This week I signed up for a LinkedIn account. Aside from Twitter, I’ve never used any other social media platforms, and it feels weird. My dear wife has been very patient with my out-of-loop questions such as “should I make this public?”, “isn’t it weird to send a connection request?” and so on. However, since this newsletter might benefit others, and serve as a nice pass-time with a Friday coffee (or beer 🍺) while sitting-on-the-porch routine, I took the plunge.

This week we are hoping to finally get a car. The prices of cars went up just before coming here, and the demand increased accordingly. It is now a seller’s market, i.e., the sellers don’t need you as an individual. If you opt not to pay the sticker price for a particular car, another buyer will. We almost purchased a car (second-hand, of course) a couple of weeks ago, but since I still don’t have a US driver’s license, they wouldn’t sell it to me.

Today I’m trying another agency with my uncle, so hopefully, it will go somewhat smoothly. We can certainly get by without having a car, but it costs us about two quality hours a day and limits us on weekends in places where public transportation is unavailable. We decided that although the expense is considerable, having a car will upgrade our Boston experiences, and these experiences will last us for life. So fingers are crossed! 🤞

Firstborn joined the Israeli Boyscouts here in Boston and will start taking Taekwondo lessons🥋(got his yellow belt just before coming here). Secondborn got his practice organ delivered 🎹 and is already working on his keystrokes (thank you Amazon, for making it cheap for us).

The temperatures dropped as expected 🌧, it’s raining almost every day, but it’s definitely not the dreaded Boston winter yet. We’ll see how it goes.

Today’s theme is how to take pictures, a favorite subject of mine (exciting!). Everything about photography I learned by myself with experience and watching youtube videos.

#7, here we go!

Table of contents

1. Main Article - How to take great pictures

2. OMFS World

3. Stuff (Book, Gear)

Main Article - How to Take Great Pictures

📷 Before we begin, let’s discuss your current photography habits. Suppose you’re interested in improving your picture-taking skills without effort or too many details. In that case, the first section (Photography 101) is definitely for you, and you can just skip the second section (Taking it to the Next Level). If you already know all the basics and want to take it to the next level, you might find the second section more appropriate to your needs. You may want to skim through the first section just so we’re all on the same page. So let’s get to it!

Photography 101

💻 The process of taking pictures has changed tremendously in recent years. No longer do we need to carry a dedicated camera, and no longer do we print pictures to enjoy them. However, quantity-over-quality has become a real issue, and most of us have many pictures saved up, which we hardly ever look at. Picture-taking also suffers from this quantity-over-quality tendency: many of us “spray and pray” with our cameras, or in other words, take multiple pictures without paying attention to details, hoping that one of them will be good enough. The result is usually file folders that are packed with mediocre pictures.

🪂Our article today will focus on the process of taking great pictures, both in our day-to-day lives and during clinical scenarios. Getting the process right is far more important than having the greatest or most expensive gear. To take great pictures, you need to do three things: prepare your subject, pay attention to your lighting, and be aware of your zoom.

“Nine-tenths of wisdom is being wise in time.” - Theodore Roosevelt

👫Your subject: Without a strong subject, your picture will be bland, no matter how good the lighting is or how interesting the background is. Position your subject in the center of the frame and clear the surrounding area of any clutter. This will help the focus to remain on your subject and create a more pleasing composition. If you’re taking a picture of your family - make them laugh! If you want to take a selfie - ask a stranger to take the picture for you. You will look more natural, and each selfie will look different because it was taken by someone else. In the clinic - position your subject in front of a solid-color background, tie long hair, wipe your instruments, and use retractors and rulers.

☀️ Your lighting: The lighting, oh, the lighting. I can’t stress it enough: In photography, LIGHTING IS EVERYTHING. Proper lighting can make or break a photo! First, use existing lighting whenever possible. The sun is your best friend, and if you can, position yourself so that the sun is behind you and shining on your subject. If using the sun is not an option, you can achieve it by lifting the curtains, opening the windows, or turning on more lights in the room. Natural light will give your pictures an airy feel and make them look more professional. Your subjects should be positioned accordingly so that they are evenly lit and there are no harsh shadows.

If it’s too dark, and in most cases where clinical pictures are taken, you can use a flash 📸. A flash can brighten up a photo and make it look much better than taking it without one. However, if a flash is not used correctly, it can wash out the colors in a photo and make it look awful. Besides macro pictures (images taken from an extremely short distance), the flash should not be pointed directly at your subject. Instead, its light should bounce off the ceiling or through a diffuser that will spread evenly in space. In other words, point your lens at your subject and flash at the ceiling right above your subject. Since phone cameras don’t have this functionality, I NEVER use a flash while taking pictures with my phone. I would rather have a grainy-yellowish but natural picture taken in the dark than a washed-out flash-in-your-face unnatural picture.

Intermission:

A great lullaby; I love how Kylie Minogue sings it:

Kylie Minogue was diagnosed with Breast Cancer in 2005, shortly after she launched her tour. In 2007, after beating cancer, she returned to her home country Australia to resume her tour. As a primary school kid who had her tape cassettes 📼 and watched “Neighbours” on the 2-channel TV in the 80s, and as an adult who devoted himself to treating cancer, I have a soft spot for Kylie Minogue.

🎥 Your zoom: There are two kinds of zoom: Optical zoom and digital zoom. An optical zoom means that by changing the zoom, you are moving the glasses inside your lens, so there’s no change in the quality or resolution of your image. On the other hand, digital zoom is like taking a picture but cutting out and using only a tiny piece of it. It means that whenever you use digital zoom, you delete a part of the image and use computer power to make it look like you didn’t. The result is a worse-looking picture. “But how do I know which zoom I’m using?” So, in general, phone-camera zoom is digital (the lousy kind of zoom). Newer phones have some optic zoom capabilities (i.e., 2x zoom is optic, but X2.1 and beyond is digital). You can google your phone model and add “optic zoom” to see if you have a limited optical or digital zoom. My advice to you is simple - zoom with your feet! Just move closer to your subject…

So that was Photography 101. If you want more, the next section is exactly for you! If not, feel free to skip it

Photography - Taking it to the Next Level

🐞 Macro images: If you’re taking macro images outside, such as flowers and small animals, you probably have good lighting, and a macro lens is more than enough to achieve great results. However, suppose your macro-photography involves limited lighting, such as a surgical site or the oral cavity. In that case, I advise you to invest in a good dedicated flash like a ring-flash. A cheap ring-flash will ruin your images, and your images represent your professional identity. Instead of upgrading your phone, invest in your flash! I’ve been using the same Canon MR-14EX II Macro Ring Lite since 2016, and I don’t see a reason to replace it soon.

👩🏻‍🌾Portrait images: For those who shoot portraits with a ring flash - I highly recommend you try other methods: If you have a flash built into your camera - use it! Just tilt it with your left index finger toward the ceiling (it has a hinge, especially for that). Otherwise, invest in a dedicated flash. Point your dedicated flash to the ceiling above your subject and pull up the white bouncer card. This way, some light will bounce off the ceiling, and some will bounce softly to your subject’s eyes. You will know that you achieved excellent flash photography when your image shows evenly spread light, minimal shadows, and small white dots in the middle of your subject’s eyes (right in the center of the pupils). For portraits, I use Canon Speedlite 430EX II Flash, the same one since 2016, and it still serves me well.

🎞️Zoom: Earlier, I mentioned “zoom with your feet” as a guiding mantra to avoid ruining your images with digital zoom. However, if you use a dedicated camera with a zoom lens - you can rotate the rings in your lens to achieve the zoom you desire without compromising on quality. This is why high-quality zoom lenses are expensive: You pay for more glass and a mechanism to move it within the lens. Some clinicians already use a dedicated camera with a macro lens and want to take portrait images. In this case, I don’t see a reason to purchase a zoom lens. You can take great portraits with a macro lens, you just need to position yourself farther away from your subject and use proper lighting.

Damn, this is the most technical article we’ve had here yet. Let’s relax with some classic music:

This bit always ends with my kids asking: “Dad, why is she crying?” I guess I need to learn Spanish…

💰 Budget: What If you want to take great pictures and don’t want to spend too much money? If you already have a phone, your first and cheapest option is to use it as your camera. Remember to take care of the lighting, zoom with your feet, and don’t use the flash. Your second, and more expensive option, is to invest in a dedicated camera. You can start with a basic camera and a fixed zoom but high-quality lens. Depending on your needs, you can choose 24mm, 35mm, 50mm, or 85mm fixed zoom lens. Your third, and most expensive option, is to invest in more expensive gear. This is beyond the scope of today’s newsletter, but I’ll just say that, in my experience, to achieve high-quality images, the lens is far more important than the body of the camera. So this is where your budget should be invested. See issue #1 for my current macro pictures gear, and today’s gear section for my portrait lenses.

🏃‍♀️More to come: We still have a lot that we haven’t covered today: Mirrorless vs. mirror cameras, raw vs. jpeg, manual vs. autofocus, adobe lightroom, iso, shutter speed, and aperture. Controlling the aperture (instead of letting the auto-mode do that for you) is an extremely important parameter for taking macro images of a surgical site and the oral cavity. Once you start using the aperture function on your camera - you’ll never look back! Your images will become much clearer with an excellent focus throughout. I’m taking pictures in full manual (I define the aperture, shutter speed, and iso) and am not afraid anymore to adjust my parameters on the go, even when I’m pressed for time.

📱I will also want to go into a debatable subject - do surgeons with an iPhone 14 still need macro camera gear in the OR? Peter McKinnon has made a great video about the iPhone 14 Pro Max. His questioning the need for a dedicated camera, now that we have excellent phone cameras, made me wonder whether it is also true for medical photography. What do you think?

In the future, I will touch on these as part of a special edition newsletter about professional photography.

On to the OMFS world section; feel free to skip it if it’s not up your alley.

OMFS World

👩‍🎓For the student - When it comes to practicing exam questions - there’s no such thing as “too early”. My advice is to start practicing questions at THE BEGINNING of the school year. There’s no reason to “save” these questions until the exam. The best way to remember is by ACTIVE learning, and only by practicing questions will you truly achieve that. For med students, UWorld is top-notch (Medexams for Israeli med students). It took me a while to realize it, but since I have, the amount of time I needed for studying has dropped considerably, and my retention of knowledge has improved tremendously.

🥼For the OMFS resident - Suppose you’re on call, it’s now 4:30 am, and you need to start your morning rounds at 5:00 am (you haven’t slept since yesterday). Do you rather sleep for half an hour or not sleep at all? I prefer to take advantage of this half-hour and sleep. It makes it easier for my mind to separate between yesterday and today, and I feel refreshed. Not immediately (the first hour after waking up from that “nap” is hell on earth), but later that morning. This sleep is actually a power nap, more on that in issue #2.

🩺For the non-MD medical professional - When a person has an ischemic stroke (CVA), remember that “time is brain”. In other words, you should get this person into a stroke center fast (a hospital capable of managing strokes). After ruling out a hemorrhagic stroke, i.e., a stroke caused by bleeding and not by a clot, the patient will receive treatment. If less than 4.5 hours have passed since the onset of symptoms, the patient may be eligible for both thrombolysis (drugs to break the clot) and mechanical thrombectomy (fishing the clot out). If more than 4.5 hours but less than 24 hours have passed, mechanical thrombectomy (but not thrombolysis) may still be relevant. After 24 hours, none of these will be applicable anymore. In summary, the best thing you can do for patients with a stroke - is to rush them into a STROKE CENTER as soon as possible.

Stuff

📚Book I read - Smartcuts: The Breakthrough Power of Lateral Thinking by Shane Snow. Lateral thinking is a way of thinking that allows you to find creative solutions, what some of us call “thinking outside the box”. This book reveals how the world’s most successful people take “smartcuts” to achieve their goals. As a firm believer in unconventional thinking and that any problem has a solution, this book made me feel more confident whenever I embarked on a so-called “impossible” path.

“Integrity is the only path where you will never get lost.“ - Timothy Ferriss, Tribe of Mentors

💡Gear I use - I moved into professional photography in 2014 and started investing in camera gear in 2016. It was quite a lot to invest, but I’m extremely glad I did. I still use pictures I took a few years ago, and since I always shoot RAW images, I can bring out the best of each picture using 2022 software. Only recently, I added Canon RPto my arsenal (more on that in issue #1), but all the other gear I use is from 2016. I don’t see any reason to upgrade any of it soon. My portrait zoom lenses are Canon EF 24-70mm f/2.8L II USM and Canon EF 70-200mm f/2.8L IS II USM. I LOVE these lenses. The pictures are always on point, with magnificent dynamic range and fabulous lighting. Going for a f/2.8 lens (or even lower than that) is definitely worth the price bump over a f/4.0 lens. More on that in the special edition issue.

Epilogue

That’s it for this issue.

In the next issue, we will discuss fitting workouts into a busy schedule.

If you enjoyed this issue and haven’t subscribed yet, you can do so using the link below. Subscribing supports this newsletter, and it will be sent to your email every Friday (no spam!).

So take out your camera and have a great weekend!

Shay