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Chief Medical Editor's Page | June 2021

Hard Work Versus Good Fortune

You have achieved success in your life and career thus far and have managed to get through the pandemic in one piece—or at least better off than most people in the hospitality and entertainment industries. Your path to becoming an ophthalmologist was long and hard. It started in school, when you had to get grades good enough to gain entry to medical school. In medical school, you had to do well enough to gain admission to the ophthalmology residency program. Then, finally, you got to practice ophthalmology.

Most would remark, “Well done! Congratulations. Well-deserved. You have worked extremely hard for all that you have.”

I just read Think Again: The Power of Knowing What You Don't Know.1 The author, Adam Grant, recommends rethinking the facts that we take for granted. Ophthalmologists, for example, have often been told, “You deserve this because you have worked so hard.” This book, however, made me consider how much of our collective success is actually good fortune.

Veritasium is a YouTube science channel hosted by Derek Muller. In one of his videos, Mr. Muller discusses the parts that talent, hard work, and luck play in success.2 Here's what I learned.

Most people have an egocentric bias, which means that they know what they have achieved, they recognize the role they played in achieving it, and they underestimate the roles that others played in these achievements and overestimate their own contributions. An egocentric bias is human nature, not a character fault. People also tend to underestimate the part that luck plays in their success.

What about ophthalmologists? Like the protagonists of many IT and computer success stories, many well-known and successful refractive surgeons were born in the late 1950s. Both groups entered the workforce just as new technology was taking off. The success of both groups has a lot to do with timing, seizing opportunities presented to them, and applying their talent and hard work. Without the right timing, however, the level of success that is achievable with the same amounts of talent and hard work is not the same.

Further, people born in high-income countries may not take this stroke of good fortune into account. It affects every aspect of their lives, however, from surviving birth and childhood illnesses to having access to good-quality schooling to having the opportunity to pursue tertiary education.

Chance is a major factor in anyone’s success. Many people are offended by this idea and choose to believe that their success is the result of personal effort alone. People also often think of achieving success in terms of either skill or luck, but the truth is that both are required. Being talented and hardworking is not enough.

Removing good fortune from the equation of success creates a distorted view of reality, which is otherwise known as survivor bias. For individuals who exhibit a survivor bias, the world appears to be fair, and they are successful because they have worked hard. In their view, those who achieve less success in life simply did not work hard enough. It is a cruel trick of society that the fortunate credit their good fortune to their hard work.

The advice that Mr. Muller and science offer to provide you with the best tools for success is paradoxical: Believe that your future is in your hands and that your talent and hard work are what it will take to achieve success and know that, if you do achieve success, luck played a significant role. Then do your best to increase the luck of others.

All the best of luck to you, and keep working hard to achieve your dreams!

Arthur B. Cummings, MB CHB, FCS(SA), MMED(OPHTH), FRCS(EDIN)
Physician CEO, Wellington Eye Clinic, and Consultant Ophthalmologist, Beacon Hospital, Dublin, Ireland

1. Grant A. Think Again: The Power of Knowing What You Don't Know. Viking; 2021.

2. Muller D. Is success luck or hard work? YouTube. August 28, 2020. Accessed May 26, 2020. https://youtu.be/3LopI4YeC4I