29 October 2024

The fine art of choosing between medical options

“Good news, Mr. Roy. There is no cancer!”
“And, what is the bad news?”, I asked my otolaryngologist, mildly worried
“Well, we still have to go in and take it out”, he said sympathetically.

I kept on staring at the small outgrowth in my voice box showing up brilliantly in the big monitor. A few minutes back, I had to go thru the uncomfortable procedure of cameras going down my nose and diving deep in the voice box and then video recording all the muscle movements as Joey (doctor’s assistant) instructed me to make all sorts of weird noises.

All this came about when I reported to my general physician about breathing shortness while talking. I thought he would take me thru all sorts of lung and heart tests to look at abnormalities. Instead, he asked a few questions and did the initial diagnosis. The logic of which was pure and I was struck by how quickly he narrowed it down.

“Are you still running?” he had asked.
“Yes. Although miles have gone down and so has speed. Also, I have started biking.”
“Good. Good. Good. Are you feeling any shortness of breath while running or biking – more than what it used to be a year back?”

It suddenly occurred to me. I have had no discomfort doing any exercise. Only when talking – especially in the morning, on Zoom calls or phone calls.

“Actually no.” I said, a bit perplexed myself.

He was clear in his mind though. “Well, there you go. Your lungs and heart are fine. There seems to be a problem in the voice box and you are having to take more effort to push the air thru. I would ask you to immediately see my friend Dr. Law”.

And there I was as Dr. Law, laid down the law for me on a surgery.

I was too busy staring at the video and in complete awe of how the whole thing works. I guess I had asked one too many question. The doctor asked his assistant to instruct the scheduler to give him ten minutes. She stepped out. He took off his gloves and manipulating the video frame by frame, patiently explained to me the different muscles that come together to make noise. He showed me how my flaps were closing asymmetrically compared to another video he had. And all this because of the outgrowth. I could have sat there for another hour and learnt how the whole laryngitis area works.

But I was struck with another question.

“Without biopsy, how did you know it is not cancer?” I asked getting a bit worried that I was taking too much of his valuable time.

I guess doctors do live by the maxim “Treat the patient, not the disease.” Because he doubled down on showing me pictures of what a cancer in that area would look like. The surface dryness, the shape of the outgrowth and all that.

“You match none of the three mandatory symptoms. I will return my degree if proven wrong.”

Somewhat assured by his confidence, I returned to our question in hand…

“So, what are our options?”

“Well, Option 1 is surgery. We will go thru your mouth and take it out. 100% chance of recovery.”

“What are the risks?”

“Negligible. No more and no less than other options.”

“Can it come back after the surgery?”

“Very rare. We might see one case in three to four years. Usually always benign.”

“Post surgery, will there be any restrictions – like eating and all that?”

I suddenly remembered that Dr. Vine in Dallas had told me I had to stop drinking wine for the medicine (Methotrexate) that he was going to put me on to combat the onset of psoriatic arthritis. I landed up getting him to refer me to another doctor who would do a deal with me – half a glass of wine every evening, half the dose of medicine, twice the time of recovery and every Monday drawing of blood to keep a watch on the liver.

“Well, we do not want any scars in that area immediately after surgery. So, you cannot talk for 5 days.”

“Come again?”

“No talking for 5 days. Absolute silence.”

“Well, Option 2 it is then, doctor!” I declared without even hearing what that option was!!! So much for my intellectual curiosity.

This had nothing to do with learning. I was in no mood to make Sharmila THAT happy.

Or my office friends, for that matter!!!

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27 October 2024

Throwback to the past

Sharmila is in India. I had already given Jay Jay a long walk. Needed a place to settle down and read my new book. Went to good old Miltons Cuisines where Sharmila and I were an every Sunday evening feature at the bar making friends with the folks behind the bar and watching the Sunday night football game. Struck a life long friendship with so many of the staff there.

I was not sure what to expect. I had not been there for 7-8 years.

I need not have worried. Nothing has changed! The bar, the furniture, the hospitality is just like it was before. Met Victoria who has been there ever since the restaurant opened.

Also made a few new friends – Eva (in the picture and who went to the same high school as my two daughters), Shelby, Shawna and Daniella to name a few. Best part was Daniella saying “Did you say Raj? I have heard your name from Ben and Roy.” That brought back memories of two young gentlemen from those days.

Another funny incident… Eva and I were talking about her high school. When she suddenly said – “Our cleaner Juan talks about a friend he has whose kids were in Cambridge too!”.

Imagine her surprise when I said – “I am that friend!! He has been cleaning our house for 15 years now!!”

Lovely evening!

I watched the first half of the football game, chatted with Juan for some time (he came out from his cleaning duties), shut the bar down and the valet came in and gave me my keys saying it was time for him to go.

EXACTLY like it used to be those days!

26 October 2024

Book Review: Obliquity by John Kay

This is one of those books that totally gets me. I cannot possibly overemphasize the importance of reading this book if you are a leader of any kind – business, community, politics or even of your own household. The book, at least for me, articulates eloquently the struggle I have had with simplistic solutions I hear in business world on how to solve problems – “right talent” often being suggested as the panacea. This book – along with a cursory reading of a book like The Drunkards Walk should give a sobering thought to anybody who wants to be a leader.

By the way, I got to know about this book while listening to a Ted Talk by Rory Sutherland. Another guy with some great concepts

I am quoting a few paragraphs together from the book as is but there is simply no substitute to reading the book. And if you do read the book, call me. Would love to discuss your thoughts.

Excerpts:

The success of the physical sciences has encouraged us to believe there might be a science of decision making. All kinds of problems in our business and our financial lives, in the political and personal spheres, could then be managed objectively. Such a scientific procedure would, if done carefully enough, lead every conscientious person to the same answer. As a result, both political and personal disputes could be resolved by applying evidence and rational discourse. The distinction of the great business leader, the measure of financial acumen, would rest only in the ability to arrive at the right answer faster than other people.

There is no such science, and there never will be. Our objectives are typically imprecise and multifaceted; they change as we work toward them, as they should. Our decisions depend on the responses of others and on what we anticipate those responses will be. The world is complex and imperfectly understood, and it always will be.

We do not solve problems in the way the concept of decision science implies, because we can’t. The achievement of the great statesman is not to reach the best decision fastest but to mediate effectively among competing views and values. The achievement of the successful business leader is not to foresee the future accurately but to continuously match the capabilities of the firm to the changing market. The test of financial acumen, as described by Buffett and Soros, is to navigate successfully through irresolvable uncertainties.

Mostly, we solve problems obliquely. Our approaches are iterative and adaptive. We make our choices from a limited range of options. Our knowledge of the relevant information, and of what information is relevant, is imperfect. Different people will form different judgments in the same situation, not just because they have different objectives but because they observe different options, select different information and assess that information differently; and even with hindsight it will often not be possible to say who was right and who was wrong. In a necessarily uncertain world, a good decision doesn’t necessarily lead to a good outcome, and a good outcome doesn’t necessarily imply a good decision or a capable decision maker. The notion of a best solution may itself be misconceived. The skill of problem solving frequently lies in the interpretation and reinterpretation of high-level objectives.

There is nothing wrong with using trust as a basis for decision. Finding people you can trust, or establishing trusting relationships with them, is the most effective—often the only effective—means of achieving the delegation that is necessary to accomplish objectives and goals in large organizations. Successful decentralization relies on the transmission of high-level objectives, not just intermediate goals and basic actions, to the agents who will implement them. This is a world apart from principal-agent models that treat social organizations as mechanical systems in which agents respond to the stimuli that incentive structures impose.

Obliquity is the best approach whenever complex systems evolve in an uncertain environment and whenever the effect of our actions depends on the ways in which others respond to them. There is a role for carrots and sticks, but to rely on carrots and sticks alone is effective only when we employ donkeys and we are sure exactly what we want the donkeys to do. Directness is only appropriate when the environment is stable, objectives are one-dimensional and transparent and it is possible to determine when and whether goals have been achieved. The world of politics and business today is afflicted by many hedgehogs, men and women who mistakenly believe the world is like that.