eliminated in all
subjects. Importantly, the change in snoring habits of this
group correlated well with the changes in the number of respiratory
events per sleep period both on the ground and in space
(Figure 3). The correlation between snoring and AHI suggests
that the hypopneas were likely obstructive as opposed to central
in nature.

So truly, in space no one can hear you snore.

Presentation by Pedro de Bruyckere: Urban Myths about Learning and Technology

An excellent presentation by Pedro De Bruyckere, co author of the recent paper on the myth of the digital native I blogged about before… “I believe in education, I believe in teachers… but do I believe in technology in education? It depends”

Obviously these are slides which can’t compete with the real thing and clearly Pedro de Bruyckere has a rich sense of humour!

From experience to meaning...

This is the presentation I gave at the National ResearchED conference, September 9 2017. The presentation is in part based on our book Urban Myths about Learning and Education and in part based on the recent article I co-wrote with Paul Kirschner published in Teaching and Teacher Education (yes the one that was mentioned in Nature).

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The myth of the misplaced decimal point: Very interesting presentation by Christian Bokhove: “This is the new m*th!”

I am aware of the irony of posting based on the slides here alone and not on the context of the presentation as a whole! This from Christian Bokhove from the University of Southampton is excellent on the various myths that can arise in science, education and technology … but also their at times equally mythical rebuttals! For instance, the persistent belief that spinach is an excellent source of iron is a myth… but so is the persistent claim that the myth arose because of a misplaced decimal point. There is also a slide on the claim that papers/articles featuring neuroimages are judged more favourably than those without…     a myth (or rather selective selection of it-seems-true evidence?)  I am afraid I may have helped perpetuate :


In 2007, Colorado State University’s McCabe and Castel published research indicating that undergraduates, presented with brief articles summarising fictional neuroscience research (and which made claims unsupported by the fictional evidence presented) rated articles that were illustrated by brain imaging as more scientifically credible than those illustrated by bar graphs, a topographical map of brain activation, or no image at all. Taken with the Bennett paper, this illustrates one of the perils of neuroimaging research, especially when it enters the wider media; the social credibility is high, despite the methodological challenges.

From experience to meaning...

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“a tendency to overhype fixes that later turn out to be complete turkeys”

An interesting passage on the contemporary dynamics of the quick fix, from “The Slow Fix: Solve Problems, Work Smarter and Live Better in a Fast World” by Carl Honore:

“The media add fuel to that fire. When anything goes wrong – in politics, business, a celebrity relationship – journalists pounce, dissecting the crisis with glee and demanding an instant remedy. When golfer Tiger Woods was outed as a serial philanderer, he vanished from the public eye for three months before finally breaking his silence to issue a mea culpa and announce he was in therapy for sex addiction. How did the media react to being made to wait that long? With fury and indignation. The worst sin for a public figure on the ropes is to fail to serve up an instant exit strategy.

“That impatience fuels a tendency to overhype fixes that later turn out to be complete turkeys. An engineer by training, Marco Petruzzi worked as a globetrotting management consultant for 15 years before abandoning the corporate world to build better schools for the poor in the United States. We will meet him again later in the book, but for now consider his attack on our culture of hot air. ‘In the past, hard-working entrepreneurs developed amazing stuff over time, and they did it, they didn’t just talk about it, they did it,’ he says. ‘We live in a world now where talk is cheap and bold ideas can create massive wealth without ever having to deliver. There are multi-billionaires out there who never did anything but capture the investment cycle and the spin cycle at the right moment, which just reinforces a culture where people don’t want to put in the time and effort to come up with real and lasting solutions to problems. Because if they play their cards right, and don’t worry about the future, they can get instant financial returns’

The curse of the quick fix

I’ve been reading Simon Garfield’s wonderful book Timekeepers: How The World Became Obsessed With Time. It is a fascinating set of narratives on the modern relationship with time. Towards the end, it slightly turns into a series of lists of conceptual art pieces that sound less Deeply Meaningful than Garfield makes out (oddly reminiscent of Evgeny Morozov’s To Solve Everything Click Here in this regard) and occasionally some of his more jokey passages grate, but most of the time (ho ho) it is a book that makes one see the taken-for-granted of the modern world for what it is. There are very funny passages on time management self-help books and on the world of haut horologie, and extremely thought-provoking ones on our time-poor age (or is it a perception? One of the time management gurus is actually wisest on this…)

Anyway a passage which struck me as especially germane to medicine, health care in general, and health IT in particular was the following – which is actually Garfield citing another author, but there you go:

And can any of these books really help us in these decisions? Can even the most cogently aligned bullet point and quadrant matrix transform a hard-wired mind? The notion of saving four hours every ten minutes is challenged by The Slow Fix: Why Quick Fixes Don’t Work by Carl Honoré. The book set its tone with an epigram from Othello: ‘How poor are they who have not patience! What wound did ever heal but by degrees?’6

The quick fix has its place, Honoré argues – the Heimlich manoeuvre, the duct tape and cardboard solution from Houston that gets the astronauts home in Apollo 13 – but the temporal management of one’s life is not one of them. He reasons that too much of our world runs on unrealistic ambitions and shabby behaviour: a bikini body within a fortnight, a TED talk that will change the world, the football manager sacked after two months of bad results. [<a href=”https://www.ted.com/talks/carl_honore_praises_slowness”>Honoré himself has nevertheless done a TED Talk – SS]

He cites examples of rushed and dismal failings from manufacturing (Toyota’s failure to deal with a problem with a proper solution that might have prevented the recall of 10 million cars) and from war and diplomacy (military involvement in Iraq). And then there is medicine and healthcare, and the mistaken belief – held too often by the media and initially the Bill and Melinda Gates foundation – that a magic bullet could cure the big diseases if only we worked faster and smarter and pumped in more cash. Honoré mentions malaria, and the vague but quaint story of a phalanx of IT wizards showing up at the Geneva headquarters of the World Health Organisation with a mission to eradicate malaria and other tropical diseases. When he visited he found the offices somewhat at odds with those of Palo Alto (ceiling fans and grey filing cabinets, no one on a Segway). ‘The tech guys arrived with their laptops and said, “Give us the data and the maps and we’ll fix this for you.”’ Honoré quotes one long-term WHO researcher, Pierre Boucher, saying. ‘And I just thought, “Will you now?” Tropical diseases are an immensely complex problem . . . Eventually they left and we never heard from them again.’”

As my own practice has developed over the years, I have come to a realisation that quick fixes tend to unfix themselves over time, and the quick fix mentality carries a huge cost over time.

Here is Honoré’s TED Talk. Garfield has a very entertaining passage in the book where he talks at a rival of TED’s, which has a 17 minute limit (TED has an 18 minute one)