Posted: Wednesday, December 10, 2014

OK, so I’ll go ahead and plan your cataract surgery,” I said to my patient, a friendly woman of about 75 years old. She nodded in agreement.

“Would you like me to do the operation?” I asked. She looked around the examination room, as though she were looking for someone else. She then looked back at me, somewhat surprised. “Yes, of course, who else?”

Good point, I thought. Who else? It was the first day of my six-month general ophthalmology rotation in Saint Francis Hospital, a large community hospital serving northwest Rotterdam.

I had not yet gotten used to the context in which I was working. In my teaching hospital, the Rotterdam Eye Hospital, residents are referred to as “assistants”.

For historical reasons, “doctor’s assistant” is the Dutch term for “resident in training”. Everyone in our hospital understands this outdated term, except the patients themselves, who seem to interpret this as, “Assistant? This person is not qualified to operate on my eye.”

In the community hospital, it’s quite different. Despite being a teaching hospital, with residents in every department, the vast majority of the doctors are full-time staff members.

But for patients, there is no obvious difference between residents and staff doctors; we’re all referred to as “doctors”.

Although I always introduce myself as “Leigh Spielberg, ophthalmologist in training”, my patients simply regard me as their ophthalmologist.

This trust is supported by Dr Gan, the coordinator of ophthalmic resident training in Saint Francis, who is always prepared to strengthen this confidence in his trainees.

So when I asked my patient whether she would like me to perform her cataract operation, it was an unexpected question for her.

For patients in a community hospital, this is their hospital, where they’ve come their entire lives. Their children were born here; their husbands were operated on here.

All their medical records are stored on the hospital’s files. They have a deep-rooted and age-old trust in everything that happens here.

Their hospital-printed appointment card says: “You have an appointment with Dr Spielberg on July 23rd at 14:20.” This trust is thus immediately transferred to me, whether I have my ophthalmologist’s diploma yet or not.


Responsibility and respect

The ophthalmology department at Saint Francis is used to this. Since there’s only one resident in the department at any given time, and since it’s always a resident with four years of experience, we are allowed a great deal of autonomy.

This autonomy, however, is paired with its ever-present siblings: responsibility and respect. This is sharply different from the patients’ expectations in my training hospital, which is a tertiary referral centre
staffed by 30 sub-specialists and 20 residents.

Some patients have been sent here by their primary ophthalmologist for difficult-to-manage conditions, which often require multidisciplinary ophthalmic care.

Others have been treated by the same sub-specialist for 10 years and are not inclined to trust their ocular health to a young, unknown doctor.

Yet others have come from a hundred miles away in search of the “best” care from the “best” doctors, and are convinced that the professor in the next exam room is the best person to treat their blepharitis.

As a young resident, I was often either frustrated or intimidated by these patients, but as my training progressed, this seemed to become less and less of a problem.

“Who else?” my 75-year-old patient repeated. “Who else would do it if you didn’t?” I snapped out of my dreamland. “Well, there are four doctors who work in this department,” I answered, starting my standard cataract-surgery-planning-story.

“All four of us perform cataract surgery. Three are full-time staff ophthalmologists, and I’m in training. I’ve done this operation hundreds of times, but I haven’t yet received my eye doctor’s diploma. However…”

“I trust you,” she said, interrupting me. “Thank you,” I said. “I do too.”

I wasn’t sure whether this was fully true. How could I know for sure? Patients generally seem to trust us, but they don’t really have a choice.

But we have to make this decision for ourselves. We have to take this leap of faith, to jump from the resident’s mindset to that of the ophthalmologist.

At a certain point, a trainee like me has to get used to the idea that I’m the one to whom people are coming for help. I have to develop faith in myself as a doctor, and then I know my patients will, too.

Ernest Hemingway once wrote, “The best way to find out if you can trust somebody is to trust them.” In our context as ophthalmologists, “The best way to allow patients to trust you is to trust yourself.”