11 things I know at 37 I wish I'd know at 27. For surgeons and doctors 🧵

Are surgeons technically less skilled than their trainers? From the 100th society of British neurological surgeons meeting this month. Also, have “principles” (decision making) stayed the same?

The mature healer is not the one who controls everything, but the one who can act decisively, acknowledge what they cannot control, ask for help when necessary, and remain sufficiently open to be astonished by the patient's - and life's - capacity to heal.

12 years later and back at the ST1 “bootcamp” for neurosurgical trainees. Still learning from other consultants. The Tsang ABC for TBI was a highlight. Any suggestions for Y and Z welcome.

As true today as it was in 1947. Simone de Beauvoir - The Ambiguity of Ethics

Post vestibular schwannoma ritual - flapjack and Pepsi max. Not entirely sure how this started, but it’s staying.

The cuts you don’t make are just as important as the ones you do. Learning when to act and when not to will take a lifetime.

Brook’s Law- Adding manpower to complex projects delays progress because time spent on communication increased in proportion to number of people on project - slows decisions, closest person to the problem is the best to solve it.

Fear cliffs less. Fear long slopes more. Decision tree: - Identify a risk. - Estimate its intensity (acute vs chronic). - Estimate its containability (engineerable vs diffuse). - Place in quadrant. Strategy: - Q1: prevent early, systemic safeguards - Q2: engineer, regulate, own it - Q3: structural intervention, incentives, persistent attention -Q4: scale and maintain — low-hanging fruit We over-allocate fear to Q2 and under-allocate effort to Q3. @nntaleb

Barbells and brain surgery. Yesterday I taught our trainees about surgical strategy. How to plan an operation and execute that plan. There was a long silence after my main message. We plan operations in the perfectly wrong way. Skin incision - craniotomy - corridor - tumour. That is the order of an operation, so we should plan that way. I teach the reverse: Tumour - corridor - craniotomy - skin incision. It’s about the tumour coming to us (through the least destructive path). Not us going to the tumour. This inversion encourages tailoring operations to each patient while avoiding cookie cutter thinking. Only this morning while lifting heavy things did I realised I learnt this inversion over a decade ago. A deadlift looks like a pulling movement. The bar starts on the floor and you pull it off the ground. This is the perfectly wrong way to teach this movement. Instead after setting up correctly, you should generate tension in your body, take any slack out of the bar (watch it bend before it comes of the ground), then push the earth away from you. This imaginary push creates leg drive to break the weight off the ground and is the key to lifting heavy weights. If you’ve made it this far you are probably interested in this inner game. I can’t find any writing about this method of inverted thinking (though am familiar with Inversion popularised by Munger). If anyone could point me to some related resources it would be muy bueno. Keep learning. Stay strong.

Mistakes are the privilege of the active. Only those who are asleep have a perfect score sheet.

Compounding will make your career. 30 minutes a day of reading and practice will add up to: - 182.5 hrs year 1 - 912.5 hrs year 5 - 1825 hrs year 10 For someone to catch-up, they would need to spend 76 days straight honing their craft. A little today means a lot tomorrow.

The person closest to the problem is usually the best person to solve it. Encourage trainees to be autonomous. Sign off on their decisions, but give them the space to formulate and think.

If you can’t beat them talent you can beat them with time. Happy Monday.

I love my secretaries. They gave me a simple filing system to keep us organised. In. Pending. Out. Add a 10 minute catchup each week and we keep things on course. How does your team stay on top of things?