Sunday Surgical Scrub

sss-disclosure

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

 

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

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

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

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

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

“When you are facing a deceptive strategist,

start with disclosure and

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

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

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

jama-endophth-2016

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

Check out the publication here.

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

My best to you,

David Almeida

david@davidalmeidamd.com

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sss-compare-despair

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

-Lao Tzu

 

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

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

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

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

When we compare and judge ourselves as inferior,

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

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

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

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

max-halloween-school-high-res

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

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

scary-eyes

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

My best to you,

David Almeida

david@davidalmeidamd.com

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sss-survival-bias

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

 

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

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

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

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

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

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

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

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

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Check out the publication here.

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

My best to you,

David Almeida

david@davidalmeidamd.com

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sss-enigma-2

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

 

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

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

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

 

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

trapped-gas

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

trapped-gas2

 

Check out the publication here.

rcbr

 

 

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

 

My best to you,

David Almeida

david@davidalmeidamd.com

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sss-sunk-cost-2

“Don’t dwell on what went wrong. Instead, focus on what to do next. Spend your energies on moving forward toward finding the answer.” -Denis Waitley

 

TASK AT HAND: This week I’m thinking about sunk costs. Also known as retrospective costs or the fallacy of commitment to sunk costs. Do you own an old pair of shoes you don’t wear any more but, because you spent a pretty penny on them, you refuse to throw them away? This is the sunk cost fallacy at work. It is an erroneous approach to strategy focusing on trying to recover your past investment by holding onto something because you cannot accept it is no longer working (Psychology Today, 24 September 2014). By definition, it is a cost that has already been incurred and cannot be recovered. In other words, it’s time to throw away those shoes!

When trapped by the sunk cost fallacy, you become concerned with what you “paid” for something in the past, rather than what you will get out of it in the future. The fundamental problem with commitment to sunken costs owes to it being a backward looking decision. Consequently, it does not offer you any prospects or opportunities for the future. Interestingly, humans are the only animals who honor sunk costs. Other animals will look for new opportunities as soon as previous ones have been exhausted (Psychological Bulletin 125(5):591–600).

The fallacy of honoring sunken costs resides in our old nemesis of insecurity. The insecurity that changing or giving up on a sunk cost will show others we made a mistake. This relates directly to the phenomenon of loss aversion: we all fear loss and we all want to avoid it. However, you need to see beyond this. That submerged boat, let it sink. Feel stagnation in your current job but afraid start over? It is time to consider your options. Is there a void in your relationship but deny it because of the “time you have already invested in it”? Abandon old rationalizations and bring yourself to realization.

The mindset to best eliminate loss aversion and bypass the sunk cost fallacy is to consider only future benefits and costs when pondering a decision. Assess what you need to invest moving forward. Minimize the desire to include resources, capital or emotion that has been previously spent. The latter is baggage which can weigh you down. By letting go of past costs incurred, you can frame your strategy de novo with improved clarity.

MEDICINE & MACULA: I was in Chicago this week for the American Academy of Ophthalmology (AAO) annual meeting!

aaoembolectomy1-copy

On Friday I presented a talk on our technique for retinal embolectomy at the AAO Retina Subspecialty Day. Retinal embolectomy involves the removal of emobli from the retinal vasculature in selective cases of arterial occlusions.

embolectomy2-copy

Thanks to everyone for their interest in our technique!

GRATIS: For those who know me, a common place to find me is on a squash court. This past week was the Beyond Walls Squash Week in Saint Paul MN. My home club, The Commodore, was the host club.

squash-mn

In addition to playing in the A singles draw, davidalmeidamd.com was a proud sponsor of this fantastic event benefiting Beyond Walls.

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For more information, check out the MN Squash Week page.

My best to you,

David Almeida

david@davidalmeidamd.com

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sss-forgive-enemy

“Always forgive your enemies; nothing annoys them so much.”― Oscar Wilde

 

TASK AT HAND: This week I’m thinking about forgiveness. Whether we accept it or not, it’s easy to forgive our family for errors. It’s convenient to forgive our loved ones for most omissions. We want to let transgressions from friends disappear. But, how about your opponents or those you distrust? What happens when these transgress against you? The simplest strategy for this complex intonation is forgiveness.

1. Forgiveness annoys those who attack you. As the introductory quote above explains, forgiveness – to the closed arms of an opponent – is extremely annoying. Your sporting opponent, corporate rival, or feuding adversary attack you to elicit a reaction. The hope is your reaction is irrational, hastily conceived, and poorly executed. This is the benefits of an attack and why we don’t just engage in predetermined deliberations. By responding with forgiveness, you disarm most of the possibilities your opponent is trying to elicit from you.

2. Forgiveness is strength. Forgiveness is not about being a doormat. Forgiveness is not about being a pushover. “Forgive your enemies, but never forget their names” (John F. Kennedy). Forgiveness is about strength!

By forgiving, you show restraint and the ability to strategize counterpoints. Forgiveness, in this context, is counterintuitive because of our overriding desire to tap into primal reflexes in moments of duress. But, “the weak can never forgive. Forgiveness is the attribute of the strong” (Mahatma Gandhi). Your opponents will be dumbfounded by your act of forgiveness and your enemies will be confused by this show of strength. Then, consider what the attack was based on and begin to develop a plan that addresses the reasons for the existing adversarial relationship and how it can be mutually overcome.

3. Forgiveness is a sustainable overarching strategy. No one can survive with grudges against all who have ever crossed them. No one can grow while holding anger and resentment in their hand. Strategy, without the ability to forgive, eventually falls to some stronger opponent. However, one who shows forgiveness can broker relationships based on trust. The latter is a fundamental part of a long-term successful strategy.

MEDICINE & MACULA: Check out our new photo essay in the October 2016 issue of Ophthalmology entitled, Pigmented Paravenous Retinochoroidal Atrophy (Lucas T. Lenci MD, D. Wilkin Parke III MD & David R.P. Almeida MD MBA PhD)

pprca

This is a great example of prominent atrophy of the retina and choroid surrounding the retinal venous circulation. You never know what’s going to walk into clinic…

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Check out the publication here.

GRATIS: There is another benefit to acts of forgiveness. “If you haven’t forgiven yourself something, how can you forgive others? (Dolores Huerta) If you can forgive others, it means you can forgive yourself. That you can accept events beyond your control. That you can let go of the errors we are all bound to make.

My best to you,

David Almeida

david@davidalmeidamd.com

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sss-forget

“Even if a minefield or the abyss should lie before me,

I will march straight ahead without looking back.” Zhu Rongji

 

TASK AT HAND: This week I’m thinking about hindsight and the ability to forget. You know the old adage, “hindsight is 20/20”? This is not the whole story. Yes, you can look back and sometimes find explicable nature to events. However, looking back can leave you in an abyss of insecurity. The discrepancies of past actions can hinder our future movement by leaving us stranded on an island of insecurity. This plagues our ability to decisively carry out optimal strategy.

Why is looking back harmful? I heard Andrew Lincoln, the actor who plays Rick Grimes in the television show, The Walking Dead, say: “I would find myself getting deeply distressed if I lived in hindsight all the time”. I like this. Past events, while they allow you to learn and thus are of value, they can also paralyze you from future action if you do not let them go. They create bias in your vantage point that can then preclude you from realizing the potential of events not yet happened.

The ability to forget. The skill of not remembering allows us to move forward with confidence. “It is not possible to go forward while looking back” (Ludwig Mies van der Rohe). You cannot look back and move forward at the same time. Incessant retrospection is as deleterious as never looking back. At some point, you have to forget past triumphs, errors, wins and losses, and strike forward. Leave the past as rough notes on a story that you continue to develop.

I am a surgeon, and I believe the difference between good surgeon and great surgeon is a great surgeon has no memory. He or she forgets both the complications and successes of previous cases, and continues to work for the best possible outcomes. Whenever I operate, whether it be a straightforward procedure or a high-risk complicated case, I draw on collective experience and knowledge – but at the same time – I remain free of any worry of that which has happened before. For, if you look too far back, you might stumble into tomorrow without living the time that exists today. Besides, looking back for too long is bound to hurt your neck.

MEDICINE & MACULA: Check out our new feature in the September 2016 issue of Retina Specialist entitled, MIVS and Post-op Endophthalmitis: A look at evolving trends and techniques.

retina-specialist

Thanks for the continued interest in our microincisional vitrectomy surgery (MIVS) technique for infectious endophthalmitis. Early vitrectomy for endophthalmitis provides significant benefit in removing infectious material and look out for a study we are putting together on this topic.

044_rs0916_North_RK.indd

Check out the publication here.

GRATIS: If you enjoy the Sunday Surgical Scrub, sign up with your email and receive a new Scrub every Sunday in your inbox! Also, I’ll keep you posted of updates and new material planned for 2017!

My best to you,

David Almeida

david@davidalmeidamd.com

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sss-long-game

“I don’t think anyone is thinking long-term now.” -Thomas Mann

 

TASK AT HAND: This week I’m thinking about long-term plans. Strategy based on delayed gratification and personal investment. Plans that require patience, pragmatism, and perseverance. Playing the long game. Taking the long road.

We are endlessly inundated with short sells, quick fixes, and the lure of easy money. These are but myths, blasted on billboards, and endlessly running on our screens. Beware of those selling overnight success; sometimes they work, but most times they do not. Behind the overnight success, you can usually find years of work and dedication.

With everyone working the fast hustle, don’t be afraid to contradict and make long-term plans. Instead, hone strategy that takes time and consequence to develop. Having a long-term plan dramatically increases your chances of success solely because most are playing some version of the  fast hustle.

Obsession with overnight success. The want for short-term success is rooted in the desire to avoid pain. It is much easier to create a flash in the pan than stoke a fire. Inherent within us is a low baseline threshold for pain. This is a biological design so that we don’t get hurt. But don’t let this biology disrupt your ability to navigate complexities that require time.

We all know those who start out on a plan, only to abandon it as soon as they feel pain. Discomfort forces a switch to another project. I have found that one must train and accept that negative short-term pain is acceptable. It is merely a method to make us slow down and take notice. Then, upon realizing this, we can evaluate and look to overcome. It is a necessary (painful!) reminder of importance.

Planning for the long road. Personally, “we don’t mature momentarily, but over the long-term” (John C. Maxwell). Having long-term plans gives you significant advantages due to increased maturity and improved comprehension of the emotional intelligence inherent in relationships. In professional life, remember that “good decisions can have bad short-term outcomes but be great for the business long-term” (Gerry Schwartz). Excessive focus on short-term gains – and the inability to sustain short-term pain – can hinder your ability to prepare for long-term survival as business landscapes evolve.

How do you survive the long-term plan? Patience, perseverance, pragmatism. And when failure occurs, “keep your face always toward the sunshine – and shadows will fall behind you” (Walt Whitman). Night will come, and with it, darkness and doubt. Keep walking, and surely if you play the long game, you will see the sun come up again, and the shadows will once again fall behind you.

MEDICINE & MACULA: Check out our new publication in the September 2016 issue of the Canadian Journal of Ophthalmology entitled, Low power and type II errors in recent ophthalmology research (Zainab Khan MD, Jordan Milko MD, Munir Iqbal MD, Moness Masri MD & David RP Almeida MD MBA PhD).

cjo-power-study

We show that a large proportion of randomized clinic trials contain statistical errors. The results of the studies have dramatic effects on day-to-day clinical practice and need to be designed and evaluated carefully. Check out the publication here.

GRATIS: “I believe it’s less risky long-term to embrace change.” Charlie Ergen

My best to you,

David Almeida

david@davidalmeidamd.com

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sss-fear-failure

“Fail early, fail often, but always fail forward.”

John C. Maxwell (Failing Forward)

 

TASK AT HAND: This week I’m thinking about failure. A word associated with massive negative connotation. Imbedded within insecurity, fear of failure enforces the concept that we need to avoid failure if want to be successful. That failure is for the weak and lazy. That if you are intelligent and industrious, failure can be avoided. This is wrong and ignorant. Failure – and how we cope with it’s force – is of crucial importance to our character development.

Why is failure important? Failure is part of the iterative process of learning. Like trial-and-error, it is a basic process that we master in order to develop higher forms of reasoning and decision making. Thomas A. Edison writes, “I have not failed. I’ve just found 10,000 ways that won’t work.” Failure allows us to improve processes and techniques and is essential to the learning of individuals, growth of organizations, and coherence of cultures. “Ever tried. Ever failed. No matter. Try Again. Fail again. Fail better”; these words by Samuel Beckett see failure as this fundamental process of learning.

Why is fear of failure debilitating? The shame of failure comes from the pervasive negative assumption that failure is an ultimate end. In truth, failure is just another step in the process. I’m a vitreoretinal surgeon and I regularly operate on blinding diseases. I am humbled by the eye and the gravity of complications that may, without notice, occur during surgery. I orchestrate every movement to avoid complications, but I do not fear them. If so, I would be paralyzed with fear and overwhelmed by the weight of possibility. This would dramatically hinder my performance and limit my ability to help patients. Show me a surgeon with no complications, and I’ll show you a surgeon who never operates. Failures are not final but part of evolving solutions and strategies.

How can you erase your fear of failure? If you fail at something, the first step is to give yourself the opportunity to learn from it. There is a twisted irony in the failure to learn from your failures. Don’t do this. Take ownership of your failure. “A man can fail many times, but he isn’t a failure until he begins to blame somebody else” (John Burroughs). Realize your error. Take ownership of the failure. Accept responsibility for the consequences. This provides you with immense learning. See this as a temporary event and in no way a synopsis of your life.

MEDICINE & MACULA: Check out our new feature in the September 2016 issue of Retina Today entitled, Postoperative Infectious Endophthalmitis: Evolving Trends and Techniques.

retina-today-sept-2016

Infectious endophthalmitis is a vision-threatening condition that involves inflammation of the entire eye. Early vitrectomy for endophthalmitis provides significant benefit in removing infectious material. We describe how vitreoretinal practices have changed with the adoption of small-gauge surgery.

endopth-ppv

Check out the publication and video here.

GRATIS: If you’re not failing often, you’re not trying hard enough.

My best to you,

David Almeida

david@davidalmeidamd.com

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sss-good-relationships-study

“Nothing is perfect. Life is messy. Relationships are complex. Outcomes are uncertain. People are irrational.” -Hugh Mackay

 

TASK AT HAND: This week I’m thinking about relationships after reading Harvard’s 75-year study of human happiness. Called the Study of Adult Development at the Harvard Medical School, but better known as the Grant Study, this recently published investigation is the longest-running study of human happiness. You can find the study here.

The Grant Study began in 1938 as a counterpoint to the disease model of medicine and sought to ascertain the conditions that enhance wellbeing or happiness. It followed the lives of 268 healthy sophomores from the Harvard classes between 1939 and 1944. There is no other study like it in length of follow-up.

The conclusion after 75 years of study: good relationships make us happier and healthier! There is of course significant bias in a study with a homogenous population based entirely on privileged white men. While the latter serves to emphasize the need to critically interpret any piece of information, it reminds me that relationships – how we collide and interact with others – has the potential for massive impact on our happiness and health.

Relationships are complex, but there are certain strategies that give you the best chance of cultivating a matter of significance with other people and groups.

1. Enter relationships without expectations. Entering a relationship with expectation is akin to degrading human encounter to transaction. As I’ve written before on anticipation (see here) – rather than expecting – look to give. “Relationships based on obligation lack dignity” (Wayne Dyer), so enter them openly, without bias, and contribute rather than collect.

2. Everybody hurts. REM was right. If you enter a relationship with honesty, there is always the chance of getting hurt in the process. Bob Marley’s words: “truth is everybody is going to hurt you: you just gotta find the ones worth suffering for” strikes at this chord. Committing with honesty is an exemplary way to build relationships. “Be honest, brutally honest. That is what’s going to maintain relationships” (Lauryn Hill).

3. Work at it! Relationships require work. In the economics of human emotions, a zero-sum game is of no value. A balanced budget has no use. There is an ebb-and-flow that occurs with communication – and you have to work at this. Failure to communicate leads to failed relationships. When communication and conversation stall, remember: “you can discover more about a person in an hour of play than in a year of conversation” (Plato). Every young child knows the meaning of these ancient words. I have learned this principle best from my children.

Enter relationships without expectation. Don’t be afraid of getting hurt. Cultivate, communicate and work towards building strong relationships. With this, I hope you find some elements of happiness.

 

 

MEDICINE & MACULA: I’m in Copenhagen, Denmark this week for the EURETINA annual meeting – one of my favorite meetings! I love conversing and contrasting new therapies and techniques with my European and International colleagues.

euretinacopenhagen

Yesterday I presented two talks and enjoyed the discussion immensely. I presented, Comparison of microbiology and visual outcomes of patients undergoing small-gauge and 20-gauge vitrectomy for endophthalmitis in one of the morning sessions and Long-term outcomes in patients undergoing vitrectomy for retinal detachment due to viral retinitis in the afternoon session. Thanks EURETINA!

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GRATIS: I have discovered the concept of hygge in modern Copenhagen. It is of serious gravity here! The best English word seems to be “cozy” or “coziness”. It’s about feeling comfortable like one is at home or in a “homely state”. Thank you Copenhagen!

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My best to you,

David Almeida

david@davidalmeidamd.com

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