A Financier & his Backache

Back pain as an expression of internal/external incongruency that can generate a fortune? Possibly. The following two passages are from George Soros‘ book, The Alchemy of Finance.

My biographer quotes my son Robert as saying:

My father will sit down and give you theories to explain why he does this or that. But I remember seeing it as a kid and thinking, Jesus Christ, at least half of this is bullshit. I mean, you know the reason he changes his position on the market or whatever is because his back starts killing him. It has nothing to do with reason. He literally goes into a spasm, and it’s this early warning sign.

Mr. Soros goes on to explain,

My son is right about the backache. I used to treat it as a warning sign that something was wrong in the portfolio. It used to occur before I knew what was wrong, often even before the fund began to decline in value. That is what made it so valuable as a signal. It would be wrong, however, to dismiss the theory on that account because it was the theory that me take the signal so seriously. I knew that I did not act on the basis on knowledge; I was acutely aware of uncertainty and was always on the lookout for mistakes. As I mentioned earlier, it is when I did not know the flaws in my positions that I had to worry. When I finally discovered what was wrong my backache usually went away.

The Irish Times celebrated the 84th birthday of “the most successful hedge fund manager in history” with an article on some lessons you can glean from Mr. Soros’ storied career. Included in the article was the following:

Soros has admitted to relying greatly on “animal instincts”, saying the onset of acute pain was often “a signal that there was something wrong in my portfolio”.

His decisions, then, “are really made using a combination of theory and instinct.

Sometimes our bodies express themselves from a base of unexplainable manifestation and intelligence. The question is: What do you do when your body speaks to you?



Andre Agassi on his Back Pain

Tiger Woods’ remarks about his back pain spawned a rumble in the physio community. This piece by Peter O’Sullivan sums things up nicely. My favorite thing about Peter’s write-up is that it’s aimed at health care providers, not the athlete. Tiger’s latest injury involves his right wrist:

Keeping with the theme of athletes and their bodies, check out the following excerpts from Andre Agassi’s autobiography, Open, describing his experience with back pain. It’s a great first person’s view on the relationship between back pain and emotions.

Now rising from the center of the fatigue comes the first wave of pain. I grab my back. It grabs me. I feel as if someone snuck in during the night and attached one of those anti-theft steering wheel locks to my spine. How can I play the U.S. Open with the Club on my spine?

I was born with a spondylolisthesis, meaning a bottom vertebrae that parted from the other vertebrae, struck out on its own, rebelled. (It’s the main reason for my pigeon-toed walk.) With this one vertebra out of sync, there’s less room for the nerves inside the column of my spine, and with the slightest movement the nerves feel that much more crowded. Throw in two herniated discs and a bone that won’t stop growing in a futile effort to protect the damaged area, and those nerves start to feel downright catastrophic. When the nerves protest their cramped quarters, when they send out distress signals, a pain runs up and down my leg that makes me suck in my breath and speak in tongues. At such moments the only relief is to lie down and wait. Sometimes, however, the moment arrives in the middle of the match. Then the only remedy is to alter my game – swing differently, run differently, do everything differently. That’s when my muscles spasm. Everyone avoids change; muscles can’t abide it. Told to change, my muscles join the spinal rebellion, and soon my whole body is at war with itself.

The cortosine injection:

I stretched out on the table, face down, and the nurse yanked down my shorts. The doctor said he needed to get his seven-inch needle as close to the inflamed nerves as possible. But he couldn’t enter directly, because my herniated disc and bone spur were blocking the path. His attempts to circumvent them, to break the Club, sent me through the roof. First he inserted the needle. Then he positioned a big machine over my back to see how close the needle was to the nerves. He needed to get that needle almost flush against the nerves, he said, without actually touching. If it were to touch the nerves, even if it were to only nick the nerves, the pain would ruin me for the tournament. It could also be life-changing. In and out and around, he maneuvered the needle, until my eyes filled with water.

Finally he hit the spot. Bull’s-eye, he said.

In went the cortisone. The burning sensation made me bite my lip. Then came the pressure. I felt infused, embalmed. The tiny space in my spine where the nerves are housed began to feel vacuum packed. The pressure built until I thought my back would burst.

Pressure is how you know everything’s working, the doctor said.

Words to live by, Doc.

Soon the pain felt wonderful, almost sweet, because it was the kind that you can tell precedes relief. But maybe all pain is like that.

Perception of our bodies, pains, and injuries can have stunningly strong effects on our daily function.

Andre Agassi’s book is the first autobiography I’ve read cover to cover. And, it’s one I’ll be re-reading over & over. Pick it up here.


Efficient Communication Saves Lives…

While many medical professionals spend their days juggling patients and insurance companies (and more!), they are also expected to keep up with the latest research. Research that might save lives and improve quality of lives are obviously important, but what about the integration of new or novel data?

Change in the medical world takes years. Possibly decades. This passage from Atul Gawande’s The Checklist Manifesto speaks to the difficulty and delay in adoption of new or novel data derived from research:

     Sometimes, though, failures are investigated. We learn better ways of doing things. And then what happens? Well, the findings might turn up in a course or seminar, or they might make it into a professional journal or a textbook. In ideal circumstances, we issue some inch-thick set of guidelines or a declaration of standards. But getting the word out is far from assured, and incorporating the changes often takes years.

One Study in medicine, for example, examined the aftermath of nine different major treatment discoveries such as the finding that the pneumococus vaccine protects not only children but also adults from respiratory infections, one of our most common killers. On average, the study reported, it took doctors SEVENTEEN YEARS to adopt the new treatments for at least half of American patients.

What experts like Dan Boorman have recognized is that the reason for the delay is not usually laziness or unwillingness. The reason is more often that the necessary knowledge has not been translated into a simple, usable, and systematic form. If the only thing people did in aviation was issue dense, pages-long bulletins for every new finding that might affect the safe operation of airplanes – well, it would be like subjecting pilots to the same data deluge of almost 700,000 medical journal articles per year that clinicians must contend with. The information would be unmanageable.

(Emphasis mine)

While we cannot deny the importance of medical research, it is just as (maybe even more) important that the information is structured into an actionable architecture for efficient practicality.


My Morning Routine

This is something that has interested me for at least the last year. How can I optimize my day so that I feel productive by the end of the day?

Morning rituals have been a popular topic in the last year or so, and it was my first exploration. I’ve found my preferred waking time lies around 2 hours before I have to leave the house. What I choose to do with these 2 hours is, essentially, my morning routine. The following is a list of my attempts to fill these 2 hours in order to optimize my day starting from when I first wake up.

1. Block off the internet. This was my first attempt at altering my morning routine. At face value it is seems very simple, but in practice it can get a bit tricky. Here’s the rule: no social media, email, or internet before 10AM.

2. Read or Write. The first 30-45min might just be the best time to work on that book you wanted to start (or finish). You could also spend this time exercising your idea muscle by trying to come up with 10 new ideas every morning. This, just like everything, else is hardest at first, but after a few days or a couple weeks you’ll be surprised at the connections you can make. If 10 new ideas are too much, then do not settle for less than 5.

3. Liquids. There’s something about rituals that provide a sense of structure and framework to think (about anything). This isn’t new to you; in fact, you probably do this already. What do you do when you’re stressed? Exercise? Sleep? Watch TV? Grab that pint of ice cream? These are routines that you’ve created for yourself without intentionally fostering an end result. So why not create a routine intentionally? A morning routine of making tea or coffee, or simply making breakfast fits the bill.

4. Shower. Not everyone prefers morning showers, but if you are, then consider the James Bond shower. This just involves taking your usual warm/hot shower, followed by a minute or two of cold shower. How cold? As cold as you can tolerate. Ease into it. You’ll be more awake than you thought you could be at this hour of the day.

5. Clothes. Will-power is limited. Minimize decision-making in the morning by doing one of two things: 1. wear the same clothes every day (like a uniform), or 2. decide what you’re going to wear before you go to bed. This step should not involve having to decide which shirt, socks, shoes, etc. to put on in the morning.

Mea Culpa: I haven’t stuck to this 5 step routine as consistently as I hoped I would, but I can say that having some routine puts your day on the right track from the start. You might include other activities in your routine; maybe running, exercise, yoga, meditation. Whatever you chose, it should probably be something that you want to do in order to become the person you’ve always wanted to become.

What’s your morning routine?


Deliberate Practice

Michael Mauboussin (from Think Twice) on Deliberate Practice:

Let me emphasize one point. I suggested that people become experts by using deliberate practice to train their experiential systems. Deliberate practice has a very specific meaning: it includes activities designed to improve performance, has repeatable tasks, incorporates high-quality feedback, and is not much fun. Most people – even alleged experts – do not come close to satisfying the conditions of deliberate practice and, accordingly, do not develop the necessary abilities for reliable intuition.


The Inside-Outside View to Better Decision-making

Decision-making isn’t always the easiest thing in the world. While many errors may seem obvious in hindsight, they’re rarely as crystal clear during the decision-making process. Even worse, we have a tough time imagining the opposing view. As Michael Mauboussin states in his book Think Twice, we have “a tendency to favor the inside view over the outside view.” He goes on to explain,

An inside view considers a problem by focusing on the specific task and by using information that is close at hand, and makes predictions based on that narrow and uniques set of inputs. These inputs may include anecdotal evidence and fallacious perceptions. This is the approach that most people use in building models of the future and is indeed common for all forms of planning.

Compare that with The Outside View:

The outside view asks if there are similar situations that can provide a statistical basis for making a decision. Rather than seeing a problem as unique, the outside view wants to know if others have faced comparable problems and, if so, what happened. The outside view is an unnatural way to think, precisely because it forces people to set aside all the cherished information they have gathered…. The outside view can often create a very valuable reality check for decision makers.

He goes on to list three illusions that lead one to the inside view: the Illusion of Superiority (I’m better than them), the Illusion of Optimism (that’ll never happen to me), and the Illusion of Control (I can make this happen). Obvious question: “How can we get better at adopting The Outside View?”

Mauboussin pulls from Kahneman and Tversky, and distills their 5 step process into 4 steps.

  1. Select a reference class: “Find a group of situations, or a reference class, that is broad enough to be statistically significant but narrow enough to be useful in analyzing the decision that you face. The task is generally as much art as science, and is certainly trickier for problems that few people have dealt with before. But for decisions that are common – even if they are not common for you – identifying a reference class is straightforward.”
  2. Assess the distribution of outcomes: “Once you have a reference class, take a close look at the rate of success and failure…. Two other issues worth mentioning. The statistical rate of success and failure must be reasonably stable over time for a reference class to be valid. If the properties of the system change, drawing inference from past data can be misleading…. Also keep an eye out for systems where small perturbations can lead to large-scale change. Since cause and effect are difficult to pin down in these systems, drawing on past experiences is more difficult.”
  3. Make a prediction: “With the data from your reference class in had, including an awareness of the distribution of outcomes, you are in a position to make a forecast. The idea is to estimate you chances of success and failure…. Sometimes when you find the right reference class, you can see the success rate is not very high. So to improve your chance of success, you have to do something different that everyone else.”
  4. Assess the reliability of your prediction and fine-tune: “How good we are at making decisions depends  a great deal on what we are trying to predict. Weather forecasters, for instance, do a pretty good job of predicting what the temperature will be tomorrow. Book publishers, on the other hand, are poor at picking winners, with the exception of those books from a handful of best-selling authors. The worse the record of successful prediction is, the more you should adjust your prediction toward the mean (or other relevant statistical measure). When cause and effect is clear, you can have more confidence in your forecast.”

The more probabilistic the context, the better these step will work. Now you know how to take The Outside View to increase the odds of a better decision.

The main lesson from the inside-outside view is that while decision makers tend to dwell on uniqueness, the best decisions often derive from sameness. – Mauboussin

— @Cinema_Air

LeeAnne K-G: Top 5 Life lessons Learned So Far

I recently asked LeeAnne Ketchen-Gullett, ATC, MS about her “Top 5 Life Lessons So Far” and she was generous to respond with this fantastic guest blog. It is a worthwhile read that I will definitely re-visit periodically. In case you haven’t already met LeeAnne, you can find her on twitter @LKetchen14ATC (not only is she a Certified Athletic Trainer, but she’s also a Full-time Volunteer!). Enjoy the read and I hope you get as much out of it as I do.

There is Value to Each Individual You Meet

Meeting new people is one of my favorite things whether it is on a plane, conference, sports event,  work related or standing in a line. I take it as an opportunity to understand people and myself. I am not saying I “like” or have great experiences with every person I meet but I do take something away from each individual and interaction and carry it with me. During good or bad interaction I learn how to listen, engage in intellectual conversation, know when not to speak, and use of body language.  I’ll admit, often I have learned communicating the hard way but its valuable the next time a similar situation presents itself. I have met amazing people in unique circumstances and they have made an impact on me forever and may or may not even realize it. The world is big and full of incredible people. I would like to meet as many people as possible for the experience and to take a little bit of them with me. I find great importance to live in the moment and take the opportunity for person interaction because everyone has their own story and we can all learn from one another. That being said- even the smallest interactions can play a role, never underestimate the impact you can have on someone else’s life.

The world owes you nothing

Just because bad things happen doesn’t mean something good will happen to make up for it. Just because you work your tail off may not mean you get the job you want or put you necessarily where you want to be. I have learned to not “expect” much in return for what I do or accomplish. It is about changing your mindset and attitude. I work and am there for people because I love to do it and the reward is it makes me feel good. It is about being a good person and waking up with a positive attitude. I find that if I can do that then it will trump many things. It is important to focus on what we do have control over and the goals we set for our self. It is not okay to expect rewards for all things we do because we feel that we “deserve” it. It doesn’t always workout that way and we must carry on, work hard, and move forward. In life nothing is ever guaranteed, so everyday create your own luck and opportunity.

You cant wait for the perfect opportunity- Take a chance and step out of your comfort zone

Looking back I feel like I missed out on some opportunities because I was waiting for the perfect “moment” or “timing” where everything would fall together nicely and work out perfectly. What I’ve learned: rarely does this happen. I discovered that I wasn’t good at having a plan. I just ruined plans. However, I was better at planning and found it to be more efficient in accomplishments. If you take a chance and go with a positive attitude, it WILL work out and you will find success. I used to be scared that something bad would happen and it would mean a big set back in my life. I was wrong. It was in the moments where I didn’t have a plan, that potential opportunities opened up, when I dove in fully. I had no idea how things were going to turn out or where it was going to lead me, but it is in those moments I learned the most. Being in uncomfortable situations uncovered feelings I didn’t know I had and didn’t know I could handle. It’s about discovering parts of yourself you didn’t know existed and using them for future situations. This has happened to me on more than one occasion and I couldn’t be more grateful for chances that I have taken on a whim. It has lead me down a strong path of meeting amazing people and being put in tough situations that has built me as a person and professional.

Show that you care, be present

I believe that we are all connected somehow and this kind of goes hand in hand with my lesson number one.  I have found that building trust, being passionate, being considerate and caring can be the most rewarding thing one can do.  I didn’t understand this until I started getting e-mails and cards from people expressing gratitude about how important it was to them that I gave them time, listened to them, and show that I care. I truly value each person I work and interact with. It has to do with being a good person, doing the right thing, and being there for someone because you want to be genuine, to be their listening ear, and show concern. When I get feedback (cards and emails), I realize how much their feedback affects me, and I then understand the impact I may have on others. That is what feels amazing.  I think it is so important to not only show that your care, but when given the opportunity, let others know that you appreciate them. Even if it is as simple as a solid “thank you”, I know in my industry it can go a long way.

“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” ― Maya Angelou

Intuition and instinct can go a long way.

I think it is important to be in tune with our instinctive nature and follow the path it leads us down. Intuition and instinct isn’t measurable, it’s a feeling and belief based around experiences and facts that have been in our life. These experiences turn into our ability to problem solve and respond to situations for success. I suppose I can take the top four life lessons already mentioned and say intuition and instinct play a huge role in all of them. I would like to think growing up I have had a solid foundation built around strong morals and beliefs. As I get older and go through new experiences and challenges, I find self-talk and reflection to be one of the most beneficial parts to my day. Trusting my intuitive nature and making quick decisions has led me down an amazing journey.

Accept no ones definition of yourself because no one knows you better than you do. Society, parents, teachers may have an image about how you need to be and how to live your life in order to be successful. Fact of the matter is that everyone reacts and responds to situations differently. Life is here for us to create and define our self as a person, how we want to be and what path we choose. It is important to spend life on your own terms and what you believe in.  This is created by the choices we make and not the choices people think we should make. Be you, listen to yourself, and create yourself based on your intuition and instinct. I look forward to each morning, excited to create new opportunity and another day to build a better version of myself.

Connect with LeeAnne Ketchen-Gullett, ATC, MS on Twitter.

And find me @Cinema_Air

“Regret Minimization Framework” by Jeff Bezos

Making major life-altering decisions is inherently daunting. Jeff Bezos, Amazon’s founder and CEO, provides a brilliant filter that simplifies the decision – A “Regret Minimization Framework.” (video at bottom of post) This is simply beautiful:

I went to my boss and said to him, “You know, I’m going to go do this crazy thing and I’m going to start this company selling books online.” This was something that I had already been talking to him about in a sort of more general context, but then he said, “Let’s go on a walk.” And, we went on a two hour walk in Central Park in New York City and the conclusion of that was this. He said, “You know, this actually sounds like a really good idea to me, but it sounds like it would be a better idea for somebody who didn’t already have a good job.” He convinced me to think about it for 48 hours before making a final decision.

So, I went away and was trying to find the right framework in which to make that kind of big decision. I had already talked to my wife about this, and she was very supportive and said, “Look, you know you can count me in 100 percent, whatever you want to do.” It’s true she had married this fairly stable guy in a stable career path, and now he wanted to go do this crazy thing, but she was 100 percent supportive. So, it really was a decision that I had to make for myself, and the framework I found which made the decision incredibly easy was what I called — which only a nerd would call — a “regret minimization framework.”

So, I wanted to project myself forward to age 80 and say, “Okay, now I’m looking back on my life. I want to have minimized the number of regrets I have.” I knew that when I was 80 I was not going to regret having tried this. I was not going to regret trying to participate in this thing called the Internet that I thought was going to be a really big deal. I knew that if I failed I wouldn’t regret that, but I knew the one thing I might regret is not ever having tried. I knew that that would haunt me every day, and so, when I thought about it that way it was an incredibly easy decision. And, I think that’s very good.

If you can project yourself out to age 80 and sort of think, “What will I think at that time?” it gets you away from some of the daily pieces of confusion. You know, I left this Wall Street firm in the middle of the year. When you do that, you walk away from your annual bonus. That’s the kind of thing that in the short-term can confuse you, but if you think about the long-term then you can really make good life decisions that you won’t regret later.

Sources: Academy of Acheivement and Bijan Sabet

Find me on Twitter @Cinema_Air

Why You Need Rituals

Quotes from Twyla Tharp’s The Creative Habit: Learn It and Use It For Life:

“Creativity is a habit, and the best creativity is a result of good work habits.”

“The routine is as much a part of the creative process as the lightning bolt of inspiration, maybe more.”

“Over time, as the daily routines become second nature, discipline morphs into habit.”

Many creative individuals have daily rituals. These rituals may be so routine its practice goes unrealized and its significance lost. According to Twyla Tharp, rituals play an important role in the creative process.

“It’s vital to establish some rituals – automatic but decisive patterns of behavior – at the beginning of the creative process, when you are most at peril of turning back, chickening out, giving up, or going the wrong way.”

She lists reasons why establishing rituals into your creative process is so vital:

It “has a transforming effect on the activity”
It “eliminates the question, Why am I doing this?”
It “erases the question of whether or not I like it.”

What’s needed to develop a daily ritual? More Twlya Tharp:

“The only criterion is this: Make it easy on yourself… It should make you want to be there, and once you find it, stick with it. To get the creative habit, you need a working environment that’s habit-forming.”

This begs the question: How do you create new habits? Enter Charles Duhigg, author of The Power of Habit: Why We Do What We Do in Life and Business,

“This is how new habits are created: by putting together a cue, a routine, and a reward, and then cultivating a craving that drives the loop.”

An example of a daily ritual turned habit:                                                                           1. Cue – Waking up                                                                                                       2. Routine – Boil water, grind coffee, make the coffee with hand press, pour coffee in mug 3. Reward – the Taste                                                                                                         4. The Craving – Improved Performance through the day

Thought Experiment 1: What are your daily rituals? Is your daily habit automatic? What is it about that habit that you truly enjoy? Does it make your day better? Make a list of your daily and/or weekly cravings; leverage your cravings to develop new habits. Odds of success improve when you work together, so make it a team effort.

Thought Experiment 2: Rituals also exist in the working world, embedding themselves into work-place culture. Seek to identify routines at your work-place.

The Power of Habit: Why We Do What We Do in Life and Business and The Creative Habit: Learn It and Use It For Life are simultaneously informative and practical.

Find me on Twitter @Cinema_Air

The Creative Challenge

This post on Creativity applied to Physical Therapy was inspired by Scott Belsky’s tweet: “Strategy before tactics… AND mission before strategy.” This can be simplified to “Why > What > How.” Let’s begin with The Mission: Why.

With our Healthcare industry in flux we find ourselves in the midst of potent opportunity. The convergence of data-driven Evidence Based Practice and Financial bottlenecks will drive our profession through intersections of uncertainty. Such contingency of events warrant Creative progression from within the profession, especially the independent entrepreneurs. New business models, underutilized and currently non-existent collaborations, all lay in wait of a suitor.

Twitter hashtags such as #solvePT, #bizPT, and #brandPT foster creative potential via social media collaborations. I encourage all physical therapists (and soon-to-be PT’s) to join the conversations online. This #solvePT discussion on business models is one of my favorites; click on “transcript” in the left menu.

The Mission: nurture the exploration of underutilized and uncharted territories to solidify and expand the role and value of Physical Therapy.

Necessary ingredients in the Strategy of conception of novel ideas includes 1) The Suspension of Disbelief and 2) Projective Thinking. Often times new concepts require a dose of science fiction and free thinking unhindered by mainstream conventions. A little disbelief draws one into a world full of possibilities beyond obvious roadblocks resulting in something unimaginable, yet strangely obvious. Think of Steve Jobs combining design and computers, Elon Musk combining solar power and automobiles, Jeff Bezos with Amazon, etc. Moving beyond “can it be done” to “how can I make it happen” requires an strong dose of Suspension of Disbelief. Even scientific beliefs and “facts” aren’t immune to the Suspension of Disbelief; look here (Youtube video) and here.

“Projective Thinking” was coined by Edward de Bono “to describe generative thinking rather than reactive thinking.” Linda Stone writes:

… reactive use of intelligence narrows our vision. In contrast, projective thinking is expansive, “open-ended,” and speculative, requiring the thinker to create the context, concepts, and the objectives.

Thought experiment: What conventional excuses do physical therapists come up with that prevent them from progressing or expanding their profession? Are they truly barriers? Dissolve these barriers. What new possibilities arise? How would you change your practice of Physical Therapy if money were not an issue? Think through this everyday. Write down your ideas in a notebook (see #2 in the next section).

Tactics. Experiment with these 3 ideas to jump-start your creativity:

1. Morning Routineego depletion is real, so perform your most intensive & creative tasks in the morning. Reduce early morning decision making by automating your morning routine, thereby conserving your willpower for the most demanding parts of your day. Save the mundane paperwork for later in the day.

2. Keep a notebook – Steve Jobs said “Creativity is just connecting things.” Keeping a little pocket-sized notebook with you at all times provides the opportunity to generate a list of things to connect. This insures you don’t forget unique thoughts and ideas. In just a few weeks you have a basket of ideas to review and connect in ways you could have otherwise overlooked.

3. Forced PerceptionStefan Sagmeister is famously unorthodox and creative. When asked how he comes up with breakthrough ideas, he responded:

“One trick I use a lot is to think about a problem from a totally different point of view… The idea is that you take a starting point that has nothing to do with the project itself… starting with someone, or somewhere, else is basically a trick to fool the brain out of thinking in repetition.”

Thought Experiment: Write down names of 5 (new) people/relationships that can form symbiotic relationships with your practice as a Physical Therapist to push beyond conventional boundaries. Think about Physical Therapy from their Point of View. How can you benefit each other? Go through this thought experiment every Sunday.

“There’s no time like the present; no present like time” (Georgia Byng), so practice these ideas, exercise your creative muscles, and push boundaries.

Find me on Twitter @Cinema_Air