⚠️ Tunnel vision is dangerous — in medicine and in investing. And it’s the person in the middle who pays the price. One of the most sobering lessons from my clinical work is this: Treating one problem in isolation can quietly destroy everything else. Recently, I reviewed a patient with: Long-standing liver cirrhosis from alcohol-related disease Portal hypertension and oesophageal varices Chronic low blood pressure (a common physiological consequence in cirrhosis due to systemic vasodilation and reduced effective circulating volume) Patients like this already sit on a knife edge haemodynamically. Add to that: Heart failure with an ejection fraction of ~45% Care transferred to cardiology The patient complained of dizziness, falls, and palpitations. BP was 88/60. Heart rate elevated — a compensatory response to hypotension, not the root problem. Yet the response was to: Increase beta-blocker dose eightfold to “treat the tachycardia” Switch alfuzosin (for BPH) to doxazosin MR, assuming “4mg must be weaker than 10mg” That assumption is pharmacologically incorrect. Potency is not dictated by the number on the tablet — just as bisoprolol 10mg is not less potent when compared with metoprolol 25mg!  And alpha-blockers are not equal: 👉 Tamsulosin is first-line for BPH precisely because it is least hypotensive. The result? Repeated falls Head injuries Worsening renal perfusion A patient who described his head as feeling like “a bashed potato” At one point, a nephrologist quietly remarked that cardiology was killing the patient’s kidneys. This is what tunnel vision looks like. The heart was treated. The person was not. And what troubled me most wasn’t just the prescribing — it was the lack of curiosity, collaboration, and willingness to involve clinical pharmacists, often dismissed as “glorified shopkeepers”. After 25 years across liver, renal, endocrine, urology and heart failure specialties, this is the kind of practice that worries me — not because it affects my confidence as a clinician, but because it affects my confidence in who I would trust with my loved ones. The uncomfortable parallel with property development & investing Tunnel vision destroys projects here too. Focusing only on cost control can undermine structural integrity Choosing the cheapest materials or builders often hides problems instead of solving them Optimising one metric while ignoring the system weakens the foundation Just like medicine, the person who suffers isn’t the decision-maker — it’s the end user. “You can’t optimise one part of a system and expect the whole to improve.” Whether it’s a patient… Or a property… Or a portfolio… Systems thinking matters. My question to you 👇 Where might tunnel vision be costing you more — in health, investing, or leadership — than you realise? 👇 Comment if this resonates 👇 Follow if you value joined-up thinking across disciplines 👇 DM if you believe better outcomes come from collaboration, not silos This year, I’m choosing clarity over frustration — and systems over single-problem thinking. #SystemsThinking #HealthcareLeadership #ClinicalPharmacy #PropertyDevelopment #LongTermThinking

Posted by Per & Lily at 2026-01-08 11:44:48 UTC