Goodreads asked Don MacDonald:

Where did you get the idea for your most recent book?

Don MacDonald When one of my best friends got diagnosed with ALS and eventually died, it made me take a look at my life and the lives of the patients I had been serving over the years. Was I living my full potential or was I playing it safe? I noticed many of my patients were stuck, plateaued in their life as well. Under further reflection I discovered what caused me and the many others I had served to plateau in their lives. I called this "The Underdog Curse"

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