All posts by Peter

Learning Chinese as an ABC

This past summer, I took advantage of the two month gap between the end of medical school and the start of residency to do some serious vacationing, visiting family in Taiwan and sightseeing through Singapore and several cities in southern China. Leading up to this adventure, I spent some time beforehand – starting in the last year of med school – starting to learn Chinese.

I’m in a fairly common position for an American-born Chinese guy.  Growing up, we spoke Chinese at home, so I picked up a fair amount by osmosis – but only the sorts of things that parents would talk about with their kids in casual conversation – no curse words, no analysis of Warring-States era philosophical schools.  So I started out with a decent grasp of grammar and vocabulary, and the challenge was to go the next step and learn to read and write.  My informal goal was to be able to read at a grade-school level – the point where I could walk down a street and read signs, menus, and sitcom subtitles.

The vacation was a lot of fun, involving lots of sightseeing, catching up with relatives, and good food.  I also got plenty of opportunity to continue studying the language, and I found to my surprise that I had largely achieved my goals; I could get around town, order from menus, and even read simple books – and I’d gotten there with a minimal investment – studying Chinese about 15 minutes a day before my trip.  Along the way, I learned some valuable lessons and made some mistakes, and I wanted to share this experience for anyone else looking to pick up Chinese reading skills.

Use spaced repetition.

About a year before my trip, I sat down and tried to figure out what kind of study plan would make sense to try to accomplish my goal.  I realized that what my problem really boiled down to was matching characters to pronunciations and definitions – often, words that I already knew how to use in conversation.

I then realized that spaced repetition flashcards would be a great tool for this job.  I’ve been a fan of spaced repetition for a long time –  it forms a core component of my book Learning Medicine – and flashcard programs like Anki really shine when it comes to vocabulary learning.  The electronic flashcards would let me test myself for both reading (“here’s the character, what’s the definition?”) and writing (“here’s the definition and pronunciation; what’s the character?”), and the spacing algorithm could monitor my progress and ensure that I spent time on just the words I most needed to review.

I found a list of the 3,000 most commonly used Chinese characters and converted them into an Anki deck.  For each word, this deck contains a card showing the character and asking the definition, as well as a card showing the definition and asking how to write the character.  Paired with the touchscreen of a phone or tablet, this let me conveniently practice writing and recognizing characters.  I worked my way down the list, learning the characters for all the words I already knew how to use in conversation.  Starting several months in advance with a very leisurely schedule of 5-10 new words per day, I had almost a thousand characters under my belt before heading out.  I also created a card of a few thousand of the most commonly used words and phrases. I found this to be essential in a language so reliant on compound words, where single characters, such as 认, might mean to believe (认为), to be conscientious (认真), or to recognize (认识).

(Grab a sample of the deck here to get started, and the full decks are available for purchase here!)

Quick and dirty

In Chinese classes, they usually teach characters by having you learn a character, then write it out a dozen or so times.  This is a classic massed practice technique, and it makes sense in the classroom setting.  Having intensive training lets you lock in the words, and since your teacher can ensure that you’ll start seeing those words in your vocabulary lessons immediately, you have the spaced practice component as well.

Real life, however, isn’t as well organized as a vocabulary workbook.  You’ll be seeing street signs, magazines, TV subtitles, and more, and your goal is comprehension, not scoring 100 on a test.  There are statistics floating around about how if you learn the most common 200 characters you’ll be at 50% comprehension, but that’s a pretty misleading notion.  Yes, you’ll be able to recognize 50% of the characters in a sentence, but that doesn’t mean you’ll have a 50-50 chance of figuring out what it means.  Just imagine reading that previous sentence without knowing what “recognize,” “characters,” or “figuring out” mean – even small holes in a sentence – usually around the more difficult or specific vocabulary words – can kill your comprehension.  Getting over that hump – from understanding a few words but losing the gist, to understanding the gist but missing a character or two – is very important to making the most of immersion.

That means the breadth of your vocabulary is key.  It’s much better to have a general sense of the meanings of 1,000 characters than a superb grasp of 100.  So be aggressive about adding new words to your vocabulary.  Don’t worry if you have shaky or vague sense of what they mean – that’s what Anki and everyday immersion are for.

For similar reasons, speed is more important in the real world than it was in school.   In the real world, you don’t have more than a few seconds to read a sign or catch a subtitle, so when you’re out and about, it’s important to deliberately train the skill of reading fast, even at the expense of some precision.

Simplified or traditional: pick one

As you probably know, there are two Chinese writing systems.  Traditional Chinese characters are used in all pre-1949 writing and are still used in Taiwan and Hong Kong.  Simplified Chinese characters are used in mainland China and Singapore.  There are complicated linguistic arguments in favor of both systems, but in practice, just pick one system and stick to it.  If you’re going to a country (Taiwan, Hong Kong, some Chinatowns) where traditional characters are used, learn that; if you’ll be in a place where simplified characters (China, some other Chinatowns) are more common, go with simplified.

Transitioning between one system and another is doable but very tricky, especially for a beginner.  As with most languages, the transition from traditional to simplified characters applied a small number of definite rules, plus a lot of idiosyncratic decisions.  As a result, you can use the rules and mostly understand a sentence from the other writing system means, but it takes a fair bit of effort and there will be gaps in your knowledge.  My uncle, who lives in Taiwan, related that he once needed to consult a rare engineering textbook that was only available in simplified Chinese.  He managed to get through it, but it involved quite a bit of effort – like reading Chaucer.

My experience bore this out.  I’d focused on learning simplified Chinese in my studies, but part of my trip took me to Taiwan, where traditional Chinese ruled.  Here, I was much less adept; often I’d be puzzled by a character and look it up, only to find that it was simply the traditional version of a word I already knew.  This confusion effectively shrunk my vocabulary, which reduced my comprehension and hindered my progress.


There are a lot of apps that help in learning Chinese, but Pleco was the best I found.  It has an extensive dictionary that allows you to look up characters by writing them on a screen, as well as a cool OCR feature that lets you take a picture of something you want to read – a billboard or a printed page – and can identify the characters for you.  Either way, you can look up new words on the spot, and save them for later review – every word you see, even when you’re out and about, is a potential addition to your vocabulary.  This is a powerful way to build your vocabulary quickly.

“Respect your elders!”

One thing that I definitely got out of this experience was a new appreciation for my parents, and for immigrants in general.  Even with some reading ability, when you’re using a different language, every little task – from navigating the subway to ordering at a restaurant – is just a little bit trickier, and this burden definitely adds up over time.  And yet, at my age, my parents were able to make that transition and read and speak far better English than I speak Chinese.  On my desk I have a small stack of kid’s books that I’m slowly working through; at my age my father was reading grad school textbooks.  I may never get to that level of fluency, but if I get no other use out of my language-learning adventure, I can now really appreciate what a big hurdle that was.

The Subversiveness of Professionalism

This essay was the winner of the Andrew Puckett Essay Award at Duke University in 2014.

“I don’t know why everyone’s playing these silly games,” the man said, even before my preceptor and I walked into the room.  “I went to my surgeon and he said he wouldn’t operate unless I quit smoking.  What kind of treatment is that?”   Halfway through a busy surgery clinic, a patient like this was the last thing I wanted to see.  As he fidgeted and leaned forward in the chair, I could tell that he was exactly that sort of talkative patient that I still couldn’t figure out how to disengage from – at least, before I got a pocket lecture on the history of his illness, his parents’ health, and the nice old lady who comes by and looks after his dogs while he’s away at the hospital.

I was surprised to see my preceptor – who’d been all about efficiency earlier in the day – pull up a chair and level with the patient.  He explained clearly why his peripheral artery disease was uniquely sensitive to his smoking habit, and how surgery without any lifestyle change would have been useless to him.  In the end, the patient left not only satisfied but with a new resolve to quit smoking now that he understood its link with his disease.  When we got out, the preceptor remarked that we’d set ourselves back a good half hour on the clinic schedule.  “But in these situations, you have to do the right thing.”  I knew what he meant.  As a result of his decision, both he and the clinic staff would have to stay later.  But he turned around a patient who would otherwise inevitably lose control of his disease.  In the long run, this conversation with the patient was one of the most powerful prescriptions he could wield.  With a half-hour talk, he did more good for this patient than he could have in a whole afternoon in the OR.

A few weeks later, we had a lecture on professionalism in medicine.  Just as we were settling down into the gray seats in the auditorium, the speaker asked us for our own definitions of professionalism.  The answers were all over the place, from “being a team player” to “working hard,” – and the anodyne lecture did little to dispel our confusion.  As I existed I distinctly overheard someone guessing that professionalism simply meant whatever people wanted it to mean.  Yet as unsatisfying as I found the lecture’s exploration of the topic, I couldn’t agree with this cynical take.  I had seen, in that surgery clinic, a small example of what I admired most in medicine, and there had to be a foundation behind my preceptor’s stance.

So what was professionalism, really?  One way to approach a definition is to see what the opposite of professionalism is.  The obvious answer – the answer the lecturer would give – is that it’s sloppiness and indolence – various ways of not getting your work done.  But I don’t think that’s quite true; after all, those would be vices in any situation, not just in a job or a “profession.”  Instead, the true opposite of professionalism is being a company man.

A company man is someone who plays by the rules, who internalizes the values of his employer or the rewards system of the market and aspires to nothing greater than to play that game well.  It’s the kind of person – peaceable, flexible, capable – who can fit into any institution and make it grow.  Company men were what made it possible to build General Motors in the mid-1900s, and they’re what makes it possible to build large university health systems today.  Modern capitalism needs company men, and to be a company man is no bad thing.

But it’s a very different thing from being a professional.  A professional is someone who holds to values – whether the physician’s oath of Hippocrates or the lawyer’s reverence for the law – that transcend any other claims the world might have on him.  Professionals understand the system that surrounds their work, and are able to work with it, but do not let the needs of the institution displace their professional creed as their guiding value system.  And a profession is nothing more than a group of people who hold to a common creed.

It was a small act of professionalism that allowed my preceptor to spend the extra time it took to help that patient.  He may not have even consciously realized that he was making that choice – it may have been instinct by this point in his training.  But in that act was a small echo of the professionalism of Ignaz Semmelweis, who spent decades going above and beyond the call of duty to drastically reduce death in childbirth.  And of Barry Marshall, whose courageous self-experimentation overturned a century of dogma on the cause of stomach ulcers.  In the long journey from ignorance and folk medicine into the scientific medicine we practice today, every step was made possible only by an act of professionalism – of someone making the choice to actually help people when the easy answer was to keep doing things the way they’d been done before.

And that courage is still needed.  Scientific, evidence-based medicine may be enthroned today, but there are new challenges to providing patient care.  Distorted payment systems force doctors to spend less and less time with each patient.  The rigors of dealing with billing encourage doctors to give up independent practice and throw in their lot with ever-larger healthcare organizations.  None of these changes are bad in themselves – indeed they’re necessary defensive measures given the environment we practice in.  Yet at the same time, these changes are a recipe for turning professionals into company men.  It puts ordinary physicians under pressure to change their practice to suit the payment system or the organization’s needs, leaving them less flexibility to let their practice be guided by the dictates of their professional creed.

Perhaps the most ominous sign that professionalism is in danger is that it’s seen as a harmless bit of virtue, featured in inspirational posters and preached to medical students.  For professionalism, properly understood, is not a peaceful creed.  It’s a force that says that you must do what is right by the patient, no matter what hospital policy or your billing agent may say about it.  It says that fitting in matters much less than doing what’s right.  It is a force that topples orthodoxies, disrupts routines, and upsets accounting managers to no end.  If we had a truly vital ethos of professionalism, it would not be the kind of idea you put up on inspirational posters.  It would be the kind of ideology you furtively whisper to your close friends, and public agitation for professionalism would be a fireable offense.

Yet even if nobody’s pushing this robust, warlike professionalism, a humble, quiet version of it still lives on.  I caught a glimpse when I saw my preceptor take the extra time with that patient.  And once I started noticing it, I began to see it more and more.  I saw it in an administrator pushing for a costly quality improvement project; I saw it in the surgeon who took up precious OR time to teach the residents.  I even saw it in my classmates who chose to study important facts they will use in their careers, rather than cramming the minutiae that show up on tests.  Each of these, I knew, would pay a price – the administrator may have a harder time making budget; the students may score lower on their tests.  But it’s that willingness that made the virtue so striking.  And as long as physicians are willing to go that extra mile, I have great hope for the future of the profession.

Bell Labs and the Culture of Innovation

Bell Labs was one of these crazy institutions that did so much, in such a short span of time, that it hardly seems like a real place.  From the transistor to the laser, radio telescopes to programming languages, the amount of innovation that came out of the place puts its modern peer institutions – from other corporate R+D departments to entire universities – to shame.  Even Silicon Valley, our paragon of innovation, is not producing the same volume of truly foundational, far-reaching innovations.  It’s worth wondering why.

I recently read The Idea Factory, a history of Bell Labs, in part to glean a notion of how this place might have achieved such outsized stature.  Certainly Bell Labs was a major employer of bright minds.  But there were no shortage of bright minds at the Harvard physics department either.  Was there some secret to its culture that explained how it employed bright people in such a productive way?  And in the course of my reading, one of the major theories I came up with was that Bell Labs provided its workers with a very rare set of incentives: to be long-term ambitious.

Bell Labs was the research arm of AT+T, a monopoly.  As such, they were in a uniquely lucrative position – and a politically tricky one.  On one hand, the company was able to reinvest its monopoly profits into research in a way that companies in competitive markets simply could not afford.  On the other hand, this privilege rested on its ability to continually persuade regulators that it was operating in the public interest.  One argument they made was that the company was very generous with the free and easy licensing of its inventions, which then benefited the country as a whole.  The example of the transistor is representative: the company licensed it freely to companies for a nominal fee, which led to its widespread adoption and incidentally led to the development of the first true Silicon Valley company, Fairchild Semiconductor.  These sorts of stories came in handy whenever Bell executives had to make the case to Congress that the monopoly should be maintained.

The mandate of Bell Labs, then, was twofold.  On the business side, it was to produce technologies that would increase AT+T’s long-run profit, and on the political side it also had to produce cool technologies that could, in the long run, justify the company’s continued existence.  What this amounted to was a mandate to produce significant results in the long term: you don’t have to hit quarterly targets, but in the long run, you should produce something ambitious.

At the same time, the Bell Labs scientists weren’t completely free to go nuts and do whatever they like, as tenured professors are in theory.  Bell Labs was still a for-profit company, and they were tasked with producing significant, interesting inventions.  If nothing came out of Bell Labs in a few months, that might be okay, but if nothing came out of in five years, it would become pretty obvious that something was going wrong, and heads would start to roll.

That very specific set of incentives – strongly caring about producing marketable inventions not by next quarter or next year, but within the decade – is likely the best possible set of goals for applied science.  On one hand, you’re free to dream big and swing for the fences.  No need to study the trendy topics that will get you grants, or worry about playing games like splitting your results into multiple papers to pad your CV.  On the other hand, you aren’t given quite enough rope to hang yourself.  You’re still expected to be pursuing something commercially valuable, not just wander off into intellectually fun blind alleys or garner prestige for prestige’s sake.  And time and time again, the scientists at Bell Labs used this unique perspective to work on ambitious projects tangentially related to communication, spend years perfecting an invention, and tossing another masterpiece into the world.

One of the best-known talks in science is “You and Your Research” by Richard Hamming, a prominent computer scientist who spent much of his career at Bell Labs.  As well as being valuable advice, the talk illuminates both the scientific culture that animated the place, as well as some of the unspoken assumptions that allowed that culture to exist.  In one telling anecdote, Hamming was persuaded by senior scientists to devote 10% of his time to “Great Thoughts Time”:

“Along those lines at some urging from John Tukey and others, I finally adopted what I called “Great Thoughts Time.” When I went to lunch Friday noon, I would only discuss great thoughts after that. By great thoughts I mean ones like: “What will be the role of computers in all of AT&T?”, “How will computers change science?”… I thought hard about where was my field going, where were the opportunities, and what were the important things to do. Let me go there so there is a chance I can do important things.”

What’s striking here is the assumption – perhaps true in academia and Google but not elsewhere – that unilaterally taking time off to do some private brainstorming that doesn’t check off any to-dos is not only feasible but in fact somewhat supported.  He expected, and faced no pushback, even in the mildest form of feeling an uneasy sense of swimming against the institutional current.  Instead, he’s actively encouraged to do so by his senior scientists!  It’s worth noting, of course, that this is “10% time,” not 20 or even 100% time – the rest of his time was still needed to do his day job.  And he does dedicate a fair amount of his talk to how to deal with resource constraints and how to persuade your boss to let you work on things you prefer.  But just as much of his talk is about how to make the most of an abundance of time – how to train your public speaking skills by giving outside talks, to work with the door open to allow interruptions and serendipity into your work, how not to get distracted playing amusing games with bureaucracy.

It’s instructive to compare the “long-term ambitious” orientation of Bell Labs to the innovative institutions we have today.  Modern research and development largely takes place in non-monopoly companies and are necessarily focused towards filling the pipeline with products that can produce results on a short time-scale.  Entrepreneurship gets a lot of headlines for being innovative, but even there, the amount of runway startups have before investors start demanding measurable traction is fairly short, on the order of one to two years – which precludes a lot of ambitious, long-term projects.  It’s notable that many of the giant technology companies of today, Facebook and Google among them, initially didn’t look like a business at all.  Indeed, they each spent several years as glorified side projects, resisting turning into a typical revenue-driven business.  Amazon, too, is arguably still in deeply in investment-and-building mode rather than trying to cash in and become a mature business.

Academia, the remaining hub of innovation, is arguably both too short-term focused and too unanchored for its own good.  On one hand, the race to getting grant funding and tenured positions is brutal on grad students and junior faculty.  Publish or perish incentivizes working on short-term projects where you can show palpable progress and papers quickly.  On the other hand, in the long run, academia is given enough rope to hang itself.  The judges of science, grant committees and referees, are drawn from scientists themselves; they’re not tethered to an external yardstick the way Bell Labs was, however loosely, tethered to the market.  And it’s therefore entirely possible, despite their best intentions, for entire disciplines, and these powerful committees in particular, to fall into fads and dogmas and become untethered to scientific realities or economic needs, and rank-and-file researchers are forced to follow suit.

If having a well-tuned planning horizon is what made Bell Labs great, then it’s dispiriting that we don’t seem to have institutions with similar planning horizons today.  The vast majority are too short-term focused, and those that are not lack the market discipline that the Bell System brought to bear, however weakly, on the Labs.  Is the answer to return to monopolistic companies?  One could certainly argue that the Bell monopoly more than paid for itself, despite any excess profits it might have made overcharging customers.  However, it is probably for good reason that “monopoly” remains a dirty word today.  In addition to the standard economic arguments against monopolies, most monopolies were not nearly as intellectually productive as Bell Labs.  More accurately, a monopoly seems to set up conditions that are necessary but not sufficient for intellectual productivity.  The most important thing to take away from this is that “long term ambitious” is a very valuable set of incentives, and if we want to replicate the successes of Bell Labs, it’s a culture we’ll have to replicate.