Your personal bias will impact your practice decision making. Make it your business to protect you from you.

Well, this is kind of embarrassing, but for the sake of your entertainment, I’ll share. I tried to send a not so small amount of “preliminary bail” money on PayPal to the “sheriff’s office” PayPal account to avoid being arrested for taxes I had allegedly overlooked (not true). Sounds crazy but this “sheriff” got me, even had me on the phone a continuous 90 minutes. I had convinced myself that I must have done something wrong and I was willing to pay any amount to avoid risk of getting arrested. Looking back, it was ridiculous for me to believe the caller’s story.

To avoid this threatened arrest, I was willing to deny and distort reality to make choices that allowed me to feel safe in that moment — thus, painfully proving that there is no easier person to fool than ourselves.

We are faced almost daily with the need to make minor and sometimes major strategic decisions that will impact the capacity for personal or practice growth. Making a plan typically assumes that a combination of researching relevant data and listening to our gut will guide us. However, human beings have inherent biases that often subconsciously cloud our ability to make sound strategies.

DON’T ONLY CHASE REWARDS

Strategic planning focuses on the benefit sought. For example, a new practice software may help keep a schedule full because of enhanced features that can confirm or book patients via text message. The reward is having a busier doctor, staff with less phone time making or changing appointments and increased patient satisfaction due to more efficient interaction with your practice. But what happens when chasing the reward takes you on a detour with some significant speed bumps?

For me, the journey to incorporating microinvasive glaucoma surgery (MIGS) began with chasing the reward of better patient care. The data clearly showed it was an opportunity to impact the long-term disease in my glaucoma patients when undergoing cataract surgery. In 2022, the HORIZON investigators even showed that the risk of needing a later incisional glaucoma surgery is reduced by as much as 50%. Since I am in the eye anyway for the cataract, performing a MIGS procedure was an opportunity just 2 mm away. 

The reality of my plan to begin a new procedure caught me off guard. It surprised me how unprepared I was at times as I learned a new procedure. There were moments I felt like a second-year resident again! I had trouble finding the meshwork, created more inflammation inside the eye early in the learning curve, and ran behind since these cases took more time. It was challenging and mentally discouraging. It would have been easy to just stop offering MIGS. Inaction is safe.

However, knowing negative feedback is part of chasing a reward can set the stage for success. Expecting these “punishments” will allow you to reframe these setbacks and use them as an opportunity to learn and redirect. For me, it required pivoting to different MIGS devices, calling other surgeons for guidance, and even informing patients of a small chance I would not be able to access their drain to do the glaucoma part of the procedure.

Now, my MIGS learning curve is mostly over and the reward is superior glaucoma management for my patients and more referrals due to the limited number of cataract surgeons in my area offering glaucoma management at the time of cataract surgery. Have the ability to risk personal mental harm (not physical harm to your patients) when making decisions. The key to chasing greater rewards is to have a plan to react thoughtfully to setbacks or negative feedback. 

DOING NOTHING IS A DECISION

Buying a stock is betting that you are smarter than the person who sold it to you. Most often we hold onto a stock when it is down because if we sell it then we have to admit we were wrong. For this reason, our bias justifies our inaction, with hope it will get better soon. To create a great practice, one must see it as it is and not what we want it to be. It is poor business to waste more time and money to just stick with it.

I learned this the hard way by purchasing more office space to grow my practice billing department and start a call center. After 3 years of challenges, I realized that a better solution was to outsource these departments and eliminate them internally. This freshly painted, newly purchased space sat empty for 2 years before I decided to lease it — 2 years of taxes and lost rent, all while I still had to pay the condominium fees. But I had kept telling myself that I may put “something” there and needed the space.

We deny and distort reality to feel more comfortable. Our bias creates a narrative to trick us to stay with our original decisions since it will be a path of least resistance. Becoming aware of this risk will allow you to make certain your decisions are still sound as time passes.

LET GO AND MOVE ON

John Maynard Keynes said, “The difficulty lies, not in new ideas, but in escaping the old ones.” It is easiest to just continue to do what you are doing. Stick with the plan. But not having a plan to re-examine your plan could cause you to miss facts that could erode potential outcomes. Opportunity costs are only discovered if you seek them out.

Our plans do not always go, well, as planned. Learn to be comfortable with being uncomfortable. The greater the struggle, the more you expect setbacks, the more likely you will end up in a better place. The key is to become aware that your own bias and mental justifications will skew your decision making.

Oh, back to my trying to pay a scam artist. The payment app did not allow my payment to go through because the receiver account was flagged. Turns out computers have much less bias than humans. I learned a hard lesson and put it behind me. After all, it is important to make certain not to stumble on what’s behind you. OM

 

Scott LaBorwit, MD, is founder of Select Eye Care in Maryland, chairperson of the Medical Advisory Board for Vision Innovation Partners and assistant professor, part-time faculty, at Wilmer Eye Clinic of Johns Hopkins Hospital, Baltimore. His e-mail is Sel104@me.com.