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Ophthalmology in crisis

Confronting new realities is key to successfully reopening after COVID-19

Howard Larkin

Posted: Thursday, July 30, 2020

In times of great trials, Eric D Donnenfeld MD reflects on the words of Admiral James Stockdale, who spent seven years as the most senior US Naval officer in a North Vietnamese prison camp and received the USA’s Medal of Honor for his leadership.

“You must never confuse faith that you will prevail in the end – which you cannot afford to lose – with the discipline to confront the most brutal facts of your current reality, whatever they might be.”

Such is the essence of leadership required of ophthalmologists returning to practice in the face of COVID-19, said Dr Donnenfeld, of New York University, at the ASCRS Virtual Annual Meeting 2020. “We must care for our patients, we must preserve and improve vision, and we must do no harm.”

That means not only providing technologically advanced eyecare. It also means straightforwardly addressing new realities, such as enhanced infection control, virtual medicine, and financial and management stress, required to provide patients with the safety they expect and deserve.

“Hope is on the way. I look forward to a new dawn in managing ophthalmic care,” said Dr Donnenfeld, who co-chaired two symposia on reopening practices after one-to-three months away due to the COVID-19 pandemic.

Leadership qualities


Bruce Maller

The job of a practice leader is three-fold, said Bruce Maller, founder and CEO of BSM Consulting, based in Incline Village, Nevada, USA, and specialising in healthcare practice management: protect the integrity of your business; responsibly manage your team to the other side; and stay connected with patients, colleagues and strategic partners. That means ensuring practice finances and business arrangements are preserved as much as possible while doing right by employees and others critical to reopening.

Mr Maller identified several important qualities of a successful leader. Stay calm at all times. Educate yourself on the challenges – and opportunities – you face. Act the part – what you do and say and how you say it affects other people. Be decisive; this is not time for paralysis by analysis. Be selfless; many are leading the way by cutting their own salaries to help employees.

Effective leadership also requires hope to inspire yourself and your team, Mr Maller said. “We got this. I’m confident we as a team can appropriately manage our way.” Be clear and concise in your communication, including business essentials such as how much cash the practice has and how it is being used. And always demonstrate empathy for the trials of others.

Mitigate fear

Cultivating courage and confidence among staff and patients is a critical leadership skill for emerging from the current crisis, said psychologist Craig Piso PhD, president of ophthalmology management consultants Piso and Associates, based in Larksville, Pennsylvania, USA. “The linchpin question is will people feel safe enough to re-engage in their previous roles.”


Craig Piso PhD

The answer comes in two steps. First, practice leaders must find within themselves the courage and strength to face the deadly virus itself as well as all the physical, financial and psychological challenges that come with it. Second, leaders must provide influential leadership that instils that courage and strength in patients and staff.

“Courage is not the absence of fear, it is taking deliberate, effective action even when your knees are shaking,” Dr Piso said. He recommended stoicism as a philosophy and a practice to gain internal courage. It entails shifting focus from external circumstances over which we have no control, to managing internal thoughts, beliefs and expectations.

The resulting internal victories in managing attitudes, emotions and exercising personal will pay off in enhanced tranquillity, fearlessness and freedom in the face of adversity, Dr Piso said. “This will exude a vibe that helps your people.”

Dr Piso also referenced what he called the Stockdale paradox as a touchstone for crisis leadership. Through years of torture “he maintained an unwavering sense that he would prevail in the end, details to follow, not knowing when or what would happen, but believing in the end that victory was his to have”.

For the public victory, shift from “I” to “We,” engage staff in developing a detailed action plan and empower people with information, Dr Piso said. “Inspire loyalty and followership.”


The newest addition
to the Berdahl household

It took a pandemic too…

Leadership also means taking the opportunity to re-evaluate professional and personal goals, said John P Berdahl MD, of Sioux Falls, South Dakota, USA. It took a pandemic to bring home first principles.

Just as in the military where officers eat after their troops, “we need to put our team and those that are most vulnerable first”, Dr Berdahl said. He also realised the rules of the game of life and practice are shifting rapidly, requiring constant attention and more-adaptable responses. “The goal is to keep playing and keep playing better.”

On a more personal level, the pandemic has given Dr Berdahl time to build a non-ophthalmology dimension to his life. “Life has slowed down enough that we can seek out whatever it is to be a normal family.”

That includes getting a puppy, learning guitar and walking an hour a day with his wife, which has become a powerful grounding force in Dr Berdahl’s life. “Working 20% less for 30 % less pay is probably a good trade.”