Eyeworld

109 OPHTHALMOLOGY BUSINESS February 2018 digital.ophthalmologybusiness.org have trained and include your years in medical school," Dr. Lombardi said, adding, "You can also mention any experience with eyes or surgi- cal techniques in your research or other settings. This is all worthwhile training and experience that has led you to the point of practicing independently." One thing physicians can con- trol about their physical appearance is how they present themselves. Dr. Loh said she has made a concerted effort to be more even formal in her professional dress while in clinic. Dr. Garg noted that 4 years ago he grew a beard, and afterward he seemed to receive fewer questions about his age and experience. He acknowl- edged he is not sure if this resulted because he looked more mature or if his reputation in the field was growing. "Looking true to your profes- sion, head-to-toe, is important," Dr. Ram said, adding later, "The most important thing you can do is maintain your confidence and positivity throughout the day. I think that maintaining a good pos- ture, speaking with confidence, and acting confident (but not obnox- iously confident) can help you gain a patient's trust." Dr. Lombardi said when she was young in practice, dressing professionally made her feel more confident in her interactions with patients, but as years have passed, she now feels comfortable wearing nice scrubs and her white coat with- out thinking she is perceived as "too young." Outside of outward appearance, Dr. Loh said she makes an effort to speak slowly with good enunciation and eye contact. "A lot of our cataract patients might be hard of hearing," she said. "I always try to be friendly and take pauses in my speech. I give them 10 to 15 seconds of silence so they can ask a question. I slow down the pace a little bit." How many times you've seen a patient could influence his or her confidence in you, too. Dr. Garg said his approach to preoperative appointments prior to scheduling surgery is individualized based on the patient. "Some patients are referred in for cataract surgery, so one visit is enough," Dr. Garg said. On the other hand, "Some patients ar- en't mentally ready for surgery, so reassuring them that waiting a few months likely won't change their outcome is appropriate. Others need several visits to optimize their ocular surface and [getting] repeat measure- ments is necessary." Dr. Ram also said a single visit can be enough to develop rapport with patients, especially if they were referred for surgery by another doctor. If patients didn't know going into the appointment they might need surgery (if they didn't know they had a cataract, for example), having a follow-up visit before scheduling leads to more productive discussions. "Splitting one visit into two can decrease the burden on both the patient and the physician; two visits usually allow enough time to answer questions, gain trust, and increase confidence in proceeding with sur- gery," Dr. Ram said. Dr. Lombardi follows a similar approach. "During our first meeting, we determine if the cataract is surgi- cal, review the risks, benefits, and alternatives to surgery, and answer any questions they may have about surgery," she said. "If they are inter- ested in a premium lens implant, I will usually give them an informa- tion packet about the lens options and have them come back for another visit to discuss which tech- nologies they are interested in and are candidates for. If a patient has a complex situation or seems to need more time to digest the information presented to them, I will see them back for another visit, so we can readdress the options. This is helpful so that patients feel that they do not need to make rushed decisions about their surgery." Keeping one's skills and knowl- edge up to date outside of training is important for young physicians as well. Dr. Garg said attending and actively participating in meetings was key for him to build his skills after residency. "Wet labs, discussions with more seasoned ophthalmologists, online videos, surgical technique papers, and trade journals were all resources I used and continue to use. Certainly, watching videos from other surgeons is important," he said. Dr. Loh found a similar strategy useful for her. After being out of the academic environment residency offered, she craved further educa- tional experiences. Dr. Loh said she started reading trade journals, which she hadn't been doing in residency, and found they had practical tips and insights now applicable in her daily practice. Early in practice, before a day of surgery, she would watch a DVD series that had video of surgical cases and complications to prepare herself, and she also did a couple of wet labs. More recently, Dr. Loh said she has found ophthalmic meetings to be helpful. She finds the expe- riences, anecdotes, pearls, and tips offered by experts to be valuable. Observing other surgeons in the operating room, even if it's just for 15 minutes, has given her the op- portunity to see new procedures and techniques as well. Practicing or staying current on surgical techniques is not the hard- est part of surgery, according to Dr. Ram, but decision making at "forks in the road" is. "To sharpen my decision-mak- ing acumen and to learn about new techniques and technologies, I do everything," Dr. Ram said. "I watch YouTube videos, attend webinars and conferences, skim journals, and discuss cases with my colleagues, friends, and mentors. If there is a new instrument or device you would like to experiment with, the company reps are invaluable." Handling your first complica- tions when you're new in practice can be daunting, but you might also worry about how it will affect your patient relationships. "Complications are part of sur- gery," Dr. Garg said. "It is important to be forthright with patients and make sure to answer all of their questions. See them often after sur- gery to make sure they are progress- ing well and provide reassurance. Make sure to involve other special- ties (e.g., retina) early, if needed. In most cases the patient will do fine. It is important to realize that part of operating is having complications— the goal is to properly manage them, learn from them, and mini- mize them." Dr. Loh said in the moment of a complication, you should remind yourself that you have the skills to handle this. She also finds it useful the night before surgery to think about some of the more common complications that could occur, talking through what you will ask for in that moment, how you will handle it. "Mentally rehearsing helped me so that when it did happen, I had a plan already," Dr. Loh said. As for talking with patients about their complications, Dr. Loh said she finds it helpful to learn from colleagues—how did they address a specific complication with their patients? "Learning how to speak to patients after a complication is as important as managing the com- plication," Dr. Loh said. "Be honest and truthful without scaring anyone … give patients hope." Dr. Ram said phrases like "I want the best for you" and "We are doing everything to ensure you get the best outcome possible" can go a long way. "The most important thing is to make sure that the patient does not feel abandoned. Do not worry about what your new colleagues will think—everyone has complications, and chances are that others have had the same complication as you," Dr. Ram said. Giving patients and their family adequate time to hear explanations about what happened with the com- plication is important as well, Dr. Lombardi said. "You may need to repeat what happened during multiple visits with patients to help them pro- cess what has happened," she said. "Complications are hard for the pa- tients, but also very hard on the sur- geon. Remember that most patients do fine in the long run (better than if they had their original pathology), so try to highlight this when you talk to them so they do not lose hope of a good outcome." EW Editors' note: The physicians have no financial interests related to their comments. Contact information Garg: gargs@uci.edu Loh: jenniferlohmd@gmail.com Lombardi: lombardi@ohsu.edu Ram: radharammd@gmail.com

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