Streamlining a process eliminates the confusion involved with extraneous tasks and concerns
I couldn’t believe it. An elderly patient who I had seen in the clinic an hour or two earlier was walking into my operating room, a relieved smile on his face. This patient, who I knew to suffer from vascular dementia that led to extreme agitation when he was confronted with stressful situations, was the picture of calm, despite his very recent diagnosis of endophthalmitis. Here he was, about to receive a vitreous tap and intravitreal antibiotics under local anesthesia, and there was nothing about his demeanor to suggest that anything had progressed anything less than perfectly since I had planned his surgery.
We had worked long & hard for this moment. What caught me by surprise when I started working as a full-time university staff ophthalmologist is the amount time and energy that needs to be devoted to coordinating logistical processes.
As a resident and fellow in another institution, I took the organisational aspect of the whole process for granted. That’s the way I’ve always known it, so it must have always been that way. And anyway, I had other things to worry about, like learning how to be an ophthalmologist and a retinal surgeon.
But once I graduated from training, started working elsewhere and inherited another system, I started looking critically at the organization in which I work. Identifying and eliminating inefficiencies became a top priority of mine. This is in part because a more efficient system is a safer system. Streamlining a process eliminates the confusion involved with extraneous tasks and concerns so that the focus can be placed on what’s important. But also because it’s more pleasant for everyone involved.
I have been concentrating on what happens from the moment I plan a surgical procedure to the moment the patient leaves the operating room. A clear, concise, 1-page surgical planning document has, I think, helped everyone involved know what’s going on (What’s the diagnosis? What’s our plan? What do we need to carry it out? Vision blue? ILM blue? Membrane blue?) and how we’re going to achieve it. My colleagues in the planning department have received clarified instructions on how to plan procedures, with unambiguous documents and materials lists for each specific operation.
The nurses in the operating room greatly appreciate this simplification. Everything moves more quickly, despite less effort being expended.
I’ve had a lot of help. My colleague, Thierry Derveaux, returned from his phaco fellowship full of insight into how a well-run and highly professional clinic works, along with the energy and motivation to make it happen. The resident currently rotating through the operating room, Geraldine Accou, is highly organised, well-prepared. As we say in NY, she gets the job done. No procrastination, no forgetting, no nonsense.
Ever since I spent many of my first days in the university hospital working until 7pm, either supervising the clinic or operating, two of my (many) goals have been the following: first, to finish the workday earlier. Second, to see more patients every day. My goals have seemed to many to be mutually exclusive. I disagree.
Dr Leigh Spielberg is a vitreoretinal and cataract surgeon at Ghent University Hospital in Belgium
A cocktail party or wedding is not necessarily the best opportunity to dispense medical advice
“So you’re an eye surgeon?” is a frequent question that we are often asked in social situations. It opens a conversation that is generally quite standard, but occasionally takes an interesting turn.
Usually, the question that follows is, “So why do you still wear glasses? I thought all eye doctors would definitely get their eyes lasered? Do you not trust the procedure? I guess you’ve seen all the ways it can go wrong, huh? Do you think I should get my eyes lasered? I’ve always wanted to get my eyes lasered, because I’m tired of dealing with contact lenses and I don’t look good with glasses. But I’m too scared! I can’t imagine a laser shooting my eyeball while I’m awake. There’s no way I could keep my eyes open for that long. But so many of my friends have had it done, so it can’t be that bad. Who’s a good surgeon? I’d only want the best to treat my eyes. Do you do laser surgery?”
I frequently can’t even get a word in, so I’ll just stand and listen, to see whether this new person delivering this monologue is actually interested in hearing my opinion on refractive laser surgery, which is very positive, or is instead simply interested in discussing it without forming any conclusions. But I don’t find a cocktail party or wedding to necessarily be the best moment to dispense medical advice. And anyway, refractive surgery isn’t my field of expertise.
“I do a different type of laser surgery, a type that I hope you never have to undergo,” I’ll say, referring to retinal lasers in the context of a retinal tear or a vitrectomy for retinal detachment.
PLEASE PASS ME THE WINE
Another route of inquiry involves the details of how eye surgery is performed, which to most people, especially the young, is unbearably grisly. “How do you take the eye out to operate on it? Do you remove it completely, or just pull it out of the patient’s head so that you can get behind it? When you make holes in the eye, how come everything inside doesn’t just leak right out? And how do you see what you’re doing? It’s all so small! What if your hand trembles? Eye surgeons must have really steady hands.”
I tell them that we use microscopes that make the eye look the size of a large dinner plate. Seeing everything is no problem at all. I suppose most eye surgeons were born with reasonably tremor-free fine motor coordination. But tremor also something that simply wanes with experience, confidence and a relaxed state of mind.
The eye fascinates most people, and is right up there with the heart as an organ that captures peoples’ imagination. And yet it remains a mystery for most people, something that they prefer to think about in more abstract terms.
“The eye is a beautiful thing,” I’ll sometimes say to end this line of conversation on an uplifting note. “So, do you have any interesting vacations planned? And can you please pass me the wine?”
Dr Leigh Spielberg is a vitreoretinal and cataract surgeon at Ghent University Hospital in Belgium
Another year is almost over and a new one will soon begin
Wikipaedia defines Ephemerality (from Greek εφήμερος – ephemeros, literally “lasting only one day“[) as the concept of things being transitory, existing only briefly. The term ephemeral is frequently used to describe objects found in nature, although it can describe a wide range of things, including human artifacts intentionally made to last for only a temporary period.
Ephemeral can also be used as an adjective to refer to a fast-deteriorating importance or temporary nature of an object to a person.
William Dean Howells (March 1, 1837 – May 11, 1920) was an American realist novelist, literary critic, and playwright, particularly known for his tenure as editor of The Atlantic Monthly as well as his own prolific writings, including the Christmas story Christmas Every Day, and the novels The Rise of Silas Lapham and A Traveler from Altruria.
His work can be read in The Complete Works of William Dean Howells which includes the following musing: “…I am impatient of the antiquated and ignorant prejudice which classes the magazines as ephemeral. They are ephemeral in form, but in substance they are not ephemeral…”
This was written long before the development of the internet which has completely transformed the nature of magazine publishing. While many of the readers of EuroTimes may keep the printed magazine in their offices for months, even years, they will eventually have to free up space and reluctantly dispose of their back issues.
And one day, they may regret this act when a colleague says: “Did you read the article in EuroTimes which talks about the downturn in LASIK procedures?”. The answer is no because that issue of the magazine has been binned.
But there is redemption. Howard Larkin’s article in December/January EuroTimes points out that global LASIK volume peaked at about 3.8 million procedures in 2007, and has struggled to break 3.6 million since.
In the USA, volume peaked at 1.4 million procedures in 2000, and has bumped along around 600,000 for the last five years, according to Market Scope data presented by Richard L Lindstrom MD at the 2016 ASCRS•ASOA Symposium & Congress in New Orleans, USA.
“We are in a no-growth market globally and in the USA. The question is, why is that?” asked Dr Lindstrom, founder of Minnesota Eye Consultants in Bloomington, Minnesota, USA.
To find out the answer to this question you can read the latest issue of EuroTimes but you can also go online and find the article at http://www.eurotimes.org/lasik-growth.
But you want to research further, so you can then another article from November EuroTimes http://www.eurotimes.org/lasik-studies, which is also written by Howard Larkin.
And the more you surf www.eurotimes.org , the more you will learn about LASIK and patient satisfaction.
Another year is almost over and a new one will soon begin and I wish all of our readers a happy and successful 2017.
* Colin Kerr is Executive Editor of EuroTimes, the award-winning news magazine of the ESCRS.
The great ophthalmologists are like the Arctic explorers and adventurers of old
The great ophthalmologists are not just surgeons. They are like the Arctic explorers and adventurers of old who went boldly where no man or woman had ever gone before.
They had an insatiable thirst for knowledge which laid the benchmark and foundations of modern ophthalmology as we know it.
But let’s digress for a moment.
Some of you old enough to remember may remember the old Buggles hit “Video Killed The Radio Star” which lamented the demise of radio in the new video age.
The song, recorded in 1979, had a catchy chorus with a bittersweet message:
“Video killed the radio star
Video killed the radio star
In my mind and in my car, we can’t rewind we’ve gone too far
Pictures came and broke your heart
Put down the blame on VCR”
As Wikipedia notes, although the origin of music videos dates back to the 1920s, they came into prominence in the 1980s when MTV based their format around the medium
The first pop music video aired on MTV (Music Television) was, yes, “Video Killed The Radio Star” and the rest is pop music history.
So, what about the first ever ophthalmology video? This year, ESCRS launched a new online museum which shows historic videos from some of the great innovators in the field. The videos, which are submitted by ophthalmologists are studied, verified and curated by Dr Richard Packard and Andrzej Grzybowski and date back to the 1930s.
The videos are featured on the ESCRS player at http://player.escrs.org/category/online-muesum
The online museum includes a treasure trove of material including the first LASIK procedure in 1990 by Prof. Ioannis Pallikaris, a video of the logbook from 1949 showing a summary of Sir Harold Ridley’s operations from 1949 and 1950 and a fascinating video from Prof. H.J.M. Weve showing an Intra-Capsular Extraction in late 1930s.
We have lot more material which is being reviewed by our curators and we plan to publish these online in the coming months.
Like all museums we are always on the look out for rare artefacts and maybe some day we will find the first ever ophthalmological video.
We cannot publish every video but we will do our best. All videos that we receive and publish will be fully credited, downloaded by users and the originals returned to their authors.
So submit your videos to firstname.lastname@example.org and maybe some day you too will be standing on the shoulders of giants.
The convention centre at McCormick Place, Chicago
If you’re an ophthalmologist travelling to international conferences, you’ll know all about Chicago.
The convention centre at McCormick Place is hosting the 2016 American Academy of Ophthalmology meeting from October 15 – 18.
The centre is comprised of four state-of-the-art buildings with 11 exhibition halls providing a combined total of 2.6 million square feet of exhibit space and attractsclose to three million visitors annually.
Of course, the centre isn’t just for eye doctors, although over the years it has become a regular host to AAO and ASCRS conferences.
When the AAO moves out of the centre on October 18th, work will begin on getting the centre ready for the American Society of Anesthesiologists annual meeting which takes place from Saturday October 22nd to Wednesday October 26th.
As my colleague Leigh Spielberg once observed, a large conference centre is like the Olympic Village that’s always built in the Olympics’ host city. with a collection of like-minded individuals separated from the rest of the population, separated from friends and family, and the rest of the world.
What makes McCormick Place special is that its on the doorstep of downtown Chicago. Even the best convention centres can become claustrophobic so its a big relief at the end of the day to walk out the doors and rejoin the real world.
And Chicago is as real as it gets. As Doris Day observed in that wonderful musical Calamity Jane, the windy city is mighty pretty, with its towering skyscrapers and wonderful bars, restaurants , shops, museums and art galleries.
The ESCRS/EuroTimes team flys into Chicago on Thursday and once we arrive we’ll keep you posted on everything, or almost everything, that moves inside and outside McCormick Place.
So let’s get in the mood by listening to another great song about Chicago, “My Kind of Town”.
And each time I leave, Chicago is
Tuggin’ my sleeve, Chicago is
The Wrigley building, Chicago is
The union stockyard, Chicago is
One town that won’t let you down
It’s my kind of town
Songwriters: CAHN, SAMMY/VAN HEUSEN, JAMES