EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/76185
8 EW NEWS & OPINION The physician's continued from page 3 EyeWorld @EWNews Are you a fan of EyeWorld? Like us on Facebook at Find us on social media facebook.com/EyeWorldMagazine University of Michigan who studied outcomes among hospitals. Compli- cation rates differed little. The best failed as often as the worst. What set the best apart "was rescuing people when they had a complication, preventing failures from becoming a catastrophe." "When things go wrong, there seem to be three main pitfalls to avoid, three ways to fail to rescue." Each can turn a problem into a tragedy. On the world stage, their combination can cause a humanitar- ian crisis. The most competent among us learn to avoid choosing the wrong plan, the inadequate plan, and especially, no plan. This may be news to the naïve, but after grappling with a ruptured posterior capsule or positive vitreous pressure, eye surgeons can be par- doned for their puzzlement. It's not their extraordinary hand-eye coordi- nation that differentiates ophthal- mologists. Rather, the best manage expectations suddenly turned omi- nous, have a plan of rescue, and know how to act in the face of fail- ure. Hemingway called it "grace under pressure." The triad of pitfalls inherent to Mrs. C's presentation could bedevil a consulting ophthalmologist. Misdi- agnosis is the wrong plan potentially leading to inappropriate testing, Follow EyeWorld on Twitter at twitter.com/EWNews even surgery, while increasing the risk of cataclysmic stroke. Lack of follow-up to recognize rare compli- cations such as neovascularization and glaucoma is the inadequate plan. Neglect to coordinate with Mrs. C's internist to manage her life- threatening vascular disease is no plan, the most egregious mistake. In medicine, the calculus be- tween taking risks, an intrinsic pre- requisite of surgery, and handling the "complexity and uncertainty" of unanticipated events is exacting. Whether performing microsurgery or laboring in the clinic, how one manages the inevitable complica- tion—dislocation of the DSAEK transplant tissue, a dropped nucleus, a LASIK patient with progressive ec- tasia, a disgruntled premium lens pa- tient, or even the daily vexations of running an office—foretells failure or rescue. The best will balance con- fidence with a capacity to fearlessly question assumptions. "The sooner you're able to see clearly that your best hopes have gone awry, the bet- ter." Time to adjust, reconsider, and modify is critical. Mrs. C is alive at 88. Kindly, Dr. Gawande does not indict her for negligence. The day before losing vi- sion, she experienced a brief episode of amaurosis in her left eye. An op- portunity to rescue, she did nothing. Although her blind eye changed her life, she predictably reports that "life is not perfect, but it is good." The prudent ophthalmologists who read Dr. Gawande's address will apply his advice to their lives. Our litigious society deems even un- avoidable misfortune insufferable. Ironically, our world is increasingly fraught with risk, personal irrespon- sibility, and ever-present failure. It is the human condition. How we pre- pare and, especially, act in failure's presence helps us, the perfectly im- perfect, burnish our best within. EW Editors' note: Dr. Noreika will be writing a new column in EyeWorld and Ophthalmology Business titled "InSights." Look for his article, "Femtosecond: The billion dollar bet" in July's Ophthalmology Business. Dr. Noreika has no financial interests related to this article. Contact information Noreika: jcnmd@aol.com July 2012 Take Your Practice to the Next Level BY ADDING A HEARING CARE CLINIC Vision and Hearing - Dual Sensory Treatment • Sustainable Business with High Profit Potential Created for Eyecare Professionals by Hearing Professionals Experts in Hearing Care with 240 Locations Nationwide For More Information Call Today! Avada Hearing Care 1-888-982-8232 Partnering Vision & Hearing www.avada.com © 2012 Hearing Healthcare Management, Inc.