As I See It

The Ophthalmic Surgeon's Golden Rule

By Paul S. Koch, M.D. Editor Emeritus

Wouldn't it be cool to have "doovers" for surgery? You could finish a case, check it out, and if it wasn't quite right you could take it back and start all over again. I could have used that just the other day when I had this momentary brain cramp and, oh, never mind.

I perform my operations with a skill that ranges from beautiful (just beautiful) to "Ohmygawd-what-was- I-thinking?" and everywhere in between. I am so smart and talented on some days and so barely adequate on others. No matter which of me shows up to work, I do my best, however modest, with the very best intentions for the patient.

We've All Been There

I am quite certain that every one of my colleagues goes through the same thing, has good days and bad, but always with the best intentions. Some of their eyes look like they haven't been touched; while others look like meatloaf. When I see those eyes in consultation I never think "Well, that was screwed up," but always "Whoa, that was a tough one. I'm glad it wasn't me sitting in the chair."

I could not count how many second opinion consultations I've performed for patients who were unhappy with their results, and in each case I could see how I might have been the surgeon who got the same result. I share my thoughts with the patient and leave them with the understanding that life isn't always fair, stuff happens, and for some people it's just a matter of bad luck. To the best of my knowledge, not one of these patients has ever filed a suit against their surgeon.

I wish others were so kind to me. I know one bigwig in another state whose staff begins the poison drip. Every second opinion is greeted with, "You should have come here first. This has never happened to one of our patients." Yeah right, and pigs fly.

I know a very good surgeon who sent three patients to this bigwig for a second opinion after a complication. Each patient was told, "It's a good thing he sent you here. My patients never have this problem so I have no experience with it, but I'll try to fix this mess." All three patients stopped in at lawyers' offices on their way home and the surgeon had a request for records by the Friday of the week they were seen.

This is how that bigwig treated doctors who referred patients to him for consultation. I can't imagine what would happen if the patients arrived on their own.

What Comes Around, Goes Around

Well, would you believe that a patient showed up in my office for a second opinion for an ugly eye operated on by the bigwig, a complication he told previous patients he never had seen? He must have been telling the truth because, based on the records he had no idea how to handle this one.

I, on the other hand, had had this complication lots of time in the past (Sigh — I think I've seen every complication lots of times) and so I knew what to do. I fixed up the patient and then faced this moral dilemma. Should I nail the bastard, or let it go?

Believe me, I was tempted, but I told the patient my usual life-and-stuff-and-luck spiel. I knew that once I begin getting back at someone, someone's going to want to get back at me, and I don't need that hassle. He wouldn't ever know I gave him that pass, but I knew how to fix the patient only because I had walked in his shoes. OM