To quote the Beach Boys, “Wouldn’t it be nice?”

One of the more humbling experiences in my surgical education, which I owe solely to being in the right place at the right time, was to learn eyelid surgery directly from the founder of oculoplastic surgery, Byron Smith, MD.

Lord Byron of Broadway honed his skills on the battlefields of World War II, caring for soldiers with facial injuries. He developed many of the reconstructive lid and orbit procedures still used today, but he didn’t care much about doing cosmetic surgery. When a society matron would ask him if she would look better after surgery, he would simply reply, “How should I know? I only know that you’ll look different.”

IS RELIEF IN SIGHT?

And so if you were to ask me whether our regulatory futures are going to become better with the personnel changes in our government I can only echo LBOB: “I don’t know if it’ll be better, but it will be different.”

Already an executive order has been signed that could transform our practices. Steps have been taken to replace the Affordable Care Act. Also, the president told a group of business owners he’d like to reduce federal regulations by 75%.¹

Naturally the devil is in the details, but as these are unleashed I find myself more interested in the reducing regulations stuff than the overhauling the insurance stuff.

I used to record three office visits on one side of an index card. Now, thanks to our friends in Washington, I have a server with redundancy and a software package that requires I remark on 13 components of an examination even if they are unremarkable. I get to select my own irrelevant burden from a long list, like advising patients to have a flu shot.

I cannot do a YAG capsulotomy at my ASC on any patient 15 years or younger, nor can I do a capsulotomy on someone who had a transient ischemic attack two months ago because that’s a Class 4 anesthesia risk and those patients are not allowed through the doors.

OUR UPSIDE-DOWN WORLD

My patients have to sign a beneficiary waiver for many tests we do, resulting in patients refusing to be tested and getting inferior care.

We are rated — and perhaps one day paid based on quality of care — but quality means how much we use a computer or rack up points on a reviewer’s list. My practice still gets two points every year for having a radiuscope for hard contact lenses even though it hasn’t been used in 20 years.

How wonderful it would be to practice without bowing to new and irrelevant regulations written by some recent college graduate, and be unchained from many that now exist. We might even see the best and brightest deciding to go to medical school again. OM

REFERENCE

1. Pramuk J. Trump tells business leaders he wants to cut regulations by 75% or ‘maybe more.’ Jan. 23, 2017. https://tinyurl.com/gmonr7w . Accessed Feb. 9, 2017.

Paul S. Koch, MD is editor emeritus of OM and medical director of Koch Eye Associates in Warwick, RI. His e-mail is pskoch@clarisvision.com.