PUBLICATION EXCLUSIVE: Addressing the ‘you’ve got to go, doctor’ elephant in the room

“The FBI Academy teaches new agents that the best predictor of future behavior is past behavior.”
– Ronald Kessler

In boating circles, they say the best 2 days in a sailor’s life are when he buys a boat and when he gets rid of it. This might not be too far off the mark in ophthalmology. Adding a new doctor is always cause for celebration. But about half of the time so, too, is the removal of the same provider for one reason or another.

Here are the seven deadly sins most commonly observed in American ophthalmic practices, and in Canada, Chile, England, Singapore, Germany — actually, everywhere I have seen eye surgeons at work.

1. Poor hands. Standards vary from practice to practice. But in most settings, peer review, even though not formal, is a pretty ruthlessly effective way to weed out doctors who should not make partner. In the most effective settings, standards are kept high and reinforced with internal agreement on care pathways and operative protocols. Peer review is made more formal with doctor-by-doctor outcomes studies and periodic monitoring.

2. Poor judgement. This is actually more common — and more troubling — than poor clinical and surgical skills. It is much easier to improve the surgical skills of an undertrained young doctor than to revise poor judgement, given the deep roots of the latter.

  • Click here to read the full publication exclusive, By the Numbers, published in Ocular Surgery News U.S. Edition, August 10, 2017.

“The FBI Academy teaches new agents that the best predictor of future behavior is past behavior.”
– Ronald Kessler

In boating circles, they say the best 2 days in a sailor’s life are when he buys a boat and when he gets rid of it. This might not be too far off the mark in ophthalmology. Adding a new doctor is always cause for celebration. But about half of the time so, too, is the removal of the same provider for one reason or another.

Here are the seven deadly sins most commonly observed in American ophthalmic practices, and in Canada, Chile, England, Singapore, Germany — actually, everywhere I have seen eye surgeons at work.

1. Poor hands. Standards vary from practice to practice. But in most settings, peer review, even though not formal, is a pretty ruthlessly effective way to weed out doctors who should not make partner. In the most effective settings, standards are kept high and reinforced with internal agreement on care pathways and operative protocols. Peer review is made more formal with doctor-by-doctor outcomes studies and periodic monitoring.

2. Poor judgement. This is actually more common — and more troubling — than poor clinical and surgical skills. It is much easier to improve the surgical skills of an undertrained young doctor than to revise poor judgement, given the deep roots of the latter.

  • Click here to read the full publication exclusive, By the Numbers, published in Ocular Surgery News U.S. Edition, August 10, 2017.