Do ophthalmologists want to live in a “concrete jungle” and what role can they play in reducing “anthropogenic mass” on the planet?
Since the beginning of the COVID-19 pandemic, I have found myself accessing research material outside of my normal remit as Executive Editor of EuroTimes. In a series of articles in the coming months, I will explore some of the ideas discussed in this material that may impact on how ophthalmologists practice as they attempt to come to terms with their “New Normal”.
An article published recently by BBC Environment Correspondent Helen Briggs reported that the mass of all human-produced materials including concrete, steel and asphalt has now grown to equal the mass of all life on the planet. (www. bbc.com/news/science-environment-55239668) Briggs’ report was based on a recent study carried out at the Weizmann Institute of Science in Rehovot, Israel. (https://www.weizmann.ac.il)
The study, published in Nature (Elhacham, E., Ben-Uri, L., Grozovski, J. et al. Global human-made mass exceeds all living biomass. Nature 588, 442–444 (2020) shows that at the beginning of the 20th Century, human-produced “anthropogenic mass” equalled just around 3% of the total biomass. Today, on average, for each person on the planet, a quantity of anthropogenic mass greater than their body weight is produced every week.
Prof Ron Milo of the Plant and Environmental Sciences Department, Emily Elhacham and Liad Ben Uri say that their research can provide a crucial understanding of the future shape of the face of the Earth. It also suggests that human beings as a species, will need to behave more responsibly.
“The significance is symbolic in the sense that it tells us something about the major role that humanity now plays in shaping the world and the state of the Earth around us,” Dr Ron Milo, who led the research, told Briggs. “It is a reason for all of us to ponder our role, how much consumption we do and how can we try to get a better balance between the living world and humanity.”
This begs the question; how can ophthalmologists help to achieve this balance? Juan José Mura MD, MHA, speaking at the 37th Congress of the ESCRS in Paris, France suggested that a start could be made by looking at the use of new disposable technology. (EuroTimes Vol 25 Issue 5, May 2020). In his presentation to the ESCRS, Dr Mura discussed the economic costs, impact on marine life and adverse health consequences of plastic pollution. In addition, he cited a published study that analysed waste generation and life cycle environmental emissions from cataract surgery via phacoemulsification at the Aravind Eye Care System in India (Thiel CL, et al. J Cataract Refract Surg. 2017;43(11):1391-1398).
Dr Mura also proposed that a large portion of the carbon footprint created through cataract surgery could be reduced by changes in practice to incorporate readily available resource efficiency measures. They include optimising the use of reusable instruments and supplies, maximising single-use device reprocessing, promoting minimum waste and recycling practices, using energy efficient appliances and air handling systems, investing in low carbon energy sources, and using flash autoclaving (also known as immediate-use sterile supplies).
Returning to the theme of this article, Dr Mura’s proposals may be the first steps to reducing the reducing the anthropogenic mass. These are challenging times and we need big ideas to help us prepare for the journey that lies ahead.
For an excellent visual display of Anthropogenic Mass visit www.anthropogenic.org
Reflecting on last year's ESCRS Winter Meeting as we look to the future
This time last year many of us were preparing to travel to Marrakech in Morocco for the 24th ESCRS Winter Meeting. The multiple pleasures of travel to new locations, seeing old friends and advancing knowledge make international conferences a wonderful experience.
These have been lost, like many other aspects of life we may have taken for granted, in the wake of COVID-19. Perhaps this loss is temporary, but perhaps our lives will be changed utterly. For now, we sit at home and log on to catch up on the latest science and technology.
Marrakech sees temperatures of up to 37 degrees Celsius in summer and in February it gets to a balmy 20 degrees, perfect for those of us in more temperate or extreme climates who might be used to colder, wetter weather throughout the winter. Getting to walk around in the sunshine without bundling up was a treat we wouldn’t enjoy again until a brief summer came some months later.
While the novel coronavirus disease was named COVID-19 on February 11, and guidance was issued regarding handwashing and general advice regarding cleanliness and vigilance, COVID-19 was only declared a pandemic by the World Health Organization on 11 March 2020.
With that announcement, workplaces around the world sent their staff home and governments prepared for the worst. Words like lockdown and social distancing became commonplace. It was a world away from the togetherness and camaraderie of the Winter Meeting.
For many it was the last opportunity to spend time with friends and colleagues, to enjoy restaurants safely and to sit back and learn from experts in the field of ophthalmology surrounded by a crowd of fellow interested parties.
A snake wrangler in the main square of Jemaa el-Fnaa
This would be the last chance to browse eposters and discuss ideas with colleagues, to examine new offerings from companies at the exhibition.
A short drive from the conference centre, the historic Jemaa el-Fnaa is the centre of Marrakech’s medina, a hive of activity with snake charmers and salesman, selling everything from pottery and clothing to drums and cuddly toys (some of the items this writer came home with).
Tourism came to a halt in mid-March with the country declaring a state of emergency. Tourists and traders alike will look back at this time with bittersweet memories.
The 25th ESCRS Winter Meeting Virtual 2021, in conjunction with the Polish Society of Cataract and Refractive Surgery, will take place online from 19-21 February. While these virtual meetings mean we miss out on seeing new places, they do mean we can avoid the time-consuming travel that such conferences entail.
While we can’t meet friends for a drink, we can switch off the laptop after a meeting and go down and see family, not missing them for days at a time. If you miss out on one of the talks for any reason, you can always catch it on demand for a month after the event.
We all look forward to the day we can meet again, to shake hands and embrace one another. Until then, let’s make the best of all the digital realm has to offer.
It’s good to talk, but you have to get your message across when you converse with your patients. ESCRS Practice Management and Development Programme Manager Colin Kerr reports.
Rod Solar,Director of Practice Development Consulting, LiveseySolar
As the COVID 19 pandemic continues to restrict interactions between ophthalmologists and their patients, social media is becoming increasingly important for surgeons who need to reach out to their patients in the new era of social distancing and restricted movement.
Many opthalmologists are doing this through Facebook, LinkedIn, Instagram, Twitter and other platforms but are they reaching their targets?
“You have to be really clear about what social media is about and how it’s not just media, but it’s also social,” says Rod Solar, Director of Practice Development Consulting, LiveseySolar.
” The key thing to remember there is that it’s a conversational medium, it’s an interactive medium. It’s good that ophthalmologists are using social media, but what they are doing is that they are using it like a broadcast medium. So, they put up a picture, they put up a video, they put up a post and they say: “Here is my message to the world.”
“What they are not doing,” says Solar, “is engaging in conversations. They are not asking questions, they are not challenging people to respond, they are not inviting people to take some small action. What you need to do with social media is not only post your own material, you also have to request commentary, you also have to engage in conversation and not only that, you have to go onto other social media properties and engage in the conversation elsewhere.”
Traditionally, the only point of contact between a patient and the ophthalmologist was by phone. According to Solar, one of the key things to remember in the new era of social media is that the job of an ophthalmology practice staff member who may answer the phone, is not just to answer the phone but to also engage in the conversation on social media in, giving them the tools to interact with patients where they want to talk.
“For example,” he says, “in the past we had our practices in a specific location and people had to come to that specific location to talk to us after they had telephoned us for an appointment. These days with the internet and social media we have the ability to interact with people in so many different areas and that is what they expect from us. Long gone are the days when the only way of handling patients was on the telephone.”
Solar also stresses the importance of engaging with patients through online questionnaires.
“This helps ophthalmologists to understand what the patient’s issues are, how they assess their vision now and what kinds of problems they have. Once they fill in that form, we guide them with logic to proceed to whether or not they are qualified to go ahead with a consultation or whether we should guide them to another location or another service or just some general information online about what they might need. That way we are using the internet to triage people before we invite them to a consultation. That helps us to exclude people who are not suitable for consultation and it also helps us to educate people so that by the time they get to the consultation they are well-informed.”
When patients are shopping online, one of the first questions they will want answered is how much will these goods or services cost? Some ophthalmologists may be reluctant to have this conversation for both practical and ethical reasons, but Solar says it’s important to be upfront about the costs of specific procedures.
“The surgeons I work with value quality over quantity and being upfront about yours costs, in my opinion, is a mechanism for demonstrating your quality,” he says. “Some people may equate cost with quality. If they see something with a low price tag, they will immediately assume that the quality is poor. If they see something with a higher price, they will assume that the quality is sufficient to warrant that higher price.”
* Rod Solar, is Director of Practice Development Consulting of LiveseySolar . This article is based on a EuroTimes Eye Contact interview available on the ESCRS Player at https://player.escrs.org/eurotimes-eye-contact/how-can-i-market-my-ophthalmic-practice-rod-solar-paris-2019
Award highlights innovations from ophthalmologists and their practice staff
Julien Buratto, winner of the 2019
ESCRS Practice Management and
Development Innovation Competition
It’s time to get your entries ready for the second annual ESCRS Practice Management and Development Innovation Award. Intended to highlight innovations from ophthalmologists and their practice staff, entries for 2020 must focus on a recent innovation that’s been introduced into the practice, including activities to help your practice and patients cope with the Covid-19 pandemic.
From the addition of plexiglass barriers, masks for patients and re-arranging waiting rooms, what are the ways that you have adapted to deal with the pandemic, while making patients and staff feel safe and welcome? This year’s Innovation Award is an opportunity to share the creative ways that ophthalmologists in Europe have risen to the challenge of Covid-19.
The ESCRS Practice Management and Development Committee created the Innovation Award in order to provide a platform for ophthalmologists to demonstrate to colleagues their entrepreneurial and marketing skills used in their clinics and practices.
The entry can focus on any aspect of clinic operations or community outreach, but it must be proven and measurable — both in qualitative and quantitative terms.
For this year, the Practice Management and Development Committee will select a shortlist of entries, who will be invited to present their projects at the 38th annual meeting of the ESCRS in October in Amsterdam. The winner will be chosen by audience vote and will receive a €1,500 bursary to be used to attend the 39th ESCRS, scheduled for Barcelona in 2021.
You can find more details on the competition, as well as how to enter, by clicking on the link here.
Shortly following the WHO announced a global pandemic, we locked ourselves in a room for two full days to map out the future for our cataract and refractive surgery clients. We resolved to make informed predictions of how the COVID-19 Crisis will impact the elective surgery market in the short and medium-term and what this could mean for you and your practice, clinic or hospital.
We developed a solid framework to help practice owners strategically plan for the expected (and predictable) changes that are coming. With this information, we hope that you can take strong and specific actions to help you maintain and protect your practice (which in this economy would be an achievement), and could even enable you to achieve modest growth.
Don’t react. Respond
We all have a lizard brain, a monkey brain, and a visionary brain. Be diligent not to stimulate your lizard brain – the one that makes you fight, flight or freeze. Resist the comfortable denial of the monkey brain – this is not the time to blindly do what others do.
Instead, it’s time to stay in your visionary brain as much as you can. It will be hard. The choices you’ve made and will need to make will tax your resolve. Your visionary brain that likely led you to start your practice in the first place. That’s the calm, deliberative, creative, and optimistic brain that asks – “what do I want to see in the world, and how do I want to engineer it?”
Phase 1: Denial (1-2 weeks before your shutdown)
In the denial phase, your market is conducting “business as usual”. People are distracted, but they’re carrying on. This group is in full-on monkey-brain mode and is carrying on as they always have done. These folks will keep their appointments because, for them, nothing has materially changed. That is the minority, and they’re typically younger Millennials – your LASIK market. If your country is in Phase 1, you have an immediate opportunity to help some patients but you need to act now.
Phase 2: Panic (two to three weeks of shock)
During this phase, there is an immediate and sudden contraction of supply and demand for elective healthcare services as physiological, and safety needs supersede everything else. Your inquiries will likely slow to ZERO in this phase. Don’t market to anyone in the panic phase. The key at this time is to prepare appropriately for the next three phases.
Phase 3: Boredom (six to 12 weeks after your shutdown)
In the boredom phase, people will be hungry for information and entertainment that distracts them from current events and the sheer monotony of life inside four walls. This is your chance to create and disseminate content that is either informative, educational or entertaining while maintaining a sensitive tone to current affairs – less aspirational, more grounded in utility. Most importantly, make this content interactive.
Phase 4: Hope (One to 16 weeks from your shutdown)
After 12 to 16 weeks from your shutdown, we will be through the worst of it, and people will begin planning for their future. There will likely be steep economic decline followed by a period of bumping along the bottom, like an aeroplane, struggling to take off.
Hear me now and quote me later – this recession will likely mark the end of elective surgery as a commodity. Position it as a luxury and adjust your service-level accordingly.
Phase 5: The ‘new’ normal (four months from your shutdown up to two years)
In February, I’d only read the phrase “social distancing” once. Now, it’s everywhere. And unless experts’ most optimistic models come to pass, we should expect to be subject to social distancing.
Consider a typical reception/waiting room that’s about 7×7 metres (23×23 feet) with 32 chairs all neatly placed together – set mere inches apart. Now take those chairs and distance them by 6 feet/2 metres each – in every direction. Now, in a space you could fit 32 people, you can only fit nine chairs. Your reception room capacity has just reduced by 72%.
Another point worth mentioning is, no matter how safe you feel your environment is, people who’ve avoided restaurants for two months aren’t about to go out for dinner twice a week. If you decide to do anything this week, add video appointments to your service offering. Before the Coronavirus, they were already becoming a standard feature in today’s society – particularly the health sector. Today, they are a must if you want to protect your patient pipeline during the coronavirus crisis shutdowns, and beyond.
Now is the time to help, to share, and to support each other through this challenge.
* Rod Solar, is Director of Practice Development Consulting of LiveseySolar
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Some tips to make the patient experience easier
Most of us have a complicated relationship with time. We willingly spend it, save it, kill it, but nobody likes wasting it. And waiting for an appointment often feels like time wasted. In a perfect world, every ophthalmologist patient would arrive on time, be seen within 10 minutes and leave the clinic with thoroughly positive feelings about the experience. That’s certainly a goal worth striving for and there are lots of online suggestions to help you achieve it. This is one. And this is another.
But a late patient, an emergency, a complication can block the best-laid patient flow. What then?
If a wait is unavoidable, the best plan B is to make the delay seem shorter than it is. The waiting room facilities are key. I know because the waiting room of a practitioner I visit occasionally is a textbook case of what can be wrong. A gruff ‘take a seat’ floats up from behind the bunker that is the receptionist’s station when a new patient arrives. Behind this bunker, which takes up most of the available floor space, the receptionist is cut off from the patients, lifting her head only occasionally to call out a name. Metal chairs are strung out along the wall where patients perch like birds on a wire. There’s nothing to look at on the walls bar flu vaccine posters. Magazines are stacked high, some so old you can still join the debate on whether Prince William will ever marry Kate Middleton. A TV plays forlornly and unwatched.
What I’d like would be good Wi-Fi so I could work on my phone or iPad while I wait. I’d appreciate comfortable chairs, grouped informally. Some green plants would make the room seem warmer, along with an interesting painting or wall decoration. A few attractive ‘coffee table’ books would be diverting. There would not be a TV, though low background music would work. Crucially, the receptionist would know my name, let me know if the wait was going to take longer than 10 minutes and apologise sincerely if the wait, however unavoidably, goes into overtime.
A simple formula for improvement of the waiting room is covered in this article – which has checked just about everything on my wish list and a few things more. It works off the premise that the place where the patient experience begins should be considered the ‘reception area’ not the ‘waiting room’. When the mindset shifts from the practitioner’s viewpoint of ‘waiting’ to the patient-oriented concept of ‘reception’, the way forward seems a bit clearer.
You never have a second chance to make a good first impression
Time was when a good bedside manner was something a physician had or didn’t have, like a great smile or a firm handshake. Doctors equipped with natural charisma were assured of a loyal band of patients. Others settled for grudging respect. Today ‘bedside manner’ has morphed into ‘patient-physician communication ‘. It is no longer an optional extra, nor is it restricted to the bedside. As technology plays an ever-greater part in practices such as ophthalmology, the need for the human interface becomes ever more evident.
The concept of the bedside manner’ dates back to the late 19th Century, when a Dr Osler brought trainee doctors into the hospital to see and talk to patients – and the system of ‘internship’ was born. Ever since, patients have come to expect good communication with their doctors. And they’re right to do so. Research confirms that a good bedside manner measurably affects outcome.
Unhappily, this need goes hand in hand with more pressure on the physician for the finite amount of time he or she has available to spend with each patient. In one disastrous attempt to bridge the gap, a California hospital made video recordings to be played to the patient in place of an ‘evening round’ by the doctor. As a result, one patient was reminded via a video recording that he was past medical help. The patient died the next day but family members who were in the room when the video played never forgot the shock. (The hospital apologised.)
And here’s an account of one patient’s experience with an ophthalmologist. The doctor’s excitement at discovering that his patient had a very rare condition coupled with his enthusiasm for sharing the discovery with his staff made him forget he was dealing with a human being and a very vulnerable human being at that.
While the ophthalmologist’s practice may not focus on literal ‘bedside’ scenarios, the need to reassure and connect with patients is as compelling as in any other practice. In his popular blog, Dr Ron Rosa OD offers specific suggestions for the ophthalmologist to consider. They range from the surprising – “Beware of your posture” – to the challenging – “never stop caring”. More generalised tips are here.
Perhaps the most useful thing to keep in mind is that you never have a second chance to make a good first impression. Get the patient’s name right, call them by their last name plus Mr or Mrs (unless they are under 18 or you’re invited to use their first name). Look interested. Don’t retreat behind a screen more than necessary. And remember that a sincere smile and a welcoming handshake still set the tone for a successful ‘bedside manner’.
How to give up on giving up
Did you know that the 12th of January is ‘Quitter’s Day’? According to a survey undertaken by Strava, 12 days into the new year is the day most people give up on their new year’s resolutions.
I’ve skirted that disaster by not having started yet. My resolve is to read the Guinness World Records’ longest novel. It’s Proust’s In Search of Lost Time. I downloaded it in its entirety to my Kindle for a mere 42 pence. That was the easy part.
As an ophthalmologist your resolution may focus on achieving a satisfactory work/life balance. A recent edition of EuroTimes Eye Contact took up that question. Sorcha Ní Dhubhghaill talked to Luke Sansom and Joséphine Behaegel about the challenges facing ophthalmologists in finding a work-life balance. They stressed that cooperation and understanding between physicians and their family members was essential to achieving this goal. The Mayo Clinic offers advice too. This article on work/life balance for the physician suggest some practical approaches.
Whatever your resolutions, you’ll go farther if you take small steps. Research (Int J Psychiatry Med 2012;43(2):119-128) suggests a better work/life balance could start with an introduction to mindfulness; first step: to research resources near you. Mindfulness can be learned on your own, through books, apps or YouTube videos but good instruction speeds you on your way.
Don’t insist on going it alone. Ask for support. Just as work/life balance requires the cooperation of family and friends, a resolution to improve the business side of your ophthalmology practice, would involve your co-workers. Patient satisfaction or dissatisfaction often begins at the door with the ophthalmologist’s assistants and receptionists.
No matter what your goal, there’s an app for keeping track of your progress. One of the most popular is HabitBull, which is free for iPhone and Android. Another is Strides, which is free on the web. There’s an interesting discussion of the best of apps here.
And there’s an article on the likelihood of success with one of these apps and how to improve your chances here.
As for my own resolution, estimated reading time for In Search of Lost Time is 80 hours. So 13 minutes a day for the next 365 days should do it. Wish me luck.
Maryalicia Post reflects on the lasting impact of a hoof to the head
Someone asked me the other day if I have 20/20 vision. And actually, I don’t know. What I can say is that I can see quite well as soon as I get my eyes ‘tuned’. That requires me to tilt my head slightly to the left and down, which – I like to think – gives me the appealing look of an alert robin while at the same time bringing the two eyes into agreement as to where things are.
I must say I don’t much notice this procedure. I’ve been ‘tuning’ them for decades – ever since I had the misfortune to fall under a galloping horse and get hit in the head by a hoof. The little crescent on my velvet riding cap marked the point of contact. The broken stirrup strap explained the fall. When I woke up in hospital about six hours later my right eye was stuck up in the corner of my eye socket and remained there for six months.
I wore an eye patch during that half a year. As I was still smoking small cigars then I made a lasting impression on those who met me for the first time. Another thing that has been remembered – by those for whom I poured a cup of tea or coffee in those days – was how they had to position their cup under the spout of the pot so that what I poured landed in the cup some of the time.
During those six months, I met a lot of friendly fellas at the eye hospital In Dublin; mostly hurlers who had been clobbered with a hurley stick. Not many years afterwards, the first steps were taken to reduce the number of eye injuries hurlers used to accept as par for the course. We enjoyed our sessions in front of a device trying to bring two sets of drawings into one, exchanging comradely high fives when we came close.
As for me, I’ve given up horses (and cigars). I’m planning to channel my inner robin and focus, on the garden.
It’s a jungle out there. I’ll keep my eyes tuned.
EuroTimes Executive Editor Colin Kerr remembers Sir Harold Ridley and a momentous moment for the ESCRS
The end of every year is a time for reflection, for looking forward to a new year and looking back on the year gone by. Some people will look further back, maybe to a previous decade or a decade before that. So as we say goodbye to 2019 and look forward to 2020, let’s go back a little further, to 1999.
This was a momentous year for the ESCRS and in particular for the then president Thomas Neuhann MD, who presented Sir Harold Ridley with the Grand Medal of Merit in Vienna in 1999.
The story behind that great event is recounted by Dr Neuhann in an extract from European Society of Cataract & Refractive Surgeons – A History (Gill & McMillan 2013).
The 50th anniversary of the intraocular lens accorded me the extraordinary privilege of honouring Harold Ridley,” he says. “The occasion deeply touched my heart. His IIIC had been more a conspiratorial circle than a society and now, the whole thing having come of age, the ESCRS was a well-regarded worldwide society and lens implantation is learned in residency. And he had lived to see that happen.”
It was on that occasion that Dr Neuhann came up with the idea of the Grand Medal of Merit, to be an extraordinary distinction not to be awarded every year but just when there is an outstanding personality. “And I had the honour to present the first Grand Medal to Harold Ridley,” he says. “It is unusual for an eye doctor like myself to feel the breath of history. That was one of those rare moments.”
Dr Neuhann met Harold Ridley on the 40th anniversary of the IOL in the US, before meeting again on the occasion of the 50th anniversary. “It was not long after that,” says Dr Neuhann, “that I realised that every country in the world had paid respect to him with the exception of Great Britain, I still have to laugh that I had the courage — some might even call it arrogance — to write to the Right Honourable Mr Tony Blair, prime minister to the Queen. I proposed Ridley for the honours list of the following year, pointing out we were lucky he had lived over 90 years, and urging that he be paid the honour that was due while he was still alive.
“I learned after some time, that he got his knighthood. Ridley was a role model to me, scientific yet practical and with the courage of his convictions: Ridley stood his ground through all the bitter moments of disrespect, which as we know today was not proof that his invention was unworthy — but said more about the limited intellectual capacity of his critics. His set an example which can serve as an inspiration: while you should always be open to learn you are on the wrong side, as long as no one has a better argument — stick to your convictions.”