Think about the last thing you did that made you feel really good?

What was special about it?

Most people I ask this question answer with the resultant accomplishment or achievement related to whatever event they are thinking about. Let’s take a fictitious example; someone might say, “I enjoyed my last run. It was special because I completed 10 miles.”

There is nothing wrong with this answer and I believe it’s important to celebrate accomplishment. However, now, go back to that event or action, and describe it without using some sort of productivity or accomplishment associated with it. You cannot use an outcome as a means of ascribing value to it.

Get’s difficult right?

What am I getting at? We tend to value productivity over presence. We want to extract takeaways from actions and events like: “I had…”, “I did…”, “I got…”. Instead of the desire to immerse in moments and experiences, we are all too ready to define our life in basic terms.

To continue with our example from above, maybe the significance of that last run was it allowed connection with nature or moments of mental clarity. Only if you are present, can you catch these wonderful experiences.
 

TASK AT HAND: This week I’m thinking about presence. One of my favorite quotes is from Walt Whitman: “We convince by our presence.” The ability to be present and engaged with the turbulent twists of life – rather than a mere passenger of happenstance – is not trivial!

The title of this blog, the Sunday Surgical Scrub, is dedicated to a ceremonious time of clarity. From the blog introduction above, “Before each and every case, a surgeon scrubs and disinfects his hands. At the same time, he or she becomes solely focused on the task at hand – preparing to navigate a complex surgical path – and ready to confront any difficulties that lie ahead.” The scrub is a moment of reflection to remind the surgeon to be present in the moments that lie ahead.

Unfortunately, too many times, we lose the connection to presence. A common example I see is simple conversations. You will notice that people will speak and, as soon as they stop speaking, they focus on what they will say next rather than listening. The other person does it as well. Is the point of the conversation to conduct some sort of business (productivity) or an opportunity for engagement (presence)?

Look out for all too easy trap of productivity. Efficiency and productivity are cornerstones of success but make sure you are producing relevant outcomes. Pause and ask yourself what it is that you want out of an action or interaction. More often than not, you will find that presence in a simple conversation, a parenting action, a commitment to a cause has great worth and impact than a trivial takeaway.

 

MEDICINE & MACULA: Thank you Tina and The Morning Blend for having me as a guest this past week! I had a wonderful time on the show and continue to be humbled and excited about all the interest in Decision Diagnosis.

You can watch the interview here.

 

GRATIS: Happy Mother’s Day! Resiliency I learned from my grandmother. Kindness and unyielding support I absorbed from my mother. Every day, I am lucky to witness the virtues of patience and grace in the mother of my children

 

My best to you,

David Almeida

david@davidalmeidamd.com

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“To broker innovation is to facilitate the cross-pollination of ideas. To take concepts out of their silos, synthesize novel viewpoints, and paint new pictures where once lay empty space.”

TASK AT HAND: This week I’m thinking about brokering innovation. This is a relatively new term but the practice is longstanding. The idea is to support growth via the unique mixing of ideas from different fields or backgrounds. The cross-pollination of thought – whether it be geographically-, culturally-, or specialty-based – is a fundamental strategy for creative thought.

For example, you may work in a typical corporate culture but this does not mean you can’t incorporate strategies from a performer and team-building from sports culture. Similarly, approach you pain points with different vantage points. If all I have is a hammer, sooner or later, everything starts to look like a nail. Alternatively, if I see someone else using a different tool – even if it is for a much different task – maybe I can create a hybrid to address my need.

Personally, I have long been interested in the process of brokering innovation and this is one of the reasons for my diverse background. I find that, when we can forcefully take ideas out of their nascent environments, and join them with other disparate ideas, then creativity flourishes. Sometimes, this creativity may be hypothetical and lack practical use. Sometimes, a sort of Frankenstein is born that is difficult to categorize. However, when it comes off right, there is potential for the genesis of truly transformational thought.

“When we can forcefully take ideas out of their nascent environments, and join them with other disparate ideas, creativity flourishes. At these crossroads, there is potential for the genesis of truly transformational thought.”

The desire to work in a physical or figurative cubicle enforces constraints. Instead, much how the modern workplace has morphed into non-traditional settings and processes, how you approach challenges and conflicts must evolve. Staying fixated on strategies that exist in a vacuum risks failure in global applications.

The call to action here is to facilitate the brokering of innovation! Break down silos! One of the simplest strategies is to work with as many individuals with different backgrounds as possible. Akin to a musician who jams with someone with a different style or from a different genre, join others in the pursuit of unique thought. Support the sharing of ideas between different groups. Look to build connections between heterogeneous cohorts. Look to guide cross-functional conversation, exchange and communication. Your horizons will expand, and the accompanying understanding will lead you to ask better questions and seek better answers.

 

MEDICINE & MACULA: Check out one of our recent publications, Myelinated retinal nerve fibre, myopia, and amblyopia syndrome (Kunyong Xu & David RP Almeida) published in the Canadian Journal of Ophthalmology (April 2017).

You can find the study here.

We describe the complex relationship among myelinated nerve fibre, myopia, and amblyopia. We present the case of a 6-year-old boy who presented with blurry vision of the right eye over 2 months. The visual prognosis in these cases is variable.

 

GRATIS: “For good ideas and true innovation, you need human interaction, conflict, argument, debate.” -Margaret Heffernan

 

My best to you,

David Almeida

david@davidalmeidamd.com

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“Refuse to be average. Let your heart soar as high as it will.”

Aiden Wilson Tozer

TASK AT HAND: This week I’m thinking about “regressing to the mean”. You hear this a lot in sports, economics, and human performance. In statistics, regression to the mean describes that over time, extreme measurements will be closer to the average for the group (because measurements cluster about the average). In other words, outliers will tend to be closer to the average as more measurements are made.

For example, a baseball player may hit 2 home runs in one game but, over the season, they will perform closer to their overall batting average. In another example, the stock market may have a positive or negative run in the short term but, over any appreciable time frame, it will perform closer to the average lifetime behavior. Basically, “regression to the mean” describes that things tend to even out over time.

“Regression to the mean describes that things tend to even out over time.”

How can we use regression to the mean to improve our decision making and strategy?

What can we learn from this statistical phenomenon to illuminate our performance?

First, we need to identify that, on average, we are all average for most of our skills. Everyone cannot be the top 1% or 10% – statistically this is impossible. I find it a callous fallacy when we endow the belief that we can all be the best or fastest at all tasks. This is not possible because, over time, we will gravitate towards the average for that task in question.

But, this need not be a self-fulfilling prophecy because statistical regression toward the mean is not a causal phenomenon. Regression to the mean does not describe cause and effect. Instead, regression to the mean is based on random error about an average. The next bit is important: your performance is not destined to be average. Your performance can be an outlier. It can be bold and a superlative extension of the objective you are trying to achieve.

I have found that, self-awareness into how we are performing, can bring to light where “our average” lies for certain tasks and proficiencies. As we learn our “average”, we can work to incrementally improve them. Realizing that regression to the mean is not an eventuality opens the door to reflection and progress. Ultimately, it starts to differentiate our performance on tasks from ourselves as individuals. Our performance may sometimes be average, but our ability to learn from it will never just be average.

 

MEDICINE & MACULA: Check out one of our recent publications, Proliferative Vitreoretinopathy (PVR) Update: Current Surgical Techniques and Emerging Medical Management (Robin K Kuriakose, Kunyong Xu, Eric K Chin & David RP Almeida) published in the Journal of VitreoRetinal Diseases (April 2017).

You can find the study here.

In this detailed review, we provide an update on current surgical techniques and emerging medical management in proliferative vitreoretinopathy (PVR). PVR is the number one cause of failed retinal detachment repair and still a relatively unexplained phenomenon. We, along with Citrus Therapeutics, are working hard to find treatments for this challenging disease.

 

GRATIS: “The average adult laughs 15 times a day; the average child, more than 400 times.” Martha Beck

 

My best to you,

David Almeida

david@davidalmeidamd.com

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“Cogito ergo sum.”

“I think, therefore I am.”

This is the proposition most commonly quoted for the French philosopher Rene Descartes.

However, when you look at his text, Discourse on the Method, it actually reads:

 

“Dubito, ergo cogito, ergo sum.”

“I doubt, therefore I think, therefore I am.”

 

TASK AT HAND: This week I’m thinking about doubt and apathy. Doubt, in my opinion, is a vital force in the quest for understanding. Without doubt, the search for knowledge can become complacent and dull.

“Without doubt, the search for knowledge can become complacent and dull.”

For Descartes, the act of doubting one’s own existence served as a basic proof of the reality of one’s own mind. This doubt, allowed for thinking beasts to realize fundamentals. Today’s Sunday Surgical Scrub is not about Descartes but it serves our discussion on doubt well.

Doubt is an extension of the existence of the individual. It is this ability – the ability to doubt – that can affirm one’s existence and their associated system of beliefs and ethics. In modern living, with all its virtual connections and influences, it is necessary to doubt regularly so that one can arrive at key aspects of character in multiple scenarios.

In the modern context, there exists an endless sea of statements, many of which are derived neither from data or fact. This is where doubt can save you! Doubt what you see on social media, doubt what you hear on television, doubt what you read in the news; doubt your teacher and preacher alike. Doubt so that you may come to understand.

“Doubt so that you may come to understand.”

What role does apathy play? Apathy is defined as a lack of interest, enthusiasm, or concern. In medicine, it can be a diagnostic clue to psychiatric disease. However, I believe the strength to be apathetic – to garner little concern for trivialities can be a boon of strength. Consider the human of today as an over-connected organism and you realize that – to effectively think for yourself – doubt and apathy are cornerstones to living comfortably in your own skin.

 

MEDICINE & MACULA: Many thanks to Mpls.St.Paul Magazine for selecting me as one of their Top Doctors Rising Stars in the April 2017 issue. This is awarded to physicians selected through a peer-nomination process. You can find the list here.
 

GRATIS: Descartes published The Discourse on the Method in 1637. It was originally titled: Discourse on the Method of Rightly Conducting One’s Reason and of Seeking Truth in the Sciences. I like the long title!

 

My best to you,

David Almeida

david@davidalmeidamd.com

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“Learn about others and the world around you but, most of all, be a lifelong learner of who you are and how you are changing.”

TASK AT HAND: This week I’m thinking about what it means to be a lifelong learner. Traditionally, we consider this in the context of learning new skills or the increased proficiency of our current skill set. This is beneficial for the objectives of improving productivity and efficiency.

But, more importantly – and often neglected – is the commitment to the evolution of learning about who we are and how we are changing. Study after study shows that people generally underestimate the extent of future personality growth. Researchers call this phenomenon “the end of history illusion” in that we tend to assume that our growth ends as we get older. (You can find a nice summary of recent studies here.)

“More importantly – and often neglected – is the commitment to the evolution of learning about who we are and how we are changing.”

This “end of history” illusion creates a possible hurdle in that we stop learning of who we are and how we are changing. This occurs because we think we have stopped changing, not realizing that, like the empty pages of a book yet to be written, our personalities have ongoing potential for growth. This potential for growth is often materialized with or without our knowledge or consent.

“The ‘end of history’ illusion occurs when people underestimate the extent of future personality growth.”

In this sentiment, today’s Sunday Surgical Scrub has a simple call to action: be a lifelong learner of you! Dedicate time and resources to the reflection of who are now and who you are becoming tomorrow. This will strengthen you, support your future strategies and goals, and be a boon to the ones around you.

 

MEDICINE & MACULA: A very sincere thanks for making The Ophthalmologist 2017 Power List! I am humbled to be considered one of the top 50 rising stars in ophthalmology. Moreover, I am grateful to be in the company of such wonderful and gifted colleagues!

You can find the list here.

 

My profile is here.

 

GRATIS: “ ‘Thank you’ is the best prayer that anyone could say. I say that one a lot.” -Alice Walker

 

My best to you,

David Almeida

david@davidalmeidamd.com

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“Begin the work. Forget the phantom of failure. Just start!”

 

TASK AT HAND: This week I’m thinking about the power of starting something. For those that visit here often, you know of my contempt for procrastination. My distaste for the paralysis of inaction. The inability to overcome inertia limits positive movement and meaningful strategy.

How do you keep this from holding you or your firm back?

Start!

Begin the work. Forget the phantom of failure. Simply start. Don’t worry about how hard you will have to strive. Don’t catalogue the reasons why it won’t work. Don’t fret over details and dire straits. Don’t ingratiate with impotence and ineptitude. Be it a moment or movement, start something. Whether a decision or an affirmation, by simply starting, you have overcome dread, delay and procrastination.

“By simply starting, you have overcome dread, delay and procrastination.”

When success finds you, the wave is easy to ride. When strategic moves are clicking, the puzzle fills in an orderly fashion and it seems all too easy. But, when you hit walls, when the pieces don’t fit, when your plans fail to crystallize; this when the ability to start something must be called upon.

Pandora, the online music streaming site, was rejected by over 300 venture capitalists and spent over two years of its early life broke, without cash. Nonetheless, Pandora utilized the resources available to create a basic platform. It started a tangible access point towards the goal of its creators. Online music streaming, like other competitive spaces, ensures multitudes of roadblocks and challenges and it will require the continual call of this skill.

Let’s take a job seeker as another example. How many rejections will you take? How many “No” and “I’ll pass” will you accept before you give up? How many times will you fail before you will do not risk failure again?

There is no number to contemplate, just start! Not in the fashion of Sisyphus, where the task was stereotyped and repeated in an endless loop. Instead, start anew, be willing, be flexible to learn from previous examples. This willingness to start anew, to pivot, to find a path of positive movement serves individuals and companies alike with the vector of acceleration where many seem content to circle at some average speed. The only requirement is that you start.

 

MEDICINE & MACULA: Fantastic to be part of the faculty at the Vit-Buckle Society V meeting in Las Vegas this past weekend (6-8 April 2017). Grateful for the discussion, learning new techniques that can best help our patients, and catching up with friends and colleagues!

I presented a talk on proliferative vitreoretinopathy (PVR), including pearls and techniques, for this challenging group of patients. Patients who are current or former smokers are significantly more likely to have PVR formation after retinal detachment repair.

 

GRATIS: Go ahead, start something!

 

My best to you,

David Almeida

david@davidalmeidamd.com

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“The cure for the calamity of inaction?

A pact to make a decision with passion and purpose!”

TASK AT HAND: This week I’m thinking about decisions and indecision. Over the last few weeks, I have been repeatedly asked, “why did you write a book about decisions?” I pontificate, and answer, there is a major difference between pondering and procrastinating…

We have become accustomed to endless information, right there at our fingertips, to supplant the need for critical thinking. Through the endless notifications, messages and distractions, the data deluge has reduced our attention span and, with it, reduced our capacity for effective decision making. We procrastinate and put off for tomorrow what we should be doing today. The resultant is an overwhelming vector of negativity on our ability to solve the problems we face. Whether we like it or not, we must all make decisions. Through fear and faction, we must decide or risk time, opportunity, and fulfillment.

So, how do you come up with a strategy that will help you make better decisions? That’s the impetus of why I wrote, Decision Diagnosis: Seven Antidotes to Decision Procrastination (both paperback and Kindle versions available here). In it, I present an efficient and expedited strategy for successful outcomes regardless of the decision in question.

What’s the main takeaway?

If you are struggling making decisions, it’s time for you to make a PACT. Here is a quick summary of PACT:

1.     PRACTICE: Practice makes permanence. Practice, with purpose and passion, transforms.

2.    ASSESSMENT: Assess the problem: Identify the character of the conflict. Ask open-ended questions, “who”, “what”, “when”, “where” and “why” to uncover the character of the decision.

3.     COLLECT: Collect information on who are the people, what are the places and things, relevant to your decision. Think like a physician and collect the pertinent positives and negatives that describe your question.

4.     TIMING: Define how much time you must make the decision in question. Immediately triage your decision – do I need to resolve this right now, or can I do it later?

By applying this PACT framework, you will dramatically improve your decision making ability and the ability to seek the answers that resonate with your goals and objectives.

 

MEDICINE & MACULA: Thank you RETINA TODAY for showcasing our novel technique on retinal embolectomy in the current issue, entitled: Retinal Embolectomy: Why, When, How? (David R.P. Almeida, Eric K. Chin & Vinit B. Mahajan).

We describe surgical embolectomy as a viable technique for patients with acute fovea-threatening arterial occlusions without a patent cilioretinal artery. Our goal, with this technique, is to push forward the potential for innovation in vitreoretinal surgery. We are thankful for the interest and discussion this has generated.

You can find the article here.

 

GRATIS: “No compromise with the main purpose, no peace till victory, no pact with unrepentant wrong.” -Winston Churchill

 

My best to you,

David Almeida

david@davidalmeidamd.com

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“Routine, in an intelligent man, is a sign of ambition.”

–WH Auden

 

TASK AT HAND: This week I’m thinking about routines. Stereotypical movements, rhythmical thoughts, and choreographed actions that we employ without second thought. Sometimes blamed for lacking in creativity for the sake of productivity, routines get an unfair share of criticism. Properly employed, routines can successfully support our strategies and objectives. Below are 3 key benefits of routines.

“Properly employed, routines can successfully support our strategies and objectives.”

1. Routines minimize cognitive burden. I have talked about cognitive burden before (Sunday Surgical Scrub from 12 June 2016, you can find the original post here). Cognitive load refers to the total amount of mental effort being used in the working memory. Cognitive burden can be thought of as an excess load on our mental effort. You can minimize undue burden by employing routines. For example, email has immense potential to overwhelm our cognitive load; however, by developing a routine to manage your messages, you can efficiently meet priorities without becoming a slave to your inbox.

2. You are what you repeatedly do. Your routines speak volumes about who you are. Routines describe what you commonly do. When looking for change, don’t start with a long shot. Change a routine and build a process to achieve your goal. Are you trying to improve your physical strength? I would forego the goal to bench a new Olympic record. Instead, create a routine where, for example, you incorporate weight training on certain gym days. Simple modifications to routines can transform major behaviors.

“Simple modifications to routines can transform major behaviors.”

3. Routine = Consistency. Having a routine can improve the consistent performance of physical and mental tasks. For example, a basketball player will bounce the ball several times before attempting a free throw. He or she uses this routine as a method of preparation to improve the chances of making the basket. When I’m performing scleral buckle procedures for retinal detachments, I always re-grasp the needle before making a scleral pass. This simple routine reminds me to focus on the exact depth I want to place the needle: too shallow, and the suture will not hold but, too deep, and I will perforate the eye. Both are negative scenarios I need to avoid. This simple routine helps me achieve consistent placement of the suture.

Optimize your routines as a means of process improvement. Life will throw you distractions like travel and sickness with the potential of upending your abilities. Use routines to remain focused on your core ambitions.

 

MEDICINE & MACULA: Throwback to 2012 when we published our case, Ophthalmic artery occlusion secondary to fat emboli after cosmetic nasal injection of autologous fat. This was published in the journal RETINA (you can find the study here) and is the case of a patient who lost all vision after undergoing cosmetic nasal fat injection. The striking color fundus photograph shows fat emboli that occluded the ophthalmic artery.

A stark reminder that all procedures, even benign elective ones, have the potential for profound complication.

 

GRATIS: “The secret of your future is hidden in your daily routine.” -Mike Murdock

 

My best to you,

David Almeida

david@davidalmeidamd.com

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“From reading too much, and sleeping too little, his brain dried up on him and he lost his judgment.” -Miguel de Cervantes

TASK AT HAND: This week I’m thinking about sleep. An overlooked and neglected component that is vital to our optimal reasoning and performance. Too often we look to the lack of sleep as a badge of honor indicating exemplary endurance. I look back at my years as a researcher, medical student, and on-call intern and how I would consider 30 or 40 hours without sleep a proud achievement. Now, I realize that, in those instances, I failed to care for myself and operated in suboptimal conditions.

We know that sleep restriction and sleep deprivation is linked with the development of diseases like obesity, diabetes, and hypertension. Researchers have shown that severe sleep loss jolts the immune system just as stress does, impairing our ability to properly tackle mental and physical tasks (check out study here). Sleep loss quadruples the risk of stroke (find the study here). Lack of sleep is not a badge of honor; rather, it is a mark of embarrassment reflecting our myopic self-awareness and unwillingness to be our best.

“Lack of sleep is not a badge of honor; rather, it’s a mark of embarrassment reflecting our myopic self-awareness and unwillingness to be our best.”

 

Today on the Sunday Surgical Scrub, here are three common questions that I have received on sleep recently. Ponder and enjoy!

 

1. Once in bed, how long should it take me to fall asleep?

This is known as Sleep Onset Latency or Sleep Latency and defined as the length of time that it takes to accomplish the transition from full wakefulness to sleep. If you take less than 5 minutes to fall asleep, you are sleep deprived! The ideal target is between 10 and 15 minutes, which indicates you’re tired enough to sleep but not exhausted as to show signs of daytime sleepiness.

The most important pearl here: once you get to bed, turn off your phone. The never-ending accessibility to the internet and constant messages, notifications, and distractions will disrupt your sleep latency and your subsequent stages of sleep. Your bed should be for sex and sleep. I don’t see the need for a phone here.

 

2. How much sleep do I actually need?

Most healthy adults need 7 to 9 hours of sleep a night. Although some individuals can function without sleepiness or drowsiness after as little as 6 hours of sleep – known as short sleepers – this represents less than 1% of the population so, chances are, this is not you. Short sleepers are believed to derive this ability from a genetic mutation on the DEC2 gene (check out the study here).

When considering how many hours you need to sleep, I believe there must be a philosophical shift in how you see the objective of sleep. Commonly, we look to how much sleep we need to “get by” or “survive” the next day. Change it up: how much sleep do you need to peak and thrive tomorrow?

 

3. What’s up with nightmares? What happens when I’m sleeping anyways?

Nightmares are defined as disturbing dreams in which unpleasant visual imagery or emotions wake us up. Contrary to popular belief, fear is not to the main emotion in nightmares; instead, researchers have found that it’s most often feelings of sadness, guilt and confusion (find the study here). Self-reflection, exercise, journaling, meditation are just a few common ways to reconcile the negative emotions that we harbor and can go on to degrade our sleep quality.

This blog post is much too short to describe all the processes and mechanisms that underlie sleep. Further, its unclear exactly why organisms need to sleep. However, it seems that most, if not all, species regularly enter a circadian rest state.

 

MEDICINE & MACULA: Special mention to an excellent study entitled, Fatigue, Alcohol and Performance Impairment from the journal Nature.

 

The study looked at sleep loss in terms of equivalent alcohol intoxication. A group of 40 participants were broken up in to two groups: one group was kept awake for 28 hours, simulating pulling an all-nighter, and the other consumed 10-15g of alcohol at 30-minute intervals until their blood alcohol concentration reached 0.10% (legal limit in every state is 0.08%).

Each group was given a performance task that required them to react as quickly as possible to visual cues randomly timed on a computer. After 17 hours of sustained wakefulness, performance was equivalent to a blood alcohol concentration of 0.05%. After 24 hours of sustained wakefulness, performance was equivalent to those with a blood alcohol concentration of 0.10%. According to this study, sleep deprivation is not so much a badge of honor, as an example of public intoxication (study here).

 

GRATIS: Man is the only mammal that willingly delays sleep. Stop doing it! For your health and engagement, go to sleep!

 

My best to you,

David Almeida

david@davidalmeidamd.com

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“Perspective is Providence.”

 

What do you see in the picture above?

It is a color photograph of one of my patients, diagnosed with wet macular degeneration, who has suffered a devastating hemorrhage. Her vision is worse than legal blindness and, due to several factors, the prognosis is poor for any vision improvement.

So, what do you see in this picture of pathology?

Do you see a foregone conclusion? A lost cause? A chance for a miracle? Hope in a complicated case? Consequences of a blinding condition?

Do you fight for any gain, at any cost? Or do you accept and move on preferring to first, do no harm?

 

TASK AT HAND: This week I’m thinking about perspective. Where the painting tells the story, perspective is the frame. Perspective, must be congruent to the painting of houses, to accurately engage the conflict or decision in question. I think of perspective as the ability to see beyond the literal – to read between the lines – and akin to emotional intelligence. Perspective is to see beyond what meets the eyes. Without it, one is tone deaf. Perspective affords you the ability to decipher in real time, rather than in a vacuum.

“Perspective is to see beyond what meets the eyes. Perspective affords you the ability to decipher in real time, rather than in a vacuum.”

 

As a surgeon, I’m lucky because I get to develop a frank dialogue with my patients so that we can decide, through informed and shared decision making, on a path to purse together. I provide my professional opinion – but ultimately – we decide together. My perspective in these situations combines a mix of the unique patient before me and the knowledge, experience, and instinct within me. I must never disregard this perspective.

For the decisions in our lives, many of the times, we are not so lucky as to have a second vantage point on decision making. This is one of the reasons why fallacies and bias are so troubling and can cause much of misguided strategy. As we bounce possibilities around, they can become extricated from reality and adorned with bias.

Now, what does providence have to do with any of this?

Providence can be defined as protective care from a higher power such as nature, spiritual forces or religious deities. But, I use it here as defining the timely preparation for future eventualities. Providence, to be prepared for the future, can be found in perspective. In other words, to have perspective and insight, provides preparation for what you may encounter in the unknown path in front of you. For all the apparitions of darkness, joy, pain, success, and failure that you may encounter, find providence in perspective. Use perspective for comprehension. Let your execution be guided by providence.

“Providence, to be prepared for the future, can be found in perspective. Use perspective for comprehension. Let your execution be guided by providence.”

 

MEDICINE & MACULA: If you haven’t had a chance, check out my new book, Decision Diagnosis: Seven Antidotes to Decision Procrastination. For those who have already gotten their copies, sincere thanks for your interest and for making it an Amazon best seller in multiple categories and countries!


Both paperback and Kindle versions are available here.

GRATIS: “The only real voyage of discovery consists not in seeking new landscapes but in having new eyes.” -Marcel Proust

 

My best to you,

David Almeida

david@davidalmeidamd.com

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