sss-2016yir

“Ring out the false, ring in the true.” -Alfred Lord Tennyson

 

TASK AT HAND: This week I’m looking back on 2016 and trying to learn from error and success alike. It has been an incredible year: davidalmeidamd.com was launched and the Sunday Surgical Scrub, an idea that has existed for quite some time, was officially started. Above all else, thank you for your support and interest in everything that we do on the medical, research, speaking and consulting fronts.

Today I will look back on the Sunday Surgical Scrub and review some highlights of 2016 as we transition to 2017. Here are 7 highlights from 2016.

1. Strategy: It Has To Work! (From the 22 May 2016 Scrub, you can find the original post here.What makes a strategy successful? If it works, it’s successful! Ultimately, your strategy must work and you must achieve your goals; otherwise, seriously consider switching strategies. The core of any successful strategy is the ability to plan and execute. I plan like an economist, but execute like a surgeon. In planning, you should employ some sort of analysis but then bring your decision out of your personal vacuum and into context and consequence. Then, when all planning is done, go out and execute it.

2. Minimize Cognitive Burden (From the 12 June 2016 blog, you can find the original post here.) Minimize your cognitive burden – both the extrinsic inconsequential happenings and the intrinsic personal trappings – so that in clarity you can fulfill your potential. 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. Minimize undue burden due to meaningless or inconsequential items.

3. Passion Is Essential (From the 24 July 2016 post, you can find the original post here.) Living with passion is to live days immersed in the strength of barely controllable emotion. Passion, as a source of energy, can be oppressed by the many tasks and distractions endlessly intruding into our lives. However, being reacquainted with your passion is a revitalizing elixir of energy, focus and determination that cannot be neglected. When you look back – which we are doing here in this year in review – you must recall a life lived with passion! Days filled with this barely controllable emotion that allows you to create and touch the lives of others in fantastical and wonderful ways. Find passion and “Let us live so that when we come to die even the undertaker will be sorry” (Mark Twain).

4. Be Careful of The Company You Keep (From 28 Aug 2016, you can find the original post here.) “If you’re the smartest one in the room, you’re in the wrong room” (Richard Tirendi). 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. Seek to be influenced by the best, and you will find yourself in good company.

5. Eliminated Fear of Failure (From 18 Sept 2016, original post here.If you’re not failing often, you’re not trying hard enough. 2016 was the year we let go of the fear of failure. Failure – and how we cope with its force – is of crucial importance to our character development.

6. Choose Fulfillment Over Achievement (From 23 Oct 2016, original post here.) Achievement is commonly confused for fulfillment. In the culture of 80-plus hour work weeks, dog-eat-dog cynicism, and the perpetual climb of the job ladder, one can easily place achievement as the ultimate external benchmark of success. This strategy will eventual burn out. Instead, the focus should be on the internal barometer of fulfillment, to guide our plans.

7. Beat Your Own Drum (Originally posted 27 Nov 2016, you can find the original blog here.) Live dangerously. Embrace pain and take risk. Desire to beat your own drum. Embrace pain and risk for it is in these moments that we carve out character and define development.

GRATIS: “Be at war with your vices, at peace with your neighbors, and let every new year find you a better person.” -Benjamin Franklin

 

Merry Christmas, Happy Holidays and my best to you always,

David Almeida

david@davidalmeidamd.com

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sss-unexpected-opportunities

“Opportunity dances with those already on the dance floor.” -H. Jackson Brown, Jr.

 

TASK AT HAND: This week I’m thinking about opportunities and how to catch unexpected prospects. I believe that unexpected opportunities are events that need to be created. Expecting the unexpected, when it comes to opportunity and progress, rarely works. One is best guided by a proactive nature to facilitate and cultivate these opportunities. “If opportunity doesn’t knock, build a door” (Milton Berle). As this fitting quote so nicely summarizes, opportunities require active participation. You need to build a bridge to get to the opportunity you seek.

“Expecting the unexpected rarely works.

Opportunities require active participation.”

But how do you create opportunities or uncover unexpected ones? There are three strategies you can consistently use to increase your yield on opportunities. First, change something. “Change brings opportunity” (Nido Qubein). Change a habit, change a routine, change a relationship, change the way you go about completing some task. Change is a powerful conduit for opportunities and can greatly help your ability to improve processes and pain points. At the very least, committing to changing a routine or practice allows for reflection on subtleties and nuances you may not have been previously aware of.

“Change is a powerful conduit for opportunities.”

Second, don’t be afraid to fail. “Failure is simply the opportunity to begin again, this time more intelligently” (Henry Ford). On a previous Sunday Surgical Scrub, I averred the need to fail and the benefits inherent is this necessary stage of growth (you can find the post here). Failure is the most common missed opportunity I see. Whether it is a failed drug trial or a contract not landed, these “failure” events usually possess unexpected opportunities but, as stated above, they require active consideration and proactive pursuit to materialize any merit or substance.

“Failures usually possess unexpected opportunities but require active consideration and proactive pursuit.”

Third, prepare for all possible outcomes. Pilots routinely use situational analysis to algorithmically assess all possible outcomes in flight scenarios. This allows pilots to be prepared for all situations. We can extrapolate this situational awareness to our personal and professional lives. Be prepared for the ideal outcome, the worst-case scenario, and all possible eventualities and the unexpected becomes opportunity.

“Be prepared for the ideal outcome, the worst-case scenario, and all possible eventualities and the unexpected becomes opportunity.”

MEDICINE & MACULA: One of our surgical techniques for endophthalmitis was published earlier this week. The study entitled, Five-Port Combined Limbal and Pars Plana Vitrectomy for Infectious Endophthalmitis, was published in Case Reports in Ophthalmology (2016;7:289–291) and centers on how acute infectious endophthalmitis can be challenging due to severe inflammation. In it, we describe a surgical technique combining limbal based vitrectomy and pars plana vitrectomy to manage acute infectious endophthalmitis. You can find the study here.

case-rep-opthalmol-2016-5-port-endophthalmitis

 

GRATIS: “There is no security on this earth; there is only opportunity.” -Douglas MacArthur

 

My best to you,

David Almeida

david@davidalmeidamd.com

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sss-bias-opinion

“Every piece of data is biased. Every argument has opinion.”

 

TASK AT HAND: This week I’m thinking about the effects of bias and opinion. Analysis after the US election show that “fake news” – stories that are false but presented in a truthful manner (e.g., newspaper article format) so as meant to deceive – outperformed legitimate news stories on social media. We now occupy the post-truth economy of thought. In this state, opinion and argument are given the same credence as fact and truth.

Recently, the Oxford Dictionary announced that “post-truth” is its 2016 word of the year. It defined it as ‘relating to or denoting circumstances in which objective facts are less influential in shaping public opinion than appeals to emotion and personal belief.’ Simply put, If you believe something strongly enough, talk loudly enough about it, and can connect with someone emotionally with your argument, then it impacts others like truth or fact.

As a scientist, I am vehemently against this idea that opinion can be substantiated for fact. Truth requires evidence and logic. Truth should be void of bias and opinion.

“Truth requires evidence and logic. Truth should be void of bias and opinion.”

I have heard many times, “what’s the problem with voicing your opinion?” There is nothing wrong with expressing your opinion – I encourage this! However, please don’t confuse the expression of worthy words versus baseless chatter. Your argument should still be based on truth and constructed in a logical manner.

The problem of repeating nonsense over and over is related to how our brains form memories. Studies show that the more often a message is repeated, the more likely we are to remember it. This effect is called fluent retrieval. However, our brains then erroneously extrapolate that, what we can remember easily, must be true (Inferring facts from fiction: reading correct and incorrect information affects memory for related information. Memory 2012 Jul;20(5):487-98; you can find the full study here). The effect is that if you repeat a lie often enough, it starts to feel like truth.

But how to uncover bias and opinion? First, assume every piece of data is biased and every argument, whether it be in a newspaper article, social media post or formal communication, has opinion. You are a detective and must identify the bias and opinion in everything you consume.

“You must identify the bias and opinion in everything you consume.”

You can minimize bias and opinion by sticking to trusted reporting. However, this is not enough. In science and medicine, we have peer-reviewed literature which is considered the benchmark for bias-free communication. Peer-reviewed studies have experts and thought leaders review the work in question to ensure it is scientifically sound before being published. Having personally published over 100 papers, I can tell you that even this process can have bias. Reviewers have personal and professional biases and humans operate poorly in recognizing their own biases.

Second, when developing an argument, use multiple sources. Never stick to one reference and never rely solely on one authority. Attempt to survey as many respectable sources as possible when trying to come to a conclusion. This synthesis of thought is the crux of thinking for yourself because it forces you to take multiple vantage points and create a unique one for yourself. This is hard work and the main hurdle to overcoming herd mentality.

Finally, refute and reject frequently.Blind belief in authority is the greatest enemy of truth” (Albert Einstein). This is not a call for anarchy but a reprisal for individual thought. Authority, or that which is accepted as truth, needs to be questioned. Force yourself to formulate independent thoughts as often as possible. This is not your brain’s default mode so you have to work at it. The goal is to have a society of independent thinkers that question truisms and myths alike. A culture that challenges arguments without fact and calls out opinions lacking logic.

How to uncover bias and opinion:

1.    Assume every piece of data is biased and every argument has opinion.

2.    Never stick to only one reference. Use multiple sources.

3.    Refute and reject regularly.

 

“The goal is to have a society of independent thinkers that question truisms and myths alike. A culture that challenges arguments without fact and calls out opinions lacking logic.”

 

MEDICINE & MACULA: One of our recently featured publications on the ongoing debate of auto-antibodies.

osli-auto-ab

Check out the paper, Positive Auto-Antibody Activity With Retina and Optic Nerve in Smokers and Non-Smokers: The Controversy Continues, published in Ophthalmic Surgery, Lasers and Imaging Retina (OSLI Retina). You can find the study here.

osli-retina

 

GRATIS: “If you tell the truth, you don’t have to remember anything.” ―Mark Twain

 

My best to you,

David Almeida

david@davidalmeidamd.com

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sss-no-time-no-rush

“It’s when you realize that you are out of time that you must focus on not rushing.”

 

TASK AT HAND: This week I’m thinking about the last minute, the eleventh hour, time as it expires. We are constantly rushed and hurried in our professional commitments and personal relationships. In these pressured moments, we tend to rush when, in fact, we should be deliberate and purposeful with our strategy. As time slips away, we can succumb to bad decisions but there are strategies you can use to avoid errors in these situations.

“As time expires, each second is worth more.”

First, realize that, as time expires, each second is worth more. I like to think of the eleventh hour in terms of relativity. Although one second is one second, in the closing moments of an assignment or instances where a quick decision is required, I like to think of those seconds as “more valuable” than previous ones. When you only have minutes to act, each second is crucial. When you have days to decide, deliberation can be consummate with a longer time window, and seconds seem to matter less.

Previously, on the Decision Triage post of the Sunday Surgical Scrub (you can find it here), I emphasized that, in the last minute, every decision must be made right away and that all triages become urgent in this context. For example, in surgery, I imagine expanding each second to feel like minutes so that I can carefully execute the maneuvers that will bring the outcomes that are required. If there is an unforeseen complication or adverse event – where there is a very small amount of time to correct the error – it is here, I cannot rush! Realizing each second here is worth more than at any other time during the surgery, I can focus solely on these intense junctures. This approach allows speed and efficiency, without ever being rushed or forced into shortcuts.

“Quiet your mind, then plan and execute!”

The feeling of “running out of time” is an external force. It comes from outside you and is then transferred onto your inner self. This creates needless self-inflicted pressure. Quiet your mind, then plan and execute! When you are left with what seems as no time and limited options, still your mind and see beyond the time frame. Find the character of the decision  and align yourself with the basic principles of what you want to achieve.

 

MEDICINE & MACULA: I was in Toronto this weekend for the 56th Annual Walter Wright Symposium, Retina 2016: A Practical Approach to Navigating the Future.

walter-wright-2016

On Saturday, I presented a talk on my approach and techniques for infectious endophthalmitis. The evolving paradigm calls for early surgery and aggressive treatment to salvage vision from this devastating infectious condition.

044_rs0916_North_RK.indd

 

GRATIS: “Why do they call it rush hour when nothing moves?” -Robin Williams

 

My best to you,

David Almeida

david@davidalmeidamd.com

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sss-paloma-beat-your-own-drum

“Live dangerously.

Embrace pain and take risk.

Desire to beat your own drum.”

 

TASK AT HAND: Last week, here on the Sunday Surgical Scrub, we discussed the idea that pain is certain but suffering is optional (you can see the post here). Thank you kindly for all your emails on this topic. Given the interest, today we are going to take this one step further.

This week I’m thinking about not only accepting pain as certain, but embracing this as an opportunity for growth and discovery. Yes, embrace pain, risk and the myriad of challenges that confront you. Live dangerously without fear of these experiences. As humans, we have evolved a strong tendency for loss aversion: avoiding that which is unpleasant is hardwired into our central nervous system. I prefer to invert this reaction: embrace the pain and risk that life brings forward because, it is in these moments, that we carve out character and define development. It is in these formative moments that lies occult opportunities to beat our own drum.

“Embrace pain and risk for it is in these moments that we carve out character and define development.”

“Believe me! The secret of reaping the greatest fruitfulness and the greatest enjoyment from life is to live dangerously!” (Friedrich Nietzsche) I have never known convenience to be a great innovator. I have never met idle chatter that sparked sentiment. I have yet to see predictability spawn spontaneity. It is when we take risks, accept difficulties, and elevate ourselves that we – more often than not – push through boundaries and breakthrough into new landscapes of creativity, sincerity, and understanding.

As you move in the pursuit of happiness and satisfaction, it may be necessary to live dangerously and take risks. Next time you are confronted with difficulty and dissatisfaction, embrace it and attempt to reveal its impact on you. Accept the painful transition and see how you are forced to adapt to navigate it. There is no permanence in pain.

“Accept painful transitions and see how you are forced to adapt. There is no permanence to pain.”

Refuse to bow to the pressures and difficulties you encounter. You will be left with the ultimate satisfaction that no matter what song echoes in the background, you’re playing to your own beat.

 

MEDICINE & MACULA: Thank you, Retina Specialist magazine, for showcasing our work on complicated viral retinitis retinal detachment repair in the November 2016 issue. This is part of our evolving work on approaches to complex retinal detachments.

viral-retinitis-retinal-specialist-nov-2016

Check out the publication here.

retinal-specialist-mag

 

GRATIS: I was in New York City yesterday to watch the musical Hamilton. This fantastic production made me smile as it reminded me of the Stella Adler quote: “Life beats down and crushes the soul, and art reminds you that you have one.”

hamilton

 

My best to you,

David Almeida

david@davidalmeidamd.com

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sss-pain-vs-suffering

“Pain is certain, suffering is optional.”

 

TASK AT HAND: This week I’m thinking about pain and suffering. Take the sutured incision pictured above. After a surgical wound, almost everyone will experience pain. However, only some become burdened with suffering, while others do not. As a surgeon, I realize that almost all patients experience pain, but I find it distressing when patients become entangled in prolonged suffering.

We can extend this concept to the trials we encounter in our personal lives. We all have to bear duress, inflictions, and loss. The twists of life invariably ebb and flow between states of pain and vulnerability and moments of joy and satisfaction. Experiencing pain is certain. But we do not need to suffer. Suffering is optional.

Accept pain. One of the fundamental strategies to minimizing the experience of suffering from the pain we face is to, simply, accept the pain. This can be somewhat counter-intuitive but, by accepting the pain we face, we choose to not react to it. In not reacting, we are denying the possibility of succumbing to maladaptive behaviors like suffering. Accept your pain, and if at all possible, let it not elicit any reaction from you.

Deny suffering. Suffering can become a haze. A fog of uncertainty that can impair your ability to make effective decisions. We too often aggrandize the value of suffering. Instead, avoid internalizing forces that may weaken you. “Life is short. You have to be able to laugh at our pain or we never move on” (Jeff Ross).

If you take one sentiment from this post, please know that suffering is optional. I have found this alone to be liberating because it gives us this choice of how to react to the pain we encounter in life. Pain is guaranteed but suffering is not. Suffering is not predestined or inevitable. Instead, find a way to look back, laugh, but then move on.

MEDICINE & MACULA: Check out our new publication, Ocular Hypertension After Intravitreal Dexamethasone (Ozurdex) Sustained-Release Implant, published in RETINA. Our report shows that the intravitreal dexamethasone implant, Ozurdex, can be used in various types of patients, including glaucoma suspects, with a good safety profile.

ozurdex-retina-nov-2016

Check out the publication here.

retina

 

GRATIS: “One good thing about music, when it hits you, you feel no pain.” -Bob Marley

 

My best to you,

David Almeida

david@davidalmeidamd.com

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sss-disclosure

“Men often hate each other because they fear each other; they fear each other because they don’t know each other; they don’t know each other because they can not communicate; they can not communicate because they are separated.” -Martin Luther King, Jr.

 

TASK AT HAND: This week I’m thinking about truth and lies. All humans lie. There are numerous research reports and published studies that show that we all lie. Whether a pastor or prisoner, black or white, we all lie. From rationalized half-truths to orchestrated cons, lies hurt our unique ability to communicate. They, as the MLK quote states above, separate us and break down real discourse with each other. This has serious consequences that negatively impair our personal and professional relationships.

However – in knowing we all lie – what is the best strategy to free us from lies and liars? Disclosure is a forgotten tool that helps us navigate the byways of truth and lies. Disclosure, loosely defined as the action of making new information known, is a powerful weapon against the tendency to blur reality and fiction.

“Disclosure is a powerful weapon against the tendency to blur reality and fiction.”

As a surgeon and scientist, I disclose all possible positive and negative outcomes of a treatment or surgery to my patients. Before I say anything else, I disclose to the patient. I disclose all the good and all the bad. My hope is that the patient then reciprocates and starts an honest conversation with me about their questions, fears and anxieties. From here, we can cement a trustful rapport that will allow us to share in decision making and achieve what is in the best interests of the patient.

One can build on this concept of disclosure. Whether you are discussing with a friend or negotiating with a competitor, start by disclosing up front. Leslie K John’s book, How To Negotiate With A Liar, shows that humans have a strong reaction to reciprocate and return disclosure with truth. This disclosure is a surprise tactic when you encounter a liar. When you are facing a deceptive strategist, start with disclosure and they will find it difficult to avoid the honest road.

“When you are facing a deceptive strategist,

start with disclosure and

they will find it difficult to avoid the honest road.”

MEDICINE & MACULA: Check out one of our recent publications, Chronic Recurrent Pseudophakic Endophthalmitis, published in JAMA Ophthalmology (JAMA Ophthalmol. 2016;134(4):455-456. doi:10.1001/jamaophthalmol.2015.3638).

This study details a case of an immunosuppressed patient with active chorioretinitis and chronic endophthalmitis after cataract surgery.

jama-endophth-2016

Thanks to everyone for their interest in our growing body of endophthalmitis literature. This is a significant interest of mine and we have more studies planned.

Check out the publication here.

GRATIS: “No man has a good enough memory to be a successful liar.” -Abraham Lincoln

My best to you,

David Almeida

david@davidalmeidamd.com

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sss-compare-despair

“When you are content to be simply yourself and don’t compare, everybody will respect you.”

-Lao Tzu

 

TASK AT HAND: This week I’m thinking about the pitfalls of comparing ourselves to others. “The human brain is built to compare; it’s Darwinian to consider an alternative when one presents itself” (Helen Fisher). Multiple studies, from monkeys to humans, show that we are hardwired to compare ourselves to others. There is a basis for a need to compare – it’s part of our evolutionary drive. We look to compare options for refuge and food, to assess alternatives to mates and future offspring, and how to judge potential threats in our environment.

Now, the pitfall occurs when comparison is escalated with judgment. It’s fine to compare one hotel to the other, consider prices and geography when making a choice for lodging. However, when we compare our hotel to a nicer option, and judge ours as inferior, we start to degrade our degree of satisfaction from an experience. This need to compare is a sure way to decrease our happiness because we ostensibly look at those who have more leading to judging ourselves as lesser.

“You can’t compare an apple to an orange. It will cause a lot of self-esteem issues” (Craig Sheffer). The problem is magnified when we compare ourselves to other people. This is never a fair comparison because we tend to, as the preceding quote describes, compare apples to oranges. No two individuals are the same, and thus, any subsequent comparison is faulty. You need to avoid this malevolent want to compare because its eventual conclusion is despair and insecurity.

How do you avoid the cycle of compare and despair? Judgment is the key! Compare all you want, but don’t judge. Don’t judge a better or worse option. And, most importantly, avoid comparisons between individuals with simplified “better” or “worse” terms. This faulty comparison is filled with intangibles that surfaces insecurities and inadequacies.

When we compare and judge ourselves as inferior,

we start to degrade our degree of satisfaction from an experience.

Similar to my previous post on Anticipation versus Expectation (you can find that post here), liberate yourself from mindless comparisons and find value in the attributes of different individuals and the characteristics of different options. “The surest route to breeding jealousy is to compare. Since jealousy comes from feeling less than another, comparisons only fan the fires” (Dorothy Corkille Briggs).

In my opinion, the most vital form of happiness is derived from the respect we pay to others, and the respect we receive in return. Focus on the value you provide to relationships and members of your tribe. Hone skill in accepting events beyond our control. You will find that the need to compare to others fades away into the singularity of realizing that, the only one worth comparing to, is yourself.

MEDICINE & MACULA: I do a significant amount of speaking and presenting to diverse groups, from retina surgeons to corporate clients. But this past Monday, on Halloween, I got the privilege of presenting an “eye introduction” to my son Max’s preschool class. It was a wonderful time with a lot of props as you can see below.

max-halloween-school-high-res

Although rudimentary in its content, it served to remind me that I sometimes get caught up in esoteric specialized terminology. Speaking to these hungry-eyed preschoolers emphasized that one must have a bulletproof ability to distill complex information in a basic and accessible form to any audience. I am grateful for this.

With the help from my wife, Jasmine, we all made scary eyes for the class!

scary-eyes

GRATIS: “If you’re asking me to compare myself to other people, I don’t really know what other people are like.” -Jules Shear

My best to you,

David Almeida

david@davidalmeidamd.com

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sss-survival-bias

“Hi, I’m Bill. I’m a birth survivor.” -Bill Maher

 

TASK AT HAND: This week I’m thinking about survival bias, also known as survivorship bias. Survival bias is a logic error that produces false conclusions by looking at a person who achieved an outcome and overlooking those that did not, despite both having similar characteristics. Simply put, the “survivor” is used as a model to extrapolate from, only because they survived the event, despite the fact that many similar individuals exist for comparison that did not survive the event.

Let me use a couple of examples to illustrate the point. Usain Bolt, the Jamaican sprinter, is heralded as the fastest human ever timed. He is the first man to hold both the 100 and 200 meter records. He is an amazing sprinter, a charismatic character, and a fantastic entertainer. Many have tried to ascertain how he is able to run so fast. Bolt usually states common athletic creeds such as “belief in yourself” and “training hard”. Survival bias enters here because Usain Bolt is the fastest human in the history of mankind not because he trains hard and believes in himself, but despite this.

How many athletes believe in themselves and train hard? How many fall short? Too many to count. Many times athletes are asked how they achieve greatness and they usually provide the same predictable answers. The reason is, because they don’t know. They trained hard like everyone else but they, for some reason, were able to produce superlative results. Now, in no way do I diminish these feats. I celebrate them! But, you have to be careful in their extrapolation to your life.

Another example. Many want to be the next Steve Jobs and create a behemoth success like Apple. Steve Jobs dropped out of college and started a business. Do you think this was the reason? How many others have dropped out of school and started business that failed? Too many too count. Steve Jobs was the “survivor” of this event and succeeded not because he dropped out of school, but in spite of this.

There are numerous examples of survival bias in a myriad of disciplines so one needs to be aware of this erroneous process of reasoning. Survivorship bias leads to overly optimistic and simplified beliefs because only successful survivors are used while the many similar failures are ignored. Most of the time, the failures have very similar attributes and no significant relationship is evident.

This important because one needs to understand that successful groups – most of the time – do not have any special property. This does not diminish or lessen their achievement. But, when you are trying to reproduce some of these behaviors, consider both successful and failed examples. The role of timing, coincidence, and serendipity will become apparent.

How does this help you? Personally, it serves to balance my emotional reaction to events. I know I’m never as good as my best day. But, I’m also not as terrible as my worse day – and I don’t beat myself up over it. I survive each day, despite how factors beyond my control play out, and I remain focused on what I have defined as important.

MEDICINE & MACULA: A couple of weeks ago I described our technique for retinal embolectomy. This technique was recently published in Retinal Cases & Brief Reports. Retinal embolectomy involves the removal of emobli from the retinal vasculature in selective cases of arterial occlusions.

embolectomy1-copy

embolectomy2-copy

Check out the publication here.

rcbr

GRATIS: “Science is the search for truth, that is the effort to understand the world: it involves the rejection of bias, of dogma, of revelation, but not the rejection of morality.” -Linus Pauling

My best to you,

David Almeida

david@davidalmeidamd.com

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sss-enigma-2

“People want riches; they need fulfillment.” -Robert Conklin

 

TASK AT HAND: This week I’m thinking about the difference between achievement and fulfillment. Achievement is commonly confused for fulfillment. In the culture of 80-hour work weeks, dog-eat-dog cynicism, and the perpetual climb of the job ladder, one can easily place achievement as the ultimate external benchmark of success. This strategy will eventual burn out. Instead, the focus should be on the internal barometer of fulfillment, to guide our plans.

Achievement can be defined as the process of successfully completing a task. As one can see, there is lots of good in achievement. It requires commitment to an end. It emphasizes  ability. However, achievement can become an empty end. Without an internal desire for excellence and without a process of development and introspection, achievement can result in empty goals and lackluster methods. Fulfillment, in totality, extracts meaning from our tasks. In other words, it is why we want to achieve a goal? This why is the crux of what fulfills you. While achievement is the “how”, start to think of fulfillment as the “why” to a strategy or goal.

People often ask me, “what is the easiest path to fulfillment?” I say: start by collecting experiences and not things! Collecting experiences, for example by traveling, allows you to focus on transitions without some definitive end target. One of the most common end-of-life regrets is the wish to have traveled more during years of good health.  Too often, the substitution to the acquisition of items creates confusion in endless consumption. Goods – are only of value – if they are good for something.

 

MEDICINE & MACULA: Check out our new publication, Elevated intraocular pressure following pars plana vitrectomy due to trapped gas in the posterior chamber, published in Retinal Cases & Brief Reports (Fall 2016, Volume 10, Issue 4, pages 334–337).

trapped-gas

Clinicians should be aware of elevated intraocular pressure secondary to trapped gas in the posterior chamber. Aspiration of the trapped gas can alleviate both pupillary block and angle closure without compromising gas tamponade.

trapped-gas2

 

Check out the publication here.

rcbr

 

 

GRATIS: In your achievements, find fulfillment. And, in the life you are creating, seek a path that leaves you fulfilled and you will achieve that which is paramount.

 

My best to you,

David Almeida

david@davidalmeidamd.com

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