Triage and the process of prioritisation


In medical emergencies, such as a large scale disaster, where need is more than the supply of resources, “triage” is a way of determining priorities. At the most primitive level it is:

  • Those who are likely to live, regardless of what care they receive;
  • Those who are likely to die, regardless of what care they receive;
  • Those for whom immediate care might make a positive difference in outcome
Looking at the above, those who are likely to die should not be given treatment. This seems inhuman, unless you take into account that focusing on “first come first served” basis or any such method will create more deaths because patients who could be saved did not get timely treatment.
The concept of triage indicates that prioritisation should not be based just on “important” versus “urgent” as emotionally perceived by the decision maker but based on the common good or good of the majority. This means that sometimes we have to do things that are not palatable, but are for the benefit of the majority of the stakeholders.
Time is a resource most of us do not have in plenty. Given the conflicts between work and home, between various projects at work, and at home, how do we choose?
Maybe, by focusing on what gives the maximum benefits to most people.
As an MBA, who are our stakeholders? What should we be doing, given the paucity of time, to maximize the benefits? Which patients do we leave to die, even though it is not emotionally acceptable?
Does this define professionalism?

Mood Swings and Emotional Balance


I see students alternating between extremes: depression and elation, weeks of procrastination and sudden bursts of frenetic energy, greed and contentment, love and hatred, ‘never’ and ‘always’.

Since these swings are a function of time, they can be considered as emotional waves.

The energy provided to a wave can be expended in two ways: laterally (across the axis of the wave) by increasing the amplitude of the swing, or longitudinally (along the axis of the wave) by increasing velocity.

Mood swings can be similarly compared. Either we can have huge swings (as given in the first paragraph) and therefore get out of swings slowly (remain extremely emotional for a long time), or have smaller swings and move forward faster. Both types consume the same energy, but one gives a better balance than the other and allows you to move forward faster.

All swings have to be controlled. We cannot prevent the swings from happening. A balance is never still. Even the movement of air makes it swing. Every time it reaches equilibrium, something makes it swing again. If the balance swings too wildly, the pan may hit the ground / table and it may be deformed or the centre of the balance may shift, and the balance would never be perfect again.

Similarly extremes in emotions leave scars and sometimes we become permanently unbalanced. I see students with a negative attitude to life and wonder if it is a result of such emotional scars.

Indian philosophy advocates moderation in all things. Tolerance of all beliefs is moderation. We cannot always be truthful, specially if a white lie can save someone’s life or self-esteem (if a girl-friend asks if these jeans make her look fat, what will you answer?) . We will sometimes be sad (not depressed) and sometimes happy. We may detest something (not hate) or like something (not love?).

Moderation leads to balance.

The psychology of procrastination



It can be said that we procrastinate because of the following reasons:

  1. We are not motivated
  2. We are afraid we can’t finish the task, or we will fail or we will have to repeat the success
  3. The task is not important enough
  4. We do not know how to do the task so do not correctly estimate the time and the effort
  5. We don’t want to – the task may be dangerous – physically or emotionally

Theoretically, since we know the above, we can prevent procrastination by motivating ourselves, handling our fear and making a good estimate.  Why do we still procrastinate and ignore all the warning signs?

The reason is Affective Forecasting.

If we are full after a meal, we will buy less food at the grocery store.  If we are happy, we believe the future will be rosy. If we are sad, we predict the future to be terrible.

Our current state affects the prediction of an event in the future.

I want to watch a movie so I decide to do the assignment tomorrow. I am happy that I have made a decision. I am also happy that I can watch the movie. Therefore, I predict that doing the assignment tomorrow will be enjoyable.  This positive prediction of a rosy future prevents us from being realistic.

I decide that tomorrow 5 a.m., I will go for a jog. I feel happy that I have made some decisions about my health. I can now watch a movie. Therefore I predict, in my current positive mood, that tomorrow morning my mood will be the same and I will jump out of bed and go for a jog. I ignore the facts that I go to sleep at 1 a.m. and at 5 o’clock I will be grumpy, will definitely hit the snooze button and snuggle back into a warm blanket.

I procrastinate because I believe that by procrastinating, my present and my future will be happier.

Excuses for not doing work


Whenever we, as students, think that study or an assignment is burdensome, our minds go into overdrive how to avoid the work. The following rationalisation statements comes to mind

  1. It is of no use, in a job or in an interview.
  2. No one else is doing it.
  3. There are other pleasurable things to do.

Not a problem. We can live our entire life making excuses. But remember, that when success eludes us, we should also use the same rationalisation statements:

  1. Success is of no use in a job or life, as we cannot take it to the grave.
  2. No one else is being successful. We should start hanging out with other failures; all of us together can complain about unfairness in life. Successful people will shun us because of our negative attitude to life.
  3. There are more pleasurable things to do, like spending money on material possessions, and pressing the remote button of our TV for hours at length.

The purpose of assignments is to create a disciplined approach (remember that discipline means being a disciple, or following a path) to the various paths that we will have to follow in life. People who cannot follow any path to completion, reach nowhere.

“If you don’t like something change it; if you can’t change it, change the way you think about it.”


When I posted this quote on facebook, I got queries on “how to change the way we think about it?”

I have some comments to make.

The quote simply says, either change what is bothering you or change yourself so that it does not bother you.

Why did we precipitately decide that we can’t change what is bothering us?  Did we make enough effort to change things? If you refer to Mr. Hazare’s agitation, did not a change happen?

Take rules – be it college rules or government rules. Are we saying these cannot be changed, therefore we need to change our attitude towards them?

Did we really try? If we tried and failed, is it because we do not know how to change? Or are we lazy and did not make enough or right effort, or have patience? Either way, suppose we talk about corruption – are we therefore saying we can’t change corruption, so let us change our attitude towards corruption? Are we saying that we cannot change the rules, so we change our attitude towards them?

Let us assuming that we tried to change what is bothering us, be it people, things or ideas. Let us also assuming that we tried different ways, we asked around if others also have the same opinions as us, we gathered support and made an effort to change.

Then comes the second part – changing our attitude or our belief towards what we do not like. to do that, let us first examine our emotions towards what we do not like. What is really causing those emotions? is it the rules or the corruption, or is it our feeling of helplessness? Does the feeling of helplessness come because we have low self confidence, and because we remember past incidents which created such feelings?

This is a root cause analysis of our emotions, to find out the deep-rooted belief that is really the cause of the emotions.  If we do not handle this deep rooted cause of the emotions, we will be dealing with the symptoms, not the real reasons.

So maybe rules in the college remind us of the rules at home or school, which is what we wanted to avoid by joining a college far far away! Maybe these rules remind us of past incidents when we wanted to do things, and other members in a group or other powers of authority prevented us from doing what we wanted? If we do not handle our emotions with respect to those incidents, these emotions will recur.

Our current beliefs are a result of our past experiences and the inferences that we have drawn from them. To change our current beliefs, we need to change the past inferences and our memories of those past incidents.

Kipling’s “If”


I know that I have circulated this before to some batches, but I just love this poem so much, although the conditions in which this was written were less than perfect.


If you can keep your head when all about you
Are losing theirs and blaming it on you,
If you can trust yourself when all men doubt you,
But make allowance for their doubting too;
If you can wait and not be tired by waiting,
Or being lied about, don’t deal in lies,
Or being hated, don’t give way to hating,
And yet don’t look too good, nor talk too wise:

If you can dream – and not make dreams your master,
If you can think – and not make thoughts your aim;
If you can meet with Triumph and Disaster
And treat those two impostors just the same;
If you can bear to hear the truth you’ve spoken
Twisted by knaves to make a trap for fools,
Or watch the things you gave your life to, broken,
And stoop and build ’em up with worn-out tools:

If you can make one heap of all your winnings
And risk it all on one turn of pitch-and-toss,
And lose, and start again at your beginnings
And never breath a word about your loss;
If you can force your heart and nerve and sinew
To serve your turn long after they are gone,
And so hold on when there is nothing in you
Except the Will which says to them: “Hold on!”

If you can talk with crowds and keep your virtue,
Or walk with kings – nor lose the common touch,
If neither foes nor loving friends can hurt you,
If all men count with you, but none too much;
If you can fill the unforgiving minute
With sixty seconds’ worth of distance run,
Yours is the Earth and everything that’s in it,
And – which is more – you’ll be a Man, my son!

Rudyard Kipling (1865-1936)

Emotions and beliefs


If my girlfriend is late  for the movie, I can be anxious if I believe she may be in an accident, or I can be angry if I believe that she does not care for my time, or I can be depressed if I believe that she does not like me any more.

Therefore the same event can cause different reactions based on our beliefs about the event.

Even if I know that my belief is incorrect, why can’t I change my belief?

  1. It may be that I get some benefit out of this belief. For example, it justifies my anger or my continued depression.
  2. It may be that I do not know how to change this belief.
  3. I, subconsciously, may still think that this belief is true. This could be because admitting that I am wrong means admitting that all my previous emotions and actions were incorrect and I may have to correct the impact of those actions on people who were affected. To eat humble-pie in front of all those persons would be terrifying.
  4. I am too involved in the emotion and I cannot detach myself from my experiences. It is easy to advise people on what to do, when they have emotional experiences – because you are detached from the problem. But to do the same to myself means detaching myself from my emotions and that is difficult to do.
Exercises 5 in the chapter on “Managing Negativity”, in my book talks about how to learn the process of dissociation, so that you can learn to detach yourself from your emotions and so be able to advise yourself.

The self esteem of a Bhindi


I hate Bhindis (okras, lady’s fingers). When I go to the vegetable market, I pass over Bhindi, even if they are fresh and tender. I do not even see them. Should the bhindi have low self esteem? Should the bhindi start believing that because I have not considered it, there is something wrong with it?

If my boss loves Bhindi and he is coming to my house for dinner, I will pick up the Bhindi. Should the Bhindi now have high self esteem?

The point is, when people ignore me, or do not return my overtures of friendship, I feel rejected. When I feel rejected, slowly I start believing that I must have done something wrong, or there is something wrong with me.
People interact with me when they need me. sometimes they need, sometimes they do not. Some people like me, some do not. Some people have time for me, some do not. Why should I believe there is something wrong with me? Why is my self esteem going up and down based on other person’s reaction towards me?
It is all a matter of taste. There is nothing wrong with the Bhindi

Don’t shoot the messenger – ad hominem attacks


What is effective communication? It is a good composition of the message and its flawless transmission? Is it reception of the message without distortion?

Distortion of the message happens at two points

  • during transmission – physical distortion
  • due to the belief of the receiver

The same message, to two different persons will have different reactions. There are three types of beliefs that a receiver has that can impact distortion:

  1. the beliefs that a receiver has and therefore how he interprets the message itself – this is impacted by the language, the tone and the structure of the message. Sometime the size of the message makes a difference: big emails, short sms, terse verbal responses, long and winded verbal responses (lectures)
  2. the receiver’s belief about the sender and the intent of the sender (even an innocuous birthday wishes will have sinister overtones if sent by someone who I think is my enemy; if you do not like a lecturer or his intent, then even his sincere messages will have different overtones)
  3. the communication medium : in today’s discussion, the messenger. I am ignoring physical media like telephone cables, Internet etc.

Traditionally, we are advised to differentiate the message from the messenger. We are supposed to be messenger agnostic. “Don’t shoot the messenger,” we are entreated.

But the messenger will determine how we receive the message. If we do not like the messenger or the way he delivers the message, we will not care about the content or the sender. If a book is good, but it is presented by a lecturer or a student we do not like, then we do not care about the contents of the book, or its writer. If a person gives you feedback, we will care about the feedback based on who is giving us the feedback.

Does it mean that I have to be liked before I can send a message?

Does it mean that I have to be liked before I can deliver a message?

Does it mean that my messenger has to be liked?

Does it mean the message loses its significance?

Look at the response of the receiver. If he does not like the message, he has choices:

  • attack the message,
  • attack the sender and also
  • attack the messenger

If he does not like the sender or the messenger, he has same choices.

So when people do not do what I want them to do, I need to look at my message, the receiver’s perception about me and the receiver’s
perception about the messenger.

I also run the risk that if people do not like my message, they will attack the messenger – the poor guy

So if a teacher wants the student to study, and if a student does not want to study, he will attack the message (the course is useless) or the sender (the writer is not qualified) or the messenger (the professor is useless and does not know how to teach)

If a group member does not like what another group member is suggesting, he will attack his suggestion or he will attack the person.

If a group member does not like the person delivering the suggestion, even if the suggestion is good, he will attack the person and the suggestion.

Random Events or Fate – What should I believe?


Take a hypothetical example of a road accident that I am involved in. I am being very careful, driving under the speed limit and being responsible. But the driver of the bus that barrels into me was speeding, had a few drinks and thought he had the right of way. Further, he was trying to overtake another bus, competing with that driver to pick up passengers first. The driver of the other bus too wanted to win. Neither wins, but I lose a limb.

What should I believe?

  • That it was God’s will, that he has some plans for me or some lessons that I have to learn? Is it karma, or consequence of something that I did in my past or current life?
  • That it was a random/ unpredictable/ maybe explicable act, which happened due to a set of mental models created in the drivers who were therefore competing, coupled with their low self esteem which was compensated by the false bravado of a few drinks.

How should I react?

Based on either of the above, should I

  • be inert or
  • actively forgive the driver? or
  • actively avenge my loss of limb by suing the truck company, or
  • get the driver beaten up or any such reaction?

Are events random, or are they fated to happen?

If I look at a continuum of fate vs. deliberate action: 

I could have, on one end, 100% dependency on God’s Will and the philosophy that everything is preordained.

Whatever happens to me, whether good or bad, is not of my making but “that of our stars,” as Shakespeare would say. I may explain my actions by saying that God put this decision in my mind, and at an extreme, Gods talks to me and tells me what to do – whether it is of positive consequences like Joan of Arc or negative like Charles Manson.

On the other end, I could believe that when I react to an event, I do so on the basis of my mental models and my beliefs.

These beliefs have been created based on my previous interactions with the world and my interpretation or learning from past events.

When I react, it is like throwing a stone into the water, and the ripples of my action impact a myriad of people in different ways. All these people react in different ways to my action based on their mental models and beliefs. Since I do not know their beliefs and how they were formed, it is not possible to predict what is the sum total of all their reactions and what will be the final impact of these actions.

It is sort of a Brownian motion, where random molecules collide with each other and therefore change their path. How people interact or react is based on their beliefs and since we cannot see into their mind, we cannot predict the course of action.

Hence, we would seem like a random event. These are inexplicable/ random/ unpredictable events which have a major impact on life as we know it. These random events are called “Outliers” by Malcolm Gladwell or “Black Swans” by Nissim Nicholas Taleb.

The last such random event was 9/11 according to the Western world.

In the middle of this continuum would be the 50 percent belief, that there is a grand scheme of things, and there is a randomness of nature.

We have to try our best to understand how people would react, but because we cannot be 100% certain, there will be an element of randomness, coupled with an incomprehensible hand of God. We have a tendency, after the event, to try and explain it rationally. If we cannot explain it rationally, we try to explain it as God’s Will, His Grand Plan about us.

The Impact of either fate or randomness

This entire continuum can lead to a belief that:

  1. we should not attempt anything either because God will take care of us, or
  2. the randomness of events will anyway render intended consequences of any of our actions futile.

So we can justify our inaction, our procrastination and laziness.

We have Indian philosophy from the Bhagwad Gita – of our right to action, but not to results. We have a piquant situation where we have a right to action, which (based on where you are on the continuum, has an element of pre-ordained) and no control on results (which is random or unpredictable at best).

Sort of drives the final nail into the coffin of inactivity and inertness.

If things are random or pre-ordained, how will I be motivated?

Motivation is based on

  • the needs of a person, and
  • the probability that the effort the person makes would lead to the fulfilment of the need.

If we say that we cannot predict the impact of the effort, why would we make the effort?

So forget about consequences?

Shall we follow the philosophy of existentialism, live for the moment, with no thought of either the past or the future? I am here and now, and only this is real? So there is no such thing as strategy or long term consequences? If I cannot control, why think about pollution, leaving this world a better place etc. Or it is God’s will?