July 2017

“I’m a culture vulture, and I just want to experience it all.” -Debbie Harry


TASK AT HAND: This week I’m thinking about what it means to be a culture vulture. This is a term that I have comes to admire with great esteem! I was born in Portugal, grew up in Canada, did a PhD in Hungary, an MD in Canada, and an MBA in the USA. I did my vitreoretinal surgery fellowship in Iowa and now I am proud to be part of VitreoRetinal Surgery, PA and call Minneapolis-St Paul, Minnesota my home.

Throughout this extended journey, I have had the privilege of experiencing different cultural mores and philosophies. Some that I like and some that I don’t. Parts which I emulate and others I prefer to distance myself from. This has been a wonderful and expanding learning experience allowing me appreciation of cultural breadth. Needless to say, over the years, I have enjoyed being a culture vulture!

Within the Urban Dictionary, one of the  definitions of a Culture Vulture is “a person who loves art, music, movies, and dance, and all forms of culture so much that they consume whatever they find.” The consumption of culture is a bona fide way to open yourself to a myriad of experiences.

Now, there is one issue that we must note; the mass consumption of culture can be confusing if you curate without context. While I have no issue with exposure to all forms of art or culture – both good and bad – you still need to be cognizant of that which you are incorporating into your practices. A degree of discernment, a slice of skepticism, query and questioning always need to be present.

As we close out the month of July, here in the western hemisphere, we find ourselves in the depths of summer. In this season of sun and adventure, I encourage you to enjoy the rest of the summer and be a culture vulture! Go out experience a wide range of contexts. Curate experiences outside your comfort zones. Take bites of the extensive palette in front of you.


MEDICINE & MACULA: A special thanks to Dr Parnian Arjmand MD, a senior ophthalmology resident from the University of Ottawa (Ottawa, Ontario, Canada). She visited us here at VitreoRetinal Surgery, PA in Minnesota in July for a research elective. Dr Arjmand analyzed outcomes in challenging cases of proliferative vitreoretinopathy (PVR) which is an ongoing active area of study for us. Additionally, she collaborated on developing a novel vitreoretinal surgical technique for optic pit maculopathy. We will keep you posted on the exciting findings from these studies!


GRATIS: “If your friend is already dead, and being eaten by vultures, I think it’s okay to feed some bits of your friend to one of the vultures, to teach him to do some tricks. But only if you’re serious about adopting the vulture.” Jack Handy (Deep Thoughts)


My best to you,

David Almeida


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“The light obtained by setting straw men on fire is not what we mean by illumination.” ―Adam Gopnik


TASK AT HAND: This week I’m thinking about the straw man fallacy. This is one of the most common logical fallacies that I see occurring in media, television, social commentary and public discourse. Touching everything from science to religion, entrenched in politics and ethics, the straw man fallacy is a hurtful and dishonest approach to discussion.

The straw man fallacy occurs when someone attempts to rebut a discussion by diverting the argument to an unrelated topic. For example, someone purports that A leads to B. The other person then attacks by bringing forth argument C. The perpetrator of the straw man fallacy, instead of opining about the argument that A leads to B, attacks position C which us unrelated and designated as the “straw man”. In practical terms, the straw man fallacy causes gross distortion of the original position by misrepresenting it with another point.

“In practical terms, the straw man fallacy causes gross distortion of the original position by misrepresenting it with another point.

I am disenfranchised by how often I see individuals attack straw man with loud voices, distasteful words, and erroneous opinions. See, the problem is, people love to attack the straw man because the straw man does not fight back. It is unrelated to the original argument which sometimes catches the first person off guard. Now, the attacker of the straw man proclaims victory in the argument but, all the while, not realizing that the straw man attack is unrelated to the original position. In actuality, the original argument is untouched by the gauche comment.

It is important to realize that, at times, there may be nothing wrong with the argument created by the one attacking the straw man – it might be correct or accepted as fact. However, it is unrelated to the original argument and therefore lacks correct context. The straw man fallacy is an easy logical fallacy to catch and many times takes the form of a counterargument beginning as “well, how about…” or “but, how about…”. What frustrates me most is the few times this logical fallacy is called out.

Now, how can this help your strategy?

When you are faced with someone attacking the strawman, DO NOT shift to their argument. Call out the fallacy, and return the discussion to the original topic. You must avoid the incredulous feelings that give rise to perplexing anger. Simply call out the fallacy and redirect them to the initial point.

This simple tactic will exhaust the ability of your counterpart to attack the straw man by diverting the discussion to the original point. The burden of proof is not on you to defend the straw man because he has no place in the argument. Your gamesmanship is to re-direct the argument to the proper context. Do not fall victim to the straw man!


MEDICINE & MACULA: The power of placebo is a real effect! A 2014 knee pain study found that 74% of patients who underwent placebo knee surgery described deriving some benefit. This was as effective as the actual elective surgery about 50% of the time. The routine of fasting, anesthesia, fake incisions – independent of actual surgery – seems to have a dramatic effect in patients undergoing elective surgery.

FiveThirtyEight.com has a fantastic piece on this (check it out here). You can find the study, Use of placebo controls in the evaluation of surgery: systematic review (BMJ 2014;348:g3253) here.

Sham or placebo surgery is a controversial topic in medical ethics but studies like this show that, without well designed placebo controlled trials of surgery, ineffective treatment may continue.


GRATIS: “A straw vote only shows which way the hot air blows.” -O. Henry


My best to you,

David Almeida


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“If ever it’s necessary to ride the bandwagon, it’s done with one leg swinging out and eyes scoping the fields.” ― Criss Jami (Killosophy)


TASK AT HAND: This week I’m thinking about what it means to jump on the bandwagon. The phrase is from the mid-nineteenth century and attributed to Phones T Barnum who, as a circus owner and showman, would urge audience to jump on the wagon that carried the circus band (a literal bandwagon). In the modern lexicon, “jumping on the bandwagon” usually refers to individuals supporting a person, team, idea or activity after it is popular or successful.

There is nothing wrong with supporting a movement or idea; in fact, you should curate movements that align with your mores, challenge your beliefs, and allow you to develop as a thoughtful creature. My issue with the pursuit of merely popular or successful people or ideas is that they limit your ability for independent thought. To join a collective for the mere sake of popularity, limits choice, and aggrandizes mass effect.

There is convenience in joining a bandwagon. There is instant common ground that, while at times merely superficial, allows connection and fabric to take hold. But, and you know how I fell about convenienceit breeds complacency – and this is where trouble begins. As you become complacent, history shows us with a multitude of examples that it becomes easier to succumb to groupthink and lose objectivity amidst the loud voices of a large group.

Be wary of bandwagons and, as the existential philosopher Criss Jami so nicely summarizes above, if you must ride a bandwagon, do so with one leg out the cart and be ready to move. Look for a landscape that challenges you as an individual. Realize that autonomous pursuit is lost on the backs of most bandwagons.


MEDICINE & MACULA: Check out one of our recent publications, Novel Technique for Submacular Hemorrhage Removal Using 27-Gauge Pars Plana Vitrectomy and Recombinant Tissue Plasminogen) Activator (Kunyong Xu MD MHSc, Eric K Chin MD, John B Davies MD & David RP Almeida MD MBA PhD).

Many thanks to the Journal of VitreoRetinal Diseases for publishing our work!

You can find the study here.


GRATIS: “If you see a bandwagon, it’s too late.” -James Goldsmith


My best to you,

David Almeida


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“Nothing’s beautiful from every point of view.” -Horace

TASK AT HAND: This week I’m thinking about points of view. Perspective is the context for processing information. Very little – if anything – is black and white. Actions and consequences rarely exist in a vacuum. Instead, there is nuanced context to words in a conversation, lines on a page, and in the decisions we act out.

We have previously talked about perspective here on the Sunday Surgical Scrub (March 2017) but, today, we are going to go beyond defining perspective and I will present 3 pearls to points of view that you need to consider for effective strategy.

1) Sensitivity Requires Perspective. Being aware of differing points of views provides sensitivity to the fact that we are all different people, from different cultures and with different mores. Sensitivity, and the ability to detect differences, aligns with one’s ability to be cognizant of diversity. Looking at a situation from the perspective of another, is empathetic and contributes to the fostering of collaborative relationships.

2) Do Not Substitute Perspective for Understanding. There is a strong desire, due to the bias of rationalization, to bend perspective to “fit” with your own thoughts and actions. Avoid this! Look to differing points of view as an empathetic tool but do not distort strategies to fit your unchanging perspective. “A point of view can be a dangerous luxury when substituted for insight and understanding” (Marshall McLuhan). The later quote is essential learning because we must remind ourselves that perspective can both help or hinder our understanding of actions. Cataloging the different points of view relevant to a certain situation are only one component of understanding.

3) Find the Vantage Point. It is possible to, when considering points of view, to ascribe to a perspective that is clear and concise. This is the Vantage Point. Vantage simply means a positon affording a good view. Think of the vantage point as a position of balanced and informative perspective; the point of view uncluttered by bias and most free of rationalization.

Try to find the vantage point of a conflict as a means to ascertain the key variables for all the parties involved. Find the vantage point for a decision you are pondering to offer you the needed perspective of consideration and avoid the collusion of bias that is so tricky whenever points of view come into play.


MEDICINE & MACULA: Many thanks to Judy Hoberman for having me on the Selling In A Skirt radio show! Judy has incredible insight into the gender differences that we should all understand and embrace instead of feeling unable to communicate about. We discussed entrepreneurship, my book Decision Diagnosis and, of course, gender differences.

You can find our July 2017 episode here.


GRATIS: “Men are disturbed not by things, but by the view which they take of them.” -Epictetus


My best to you,

David Almeida


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“Beware the barrenness of a busy life.” -Socrates

TASK AT HAND: This week I’m thinking about “the busy life”. When I ask friends how they are doing, the most common answer I get – irrespective of whether they work in medicine, business, entertainment or sports – is: “busy!”.

How’s the day going? -Busy!

How was the weekend? -Busy!

How’s the week looking? -Busy!


I hear it so much, I am reminded of this Henry David Thoreau quote multiple times a day: “It is not enough to be busy. So are the ants. The question is: What are we busy about?”

Our language has a powerful effect on how we frame our relationships and strategy. Descriptors, like “busy”, create a disconnect from actions we perform. One is less able to extract meaning from an act that is defined in an impersonal manner such as “busy”. For the descriptor of “busy”, a strategy is simply to finish the event. Unfortunately, this is a rudimentary process because, in the end, what have you achieved? Completed a busy day? Almost always, the tasks have much more meaning that simply of being “busy”. You are living more than just a “busy life”.

For example, I see patients and perform surgery. There are days with more patients than others, some days with more complex cases, etc. I have three fantastic kids under 6 years old. Some days are marathons while others are sprints. Some days I enjoy the hectic pace while others I like the pauses for reflection. If I am left describing each of these different days as a homogenous “busy”, there is the deleterious effect of disconnecting me from what it is I am doing during those very different days. Instead, if you re-frame how you look at these “busy” actions, you can open the door to more engagement.

The call to action on today’s Sunday Surgical Scrub is to avoid using the word “busy” as a descriptor. Re-frame how you look at your tasks and actions.

How was your day? -It was a day with challenges that required me to…

How’s the week looking? -I’m looking forward to…

By simply changing the language you use to describe what you do or how you go about your days, has a demonstrative effect on your level of engagement. This approach allows you greater insight into managing challenges and resolving conflicts.


MEDICINE & MACULA: A few months ago, I had the privilege of being on a panel looking at best practices of the surgical technique of the dexamethasone intravitreal implant (Ozurdex). These events always remind me how much I learn from my wonderful colleagues. Many thanks to Seenu M. Hariprasad MD, Kimberly Drenser MD PhD, Sunir Garg MD and Bruce Saran MD!

For those interested, check out the publication here.


GRATIS: Happy Canada Day! Happy Independence Day!


My best to you,

David Almeida


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