Robert Dunbar, MD

I am an asst coach for a great lacrosse program in my hometown, Mercer Island, WA. Matt Cooper @mdc5023 has put together a podcast about the values our program holds, called The Long Game. Here is an interview w/me interviewed. Kudos to Matt for helping me sound almost coherent.

In 1955, a British civil servant noticed a mathematical impossibility inside the Royal Navy. Between 1914 and 1928, the number of active Navy ships dropped by 67 percent. The number of sailors dropped by 31 percent. But the number of desk officials managing them? It increased by 78 percent. He spent years studying this absurdity. What he found is now the silent trap destroying tech careers in the age of AI. His name was Cyril Northcote Parkinson. He realized that the amount of actual work being done had zero correlation with the number of people doing it. He proved that bureaucracy creates its own internal work just to keep itself busy. He published a single sentence that changed organizational psychology forever. "Work expands so as to fill the time available for its completion." If you have two hours to write a report, it takes two hours. If you have two weeks for the exact same report, it takes two weeks. The brain creates artificial complexity, requests unnecessary meetings, and invents new subtasks to justify the allocated time. This is not a flaw in human motivation. It is a feature of survival in a corporate structure. Looking busy is historically how you keep your job. In the modern world, this is the most dangerous vulnerability for anyone working in tech. AI did not just speed up work. It collapsed the timeline entirely. Tasks that took four days now take four minutes. Most people handle this completely wrong. They fall straight into the Automation Trap. You use an AI agent to automate your workflow. You finish a 40 hour sprint in 10 hours. You proudly show your manager exactly how efficient you are. You assume this massive increase in productivity will guarantee a promotion. Leadership does not see a genius. They see a specific role they can easily eliminate to save budget. Or worse, Parkinson's Law kicks in. They do not give you a raise. They give you three more projects of equal low-level value to fill your remaining 30 hours. You did not gain leverage. You just increased your output for the exact same pay. You automated your own workflow, and six months later, they realize they do not need you. Here is how you actually survive the shift. Stop broadcasting your AI efficiency. If you automate your job, keep the timeline the same. Deliver the work on the original deadline. You protect your baseline income and job security. Take the hours you just saved and upskill aggressively. Do not use that time to scroll online. Study system architecture. Build new data models. Solve the higher-level business problems that management actually cares about. Stop attaching your worth to manual execution. Syntax and repetitive tasks are commodities now. Detach your professional identity from the labor that can be automated. Attach it firmly to business results. Parkinson published his law in 1955. The paper sat in academic literature for decades. The Navy bureaucracy he studied is long gone. But the mechanism he discovered is the exact reason why working harder is now a losing strategy. Every time you optimize a manual task. Every time you brag about saving your boss three hours. Every time you ask for more busywork to fill your Friday. It is the same exact trap. The secret to tech survival? Stop competing with the machine. Become the director of the system.

@Davembmd @traumaticum @FootAndAnkleMD That shaming septa actress is Rebecca (Hannah Waddingham), the owner of the Richmond team in Ted Lasso.

Did a @FractureDoc poller screw to correct the varus (Also sawed a lateral wedge out, and retrograde bored the canal to remove the internal remodeling) Blew the lateral wall out, but the rest looks half ok Such a shit fracture

@traumaticum @Davembmd @FootAndAnkleMD Verily.

@Davembmd @FootAndAnkleMD @FractureDoc Good sir, thy penitence hath been both florid and most excessively adorned—yet lo, it findeth favor. Take heart: thy contrition is received, thy burden lightened, and thy fault absolved with grace befitting such theatrical remorse.

@spartywrx @traumaticum @Davembmd Nope.

@FractureDoc @traumaticum @Davembmd Have you seen a difference in outcomes, pain, or other factors when doing the “blow hole?”

@spartywrx @traumaticum @Davembmd If we’ve decided we’re gonna do (& would be very reasonable to consider here), I have them come back in a few weeks & use RIA or at least put a blow hole distally, to maybe diminish the pressure generated with reaming this intact tube - or at least recognize its potential.

@traumaticum @Davembmd @FractureDoc When are you nailing the other side?

10 @TedLasso leadership lessons: 1 believe in yourself  2 winning is an attitude 3 all people are different people 4 see good in others 5 forgive first 6 stay teachable 7 be curious 8 optimists do more 9 be honest 10 doing right thing is never wrong thing

@itius @orthobullets @traumaticum @sebcyc @eric_novack @DrFraneNicholas @bonesmith_ @schulte_ss @rkh_md @EauClaireOrtho Absolutely.

@FractureDoc @orthobullets @traumaticum @sebcyc @eric_novack @DrFraneNicholas @bonesmith_ @schulte_ss @rkh_md @EauClaireOrtho Fair enough and more than accurate points I’ve been burned in a fx similar with this construction long ago,not clear if lack of fixation or lack of compliance with postop regime (probably both🤷‍♂️) I tried to avoid messing with ulnar nerve if I can

Here is a new case by Dr. Abdulraheem Alkattan and Krankenhaus Düren. SEGMENTAL DISTAL HUMERAL SHAFT FX WITH INTRA-ARTICULAR EXTENSION IN 59M How would you manage this #orthotwitter? Vote on this case for CME: orthobullets.tiny.us/bdehvsvt

@itius @orthobullets @traumaticum @sebcyc @eric_novack @DrFraneNicholas @bonesmith_ @schulte_ss @rkh_md @EauClaireOrtho I like all of that, though due to the obliquity of the fracture in the medial metaphysis I would likely work on both side of the triceps and add a medial precontoured distal humerus type plate. Also, shaft fx is oblique enough that I would likely lag rather than mini-frag plate

@orthobullets @FractureDoc @traumaticum @sebcyc @eric_novack @DrFraneNicholas @bonesmith_ @schulte_ss @rkh_md @EauClaireOrtho Probably Gerwin approach identifying and protecting radial nerve Provisional reduction and fixing with a mini fragment plate/screws )and then add Medartis posterolateral plate (has a flange to add screws lat-med to add compression iF reduced joint step off)

John Locke's argument for tolerance hits different when you realize it's rooted in humility: "We don't really know all that much. We're wrong about a lot. So we're not justified in forcing our views on others."

@bonesmith_ @centerofhip @Davembmd @traumaticum I do it free-legged on a flat-top with distal femoral skeletal traction, but yes, agree.

@FractureDoc @centerofhip @Davembmd @traumaticum Yes. My general point was about subtrochs. But agree about the comminuted ones which are best left unopened and aligned on a fracture table.

@bonesmith_ @centerofhip @Davembmd @traumaticum (Subtrochs or whatever you want to call the exploded ones, not atypicals specifically). Agree re atypicals.

@bonesmith_ @centerofhip @Davembmd @traumaticum I tend to agree, but I have some exploded ones in sick patients that I can’t really open & my ability to judge reductions fluoroscopically is ♾️-ly better supine, so I do those that way (w/joysticks, whatever). But if I see ROI on an open approach I favor lateral for sure.

@traumaticum @bonesmith_

@traumaticum @bonesmith_ Sometimes we’ll stick a plate or a malleable or even a fibular strut in the lateral part of old incision (if it’s a nonunion). Fibular strut is nice b/c it stays in and keep nail medial while the plate etc are removed and the entry is ovoid & nail can displace laterally.

@Davembmd @traumaticum Not at all, always be looking - you may be right, Ed said he’s going to post the finals

@traumaticum @Davembmd Yeah, medial cortex flow looks decent to me, broken lateral cortex with thickened cortex makes it hard for me to tell absolutely, but it didn’t scream varus to me on first glance.

@Davembmd @FractureDoc BOOOOOoooooo!!!!* *maybe i think the busted lateral wall throws off the contour of the eye-o-meter but maybe youre right? i dont know. wait for the formal postop xr

@traumaticum @bonesmith_