Sunday Surgical Scrub: 29 May 2016


mnfl final

Task at hand: This week I’m once again thinking about decision making; specifically, decision analysis and how to achieve success in your decision making process. As you know, I like to borrow from the spheres of medicine, science and business when constructing my models and frameworks. When diagnosing a patient, physicians will investigate “associated factors” –  what are the related symptoms, history, or other issues that may be contributing to the suspected underlying diagnosis? Similarly, when looking at the decision or conflict at hand, spend some time deciphering the associated factors. These are always pertinent to the outcome you are trying to achieve.


Let me use a simplified example for you here. With spring in full swing, let’s say you are trying to decide on a particular plant for your garden. Our simplified desired successful outcome of this decision is to pick a plant that will not only grow – but thrive – through the seasons. Consequently, we can quickly deduce that the “associated factors” will include environment (weather, rain, soil quality), resource availability (how much time do you have to tend to the plant, what is your budget for seed), and appearance (do you want a pretty flower or a unique plant).


The best method I have found to uncover the associated factors of a particular decision is through visualization. The concept of “visualization” is common ranging from sports to cognitive-behavioral therapy. Here, I am ascribing visualization as an act to appreciate all the forces acting on your decision. I’m always surprised at how much I uncover through this process and realize that our decisions are heavily indebted to a lot of extraneous influences: it is usually not possible to remove these factors so one would be wise to figure them out!


I actually use a lot of visualization in surgery as well – many times, the surgeon’s view is compromised secondary to many possible factors. In these challenging instances, my visualization of the problem at hand and the role of my immediate environment allow me to continue without being deviated in a negative manner. So, next time you are pondering a difficult conflict – visualize the relevant associated factors – and give yourself some clarity on your way to success!


Medicine & Macula: The first US universal newborn ocular screening initiative was recently published in the journal Ophthalmology. It showed that fundus hemorrhages are common in healthy newborns, especially in those born by vaginal delivery (9 times more likely) and in forceps assisted delivery. While the long-term consequences of retinal hemorrhages on visual development remain unknown, it is important to have empirical knowledge that these are common. The issue of child abuse and shaken baby syndrome are a natural extension of this topic, and key points of differentiation (vitreous hemorrhage, retinal hemorrhages in multiple layers, traumatic retinoschisis) in the latter need to be emphasized.

Check out the study here


Gratis: Thanks to American Journal of Ophthalmology Case Reports for recently publishing our study on Delayed fungal endophthalmitis secondary to Curvularia.


Check out the paper here



Happy Memorial Day!

My best to you,

David Almeida

17 Comments, RSS

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    • David Almeida May 30, 2016 @ 3:54 pm

      Thank you for the very kind words 🙂

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      Thank you Kristen for your interest. If you go to the blog page or the home page, you can input your email there. Thanks!

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