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Lessons gleaned from the poker table

My misspent youth wasn’t so misspent after all.

I grew up in Las Vegas, where, appropriately enough, I learned to play poker. I progressed from playing with family to cash games and then to tournaments. During that time, I learned many lessons from the poker table that I have drawn on in life and, believe it or not, in ophthalmology.

It all started with my father, a marketing manager for a big Las Vegas hotel who often brought me to work with him. One of the tasks he gave me was to proofread books and look for errors. One day, he gave me a poker book to proofread — and it enthralled me.

At 15 years old, I became friendly with the hotel owner’s daughter, Summer. This was in the 1990s, and oftentimes Summer’s father would spend time in the living room of his suite with Donald Trump. One day, they asked me if I was interested in learning how to play poker. My answer was an enthusiastic “Yes!”

Thus, I was lucky enough to get my start in poker from poker icon/hotel owner Bob Stupak and Mr. Trump. Here are the lessons I learned from playing poker and how they have helped me in ophthalmology and in life.

IMPRESSIONS ARE CRITICAL

Poker is a game of impressions. Without saying a word, everyone is telling a story. For example, at the poker table you can usually find a man with a big expensive watch and lots of jewelry; he talks loudly and whips out a big wad of cash. He makes sure to draw a lot of attention and bets big, often and early — he’s a bully.

Often, too, you find a young man, maybe 23 or 24 years old, with earbuds in his ears, a hoodie pulled over his head and dark sunglasses (even though he’s indoors). He doesn’t make small talk at all; he’s not interested in socializing. He seems almost disinterested in the game and rarely pays attention to the hand if he’s not in it. He’s a mathematician, figuring out the statistical probability of his hand and the correct mathematical amount to bet. He feels no emotion about the hand and strictly makes mathematical decisions as to whether to play or fold.

There used to be very few women in tournaments, but that’s no longer the case. Sometimes a beautiful woman is seated at the poker table. She dresses attractively and smells of expensive perfume. She appears to know very little about the game and seems like an easy target to win money from, but don’t be so quick to judge: It’s quite possible she is a “siren” and will crush you. You can never assume she is a weak player.

These are just a few examples of types of poker players one encounters. When playing, you always want to check the other players and gauge the impression they are making.

The lesson from this that I have brought to ophthalmology is to think about the kind of impression I have on my patients. Often times, the few minutes and short interaction that we have with patients is what stays with them long term. Above all, I try to leave the impression that I care about them. I do this through intentional eye contact, a firm hand shake, introduction and trying to connect with them by learning a personal detail. A great mentor once told me, “No one cares about what you know, until they know how much you care.” What impression are you leaving with your patient?

BE PHILOSOPHICAL ABOUT YOUR POSITION

In poker, position is everything. Here, “position” refers to the order in which players are seated around the table and how that affects strategy. A player “has position” on opponents acting before him and is “out of position” to opponents acting after him. The later you have to act in a hand, the better your position is because you have more information than the players sitting before you. Therefore, the best position is held by the player who is seated at the dealer button (who acts last after the flop), the worst position is the small blind (who acts first after the flop).

Depending on your position, you might choose to act very differently. For example, a hand like ace-9 is very poor in an early position. The best course of action is to fold. However the same ace-9 hand “on the button,” or in late position after everyone else has folded, is considered very strong and it is often wise to raise.

What I have learned from this is that in both life and ophthalmology, someone is always going to be in a better position and a worse position than you. Everyone has different wants, needs and aspirations for their professional career. Much of life is about timing and which “position” of your life you are in at that moment. Perhaps you want to start your own practice but don’t feel you’re financially ready. Maybe you aspire to be a chairman, be recognized in your field, be your own boss or have more time off to spend with your children.

Position is about making your move at the right moment based on the information you have gained from others before you, both in life and at the poker table. However, as in poker, your place in life rotates, so always be ready and willing to adapt.

WORK YOUR MEMORY

To become a good poker player, you must study not only the game but every move made around the table. Being attentive to how people play and analyzing their hands helps you make better decisions when playing your own cards.

My lesson from this: Care enough to remember details about the people you meet, especially your patients. Make a concerted effort to remember their names, their stories. Ask your patients and office staff about their families, and be sincere in your interest — make an intentional effort to know and remember their names and these details about their lives whenever possible.

DON’T INVEST YOUR EGO IN BAD CARDS

All poker players have been there. You have pocket kings, then an ace hits the flop. You are fairly sure that another player has an ace, but you just can’t let go of your cards. You convinced yourself “that you are already invested,” sometimes called the pre-investment trap. So you invest more in a losing hand because you have already “invested” your ego and money in cards that you knew all along were a long shot. If you make a bad decision and invest in bad cards, it is OK to fold and take a small loss vs. calling and taking a bigger loss.

It can cost a lot to learn what you already knew. Sometimes you just need to learn a lesson from the movie “Frozen” and “let it go.”

It’s the same in ophthalmology: Sometimes things start out looking really good, like pocket kings, but don’t turn out the way we had hoped or expected, like losing vitreous or breaking bag on a cataract case. Know your level of expertise and skill. Don’t be afraid to ask for and receive help, and don’t let your ego overcome good judgment.

SOMETIMES YOU NEED TO TAKE A RISK

Everyone wants to the get the perfect hand at the right time. The issue is that you never get it when you need it most. The chips you are playing the game with may run out before you get that perfect hand. Poker players who don’t take risks eventually lose. If they are too afraid to put money in the pot, they will never have the opportunity to win.

Being a practitioner is similar. If we remain too fearful to go after our dreams, we fail even before we have given ourselves an opportunity to succeed. Fortune is bestowed on those who have the courage to fail.

Sometimes we need to take a risk and push ourselves to buy a new machine, try a new technology, explore opportunities that might be scary, expand our businesses, etc. In both poker and life, if you are too passive, you lose. You need to play proactively and take calculated risks to win.

LEARN HOW TO MAKE DIFFICULT DECISIONS

This is another lesson that playing poker teaches well. In a poker game, you must rely on your instincts and intellect rather than looking to others for guidance. This teaches you both self-confidence and the ability to take calculated risks when necessary. It also teaches that both intellect and intuition have their places in the decision-making process.

In ophthalmology, you generally have more options than check, bet, call, raise or fold. Practice is more open-ended, and, when logic and intuition disagree, sometimes it’s best not to choose sides but seek out an alternative.

In poker, you are limited in how much data you can gather. But, ophthalmology and life offer other extra opportunities for peaking at the cards. So, in ophthalmology, when I want to try something new, I ask for expert advice. I try to attend as many meetings as possible, make friends in the industry and keep my mind open to new ideas regarding all aspects of ophthalmology, including patient care, business management and self-improvement. Once I take in new information to augment the data I am already processing, I can dive in with my best decision, see what the next card looks like and adjust course. OM

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