Government. Medicine. Capitalism?

Wednesday, February 27, 2019 · 8 min read

I’ve had a bit of a crazy week. Tuesday, I got a tour of the Pentagon from a friend that is in the US Digital Service (USDS) for the Department of Defense (DoD), called the Defense Digital Service (DDS). Wednesday (the day of writing this), I shadowed a friend who is a surgical resident during their shift in a hospital. Friday, I have plans to shadow a friend who is an investment banker at a private equity firm and will do a follow up post. You can consider this like “Eat. Pray. Love.” except it’s “Government. Medicine. Capitalism?”

First, I would like to thank everyone for sharing a bit of their life with me and now I get to share what I learned from these experiences with you. When I went into this, I didn’t think much of it. I wanted to go to DC to see some museums and ended up texting my friend on the way down so we made a day of it. My other friend, who is a surgical resident, and I had once gotten into a pretty deep discussion about how weird tech’s culture is compared to theirs so I always had an open offer to see how they work. Then I posted on twitter what I was doing and I guess there was a sort of pattern so it became a thing…

Let’s dive into what I’ve learned and observed, then I will try to put a nice ribbon on it and tie it all together for you.


Let me start by saying, if you ever have a chance to do a stint at the US Digital Service it seems absolutely amazing. The program is great for tech people who want to have an impact on modernizing technology for the government. Having just left a job at Microsoft, I was quite familiar with a very large organizational structure and the power dynamics that exist in people with titles. It was interesting to me to see the parallel between that and the setup of the government.

When you see someone who has served time in the military they usually have a set of badges showing their accomplishments. This is cool because it is accomplishment based. I love accomplishment based incentive systems since you have to do something in order to get rewarded. There are badges for everything, one I really liked was the “ranger tab” which effectively means if that person was ever dropped in the middle of nowhere they could fend for themselves and survive. WOW, what a meaningful item. I found this system really cool since I like decoding things and I personally hate titles that mean nothing. This badge system holds a lot of meaning and defines what the person has done.

Before going to the pentagon, I had watched this Bryan Cantrill talk on leadership where he brought up the “N+1 shithead problem”. The “N+1 shithead problem” happens when there is a person (who acts like a shithead) in a title bump above you and how it is a huge demotivator. What helped Bryan get over this was: instead of looking at the shithead a title above him, he focused on the best person in the title above him and used them for motivation. This works to an extent. I know from experience how demotivating it is seeing a shithead consistently fail up. I believe that most titles are bullshit, climbing a career ladder is bullshit, what really matters is what you do and what impact you have. The talk also covers how Bryan set up his team to only have one title, Software Engineer. And that he motivated his team with a purpose and a mission, not with climbing a ladder.

My friend and I ended up getting into an interesting conversation about this and how they handle authority and titles at the DDS and within the government. The way the DDS program is set up, the individuals who join are at a colonel level rank, which is one below a general, which means they are pretty high up in the pecking order. They also have orders from the Secretary of State to override any authority if need be. They end up not needing to escalate to using those orders though, since just the threat of using it is enough to get bad actors to listen to them.

The Defense Digital Service (DDS) also recruits internally from inside the government. If there is a truly exceptional individual technically in another role they will recruit them to the DDS. They have had people from the Army, Navy, and other parts join. Since the structure and dynamic of the organizations where they came from is so different, joining the Defense Digital Service (DDS) ends up having an effect on them. Before being a part of the DDS, they typically could not fight back from those with authority over them and the DDS is all about fighting for the truth, and fixing what is broken, even if they are the only ones that wear hoodies and not a uniform.

When a general or authority comes into the office of the Defense Digital Service they aren’t greeted with coffee and have their feet kissed, they are just asked to sit on the couch side-by-side their peers (the DDS) and to talk about things like colleagues. This is how leadership should work, not with power over someone else but working with others as peers and colleagues.

Another thing I learned was that for non-confidential code, they use GitHub and try to modernize agencies they work with to do the same and use modern languages and tools. It also reminded me of this awesome article about how someone had changed the law via a GitHub pull request because the District of Columbia’s legal code is hosted on GitHub. Wouldn’t it be cool if that’s how every part of the government worked? Then, if you wanted to change a process or law you would just send a pull request…

This is just a few of the things I learned in my day at the Pentagon, again I highly recommend applying for the USDS if this is interesting to you. Let’s move on to medicine…


My friend had a shift in a hospital here in New York City and I asked to follow along. I got to wear scrubs and everything. I also had to wake up at the crack of dawn for this (5am). This is the fourth year of my friends surgical residency so he’s considered pretty senior since usually that’s a five year thing.

The “junior residents” report to “senior residents” (my friend) who then report to the “attending physicians”. George Clooney was not their attending physician, I was disappointed since I like the show ER ;). Back to reality, we did rounds and checked on all the patients and then I got to watch a surgery. That was super cool, also not my first surgery since I had shadowed a friends dad who was an anesthesiologist in high school.

What I really took away from the day was the respect that the attending physicians had towards the senior residents. There was a lot of respect from the attendings and the senior residents seemed to have a lot of autonomy. In the operating room, the surgery was lead by a different senior resident and the attending was mostly passing tools. I thought this was super cute. I even called it “super cute” out loud after…. to which my friend rolled their eyes. But really, the surgery was done “as a team” with no one calling out orders to someone like a “code monkey.”

I thought this was great and in stark contrast to what I see when technical people are promoted to manager. Ill-trained managers pass down technical work without telling the “why” and already arriving at a solution. In contrast, it is actually the team’s goal to come to a solution, not the managers. That is not actually a part of being a manager. I wish more managers would focus on managing and growing the people on their team versus using it as a position of power over the technical work. If they still need to do technical work in that role it should be like that of “passing the scalpel” when someone needs it.

There was also a point in the day where my friend helped a junior resident with some assignments. It was super interesting and I wondered if an open source mindset could help here. I remembered a talk I saw at Linux Conf Australia in 2018 on open source pharma. The talk focused on how the open sharing of research is leading to innovation in biomedical research.

What I love about open source is the ability to share knowledge and “ping” an expert when you need it. We did this with docker a couple times, when we “pinged” the kernel namespaces maintainer on features to make sure we had implemented it correctly. It would be pretty cool to be able to learn and collaborate with the best easily in any field.

Tying it all together

In both Government and Medicine I found hierarchical structures to learn from. The badges in the military as a system of tracking accomplishments and not power really spoke to me. As well as the attending physician passing the tools to the senior residents and working as a team versus the attending taking charge completely.

I think both Government and Medicine could be changed in a way that would also change the world if more laws and open knowledge wound up on GitHub.

We live in a world where Reddit, Twitter, and other social sites are littered with hate and fake news. I wish there was a place for a source of intelligence and knowledge. I think that would change the world while also allowing the world (or a law) to be changed with just a pull request.