August 2016

smartestintheroom?

“If you’re the smartest one in the room, you’re in the wrong room.” -Richard Tirendi

 

TASK AT HAND: This week I’m thinking about the company we keep and the people that influence us. There is a sentiment that we should strive to be the smartest person in the room. That this is a worthy goal to aspire to. That, somehow, if we are the “smartest” or “best” in the room, we will be able to exert influence or hold power over those around us. And thus, we will be successful. This is a dangerous myth! As the opening quote states, if you are the smartest person in the room, turn around, exit the room, and run – as fast as possible – in the opposite direction!

I’m often asked if this advice should be applied to professional relationships, or personal ones as well. In my opinion, you should apply this advice in its most general form: find people that will challenge and encourage you to grow. Find groups that will contribute to your proficiency and petitions. Avoid the fallacy of superiority – which is seeded in insecurity – by denying the need to be the smartest in the group. Instead, look to develop yourself by surrounding yourself with thoughtful and creative characters.

smartest in room

When it comes to coworkers, Donny Deutsch surmised it best: “my philosophy is to always find the smartest people you can. Hire people smarter than you.” The idea here is simple – but of utmost importance – you must surround yourself with colleagues and coworkers of the highest caliber possible. Whether you are in a small business or a large organization, collaborations should always have you reaching up! The simplest path to this growth is by surrounding yourself with those that have varied vantage points and see problems differently than you.

Why is this so important? The answer: “the people that you have around you are your biggest influence” (RJ Mitte). Since you are a running average of the people you most interact with, you need to be cognizant of who these people and groups are. If “leadership is influence” (John C. Maxwell), seek to be influenced by the best, and you will find yourself in good company.

MEDICINE & MACULA: Check out one of our recent publications, Acanthamoeba endophthalmitis after recurrent keratitis and nodular scleritis. Acanthamoeba species are ubiquitous free-living protozoa and are usually responsible for corneal disease. We present the first case with confirmed involvement of Acanthamoeba in all ocular layers, including choroidal involvement.

acanthamoeba panuveitis

Thank you Retinal Cases & Brief Reports for publishing our case! Check out the study here.

GRATIS: “Follow those who are seeking the truth, but run away from those who have found it.” Goethe

My best to you,

David Almeida

Read more

triage decision sss

“Don’t fight the problem, decide it.” -George C. Marshall

 

TASK AT HAND: This week I’m thinking about triage. In medicine, triage is the process of assigning degrees of urgency. In any hospital Emergency Department, you will find a Triage desk that functions to grade the severity of your ailment. Triage decides if your problem is an emergency (must be assessed and resuscitated right away), emergent (needs assessment very soon), urgent (important but can usually wait some amount of time), or nonurgent (can wait). An emergency has the potential to kill or seriously harm your patient and needs to be addressed right now. An emergent condition has the potential to inflict significant morbidity and cannot be delayed any significant amount of time. An urgent state needs to be assessed but usually lacks immediate temporal gravity.

Over the years, I have found that you can apply this same triage process to decision making. One can formulate strategy by triaging decisions and prioritizing subsequent actions. Whether you are taking inventory of personal sentiments, deciding on a strategy for an ambitious project, or developing a new idea, the ability to triage allows you to set priorities, execute strategy, and engage in effective delegation. The goal of decision triage is to emerge from the deluge of questions with a set of priorities aligned with your strategy. Clarity for success by means of deciding how to tackle multiple problems.

now

I triage decisions using these same emergency principles: an emergency requires an answer or decision right now – no exceptions! I reply to all emergent decisions within 12-24 hours. For urgent decisions, I reassess later. Nonurgent matters tend to be delegated elsewhere. Try this next time you are asked to solve a problem or your input is required. If the issue has immediate consequences, deal with it straightaway. Don’t procrastinate and don’t delay. Is it emergent? If so, you have some time. Relatively urgent? Maybe you can delegate this task or move it down your prioritized to-do list.

In triaging decisions, will almost always find conflict and disagreement because, what to one is an emergency, to another is only urgent. What do you do when this occurs? Make sure you communicate clearly so that trust is built in your assessment skills. Lead by example and never trivialize the conflicts of others. When in doubt, have the best interests of others in mind. Selfish behavior is based out of insecurity. Act selfless and create value for others in your triage. This is a key principle of successful decision making.

“Nothing is more difficult, and therefore more precious, than to be able to decide.” –Napoleon Bonaparte

As the quote above emphasizes, the ability to decide deserves your judicial attentiveness. Decision making and strategy are topics we revisit frequently here on the Sunday Surgical Scrub and you can think of decision triage at the top of the algorithm. Once you decide on the priority of the decision, you can use the many tools presented here to resolve the crux of your conflict and put forward the best decision.

 

Caregiver burden fig

MEDICINE & MACULA: Check out our new systematic review pertaining to depression and burden among caregivers of patients with visual impairment. While caregiving allows those with vision problems to better adapt, it has been shown to take a toll on the caregiver on various levels, such as invoking depression and burden. Recognition of this is key for awareness, prevention and management.

burden study paper

Thank you International Ophthalmology for publishing our study! Check out the study here.

GRATIS: One last note on the decision triage system above. By frequently using this method of triage for decision making, I have found a wonderful unexpected side effect: I gain perspective by realizing that few things are a true emergency that require destabilization to correct. This calming vantage point will allow you to appreciate that many decisions – whether we like or not – are just not that important. Find those that are, prioritize them, and then successfully attend to them.

My best to you,

David Almeida

Read more

constant change

“There is nothing permanent except change.” -Heraclitus

 

TASK AT HAND: This week, after reading the recent Fortune 500 review, I’m thinking about change. The Fortune 500 survey found that 97% of CEOs say their companies will change more in the next five years than in the past 5 years (Fortune.com, 15 June 2016). Fortune 500 CEOs, which lead benchmark business successes representing revenues equal to two-thirds of US gross domestic product, in majority “strongly agree” with this statement of emphasis on change.

The ability to change, at an organizational level, means adapting to growing market demands and is essential for survival. As a biological species, our ability to evolve granted us survival via constant differentiation. What happens now? At a personal level, the ability to change is paramount to fulfillment. I agree that, “To improve is to change; to be perfect is to change often” (Winston Churchill). This quote implores our need to constantly seek improvement. To seek constant change.

 

agentofchange

How do we seek change? First, realize “different” is not “change”. Different may be an avenue for change and may offer one the potential to change, but in of itself, does not permeate change. A clear example is traveling. One may travel to exotic places, see novel vistas and villagers, yet return to a baseline state soon thereafter. Actual change requires a loss of original identity. Simply recognizing that we are not permanent – that all our hang-ups and hiccups – are not perpetual opens us to the possibility of letting go of these old happenstances that prevent positive personal change.

 

“Only the wisest and stupidest of men never change.” Confucius

I have yet to meet the wisest man or woman, and myself feel a fool compared to the sages and stoics I am lucky enough to collide with. Approach change constantly. Let go of preset conditions. Change. Grow. Fulfill.

PS If you liked this Task At Hand, check out my post from last week on Anticipation vs Expectation; disregard expectations and find the purity of the challenge. You can find it here.

 

 

asrs 2016

MEDICINE & MACULA: This week I’m attending the American Society of Retina Specialists (ASRS) Annual Meeting in San Francisco, California. I wanted to thank everyone who reached out in interest of the work we presented. Also, a kind thanks to all my collaborators!

 

Here is a brief summary of the work we presented:

Comparison of microbiology and visual outcomes of patients undergoing small-gauge and 20-gauge vitrectomy for endophthalmitis. David RP Almeida, Eric K Chin, Benjamin Bakall & Vinit B. Mahajan

 

Long-term outcomes in patients undergoing vitrectomy for retinal detachment due to viral retinitis. David RP Almeida, Eric K Chin & Vinit B Mahajan

 

Ocular hypertension after intravitreal dexamethasone (Ozurdex) sustained-release implant. Eric K Chin, David RP Almeida, Gabriel Velez, Kunyong Xu, Maria Peraire, Maria Corbella, Yasser M Elshatory, Young H Kwon, Karen M Gehrs, H. Culver Boldt, Elliott H Sohn, Stephen R Russell, James C Folk & Vinit Mahajan

 

Bimanual pars plana vitrectomy for removal of a dislocated descemet stripping automated endothelial keratoplasty graft from the vitreous cavity. Kunyong Xu, Eric K Chin, Emmett Carpel & David RP Almeida

 

Intravitreal foscarnet with concurrent silicone oil tamponade for rhegmatogenous retinal detachment secondary to viral retinitis. Kunyong Xu, Eric K Chin, Vinit Mahajan, & David RP Almeida

 

GRATIS:

Yes, there are two paths you can go by, but in the long run


There’s still time to change the road you’re on


And it makes me wonder.

“Stairway to Heaven” by Led Zeppelin

 

My best to you,

David Almeida

Read more

expectation anticipation art

“We need the sweet pain of anticipation to tell us we are really alive.” 

Albert Camus

 

TASK AT HAND: This week I’m thinking about a couple of concepts that tend to get incorrectly used interchangeably: anticipation and expectation. These are two concepts that frequently occupy my headspace because they have a strong potential to influence outcomes.

Anticipation is a fantastic moment that speaks to an aura of readiness. Much is possible in the moment of anticipation. It means you are getting ready, trying to comprehend, commencing an engagement with the road ahead. Anticipation is selfless. It does not expect anything. It possesses all potential for a future moment. There is no defined outcome in anticipation because all possibilities may exist in that sphere. In decision making and problem solving, anticipation can be critical to highlighting possible outcomes; some would argue “wisdom consists of the anticipation of consequences” (Norman Cousins). Because anticipation does not define one expectation, you can consider all possibilities with an expansive vantage point.

 

waiting for santa

Think about yourself as a child, or think about your own children, waiting for an event. Anticipation is a seed that blooms into wonder because all is possible. Indeed, Andy Warhol tapped into this sentiment: “the idea of waiting for something makes it more exciting”. Anticipation will always have elements of surprise – an excitement that does not exist in most other forms of preparation. This keeps you engaged, tactful and ready.

 

crowd
Now let us meet expectation – an endless source of exasperation and annoyance. Expectation is an irritant that can ruin many an event. With expectation, there is the creation of a specific outcome you predict or hope will occur, opening the door to disappointment. If your experience is less than your expectation, you are left disappointed. “Life is so constructed, that the event does not, cannot, will not, match the expectation” (Charlotte Bronte). So, the best remedy is, to discard these expectations.

If you start with preconceived notions, for any encounter or challenge, you’re coming in with expectations that essentially define certain parameters of your experience, and consequently, degrade your experience. Avoid this! “Blessed is he who expects nothing, for he shall never be disappointed” (Alexander Pope). Change this behavior and assume the purity of anticipation. The examples are few – unfortunately – where your experience goes beyond your expectations so avoid the expectations that build resentment and create dissatisfaction.

How do we apply this? Anticipate more and expect nothing! Anticipate. Be ready. Wonder at the possibilities.  Anticipate the challenge. Try to focus on a current challenge and anticipate the possibilities and consequences. Let us not expect some single quanta from any experience. Some will say, “well, you’re just setting really low expectations.” No, I’m taking it one step further. I’m setting no expectations. I want the purity of the challenge that leaves me with wonderment from my subsequent experience.

MEDICINE & MACULA: This week, for Medicine & Macula, I want to highlight our recently published paper on Zika-related maculopathy. We show posterior segment changes in a confirmed case of Zika in the hope of adding further knowledge to the growing spectrum of Zika-related pathology.

zika fa

Thank you Ophthalmology for publishing our case! Check out the study here.

zika citation

 

GRATIS: “I’m not in this world to live up to your expectations and you’re not in this world to live up to mine.”― Bruce Lee

 

My best to you,

David Almeida

Read more