September 2017

“Even a happy life cannot be without a measure of darkness, and the word happy would lose its meaning if it were not balanced by sadness. It is far better take things as they come along with patience and equanimity.” Carl Jung

TASK AT HAND: This week I’m thinking about equanimity. Let me preface, without writing another sentence, that the secret anxiolytic elixir of life is equanimity. I don’t usually bestow such praise on any one quality but – in the case of equanimity – it is warranted.

What is equanimity?

Equanimity is not a virtue or emotion but instead a skill. Equanimity is the ability to remain stable and composed when under stress. Equanimity is the skill to exercise calmness in the midst of a storm; the faculty to remain balanced in a state of disequilibrium. Equanimity comes and goes but, as you will see below, is a competence worth cultivating because it is essential for navigating the choppy waters that we are sure to encounter. Without equanimity, there is a propensity to slide into reaction without strategy.

Stability Under Stress. Composure Amidst Concern. How do we go about cultivating equanimity? How do we strengthen ourselves to remain stable under stress? How do we exert control to remain composed amidst anxiety and concern?

The strategy I have found to yield the most benefit towards a state of equanimity is summed up as follows: “analysis without judgment”. Take any situation, especially those that cause you to have unpleasant feelings, and you will see that the negativity arises from the emotions we placate on situations. This is happening because, during our analysis of a situation, we judge. Consequently, when we judge, we attribute qualifiers like “good”, “bad”, “terrible” that ultimately spawn anxiety and fear.

Alternatively, exercise the skill of analysis without judgment as follows:

1. Analyze the situation or conflict.

2. Assess the relative consequences possible.

3. Decipher the relative impact of different strategies to a satisfactory resolution.

No need for anxiety, fear or pain in any part of this process. By taking away judgment, you remain with analytic faculties to work out a solution. You will notice that this allows you to remain composed despite chaos and disaster. There is a wonderful Tori Amos quote that I believe sums up this strategy well and I paraphrase to: “It’s okay when everything is not okay.”


MEDICINE & MACULA: Today, Sunday September 24, I have the privilege of walking with my wife Jasmine and my children Max, Leo and Paloma as part of the VitreoRetinal Surgery, PA (VRS) team for the Foundation Fighting Blindness VisionWalk.

Today is the 11th Annual Twin Cities VisionWalk to be held at the Lake Harriet Bandshell in Minneapolis MN. The VisionWalk Mission – Changing Lives One Step at a Time – speaks to the fact that since its inception in the Spring of 2006, VisionWalk has raised over $45 million to fund sight-saving research.

Great time walking with my family and the VRS team for a wonderful cause! Many thanks for everyone who participated!


GRATIS: “Never let the future disturb you. You will meet it, if you have to, with the same weapons of reason which today arm you against the present.” Marcus Aurelius (Meditations)


My best to you,

David Almeida

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 “Your first ritual that you do during the day is the highest leveraged ritual, by far, because it has the effect of setting your mind, and setting the context, for the rest of your day.” –Eben Pagan


TASK AT HAND: This week I’m thinking about the concept of a morning ritual. The morning ritual is the practice of having some set approach to the commencement of the day. The morning ritual is a strategy that will support a composed and successful mindset for the day. Despite the challenges, surprises and shortcomings that lie ahead, the morning ritual allows for preparation. From innovators to iconoclasts, found in teachers and thinkers alike, almost all individuals of genuine merit prescribe to some sort of morning ritual.

“Despite the challenges, surprises and shortcomings that lie ahead, the morning ritual allows for preparation.”

What is the morning ritual?

The morning ritual can take many forms: meditation, exercise, reading, journaling, nature walks, stretching, thought exercises are just a few examples. The overarching purpose of the morning ritual is to allow you a few moments of honest self-reflection. In reality, it actually doesn’t matter what your morning ritual is or how you do it; the focus is to have one that allows you to connect with yourself in a genuine manner. Over time, you can hone the morning ritual as a barometer of your willingness and preparedness for the uncertainties that await you.

“The overarching purpose of the morning ritual is to allow you a few moments of honest self-reflection.”

Now, it is important to note that this genuine willingness to look at yourself has much less to do with catering to emotional whims but rather, it is about curating strength in your ability to be ready for what lies ahead. The goal is to be poised and prepared for the traps and trickery that suffocate modern life. Bias, rationalizations, lack of self-control can rob you of effectiveness and leave you to act as a reactionary animal. Use your morning ritual for a measure of peace as you align strategy with execution.

“Use your morning ritual for a measure of peace as you align strategy with execution.”


MEDICINE & MACULA: Last week, I was a guest on the Cognified Marketing & Selling podcast with Joel Gaslin. If you haven’t heard of this podcast before, it focuses on marketing and selling by blending multiple strategies and techniques. I had a great time discussing some of my decision diagnosis strategies as applied to marketing and selling. No matter what your background is, I think you wil find this episode insightful and intriguing.

You can find the entire interview here via the iTunes link.

For other episodes, transcripts and other information, check out the homepage here.


GRATIS: “Every morning we are born again. What we do today is what matters most.” – Buddha


My best to you,

David Almeida

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“Hindsight is always twenty-twenty.” Billy Wilder


TASK AT HAND: This week I’m thinking about hindsight bias. In my opinion, this is one of the more comical fallacies for the degree of rationalization and inaccuracy inherent in its fabric. The hindsight bias, also known as the “knew it all along” effect, occurs when after an event has happened, we purport that we correctly predicted the outcome. However, the fallacy exists because there is no objective evidence for us having predicted the event.

Hindsight bias, commonly referred to as creeping determinism, is the basis for that feeling we get, “I knew it all long…”. For example, a patient presents with loss of vision and the eye physician diagnoses a retinal detachment. In summary, the doctor concludes, “I knew it! I had a feeling it was a retinal detachment”. Or take last year’s dramatic Super Bowl comeback win by the New England Patriots over the Atlanta Falcons. In various debriefs, you heard fans, players and commentators alike with phrases like: “I knew we were going to come back and win” or “I knew we could do it”. In reality, there was no way possible to predict this. Sports and medical diagnoses are areas where the hindsight bias has been extensively studied. You can find a nice summary here by Neal J. Roese of Northwestern University. Hindsight bias is a decision trap because it falsely supports our ability to predict events that cannot be predicted.

In an excellent commentary, from the September 2012 issue of Perspectives on Psychological Science, psychological scientists Neal Roese and Kathleen Vohs (you can find the article here) show that we bias and selectively recall information that confirms what we know to be true; then, we synthesize a narrative to describe this truth. If our brain has an easy time creating this narrative, then we interpret it to mean that the outcome must have been predictable and we identify with having correctly predicted it.

How does hindsight bias hurt us?

Hindsight bias is troublesome because it limits our ability for introspection. We all have a need for closure and a strong innate desire to make sense of events. Whether they be close relationships, world politics or natural disasters, we strongly want to establish some order and cause to events. This benefits our view of ourselves and the world. However, much – if not everything – lacks any sense or logic. Randomness runs rampant! Hindsight bias limits our ability to learn from events because, if we feel we correctly predicted them, then it follows that we must be in tune with the decision-making process  – which is untrue if this fallacy is present. Contrastingly, with honesty, as witnesses to our errors and miscalculations, we gain valuable insight and maturity in how we come to terms with external stimuli.


MEDICINE & MACULA: I was in Barcelona, Spain this week for the EURETINA 2017 Congress.

On Friday (8 September 2017), I presented a talk on our recent findings and techniques for proliferative vitreoretinopathy (PVR). My talk, Predictive factors for proliferative vitreoretinopathy formation after uncomplicated primary retinal detachment repair (David RP Almeida, Kunyong Xu, Eric K Chin & D Wilkin Parke III) looked at predictive tools for patients who develop this complex condition.

Many thanks for all the interest and international support!


GRATIS: “You can’t operate by hindsight.” -Max Baucus


My best to you,

David Almeida

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“Grit is living life like it’s a marathon, not a sprint.” -Angela Duckworth


TASK AT HAND: This week I’m thinking about grit. A trait commonly alluded to while, at the same time, rarely well-defined or understood. Most people identify grit as a requisite trait for success yet few can define its crystalline qualities. On today’s Sunday Surgical Scrub, let’s deconstruct the quality of grit and find ways which you can develop more of it.

What is grit?

Merriam-Webster defines grit as “firmness of mind or spirit” and “unyielding courage in the face of hardship”. In my opinion, the former definition lacks direction as it tends to imply “strength” without context. However, the latter definition is right on! Grit is the ability to withstand hardship without compromise to integrity, intuition and individuality. Grit allows your character to carry on despite conflicts and confusion. Without grit, you risk being swallowed by the tides of misfortune and disaster. Like the opening quote by Angela Duckworth, you can think of grit as the kind of energy and focus that allows you to push through the pain and fatigue of a marathon; having the dedication and courage to continue when all you want to do is quit.

“Grit is the ability to withstand hardship without compromise to integrity, intuition and individuality.”

How do I acquire grit? How do I get more of this ephemeral quality?

This is a question I am frequently asked. First, I do not believe that you are binary in this regard; i.e., you are either born with grit or not. To the contrary, grit can be pursued the same manner meaning in sought when faced with despair. If grit is the ability to maintain courage and withstand hardship, then surely discomfort is the surest path to this goal. 

How do you know if you have the necessary grit to face hardship? 

Start by reveling in instances of discomfort. If these occur, don’t retreat. Instead, maintain focus on your goals and ensure your objectives remain intact. When faced with a negative fury, brace and stay committed to what brought you there. See it through and you will find that it was grit that accompanied you across the finish line.

“If grit is the ability to maintain courage and withstand hardship, then surely discomfort is the surest path to this goal.”

I do not wish you calamity or disaster, but discomfort is ok. The call to action from today’s Sunday Surgical Scrub is, over the next week, look for instances of discomfort. Identify what makes the situation or scenario uncomfortable. Next, align the original motives that brought you there and make sure you see them through. Take joy in these instances and you will begin to find that discomfort is a challenge with positive consequence irrespective of a negative result.


MEDICINE & MACULA: It was fantastic to be an expert guest on The Don and Gino Radio Show and their new series, Interview With The Giants!

We discussed how to get uncomfortable, leadership and effective management strategies, Citrus Therapeutics and, of course, the effect of procrastination on decision-making. You can find the entire interview here.

You can also find the interview according to 4 topical segments via the YouTube links below. Many thanks again to Don & Gino!!

 Segment 1

Segment 2

Segment 3

Segment 4


GRATIS: Happy Labor Day and may you find joy in the celebration of hard work!


My best to you,

David Almeida

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