EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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30 EW NEWS & OPINION October 2012 Insights Ask Alice by J.C. Noreika, M.D., M.B.A. Author's note: This unique opportunity to write creatively for EyeWorld is extraordinary. Lewis Carroll might have recorded the discussion thus: Editor: "Do you think I've gone round the bent?" Noreika: "I am afraid so. You're mad, bonkers, completely off your head. But I'll tell you a secret. All the best people are." C harles Dodgson was an Anglican cleric, Oxford mathematician, logician, poet, and photographer of Alfred, Lord Tennyson, Michael Faraday, and children. As Lewis Carroll, he is best known for writing "Alice's Adventures in Wonderland" and its sequel, "Through the Looking Glass and What Alice Found There." Classics of the Victorian age, they are unsurpassed examples of nonsense literature. James Joyce's "Finnegan's Wake," George Orwell, "The Wizard of Oz," Tim Burton, The Jefferson Airplane, Pink Floyd, and many oth- ers have been influenced by Carroll's genius. It has been stated that only Shakespeare is more quoted in Eng- lish literature. In neurology, a form of migraine manifesting micropsia or macropsia is called the Alice in Wonderland Syndrome in deference to Alice's ability to change size. We live in curious times: practic- ing ophthalmology, managing offices, providing service, and selling product while keeping abreast of regulation and political inclination in a world that defies logic. The fu- ture promises to become "curiouser and curiouser." Expectations "Just look down the road and tell me if you can see either of them." "I see nobody on the road," said Alice. "I only wish I had such eyes," the King remarked in a fretful tone. "To be able to see Nobody! And at such a distance too!" An ophthalmologist's vexation may be forgiven if aging patients are unrealistic regarding their vision. "Premium" IOLs, "laser" cataract procedures, the "miracle" of LASIK surgery have raised the bar such that anything less than perfection is perceived as a failure. Victims of success? Of media? Of culture? Of ourselves? We may be better served promoting what modern eye surgery can't do. Otherwise, a trial-lawyer Queen might advise, "Off with their heads." Practice as art Alice came to a fork in the road. "Which road do I take?" she asked. "Where do you want to go?" responded the Cheshire Cat. "I don't know," Alice answered. "Then," said the Cat, "it doesn't matter." Young and old, ophthalmolo- gists face many choices. Private practice? Consolidate? Stay small, independent? Retire? Adopt new technology? Electronic health records? Hire an optometrist? Offer optical dispensary services? Who's going to manage all this? Who's going to pay for it? In unfeigned nonsense, there are no answers, just more questions. But if you don't ask the right questions, it truly won't matter. Universal healthcare "Now, here, you see, it takes all the running you can do, to keep in the same place. If you want to get somewhere else, you must run at least twice as fast as that!" The erstwhile uninsured are predicted to at least double demand for healthcare services. Ophthalmol- ogists are caught in a farce of Joseph Heller dimensions. The U.S. is broke. It cannot fairly compensate doctors. Yet millions of potential patients have been legislated access to the system. Apropos of the old joke, lose money on each patient but make it up in volume. Economically, ophthalmologists "used to be much more "muchier." The coming of ICD-10 "When I use a word," Humpty Dumpty said in rather a scornful tone, "it means just what I choose it to mean—neither more nor less." "The question is," said Alice, "whether you can make words mean so many different things." "The question is," said Humpty Dumpty, "which is to be master— that's all." Human Health & Services Secre- tary Kathleen Sebelius has delayed the Centers for Medicare & Medic- aid's implementation of ICD-10 to Oct. 1, 2014. ICD-9 has approxi- mately 13,600 different codes that must be used to comply with and obtain compensation from health insurance programs. ICD-10 will include—wait for it—more than 69,000 codes. By design or poor planning, physicians will concur- rently be required to have imple- mented electronic health records by 2015 or face economic penalties. Cheshire Cat: "She's mad. He's Mad. I'm mad. We're all mad here." Alice: "I don't want to be among mad people. I'm not mad!" Cheshire Cat: "But, you're here, aren't you?" What to do? "Everything is funny, if you can laugh at it." Can't? Lewis Carroll can still help. "One of the secrets of life is that all that is really worth the doing is what we do for others."We have the opportunity everyday. It'll get us through the absurdity. EW Editors' note: Dr. Noreika has practiced ophthalmology in Medina, Ohio, since 1983. He has been a member of ASCRS for over 30 years. Contact information Noreika: JCNMD@aol.com