September 2016

sss-long-game

“I don’t think anyone is thinking long-term now.” -Thomas Mann

 

TASK AT HAND: This week I’m thinking about long-term plans. Strategy based on delayed gratification and personal investment. Plans that require patience, pragmatism, and perseverance. Playing the long game. Taking the long road.

We are endlessly inundated with short sells, quick fixes, and the lure of easy money. These are but myths, blasted on billboards, and endlessly running on our screens. Beware of those selling overnight success; sometimes they work, but most times they do not. Behind the overnight success, you can usually find years of work and dedication.

With everyone working the fast hustle, don’t be afraid to contradict and make long-term plans. Instead, hone strategy that takes time and consequence to develop. Having a long-term plan dramatically increases your chances of success solely because most are playing some version of the  fast hustle.

Obsession with overnight success. The want for short-term success is rooted in the desire to avoid pain. It is much easier to create a flash in the pan than stoke a fire. Inherent within us is a low baseline threshold for pain. This is a biological design so that we don’t get hurt. But don’t let this biology disrupt your ability to navigate complexities that require time.

We all know those who start out on a plan, only to abandon it as soon as they feel pain. Discomfort forces a switch to another project. I have found that one must train and accept that negative short-term pain is acceptable. It is merely a method to make us slow down and take notice. Then, upon realizing this, we can evaluate and look to overcome. It is a necessary (painful!) reminder of importance.

Planning for the long road. Personally, “we don’t mature momentarily, but over the long-term” (John C. Maxwell). Having long-term plans gives you significant advantages due to increased maturity and improved comprehension of the emotional intelligence inherent in relationships. In professional life, remember that “good decisions can have bad short-term outcomes but be great for the business long-term” (Gerry Schwartz). Excessive focus on short-term gains – and the inability to sustain short-term pain – can hinder your ability to prepare for long-term survival as business landscapes evolve.

How do you survive the long-term plan? Patience, perseverance, pragmatism. And when failure occurs, “keep your face always toward the sunshine – and shadows will fall behind you” (Walt Whitman). Night will come, and with it, darkness and doubt. Keep walking, and surely if you play the long game, you will see the sun come up again, and the shadows will once again fall behind you.

MEDICINE & MACULA: Check out our new publication in the September 2016 issue of the Canadian Journal of Ophthalmology entitled, Low power and type II errors in recent ophthalmology research (Zainab Khan MD, Jordan Milko MD, Munir Iqbal MD, Moness Masri MD & David RP Almeida MD MBA PhD).

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We show that a large proportion of randomized clinic trials contain statistical errors. The results of the studies have dramatic effects on day-to-day clinical practice and need to be designed and evaluated carefully. Check out the publication here.

GRATIS: “I believe it’s less risky long-term to embrace change.” Charlie Ergen

My best to you,

David Almeida

david@davidalmeidamd.com

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sss-fear-failure

“Fail early, fail often, but always fail forward.”

John C. Maxwell (Failing Forward)

 

TASK AT HAND: This week I’m thinking about failure. A word associated with massive negative connotation. Imbedded within insecurity, fear of failure enforces the concept that we need to avoid failure if want to be successful. That failure is for the weak and lazy. That if you are intelligent and industrious, failure can be avoided. This is wrong and ignorant. Failure – and how we cope with it’s force – is of crucial importance to our character development.

Why is failure important? Failure is part of the iterative process of learning. Like trial-and-error, it is a basic process that we master in order to develop higher forms of reasoning and decision making. Thomas A. Edison writes, “I have not failed. I’ve just found 10,000 ways that won’t work.” Failure allows us to improve processes and techniques and is essential to the learning of individuals, growth of organizations, and coherence of cultures. “Ever tried. Ever failed. No matter. Try Again. Fail again. Fail better”; these words by Samuel Beckett see failure as this fundamental process of learning.

Why is fear of failure debilitating? The shame of failure comes from the pervasive negative assumption that failure is an ultimate end. In truth, failure is just another step in the process. I’m a vitreoretinal surgeon and I regularly operate on blinding diseases. I am humbled by the eye and the gravity of complications that may, without notice, occur during surgery. I orchestrate every movement to avoid complications, but I do not fear them. If so, I would be paralyzed with fear and overwhelmed by the weight of possibility. This would dramatically hinder my performance and limit my ability to help patients. Show me a surgeon with no complications, and I’ll show you a surgeon who never operates. Failures are not final but part of evolving solutions and strategies.

How can you erase your fear of failure? If you fail at something, the first step is to give yourself the opportunity to learn from it. There is a twisted irony in the failure to learn from your failures. Don’t do this. Take ownership of your failure. “A man can fail many times, but he isn’t a failure until he begins to blame somebody else” (John Burroughs). Realize your error. Take ownership of the failure. Accept responsibility for the consequences. This provides you with immense learning. See this as a temporary event and in no way a synopsis of your life.

MEDICINE & MACULA: Check out our new feature in the September 2016 issue of Retina Today entitled, Postoperative Infectious Endophthalmitis: Evolving Trends and Techniques.

retina-today-sept-2016

Infectious endophthalmitis is a vision-threatening condition that involves inflammation of the entire eye. Early vitrectomy for endophthalmitis provides significant benefit in removing infectious material. We describe how vitreoretinal practices have changed with the adoption of small-gauge surgery.

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Check out the publication and video here.

GRATIS: If you’re not failing often, you’re not trying hard enough.

My best to you,

David Almeida

david@davidalmeidamd.com

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sss-good-relationships-study

“Nothing is perfect. Life is messy. Relationships are complex. Outcomes are uncertain. People are irrational.” -Hugh Mackay

 

TASK AT HAND: This week I’m thinking about relationships after reading Harvard’s 75-year study of human happiness. Called the Study of Adult Development at the Harvard Medical School, but better known as the Grant Study, this recently published investigation is the longest-running study of human happiness. You can find the study here.

The Grant Study began in 1938 as a counterpoint to the disease model of medicine and sought to ascertain the conditions that enhance wellbeing or happiness. It followed the lives of 268 healthy sophomores from the Harvard classes between 1939 and 1944. There is no other study like it in length of follow-up.

The conclusion after 75 years of study: good relationships make us happier and healthier! There is of course significant bias in a study with a homogenous population based entirely on privileged white men. While the latter serves to emphasize the need to critically interpret any piece of information, it reminds me that relationships – how we collide and interact with others – has the potential for massive impact on our happiness and health.

Relationships are complex, but there are certain strategies that give you the best chance of cultivating a matter of significance with other people and groups.

1. Enter relationships without expectations. Entering a relationship with expectation is akin to degrading human encounter to transaction. As I’ve written before on anticipation (see here) – rather than expecting – look to give. “Relationships based on obligation lack dignity” (Wayne Dyer), so enter them openly, without bias, and contribute rather than collect.

2. Everybody hurts. REM was right. If you enter a relationship with honesty, there is always the chance of getting hurt in the process. Bob Marley’s words: “truth is everybody is going to hurt you: you just gotta find the ones worth suffering for” strikes at this chord. Committing with honesty is an exemplary way to build relationships. “Be honest, brutally honest. That is what’s going to maintain relationships” (Lauryn Hill).

3. Work at it! Relationships require work. In the economics of human emotions, a zero-sum game is of no value. A balanced budget has no use. There is an ebb-and-flow that occurs with communication – and you have to work at this. Failure to communicate leads to failed relationships. When communication and conversation stall, remember: “you can discover more about a person in an hour of play than in a year of conversation” (Plato). Every young child knows the meaning of these ancient words. I have learned this principle best from my children.

Enter relationships without expectation. Don’t be afraid of getting hurt. Cultivate, communicate and work towards building strong relationships. With this, I hope you find some elements of happiness.

 

 

MEDICINE & MACULA: I’m in Copenhagen, Denmark this week for the EURETINA annual meeting – one of my favorite meetings! I love conversing and contrasting new therapies and techniques with my European and International colleagues.

euretinacopenhagen

Yesterday I presented two talks and enjoyed the discussion immensely. I presented, Comparison of microbiology and visual outcomes of patients undergoing small-gauge and 20-gauge vitrectomy for endophthalmitis in one of the morning sessions and Long-term outcomes in patients undergoing vitrectomy for retinal detachment due to viral retinitis in the afternoon session. Thanks EURETINA!

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GRATIS: I have discovered the concept of hygge in modern Copenhagen. It is of serious gravity here! The best English word seems to be “cozy” or “coziness”. It’s about feeling comfortable like one is at home or in a “homely state”. Thank you Copenhagen!

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My best to you,

David Almeida

david@davidalmeidamd.com

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SSS face punch

“Everyone has a plan ’till they get punched in the mouth.” Mike Tyson

 

TASK AT HAND: This week I’m thinking about strategy setbacks. We all have to soothe the bumps, bruises, blisters and burns associated with negotiating the often rocky landscape of our evolving strategies on the way to successful solutions.

But what happens when you hit a wall with your strategy? Or as Mike Tyson aptly summarizes – what happens when you and your plan get punched in the mouth? As much as your strategy may be well-being, it’s at this point that we must clarify core principles to break through.

What do you do when your best laid plans, your carefully tailored approach, your curated strategy stall? I have found 3 approaches to help navigate these difficult times.

1. Realize and accept that you will eventually get punched in the mouth. It will happen sooner than you think. It will happen multiple times. “Any time you think you have the game conquered, the game will turn around and punch you right in the nose” (Mike Schmidt). Denial of this truism will cause you to hold faulty strategies and you will fail to see the emerging landscape. Don’t bother with the padding…

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2. When you get hit, be receptive and flexible. This is counter-intuitive because the first reaction is to get defensive. The ability to be receptive allows you to discover what details you missed. Then, flexibility allows you to adapt your strategy to the new conditions. Being flexible does not mean quitting on your plan. “Take things as they are. Punch when you have to punch. Kick when you have to kick” (Bruce Lee). Be open and receptive but remain committed. This is counter-intuitive but is of immense advantage.

3. The ability to take a punch is good, but the ability to avoid one is best. Your ability to navigate assaults is a defining property of your defensive strategic framework. “In the battle of existence, talent is the punch; tact is the clever footwork” (Wilson Mizner). Your strategy is your footwork – it will provide you with the needed defence for when you under duress, and it will allow you to counter when an opening occurs.

In chemistry, a transition state is a temporary high-energy configuration existing between two stable forms. The transition state corresponds to the highest potential energy along a reaction path. It is often violent and tumultuous but the potential energy allows for the formation of new stable forms. Think of these periods of your life – times of setbacks and shock – as transition states and look for ways to harness the potential energy to form an improved baseline.

 

MEDICINE & MACULA: Check out our most recent publication, Retinal Injury Secondary to Laser Pointers in Paediatric Patients. Our study describes children who had laser-related retinal injury to the macula due to the mishandling of the laser pointer devices.

Peds citation

Peds laser figure

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

 

GRATIS: There is no shame in taking a punch, and there is much character growth in our ability to transition into an improved form during the difficult transition states. However, there may be times where you find yourself constantly under assault. If this occurs, you may have to punch back. Unfortunately, this is the only currency some understand.

“You punch me, I punch back. I do not believe it’s good for one’s self-respect to be a punching bag.” Ed Koch

 

My best to you,

David Almeida

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