“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



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“Allow yourself to change.

Allow yourself to change your mind.

At the dawn of a new year, you don’t have to be the same, so allow yourself to change.”


TASK AT HAND: This week I’m thinking about agents of change. Specifically, how you can be your own agent of change. Today, New Year’s Day 2017, many will awaken with resolutions and recipes to improve during the year ahead. However, from the best available evidence, only about 8% of people are successful at achieving their new year’s resolution and implementing some sort of meaningful change in their life. That is less than 1 in 10.

I find this failure rate surprising because we have an incredible ability to process and understand information. The bottleneck is in its implementation and persistent application. So, here are three quick tips to facilitate your ability to be an agent of change.

1. Start Small. Don’t attempt to change a multitude of behaviors overnight. Don’t set a plan that is beyond your reach. I see this commonly done. It is a predictable form of self-sabotage. This causes you to start with unrealistic plans, quickly fail, and then you are back to old stagnant ways. Instead, start small, set mini-goals, achieve, and build momentum.

2. Be Persistent. Stick to that which you want to change. In this regard, persistence and perseverance are congruent to progress and the powers of invention. Aim for a minimum of 80% adherence to the change you want to see. Let’s take learning a new language as an arbitrary example. Practice 4 days a week (80% of a 5-day work week) and go from there.

3. Be Kind. Be kind and allow yourself to change. This is the whole barrier. This is the singular obstacle in our puzzle. When I allow myself to change, I am forced to adapt in a new manner to the circumstances that exist. When you are kind to yourself, you accept that behaviors are not a binary process of pass/fail or yes/no but rather processes of evolution.


“It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is most adaptable to change.”

-Charles Darwin


So, as you step into the hours of a new year, as the days click by on the 2017 odometer, allow yourself to change constantly. In the months that lie ahead, procure problems and opportunities in some new manner so that, when you look back this time next year, you see yourself as an agent of change.


MEDICINE & MACULA: Let’s start off the year with a wonderful image of a hemispheric retinal arteriovenous anastomoses from a patient with Wyburn-Mason Syndrome.

We published this image back in November 2015 entitled, Hemispheric Retinal Arteriovenous Anastomoses (Eric K Chin, D Brice Critser &  David RP Almeida) in JAMA Ophthalmology (2015;133(11):e151687. doi:10.1001/jamaophthalmol.2015.1687).

You can find the study here.


GRATIS: “Cheers to a new year and another chance for us to get it right.” -Oprah Winfrey


Happy New Year!

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 (, 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.



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



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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