December 2016


“Ring out the false, ring in the true.” -Alfred Lord Tennyson


TASK AT HAND: This week I’m looking back on 2016 and trying to learn from error and success alike. It has been an incredible year: was launched and the Sunday Surgical Scrub, an idea that has existed for quite some time, was officially started. Above all else, thank you for your support and interest in everything that we do on the medical, research, speaking and consulting fronts.

Today I will look back on the Sunday Surgical Scrub and review some highlights of 2016 as we transition to 2017. Here are 7 highlights from 2016.

1. Strategy: It Has To Work! (From the 22 May 2016 Scrub, you can find the original post here.What makes a strategy successful? If it works, it’s successful! Ultimately, your strategy must work and you must achieve your goals; otherwise, seriously consider switching strategies. The core of any successful strategy is the ability to plan and execute. I plan like an economist, but execute like a surgeon. In planning, you should employ some sort of analysis but then bring your decision out of your personal vacuum and into context and consequence. Then, when all planning is done, go out and execute it.

2. Minimize Cognitive Burden (From the 12 June 2016 blog, you can find the original post here.) Minimize your cognitive burden – both the extrinsic inconsequential happenings and the intrinsic personal trappings – so that in clarity you can fulfill your potential. Cognitive load refers to the total amount of mental effort being used in the working memory. Cognitive burden can be thought of as an excess load on our mental effort. Minimize undue burden due to meaningless or inconsequential items.

3. Passion Is Essential (From the 24 July 2016 post, you can find the original post here.) Living with passion is 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, being reacquainted with your passion is a revitalizing elixir of energy, focus and determination that cannot be neglected. When you look back – which we are doing here in this year in review – 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).

4. Be Careful of The Company You Keep (From 28 Aug 2016, you can find the original post here.) “If you’re the smartest one in the room, you’re in the wrong room” (Richard Tirendi). 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. Seek to be influenced by the best, and you will find yourself in good company.

5. Eliminated Fear of Failure (From 18 Sept 2016, original post here.If you’re not failing often, you’re not trying hard enough. 2016 was the year we let go of the fear of failure. Failure – and how we cope with its force – is of crucial importance to our character development.

6. Choose Fulfillment Over Achievement (From 23 Oct 2016, original post here.) Achievement is commonly confused for fulfillment. In the culture of 80-plus 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.

7. Beat Your Own Drum (Originally posted 27 Nov 2016, you can find the original blog here.) Live dangerously. Embrace pain and take risk. Desire to beat your own drum. Embrace pain and risk for it is in these moments that we carve out character and define development.

GRATIS: “Be at war with your vices, at peace with your neighbors, and let every new year find you a better person.” -Benjamin Franklin


Merry Christmas, Happy Holidays and my best to you always,

David Almeida

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“Opportunity dances with those already on the dance floor.” -H. Jackson Brown, Jr.


TASK AT HAND: This week I’m thinking about opportunities and how to catch unexpected prospects. I believe that unexpected opportunities are events that need to be created. Expecting the unexpected, when it comes to opportunity and progress, rarely works. One is best guided by a proactive nature to facilitate and cultivate these opportunities. “If opportunity doesn’t knock, build a door” (Milton Berle). As this fitting quote so nicely summarizes, opportunities require active participation. You need to build a bridge to get to the opportunity you seek.

“Expecting the unexpected rarely works.

Opportunities require active participation.”

But how do you create opportunities or uncover unexpected ones? There are three strategies you can consistently use to increase your yield on opportunities. First, change something. “Change brings opportunity” (Nido Qubein). Change a habit, change a routine, change a relationship, change the way you go about completing some task. Change is a powerful conduit for opportunities and can greatly help your ability to improve processes and pain points. At the very least, committing to changing a routine or practice allows for reflection on subtleties and nuances you may not have been previously aware of.

“Change is a powerful conduit for opportunities.”

Second, don’t be afraid to fail. “Failure is simply the opportunity to begin again, this time more intelligently” (Henry Ford). On a previous Sunday Surgical Scrub, I averred the need to fail and the benefits inherent is this necessary stage of growth (you can find the post here). Failure is the most common missed opportunity I see. Whether it is a failed drug trial or a contract not landed, these “failure” events usually possess unexpected opportunities but, as stated above, they require active consideration and proactive pursuit to materialize any merit or substance.

“Failures usually possess unexpected opportunities but require active consideration and proactive pursuit.”

Third, prepare for all possible outcomes. Pilots routinely use situational analysis to algorithmically assess all possible outcomes in flight scenarios. This allows pilots to be prepared for all situations. We can extrapolate this situational awareness to our personal and professional lives. Be prepared for the ideal outcome, the worst-case scenario, and all possible eventualities and the unexpected becomes opportunity.

“Be prepared for the ideal outcome, the worst-case scenario, and all possible eventualities and the unexpected becomes opportunity.”

MEDICINE & MACULA: One of our surgical techniques for endophthalmitis was published earlier this week. The study entitled, Five-Port Combined Limbal and Pars Plana Vitrectomy for Infectious Endophthalmitis, was published in Case Reports in Ophthalmology (2016;7:289–291) and centers on how acute infectious endophthalmitis can be challenging due to severe inflammation. In it, we describe a surgical technique combining limbal based vitrectomy and pars plana vitrectomy to manage acute infectious endophthalmitis. You can find the study here.



GRATIS: “There is no security on this earth; there is only opportunity.” -Douglas MacArthur


My best to you,

David Almeida

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“Every piece of data is biased. Every argument has opinion.”


TASK AT HAND: This week I’m thinking about the effects of bias and opinion. Analysis after the US election show that “fake news” – stories that are false but presented in a truthful manner (e.g., newspaper article format) so as meant to deceive – outperformed legitimate news stories on social media. We now occupy the post-truth economy of thought. In this state, opinion and argument are given the same credence as fact and truth.

Recently, the Oxford Dictionary announced that “post-truth” is its 2016 word of the year. It defined it as ‘relating to or denoting circumstances in which objective facts are less influential in shaping public opinion than appeals to emotion and personal belief.’ Simply put, If you believe something strongly enough, talk loudly enough about it, and can connect with someone emotionally with your argument, then it impacts others like truth or fact.

As a scientist, I am vehemently against this idea that opinion can be substantiated for fact. Truth requires evidence and logic. Truth should be void of bias and opinion.

“Truth requires evidence and logic. Truth should be void of bias and opinion.”

I have heard many times, “what’s the problem with voicing your opinion?” There is nothing wrong with expressing your opinion – I encourage this! However, please don’t confuse the expression of worthy words versus baseless chatter. Your argument should still be based on truth and constructed in a logical manner.

The problem of repeating nonsense over and over is related to how our brains form memories. Studies show that the more often a message is repeated, the more likely we are to remember it. This effect is called fluent retrieval. However, our brains then erroneously extrapolate that, what we can remember easily, must be true (Inferring facts from fiction: reading correct and incorrect information affects memory for related information. Memory 2012 Jul;20(5):487-98; you can find the full study here). The effect is that if you repeat a lie often enough, it starts to feel like truth.

But how to uncover bias and opinion? First, assume every piece of data is biased and every argument, whether it be in a newspaper article, social media post or formal communication, has opinion. You are a detective and must identify the bias and opinion in everything you consume.

“You must identify the bias and opinion in everything you consume.”

You can minimize bias and opinion by sticking to trusted reporting. However, this is not enough. In science and medicine, we have peer-reviewed literature which is considered the benchmark for bias-free communication. Peer-reviewed studies have experts and thought leaders review the work in question to ensure it is scientifically sound before being published. Having personally published over 100 papers, I can tell you that even this process can have bias. Reviewers have personal and professional biases and humans operate poorly in recognizing their own biases.

Second, when developing an argument, use multiple sources. Never stick to one reference and never rely solely on one authority. Attempt to survey as many respectable sources as possible when trying to come to a conclusion. This synthesis of thought is the crux of thinking for yourself because it forces you to take multiple vantage points and create a unique one for yourself. This is hard work and the main hurdle to overcoming herd mentality.

Finally, refute and reject frequently.Blind belief in authority is the greatest enemy of truth” (Albert Einstein). This is not a call for anarchy but a reprisal for individual thought. Authority, or that which is accepted as truth, needs to be questioned. Force yourself to formulate independent thoughts as often as possible. This is not your brain’s default mode so you have to work at it. The goal is to have a society of independent thinkers that question truisms and myths alike. A culture that challenges arguments without fact and calls out opinions lacking logic.

How to uncover bias and opinion:

1.    Assume every piece of data is biased and every argument has opinion.

2.    Never stick to only one reference. Use multiple sources.

3.    Refute and reject regularly.


“The goal is to have a society of independent thinkers that question truisms and myths alike. A culture that challenges arguments without fact and calls out opinions lacking logic.”


MEDICINE & MACULA: One of our recently featured publications on the ongoing debate of auto-antibodies.


Check out the paper, Positive Auto-Antibody Activity With Retina and Optic Nerve in Smokers and Non-Smokers: The Controversy Continues, published in Ophthalmic Surgery, Lasers and Imaging Retina (OSLI Retina). You can find the study here.



GRATIS: “If you tell the truth, you don’t have to remember anything.” ―Mark Twain


My best to you,

David Almeida

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“It’s when you realize that you are out of time that you must focus on not rushing.”


TASK AT HAND: This week I’m thinking about the last minute, the eleventh hour, time as it expires. We are constantly rushed and hurried in our professional commitments and personal relationships. In these pressured moments, we tend to rush when, in fact, we should be deliberate and purposeful with our strategy. As time slips away, we can succumb to bad decisions but there are strategies you can use to avoid errors in these situations.

“As time expires, each second is worth more.”

First, realize that, as time expires, each second is worth more. I like to think of the eleventh hour in terms of relativity. Although one second is one second, in the closing moments of an assignment or instances where a quick decision is required, I like to think of those seconds as “more valuable” than previous ones. When you only have minutes to act, each second is crucial. When you have days to decide, deliberation can be consummate with a longer time window, and seconds seem to matter less.

Previously, on the Decision Triage post of the Sunday Surgical Scrub (you can find it here), I emphasized that, in the last minute, every decision must be made right away and that all triages become urgent in this context. For example, in surgery, I imagine expanding each second to feel like minutes so that I can carefully execute the maneuvers that will bring the outcomes that are required. If there is an unforeseen complication or adverse event – where there is a very small amount of time to correct the error – it is here, I cannot rush! Realizing each second here is worth more than at any other time during the surgery, I can focus solely on these intense junctures. This approach allows speed and efficiency, without ever being rushed or forced into shortcuts.

“Quiet your mind, then plan and execute!”

The feeling of “running out of time” is an external force. It comes from outside you and is then transferred onto your inner self. This creates needless self-inflicted pressure. Quiet your mind, then plan and execute! When you are left with what seems as no time and limited options, still your mind and see beyond the time frame. Find the character of the decision  and align yourself with the basic principles of what you want to achieve.


MEDICINE & MACULA: I was in Toronto this weekend for the 56th Annual Walter Wright Symposium, Retina 2016: A Practical Approach to Navigating the Future.


On Saturday, I presented a talk on my approach and techniques for infectious endophthalmitis. The evolving paradigm calls for early surgery and aggressive treatment to salvage vision from this devastating infectious condition.



GRATIS: “Why do they call it rush hour when nothing moves?” -Robin Williams


My best to you,

David Almeida

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