“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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“Creativity, in an unproductive form, may emit a flash in the pan, but rarely creates enough light to sustain the night.”

 

TASK AT HAND: This week I’m thinking about productivity versus creativity. Productivity – how we think – can be thought of as the grammar or syntax of a sentence. Creativity – what we think – are the words, concepts and emotions in that sentence. I think of productivity as the order and arrangement of a composition whereas creativity is the unique melody. While productivity tends to have basis in ordered and logical processes, creativity can be borne out of entropy and randomness.

“Productivity is the order and arrangement of a composition.

Creativity is the unique melody.”

 

Linear thinking; for example, events separated by time, follows a predictable pattern of organization and can be connected without much labor. On the other hand, the connection of multi-dimensional coordinates usually requires creativity to consolidate disparate variables. Creativity can provide wonderful and novel insights into problems and phenomenon but, the crux is that creativity is not enough for successful strategy. At some point, creative findings need to be distilled into elements of capable comprehension for effective decision making. In summary: being creative is not enough! Much talent is wasted and, we all know examples, where lack of work ethic undermines the creative process.

“At some point, creative findings need to be distilled into elements of capable comprehension.”

Why discuss these two concepts here on this week’s Sunday Surgical Scrub? Over the last few weeks, I have received emails and questions on how to enrich one’s creativity. Personally, few wonders are as rewarding as the creative process; however, often, creativity, or a lack thereof, is not the problem. The more commonly encountered issue lies in deficiencies in bringing that original concept – what you thought – into a thesis that can be evoked and understood.

I need to emphasize that the call to action here is not for more productive individuals at a cost of creativity. Rather, seek a state of wholeness where both the synthesis and organization of new thoughts and ideas coexist. Find congruency in their relationship.

“Seek a state of wholeness where both the synthesis and organization of new ideas coexist.”

Next time you are pondering problems or reflecting on ramifications, break down the elements of your decisions into the aspects of productivity (how you think) and creativity (what you think). This will give you valuable insight into the overall process. You will be surprised at your creativity, and you will appreciate the process for decoding it.

 

MEDICINE & MACULA:  Many thanks to Scott Krzywonos, Editor-in-Chief of New Retina MD and producer of the New Retina Radio podcast.

I was on the latest New Retina Radio Podcast. Check out Episode 4, PhD, MBA, JD, MS: Alphabet Soup where we discuss how multiple degrees, beyond the Medical Doctor, enrich the role of the physician and the subspecialty of vitreoretinal surgery.

You can find the episode here.

 

GRATIS: Both productivity and creativity are concepts that improve with journaling. Write down 1-3 new ideas each day. Do this at a time of day when you are alert and awake (not as a checklist before bed). Warning: they will be terrible at first, but this is ok. Like working a muscle, you need to build up strength, endurance, and precision in the execution of creative thought. Next, write down one problem or process that hinders your productivity (look out for the repeated theme of procrastination). The latter will allow you to identify areas that bleed productivity from your life. Finally, periodically reflect on your points to strengthen your creativity and intellectual prowess. Not uncommonly, you will be pleasantly surprised to find creative solutions to productivity problems.

 

My best to you,

David Almeida

david@davidalmeidamd.com

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“Do not be sunk by the weight of history and do not let inertia impede your improvement.”

 

TASK AT HAND: This week I’m thinking about two stumbling blocks that can insidiously creep into our perceptions and influence our strategies.

1. The weight of history. The weight of history is the concept that our personal and collective historical baggage can be so heavy that it limits our progress. This can strain relationships and hinder decision making.

Now, it is imperative that you live with the correct – i.e., true – facts and conclusions from your history. However, it does not mean you must be weighed down by them. History is an ocean of knowledge, but it can also drown you. If you shackle yourself to the portrait of who you were yesterday, you may bind yourself to painting the same picture again today.

“If you shackle yourself to the portrait of who you were yesterday, you may bind yourself to painting the same picture again today.”

I want you to let go of this weight! How? Find an action or outcome from the past that you felt delivered underwhelming results. Look for the root cause; for example, a tendency to rush decisions. Now, find a tentative solution; like being cognizant of the time available for each decision. Then, institute a change as a means of unburdening yourself of a negative historical weight.

 

2. Law of inertia. This concept is from Newton’s First Law of Motion which reads:

“An object at rest stays at rest and an object in motion stays in motion with the same speed and in the same direction unless acted upon by an unbalanced force.” Newton’s First Law of Motion

I want to surmise this law into a simple statement: “objects tend to do what they do”.

What’s the relevance for us? Where the weight of history limits our progress, the inertia in our lives – the stereotypical rhythms of our actions and strategies – can keep us from findings new directions to grow, learn, and discover.

How do you curate the change to overcome inertia? Newton answers this for us: “unless acted by an unbalanced force”. Find an unbalanced force – spontaneity, travel, a rewarding relationship – and invest time and energy in it to overcome the inertia and resistance blowing against you.

 

MEDICINE & MACULA: Check out our newest publication, Efficacy of the Intravitreal Sustained-Release Dexamethasone Implant for Diabetic Macular Edema Refractory to Anti-Vascular Endothelial Growth Factor Therapy: Meta-Analysis and Clinical Implications (Khan, Kuriakose, Khan, Chin & Almeida) published in Ophthalmic Surgery, Lasers and Imaging Retina (February 2017, Volume 48, Issue 2, pages 160-166, DOI: 10.3928/23258160-20170130-10).


In this meta-analysis, we examined a total of 3,859 patients among 15 studies and found that treatment with Ozurdex is associated with significant mean improvement in visual acuity in patients with diabetic macular edema who have a sub-optimal response to anti-vascular endothelial growth factor therapy. This is further support to a multimodality approach to treating diabetic macular edema.

You can find the study here.

GRATIS: “The reason men oppose progress is not that they hate progress, but that they love inertia.” -Elbert Hubbard

 

My best to you,

David Almeida

david@davidalmeidamd.com

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“Panic causes tunnel vision. Calm acceptance of danger allows us to more easily assess the situation and see the options.” -Simon Sinek

 

TASK AT HAND: This week I’m thinking about the pitfall of cognitive tunneling. Cognitive tunneling, also known as cognitive capture, is an inattentional blindness phenomenon where one becomes hyper-focused on some variable other than the present environment. When this occurs, as the old axiom states, you “can’t see the forest for the trees”; or in other words, you become obsessed in some sentence that you lose perspective of the story.

“Cognitive tunneling is an inattentional blindness phenomenon where one can’t see the forest for the trees.”

When cognitive tunneling occurs, the individual may become lost in internal thought or instrumentation and lose focus on the present action or environment. An example would be a pilot focused on an altimeter rather than the runway ahead. More commonly, we tend to become entrenched in inner negative thought rather than executing effective strategies for the conflicts we face in our lives.

Inattentional blindness is primarily caused by our unconscious minds, particularly when we are overwhelmed with information or options, fatigued, inebriated or panicked (Caroline Beaton, Millennial Cognitive Tunnel Syndrome: Why We Miss The Solutions To Our Career Crises, Forbes July 2016). Realizing that our unconscious minds aren’t always the best at determining what’s important, cognitive tunneling helps explains why we tend to react to failures in counterproductive ways. Instead of remaining focused on the conflict, we lose awareness and move farther away from resolving the issue.

As mentioned above, under stress, this cognitive capture is exacerbated into the error of tunnel vision where the range of cue utilization is reduced (Dirkin GR, Cognitive tunneling: use of visual information under stress, Percept Mot Skills 1983;56(1):191-8). Simply put, tunnel vision limits our ability to process peripheral information because we are over-committed to some central issue.

“Under stress, this cognitive capture is exacerbated into the error of tunnel vision.”

Why is this important?

The crux here is awareness! You are at your best with maximal awareness for the task at hand, but also by being cognizant of the variables that influence it. Awareness is akin to context and, minimizing cognitive tunneling, aids you in the processing of relevant information. One step further, improved contextual awareness allows you to filter out the relevant from the irrelevant which minimizes your chances of becoming trapped by unimportant details.

“Awareness is akin to context and, minimizing cognitive tunneling, aids you in the processing of relevant information.”

 

MEDICINE & MACULA: Thanks again for all the interest in my new book, Decision Diagnosis: Seven Antidotes to Decision Procrastination, and for making it an Amazon best seller in multiple categories and countries!

Both paperback and Kindle versions are now available here.

GRATIS: “Stress makes us prone to tunnel vision, less likely to take in the information we need. Anxiety makes us more risk-averse than we would be regularly and more deferential.” -Noreena Hertz

 

My best to you,

David Almeida

david@davidalmeidamd.com

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“Man is the only kind of varmint who sets his own trap, baits it, then steps in it.”

-John Steinbeck

TASK AT HAND: This week I’m thinking about the confirmation trap. Confirmation bias, also known as the confirmation trap, occurs when we procure data and information that aligns with our beliefs and ignore that which runs counter to our arguments.

“The confirmation trap occurs when we procure data and information that aligns with our beliefs and ignore that which runs counter to our arguments.”

The ability to recognize bias is essential for survival. To be cognizant that we are strongly attracted to our own beliefs and that these biases, left unchecked, increase our vulnerability for errors needs to be constantly addressed. Bias in opinion is easier to detect and correct; however, confirmation bias – when we actively seek out information to back our preconceived beliefs is dangerous!

“The ability to recognize bias is essential for survival.”

 

How do you avoid the confirmation trap?

How do you escape the fallacy of searching for information that propagates an erroneous echo chamber?

There are three strategies you can employ that are effective at liberating you from this trap.

1. Be a cynic. Act like a doubter. Question as a skeptic. Question both the quality of the data and the validity of the source. Those that know me, come to recognize that engagement by means of doubt is something I value dearly. I believe that the ability to question is essential for the overall health of the individual and the common collective. Worthwhile societal contributions are commonly created by this process of questioning and conflict.

“The ability to question is essential for the overall health of the individual and the common collective.”

2. Plan how you acquire your data or information. This strategy tends to apply more towards your professional tasks but I recommend you plan your data gathering ahead of time. In the medical and scientific literature, we describe this as a priori endpoints and outcome measures. The act of specifying analytical methodology before you start looking at the results minimizes haphazard and scattered conclusions.

3. Two sources are better than one. When in doubt, have multiple sources. Few strategies are as simple, yet as effective, as having multiple trusted sources to ascertain the validity of the information you are analyzing. As I have mentioned here on the Sunday Surgical Scrub before, never rely on just one source for any meaning analysis.

 

MEDICINE & MACULA: My new book, Decision Diagnosis: Seven Antidotes to Decision Procrastination, is now available on both Kindle and as a paperback.

My sincere thanks for making it an Amazon best seller in multiple categories and countries!

 You can find it here.

 

GRATIS: Whenever I’m lucky enough to get the opportunity to drive my kids to school, I always remind them to ask one good new question each day. Then, I ask them to look for holes, fallacies and inconsistencies in the answer they get back. Always be on guard for the confirmation trap!

 

My best to you,

David Almeida

david@davidalmeidamd.com

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“Think outside the box, collapse the box, and take a sharp knife to it.”

–Banksy (Wall & Piece)

TASK AT HAND: This week I’m thinking about the axiom, “think outside the box”. I don’t particularly like clichés but they sometimes are exemplary to illustrate a concept. For example, what does it mean, “think outside the box”? This is one you hear constantly, irrespective of field or expertise.

When I hear, “think outside the box”, I interpret this as the pursuit of original thought, creative discourse, or innovative strategy. These are all worthwhile goals! In fact, I believe these to be crucial to personal growth. As we previously discussed here on the Sunday Surgical Scrub with Constant Change (August 2016) and Agents of Change (January 2017), one must change or pay the heavy price for staying the same.

Banksy, the infamous social artist articulates and extends this concept one step further with our introductory quote. He feels that thinking outside the box is not enough; you need to shred and destroy the box – thereby eliminating boundaries – to appreciate your full creative potential. I like this!

 

But how do we go about getting outside the boxes that constraint our deliberations and decisions? There are two strategies that are central to getting outside the box.

1. Grow your capacity for self-awareness. Pursue self-enquiry and probe the degree of self-awareness you currently occupy. Do you constantly revisit your ability to look inward? This is challenging and difficult but, your ability to get out of the box and escape its boundaries, relies on your ability to be self-aware. Only when you recognize your comforts and conveniences can you eclipse them. The knife you need to cut this box into pieces is your degree of self-awareness. Sharpen it often!

2. Invite conflict. Akin to your degree of self-awareness is your desire to invite conflict in your life. Note, I do not mean to invite melodrama or perfunctory argument. Invite genuine conflict into your ideas. Invite conflict so as to challenge your strategies. You will find the resultant solutions are wonderful elaborations rather than products of simple linear thinking. Having conflict need not create a discordant song but rather allows for a symphony with rich notes and rhythms.

So, next time you are faced with dilemma or decision, get out of the box, stomp on the box, cut up the box, and realize that you need not be confined to its boundaries. Instead, use self-enquiry and self-awareness to invite conflict as a means for the creative expression of innovative solutions and strategies.

 

MEDICINE & MACULA: Thanks to everyone for all the support and interest in my new book, Decision Diagnosis: Seven Antidotes to Decision Procrastination.

It is a now an Amazon best seller in multiple categories and countries!

My sincere thanks!

You can find the book here. 

 

GRATIS: “Instead of thinking outside the box, get rid of the box.” -Deepak Chopra

 

My best to you,

David Almeida

david@davidalmeidamd.com

 

 

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“Gambling: The sure way of getting nothing for something.”

-Wilson Mizner

 

TASK AT HAND: This week I’m thinking about the gambler’s fallacy. When you flip a coin, the outcome (assuming a fair coin) is independent of the previous result. The gambler’s fallacy is the mistaken belief that, what happens more frequently in one time period, will happen less frequently in another time period.

“The gambler’s fallacy is the mistaken belief that, what happens more frequently in one time period, will happen less frequently in another time period.”

For example, someone flips a coin and it lands on heads five times in a row. What do you expect the next result to be? It’s still a 50% chance of heads or tails because, in situations where what is being observed is truly random, the previous result has no effect on the next result. The fallacy to think that the next coin flip will reveal tails, because the last five were heads, occurs by the appeal of this fallacy to the human mind which surmises that the next result “should” be different than the previous ones.

“In situations where what is being observed is truly random, the previous result has no effect on the next result.”

Why are we talking about this on today’s Sunday Surgical Scrub? The reason is this fallacy arises in varied situations and needs to be differentiated from the principle that, the best indicator of future performance is past performance. The significant difference between this key principle and the gambler’s fallacy is that the latter applies to random events while the former is best applied to the complex personal and professional strategies we employ.

For example, let’s take the situation of a job application. Let us take someone who has been turned down for five straight positions and has a sixth interview scheduled. He or she can take the approach that, “I’m bound to get one of these jobs sooner or later since I’ve been rejected so many times”. This is the gambler’s fallacy at work. Don’t see this as a random event in the same way a roulette spin is a random event. Our choices involve a multitude of inputs that we must process and then synthesize a coherent strategy from. The preferred adaptive approach would be to ask for feedback at the five rejections and look for common themes. Why are you not getting these jobs? Are there more qualified applicants? Is there a problem with your skill set? Do you have a bad reference? If you don’t seek this crucial information out, it will be difficult to break through and change the result. Contrast this with someone who pays attention to detail and seeks out positions that best suit his or her skill set. They may only get two or three interviews but, the chance of successful conversion, will be higher.

“Our choices involve a multitude of inputs that we must process and then synthesize a coherent strategy from. They are not random events in the same way a roulette spin is a random event.”

“Casino gambling is colorful and dramatic and theatrical” (Steve Wynn). Leave gambling to the theatrics of the casino. Don’t gamble with the decisions we ponder and pontificate on. Avoid the gambler’s fallacy in random events and, when it comes to choices and crossroads, use the power of analysis to maximize your performance and achieve the objectives you seek. Don’t ever leave these to chance.

 

MEDICINE & MACULA: Many thanks for the interest and support for my new book, Decision Diagnosis: Seven Antidotes to Decision Procrastination. Since its release, it has held a top spot on Amazon in multiple categories and in multiple countries.

It is currently listed as:

#1 in Decision-Making & Problem Solving (USA)
#1 in Management & Leadership (USA)
#2 in Business & Money (USA)
#3 in Management & Leadership (UK)
#2 in Decision-Making & Problem Solving (Germany)
#1 in Self-Help & Success (Canada)
#1 in Decision-Making & Problem Solving (Canada)
#1 in Management & Leadership, Decision-Making & Problem Solving (Canada)
#1 in Decision-Making & Problem Solving (Australia)

My sincere thanks for the support!

The paperback will be released in the next few days and you find it here.

 

GRATIS: “In a bet, there is always a fool and a thief.” -Unknown
 

My best to you,

David Almeida

david@davidalmeidamd.com

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