Eyeworld

18 Ophthalmology Business • September 2016 [operating on someone you know well] is a very reasonable to do," Dr. Tipperman said. The possibility of complications and how that would affect a person- al relationship should be discussed during the initial consultations, Dr. Berdahl said. "What I say is, 'We're friends and what I want you to know is that in this moment, when I'm your doctor, all I care about is what's best for you. Part of that is how you feel about me doing your surgery and how you feel about our relationship in the event that we don't have an outcome that we're expecting and hoping for. It's not a concern for me. I'll be able to play the professional role and the friend role, but if it is a concern for you, let me get you to one of my partners or a colleague in town that will do a great job for you. All I am committed to is you having the best outcome and the best experience pos- sible, and part of that is the psychol- ogy of the situation,'" Dr. Berdahl said. "I think that people appreciate that honesty and that you addressed it, and they usually say, 'No, I'd rath- er have you do it.'" OB References 1. Anyanwu EB, et al. Ethical issues in treating self and family members. American Journal of Public Health Research. 2014;2:99–102. 2. Jones JW, et al. The ethics of operating on a family member. J Vasc Surg. 2005; 42:1033–35. 3. American Medical Association. Preliminary AMA Principles of Medical Ethics: I, VI, VIII, X. Section 1.2.1. 2016. Accessed August 10, 2016. download.ama-assn.org/resources/doc/ code-medical-ethics/code-2016-ch1.pdf Contact information Berdahl: john.berdahl@vancethompsonvision.com Greenwood: michael.greenwood@vancethompsonvision. com Tipperman: rtipperman@mindspring.com could do your surgery, or I can send you to anybody in the world. He said, 'Son, I trust you and I want you to do it,'" Dr. Berdahl said. "It was a mix of pride, wanting to please my dad, nervousness—all of that stuff was mixed into this." In the end, the procedure went flawlessly, despite what Dr. Berdahl admitted were some more nerves than usual on his part. But had it not gone as well as they'd hoped, he and his father were prepared. "A surgeon has to carefully weigh the likelihood of that happen- ing and make sure it's the same thing we do with every single patient," Dr. Berdahl said. "We do the right thing for them, not the right thing for us. So if the right thing for them is to have us do [the procedure], we should do it. If the right thing for them is to have someone else do it, we should have someone else do it." "I think sometimes one of the most effective conversations we have with patients is if we say 'If it were my mother, father, brother, this is what I would do.' Having actually done that on your mother, father, brother crystallizes it," Dr. Berdahl said. Dr. Tipperman said he and his partner use similar logic. "If this person were in your family, what would you tell them to do? If you use that viewpoint, you're always looking out for the patient's best interest. I think if it's something the surgeon is comfortable with and the patient is comfortable with, "I know a lot of people think it's completely inappropriate, but I think many times, especially if the family member is older or English isn't their primary language and the surgeon speaks the primary language that is spoken at home, it makes the patient more comfortable and probably does provide for better care," he said. Michael Greenwood, MD, Vance Thompson Vision, Fargo, North Dakota, said he performed cataract surgery on his mom and LASIK on his wife. While his heart might have been beating a bit faster in these operations, he said once the patient is draped and you're at the microscope only seeing her eye, "you're so focused on doing a good job and taking care of [the patient] just like you would anyone else. "If you're treating every [pa- tient] special, then when you step to someone you know, you're not really changing anything and that helps," Dr. Greenwood added. Cataract and refractive surgeries are more likely to have straightfor- ward outcomes and less risk, though. Dr. Berdahl said a more complicated procedure on a close family member would give him more pause. But when his father, who had Fuchs' dys- trophy, couldn't drive comfortably at night anymore and was recom- mended to have cataract surgery and DMEK, the question of who would do the surgery was raised. "I said, 'Dad, I can do your surgery. There is another surgeon in town who does a nice job and he continued from page 17 " If you're treating every [patient] special, then when you step to someone you know, you're not really changing anything and that helps. " –Michael Greenwood, MD

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