Strategy

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.

embolectomy1-copy

embolectomy2-copy

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-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.

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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-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!

euretina-logo

 

 

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!

copenhagen2016copenhagenanchor

My best to you,

David Almeida

david@davidalmeidamd.com

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SSS face punch

“Everyone has a plan ’till they get punched in the mouth.” Mike Tyson

 

TASK AT HAND: This week I’m thinking about strategy setbacks. We all have to soothe the bumps, bruises, blisters and burns associated with negotiating the often rocky landscape of our evolving strategies on the way to successful solutions.

But what happens when you hit a wall with your strategy? Or as Mike Tyson aptly summarizes – what happens when you and your plan get punched in the mouth? As much as your strategy may be well-being, it’s at this point that we must clarify core principles to break through.

What do you do when your best laid plans, your carefully tailored approach, your curated strategy stall? I have found 3 approaches to help navigate these difficult times.

1. Realize and accept that you will eventually get punched in the mouth. It will happen sooner than you think. It will happen multiple times. “Any time you think you have the game conquered, the game will turn around and punch you right in the nose” (Mike Schmidt). Denial of this truism will cause you to hold faulty strategies and you will fail to see the emerging landscape. Don’t bother with the padding…

KONICA MINOLTA DIGITAL CAMERA

2. When you get hit, be receptive and flexible. This is counter-intuitive because the first reaction is to get defensive. The ability to be receptive allows you to discover what details you missed. Then, flexibility allows you to adapt your strategy to the new conditions. Being flexible does not mean quitting on your plan. “Take things as they are. Punch when you have to punch. Kick when you have to kick” (Bruce Lee). Be open and receptive but remain committed. This is counter-intuitive but is of immense advantage.

3. The ability to take a punch is good, but the ability to avoid one is best. Your ability to navigate assaults is a defining property of your defensive strategic framework. “In the battle of existence, talent is the punch; tact is the clever footwork” (Wilson Mizner). Your strategy is your footwork – it will provide you with the needed defence for when you under duress, and it will allow you to counter when an opening occurs.

In chemistry, a transition state is a temporary high-energy configuration existing between two stable forms. The transition state corresponds to the highest potential energy along a reaction path. It is often violent and tumultuous but the potential energy allows for the formation of new stable forms. Think of these periods of your life – times of setbacks and shock – as transition states and look for ways to harness the potential energy to form an improved baseline.

 

MEDICINE & MACULA: Check out our most recent publication, Retinal Injury Secondary to Laser Pointers in Paediatric Patients. Our study describes children who had laser-related retinal injury to the macula due to the mishandling of the laser pointer devices.

Peds citation

Peds laser figure

Thank you Pediatrics for publishing our study! Check out the study here.

 

GRATIS: There is no shame in taking a punch, and there is much character growth in our ability to transition into an improved form during the difficult transition states. However, there may be times where you find yourself constantly under assault. If this occurs, you may have to punch back. Unfortunately, this is the only currency some understand.

“You punch me, I punch back. I do not believe it’s good for one’s self-respect to be a punching bag.” Ed Koch

 

My best to you,

David Almeida

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smartestintheroom?

“If you’re the smartest one in the room, you’re in the wrong room.” -Richard Tirendi

 

TASK AT HAND: This week I’m thinking about the company we keep and the people that influence us. There is a sentiment that we should strive to be the smartest person in the room. That this is a worthy goal to aspire to. That, somehow, if we are the “smartest” or “best” in the room, we will be able to exert influence or hold power over those around us. And thus, we will be successful. This is a dangerous myth! As the opening quote states, if you are the smartest person in the room, turn around, exit the room, and run – as fast as possible – in the opposite direction!

I’m often asked if this advice should be applied to professional relationships, or personal ones as well. In my opinion, you should apply this advice in its most general form: find people that will challenge and encourage you to grow. Find groups that will contribute to your proficiency and petitions. Avoid the fallacy of superiority – which is seeded in insecurity – by denying the need to be the smartest in the group. Instead, look to develop yourself by surrounding yourself with thoughtful and creative characters.

smartest in room

When it comes to coworkers, Donny Deutsch surmised it best: “my philosophy is to always find the smartest people you can. Hire people smarter than you.” The idea here is simple – but of utmost importance – you must surround yourself with colleagues and coworkers of the highest caliber possible. Whether you are in a small business or a large organization, collaborations should always have you reaching up! The simplest path to this growth is by surrounding yourself with those that have varied vantage points and see problems differently than you.

Why is this so important? The answer: “the people that you have around you are your biggest influence” (RJ Mitte). 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. If “leadership is influence” (John C. Maxwell), seek to be influenced by the best, and you will find yourself in good company.

MEDICINE & MACULA: Check out one of our recent publications, Acanthamoeba endophthalmitis after recurrent keratitis and nodular scleritis. Acanthamoeba species are ubiquitous free-living protozoa and are usually responsible for corneal disease. We present the first case with confirmed involvement of Acanthamoeba in all ocular layers, including choroidal involvement.

acanthamoeba panuveitis

Thank you Retinal Cases & Brief Reports for publishing our case! Check out the study here.

GRATIS: “Follow those who are seeking the truth, but run away from those who have found it.” Goethe

My best to you,

David Almeida

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triage decision sss

“Don’t fight the problem, decide it.” -George C. Marshall

 

TASK AT HAND: This week I’m thinking about triage. In medicine, triage is the process of assigning degrees of urgency. In any hospital Emergency Department, you will find a Triage desk that functions to grade the severity of your ailment. Triage decides if your problem is an emergency (must be assessed and resuscitated right away), emergent (needs assessment very soon), urgent (important but can usually wait some amount of time), or nonurgent (can wait). An emergency has the potential to kill or seriously harm your patient and needs to be addressed right now. An emergent condition has the potential to inflict significant morbidity and cannot be delayed any significant amount of time. An urgent state needs to be assessed but usually lacks immediate temporal gravity.

Over the years, I have found that you can apply this same triage process to decision making. One can formulate strategy by triaging decisions and prioritizing subsequent actions. Whether you are taking inventory of personal sentiments, deciding on a strategy for an ambitious project, or developing a new idea, the ability to triage allows you to set priorities, execute strategy, and engage in effective delegation. The goal of decision triage is to emerge from the deluge of questions with a set of priorities aligned with your strategy. Clarity for success by means of deciding how to tackle multiple problems.

now

I triage decisions using these same emergency principles: an emergency requires an answer or decision right now – no exceptions! I reply to all emergent decisions within 12-24 hours. For urgent decisions, I reassess later. Nonurgent matters tend to be delegated elsewhere. Try this next time you are asked to solve a problem or your input is required. If the issue has immediate consequences, deal with it straightaway. Don’t procrastinate and don’t delay. Is it emergent? If so, you have some time. Relatively urgent? Maybe you can delegate this task or move it down your prioritized to-do list.

In triaging decisions, will almost always find conflict and disagreement because, what to one is an emergency, to another is only urgent. What do you do when this occurs? Make sure you communicate clearly so that trust is built in your assessment skills. Lead by example and never trivialize the conflicts of others. When in doubt, have the best interests of others in mind. Selfish behavior is based out of insecurity. Act selfless and create value for others in your triage. This is a key principle of successful decision making.

“Nothing is more difficult, and therefore more precious, than to be able to decide.” –Napoleon Bonaparte

As the quote above emphasizes, the ability to decide deserves your judicial attentiveness. Decision making and strategy are topics we revisit frequently here on the Sunday Surgical Scrub and you can think of decision triage at the top of the algorithm. Once you decide on the priority of the decision, you can use the many tools presented here to resolve the crux of your conflict and put forward the best decision.

 

Caregiver burden fig

MEDICINE & MACULA: Check out our new systematic review pertaining to depression and burden among caregivers of patients with visual impairment. While caregiving allows those with vision problems to better adapt, it has been shown to take a toll on the caregiver on various levels, such as invoking depression and burden. Recognition of this is key for awareness, prevention and management.

burden study paper

Thank you International Ophthalmology for publishing our study! Check out the study here.

GRATIS: One last note on the decision triage system above. By frequently using this method of triage for decision making, I have found a wonderful unexpected side effect: I gain perspective by realizing that few things are a true emergency that require destabilization to correct. This calming vantage point will allow you to appreciate that many decisions – whether we like or not – are just not that important. Find those that are, prioritize them, and then successfully attend to them.

My best to you,

David Almeida

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TOSHIBA Exif JPEG

Take from all things their number and all shall perish.
Saint Isidore of Seville, Etymologies (Book III, c.600)

 

TASK AT HAND: This week I’m thinking about “quantity” and the tangible aspects of strategy. A few weeks ago we discussed the intangibles of decision making and I thank you for the enthusiastic response. Today, contrasting with the quality or intangibles of a decision, you can think of tangibles as decision making items that have inherently associated metrics – a quantity that we can explore to make better decisions.

In medicine, when eliciting the history of an illness from a patient, the quantity is many times simply a number: how bad is your pain? 0 is no pain and 10 is the most pain you can imagine – what is your pain? This simple metric has massive impact and aids your diagnostic workflow significantly. In strategy, think of this quantity as tangible aspects of decision making that can be measured. When teaching, I often refer to these tangible metrics as the quantity relevant to my strategy.

measuring tape

For example, you may purchase a car for intangible qualities like how it makes you feel or your first memory of that model. On the other hand, quantity or tangibles metrics would include items like horsepower, fuel economy, braking distance, etc. One can quickly appreciate that these metrics can get very extensive so I have created 3 B’s – basic components for ease of applicability to any decision.

 

1.   Bank: this is your budget and contains all aspects of funding critical to your decision. How much in your bank?

2.   Bread: raw materials, intellectual capital, workforce, customer base. This describes the resource metrics relevant to your decision. How much bread do you have?

3.   Brawn: This is the amount of effort you have to put into a decision; 0 is no effort and no action desired while 10 is an all-consuming action. How much effort are you willing to put into a strategy?

 

In my opinion, you need 2 of these 3 to be positive for you to have a beneficial quantity component to your strategy. The power of this simple approach is that it can be applied to any scenario. For example, let us suppose you are considering moving to a new city. Palo Alto is a very innovative part of the country, but it is also very expensive. If your bank is low (small budget), you don’t have much bread (unsecured job or resources), but your brawn is high (highly motivated to move there), this is still not the best decision from a tangible metric point of view.

Let’s do another: your single site business is thinking of expanding to another state. Your bank is good (selling well enough to support another site), your bread is positive (growing customer base, physical space to accommodate a second location is doable), but your effort is low (2 out 10 because you really don’t want to deal with expansion). Based on quantity, this would be a positive decision to make so you should carefully consider it.

 

piggy bank

Use quantity – the application of tangible metrics – to your professional and personal decision-making to clarify measurable components of your strategy. Don’t neglect what you can measure! An experiment is a question which science poses to Nature, and a measurement is the recording of Nature’s answer.” (Max Planck)

 

 

MEDICINE & MACULA: As the Max Planck quote shows above, metrics and science are intrinsically link, but, as a scientist, a major task is to ask difficult questions. A recently published commentary refreshes the importance of learning from failed experiments – and the importance of trying again. To effectively achieve this, the author concludes that communicating your struggles to others, asking for help, and accepting it when it is offered allows you to foster the needed resilience to cope with fear of failure and find your success.

The study was published July 29 in the journal Science. Check out the study here.

 

 

DA Sx Maneuvers

GRATIS: Thank you Retinal Physician for showcasing my new technique on Surgical Maneuvers Tip of the Month! In it, I describe the repair of complex retinal detachments secondary to viral retinitis. This novel technique combines triamcinolone-assisted chromovitrectomy with silicone oil tamponade and intraoperative antiviral therapy with foscarnet. Check out the article here.

 

My best to you,

David Almeida

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hand print identity

“In the social jungle of human existence,

there is no feeling of being alive without a sense of identity.”

Erik Erikson

 

TASK AT HAND: This week I’m thinking about the intangibles of strategy. We are well versed in the tangible data of decision making: spreadsheets, SWOT analyses, and projections. But today, let’s look at the intangibles – those aspects that are sometimes neglected when we devise a strategic plan .

 

Let me divert for a couple of sentences… In medicine, one of the ways we can describe a patient complaint is in terms of “quality”: how does it make them feel? Similarly, I adopt this same descriptor to strategy and have arrived at three distinct aspects of the quality, or intangibles, of a decision or strategy: satisfaction, opportunity lost, and identity.

 

Satisfaction. Good decisions need to make sense. Good decisions need to respect budgets and achieve objectives. Great decisions should satisfy. That is, they should provide adequate information or proof so that they are convincing. Extrapolating, effective decisions should convince stakeholders of its ascribed path. Try this next time you have a conflict or decision and are considering options. Ask yourself if the decision you have arrived at satisfies the need or problem at hand. At this moment, you realize: “The ultimate victory in competition is derived from the inner satisfaction of knowing that you have done your best and that you have gotten the most out of what you had to give.” (Howard Cosell)

 

Opportunity Lost. Most are familiar with the microeconomic concept of opportunity cost: the value of the best alternative forgone where, given limited resources, a choice needs to be made between several mutually exclusive alternatives (Investopedia). Assuming the best choice is made, it is the “cost” incurred by not enjoying the benefit that would have been had by taking the second best available choice. The latter can sometimes become arcane, esoteric, and neglected in strategy. I frequently use the term opportunity lost to highlight the fact that, in making a certain decision, what have you given up in turn? This is not simply the best alternative foregone, but all other options lost. In my opinion, this drives home the professional, personal and intangible consequences of the decisions I make.

 

Identity. This one is simple. The best decision available, if it does not identify with who you are, with what message your business is trying to convey, or leaves you with doubt about ethics, is a decision that is not congruent with your identity. Be careful with these! Decisions without respect for identity risk entering a path without direction. Actions without regard will leave you in an abyss; this void expands without reflection and consideration.

solo business man

As you continue to improve your personal and professional strategy, remember the power of intangibles to transform good decisions into great ones! Satisfaction, opportunity lost and identity are integral components to the quality of the decision you make.

 

MEDICINE & MACULA: Interesting study found that excessive stress can cause memory problems in women who had survived breast cancer. This study examined 1,800 breast cancer survivors and found that those with a greater level of physical activity had higher levels of self-confidence and less stress, and as a result fewer perceived memory problems.

If you didn’t know already, it seems the benefits of exercising regularly are practically limitless!

The study was published July 8 in the journal Psycho-Oncology. Check out the study here.

 

 

GRATIS: Check out our new paper: Bimanual pars plana vitrectomy for removal of a dislocated DSAEK graft from the vitreous cavity published in Retinal Cases & Brief Reports. We describe a new technique for removing dislocated grafts.

PPV K graft 1PPV K graft 2

 

My best to you,

David Almeida

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