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.”
Truly original changes need a particular kind of environment
Does regulation result in decreased levels of innovation? Looking at the history of ophthalmology, one has to wonder if the advances made by the greats such as Harold Ridley and Charles Kelman would have been possible if the arms of medical ethics and safety were as prevalent as they are today.
“Things were different in those days,” said Prof David Spalton in a EuroTimes Eye Contact interview with Paul Rosen MD. “These days, with ethics and regulation – I think there’s always room for someone with a brilliant new idea to do things differently, but I don’t think anyone could do it in the same way that they did, which was really without any ethics, consent or that sort of thing.
“It’s a good thing now, things are better regulated and that must be in the patient’s interest.”
Harold Ridley, who first saw the possibilities of intraocular lenses and indeed brought them to reality, performed his first operations in secret, such a revolutionary procedure it was at the time.
It’s important to remember that while the reward was truly great, for many millions of patients, there was also substantial risk in his novel idea. “Had Harold Ridley’s first operation gone wrong, we might not be here,” said Prof Spalton.
Indeed, the materials used to sterilise early PMMA lenses leached into the eye, causing anterior uveitis, to give just one example of something that could ideally be prevented by regulation. “Times were different back then – surgeons had an idea and they could try it out and experiment,” adds Prof Spalton.
Charles Kelman, a showman by nature as well as being a pioneering ophthalmologist, took the opposite approach, going on television talk shows to expound about the possibilities of his approach, which he famously arrived at after many failed attempts over a course of nearly three years searching for a method of cataract removal that would require no hospitalisation.
It almost goes without saying that phacoemulsification is now the norm, and advances like femtosecond laser-assisted surgery have been shown only to be as good as phaco.
It’s unclear what the next major change in ophthalmology will be, but artificial intelligence is sure to play a part, Prof Spalton believes. “Automation, robotic surgery is coming in, and we’re going to see that taking an increasing role.”
He also suggests that eye trackers could be combined with femto lasers for lens removal. Maybe not just yet, but the rate of progress to date has been such that nothing can be ruled out.
Whether such things will be helpful in creating a truly accommodative lens, the next hurdle for ophthalmology according to Prof Spalton, remains to be seen. The only change we can be certain of, is change.
Maryalicia Post shares some hard-earned tips for visitors to the French capital
What do Gene Kelly and I have in common? Singing? Dancing? No, and not a cheeky grin either. He and I were each An American in Paris. In his case it was for two hours in the famous film; in mine it was for six years in real life. In that time I made a few observations that might be helpful to anyone planning a visit. I realise they are only my conclusions seen through the lens of my personal experience, but if they’re of any use to you – you’re welcome.
1) The French are ‘serious’… by which I don’t mean they are reluctant to laugh. I mean shop attendants, waiters, bus conductors et al seem to have a more professional approach to their job than you might find elsewhere and expect to be treated with due courtesy. On going into any shop greet the staff with ‘bonjour’. (If there are other customers include them with a smile). In a bakery, for example, do not rush in and snap ‘one croissant’. Start with Bonjour and end with Merci.
2) You can’t go wrong if you wait to be shown where to sit, even in an informal cafe. If in any doubt, just stand and look bewildered; someone will point you to a seat, and you’re off to a good start.
3) Don’t feel rebuffed if sales attendants ignore you. In most cases the custom is for them to be available when/if you want help and to stay away until addressed. And, nothing personal, but a French waiter is not automatically your new friend. A smile may not be on the menu.
4) Expect your appearance to be checked out by both men and women in public places like the Metro. Parisians go to some trouble to look their best and assume you do too; being invisible is not the goal.
5) In general, don’t go looking for examples of ‘how rude the French are’. Don’t construe a runny omelette, bloody lamb or smelly cheese as indifference. Au contraire. It’s the way ‘they’ like it and they assume any reasonable person would as well. Make a polite request for a change if necessary.
6) Use whatever French you have. I got used to asking a question in French which would be answered patiently in English, leading to my next question in French, also answered in English… a kind of bilingual duet. When the answer comes in French, buy yourself a drink.
7) If you can’t walk to your destination even in your most comfortable shoes (which you should bring for this very purpose), take the Metro. The best reason for taking the Metro is to avoid taking a taxi. Here’s a useful Metro guide.
8) Are there really rude people in Paris? Oh yes, and they all drive. If you take a taxi you may well find yourself up close and personal with a very rude person indeed. He or she may pretend not to know where you want to go – I always write out the destination and show it in advance – or will bury you under an avalanche of explanations in French as to why he or she is approaching the city via Versailles. Meanwhile, the meter runs on. I pre-book a car to meet me at the airport as this scam seems endemic at CDG. However, if you must, well, c’est la vie. Here’s a good guide to taking a taxi in Paris.
Bon voyage and merci.
How one hospital built awareness and leads by drawing from the digital marketing toolkit
I think it’s common knowledge now that if you want a healthy body, there’s no magic bullet. The celery diet is neither sustainable nor effective alone. You need to combine a balanced diet with an active lifestyle, plenty of rest and recuperation, and a positive mindset. It’s this combination that achieves the best results.
We can apply this concept to your practice. If you want a healthy marketing function, you can’t rely on a panacea to solve all of your marketing challenges. Equally, you can’t expect a shotgun approach to work either – firing as many pellets as possible and hoping something hits. The best results come from a synergy of approaches aimed at very focused objectives.
In 2018, the ESCRS Practice Management Conference set its attendees a challenge; create a marketing campaign that:
Helps create awareness about the practice clinic;
Results in an increase in inquiries and new patients that translate into additional revenue.
Ready to take on the challenge using a multidisciplinary approach was The Beirut Eye & ENT Specialist Hospital (BESH).
BESH is one of the top specialist eye hospitals in the North Africa and the Middle East region. It offers a complete range of services covering all subspecialties in the ever-growing field of ophthalmology.
BESH took the criteria set out by ESCRS and designed a digital marketing mix to generate awareness about glaucoma and promote the company. And it won!
In fact, it exceeded all expectations; reaching thousands of individuals, screening hundreds of patients, collecting data for more than one-thousand patients and scheduling hundreds of follow-up consultations.
Sharing the company’s success story at this year’s ESCRS will be BESH General manager and Director, Michael Cherfan.
He will be revealing the company’s winning approach and sharing helpful advice and tips so that you too can leverage digital media to improve awareness of your clinic, increase inquiries, attract new patients and ultimately drive revenue.
Specifically, he will explain how you can design an interdisciplinary digital platform that focuses on four main channels:
SEO / Google
By the end of this presentation, you will have the knowledge and awareness of how one clinic completely revamped their digital presence to benefit from improved publicity and more leads.
The ESCRS Practice Management and Development Programme will take place on Monday 16 September from 08.00 – 18.00
Divers come to manta ray's aid as ophthalmology goes underwater
Giant manta rays can reach up to seven feet in length. That’s a whole lot of body to come up against whatever ends up in our seas and oceans. One such ray recently found herself with metal hooks in her eye. Thankfully, some conscientious divers were on hand to help out the poor creature.
“I went for a few dives down just to see how she’d react to us being close to her,” said Jake Wilton, photographer and diving instructor.
“This wasn’t my imagination, again and again it came back, turned over, and paused in the water, and – plainly – was looking to us to be helped,” added Monty Halls, photographer, naturalist and marine biologist.
Just like in ophthalmology, the doctor had to gain the trust of the patient.
“Jake went down again and again and again and the animal didn’t move away, because I think the manta knew that Jake was trying to get the hooks out,” Halls said.
He managed to remove the hooks with pliers, to everyone’s relief.
“I went down again one last time to say goodbye – she actually stopped and just waited there,” said Wilton.
Freckles and Jake's story has just featured on @thismorning! Amazing to see that it has reached so many – really demonstrates the power of video and an incredible story! #MondayMotivation #AnimalRescue #FilmProduction #MarineLife pic.twitter.com/hNhgHvKUJN
— Seadog TV & Film Productions (@SeadogProds) July 15, 2019
“Many divers dive ‘to get away from it all’, to disappear into a place completely separate from the rest of the world,” says vitreoretinal and cataract surgeon and diving enthusiast Leigh Spielberg. “It is a form of escapism into the beauty and silence of the sea.
“One’s day job is usually as far from one’s mind as possible while exploring under water. However, in this video, the divers were confronted with what might be considered an ophthalmic emergency; a hook was lodged in or around the manta ray’s eye,” he said.
“As someone who has operated my fair share of ocular trauma, I am aware of the difficulty and potential danger associated with ocular foreign objects, but these divers, presumably non-ophthalmologists, seem to have done a great job combining their hobby with impromptu ophthalmic care for this gentle giant,” Dr Spielberg concluded.
The prompt I needed to declutter my email inbox
I got an email from my potted palm the other day. I was reminded of the letters I sent home from summer camp when I was a kid. No preamble, no ‘hope you’re well’.. Just straight into the complaint. The plant was reporting that it was thirsty and needed more sunlight. As it happened, I felt exactly the same, so I could hardly blame the plant. Still, receiving an email from a palm tree reminded me I’d been meaning to cut the clutter in my email box… and prodded me to start looking at all the good advice out there on the net.
If you are finding a marked increase in the volume of your email, it may be helpful to know it’s not you – it’s us. It’s a worldwide phenomenon. As a travel writer, for instance, I’m getting email from the tourist bureau of every place I’ve ever visited including some I hope never to visit again. Although the inbox of an ophthalmologist or other medical specialist is not as overloaded as that of general practitioners, there’s no escaping the trend and the overall trend is up across the board (regardless of your field of endeavour). An article in MD focuses on the physician’s problem and offers suggestions for dealing with it. Another handy list of tips is here.
Perhaps you’ve chosen to offer your patients the option of email communication with you – and there are arguments for and against offering this service. If you have opened email communication with patients, you’ve probably set up a secure email address for the purpose and may well have messages screened by an assistant, which makes life easier. Detailed advice for managing patient emails can be found here.
All this negative talk about emails doesn’t paint the whole picture. One article describes emails as “an exciting landscape of freedom amidst the walled gardens of social networking and messaging services”. It talks about the feeling we all sometimes experience when a welcome message comes bounding in; it concludes that “email is exciting”.
And so it can be. To be honest, I didn’t really mind receiving that message from a thirsty plant and was glad to be reminded to water it (as for the sun shortage, I’ve ordered a grow light). Obviously, I could unplug the Bluetooth-enabled gizmo I stuck in the soil, thus cutting off communication at the root. But I’m not sure I am ready to ghost the palm tree so early in our relationship. A message from a potted palm seems ‘special’, like hearing from a distant star. Come to think of it, I’ll probably find a transmission from a distant star in my inbox one day. And when I do, it will be exciting.
Maximising patient flow in a busy refractive clinic starts before patients arrive
I’m excited to welcome Arthur Cummings to the Practice Development Workshop that I’ll be moderating at the 37th Congress of the ESCRS this September. In Paris, he will present a session called “Optimising Patient Flow in a Busy Practice”. Having consulted in busy refractive settings for the past 20 years (including Mr Cummings’ practice), I have accumulated a wealth of experience in planning effective patient pathways – especially before patients have surgery. In this article, I share my top tips for maximising your patient flow before and during first appointments.
Send an effective confirmation email
Maximising patient flow in a busy refractive clinic starts before patients arrive for their first appointments. Begin with an effective appointment confirmation letter. Here’s the outline I recommend:
Begin enthusiastically and continue that tone throughout the letter
Write personally, from a real person to another real person – avoid stuffy corporate-speak
Take personal responsibility for your patient’s experience and let them know who is responsible to answer their questions before they visit
Mention the date and time (in bold print) within 15 seconds of reading
Tell your patient exactly what you’ll do at the appointment in bullet points – this is your opportunity to show value
Tell your patient how long they can expect to be there (this is crucial to avoid patients needing to leave before you’re done)
Tell your patient how much they can expect to pay (using guide price ranges) should they wish to commit to a procedure so that you can qualify and prepare patients financially
Tell your patient how to prepare for their appointment using a numbered list (what to bring, what to do)
Provide specific instructions related to any attachments you send (maps, questionnaires, registration forms)
Finish with an open invitation to ask questions or change their appointment
Send a follow-up message to the patient’s mobile phone
We get so much email today, many people fail to check it. Nearly everyone, however, looks at text messages on their phones shortly after they arrive. I recommend sending an SMS or WhatsApp message to patients a couple of days before their appointment. In the message, write something like:
“We’ve sent you important information relating to your upcoming appointment at [our clinic]. Check your email.”
That should prompt the patient to check their email so they have the information they need, saving you time down the road.
Plan your clinic day to convert the patient at the first appointment
To perform a reasonable volume of refractive surgery, you need to dedicate a floor’s worth of your clinical space and a team that devotes its day to efficiently processing first appointments. I appreciate that not every clinic chooses this route. However, if you want to do this, this is my best plan for it.
I recommend your clinical team starts every day with a daily huddle that everyone seeing patients that day should attend. That includes receptionists, patient liaisons, healthcare technicians, optometrists and surgeons. During the huddle, share wins, share MTD (month-to-date) numbers, follow-up on errors and go through every patient’s top line notes made by the booking team. Anticipate, discuss and then plan accordingly for circumstances that might affect today’s diary.
For every patient, I recommend the following timeline assuming a patient arrives at 8:45am:
8:45am: The patient arrives 15 minutes before their appointment begins in your diary (if you book a patient in for 9am – have the booking team tell them their appointment starts at 8:45am). That accounts for lateness and enables on-time patients to complete necessary registration forms before someone needs to see them. This is the receptionist’s opportunity to make the patient feel at home and help them transition from their journey into the appointment. Relaxed patients make for cooperative patients.
9:00am: The patient liaison should see the patient for 10 minutes (I allow 15 minutes) in a private room. This gives the patient liaison time to lead the patient through a discovery questionnaire (in private). This step helps to clarify expectations for the patient and prepares the clinical team to address the patient’s emotional needs. You may imagine this might be an unnecessary luxury of time and space, but it can save a lot of time down the road and definitively improves conversion rates.
9:15am: In a flexible refractive surgery pathway (allowing for assessments for both laser vision correction and lens surgery), a healthcare technician will need 30 minutes to perform the necessary assessments. I recommend two diagnostic rooms so you can swap post-ops in-between first appointments for maximum efficiency.
9:30am: In the UK, optometrists can assess a patient for vision correction suitability and recommend a treatment plan. In this scenario, I favour having the optometrist doing most of the initial work-up because they are a less expensive resource compared to a surgeon. I recommend 45 minutes for this part of the appointment. If your setting doesn’t allow for this scenario, an optometrist can see the patient for 30 minutes and then a surgeon must see them for 15.
10:15am: Now, the patient goes back to the reception room where the patient liaison sees them again for up to 15 minutes to offer dates and times for the surgical and consent appointment with the surgeon. That should give them enough time to answer administrative questions, ask for a payment, overcome objections, and provide the patient with the takeaway information they need.
If you have a surgeon available during the clinical day, then I recommend having the patient go through a 15-minute consent appointment with the surgeon on the same day – immediately following their visit with the patient liaison – whenever possible. If you do not have a surgeon available on the same day, then you’ll need to book this appointment at a mutually convenient time before the surgical appointment.
Ideally, my patient pathway plan relies on having two patient liaisons, two healthcare technicians, two optometrists and one (optional) surgeon (if you want post-op support and same-day consents) on the clinic floor.
Regarding space, my plan relies on two private rooms for patient liaisons, two diagnostic rooms, two optometric lanes and one (optional) surgeon’s office (again, if you want post-op support and same-day consents) on the same floor.
My plan allows everyone to get a 30-minute lunch. Furthermore, I schedule the patient liaisons to cover reception when they go on staggered lunch times.
As a buffer to account for lateness and unforeseen events, I add 15-minute buffers between tests and exams to allow for late patients.
With my plan, you can see eight initial refractive appointments per day. Double up the diary and you can see 16 initial refractive appointments and still see all the necessary post-op appointments in between. To the left I share a sample of a diary I planned for a busy refractive clinic in London, UK.
I hope you’ve found this useful. With the necessary customisations, you can apply this to your own setting. If you need assistance, contact me at email@example.com
Why is it you can often struggle to innovate when it comes to marketing or enhancing customer service?
Innovation is the art of introducing something new, and cataract and refractive surgery have an impressive history of innovation. Think:
Phaco and small incisions
Refractivisation of cataract surgery
As an ophthalmologist, your practice constantly challenges you to think divergently, come up with new solutions for patients and pivot when initial ideas fail in order to achieve the results you want. It’s in your nature. So why is it you can often struggle to innovate when it comes to marketing or enhancing customer service?
Perhaps you just need some inspiration. Here are some useful ways you can foster innovation within your practice:
Be a conscious consumer. Whenever you’re engaging with any business as a customer, ask yourself, what’s the story they’re selling? Who is the ideal customer they are trying to attract? How do I differ from that? How do I fit? What stage of the sales funnel am I in? What phase of the customer value journey am I at?
Hundreds if not thousands of messages impact you every day. Consume consciously and you’ll be on the way to picking up valuable ideas and lessons from your daily interactions with companies.
Maximise everything. When you see robust marketing communications or experience superior customer service, ask yourself – how could I apply this to my practice? How would I make this even better? How could I make this even more customer-oriented?
Copy existing ideas. You don’t need to reinvent the wheel or be the first person in the world to come up with an original plan. The most creative people also tend to be excellent copiers. The famous composer Igor Stravinsky supposedly said: “Immature artists copy, great artists steal.” That doesn’t mean to plagiarise. Instead, find inspiration in the work of others, then use it as a starting point for original creative output. What great ideas already exist that you could apply to your practice?
Generate lots of bad ideas. Self-censorship is the thief of creativity. Don’t reject your ideas too early. Just get them out (write them down, speak them out) and only evaluate them on their merits once you’ve spent all of your creative juices.
Embrace constraints. Some would argue that constraints are a necessary condition for innovation to occur. How can you make the boring, sexy? How can you get attention with no money? How can you stand out in a sea of established competitors? How can you make a commodity feel like an experience?
When faced with limited options, you’ve got to think your way out of a little box – and therein lies the breakthrough.
Remember, ideas are typically free and when executed with enough flair and passion can bring huge rewards even on a tight budget.
If you’re an ophthalmologist with an innovation that enhances patient services, you should enter the ESCRS Practice Management and Development Innovation Award 2019.
Shortlisted entrants will be invited to give a presentation on their projects at the 37th Congress of the ESCRS in Paris. The winning entrant will receive a €1,500 bursary to attend the 38th Congress of the ESCRS in Amsterdam, The Netherlands in October 2020.
Go here to enter.