The Staff Who Steps Up

 Doing cataract surgery with a resident who is just starting out is surely a very stressful thing for the attending. The patient may not even belong to the attending - they're just here to oversee the care. But there comes a certain time when as an academician, as a teacher, you have to step up and be there for the resident.

I had a patient come to the pre-operative holding area one morning in preparation for his cataract surgery. Despite being told multiple times by multiple people to stop his aspirin a week before the surgery, he didn't to it. We always discuss with our patients, as residents, the use of blood thinners, primarily because in preparation for the surgery we give a retrobulbar block, the biggest risk to which is hemorrhage. But on aspirin, this risk is fairly low. And in the "real" world, a cataract surgeon may not even blink an eye about a patient being on aspirin.

OR, they change their game plan. Doing an anesthetic injection behind the eye (the retrobulbar block) is only one option for anesthesia. The other is simply using topical anesthetic with maybe a little bit injected into the eye. At my stage of training, many of my current attendings would have just cancelled the case - sent the patient all the way back home, only to have to reschedule and repeat the whole process, costing everyone more time and money.

But I was lucky enough to have an attending that day who stepped up. Everyone else would have cancelled the case. But he walked up to me, handed me the appropriate topical anesthetics and said, "We're doing this one topical. See you back there."

That about made him the best attending to do cataract surgery with.  I think.

The Consultant's Magic Words

As ophthalmologists, a surgical subspecialty, we are consulted a lot. As ophthalmologists in an academic center, we are consulted far more than is appropriate. And because we're residents, consults are frequently downright abused.

The fact is, people have learned the so-called magic words which buy a guaranteed-to-see consult. Even if it means the story is grossly exaggerated, if it gets the patient seen that day, that's all the consultee cares about. Of course it's not like this happens all the time, but there are a few key examples.

"It's a painful eye."  I have been told this before only to find out from the patient that, in fact, there was no pain at all. "No, Doc, there's no pain. It's just that I have had this bump on my eye for a few months and decided to come to the ER at 5 PM on a Friday. Gee, I'm sorry you had to work me in for this." Yeah, right.

"The vision is worse than before."  I have been told this before only to find out from the patient that, in fact, the blurriness is only when they first wake up and it goes away after a few blinks. "Oh, and let me guess, you're having eye pain too, right?" "No, Doc, just a little fuzzy after I intensely rub my eyes in the morning. Should I sleep in my contacts?"

Don't exaggerate just to get us to see the patient. It doesn't make you look any better to me. And I will be sure your attending doesn't think better of you for it.

Yes, I Worked Through Lunch

It has not happened recently, seeing as I have been at JEI and ACH lately, but yes, sometimes I have to work through lunch.

What's funny is that some patients, should they come to find out this little piece of information, show a fake sense of sorrow about it. We all know that if they saw me walk by with lunch in my had, they would grumble about their "prolonged" wait.

"Oh, you haven't eaten yet?"
"Why no, I haven't."

For some reason, this is not a subject I like to discuss with patients. It's on par with discussing my age. I am not sure why this is, but it is. Maybe it is because lunch is that brief period of time during the day, even if only for five minutes, when my obligations to the patient population are nil. That is my time, whether I choose to spend it alone or with my coworkers. Or sitting on the phone with my wife. Or running a quick errand to the post office.

I don't ask you about your age or lunch break, so please feel free not to ask about mine.

The Apparent Stigma of Pink Eye

I find it somewhat comical when a patient comes in to the clinic with a routine case of pink eye. Well, not funny that they have pink eye, but how it is often dealt with.

The first thing they do is put up a thick wall of defense. They come in knowing their eye is red and irritate. But there is no way in hell they have been doing anything that would give them pink eye. And so when I bring this up as a possibility from the get go, not long after entering the room, it's as if I have accused them of something dirty. It seems as though this disease is put on par with the clap or something. Then there is this wave of depression or let-down. I've told patients they had cancer and had them handle it better sometimes. Sometimes not.

Well, I don't know where it is you're putting your face, but pink eye not any different from any other infection. I suppose it has something to do with the fact that everyone can immediately tell you're "infected," whereas other infections may require special privilege to know about them.

Update

So allow my to apologize for a little bit of a hiatus there. I have been quite busy with a number of things: writing a paper, trying to polish up an IRB proposal (over and over and over and over), and oh yeah, gathering everything needed to apply to fellowships. I have had a little stress to say the least, and although I enjoy writing here, other things just needed to take precedence.

That paper is more or less finally written. It has been rewritten more times than I can count. All that's really left is going through the arduous process of submitting the whole thing online. We'll see how it goes.

The IRB proposal has been a learning experience for more people than just myself. Starting a prospective study from square one is not something many people at JEI are familiar with. In fact, practically no one is. I have had to have multiple meetings with multiple people just to figure out what might fly. We shall see.

Then there has been the application process. The amount of redundancy has been sickening. Assimilating the information was probably ten times more work than it was for residency - even though the exact same centralized application service is used for both. Where's the trust?

Anyways, as I promised a mentor, here is a plug to his newly begun blog:
http://eyelidsurgeon.wordpress.com/  He has several posts about the do's and don't's that people in the real world care about. Check it out - he is looking for more hits.