Thoughts

The Secret

My dad has a gift.

Opened packages of socks. Special order furniture. A worn, washed, and shrunken J. Crew sweater that was disclosed as worn, washed, and shrunken. You name it, the man has successfully returned it.

He routinely pulls off returns that most of us wouldn't dream of attempting. In fact, in the 35 years I have known him, the only item he's ever failed at returning was a Christmas gift box of nuts from Western Nut Company. Though occasionally frustrating to those who give him gifts, Dad's ability to exchange what he has for something he wants more -- another item, store credit, usually cash -- has long since held my respect and interest.

Initially, I figured that his incredible track record was mostly attributable to his height; being a tall drink of water doesn't help on airplanes, but it must help when you're trying to return something, right? 

benice

I've since realized that Dad's success didn't have nearly as much to do with his height as it did with his personality. I've seen him in action -- he treats the store's employee with respect, smiles, and is never rude or angry or dismissive. He knows The Secret: if you're nice to people, they are much more likely to help you.

Now, we have to be careful here, because being nice to people is not a means to an end. Feigning interest and respect just to get what one wants is often transparent and annoying. Ideally, we are genuinely nice to people for the sake of being nice. Living this way pays dividends not just in terms of getting what you want, but also in happiness and friendship. That being said, there is no doubt that being nice to those around you will make them more willing to help you.

This widely-applicable principle is easily recognizable in the medical field. A physician taking care of patients in the hospital often receives messages from his patients' nurses. Although he may be busy, stressed by caring for his patients, documenting his care properly, declining reimbursement, home life, etc etc etc, if he is rude, dismissive, condescending, or abrupt with the nurse, although the nurse will still perform the necessary duties to care for their patients, he or she will undoubtedly remember the negative interaction and be much less likely to go the extra mile for that physician in the future. That feeling of being treated poorly doesn't go away easily.

By contrast, consider a surgeon who is frustrated from struggling to have her patient transported to the operating room from the hospital floor. She has a clinic she has to get to in the afternoon, and things are running late. She is tempted to call up the ward's nursing station and demand to know where her patient is. Instead, she calls the ward, and asks to know who is taking care of her patient. When she gets ahold of the right nurse, she uses his or her name, and thanks them for taking care of her patient. She asks politely about whether they will soon be ready to head to the operating room, instead of barking out a demand. She asks, sincerely, whether there is anything she can do to help.

People will forget what you said, people will forget what you did, but people will never forget how you made them feel.
— Maya Angelou

The nurse in the second situation is likely to remember being treated respectfully, and to respond favorably when the surgeon needs help in the future. The nurse in the first scenario, however, is much less likely to do so. Doctors who value other members of the team, including nurses, secretaries, schedulers, technicians, janitors, and others, who learn their names and act like a real human being around them, will be surprised not only by others' willingness to help, but by real, abiding friendships that will develop.

I'm grateful to my Dad for what he taught me about being nice to others. Maybe he wasn't just trying to return a pair of socks.

The Solar Eclipse: Even Better than Expected!

Rarely does an event with as much hype as the 2017 Solar Eclipse live up to expectations. Preparing for this week's eclipse, I was moderately excited and figured it would be a neat thing to see, but I anticipated feeling a little let down when I actually saw it. I was wrong!

Leading up to the eclipse, I was honored to be interviewed on the local CBS Evening News, discussing why and how to view it safely. Here's a link if you'd like to see the video.

solar eclipse glasses

On the day of the eclipse, I was in the operating room, doing surgery for patients with strabismus to help realign their eyes. In between surgeries, I had a minute to peek out the window and see the eclipse as it was developing. Here in Spokane, we weren't in the path of totality, and because of the surgery schedule, I didn't get to see the partial eclipse at its maximum, but I was caught off guard by how cool it was. Seeing a crescent sun in a black sky with my eclipse glasses was definitely neat.

I was also pleasantly surprised to see the social media reaction -- it seems I wasn't the only one who found the eclipse incredibly cool. Videos from all over the country, especially those from people in the path of totality, showcased what an incredible experience this was.

If you looked at the eclipse in an unsafe way, and are now experiencing decreased vision or a blind or dark spot in your central vision in one or both eyes, you may have a condition called solar retinopathy. Solar retinopathy is a burn, caused by ultraviolet light, of the retina, the inner lining of the back of your eyes, and the home of the rod and cone cells that sense light. There is no treatment for solar retinopathy, and although some patients' symptoms may improve over the ensuing months, other people's vision loss may be permanent. If you think you may have this problem, you should see your eye doctor.

Today, the local CBS Evening News invited me back for another interview, to discuss solar retinopathy symptoms and what to do if you think the eclipse may have damaged your eyes. Here's the video of the interview.

Finally, here is a video generously shared with me by my friend Melanie Slater Munns, which shows the magical moment when the lights go out during the eclipse in the path of totality:

The Power of Good News

Recently, I had the opportunity to see a young boy in my clinic, a great little guy who had had a bit of a rocky start to life. He had been born four months premature, and had sustained an intraventricular hemorrhage, a type of bleeding within the brain that is, unfortunately, quite common in severely premature infants. To reduce the swelling and pressure in his head created by this bleeding, a shunt was placed, which drained fluid from around the brain into his abdomen.

Between this brain hemorrhage and a number of other medical problems, my little patient's first few years were tough. His mother had been told that, because of the swelling, he had likely suffered some damage to his optic nerves, the structures that connect the back of the eye to the brain, and transmit the signal that the eye sees to the cerebral cortex for processing.

Fortunately, when I examined his eyes, I was able to get a good look at his optic nerves, and they appeared very healthy -- flat and pink, just like they should be, with no swelling, pallor, or hemorrhage. I told Mom that her son's optic nerves looked great, and that I was encouraged by that. Her response caught me off guard.

She said, somberly but matter-of-factly, "That's great. We never get good news."

This made me feel very sad.

One of the blessings of my job is that I work with kids all day -- kids who are often, though not always, generally quite healthy. This means that my experience in the "doctor's office" (in this case, my own), is usually very positive and full of good news.

This young family, by contrast -- and many others like them -- has a much different typical doctor's office experience. Because of the many, severe health problems their son has dealt with, his physicians have, unfortunately but appropriately, had to give an awful lot of bad news.

Sometimes as physicians, we may forget how devastating a seemingly endless parade of bad news can be.

My friend Dr. Erin Schotthoefer, a fellow pediatric ophthalmologist who also did her ophthalmology residency at the University of Iowa like I did, taught me something very profound. During a lecture given 10 years after finishing her training, she told the audience that, for every patient she saw, she always tried to find at least one bit of good news she could share, one thing about which the child's parents should be happy and encouraged.

Inspired by her words, I have tried to do the same in my practice, and have found it both possible and powerful. Sometimes, we all just need something to hold on to, and findings those things and sharing them is one of my favorite parts of what I do.

How to Be Successful When on Call

I was on call over Christmas here in Spokane, and it was fairly busy. Not as busy as it would be for some other specialties, but still busy. For 96 straight hours, I was the ophthalmologist covering all consults for three hospitals in the city, and I was also on call for the patients in our call group, which consists of about 25 ophthalmologists. 

For the past eight years, I've had the opportunity to be on call hundreds of times. It's not my favorite part of my job -- and I'm not sure it is for anyone! -- but I've found a few tips that have helped me be successful on call:

1. Manage your expectations. If you assume you won't be busy, at best you will be satisfied, and more than likely you will be disappointed. By contrast, if you prepare for nonstop action, you will be pleasantly surprised and grateful if you get some sleep or time to sit down.

2. Be efficient. Focus on the "W-I-N" strategy: what's important now? What do you need to do to save this person's life/limb/vision until the morning? Don't get bogged down.

3. Most importantly: Remember, you signed up for this. Your patient did not. He or she is seeing you at one of the most vulnerable times in their life. They need your help.

When I posted this on my Facebook page, Dr. Tom Oetting, a great mentor and friend, had the following to say:

People are scared and often just need reassurance. Took me a long time (and having kids) to figure out just how anxious we as parents can get. . . Even though some of the things we see on call seem trivial to us they can really jazz up a family unit! So we shouldn't be surprised or resentful if some of our on call activity seems trivial.

Another friend, the retina surgeon Dr. Jayanth Sridhar, whose new podcast can be heard here, recommend the following:

Keep snacks in your bag. Something quick may end up being longer than you think. Always carry a phone charger.

What do you think? What tips for success on call have you found? Have you had any experience with on-call physicians that were particularly memorable? Comment below!

Being Fast

It was a hot, sunny summer afternoon, and we were all excited for high school graduation the next day. As was our habit, after school got out, my friends and I went over to a neighbor's house to play basketball on their beautiful outdoor full court, complete with painted lines and breakaway rims, just like the pros used. I grabbed a rebound, dribbled the length of the court, and went up for a dunk. I vividly recall being in midair, the defender underneath/in front of me, and realizing my body was now parallel to the ground and bad things were about to happen. I landed awkwardly on my arm, figured it was broken, and went to the emergency room with my mother.

  Dr. Swensen, recipient of the Utah State Orthopaedic Society's  2013 Sherman S. Coleman Humanitarian Award .

Dr. Swensen, recipient of the Utah State Orthopaedic Society's 2013 Sherman S. Coleman Humanitarian Award.

Mom asked for Dr. Laird Swensen, a hand surgeon who had taken care of my family in the past. Dr. Swensen, a tall, kind, soft-spoken 50-something-year-old, graciously rearranged his schedule to come see me. My wrist was indeed broken, and Dr. Swensen set the fracture and put on a cast. A few weeks later, when X-rays revealed the fracture wasn't healing perfectly, Dr. Swensen recommended surgery. Nervous that I would never be able to play basketball again (18-year-olds have a different version of what's important), I called him the night before surgery. He reassured me. The surgery went great, and my wrist has been as good as new ever since. Dr. Swensen became a hero of mine.

A few years later, I had the opportunity to work as an orderly in the operating rooms where Dr. Swensen and other orthopedists operated. I took patients to and from surgery and helped prepare and clean the operating rooms. Early on, while chatting with one of the surgical technicians, I mentioned how highly I thought of Dr. Swensen. My coworker shrugged and said, "He's so slow."

This comment caught me completely off guard. Slow? What does that mean? Who cares if he's slow? Why is that even a thing? Isn't the only thing that matters whether he's "good" or not? Perhaps my colleague was just accustomed to other orthopedic surgeries, which are often much quicker, and not to hand/wrist surgery, which, due to the intricate anatomy, is meticulous and often drawn-out. But I was still miffed that the first adjective used to describe this excellent surgeon was the word "slow."

Since that time, I have on occasion noticed that a slow surgeon can be an annoyance to others that work in an operating room -- including nurses, technicians, anesthesiologists, etc. -- because of how long their cases take. Also, from a patient safety standpoint, all other things being equal, the less time spent under anesthesia, the better, and from a business standpoint, the quicker a procedure is, the more time available for other patients and procedures. And slow doesn't automatically equate with good. I understand all of that. Maybe I was naive, but I just never imagined that a physician's speed would have any bearing on what colleagues thought of him or her.

This pressure, to be not only excellent but also efficient, is something that every surgeon and every physician faces. Clearly, the ideal is that care is both excellent and efficient, 100% of the time. That's what's best for patients. In most cases, it's possible. But sometimes things aren't straightforward; surprises happen in the operating room or in the clinic, and when that happens, it's crucial that speed take a back seat to quality. I believe it's important to strive for perfection, not just "good enough."

My favorite anecdote regarding this issue comes from a surgeon I know who, during a meeting with his boss, was made aware that he took longer to do a given type of surgery than his colleagues did. The surgeon -- accurately, by the way -- replied, "Yeah. But mine work." That surgeon understood that while time is of the essence in the operating room for many reasons, the most critical aspect of the case is that it's done well, not that it's done quickly.

Every time I enter the operating room, I think about that surgeon, and about Dr. Swensen. I am so fortunate to have trained at the University of Iowa and to work at the Spokane Eye Clinic with colleagues that share this same approach.

What do you think? Have you faced pressure to be both good and fast in your career? How have you handled that? Comments welcome!