Having Someone Under Me

You've probably heard of my intention of going into academic medicine. You may have hear me mention it. Sure there is a pay cut with it, sometimes quite a large one; although, the hours aren't near as strenuous for the most part.

But now that I've been something more than the most junior of residents for over six months now, I really think I have had a chance to confirm what I want to do. I rather enjoy the opportunity to teach. Since I've had more junior residents around, I have had plenty of opportunity to do this. Even if it's not always teaching a blurb about ophthalmology but rather imparting a gem of practicality in the management of a patient. Presenting a case at grand rounds is not such a bad thing, though sometimes the simple act of putting together the information in the form of a power point can be grueling and hard to begin. And I am supposed to have a lecture with the technician students coming up as well. Good stuff.

If only I could teach some people (no, not just any people; trained and practicing ophthalmologists in group practices) how to manage text book cases and navigate the health care system. I don't know a lot of things, but sometimes I just want to say, "C'mon!!" I've always thought a good reason to stay in academics was easy access to staying up to date on things, but one would think so-called "continuing education" would do the same thing.

Seeking a Travel Agent

Job Description: Must be able to adequately and efficiently book multiple short-duration trips, sometimes at the drop of a hat. Must be flexible in terms of departure/arrival times and able to make changes to any previously arranged trip. Must be able to contact airport security prior to any departure so that they may understand why I have a one-way ticket somewhere so as to minimize suspicion and unwarranted overly friendly body searches. Must use my account with Southwest and my credit card so that I continue to accumulate points with both. Must be able to research and effectively utilize all methods of travel, including plane, car, public transport (rails, buses, carriages), taxis, horseback, and shuttles while minimizing use of rental vehicles. Must be effective and utilizing family, friends, and friends of family for reasonable lodging options. Must be able to select hotels, when appropriate, which combine in the best way possible shuttle service, proximity to target interview and dining locations, cleanliness, and cost while avoid the use of brothels. Must be able to ensure that my suits, shirts, ties, shoes, and underwear are clean before packing for each trip. Must be available via telephone, text message, or email throughout the entirety of the day. Must be willing to coordinate my absenteeism with my superiors and fellow residents in terms of clinic and call duties, respectively.

Oh, and one more thing. Compensation will not be monetary and may be in the form of a hug, small gift or gift card, or dinner where I may or may not cover your meal.

Please contact me if you are interested or need more information.

The Facebook Dilemma

The whole process of applying to fellowship programs has been many things: expensive, stressful and tiring, exciting, humbling, just to name a few. But it is also far more intimate than the residency application process. A few hundred people apply each year to ophthalmology residency programs, and what program would have the time to thoroughly investigate each applicant?

Fellowship is different. In a given match cycle for an ASOPRS oculoplastics fellowship, there are typically between 20 and 25 positions available across the country. These will be applied for by between 40 to 60 or more people. If I haven't mentioned it before, those are the odds I am up against - pretty steep. At any rate, the point is, it's a much more intimate. There are few applicants that can be eliminated early and easily - those who try to "see what will happen" but aren't competitive on paper.

So suppose you've been able to knock your applicant pool down to around 30 to 40 candidates. That's still a lot of people to try to interview for only one position, and you simply don't have the time - your clinic and OR are still booked after all. So how do you further screen these people quickly, without making them pay a bunch of money to come out and talk with you only to find out they don't belong with you? A couple programs have chosen to do Skype interviews - two of which I have done. (I will discuss the pros and cons of a Skype interview later.) 

The other option is Facebook. Let me first point out that I am vehemently against employers using Facebook as an additional source to screen potential employees or candidates. There remains, for most people, a sharp distinction between one's professional life and one's concurrent (or especially past) social life. Let's not forget that Facebook is a social network, not a professional network. There are separate networks for the professional side of things. But still, people do this.

While I used to have my Facebook profile open to viewing by people not listed as "friends," I recently restricted viewing to only my friends. Not that there is anything too incriminating on there - no pictures of me drunk and stupid, barely half dressed (except for some beach photos of my pale bod),  or overly direct, opinionated statements. Nonetheless, some people would think to form opinions of how I would function in a fellowship based on all that stuff.

Well now they can't.

My Own Office Space

You know what I think one of the best things about the VA is?  My own office space. Or at least it's mostly mine. It gets used from time to time by other folks when I'm operating or not there, but overall it's my space. I can organize and run it however I want. At JEI and ACH, we are not afforded this liberty and the rooms are much more public which means searching for what I need every time I see patient. I'm not sure what the best solution for this is, but it can be a problem.

I never understood why people with their own rooms felt the need to put up signs that instructed borrowers of the room to be sure to leave it in its original condition. I always felt it was a little juvenile. But I can see where the point is - I hate it when I walk into my room on a Friday morning after someone else used it Thursday afternoon and there is trash on the desk, bottles of drops strewn all about, and materials not stocked. This is not an exaggeration at all - it's typical. I still don't think I'll put up a sign in colorful, bold letters, but then again, it should be universally understood.

I wonder if it needs new cabinets?

Hiatus

Allow me to apologize for my recent hiatus. December proved to be busier than I planned. But alas, here is a quick update to be followed by more regular posting again in the present future.

The last time I wrote I had only two weeks before submitted the majority of my application materials to the available programs. Well, it's nearly two months later - what's going on?

I have had two interviews so far - at University of West Virginia and Massachusetts Eye and Ear Infirmary (Harvard) - but both via Skype. The up - I didn't have to travel all the way to these places only for them to decide they don't like me well enough to actually want me. This allows them to screen a lot more people, and then only invite out the ones they want. So I know if I ever get invited to actually visit, they are seriously interested in me and I should thus be very interested in them. The down - it is very hard to gauge a program and its personalities through a computer monitor and headphones.

I have also since then booked three more interviews - at Indianapolis, Seattle, and Milwaukee. The worst part about these is paying for lodging, followed by the flight, followed by transportation, and then the actual travelling. We shall see.

And I just found out today that the University of Iowa is only accepting internal applicants this year - sure seems they could have made that decision before I payed the money to send them my application. Their loss overall, I guess. Sounds like some internal shadiness anyway.

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.