Hooked by Nir Eyal

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The step by step approach to get people addicted to your product!

We’ve all done it.  We’ve all been dead set on getting down to work, but then end up watching random cat videos on YouTube, or ended up looking at random pictures on Pinterest for hours on end.

This book is precisely about that.  It reveals the techniques that some successful companies use to get us addicted and keep us coming back for more.

I won’t go into the techniques used too much as I want you to get and read the book yourselves!  However it can be summarised with a pretty basic flowchart:

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The four steps to hook users

Essentially, there are four steps.  Triggering (for example your phone vibrating or ringing), users taking action (opening emails or liking photos etc.), getting rewarded (people liking your comments, viewing your content), investing (giving companies data such as your personal information or uploading content).

Yes, hooking is basically synonymous with manipulation or getting people addicted to your product.  As much as the author, Nir Eyal  espouses that this information should be used for the good of mankind, I am sure people will use this information for the exact opposite reason and to make a quick buck.  However, even if you disagree with a step by step guide to hooking/manipulating people I think it’s pretty important to be aware of how you are likely being manipulated already.  At least if you are aware of this then you can choose to continue in your habits, break free or consciously take part.

The problem is that the hooked model is just so damned effective because of what Nir calls “internal triggers”.

One of the “internal triggers” that seems to motivate people the most are negative emotions.  For example studies have shown that depressed people tend to use Facebook much more than others.  It’s our fear of missing out that keeps us checking that Twitter feed.  We keep checking our e-mails because we’re worried that something has happened at work.

Personally I found the psychological implications and insights much more eye opening than what techniques large companies use to keep us using their products, as I think most people out there have already guessed that corporations have invested large amounts of money and research into making sure we keep using what they’re selling.  It’s just a very powerful reminder on how primal human beings really are and how our fear of scarcity, failure, rejection etc. motivate us to literally spend hours everyday with technology.

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Decoding the DNA of the Entrepreneur

I don’t know about you, but I always envisioned entrepreneurs to be these kind of lone warriors – total outlaws who have carved their own path with their innate genius and sheer force of will.

Richard Branson’s first successful business was his magazine business at age 18.

Mark Zuckerberg started Facebook at age 20.

Bill Gates dropped out of Harvard to start Microsoft.

It seems that every so often we come across yet another story of a teenager becoming a billionaire overnight.  But are these guys the norm?  Or are they outliers?  Could it be that their stories are so infamous purely due to how unusual their journeys have actually been?  In the world of medicine anecdotes and hearsay just don’t cut it.  So what does the actual evidence say?

I recently came across a report by Ernst & Young from 2011 which looked at 685 successful entrepreneurs.  The report shatters many widely misheld beliefs with regards to what actually goes into making an entrepreneur successful!

In reality most entrepreneurs go to higher education.  Most spend time working for an organisation before “transitioning” to becoming their own boss.  One third actually start their first venture in their 30’s!

 

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What entrepreneurs really attribute their success to

It seems that in reality most of the things that people think would hold them back is exactly what’s going to give them the know-how and connections to be really successful.  It’s likely that the only thing holding most people back is their own mind-set and drive, which the report also touches upon.

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The mind-set of a successful entrepreneur

I highly recommend reading the full report.  It sheds a lot of light on what actually goes into becoming a successful entrepreneur.

Linchpin by Seth Godin

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Are you a linchpin?  Or are you listening to you lizard brain and are part of the crowd?

This is an excellent book which I highly recommend – especially for people who are stuck in a rut and not satisfied with their life/career and where it is going.   Not only is it for those people, but it’s a wake up call to everyone who is stuck in the comfort zone.

As a doctor I believe I am in one of the “safest” professions – as in I am not easily replaceable.  If I go off sick then patients may come to serious harm.  When I become a senior physician I will be a named physician for my patients and will often have to accept sole responsibility for their wellbeing.

Why is it then that I have an uneasy feeling about being your run of the mill senior physician and about the future prospects of my career?

It’s because times are changing.  People can no longer expect to go to school, college and University and gain an education that will last them a life time.  I simply can’t believe how the doctors who are near to retirement age right now have managed to get through their whole career without hardly learning anything new.

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The fact is that the world is changing at such a rate that people will have to more and more reinvent themselves in very short time frames.  The large companies that used to employ us are all collapsing because there’s a “second industrial revolution” going on right now with the internet and low cost technologies.

People can no longer expect to be employed by a large organisation and get that 401K and gold watch at retirement.  More and more, we will be independent workers, workers in small organisations and if you are not a linchpin  – that is, if you are not causing a ruckus, not trying to strive to be better and offer some real value to the word in your own unique, weird and wonderful way – then you’ll be in trouble.

NHS Health Innovation & Meeting Professor Tony Young!!! :)

People that know me know that I’m always thinking and talking about the future of healthcare and what it may look like.

The thing that excites me about technology and innovation is how whole industries have been completely disrupted in recent times.

The internet has put dozens of companies out of business.  Amazon for example has been blamed for eating into Waterstones sales of books.  Uber is completely disrupting taxi services on a worldwide scale.  Online news outlets such as the Huffington Post have been blamed for the recent demise of The Independent physical newspaper in the UK.  The list is really endless.

But how about healthcare?  Could certain technologies disrupt the whole system as it is?

My father leant medicine in 1960’s Calcutta.  I find it hilarious that what he did as a Junior doctor in the 60’s and 70’s is largely the same as what I do as a Junior Doctor in 2016!  When we talk about medicine we talk about exactly the same experiences as one another and the same ways of diagnosing and managing patients.

Medicine is arguably one of the most important fields in the world to be working in and yet it seems to be progressing at a snails pace when compared to many other industries.

There are certain people in England that have the vision to see what the future of medicine is going to be like.  I had the pleasure of attending a lecture by Professor Tony Young in Chelmsford, Essex recently.  He is the NHS lead for Innovation and is also in charge of the Clinical Entrepreneurship programme for the NHS (which encourages innovation and the application of novel technologies to improve patient care).

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Me looking very happy at the lecture!

I have been a massive fan of Professor Young’s for a while now – often reading his twitter feed on lunch breaks and watching his YouTube videos after work.  His talks and lectures simply resonate with me and I find it a breath of fresh air to hear someone talk about innovations that can really disrupt how we do things and bring technologies to the fore that are going to change the world forever!

His lecture blew my mind, because there’s so much cool stuff out there already! Software that can detect if your heart failure has gotten worse just by hearing your voice on your phone! Technology that looks at blood test results already available on any hospital computer server and can predict the likelihood of colorectal cancer (and has been shown to be far more accurate than the faecal occult blood test currently used for screening in the UK)!  How about a piece of software that looks at CT scan results and looks at bone density to diagnose osteoporosis and prevent fractured neck of femurs!!!!!  This is cool stuff which is already available!  Why are we not using this stuff??!

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Me (looking shiny for some reason) and The Man himself – Professor Tony Young!

Anyone that doesn’t see that healthcare is going to be massively disrupted in this age of exponential innovation is mad.  Unfortunately in my anecdotal experience it is the doctors and other allied healthcare professionals that are the ones that do not see this.  The public are crying out for this stuff.  Like it or not things will change and I for one am glad because as the Prof pointed out – even the doctors bag has hardly changed in over a hundred years!!  It’s time for a change!

First They Tell You What to Think, Then They Tell You What to Say

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I got mad consultation skillz

It happened the other day.  I felt like I was sat amongst cyborgs sent from the future – trained to diagnose and investigate.  Lean mean treating machines.

Not many patients realise this, but primary care physicians are trained to communicate with their patients in a very specific way.  We are trained to ask the same things, trained to think the same way and trained to always seem sympathetic even to patients who are incredibly rude.

This is what a typical (fake) consultation (that we are trained to deal with by our training scheme) goes like:


 

Doctor (D): “Hello Mr Smith, what has brought you to the surgery today?”

Mr Smith (MrS): “Well it’s a bit embarrassing, but I have a lump on my, how do you say….meat and two veg…”

D: “Oh dear, I’m so sorry to hear that.  Have you had any ideas as to what this may be?”

MrS:”Well, I’m not sure…..but it’s not normal is it?”

D: ” I see, but do you have any concerns as to why you have a lumpy…..vegetable?”

MrS: “Well now that you mention it doctor, my mothers butchers best friend died a hideous death due to testicular cancer last week.  Now I think I am going to die too.”

D: “Is there anything in particular you were expecting me to do for you today?”

MrS: “I would like an ultrasound please! :)) ”

D: “No problem!  By the way how has this affected your personal life?”

MrS: “Well, now that you mention it, my part time job is as a male stripper.  My very particular clientele have started to notice.”

D: “Oh dear.  Well let me order that scan for you.  By the way if your meat and veg turn black, or drop off suddenly then please seek urgent medical advice.  Cheerio.”

MrS: “Oh Doctor Chowdhury you really are my hero!”


 

The whole consultation model above is predicated on finding out the patients Ideas, Concerns and Expectations.  Theoretically it’s actually quite a good way of approaching a patient, especially since primary care doctors in the UK have a ten minute time limit per patient.  So a way to address the patients concerns as well as extracting medically relevant data to create a management plan seems great.  Unfortunately in the real world the consultation goes more like this:


 

Doctor (D): “Hello Mr Smith, what has brought you to the surgery today?”

Mr Smith (MrS): “I have a lump on my willy!”

D: “Oh dear, I’m so sorry to hear that.  Have you had any ideas as to what this may be?”

MrS:”What?!  You’re the doctor aren’t you?!”

D: ” I see, but do you have any major concerns about this situation?”

MrS: “Huh??!  I already said!  I have a lump on my manhood!!!  Wouldn’t you be concerned?!”

D: “Is there anything in particular you were expecting me to do for you today?”

MrS: “To get rid of this damn lump!!”

D: “No problem!  By the way how has this affected your personal life?”

MrS: “Well, that’s none of your effing business!”

D: “Oh, alright, well I’ll order a scan for you and will see you again in a couple of weeks with the results.”

MrS: “Can I book in with another doctor?  Because you don’t seem to have a clue what you’re doing…..”


 

I’m pretty sure that every GP trainee in the country can relate to this scenario.  I find it amusing that the way we are assessed is by sitting through fake consultations which frankly bare little resemblance to the real world.  Wouldn’t it make more sense to be supervised by trained professionals and if there are any concerns in your day to day job (by the end of which you will have seen hundreds of patients), then these issues can be raised rather than to sit through an exam which costs 1,500 pounds and is arguably biased against Black and Ethnic Minority trainees.

Dr Ramesh Mehta, the President of BAPIO legally challenged the Royal College of General Practitioners on this issue.  The final post graduate exams were then asked to be reformed but the outcomes for Black and Ethnic Minorities are still the same.  (Please see this recent fantastic article by PulseToday: Click Me!).  Dr Mehta believes that the high failure rate need not exist and many capable doctors are being failed at a time when the UK is in a desperate needs for GPs.

In my humble opinion it’s not hard to see why doctors who were not born and raised in the UK would fail scenarios like the ones above.  They already are speaking in a language which is not their first and then they are being forced to communicate in a way which is not even natural or coherent for most native English speakers.  Really, it’s about time we start assessing doctors on their knowledge and real world ability to do the job isn’t it?

 

Doctor Informed

“Hi, this is the biochemist.  A midwife took a blood test from a new born baby earlier today and I know it’s 3am and that I have no idea how to interpret the results, but I’ve told you now, so you can sort it out.”

………Looks on the blood results server “Dr Chowdhury informed of results 3AM”.

“Oh Hi-ya!  I’m the nurse up on ward 30.  I’ve given a patient tomorrow’s oral dose of antibiotics by accident…..so they’ve had their IV dose today as well as their dose for tomorrow….is that ok?  No?   Well what are you going to do about it?”

………Reads nursing notes.  On call doctor informed of drug error.

“No I can’t wait for three minutes until this patient finishes his breakfast.  You’ll just have to take the blood test yourself later.” – Every phlebotomist in the country ever.

“No I won’t be able to fax this referral for you, because I’m too busy to do anything you ever ask me for”

“I’m on my break….so…no”

“Sorry, I have to work in order of my list.  I can’t do that urgent ECG on the patient with chest pain next, because of the list!  You’ll just have to do it yourself.”

“Please can you come and see this patient in the nursing home.  He had a little tumble and is fine, but we want a medical assessment.”


 

Yep you might be able to tell that I’ve just finished another weekend on call at the hospital.

The amount of responsibility that gets placed on doctors nowadays can be very overwhelming a lot of the time.  I don’t think any doctor minds the responsibility, but it really gets to me when people do not use their own common sense and professional skills to assess a patient and really consider whether a doctor really needs to get involved.

It could be one of the many reasons so many doctors are disillusioned by their career – all the bureaucracy, paper work and box ticking can really take its toll over time.

How to Lose Weight

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Obligatory fat person photo

Introduction

I’ve had loads of people ask me how to lose weight.  With one quarter of adults in the UK being classified as obese it is not surprising that people all over the country are looking for realistic methods of weight loss.

In my experience the public generally have a very poor understanding of nutrition and exercise.  Also in my experience, doctors have a very poor understanding of realistic, implementable methods of weight loss for their patients.  From what I have seen a lot of doctors understand the theory and how the body actually works, but do not know what to recommend for their patients.

One of the reasons for this difficulty is that everyone is different, in so far as their preferences to food choices, activity levels, co-morbidities, peer group, employment etc etc.

I hope that the following blog entry will help a few people out.

The Only Way to Lose Weight

The only method of losing weight, that has been proven in study after study is to sustain a caloric deficit.  That is, that the total number of calories that you burn in a day should be more than you consume in a day.

Most fad diets (low carb, gluten free when not suffering from Coeliac’s Disease etc.) work as they produce a calorie deficit.  However, these fad diets are not sustainable and most people fall of the band wagon after a little while gaining back their weight.*

Caloric Deficit ≠ Eating Less

Let me say that again.  Eating a caloric deficit does not mean that you have to eat less food!

This is where most people mess up.

Let’s take a quick example.  Let’s say that you have the inkling for a McDonalds Big Mac menu with a diet Coke.  According to their calorie calculator this would come to a total of 845 calories.

Now let’s say the following night you feel like eating a home cooked Chicken Parmesan with some beans, an avocado, a boiled egg and a side of green leaf salad.  This meal would come to a total of around 900 calories.

The second meal option has pretty much the same number of calories as the McDonalds however, the total volume of food is much greater in the second meal option.  Arguably the second meal option is also all around healthier as it would be full of healthy fats, a balanced amount of carbohydrates and a decent amount of protein as well.

How to Eat More and Eat a Caloric Deficit

So here are the key points on how to eat more food and still be in a caloric deficit:

  1. Pick single ingredient foods

If you can look at your plate and name each component just by looking then you’re most likely eating nutritionally dense, low calorie foods

2.  Protein fills you up

Protein is the most satiating macronutrient and will keep you full.  When trying to stay in a deficit it is important to pick good sources of protein – chicken, beans, fish, whey protein, eggs etc.

How to Calculate Your Caloric Intake

Use an online calculator.  For a quick guide here are a few pictures from a well known home workout programme to help you:

 

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Outro

This is essentially all you need to know.  In the future I will post more on how to create a diet that you can enjoy and can stick to which will help you lose weight/maintain weight.

*One point to note is that eating carbohydrates causes your body to retain water.  Quickly moving over to a low carb diet can produce a quick reduction on the number on your scale, however as soon as you eat some carbs the number will go up again.  This is quite clearly not fat loss, but a lot of people end up claiming impossible weight loss results due to this reason.