Biography: Hovanesian is a faculty member at the UCLA Jules Stein Eye Institute and in private practice at Harvard Eye Associates in Laguna Hills, California.
November 04, 2019
2 min read

Blog: Which shoe do you put on first?

Biography: Hovanesian is a faculty member at the UCLA Jules Stein Eye Institute and in private practice at Harvard Eye Associates in Laguna Hills, California.
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Which shoe do you put on first in the morning? Most of us have no idea because, although it’s part of a complex set of actions, we do it without conscious thought.

In fact, psychologists say that about half our actions throughout the day are just driven by deep-seated learned behaviors rather than conscious thought. We repeat them without ever challenging whether we’re doing them the best way. Oddly enough, even the complex art of performing surgery is mostly driven by habitual motion that we repeat in case after case.

A fascinating book called How Doctors Think by Jerome Groopman explores this topic in detail. Essentially, we doctors are so comfortable with our habits that we tailor patients’ treatment to what is most comfortable for us rather than what is best for them. This is natural. It’s the human condition to save energy, and using “muscle memory” instead of active contemplation is just much easier.

This is relevant to the cover story in this issue of Ocular Surgery News, where we explore giving patients a lifetime plan for vision. In the near future, we will see new therapies come along, such as eye drops for presbyopia and surgical procedures that purport to restore natural accommodation. Adopting a new procedure challenges our habits in every single way. It requires us to become comfortable with new instruments, new implants and new ways of thinking about ocular anatomy. Every part of our practice is touched, including our technicians, whom we have to train; our billing staff, who must adopt new codes and fees; and our counselors and phone staff, who must alter their own habits. This takes a great deal of energy, so it’s tempting to ignore new treatments, dismissing them as “unproven” or “ineffective.” Sometimes this sentiment is right, as with conductive keratoplasty, a procedure that was effective but not enduring and, therefore, not best for patients. Sometimes we are wrong, though. The Kamra inlay (CorneaGen) is an effective and enduring presbyopia treatment that still struggles, largely because its learning curve hinders physician adoption.

In my practice, I try to adopt at least one major new procedure or technology each year. I choose carefully, gauging what will have the biggest impact on my patients and my practice. Sometimes it’s two or three procedures, and sometimes it’s none. With new implants, I don’t restrict the number I adopt each year. IOLs require new knowledge but little change in surgery. I try to learn as much as I can and adopt them quickly, sharing learnings with my partners and other colleagues to gauge their place in practice. Patients genuinely appreciate this interest in bringing them the most advanced technology, and my surgical practice has flourished as a result. It also keeps the practice of medicine fresh and exciting, making me eager to open the door at the office every day.

To be good, we need lots of practice. To stay good, we must adapt. Welcoming new techniques and technologies makes us better doctors and happier in our careers.

Disclosure: Hovanesian reports he has a financial interest in CorneaGen.