Sunday Surgical Scrub

“Always do what you are afraid to do.” -Ralph Waldo Emerson

TASK AT HAND: This week I’m thinking about success; specifically, the fear of success. Success, this nebulous and enigmatic concept, fascinates me in that it is desired and revered but, at the same time, can create fear and depression.

In a previous Sunday Surgical Scrub, I defined the achievement of success 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 (you can find the blog post here). In my opinion, there are no other acceptable definitions of success.

But where do the elements of fear come from when we discuss success?

Is fear just an apparition of objectives that have not yet been achieved? Or does fear and success represent a more complex interplay?

There are two aspects of the fear of success that we will discuss here. First, as the Emerson quote above states, there is a natural fear of the unknown. Success, usually in terms of achievement, represents a journey we have not yet completed. Consequently, a fear of unknown outcomes is a common reaction and akin to the fear of an adventurer seeking discovery. One should use this fear as a motivator for that which we desire, pursue and value.

The second aspect of fear in the context of success is more troubling and is applicable to instances where some success has already been achieved. Whether it be in business, sports, arts or simple hobbies, past success can confound further progress. The fear of success here is dependent on emotional factors where previous success leads to expected future success. The fear of not being able to “back it up” can leave us feeling like an imposter. This fear can cause us to shy away from opportunities which limits our ability for success. This can create stagnation and hinder our willingness to take on fresh challenges.

Stagnation breeds depression which creates paralysis.

How do you overcome the fear of success?

The answer, and I’ve touched on this with the Sunday Surgical Scrub before, requires a commitment to acquainting yourself with the energy and passion to move beyond this fear (check out this Sunday Surgical Scrub blog post here). Remember, worst case scenario is you don’t back it up and fail. So, what? There is no apocalyptic outcome here. There is no fatal end. You will still move on but maybe at a slower pace or in a more prolonged route. Take your task or objective seriously but realize that this fear is miniscule and let it not hold you back from that which you define as success.

 

MEDICINE & MACULA: Last week I played in the Beyond Walls Squash Week held at the Commodore Club in St Paul MN.

Beyond Walls is an incredible organization aimed at promoting academic excellence, healthy lifestyles and access to meaningful opportunities for all youth. It is a year-round scholar/athlete approach to youth development and out-of-school time for 6th to 12th grade students. It uses a one-to-one academic mentoring with physical fitness via the racquet sport of squash aimed at community engagement and college-readiness. You can find more information here.

I won the amateur A singles squash draw with a bevy of tough matches! I won this tournament in 2016 and was very excited to repeat in 2017. I’ll keep working hard and try for the three-peat in 2018…

In addition to amateur singles, there was a professional singles tournament, a pro-am doubles and an amateur doubles draw.

With sincere gratitude, I thank everyone involved for their energy in growing the sport of squash in the Twin Cities!!

 

GRATIS: “Courage is resistance to fear, mastery of fear, not absence of fear.” -Mark Twain

 

My best to you,

David Almeida

david@davidalmeidamd.com

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“More matter with less art.”

Queen Gertrude, speaking to Polonius, in Hamlet (Act 2, scene 2)

 

TASK AT HAND: This week I’m thinking about Shakespeare’s Hamlet. Specifically, in Act 2, there is long speech by the verbose politician Polonius. Queen Gertrude, Hamlet’s mother, quips: “More matter with less art.” She is calling for Polonius to tone down the fancy speech and get to the point.

In both modern times and past cultures, the ability to get to the point is valued but unfortunately underutilized. Thomas Jefferson wrote, “The most valuable of all talents is that of never using two words when one will do.” Language allows humans a medium of communication unmatched by any other species; however, it also has the potential to create misunderstanding and confusion. Clarity is many times lost in excess.

What is the best strategy to pursue this principle of “more matter with less art”?

How do you remain direct without over-simplification?

Albert Einstein perhaps best describes the optimal approach to answer this question: “Everything should be made as simple as possible, but not simpler”. Be deliberate in your content and message. Be as specific as possible in your brand. But don’t dumb it down. Be surgical in your commitment to cut out that which lacks value, purpose or breadth.

Let us conclude today’s Sunday Surgical Scrub with a call to action of more substance, less rhetoric! Nothing more.

 

MEDICINE & MACULA: Here are some images of me using Alcon’s NGENUITY 3D visualization system for removal of epiretinal membrane (ERM, also known as a macular pucker).

An ERM occurs when there is cellular proliferation over the macula. In many instances, this membrane remains mild and does not have any significant effect on the macula or the person’s vision. However, in other cases, membranes become prominent leading to vision loss and metamorphopsia. For visually significant membranes, vitrectomy with membranectomy is needed to remove the proliferative tissue and restore the normal macular anatomy.

The Beaver Dam Eye Study (Ophthalmology 2015;122:787) showed a prevalence for ERM of 34.1% so this is a very common surgery I perform. Above is a high-magnification image of the ERM being removed with microsurgical forceps.

 

GRATIS: “Less is more.” -Ludwig Mies van der Rohe

 

My best to you,

David Almeida

david@davidalmeidamd.com

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“All you need is the plan, the road map, and the courage to press on to your destination.” -Earl Nightingale

TASK AT HAND: This week I’m thinking about DADA. This abbreviation is borrowed from the covert playbook of spies and intelligence agents. The idea is to have a blueprint to evaluate, plan and execute in an instant. I commonly refer to DADA as “strategy on the run” because of the ease and rapidity of its use. Whether you are under duress or require a quick plan, here is how you can use DADA – Data, Analysis, Decision and Action – to quickly formulate a strategy.

DATA What information is available to you? Quickly gather all the information possible to best assess the situation. This can be something as simple as taking note of where the exists in a room are to more detailed accounts such as viewpoints of the people you are negotiating with.

ANALYSIS Analyze the information. The benefits of DADA are brevity so you want to make this analysis quickly. If you are under physical danger, you need to determine the likelihood of harm. Another example; if you are negotiating, you need to determine what the highest/lowest price you will go or the best alternative in case you fail to achieve a compromise.

DECISION Make a decision. You have gathered the requisite pertinent information and analyzed the possible outcomes. Decision involves reasoning an outcome you will be content with. With DADA, you are usually looking at short term plans and outcomes so this decision needs to be effective immediately.

ACTION Now, you must act! As I mentioned above, DADA is “strategy on the run”: it’s an excellent framework to quickly develop and execute plans of action around objectives. What is your objective? In situations where you may be in danger, safety is your primary objective; consequently, the decision is either to flee or stay and possibly have an altercation. You need to have made your analysis for the likelihood of each.

Next time you need a quick framework, consider DADA – Data, Analysis, Decision and Action – to formulate a plan. You don’t need to be Jason Bourne to make use of this technique’s effectiveness for situational awareness!

 

MEDICINE & MACULA: One of my favorite surgeries is retinal detachment repair. Each retinal detachment has subtle differences that make no two exactly alike. I like the fact that you can fix them multiple ways: vitrectomy, scleral buckle, vitrectomy with scleral buckle, air versus gas versus oil tamponade, approach to subretinal fluid drainage, membrane peeling in detached versus attached retina, etc.

Recently, I performed retinal re-attachment surgery on a monocular patient with severe colobomas in both eyes. A coloboma is a structural defect and can involve the iris, retina, optic nerve or choroid. It’s a congenital defect that occurs when the choroid fissure fails to close up completely before a child is born. In the patient’s good eye, they suffered a retinal detachment with vitreous hemorrhage. Here you see me performing vitrectomy.

Note the extensive coloboma present with a sole band of retinal tissue extending through the macula that provides photoreceptors and vision to this patient.

The patient did very well with full return to the vision they had before the retinal detachment!

 

GRATIS: “A really great talent finds its happiness in execution.” -Johann Wolfgang von Goethe

 

My best to you,

David Almeida

david@davidalmeidamd.com

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“God cannot alter the past, though historians can.” -Samuel Butler

TASK AT HAND: This week I’m thinking about revisionist history. This is a more complex topic than it seems. On the one hand, you cannot go back and revise history to fit your viewpoint. You can have an opinion on historical accounting but factual history must remain honest. Contrasting, our personal history displays more variance and offers us vast opportunity for accountability and ownership.

Let me illustrate the above point with an example. Go back and, sometime in the last five years, identify something you quit. Now, uncover the reasons why you quit that activity, pursuit or hobby.

Would the reasons why you would quit today be the same as they were when it happened?

What has changed?

When you start this self-reflection exercise you see that views change. The reasons for choices in the past evolve over time; sometimes into species that barely resemble their original proforma. Not surprisingly, we change. Consequently, our views evolve.

The goal of this exercise is to become a scientist with our history. Nikola Tesla stated, “The history of science shows that theories are perishable. With every new truth that is revealed we get a better understanding of Nature and our conceptions and views are modified.” We need to develop the skill to revisit strategies from the past and evaluate them under the light of who we are today. To forge new considerations so that we avoid previous pitfalls and can succeed when opportunities present themselves.

How can we apply this for improved decision making and strategy?

Use this exercise of reflecting on previous choices as a means to review your history. This can be of significant utility when you are faced with similar conflicts. Don’t simply apply the same strategy as in the past. Look to the past strategy, revise it with who you are today, and see if it still applies. Usually it does not. Revise your strategy and apply an improved framework.

 

MEDICINE & MACULA: This is a case of idiopathic intermediate uveitis, also known as pars planitis, showing peripheral inflammatory snowbanking.

Intermediate uveitis involves inflammation of the posterior part of the ciliary body and peripheral retina (pars planitis). It consists of mostly vitreous inflammation (“snowballs”) and may associated with inflammatory cells on the pars plana (“snowbanks”). In pure intermediate uveitis, there is usually no retinal findings, although patients may have a mild iritis.

In total, approximately 80-90% of intermediate uveitis cases are idiopathic pars planitis. Other causes include sarcoid, syphilis, inflammatory bowel disease, multiple sclerosis, lyme, tuberculosis, Behcet disease, Whipple disease and lymphoma.

 

GRATIS: “History repeats itself, first as tragedy, second as farce.” -Karl Marx

 

My best to you,

David Almeida

david@davidalmeidamd.com

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“I draw from the absurd three consequences, which are my revolt, my freedom, and my passion.” –Albert Camus

 

TASK AT HAND: This week I’m thinking about consequences; specifically, our personal consequences. The way you live has consequences. For Camus, he emphasized revolt, freedom and passion. For many years I have esteemed this quote as a reminder that struggling with the consequences of our actions is a worthwhile and rewarding duty. The concepts that Camus brings forth – revolt, freedom, and passion – are requisites for review here on today’s Sunday Surgical Scrub.

REVOLT How do you effectively express revolt? In my opinion, there is no better approach than the constant unyielding pursuit of independent thought. The struggle to hold back the convenience of conformity is a revolt we must pursue each day. Don’t let an hour go by where you don’t question dogma and doctrine. We have discussed this multiple of times here on the Sunday Surgical Scrub because this is something YOU NEED TO DO! Whether it’s fake news, peer pressure or groupthink, you need to revolt with independent thought.

FREEDOM From the bastion of independent though comes the freedom for independent action; the latter is not possible without the former. Necessity for autonomy, and the liberty to act independent without discrimination is, unfortunately, another consequence that cannot be forgotten for any lapse of time. Look at the daily news and you will see numerous examples of this consequence.

PASSION Finally, with passion, we surge the courage to pursue our desires. From the inception of independent thought, to the freedom of independent action, the final culmination is the courage to pursue these desires in our daily lives. The courage to pursue our desires – driven by passion – is perhaps the greatest of effects on the consequences we are capable of.

So, the call to action with today’s Sunday Surgical Scrub is to look carefully at our thoughts, actions and desires and ensure they are part of the pursuit of worthwhile consequences.

 

MEDICINE & MACULA: Here is a case of severe recurrent acanthamoeba infection presenting initially as keratitis, followed by sclerokeratitis and histolopathology-confirmed endophthalmitis.

For the first time, we document acanthamoeba involvement in all ocular layers. This severe case demonstrates that despite persistent medical and surgical intervention, eradication of organisms may not be possible.

This is the first case reported with confirmed choroidal involvement (histology shown above) and we have previously published this in a work entitled, Acanthamoeba Endophthalmitis After Recurrent Keratitis And Nodular Scleritis (Zaid Mammo, David RP Almeida, Matthew A Cunningham, Eric K Chin & Vinit B Mahajan), in the journal Retinal Cases and Brief Reports.

You can find the complete study here.

 

GRATIS: “Nobody ever did, or ever will, escape the consequences of his choices.” -Alfred A. Montapert

 

My best to you,

David Almeida

david@davidalmeidamd.com

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“In this world, nothing can be said to be certain, except death and taxes.” -Benjamin Franklin

 

TASK AT HAND: This week I’m thinking about death and taxes. Let me digress for a few sentences. This past week, on Thursday November 2nd, Republican lawmakers unveiled a sweeping revision of the tax code. Don’t worry, we are in no way going to get into the tax bill here on the Sunday Surgical Scrub. However, as I reviewed the proposal, it reminded me about the famous Benjamin Franklin quote above and the search for absolutes.

Today’s Sunday Surgical Scrub is about absolutes and our longing to grasp onto these as a means to reduce the anxiety of life and its transitions. We look for absolutes to reduce the inherent entropy of life. There is an overwhelming desire to find order and sense in the events that shape our days. But – and this should be apparent to anyone one of us who have attempted to exert control over extraneous circumstances that we cannot dictate – this is an anxious futile state. Instead, as we discussed on last week’s Sunday Surgical Scrub (you can find it here)you are not in control! As you master your ability to let go of this need for control, you find the peace it brings.

What does this have to do with death and taxes?

You can use death and taxes as reminders of absolutes. Everyone will die. Everyone has to pay taxes. If you are looking to grab onto absolutes, here are two that should make you relaxed that everything else is transient and you need not worry about it. In fact, you can argue that the paying of taxes is a somewhat negotiable and varied, albeit with consequences. I like this rationalization because it means that there is only one absolute.

Death is guaranteed.

This is not simply for macabre effect. This is actually a wonderful liberation that we should use our talents and energy to effect genuine meaning in our lives and those we come in contact with. The anxiety and worry surrounding most items is not necessary and often hinders our duty in the latter regard.

 

MEDICINE & MACULA: Here is a color fundus photograph of a patient with intraocular inflammation secondary to sarcoidosis. Sarcoidosis is a chronic systemic granulomatous disease from an exaggerated cellular immune response to a variety of self antigens or non-self antigens.

Characteristic funduscopic findings in posterior segment involvement include periphlebitis, sheathing of vessels, perivenous exudates and multiple small round chorioretinal lesions.

 

GRATIS: “The only difference between death and taxes is that death doesn’t get worse every time Congress meets.” -Will Rogers

 

My best to you,

David Almeida

david@davidalmeidamd.com

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“We should always be asking ourselves: Is this something that is, or is not, in my control?”– Epictetus (Enchiridion)

 

TASK AT HAND: This week I’m thinking about the illusion of control. This powerful mirage commonly creates a façade we believe to be actually present. While the desire for control may be real, in actuality, control is an illusion that can impair our judgement and create anguish and anxiety that does not exist.

How can we give up on the illusion of control?

The first step is to realize – you are not in control! You are not in control of the weather. You are not in control of what others think of you. You are not control of any external events. So, as the Stoics accepted long ago, you too must accept this as a means to fulfillment. All you can control is your reaction. Be honest, caring and genuine in the acts you put forth into the world but, beyond that, realize you do not have control.

The second step, which follows logically from the point above is, if you are not in control, then to worry is pointless. That flight delay, the toddler screaming from the next table, the insult from a disgruntled coworker – all inconsequential. By choosing to not worry about it, and to rather embrace that all you can control is your reaction to events, will liberate you from most of life’s torments.

The final step, in the process of letting go of this desire for control, is to come to terms that this process is not an apathetic one. Quite contrary – events may cut deep and personally injury you. This is ok. However, they need not consume you with resentment, fear and regret. The call to action is to be compassionate and honest in what you curate and create; however, beyond this, there is no need for control.

 

MEDICINE & MACULA: Thanks to everyone who regularly emails and contacts this forum with opinions, suggestions and criticisms. In response to recent comments, I will continue with regular postings of interesting patients similar to the images last week of Vogt-Koyanagi-Harada (VKH) disease.

Here is a color fundus photograph of a severely immunocompromised patient with viral retinitis. This shows the condition known as Progressive Outer Retinal Necrosis (PORN) secondary to herpetic virus infection.

 

GRATIS: “I can control my destiny, but not my fate. Destiny means there are opportunities to turn right or left, but fate is a one-way street. I believe we all have the choice as to whether we fulfil our destiny, but our fate is sealed.” -Paulo Coelho

 

My best to you,

David Almeida

david@davidalmeidamd.com

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“Body language is a very powerful tool. We had body language before we had speech” -Deborah Bull

TASK AT HAND: This week I’m thinking about the body-words disconnect. The concordance, or lack thereof, between words and actions is a powerful revealer of motive. Congruence between what someone is telling you and how their body relays those messages speaks volumes to the truth, emphasis and purpose of the message. “Reading between the lines” and “it’s not what someone says, it’s how they say it” are popular clichés that remind us of the importance of the connection between words and mannerisms.

“The concordance, or lack thereof, between words and actions is a powerful revealer of motive.”

The first step in understanding the body-words disconnect is carefully listening to what people tell you. The words serve as the message. If you don’t carefully listen to the message, any further interpretation will be lost. You need to be cognizant of what someone is telling you. Next, survey their body language. This requires visual and auditory engagement in the conversation. Visual input (facial expressions, body movement and position) is as crucial to auditory input (words, volume, inflection).

“The first step in understanding the body-words disconnect is carefully listening to what people tell you – the words serve as the message!”

The simplest – and extremely useful – aspect of the body-words disconnect is as follows: listen to the words people tell you and, if the words don’t match their body language, consider an alternative meaning or motive. For example, comments “welcoming” of your opinion expressed with a closed body posture (e.g., arms crossed) would indicate a defensive stance.

“Congruence between what someone is telling you and how their body relays those messages speaks volumes to the truth, emphasis and purpose of the message.”

Another common example involves words evoking positive emotions, like joy or happiness, with incongruous facial expressions like frowning of the brow. A few years ago, Gill and coworkers presented an excellent summary of the strategy of many common facial expressions (D Gill, OB Garrod, RE Jack & PG Schyns, Facial movements strategically camouflage involuntary social signals of face morphology. Psychological Science 2014;25(5):1079-1086. doi:10.1177/0956797614522274). Here are a few key illustrations:

·       High dominance—wrinkling the nose and snarling the lips

·       Low dominance—raising and lowering the brows, showing dimples, stretching the lips, and lowering the chin

·       High trustworthiness—raising the brows, deepening the lines between the nose and mouth, and smiling

·       Low trustworthiness—narrowing the eyes, wrinkling the nose, dilating the nostrils, frowning, and parting the lips

·       High attractiveness—raising and lowering the brows, smiling and pulling the lips back in a slight smile

·       Low attractiveness—tightening the eyelids, wrinkling the nose, and pulling the lips open and back

The purpose of today’s Sunday Surgical Scrub is not make you an expert in decoding body language. Although this is an interesting skill set, it is obviously beyond a single post. However, the call to action is for you to be cognizant of the body-words disconnect and, when these two spheres do not align, look for alternative motives for the communication in question.

 

MEDICINE & MACULA: Here is a fundus color photo of a patient I saw recently with Vogt-Koyanagi-Harada (VKH) disease. VKH is a severe inflammatory condition with a myriad of ocular and systemic effects. The fundus photo shows circumscribed retinal edema with multiple serous retinal detachments.

 

The optical coherence tomograph (OCT) shows serous subretinal inflammatory infiltrates.

 

GRATIS: “Language is a more recent technology. Your body language, your eyes, your energy will come through to your audience before you even start speaking.” -Peter Guber

 

My best to you,

David Almeida

david@davidalmeidamd.com

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“Everything that we see is a shadow cast by that which we do not see.” -Martin Luther King, Jr.

 

TASK AT HAND: This week I’m thinking about cooperation and lengthening the shadow of the future. Let me explain what this means.

In game theory, the prisoner’s dilemma – commonly evoked in strategy development – is an example of a scenario where rational individuals would do better if they did not cooperate even though it appears that it is in their best interests to work together.

The prisoner’s dilemma is as follows:

–       Two criminals from the same syndicate are arrested.

–       Each criminal is in solitary confinement with no ability to communicate with the other.

–       Prosecutors do not have enough evidence to convict either criminal on a major charge but hope to charge each with a lesser crime with a punishment of 1 year in jail.

–       At the same time, prosecutors offer each criminal a deal: testify against the other criminal and get off while the other gets convicted on a major charge and faces 2 years in jail. Or, cooperate with the other criminal, stay silent, and get 1 year in jail on the lesser charge.

 

Here are the possible outcomes:

–       If both betray each other, each of them serves 2 years in jail, on a major charge.

–       If both cooperate and remain silent, each serve 1 year in jail, on a lesser charge.

–       If one betrays the other but the other remains silent, one would get off free, and the other would serve 2 years.

 

It would seem, looking at the possible outcomes, that the rational strategy would be for both to remain silent and serve the 1 year in jail on a lesser charge. However, this is not the best strategy. Game theory purports that it is clearly in the best interests of the criminal to betray the other for the possibility of no jail time. Since betrayal always results in a better payoff than cooperation – irrespective of the other person’s choice – it is the dominant theory. Because you cannot assure that the other criminal will stay silent, your only choice is to betray. In fact, in the prisoner’s dilemma, mutual betrayal is the only strong outcome.

Where is the dilemma?

The dilemma occurs because mutual cooperation would provide a better outcome (only 1 year for both on a lesser charge) than mutual betrayal. But, this is not the rational outcome because, if you assume individuals act to maximize their self-interest, the choice to betray is preferred over cooperation.

So, what does this have to do with lengthening the future?

Shadow of the future is another basic game theory concept which states that we behave differently when we expect to interact with others repeatedly over time. At the prospect of having to interact multiple times, our behavior changes since we can now be punished or rewarded for previous choices. Our choices today are shadows on future interactions. If those criminals are loyal to their crime syndicate and expect to interact with that individual again, remaining silent becomes a significantly better strategy, albeit not entirely rational. This is a form of conditional retaliation strategy and favors cooperation.

How can we use this for our decisions, choices and strategies?

There is nothing wrong with working towards optimizing our self-interests; notwithstanding, be careful to not interpret the prisoner’s dilemma as always needing to solely pursue your best interests at one particular point in time. Assess the relationships in your decision and look for opportunities to lengthen the shadow of the future – look to cooperate and maximize value to others and support their interests as future prospects.

 

MEDICINE & MACULA: Many thanks to Clinical Ophthalmology for recently publishing our study, Epiretinal membrane and cystoid macular edema as predictive factors of recurrent proliferative vitreoretinopathy (Kunyong Xu, Eric K Chin, D Wilkin Parke 3rd & David RP Almeida).

You can find our study in the October 2017 issue here.

In it, we describe epiretinal membrane and cystoid macular edema as potential predictive factors for recurrent proliferative vitreoretinopathy. Early recognition and treatment of these conditions may be critical to prevent dreaded recurrent postoperative scarring and improve visual outcomes.

 

GRATIS: “We cast a shadow on something wherever we stand.” -E. M. Forster

 

My best to you,

David Almeida

david@davidalmeidamd.com

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“A mind cannot be independent of culture.” -Lev Vygotsky

TASK AT HAND: This week I’m thinking about the interplay between culture and strategy. What would you prefer – advantages in culture or a superior strategy? This a question that comes up frequently when looking at organizational design and strategic plans. There are two considerations we need to discuss when contemplating this answer.

1. Culture Trumps Strategy. A superior culture has definite advantages over strategy development. Organizational excellence is akin to having a built-in mechanism for effective strategy. To be part of an organization that is grounded in metrics and principles of development is always preferred because there is an inherent advantage to set processes and practices. An example I commonly use is a take a football team. A superior culture is analogous to a strong playbook whereas a superior strategy can be compared to one dominant play. You can use that one play successfully but, in the long run, developing a playbook that is composed of plays for a myriad of situations that may be encountered is best.

2. Strategy Shapes Culture. The main reason why one cannot simply rest on laurels of culture is because, culture alone, is not enough for long-term growth and improvement. There is a necessity to continue to develop strategies for the challenges encountered. It is in these circumstances where well-constructed strategy has the benefits of providing you with an approach to a problem. Moreover, at the same time, this strategy allows you to shape culture. Contrastingly, fragmented strategy that lacks cohesiveness, can harm cultural identity.

When I surmise the idea of culture and strategy, I feel the need to stress the importance of culture over strategy. However, effective strategy is a powerful influence on culture. The final point that should come to light, and one I discuss in my book in several chapters, is that strategy does not exist in a vacuum. Thus, aligning strategy with culture is an excellent path to achieving goals and objectives.

 

MEDICINE & MACULA: Yesterday, Saturday October 7th, Dr Ed Ryan presented one of our recent studies at the 50th Annual Retina Society Meeting at the Fairmont Copley Plaza Hotel in Boston, MA.

Our study, Outcomes of Current Techniques for Repair of Moderately Complex Phakic Rhegmatogenous Retinal Detachment, compares scleral buckle, vitrectomy and combined scleral buckle and vitrectomy surgical techniques in retinal re-attachment rates in phakic patients.

 

GRATIS: Last Sunday, October 1st, I had the once in a lifetime chance to share the court with Mr Karim Abdel Gawad for a squash event hosted by Boast Squash here in MN! Gawad is a professional squash player from Egypt who reached World No. 1 in May 2017.

It was humbling and an honor to share the court with a fierce talent like Gawad. I had a blast and thankful to Gawad for having some fun with us amateurs!

 

My best to you,

David Almeida

david@davidalmeidamd.com

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