smartestintheroom?

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

 

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

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

smartest in room

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

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

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

acanthamoeba panuveitis

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

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

My best to you,

David Almeida

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triage decision sss

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

 

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

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

now

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

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

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

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

 

Caregiver burden fig

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

burden study paper

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

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

My best to you,

David Almeida

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constant change

“There is nothing permanent except change.” -Heraclitus

 

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

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

 

agentofchange

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

 

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

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

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

 

 

asrs 2016

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

 

Here is a brief summary of the work we presented:

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

 

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

 

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

 

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

 

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

 

GRATIS:

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


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


And it makes me wonder.

“Stairway to Heaven” by Led Zeppelin

 

My best to you,

David Almeida

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expectation anticipation art

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

Albert Camus

 

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

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

 

waiting for santa

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

 

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

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

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

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

zika fa

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

zika citation

 

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

 

My best to you,

David Almeida

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TOSHIBA Exif JPEG

Take from all things their number and all shall perish.
Saint Isidore of Seville, Etymologies (Book III, c.600)

 

TASK AT HAND: This week I’m thinking about “quantity” and the tangible aspects of strategy. A few weeks ago we discussed the intangibles of decision making and I thank you for the enthusiastic response. Today, contrasting with the quality or intangibles of a decision, you can think of tangibles as decision making items that have inherently associated metrics – a quantity that we can explore to make better decisions.

In medicine, when eliciting the history of an illness from a patient, the quantity is many times simply a number: how bad is your pain? 0 is no pain and 10 is the most pain you can imagine – what is your pain? This simple metric has massive impact and aids your diagnostic workflow significantly. In strategy, think of this quantity as tangible aspects of decision making that can be measured. When teaching, I often refer to these tangible metrics as the quantity relevant to my strategy.

measuring tape

For example, you may purchase a car for intangible qualities like how it makes you feel or your first memory of that model. On the other hand, quantity or tangibles metrics would include items like horsepower, fuel economy, braking distance, etc. One can quickly appreciate that these metrics can get very extensive so I have created 3 B’s – basic components for ease of applicability to any decision.

 

1.   Bank: this is your budget and contains all aspects of funding critical to your decision. How much in your bank?

2.   Bread: raw materials, intellectual capital, workforce, customer base. This describes the resource metrics relevant to your decision. How much bread do you have?

3.   Brawn: This is the amount of effort you have to put into a decision; 0 is no effort and no action desired while 10 is an all-consuming action. How much effort are you willing to put into a strategy?

 

In my opinion, you need 2 of these 3 to be positive for you to have a beneficial quantity component to your strategy. The power of this simple approach is that it can be applied to any scenario. For example, let us suppose you are considering moving to a new city. Palo Alto is a very innovative part of the country, but it is also very expensive. If your bank is low (small budget), you don’t have much bread (unsecured job or resources), but your brawn is high (highly motivated to move there), this is still not the best decision from a tangible metric point of view.

Let’s do another: your single site business is thinking of expanding to another state. Your bank is good (selling well enough to support another site), your bread is positive (growing customer base, physical space to accommodate a second location is doable), but your effort is low (2 out 10 because you really don’t want to deal with expansion). Based on quantity, this would be a positive decision to make so you should carefully consider it.

 

piggy bank

Use quantity – the application of tangible metrics – to your professional and personal decision-making to clarify measurable components of your strategy. Don’t neglect what you can measure! An experiment is a question which science poses to Nature, and a measurement is the recording of Nature’s answer.” (Max Planck)

 

 

MEDICINE & MACULA: As the Max Planck quote shows above, metrics and science are intrinsically link, but, as a scientist, a major task is to ask difficult questions. A recently published commentary refreshes the importance of learning from failed experiments – and the importance of trying again. To effectively achieve this, the author concludes that communicating your struggles to others, asking for help, and accepting it when it is offered allows you to foster the needed resilience to cope with fear of failure and find your success.

The study was published July 29 in the journal Science. Check out the study here.

 

 

DA Sx Maneuvers

GRATIS: Thank you Retinal Physician for showcasing my new technique on Surgical Maneuvers Tip of the Month! In it, I describe the repair of complex retinal detachments secondary to viral retinitis. This novel technique combines triamcinolone-assisted chromovitrectomy with silicone oil tamponade and intraoperative antiviral therapy with foscarnet. Check out the article here.

 

My best to you,

David Almeida

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passion

“If I’m going to live, I want to live fully, very intensely, because I am an intense person. It would ruin my life if I had to live partially.”

Ayrton Senna (1960-1994), 3-time Formula One World Champion

 

TASK AT HAND: This week I’m thinking about passion and what it means 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, I have found that, being reacquainted with your passion is a revitalizing elixir of energy, focus and determination that cannot be neglected. Consequently, I have found three strategies to ensure that passion is a tenet not lost or neglected.

Passion in decision-making. When formulating decisions and employing strategies in your business or professional life, don’t neglect to acquaint yourself with your drives and desires. Some aspects are best decided dispassionately; but, similar to what we talked about last week with intangibles, core fundaments require a degree of enthusiasm, self-expression, and identity to fulfill the full potential of the decision in question. “Passion to a person is what gas is to a car. Without it, you won’t go anywhere!” (Alex Haditaghi; Softly, As I Leave Her). Many times, amongst decision options without major distinction, choosing the one best aligned with your passion will provide opportunities not previously foreseen.

Passion in your personal relationships. A personal relationship without some element of passion is mere acquaintance. Strive to consistently surround yourself with people who stoke the fires of vitality: those that challenge you, those that ask you to grow, and those that allow you to change. It reminds me of an Avett Brothers lyric: “I wanna have friends that I can trust, that love me for the man I’ve become not the man I was” (The Perfect Space).

MINOLTA DIGITAL CAMERA

Passion in your daily life. Finally, irrespective of your professional and personal endeavors, please commit to one act that you are passionate about each day. This need not be for more than a few minutes – but stay connected to that drive daily. Don’t lose this connection because, this connection, is very much a defining part of who you are.

When you look back – if 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).

 

MEDICINE & MACULA: Interesting study in PNAS that, after reviewing 9 studies and 2100 participants, found a consistent reduction in the clarity of people’s memory of their past unethical actions. The communication finds that people who acted unethically are the least likely to remember the details of their actions. That is, people experience “unethical amnesia”: unethical actions tend to be forgotten and, when remembered, memories of unethical behavior become less vivid over time than memories of other types of behaviors. Because of unethical amnesia, people are more likely to act dishonestly repeatedly over time. This important publication advances the science of dishonesty, memory, and decision making.

the-money-trap

Check out the study here.

 

GRATIS: “A study can be made against invasion by an army; no stand can be made against invasion by an idea.” –Victor Hugo

 

My best to you,

David Almeida

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hand print identity

“In the social jungle of human existence,

there is no feeling of being alive without a sense of identity.”

Erik Erikson

 

TASK AT HAND: This week I’m thinking about the intangibles of strategy. We are well versed in the tangible data of decision making: spreadsheets, SWOT analyses, and projections. But today, let’s look at the intangibles – those aspects that are sometimes neglected when we devise a strategic plan .

 

Let me divert for a couple of sentences… In medicine, one of the ways we can describe a patient complaint is in terms of “quality”: how does it make them feel? Similarly, I adopt this same descriptor to strategy and have arrived at three distinct aspects of the quality, or intangibles, of a decision or strategy: satisfaction, opportunity lost, and identity.

 

Satisfaction. Good decisions need to make sense. Good decisions need to respect budgets and achieve objectives. Great decisions should satisfy. That is, they should provide adequate information or proof so that they are convincing. Extrapolating, effective decisions should convince stakeholders of its ascribed path. Try this next time you have a conflict or decision and are considering options. Ask yourself if the decision you have arrived at satisfies the need or problem at hand. At this moment, you realize: “The ultimate victory in competition is derived from the inner satisfaction of knowing that you have done your best and that you have gotten the most out of what you had to give.” (Howard Cosell)

 

Opportunity Lost. Most are familiar with the microeconomic concept of opportunity cost: the value of the best alternative forgone where, given limited resources, a choice needs to be made between several mutually exclusive alternatives (Investopedia). Assuming the best choice is made, it is the “cost” incurred by not enjoying the benefit that would have been had by taking the second best available choice. The latter can sometimes become arcane, esoteric, and neglected in strategy. I frequently use the term opportunity lost to highlight the fact that, in making a certain decision, what have you given up in turn? This is not simply the best alternative foregone, but all other options lost. In my opinion, this drives home the professional, personal and intangible consequences of the decisions I make.

 

Identity. This one is simple. The best decision available, if it does not identify with who you are, with what message your business is trying to convey, or leaves you with doubt about ethics, is a decision that is not congruent with your identity. Be careful with these! Decisions without respect for identity risk entering a path without direction. Actions without regard will leave you in an abyss; this void expands without reflection and consideration.

solo business man

As you continue to improve your personal and professional strategy, remember the power of intangibles to transform good decisions into great ones! Satisfaction, opportunity lost and identity are integral components to the quality of the decision you make.

 

MEDICINE & MACULA: Interesting study found that excessive stress can cause memory problems in women who had survived breast cancer. This study examined 1,800 breast cancer survivors and found that those with a greater level of physical activity had higher levels of self-confidence and less stress, and as a result fewer perceived memory problems.

If you didn’t know already, it seems the benefits of exercising regularly are practically limitless!

The study was published July 8 in the journal Psycho-Oncology. Check out the study here.

 

 

GRATIS: Check out our new paper: Bimanual pars plana vitrectomy for removal of a dislocated DSAEK graft from the vitreous cavity published in Retinal Cases & Brief Reports. We describe a new technique for removing dislocated grafts.

PPV K graft 1PPV K graft 2

 

My best to you,

David Almeida

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stairway-to-heaven

“There is only one success – to be able to spend your life in your own way.”

Christopher Morley

 

TASK AT HAND: This week I’m thinking about success; a nebulous concept that for millennia has eluded many. Last week, a friend asked me how I define “success” – not happiness, not satisfaction – simply success. This enigmatic question consumed a lengthy conversation that I believe worthwhile to revisit here.

 

I believe success occurs in one of two ways: either you spend your days doing what your love or you craft a life where you subsidize – with money, creativity or effort – time for that which you love. Furthermore, those we love and love us, are fundamental cornerstones of success. Our relationships with those we care about is absolutely critical: clichés like the influential who neglects loved ones is not success.

 

Let’s take this first part: do what you love. I am reminded of Mark Twain’s words: “The secret of success is making your vocation your vacation.” This is the ultimate achievement and what I regard as success – no qualifiers needed. Unfortunately, this exists only in a minority of cases. If you are lucky to have this in your life – cherish, craft and confirm it because, “when love and skill work together, expect a masterpiece” (John Ruskin). Now, success is filled with bumps, bruises and bile so never confound it with convenience, which actually tends to degrade your ability to grow.

 

But, what happens when the above is not the case? In my opinion, the majority of people aren’t lucky enough to love their career or job. This is an unfair reality of civilization. However, this is not a problem: what you then have to do – to achieve success – is develop a routine that allows you to constantly revisit that which you love. Dislike your job? No problem – this does not mean you can’t be successful. Find pockets of time, a circle of friends, actions and hobbies, a lover and family that bring you closer to success and that which you love. This could mean saving for a vacation, biking with a group of friends – it doesn’t matter – as long as you are on that byway which is intrinsically yours. As the quote above implies, success is singular to you! If you find yourself at odds with this goal, remember: “success is not final, failure is not fatal: it is the courage to continue that counts” (Winston Churchill). Continue to craft the life that finds in it your success.

As you move forward, don’t feel that you have to adopt my definition in any way. But, realize that you need to define this term for yourself – this is essential if you are ever going to achieve success.

 

 

business success

MEDICINE & MACULA: In line with our discussion, let’s move over to the business literature. Here is a case study driving the point that if the sole purpose of your business or career is to make money, you’re destined for mediocrity. Change your story so that meaning is first priority and money second.

Check out the study here.

 

GRATIS: Given today’s topic, I leave you with a few words from Frank…

“Regrets, I’ve had a few

But then again, too few to mention

I did what I had to do and saw it through without exemption

I planned each charted course, each careful step along the byway

And more, much more than this, I did it my way

“My Way” –Frank Sinatra

 

 

Go out. Find success. Your Way.

My best to you,

David Almeida

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eye tree

“Practice makes permanent; practice – with purpose and passion – transforms.”

 

TASK AT HAND: This week I’m thinking about practice. We practice golf swings, practice speeches, practice free throws, practice how to be a better person. We practice work, tasks, and actions. We practice, practice, and practice. I’m a vitreoretinal surgeon and I work in a medical practice; I practice surgery, medicine, and how to restore vision.

 

But what does all this practice get us?

Entrenched in practice is the idea that repetition will allow you to achieve perfection, and therein lies the goal. This is incorrect! Practice does not make perfect, but rather only establishes permanence. This is the most common error I see in people who earnestly practice in the hope of trying to improve. Let’s disrupt this myth – practice only makes permanent – hard stop. Practicing something over and over only leads to the likelihood that you will repeat the action or reaction in that context. This is not erroneous, and is sometimes useful, but it lacks full realization. Permanency is static and not what you are trying to achieve – the whole point of practice is to transform the action in question. So, what is the first thing to do to improve how you practice? Break away from the desire to reach perfection and avoid the trap of permanence.
So, then, how do you practice?

Practice with purpose! Establish the purpose of your action. You must find the purpose in what you’re trying to achieve. That is, you must decode the objective of your achievement. Be mindful of the task you are practicing. Engrossed in it, from all aspects of yourself, allows you to find the core purpose and unlocks your ability to transform.
Practice with passion. As I said above, I work in a medical practice. I take care of patients and I practice my craft. If I pursue this with mindless application, I may become very good at satisfying procedures and protocols by repeating them over and over in an efficient manner. But when I find purpose, and couple this with passion to achieve my goal, I begin to evolve and transform my skills to achieve better results – to innovate and renew my skills for the betterment of my patients and myself.

basketball-practice

Aristotle stated, “We are what we repeatedly do. Excellence, therefore, is not an act but a habit.” So, next time you are refining what you do, remember practice only makes permanent – so practice with purpose and practice with passion – and transform to reach your peak.

 

MEDICINE & MACULA: In line with our discussion on practice, a recent study entitled, Feasibility of Human Factors Immersive Simulation Training in Ophthalmology, looked at how human factors training can enhance team working and reduce error. This is used regularly in certain medical disciplines, but its use has not been established for ophthalmology. The study found that human factors simulation in ophthalmology offers a new method of teaching team members, with the potential to reduce serious ophthalmic patient safety events. In this I see another example of practicing with purpose, driven by passion, as a means to find innovative methods and improve outcomes.

Check out the study here.

 

GRATIS: Tomorrow is Independence Day and I hope you have a wonderful celebration. I was born in Portugal, grew up in Canada, lived in Europe, and now I am privileged and grateful to call the United States home. Happy 4th of July!

usa flag

My best to you,

David Almeida

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burnout pile of papers

“I have a theory that burnout is about resentment. And you beat it by knowing what it is you’re giving up.” Marissa Mayer, Chief Executive Officer, Yahoo!

 

TASK AT HAND: This week I’m thinking about burnout. I’ve received a lot of emails about this recently and, when you consider the most recent data, US worker burnout rates are as high as 45%. So, let’s define burnout, uncover what makes you susceptible to burnout, and – most importantly – how you can avoid it.

What is burnout? This is a difficult concept to grasp and ranges from excessive work load to erosion of motivation and worth from one’s occupation. Personally, I believe that burnout goes beyond work load and is actually based on a balance between drive and work load; specifically, when work load is greater than your drive or motivation to complete it, you get into burnout territory. Burnout is a chronic condition and should not be equated with acute stress. Acute stress can be an excellent driving force but, if excessive and prolonged, can lead to burnout. As balance is lost, more work piles up, and motivation dips further. The cycle of burnout quickly gets out of control and resentment becomes a dominant sentiment. This resentment hinders both personal satisfaction and meaningful relationships.

What makes you susceptible to burnout? I have found there are two key characteristics that increase your likelihood of burnout. First, if you are the person that says “yes” to every request – be careful! Now, please realize, I am this type of person: I want to say yes to every request but, this is not a sustainable strategy! Start saying no and you will see how liberating it is. Every time you say yes to a task you are saying no to everything else: to time with family, to time with friends, to time with activities that renew you. David Allen wrote, “Much of the stress that people feel doesn’t come from having too much to do. It comes from not finishing what they’ve started.” If you say yes to every request, you will start having difficulty finishing it all. Second, isolation is a major risk factor for burn out. Isolated individuals are more likely to get caught in the cycle of dipping motivation and increased workloads because they lack positive external forces to help identify this.

So, what can you do to minimize burnout? Once again, I must emphasize that stress is not burnout; stress is acute and usually for a short period while burnout is a prolonged chronic condition. For stress, I really like Lee Iacocca’s advice: “In times of great stress or adversity, it’s always best to keep busy, to plow your anger and your energy into something positive.” However, if the stress is endless and burnout has started – mostly because your motivation and drive are fading – you need to change your strategy. This is where I really like the Mayer quote: always know what you are giving up! This way, you will learn to say no and remain focused on your priorities and principals. Finally, meaningful activities and relationships are paramount. Do not isolate yourself from loved ones, friends, or new experiences. Renew your motivation hourly and realign your focus constantly!

 

MEDICINE & MACULA: Interesting study in the journal Eye on patient perspectives in the delivery of treatment for neovascular age-related macular degeneration. Survey of 87 patients found the most important factor to patients was: (1) having good vision, (2) one-stop service, and (3) less frequent follow up. The least important factors were label status of the drug, cost to the health service, and grade of the injector. Drives home what I see in clinic every day: patients want to preserve the best possible vision in the most convenient manner.

Check out the study here.

 

GRATIS: I attended the WAVE Ocular Imaging Conference this week (June 22-25) in beautiful Vail, Colorado. It was a wonderful meeting delving deep into complex and challenging vitreoretinal topics. I presented, Surgical Techniques and Outcomes for Retinal Detachment Secondary to Viral Retinitis (below is a preoperative and postoperative photo of one of the patients), and grateful to my colleagues for the fantastic discussion.

RS Figure ARN

 

My best to you,

David Almeida

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