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< Back Tips and Tricks General Tips Despite popular belief, you don’t need a daily CXR for every ICU patient, every intubated patient or every patient with pneumonia/ rib fractures. Don't get daily labs or daily imaging "just because". Get studies that will change your management. For stable patients, you don’t need to check a CBC immediately after every transfusion. You don’t need a PaO2 to wean FiO2. PaO2 is an infinitesimally small contribution to arterial O2 concentration. The equation is often simplified by removing it all together! CaO2= (Hgb x SaO2 x 1.38) + (PaO2 x 0.03) ≈ (Hgb x SaO2 x 1.38) Avoid adjusting multiple meds at one time when addressing a symptom (for example, adding a new medication and increasing the dose of another medication). Too many changes at the same time will make it difficult to know what medication change was responsible if there is a clinical change. Most patients don’t need a CXR after chest tube removal. If the pt has PTX that requires a chest tube, they will tell you (meaning they will be symptomatic). If you check a CXR on everyone, you will find small PTXs that don't need treatment. Not everything that hurts/ bleeds is a hemorrhoid. Exam is required to identify the etiology. If you treat a fissure with hemorrhoid meds (witch hazel, suppositories) they won't get better. Plus, witch hazel will burn and suppositories will be incredibly painful. Patients often get better despite us, not because of us. Many things we believe to be optimal treatment now will be considered heresy in the future. Sometimes not doing something is the best thing to do. Sometimes not operating is the compassionate thing for the patient. A patient doesn’t have to die with an incision on their abdomen. Working with your team Trust the nurse when they say they’re concerned. Better to have a phone call for a patient who is ultimately fine vs not getting a call when the patient isn’t fine. If you respond to nurses by telling them it’s fine and not to worry, they will learn not to call you. If you respond to nurses with hostility, they won’t go out of their way to make your life easier. Don’t call your mid level resident/ chief/ fellow/ attending without any more information than you were initially given. When requesting a consult or calling your chief/ fellow/ attending about a new consult/ admit, give the bottom line upfront. This is especially true when you are waking someone up or need them to do something quickly (ie get dressed and drive in). Tips for the OR While closing fascia, if you maintain counter-traction on the fascia with your pickup as you pass the needle through the fascia, you can release the needle while it’s still in the fascia and reload the needle farther back to push it the remainder of the way through the fascia. Then you can reload the needle and be ready for your next bite without having to touch the needle (decrease risk of needle sticks). Ask for instruments and sutures several steps ahead so you minimize pauses. Always ask for cell saver for a bleeding patient heading to the OR. You don’t want to be delayed waiting for it to be set up before you make your incision. Tips in the Trauma Bay Don’t use GCS 8 as an automatic trigger for intubation. If you intubate before addressing hypovolemia or relieving obstructive physiology, there is a high risk of cardiovascular collapse and asystole. Previous Next

< Back Studying Tips Study Techniques Reading and re-reading textbooks/ notes. Pros- simple. Cons- passive. Easy to not absorb information as your eyes pass over the same text. Reading and highlighting textbooks/ notes. Pros- simple. More interactive than merely reading. Cons- similar to re-reading- still relatively passive. Risk of highlighting everything and not focusing on key points. Reading and handwriting notes in your own handwriting. Pros- active engagement in learning, reframe the information in your own style. You can color-code, reorganize, personalize it. Cons- takes more time. When to study There are two key circadian rhythm patterns. In his book When: The Scientific Secrets of Perfect Timing ," Daniel H Pink refers to these as "chronotypes." There are three chronotypes (larks, owls, and third birds), but the differences between them are largely inconsequential, so they are simplified to two different groups, classically known as early bird and night owl. If you haven't identified your chronotype, you can do a few relatively straightforward steps to determine your pattern. Identifying your chronotype will give you a framework to plan your peak time for analytical tasks, such as studying. If you have any control over your daily schedule, even if it's just weekends, take advantage of your inherent pattern to optimize your studying. Early morning studying before class/ clinical rotations might be optimal for some, while others are more conducive to evening learning. What has worked for me? I used to be a read and re-read type. I'm a fast reader, so it worked to get through high school and medical school. During surgery residency, I used iAnnotate PDF, which allows me to highlight and make notes. When I was entering fellowship, I renovated my style. First, I wrote notes for the handful of critical care texts that I read (Fink and Marino) and the trauma text (Mattox). During the summer before my ACS fellowship, I typed notes while reading Fink and Marino. I used iAnnotate PDF because it allows me to highlight and make notes. I did switch to a hard copy of Civetta because I needed a new format to re-ignite my focus. I used old fashioned lined paper and pencil and then rewrote them into a notebook. After I got burnt out on textbooks, I made the leap to reading journal articles. Switching to primary literature was a monumental change in my studying. I always marvel at attendings who can quote journal articles with ease. It always strikes me that their memory is so crisp...I've never had that gift. When I started reading articles, I developed a system for finding, reading, and then recording the salient findings. How I built my literature database for Acute Care Surgery There are several ways to find articles. Surgical Clinics (previously known as Surgical Clinics of North America) is one of my favorite journals for reviewing broad topics. Every article is evidence-based, with abundant references. The most current journals will be a treasure trove of high-yield references. The open journals and published guidelines (read: free!) are another excellent resource. The references in reviews and guidelines are the basis of evidence-based medicine. Read! You don't have to read every word, and as you read more articles, you will develop a sense of which papers can be perused and which deserve a more diligent review, such as landmark articles (see suggested articles). Highlight, make notes and ask yourself, "how will this change my practice". Previous Next

Measuring Cups and Spoons < Back Kitchen Hacks #2 Measuring Cups and Spoons Cooking versus baking…what's the difference? Technically cooking is a general term encompassing all manners of food preparation. But cooking is typically used to indicate a style that doesn't involve baking. Baking is a science that requires attention to detail and precisely measured ingredients that often have to be combined in a specific order. Recipes for baked goods frequently indicate weight in ounces (which required a small countertop scale) as well as volume (measured in your dry measuring cup). On the other hand, cooking allows on-the-fly modifications- it's much more forgiving to small variations. Baking requires precise measurements- so you'll need a variety of dry and wet measuring utensils. If you're unfamiliar with baking, here is a quick summary of how to measure dry and wet ingredients. What are dry measuring cups and how do I use them? These hold the exact amount of an ingredient (you fill these to the top). Either spoon the ingredients into the cup or scoop the cup into the container holding the ingredient (ie wide-mouthed containers). Fill to the top without packing, and level off the top (knife, the handle of a cooking utensil, chopstick, whatever you have). The only ingredient that gets packed is brown sugar- otherwise, unless the recipe specifically mentions packing, don't pack! What are liquid measuring cups or beakers and how do I use them? These have graduated indicators to allow pouring an exact amount of liquid, and the top measurement is below the top of the cup (no spills when pouring). Why can't I just use dry measuring cups for liquids? If you use a dry measuring cup for liquid, it will be very challenging to avoid spilling the ingredient when adding it to the recipe (remember, dry cups get filled to the top). What can I measure with a measuring spoon? Fortunately, these can be used for both dry and wet (although if you have beakers with small measurements, you can also use those for measuring out liquids). Warning about dry ingredients. If a dry ingredient is specified by weight (ounces), this cannot be converted to cups! 8 ounces of flour ≠ 8 fluid ounces of liquid, which is 1 cup of liquid. If you want a visual of the range of what 1 cup of dry ingredients can weigh, check out this extensive list . Previous Next

Practical Tips on Having a Difficult Discussion How Do I Do It? < Back Practical Tips on Having a Difficult Discussion This blog is complementary to the previous blog about becoming more comfortable with uncomfortable conversations. After many difficult discussions with families during my critical care fellowship, I finally became comfortable with uncomfortable conversations. It's impossible to develop a script to use for every conversation, but here are some of the techniques I've adopted over the years. Sit down in a private room, have tissues if appropriate. Make sure your phone/ pager won't interrupt the conversation. Have someone else with you. It’s always good to bring the patient's nurse, and there is often spiritual support staff (ie chaplains) who can accompany you and provide support for the family. Introduce yourself, and ask who everyone in the room is, specifically how they're related to the patient. "Nice to meet you, I'm really sorry it's under these circumstances." If it's your first conversation with the family, it's important to establish a foundation to build on (or establish the absence of a foundation). You can ask "what do you know so far" or "what's your current understanding of the situation"? This also allows them to express their current questions/ concerns. Judge their level of comprehension and adjust as needed. This does NOT mean being patronizing or imposing stereotypes. Pay attention to facial expressions and listen to their questions/ responses. It's easy to fall back into speaking medical jargon- you need to deliberately focus on using easily understandable words. Words that we use every day are meaningless to most people who aren't in the medical field. Keep the conversation brief and take frequent pauses. They don't hear everything you say, and they'll hear even less if you talk non-stop. Allow them time to process what you’ve shared, and allow them to ask any questions they have. Acknowledge that it’s common to be overwhelmed by the discussion. You can validate them by offering "I know I just told you a lot of information" or "I know this can all be overwhelming". It’s also helpful to say, “I’m sure you will think of other questions, please write them down so we can discuss them later” Encourage them to discuss things amongst themselves and provide them a quiet private place to regroup after the meeting. It’s also helpful to say, “I’m sure you will think of other questions, please write them down so we can discuss them later.” This validates their feeling and reassures them that they don't have to worry about remembering every detail. Specific difficult topics - Death and dying. Acknowledge that what they are feeling is normal- regardless of what they feel, it's normal. Denial, angry, scared, guilty, confused, conflicted, exhausted, numb. - When they are wrestling with the decision about transitioning to comfort care (colloquially known as "withdrawal of care", or crassly, "pulling the plug") and they've verbalized that they know it's what their family member would want, acknowledge how difficult that decision can be but also reaffirm that they are doing the kindest thing by honoring their family members wishes. For other helpful tips, check out "Sunburn". "For patients who are alive, concentrate on the ‘big picture’ and avoid the inclination to catalog every injury during this initial encounter. The primary concern in these settings often consists of survival, brain damage, paralyzation and other major morbidities. Again, an overabundance of information can be overwhelming." Velez D et al. SUNBURN: a protocol for delivering bad news in trauma and acute care surgery. Trauma Surg Acute Care Open. 2022 Feb 9;7(1):e000851. Previous Next

14 Scienceblind Why Our Intuitive Theories About the World Are So Often Wrong Intuitive theories- our best guess as to why we observe the events we do and how we can intervene in those events to change them. Infer causality from our observations. Similar to historical theories- how we used to understand things before we had the ability to understand the reality (like heat as an “object” versus “energy”). Emergent process- system wide (no clear cause/ effect explanation), equilibrium-seeking, simultaneous, ongoing. Heat, weather, evolution are all emergent processes. Molecular theory, scientific theory. Holistic theory- matter is continuous and has heft and bulk Intuitive theories of the physical world Matter- substances are holistic and discrete, instead of particulate and divisible. Conservation- clay flattened, water poured from short fat glass to tall skinny glass. The difference between weight and heft, volume and bulk? Energy- heat, light and sound viewed as substance instead of emergent property. Why can you touch the 400 degree air in the oven but not the pan itself (without oven mitts)? The pan transfers heat better than air. How do we change from viewing “sound” as an “object” to viewing it as “energy”? First, we stop attributing permanence (noise doesn’t continue forever), then weight (clock doesn’t become lighter with each chime) and then mass (noise can pass through a wall, doesn’t have to maneuver around wall). Extra-missionist- rays go out of the eye and then return to create vision vs intro-missionist- rays enter the eye to create vision. Gravity- weight is an intrinsic property of objects instead of relation between mass and gravity. Objects don’t fall because they’re heavy- they fall when they don’t have upward force on them that exceeds gravity (center of gravity). Motion- force is something transferred between objections (“impetus”), instead of external factor changing the objects motion. What path will an object take- for example, a ball in a spiral slide- takes straight path after exiting, doesn’t gain an inherent “spiral” motion. Cosmos- earth is a motionless plane orbited by the sun. Changing of the tides, seasons (tilt of the earth as it revolves around the sun, the side closest to the sun is summer). Earth- continents and mountains are eternal and unchanging vs transient/ dynamic. Tectonic plates- similar land features on different coasts. Greenhouse effect and global warming- humans causing it, but the earth will live beyond us. Vitalism- living things possess an internal energy, or life force, that allows those things to move and to grow. Essentialism is the idea that an organism’s outward appearance and behavior are products of its inner nature, or “essence.” Intuitive theories of the biological world Life- animals viewed as psychological agents vs organic machines. Death= cessation of biological processes. Growth- eating is for satiation rather than nourishment, aging is a series of discrete changes vs continuous change. Vitalism- living things possess an internal energy, or life force, that allows those things to move and to grow. Essentialism is the idea that an organism’s outward appearance and behavior are products of its inner nature, or “essence.” Inheritance- parent-offspring resemblance viewed as nurture, vs transfer of genetic information. Illness- disease is due to supernatural causes, instead of microorganisms. Adaptation- evolution is the transformation of an entire population (butterflies become slightly darker with each generation) vs selective survival (darker butterflies survive to reproduce). Ancestry- species develop linearly (monkey→ ape→ human) rather than branching from common ancestor. Previous Next

< Back The Trauma Bag Why was there a need for a trauma bag in the hospital? As an acute care surgeon responding to trauma activations, airway emergencies, and a variety of other hospital surgical emergencies, there are a handful of supplies that I always have with me. The two basics are a scalpel for surgical airways and trauma shears (classically used to remove clothes in the trauma bay, but I seem to find more uses all the time). Eventually, I added a Kelly clamp to my armamentarium- handy for disconnecting or unscrewing a wide variety of impossibly tight connections or securing something in place. During the COVID Pandemic, numerous changes were made in our hospital to minimize infection transmission. Unfortunately, several of the modifications had unintended negative consequences. When we stopped wearing white coats, we lost our pocket space for stashing scalpels and shears. We also carried more gear, including eye protection and N-95 masks (carried in a brown bag when not worn). Many surgeons adapted by using an assortment of bags, such as sling backpacks or CamelBak cases. My own choice is this fanny pack , which draws many compliments! The next challenge was the relocation of supplies from the wall of our trauma bay onto shelves in the hallway. Team members had to leave the trauma bay, locate which cart the item was on, and then scan for the item, which created delays. This disrupted communication as well because team members missed changes when they were outside the room. Another hurdle that existed even before the pandemic was the array of different names for the same item. Most people who place cotton-tipped applicators in their ears after their shower call them by the brand name “Q-tip”…they are actually called “cotton tip applicators” or “CTA”. **Note- don’t use Q-tips in your ears!** Drop the Q-tip! Why ENTs are begging you to leave your ears alone. The surgeon might ask for 4x4s, which is what we call gauze in the operating room. Some say "Quik-Clot” while others know the product by the name “Combat Gauze”. Sutures are a whole other bag of worms…do you use silk or Ethibond to secure your chest tube? Curved or straight needle? Countless times, the trauma chief is managing the trauma and when someone calls for a suture, their attention is often diverted to advising the person reaching into the suture box on the wall.…"no, the one to the left, top row." It’s not always easy to tell from the box what the suture and needle look like. In addition to the elimination of white coats, relocation of commonly used supplies outside the trauma bay, and different names for supplies, I noticed that several key items were frequently used and they seemed to be unreasonably challenging to locate in a timely fashion. Combat Gauze, Coban, specific suture on a specific needle, etc. Therefore, I created a backpack of supplies that I carry when on call. What does this bag do? This bag was created from my perception of a necessity to ensure specific supplies are readily available when responding to surgical emergencies. A Level 1 trauma center is equipped with the highest level of resources and personnel to manage the most complex patients, and our resources and patient population dictate what supplies are needed on a routine basis. My focus was on supplies that are (1) frequently used, (2) unique and not readily available in all locations where they are used, and when they are required, (3) delays in employment are remarkably morbid, and (4) portable. Why didn’t I include tourniquets? They’re frequently used and delays in employment are morbid, but patients typically have them in place on arrival and if not, they are readily available in the trauma bay. Why didn’t I include chest tubes? They are frequently used and delays in employment are morbid, but they are relatively widely available. In addition, the life-threatening physiology of hemothorax or pneumothorax can be resolved with a finger thoracostomy using a scalpel and Kelly (essentially the same process as placing a chest tube, but stopping at the step of a finger sweep in the thoracic cavity, releasing massive hemothorax or tension pneumothorax). Why didn’t I include a REBOA kit? This is a controversial topic. However, in the situation where resuscitative thoracotomy is deferred in favor of REBOA, rapid employment is ideal. However, this device is not frequently used at our facility. Paper clips? In a trauma bag? Yes, paper clips. They are used to mark wounds for creating a road map of the trajectory. What DOESN’T this bag do? This is NOT an all-inclusive bag for responding to all emergencies. It should not be considered a guide for pre-hospital emergency response, non-surgical emergencies, or any situations outside of the specifications reviewed above. There are other response teams in the hospital that have different supplies. For example, we have ICU nurses that respond to rapid response or code blue situations, and they carry critical care transfer bags. I don’t know the list of supplies that they carry, but here is a sample of potential contents of a “transfer bag”. In summary, my trauma bag is focused on specific needs that I perceived based on my daily work at my facility. If you perceive a need for a similar tool at your facility, I would encourage you to develop a supply list tailored to your needs. Trauma Bag- Supply List Personal Protective Equipment Blue gown, non-sterile (2) Medium gloves Mask with eye shield (1) Sterile Supplies for Procedures Pack of blue towels (1) Stapler (1) Sterile gown (1) Small Chloraprep (2) Laceration tray (1) Dressings and Hemostatic Agents Gauze, 4x4 (2) Surgicel, 2 in x 3 in (4) Quik-Clot, 3 in x 4 yds (3) Kerlix, 3.4 in x 3.6 yds (3) Kerlix, 4.5 in x 4.1 yds (1) Coban, 4 in x 5 yds (1) Large Tegaderm (4) Sutures and Instruments #1 Ethibond, curved needle (8) #0 Silk, straight needle (4) #0 Silk, curved needle (1) #2-0 Silk, curved needle (2) #2-0 Vicryl, curved needle (5) Skin stapler (1) Adsons (1) Kelly clamp (2) Needle driver (1) Laceration tray (1) Scalpel #10 (1) Scalpel #11 (1) Miscellaneous Cotton tip applicators (3) Tongue Depressors (2) Paper clips Disclaimer: This was created early in the pandemic, while I was a fellow at a different institution. Previous Next

1st day in radiology: your right is your left, your left is your right Radiologic Dyslexia < Back 1st day in radiology: your right is your left, your left is your right I have recently coined a new phrase. While showing my mom a picture, pointing out someone she had never met before, I commented, "he's the one on the right." Funny story, though- he was actually on the left side of the picture. I had to pause while I talked to my mom and reassure her that I know the difference between my right and my left. While scrolling through Twitter the other day, I was reviewing a question posed about an abdominal x-ray. Another Twitter user added a helpful hint by indicating "the right side of the circle" when pointing out an abnormality. I predicted he meant anatomical right (meaning the image's left side) based on my interpretation. We chuckled about the discrepancy between radiographic laterality and left-right differentiation in real life. I decided to designate this mix-up "radiologic dyslexia." Feel free to use this in the appropriate context! Previous Next

< Back Vent Mgmt #4: All Together Choosing a mode Controlled- patients who aren't generating breaths. PC, VC. Most common mode at initiation of MV. SIMV- patient generating some breaths, but still needs significant mechanical support. Spontaneous- not frequently used at initiation, but can be used for patients with airway obstruction and preserved lung function. How to set initial parameters TV (6-8 mL/ kg predicted body weight) [lung protective ventilation] RR 10-14 FiO2 often start at 100%, but quickly weaned unless severely hypoxic Inspiratory:expiratory ratio typically 1:2 Flow- typically set @ 60L/min, can increase if the patient is in distress or has a high minute ventilation How to adjust parameters based on arterial blood gas results Low PaO2 (low arterial oxygen content)- increase FiO2, increase mean airway pressure Markedly elevated PaO2 (hyperoxia)- decrease FiO2 Low PaCO2 (low arterial carbon dioxide concentration)- decrease TV or RR High PaCO2 (high arterial carbon dioxide concentration)- increase TV or RR *For more details, check out these resources: Lectures: Critical Care: Respiratory Failure Lectures: Critical Care: Vents Other principles of mechanical ventilation VAP bundle- elevated head of bed, oral care Daily awakening and spontaneous breathing trials Previous Next

< Back Free Fluid in the Abdomen A 62-year-old male presents following a motor vehicle collision in which he was an unrestrained driver. He was intubated in the trauma bay for decreased mental status. A focused assessment with sonography for trauma (FAST) was performed, which did not reveal intra-abdominal fluid. Computed tomography (CT) of the head demonstrated minimal intra-cranial injury. CT of the abdomen and pelvis (see below) revealed decreased blood supply to the left kidney, small irregularity of the splenic contour, and a moderate amount of free fluid in the abdomen and pelvis. Hounsfield units are consistent with simple fluid. CT of the abdomen and pelvis https://video.wixstatic.com/video/3b6ff6_b03419943e9941d281c3d8f0b800e37f/480p/mp4/file.mp4 What is the differential diagnosis for the free fluid in the abdomen? Free fluid due to trauma can be urine, enteric contents (bowel injury with spillage of succus) or blood. It is possible to have fluid present prior to the trauma, such as ascites from chronic liver disease. In this case, the free fluid in the abdomen had characteristics of “simple fluid,” based on Hounsfield units, suggesting that the fluid was not blood. In females, free fluid in the pelvis can be normal (physiologic fluid). However, free fluid is NOT normal in a male, and it's concerning for hollow viscus injury. What are the possible causes of decreased blood flow to the kidney? The renal artery can be injured in blunt trauma. Blunt injury can disrupt the layers of the artery wall, leading to thrombosis and decreased blood flow beyond the injury. He was admitted to the intensive care unit. A foley catheter was placed and demonstrated pink-tinged urine [NOT frank gross blood/ clots]. What are the possible causes of blood-tinged urine? Bloody urine indicates a traumatic injury to the genitourinary tract, anywhere from the kidneys down to the urethra. A CT cystogram was performed, which did not reveal any extravasation of contrast from the bladder. CT Cystogram https://video.wixstatic.com/video/3b6ff6_119074429b224cc98677d4f101fef666/480p/mp4/file.mp4 Next steps? Based on an unreliable physical exam and a normal CT cystogram, it is necessary to rule out bowel injury. The patient was hemodynamically stable and had normal laboratory values. He remained with a decreased mental status, and therefore serial abdominal exams were not a viable management plan. The patient was taken to the operating room and underwent diagnostic laparoscopy. His small bowel, colon, and mesentery were examined in there entirety and found to be completely normal. There was a small amount of clear thin fluid in the pelvis, but there was no evidence of bile staining or bleeding. After completing the evaluation of the gastrointestinal tract, we repositioned the patient in Trendelenburg. The pelvis was inspected, and it was quickly apparent that the patient in fact had a large defect in the dome of the bladder. We elected to proceed with a low midline laparotomy. The bladder was easily mobilized, and the extent of the defect was defined. The edges were grasped, and the defect was closed in two layers with absorbable suture. Postoperatively, we reviewed the preoperative CT cystogram. In retrospect, there was a suggestion of bladder irregularity. We reviewed the CT cystogram with the radiologist and there was no evidence of contrast extravasation. However, the bladder does not appear to have been completely distended with contrast. It is very atypical that a large bladder wall defect was not associated with contrast extravasation, and this highlights the importance and ensuring complete filling of the bladder with contrast. Evaluation and Management of Bladder Injuries Bladder injuries can occur from blunt or penetrating trauma. For example, bladder injuries can occur when blunt force is exerted on a full bladder or in the setting of a pelvis fracture. Diagnosis Gross hematuria is seen in most patients with bladder injuries. Cystography, either using plain x-ray or CT, is the diagnostic test of choice. Management The management of bladder injuries is based on location. Intra-peritoneal injuries require operative management. This is done in two or three layers with absorbable suture. A decompressive foley catheter is left following repair. Extra-peritoneal injuries can typically be managed non-operatively with a foley catheter for 10-14 days. Exceptions include large bony segments protruding into the bladder wall, associated rectal or vaginal injuries, bladder neck injuries, or an associated pelvic fracture undergoing operative intervention to prevent hardware contamination. Current guidelines recommend a cystogram before foley removal, except for the most uncomplicated injuries. Yeung LL et al. Management of blunt force bladder injuries: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2019;86(2):326-336. Previous Next

< Back Fever...pending Evaluation of Fever Previous Next

3 General Surgery Lectures General Surgery .pdf Download PDF • 152.12MB Anorectal .pdf Download PDF • 1.55MB CT Scan and X-ray .pdf Download PDF • 564KB Vascular .pdf Download PDF • 13.57MB Suture .pdf Download PDF • 4.94MB

12 Barking Up The Wrong Tree The Surprising Science Behind Why Everything You Know About Success Is (Mostly) Wrong - Good grades in school- likely to be a "rule follower", and less likely to be innovative, think outside the box. - Introverts are more likely to be experts, extroverts tend to make more money (socializing, "networking"). We should look at "networking" as "making friends". This disputes the "nice guys finish last"... - Match your strengths/ passion/ skill to the right context. - Flattery (sucking up to the boss) can work in the short term, but in the end, when people see their colleagues/ neighbors/ etc cutting corners and reaping benefits, this leads to a general collapse into distrust and rule-breaking. - IQ only matters up to a certain point, but then it yields diminishing returns. After that, hard work is what makes the difference. - Tradeoffs- every hour that you spend working is an hour spent away from other things (family, hobbies). In this age of constant accessibility, you have to decide to leave work behind (ignore your emails when you're at your kid's ball game). - Gratitude in relationships- on their deathbed, people regret working too much and not saying thanks to the people in their life. - Some helpful things I learned...please note that tact and delivery matter and these are not appropriate in every scenario. - When someone is getting upset or frustrated and starts yelling, "Please speak more slowly, I want to help." Or try, "What would you like me to do?" - When someone is upset, validate/ name their feeling. "Sounds like you’re angry/ hurt/ frustrated." If you're wrong, give them the chance to correct you. - Gratitude to relationships. Previous Next