Gaining insight into the ophthalmic personality

Part 3 of 3. How to more successfully and happily be (or work among) some of the most talented professionals on Earth.

John B. Pinto

“Happiness is always a by-product. It is probably a matter of temperament, and for anything I know, it may be glandular. But it is not something that can be demanded from life, and if you are not happy, you had better stop worrying about it and see what treasures you can pluck from your own brand of unhappiness.” – Robertson Davies, Canadian novelist

(Perpetually) semiretired ophthalmologist Herve M. Byron, MD, has long lectured and written on the personal challenges of being an eye surgeon.

In his long career, he has become one of the most respected voices in the national community on this topic. A few years ago, he generously described his own path and early motivations, which still have much in common with those of his colleagues today.

“When I was 5 years old, I was a sickly kid, a kid with chronic ear infections in an era without antibiotics. The treatment was mastoidectomy, a massive operation with a 30% mortality rate,” Dr. Byron said. “My father was a physician, and he and the other doctors on the case thought a transfusion would help. My uncles were screened, and one was a match.”

Even today, he said, he can still picture lying on a bed in his family’s living room with a tube sticking into him.

“Suddenly, the tubing broke, and there’s blood squirting all over the walls. … Not a very security-engendering experience for a 5-year-old,” Dr. Byron said. “I was also a fat kid. In the public school, you were supposed to climb the rope. I simply couldn’t. My upper body was too weak. We had to jump over the horses in gym — forget it. This was my pattern.”

Throughout his educational and professional adult life, he said he saw himself as a sick, out-of-shape child.

“I’ve had to keep showing people that I have some value. So in high school, I drove myself to being second in a class of 1,800 students,” Dr. Byron said.

“Today, people ask me, ‘Why are you still doing this, Herve? Why are you still striving?’ Until a few years ago, when I finally started developing some insights into what makes me tick, I really couldn’t answer them,” he said. “The anxiety about striving is long gone. Now it’s just a matter of having fun. But for the first 25 years or more of my career, I was compelled by those early, difficult experiences to show I had something to contribute.”

Dr. Byron said he has been through a lot of therapy and has talked to many colleagues, and has learned that ophthalmologists are highly susceptible to depression.

“We’re tightly wound. We have a great ability to use denial. We don’t have great support systems. We have lots of quick relationships with patients — and we don’t really get involved with them. If and when things fall apart in our lives, they go downhill rapidly,” he said.

Depression and ophthalmology

“When I look out over an audience of ophthalmologists today, about 80% of them look depressed. No emotion. No reaction. Nothing. The tragedy and the danger is they have no idea that they are depressed. Denial keeps us from getting help, unless we have a support system in place,” Dr. Byron said.

He said there are a number of well-documented screens for depression: Do you have trouble sleeping? Have you lost an interest in eating? Are there difficulties in your sexual life? Difficulty with relationships? Can you perform more than 8 hours in your office the way you used to? Can you make decisions clearly? Do you find you’re withdrawing, not wanting to talk to people?

“Once I was medicated for my own depression, I could eat and sleep better, I could think and operate better. I wasn’t going through anxiety crises every day,” he said.

“We’re all so focused, and our obsessing, compulsive tendencies lead us to ophthalmology. When I was at the height of my surgical career, I couldn’t wait to get into the operating room. I couldn’t wait to operate on difficult one-eyed patients because I could walk up to the table with supreme confidence. It was a challenge I know I could handle,” Dr. Byron said.

Of course, all the striving in the world cannot overcome the inevitable transition from being a surgeon to being a non-surgeon, which can be terribly painful for physicians whose sense of self is so interwoven with their surgical acumen.

“At 62 or 63 years old, I found that some of the postop results of some of the younger docs I was working with were better than mine,” Dr. Byron said. “For a while, I was striving to reach to the next level, but the bar had been raised so high. My neck was killing me, my back was killing me. I really was hurting myself physically to keep up. I decided it was time to quit, which was a difficult decision to make. What else would be left? The trick is to find solace in the conversion from digital to cerebral skills.”

The transition from being a doctor to being retired is even a greater difficulty to make, he said. Surgeons must transition their skills into something that will give them satisfaction and be of value to others.

When making any transition, from training to entering practice, from being an associate to becoming a partner, from surgical to non-surgical, and on into your retirement from medicine, get in touch with your values at each of these points.

“After a lot of life,” Dr. Byron said, “you realize that time is irreplaceable. Take the time to enjoy whatever it is that you enjoy. You have to be flexible. You have to check over and over to make sure that when you are in transition, the new direction you’re taking is right for you.”

Eye surgeons, according to Dr. Byron, are the best deniers in the world.

“In the face of total disaster, we’ll say, ‘Everything is great.’ We have to get in touch with our feelings. I’ve come to learn that, every time, my gut will make a better decision than my brain. If you are a man and have a spouse with good instincts, that’s a priceless asset,” he said. “My dear wife, Bryn, can smell a bad decision or someone who’s faking it from a mile away.”

Male vs. female surgeons

There are significant personality differences between male and female eye surgeons, and they are driven by different factors, Dr. Byron said.

“If I were many years younger and looking for an associate for my practice, I would choose a woman. They communicate better, they’re more driven in ways that I think males are often not when it comes to patient communication and care,” he said.

“Women are more pragmatic, realistic, intuitive, with far less denial than males. Male physician pilots have the highest incident of accident mortality. Female physician pilots have almost no accident mortality. It’s because women listen. When the tower says, ‘Come back,’ they follow directions,” he said.

Ophthalmologists must know their strengths and deficits. It is not enough to be bright and creative anymore.

“You have to know how to find and motivate people who can sweat the details. I urge surgeons I speak with to be at peace with the reality of change. You need to be compliant to what’s happening in the world of medicine today — that world is more powerful than you are,” Dr. Byron said, adding that communication is critical.

“If you’re going to have people tolerate working with you, you’ve got to communicate. If you’re interviewing a doctor to join your practice, look first to communication skills. It goes both ways; if you are a lay person in an ophthalmologist’s life, you have to become a good communicator,” he said.

“My advice is to know your doctor well enough that you can communicate without a confrontation. And most importantly, timing is essential. Don’t confront at the end of the day when you’re both exhausted. There should be a set time on a regular basis to do this,” Dr. Byron said.

Soliciting staff feedback

Consulting in settings with poor communication has taught us that it is helpful, as a surgeon, to give colleagues, staff, spouse and even friends permission to give you feedback. If you are comfortable with this, ask them to be bolder than they might otherwise be.

If you are the kind of surgeon who can invite openness, surround yourself with people who can give you intelligent feedback. If you are less willing to have blunt feedback, select just one trusted member of your staff to be a private, on-site coach who can praise your positive personality traits and gently remind you to adjust traits and behaviors that can lower staff morale.

Here is another major theme we have uncovered in ophthalmic circles. Eye surgeons spend the first third of their lives being, by and large, exceptional when compared with everyone else around them. They are the best in grammar and high school, among the brightest in college, the achievers in medical school.

Then reality hits for the newly minted ophthalmologist, now living in a universe of about 15,000 other overachieving American eye surgeons: “Hey. I’m no longer the smartest or most talented person in my world. I’m just an average eye doctor.” Some doctors I know have a profound difficulty handicapping themselves against the members of a rarified world and being comfortable with an average ranking.

John M. Corboy, MD, has some helpful perspectives on this. “The only thing that was acceptable to me is to be as good as I can be because only then can I accept whatever results come for the patient,” Dr. Corboy said.

“There are some docs who obviously take that to the next extreme and say, ‘Well, what I’ve just done for this patient isn’t the best in the world that can be done.’ And they get bent out of shape because of that,” he said. “You have to let go of that and instead think, ‘Yes, there is a guy in Boston or Zurich who can actually do slightly better than me, but this patient can’t go to Boston or Zurich, and I am the best this patient is going to get.’

“You just have to let go of that. You get peace with that over time,” he said. “And for some subspecialty areas, such as retina, you never get peace with it, so that’s why we refer out the difficult cases. The whole goal is to take the best possible care of the patient.”

We all know colleagues who have gone too far and lost their family or their sanity from being overly perfectionistic with their practice.

“It’s probably healthy to want to be the best doctor in town. It’s probably unhealthy to want to be the best doctor on the planet. You can get too overwhelmed by perfection,” he said. “You have to find a wholesome level of discipline, and then be gentle with yourself. You have to do the best you can and then let go.”

Generating authentic happiness

Here are a few prescriptions for any reader, but for ophthalmologists, in particular:

Find an appropriate work-life balance. Just as a triangular stool must have three sturdy legs of equal length to support your weight, all of us need to create and maintain a healthy balance in order not to topple personally or professionally. We must constantly strive to equally prioritize career success, personal health and relationships with family and friends outside of work. The more enlightened, proactive ophthalmologist recognizes the competing forces that make for conflict and is especially cognizant of the lure that “just a little bit more income” is a black hole of temptation whose gravitational pull can be irresistible and all-enveloping.

Seek out opportunities for altruism and service to others. It is well-established that healthy generosity and unselfish service to others are keys to greater life satisfaction. It must, however, be authentic and genuine, not merely role played to gain something in the form of clinical research results or community recognition. Concretely, this means demonstrating genuine interest and compassion for others, combined with unconditional, non-possessive sharing of one’s time, energy and resources. For ophthalmologists, altruistic behavior can be shown daily within the office in numerous ways, such as mentoring less experienced staff, spending time “off the clock” to listen to another’s concerns or donating services to the needy in the community. You do not have to travel to the Third World to be a humanitarian.

Appreciation, contentment and focus. The happiest people you are likely to meet are those who focus on a glass that is “half full” and experience a deep appreciation for what they have. They make it a habit to recognize how fortunate they are relative to what could be, thereby becoming increasingly content with the positive equity in life that they find within it day to day. In sharp contrast, the people who bemoan what they lack tend to suffer varying degrees of misery, jealousy, resentment and emptiness. This is more acute for individuals who see themselves as victimized by powerful external forces over which they feel little or no control. What you focus on tends to expand, so be selective about your focus and the lens through which you view your life.

Mindfulness and presence. An antidote to compulsive striving toward an idealized future is to become more mindful in each present moment, which, by the way, is the only time that life is actually lived. Become more attuned to each moment and the opportunity within it as an end unto itself, rather than viewing time and the stuff that fills it as mere stepping stones toward some better future. This may require a shift of values — what you deem to be important. Instead of clinging to any perfectionist ideals and longings outside the walls of the operating suite, learn to “go with the flow.” Instead of working so hard to get somewhere, try to be where you are each moment.

Summing up

Overachieving. Perfectionistic. Intolerant. Workaholic. Striving. Controlling. Being the absolute best. These undeniable ophthalmologist personality traits are admirable and completely essential when examined through the eyes of the patient about to undergo surgery. These same traits, carried to extremes, or untempered by a dose of humility and self-effacement, can be profoundly galling to the rest of the people who orbit every surgeon’s life — and ultimately to the surgeon.

Perhaps in the future, we will have a simple, painless test that will categorize ophthalmologists by various personality types. Perhaps we will invent an elaborate serum that can be slipped to the most abrasive doctors, without robbing them of the rarified talent so often found in greatest measure among the most difficult individuals.

Until that day, it will fall to those of us who have chosen to serve patients by serving our doctors to do the best we can with what we have got. And on the toughest days, to simply say, as one might hear a long-suffering parent sigh about their mischievous children, “Bless their hearts, they can’t help themselves.”

Read Part 1 of this series here and Part 2 here.

• John B. Pinto is president of J. Pinto & Associates Inc., an ophthalmic practice management consulting firm established in 1979. Mr. Pinto is the country’s most-published author on ophthalmology management topics. He is the author of John Pinto’s Little Green Book of Ophthalmology, Turnaround: 21 Weeks to Ophthalmic Practice Survival and Permanent Improvement, Cashflow: The Practical Art of Earning More From Your Ophthalmology Practice, The Efficient Ophthalmologist: How to See More Patients, Provide Better Care and Prosper in an Era of Falling Fees, The Women of Ophthalmology and the new book, Legal Issues in Ophthalmology: A Review for Surgeons and Administrators. He can be reached at 619-223-2233; e-mail: pintoinc@aol.com; Web site: www.pintoinc.com.
• Craig N. Piso, PhD, is president of Piso and Associates LLC, an organizational development and psychological services consulting firm based in Pennsylvania. Dr. Piso is a consultant/psychologist with 30 years of corporate executive and clinical practice experience. He is the author of Dream of Life … Live Your Dream – A Manual of Skills for Living for Today’s Young Adults. He can be reached at 570-239-3114; e-mail: cpiso@pisoandassociates.com; Web site: www.pisoandassociates.com.