Thursday, September 22, 2011

Books for sale!

Hey there,

Someone awesome has decided to give me an Amazon Kindle as a gift and it is an amazing machine if you as much of a nerd as I am. If I'm not reading one of my medical textbooks, I'm reading a novel or Time magazine, or the news or a book about investing and finance.

Owning an Amazon Kindle means I no longer need my physical books so, take a look at my library, shoot me an email or comment and we can come up with a price (which probably will be dirt cheap). I'll give it a few weeks before I put them up on ebay. My readers get priority over random people on ebay of course :)


Enjoy your evening.

Sunday, September 18, 2011

Clinical Judgement

Hey there

In medicine, we like to give fancy names to very ordinary things. For example:

Pyrexia = fever
Polydipsia = thirst
Myalgia = muscle pain
Tinitus = ringing sound in ears
Physiological = normal
Gynaecomastia = man boobs
Hirsutism = female moustache
Idiopathic = we have no fucking idea what is causing it

One more term we use is clinical judgement it means, putting the patient’s story and investigations together, making sense of it and trying to come up with a diagnosis and treatment. A lot of the times, it actually means gut feeling, or hunch.

A few days ago I witnessed this first hand. A lady came in with swelling of the neck and no fever. I thought I was a fairly straight forward case and that she was crying because she was over anxious of the situation. I could not make out if her pain was real of if she was just her hyperventilation causing some neurological symptoms.

However, even though she had no signs that she was in serious trouble besides a swollen neck, the consultant used his “clinical judgement” and decided to admit the patient. She ended up growing alpha-haemologic streptococcus in her blood, meaning that she is septic (infection spread to blood and thus, the whole body) and had mediastenitis (infection spread to the mediastinum or sternum and heart and tissues surrounding the area). Within 3 days of admission, she was in bad bad condition, required an urgent CT scan, got transferred to the ICU and is now under the care of the surgeons.

I have no idea if she is now ok or not but I’ll try to find out when I go back to hospital on Monday. If the consultant hadn’t followed his “clinical judgement” she might had been sent home and probably passed on.

This is why he is the consultant and I’m the student. I’m obviously not half as competent and experienced as he is. What I thought was a simple case of throat infection, he thought was life threatening and very well could have saved this lady’s life.

I think this applies greatly to the world of investing as well. It takes years of education and experience to develop an astute clinical judgement. We can use all the indicators and read all the reports in the world but at the end of the day, it is up to you to make sense of the information available to you and make an informed decision.

Another thing that happened was that as soon as the consultant saw the CT scan and a more life threatening diagnosis was considered, he analysed his thought process and tried finding what he could have done better and what he did well. He later said to me, that if it happened again, he probably would have done it the same but pushed for the urgent CT scan harder instead of worrying about radiation exposure which was a completely reasonable consideration.

I guess the only way to develop a good clinical judgement both in investing and in medicine is to get more exposure. More experience and knowledge will hopefully translate into good decision making.

Hope you all have been well! Thanks for reading. As usual, I always appreciate emails and comments.

Wednesday, September 7, 2011

Integrity, Intelligence and Energy

Hey there,

I was doing some work today and decided that I needed a break, so where else but to go onto YouTube and waste some time. I watched a couple of Warren Buffet’s interviews (yeah I’m that much of a nerd, using study break time to watch interviews). He said one of his friends from Omaha said that when hiring people, he looks for 3 things: integrity, intelligence and energy. He said that if a person does not have the first two, the latter two would kill them because if they don’t have integrity, you want them to be dumb and lazy instead of smart and energetic. Being intelligent and having energy is not enough, integrity plays an important role in keeping you on the straight line.

He was talking to some Harvard MBA students, I think, and as the talk went on, he asked the students to look around the room at their colleagues. Identify one person that you would buy a 10% stake in their lives. If we had a choice of buying 10% of our colleague’s life for the rest of their life who will it be? Once you’ve identified that, write out their attributes that made you come to your decision. A lot of the time, it will not be because they are smart, or because they are a top scorer, it would most likely be because you can relate to them. Or you trust that they have what it takes to succeed. Make a list and strive to gain those attributes.

He said, Benjamin Graham did the same time back in the days. He identified people that he admired and that he wanted to be admired as well. So he identified what qualities made them admirable. What he found surprising was that those attributes are quite easily achieved.

Once you’re identified qualities that you like to have, make them a habit because in time, you’re realise that you’ll be the one who you want to own 10% in and the beauty of it is that you already own 100% of yourself.

After you’ve done that, identify somebody you would short sell 10% of their lives. Identify their attributes that made you come to that conclusion and avoid having those attributes.

Warren Buffet spent hours of his day learning how to invest and thoroughly analysing companies. His dedication and desire I’ll say is what 95% of the population do not have. Most people, like myself, would rather use our time on Facebook or YouTube.

So yeah, long story short, have integrity, be smart and energetic and strive to have good qualities so that you would love to invest in yourself.