When it comes to your own practice, ‘leadership’ comes with the job
There are many reasons for choosing a career in ophthalmology; for most it’s probably the blend of medicine and surgery, the appeal of the technical environment and the satisfaction of healing and helping. An interest in leading a business practice isn’t normally high on the list. Yet in real life it turns out that ‘leadership’ comes with the job. And the first task is knowing where you’re going.
Here’s how one business guru puts it: “All successful physician practices have a clear vision of their reason for existence… This can be referred to as the corporate culture or the core values of the company that clearly defines the values and preferred expectations of behaviour.”
LinkedIn recently sent out an article on ‘building a great company culture’. The piece is written by Claude S Silver, Chief Heart Officer at VaynerMedia. A ‘heart officer’ is not someone who deals with cardiac arrest in the office setting – In this case it turns out to be someone heading up what used to be called ‘Human Resources’. It’s Claude’s job to show love and empathy to the employees while monitoring their performance, thus motivating them to do their best for the team of which they are a part.
Without going so far as to employ a Heart Officer, if you’re ready to consider sharpening up your office practice, an internet search turns up an article that outlines the ‘10 hallmarks of leadership in an ophthalmologists practice’. Realistically enough, it begins by flagging up the need to find the time: “At least eight additional hours per week on top of your core job as an ophthalmologist.” And just as realistically the author points out that: “ophthalmic microsurgery is the domain of slow, cautious, 100% perfection. Ophthalmic leadership is the domain of well-intended, timely approximations of 80% perfection. Or less. … get on with it.”
The article ends with this cautionary note: “Most patients can choose from whom they receive care. Even if they love the ophthalmologist, they might go elsewhere if the office is poorly run. As a physician, you’re more than just the doctor. You must also be an effective organiser and facilitator of a large group of staff.”
Whether you have a “large group of staff” or simply one or two overworked employees, a checklist of who does what in an ideal world – an outline of the ‘five key roles in the ophthalmic practice‘ – is a useful checklist.
Initiatives that help doctors speak to patients on a human level can only help both sides of the interaction
I read not long ago of an initiative that introduces doctors to ‘normal’ older people. One of these older people, a retired family therapist, mentioned a gastroenterologist who dismissed her complaints of fatigue by saying: “At your age, you can’t expect to have much energy.” Then, in her 70s, she switched doctors and learned she had a low-grade infection.
It happens. Not long after my husband died, I’d called in to an ophthalmologist’s clinic. For some months I’d been aware my eyes were red and didn’t feel ‘right’. Now I had time to investigate. The consultant performed his exam. “Tell your boyfriend it’s just age,” he said. That, and the bill, was the extent of the consultation.
Heavy-handed humour? Joke gone wrong? I felt affronted, an old-fashioned word for an old-fashioned reaction. When I ran out of moisturiser, my eyes cleared up. I’d been allergic to it as I discovered, no thanks to that ophthalmologist. I never did forget the insensitivity of his remark – or return to that clinic.
I was reminded of that when I read about mannequins being used in medical training.
These dolls bleed, twitch and have seizures just like real people. As no one wants to be the first patient a trainee doctor intubates, for example, it’s wonderful these dolls exist. But on the other hand, it’s already all too easy for today’s harassed doctors to regard their patients as mannequins, or at least to forget they have feelings.
Happily, empathy skills are increasingly part of medical training, both for the patient’s benefit and the doctor’s. At the University of Houston, Texas, end-of-life conversations are already being practised on mannequins.
But what about the more common situations, like routine operations? One of the most empathetic things a doctor can do is find time to stop by the bedside to ask how the patient is feeling, answer questions, assure him or her that all went well. So far, that can’t be practised on a mannequin, but if it were I’ll bet even a stand-in human would respond with lower blood pressure and a thumbs up.
'Femuring' is a well-known experience in the skydiving community
As you may or may not know, snapping the thigh bone is such a common injury in skydiving that they invented the verb ‘to femur’. I didn’t know that but it was a comfort when I femured myself two months ago.
Actually, I hadn’t been skydiving, but it cheered me to think I might have been. In fact I’d been creeping downstairs in the dark in a trailing kimono when I tripped myself up and flew off the stairs to the floor.
I’ve learned a lot since then really. What it feels like to wait on queue in hospital on an ambulance stretcher (it’s hard to keep up a conversation with an ambulance driver for three hours as he waits to retrieve his property from under you), how it feels to talk to a surgeon in dawn’s early light (amusing – but that was probably due to the drugs – mine not his). And that in hospital (the one I was in anyway) it is now standard to ask for agreement before laying a hand on you..
Nurse: I’m going to take your blood pressure. Is that alright? Me: Good idea.
Nurse: I’m going to take a blood sample. Is that alright? Me: If you must.
Doctor: I am going to repair your femur, is that ok? I’ll be using a titanium pin, a metal plate and six screws. Me: Absolutely! I have no other plans for today.
Someone: We’re going to give you a spinal (something… words indistinct). Me: Be my guest.
From then on silence interrupted only by the sound of hammering seeming to come from under the table. I wanted to tell them what my father taught me when I was young: never hammer a screw.
Afterwards I discovered that the words ‘physio’ and ‘rehab’ were often said in the tone of voice once reserved by us Catholics for ‘get confession’ and ‘go on a retreat’… the tone of the first implies ‘it won’t be pleasant but you have no choice’, and the second ‘relax and get holy at the same time’.
I said no to both. I could ‘walk through the pain’ (as skydivers say in their online femur forum) – with a little help from a blue tablet (hospital) and paracetamol (home). And I did.
My femuring is almost a memory now.
But I’m careful on the stairs.
Research shows that one-in-four retirees in Britain goes back to work either for the income or the social aspects
Is there life after ophthalmology?
If you’re an opthalmologist nearing retirement age, you might be asking yourself that question. Chances are the answer’s yes… probably many good years lie ahead. You may be looking forward to the leisure.
Or perhaps not so much. According to a 2017 study in the journal of Ageing and Society, one-in-four retirees in Britain goes back to work either for the income or the social aspects.
I’m not an ophthalmologist.. but I did retire once. It didn’t ‘take’.
My second career, as a travel writer, is already longer than my first as a medical editor. I’ve been a travel writer since 1992. In 2001, I began writing for EuroTimes, still my favourite readership.
The first assignment was Amsterdam. I remember reporting on a trip through the Netherland bogs in a rowboat; in the early days, I reported for ESCRS on places as diverse as the arctic circle and Zanzibar. Currently the focus is on congress destinations, including Vienna, which will host the 36th Congress of the ESCRS in September.
Most of of the articles are at maryaliciatravel.com. Other pieces have appeared in the Irish Independent, Irish Times, Irish Examiner as well as Abroad Magazine and France. Two of my articles were included in anthologies: Travel Guide France and Travel Guide Ireland.
I embarked on my second career when my husband died of lung cancer. I’d long been involved in anti-smoking campaigns and was editor of a respiratory news letter. Suddenly I didn’t want to read or write anything more about the subject. I was nearing retirement age anyway. So I quit.
But I missed work. I missed having a project. On the plus side, I could come and go as I pleased, be away for long periods, take risks with no one home worrying about me. I had contacts with newspaper and magazine editors. I’d travelled a lot in my first career and being a single woman in out-of-the-way destinations didn’t bother me either.
Only a month after my husband’s death, I set off on my first travel writing assignment. A friend chided me for running away from grief. I knew that was not the whole story. Starting a second career felt as if I were ‘running towards’ something rather than running away – running towards new experiences, new friends, a new life.
The ‘second career’ has been a success. Will there be a third? I hope to be travel writing for a while yet.
But I could write a book (couldn’t we all?) I did write a book, After You, to track the year after my husband’s death in poetry. Recently I discovered tanka, the Japanese five-line poem and that led on to the cherita a six-line poetry format. I’m writing in both forms now.
When the wings come off my plane – metaphorically speaking – poetry may be what holds me up.
You never know what’s next…
Travel-related stress – no one wants it, everyone faces it
Not so long ago if you told people you did a bit of travelling for work (as I do, and as many ophthalmologists do) they’d say how lucky you were. No longer. What’s changed? Travel-related stress. No one wants it, everyone faces it.
In 2016, booking.com undertook a survey to quantify the causes of travel stress, questioning more than 4,555 respondents who travelled at least four times a year. Of them, 93% suffered from stress at some point in their journey. The top three worries: missing a flight (32% of respondents), language barrier on arrival (26%) and the possibility that luggage would be lost (22%).
Oddly, my own biggest worry was way down the list – losing my passport, a concern only 18% of my fellow passengers share. Nonetheless, I’ve had mine stolen in a New York airport and again on La Rambla in Barcelona. In my opinion, no experience comes close in terms of inconvenience and, yes, stress. Now I carry a photo copy of the passport and a spare credit card separately and hang the originals around my neck the way pilgrims to Santiago once carried a scallop shell.
I don’t worry about the language barrier; there’s an app for that. I use Google Translate. There are others – for an overview: www.k-international.com.
But cancelled flights do come in second for me, ever since the frantic scramble for a seat on an onward flight after a cancellation in Catania, Sicily. I had a top-level frequent flyer card on the air-line in question, and discovered loyalty pays! I also had a membership card giving me access to a lounge where the receptionist mercifully sorted my ticket. www.prioritypass.com
My own third concern – an accident abroad – didn’t figure in the booking.com survey. But when I woke up in a Boston hospital a day after being concussed by a falling roof tile (I didn’t see that coming!), I couldn’t remember where I was staying, or where my belongings were. Now I carry a card from the hotel I’ve checked into – ‘just in case’.
There’s not much you can do about the stress of lost luggage, aside from carrying essentials in your hand luggage. However, stuck without my bags in Lyon, Air France provided me with an overnight amenity kit containing a toothbrush, an oversized tee shirt, two aspirin and a condom. Now that’s one worry off my mind.
Maryalicia Post says greens really are good for ophthalmologists
‘Earth heading for 25-hour day.’
The headline gave me a flutter of anticipation. We all know that ‘work expands to fill the time allotted to it’ and now at last the shoe might be on the other foot – time expanding to accommodate the pressure of work. But no. The article goes on to explain the extra hour is due to the slower rotation of the earth around the sun and won’t be ours to spend for 200 million years.
So that means the over-stretched among us – and that’s most ophthalmologists – will continue to fit 25 hours of work into a 24-hour day and look for other ways to reduce the stress, anxiety and depression that come with the lifestyle. A meta review of studies at www.sciencedirect.com suggests a novel approach… ‘nature therapy’… aka light gardening.
Fortunately for the city dweller, you don’t even need a garden. The main benefit comes from the interaction with nature itself; just one plant can make the difference in raising mood and reducing stress levels www.ngia.com.au. And not only do mood and creativity get a boost, other studies confirm that tending your aspidistra may lead to less sickness and improved attentiveness too.
An entertaining way to get started is to download the interactive Plant Life Balance app devised by RMIT and Melbourne University. Take a picture of your space with your mobile phone, choose the visual effect you’d be happy with, then follow instructions to add the appropriate potted plants. The app calculates the therapeutic benefits of your new decor. Free download at iTunes and the Google Play Store.
A residual benefit of growing houseplants is cleaner air. Even NASA weighs in on the ability of plants to remove “volatile organic compounds which lurk around the average office, in carpets and furnishings, solvents and ink”. https://spinoff.nasa.gov. A NASA publication, How to Grow Fresh Air: 50 Houseplants That Purify Your Home or Office, explains: “Plants emit water vapour that creates a pumping action to pull contaminated air down around a plant’s roots, where it is then converted into food for the plant.”
A TED talk , How to grow fresh air by Indian environmentalist Kamal Meattle, winnows the list down to three commonly available plants that do the job: Areca palm, mother in law’s tongue and the money plant.
Greens really are good for you..
Multitasking and medicine don't mix, but sometimes there's no way around it
Take a pen. Time yourself writing the words “I am a great multitasker”, followed by the numbers from 1 to 20. It shouldn’t take you too long. Now try this: on two different lines, write the letter “I” followed by 1, then “a” followed by 2, “m” followed by 3 and so on. It won’t be nearly as easy, and it will take a lot longer. This exercise, designed by Danish training and research firm Potential Project, shows up the futility of multitasking. Despite proven studies that show how ineffective and damaging multitasking can be, more and more doctors are forced into this style of work.
In a post entitled Multitasking and Medicine Don’t Mix, Hans Duvefelt MD wrote about the difficulties in trying to fit in paperwork, research, follow-up calls and more in between personal sessions with patients. Doctors end up taking this additional work home if they can’t get it done at their practice. He compares it to air travel: “Are airplanes scheduled to be in the air all the time, with refueling and maintenance squeezed in only if they happen to land ahead of schedule?”
This constant busy-ness is prevalent in ophthalmology too, in both private and public spheres. Arthur Cummings MD, Consultant Eye Surgeon at the Wellington Eye Clinic in Dublin, lists the many tasks he needs to complete: “Between patients I am taking and making phone-calls, replying to urgent emails and other messages, meeting with different members of my team to touch base with regards a patient, a letter, a prescription, an issue with a study, a device that requires attention, someone from the adjacent hospital, and so the list continues.”
He doesn’t enjoy multitasking and believes he works best when focused on a single task, especially given the attention required in his line of work: “When people make claims about how well they can multitask, I often ask them what additional task they would like me to do while I am making the capsulorhexis with surgical instruments in their eye.” Everyone always allows him to carry on.
One important and inescapable consideration is financial. “It may seem simple enough to simply cut back on the number of patients that we see but then we cannot cover our overheads,” says Mr Cummings, who is also heavily involved in studies regarding new innovations and technology, all of which takes up valuable time. “For me personally though, being energised by the innovation or study comfortably makes up for the additional burden on my stretched personal resources.”
Clare Quigley MD, who is currently based at Sligo University Hospital, finds it impossible to avoid multitasking. That said, there is a division of labour made for the benefit of the operating surgeon: “In theatre my trainer and I split the cataract list, with one of us operating and rescrubbing for the next procedure, while the other does all the other necessary peri-procedural tasks; admitting and blocking patients, fielding queries about the theatre list, typing and signing the post-op notes, and admitting the next patients.”
It gets busier outside the operating room, however, as doctors see casualty patients while fielding calls from GPs, referring hospitals and so forth, as well as queries from other medical teams in the university hospital. “I find it helpful to schedule incoming emergency appointments while allowing for some sort of lunch or dinner break,” adds Dr Quigley.
Ultimately, it’s all about finding the time to do everything, however hard that may be. It’s all we have, so make it count.
What does the future look like for technology and cataract surgery?
Robots have a mixed history in popular culture. From the giant Gort in The Day the Earth Stood Still (above) to the terrifying Daleks of Dr Who, from Ted Hughes’s Iron Man to Futurama’s Bender, they have been at turns terrifying, menacing, compassionate and comical. In the real world, their history is more mundane. While we may think of robots as being humanoid in appearance and nature, that’s not necessarily a given.
An editorial in the Paris Innovation Review defined robots as such: “[They] have a material existence inasmuch as they are endowed with perception (via sensors), can make decisions (via appropriate use of processors) and can undertake physical actions (using integrated motors).” The key example of a robot that has made inroads into the everyday is that of robotic vacuum cleaners like the iRobot Roomba or Dyson 360 Eye, and we can see the onset of driverless cars in our media and television.
Automation has led to greater efficiency in the areas of manufacturing, agriculture and communications, to name but a few. Such advances, however, are happening at different paces across the healthcare sphere. In some places, computers and iPads have replaced front-end staff, allowing patients to check-in digitally. In surgery, things are not quite there yet.
In a recent Eye Contact interview, Dr Richard Packard was asked if he saw robotics coming into the area of cataract surgery. He doesn’t see it happening any time soon.
“When you’re dealing with cataracts and the patients, patients are patients. And you can’t necessarily predict the way that their tissues are going to behave. We also know that there’s a significant cohort of complex patients out there that robots will simply not be able to deal with. The other issue is that if there is a problem during surgery, even if you’re a robot, your ability to adapt to the situation that you find yourself in is going to be quite difficult.”
Other doctors are more wary. Sorcha Ni Dhubhghaill MD believes that surgeons live under the same threat of automation as those in other industries. “If I think long term, I believe that a sophisticated diagnostic algorithm will eventually replace the clinician’s diagnosis just as a sophisticated robot will replace the surgeon.”
She believes that the current technical limitations, as envisaged by Dr Packard, will be overcome in time by improvements and refinements. “I don’t think it is unreasonable to think that a robot will ultimately be able to perform every move a surgeon can, but better, with no tremor and no need for a lunch break.”
Where next for the surgeon, so? Dr Ni Dhubhghaill believes a pivot is necessary. “While the robots are seeking to perfect the established techniques, the humans will have to innovate and introduce new ideas.” Human-robot co-operation will ensure the value of each working towards an enhanced patient experience.
“I would envision a robo-surgeon and innovative ophthalmic surgeon working as a team. The robot to provide the best results technically and the ophthalmologist to push the boundaries of the technology.”
Where the patient fits in remains to be seen. Would automated surgery be cheaper than the current standard? Would such a robot have automated colleagues, such as robot anaesthetists and nurses?
O brave new world, that has such… machines in ‘t!
We look at the impact smartphones and apps have had on the world of ophthalmology
In 2017 the iPhone celebrated its 10th birthday. While it was not the first smartphone in existence, its innovations helped change the landscape of personal technology like no other. Its use of a touchscreen keyboard instead of a physical keyboard, like that used by Blackberry, followed by the opening of the App Store in 2008, were great leaps forward that would change the market – and the world – forever.
iPhones paved the way for the era of the smartphone, with Google’s Android following suit and taking a huge share of the market across a variety of different devices. We call them smartphones, but essentially, they are pocket computers – we depend on them more for the news or weather, for example, than for ever actually talking to someone. The same goes for doctors.
Clare Quigley, a third-year Resident at Mater Misericordiae University Hospital in Dublin, says that while she does use her Samsung smartphone for communication purposes, she also uses it for planning ahead, be it putting her on-call dates in her calendar or preparing for upcoming meetings. She has a specific folder designated for ophthalmology: “I have Crystal.Toric for verifying my pre-op limbal markings when I use toric IOLs. I have PDFs of books that I might need to reference, including The Wills Eye Manual and Kanski’s Clinical Ophthalmology. I also have the hospital antimicrobials guide, and also the EuroTimes app for browsing.”
Most interestingly, Dr Quigley uses apps to distract or settle young children when trying to catch a view of their fundi, be it the Kids Top Nursery Rhymes app or simply YouTube for the likes of Peppa Pig. She also uses an Ishihara app when dealing with bed-bound patients who are unable to attend clinics.
Rahil Chaudhary, Managing Director at the Eye7 Chaudhary Eye Centre in Delhi, India, uses the TorEye app on a daily dasis. “It is basically a toric axis marking app that eliminates the need of devices like bubble markers, and the accuracy of which is comparable to digital axis marking devices like the Verion.” Dr Chaudhary even presented a free paper at the XXXV Congress of the ESCRS in Lisbon on the accuracy of this app, so enamoured he is with the technology.
Arthur Cummings, Medical Director and owner of the Wellington Eye Clinic in Dublin, has incorporated smartphone technology into all aspects of his practice. He can play a patient’s choice of music on Spotify, as well as remotely changing the lighting in the laser suite to any colour of the rainbow. On the surgical side of things, he uses an app called Axis Assistant for marking the cornea for toric IOLs.
“This app allows exquisite accuracy as you don’t have to place the marks exactly at 180 degrees for a reference. Instead you mark the patient freehand at what you think 180 degrees is. You then check using the app while they are upright and measure the exact location. The axis alignment for the IOL is then measured from this reference point and marked with a toric marker to the desired axis.”
He also uses apps to track analytics for the Clinic’s website and as well the various social media channels to communicate with patients and anyone else following the Clinic.
While this technology helps Mr Cummings in his work, there is also a Wellington Patient Journey app, which breaks down the various procedures available as well as advising patients on postoperative behaviour and providing push notifications for medication and appointments. Such innovation shows a willingness to use technology not only to improve surgical outcomes but also to enhance the overall patient experience.
Despite these vast advancements, Mr Cummings says it’s something much more basic that impresses patients most often. As his slit-lamp camera is in a different room to where he regularly consults, he generally uses his smartphone to take a photo through the ocular of the slit-lamp in his consultation room. He then sends it to his computer and shows the patient and save it on their file, and this is what elicits a comment on the wonders of modern technology.
From this small selection of doctors it’s clear that the smartphone has had a massive impact on the day-to-day workings of ophthalmologists. We can only wonder what might be round the corner, let alone what may be available in 10 years’ time.
The 22nd ESCRS Winter Meeting convenes in Belgrade, the capital of Serbia
The 22nd ESCRS Winter Meeting http://www.escrs.org/ convenes in Belgrade, the capital of Serbia, a country with one of the most tangled histories in Europe.
If, like myself, you find the intricacies escaping you- and you’re heading for Belgrade- a worthy travel companion is the paperback by British journalist Tim Judah, The Serbs: History, Myth and the Destruction of Yugoslavia.
Judah, a reporter for the Economist, is one of the most knowledgeable commentators on the area, having lived and worked in Serbia for years. His book outlines the history of the region and explains its effects on today’s Serbs. There’s an updated section on post-war Serbia.
For fictional insights into the White City, try The Houses of Belgrade, by the Serbian literary icon, Borislav Pekic. Born in 1930 in Podgorica, Yugoslavia, Pekic began his writing career in prison after his 1948 arrest for terrorism and espionage. In the early 1970s he emigrated to London, where he wrote The Houses of Belgrade in 1994. Interwoven into the story of an old recluse’s infatuation with the houses he owns (he gives them female names) are memories of the last time he ventured outdoors.. 27 March 1941, the day of the coup d’etat that followed alignment with Hitler.
The Diary of a Political idiot is a memoir of a Serbian civilian caught up in the NATO bombardments in the late 1990; it’s an extraordinary account of daily life under fire by Jasmine Tesanovic, a feminist writer and activist, She is a contributor to the Huffington Post where some of her blogs return to the theme of this book.
A 3-hour Belgrade walking tour dedicated to the Communist era leaves every Tuesday, Thursday and Sunday at 3 pm from Belgrade’s Republic Square. Participation, including entrance to the Museum of Yugoslavian History, is €10 . No need to book..look for guide wearing or carrying ‘something yellow’ behind the monument. According to the website (belgradewalkingtours.com) you’ll hear interesting stories of former Yugoslavia, World War II, Tito’s life, conflicts of the nineties, NATO bombing of Serbia and Montenegro in 1999 and democratic changes at the beginning of the third millennium.