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George Spaeth: glaucoma expert ‘living life right’
For more than 40 years George Spaeth, MD, has been trying to help people. Following the Quaker influences in his life, that is all he ever really wanted to do.
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PHILADELPHIA — Art, family, community, dedication, history, the greater good. These are, in large part, the principles in the life of George L. Spaeth, MD. For nearly his entire life he has remained here in the Quaker City, the city in which he was born. Here, he says, he has found the values that have helped him direct his professional and personal decisions.
“Probably there was something in the way I was made that pushed me here,” said George L. Spaeth, MD, director of the glaucoma service at Wills Eye Hospital here. “Growing up I loved art, music, nature and poetry, being a boy, running and playing and having a good time. In college I took pre-med courses as a backup, but I majored in the history of ideas. My thesis was on the role of religion in history.”
He studied music, but “I was no Bach, no Mozart. I didn’t know if I could support myself as an artist. As it turned out, I was called to be a doctor. Perhaps something pushed me there. I went into medicine, and I felt the field that would make me most able to help people would be ophthalmology,” Dr. Spaeth said.
The making of a doctor
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Dr. Spaeth has been at the forefront of ophthalmic research, particularly in glaucoma, for 40 years. Born and raised in Philadelphia, Dr. Spaeth received his bachelor’s from Yale in 1954 and his medical degree from Harvard in 1959. He interned at the University of Michigan Hospital in 1960 and began his residency at Wills Eye Hospital in 1961.
In 1968 Dr. Spaeth joined the staff of Wills Eye Hospital and has remained here ever since.
Dr. Spaeth said his relationships with his teachers, residents and fellows have been a big part of his life. “The faculty at Michigan were all heroes. The residents were very helpful. The people were wonderful, and it was a great experience.”
Although he felt he had found his calling to ophthalmology, much like his father before him, Dr. Spaeth was unsure which subspecialty he would focus on. That decision was made for him in 1963, for all intents and purposes, when he became a clinical associate in glaucoma at the National Institutes of Health.
“I went to the NIH and was able to be more focused on a specialty. At Wills the training was broader. We did a lot of work with a lot of variety. However, Ludwig von Sallman, MD, at NIH, was an exceptional man. Instead of 2-minute exams we would really delve into a patient and discuss diagnosis and prognosis. But I didn’t go to NIH to do glaucoma. I was assigned to glaucoma. It was a happy circumstance. The field has fitted me marvelously.”
The City of Brotherly Love
“My family is very close — very European in that way. We value the arts, participate in the community. All my brothers stayed in the area. We’re all very different (judge, ophthalmologist, company executive), but maintaining a relationship with family and community is important to us all,” Dr. Spaeth said.
“Philadelphia is also a wonderful community. The arts are great, excellent schools, residential areas are lovely with a lot of space. We live right next to Fairmount Park, the largest park in any city in the world. You can always see animals and feel close to nature,” he said.
Dr. Spaeth said he feels blessed to be living and working in Philadelphia.
“I’m 30 minutes away from a great hospital to work in. The drive to work is beautiful. West River Drive looks like it leapt out of a Thomas Eakins painting. It’s a visually beautiful city. Something about the Quaker influence here — I became a Quaker for a while – every person is worthwhile and God is in every person. And wealth is not the most important thing,” he said.
Twenty years of development
Asked about the developments in ophthalmology during the past 20 years, Dr. Spaeth said, “The noteworthy developments in ophthalmology mirror the developments in medicine. Most notably, the change in patient-physician relationship.
“The patient is not stupid. The patient is the senior partner in the relationship, not the doctor. The patient decides what is best for him or her. Even the most technically proficient ophthalmologist cannot make a patient healthy, only a patient can. We’ve changed from a paternalistic system to one intended to enhance the person’s chance to be healthy – physically and spiritually,” said Dr. Spaeth.
A spiritual and philosophical man, Dr. Spaeth believes vision is more than just seeing 20/20. “Vision is seeing the significance of what you see — more than just the ability to resolve objects.”
In addition to the changes in the philosophy of medicine in recent years, he noted technical changes in the field as well.
“Einstein once said there are two types of people, those who see nothing as a miracle and those who see everything as a miracle. I put myself in the latter category,” Dr. Spaeth said. He has been impressed by all the improvements in the field, from suture materials to microsurgical techniques and technology.
“All those things occurred because we responded to patients. Ophthalmology did better than any other field in doing that,” Dr. Spaeth said.
Glaucoma theory
Dr. Spaeth has been pleased to see that one of his own theories of glaucoma, the relevance of ocular blood flow to the disease, is being accepted by glaucoma specialists. He first began espousing the idea in the 1970s.
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“I think I’ve been pretty much on the right track about patients and glaucoma. However, when I and others began saying that we need to measure blood flow in the optic nerve in addition to observing changes in intraocular pressure there wasn’t much support for the idea. Now it has gone too far the other way. Blood flow problems may play a role in some people with glaucoma, but there are clearly many other factors as well. I’m glad that for a long time I’ve stressed the importance of the optic nerve more than IOP — I didn’t originate that, I merely piggybacked ideas,” Dr. Spaeth said.
“If one looks at the contributions I’ve made, I think they make a nice compendium of how we look at glaucoma. It gives me a sense my time has been productive and that I moved the field ahead a bit,” he said.
Dr. Spaeth has also been very happy with his work with the American Glaucoma Society. As the first president of the AGS, he believes he was able to set it on firm footing and moving in the right direction.
Dr. Spaeth also was involved with Ophthalmic Surgery, a SLACK, Incorporated publication. He served on the Editorial Board beginning in 1976, when the publication launched, and served as Editor from 1976 to 1995. Dr. Spaeth served as Editorial and Commentary Editor when the publication changed its name to Ophthalmic Surgery and Lasers in September 1995.
Dr. Spaeth, the teacher, is pleased with the “miraculous relationship I’ve had with my fellows. As much as I’ve learned from my teachers, I’ve learned the most from my disciples. The development of extracap and phaco I learned from them. And they told me when I was wrong.”
In return, Dr. Spaeth has always tried to teach his fellows that being a physician is more than just being technically correct.
“Fellows need to be cognitive and procedurally skilled, but there’s so much more. Our lives are so short. I work on the idea to see life as miraculous, but that we try to make a difference. Perhaps a tiny difference, but a help to the world. When we take care of a single patient we are taking care of a part of God. A single patient is not unimportant,” Dr. Spaeth said.
Values above money
Dr. Spaeth said his wife, Ann, is concerned with justice and fairness, and from her their three children “are gentle and ultimately concerned with fairness. I’ve been fortunate to spend my life with someone who challenges me. She makes me wonder about the small things and the great things. Should I step on a tent caterpillar? Do I have the right to do that? There is value in everyone and everything.
“I had the good fortune to fall in love with a beautiful woman. I had no idea what she was like other than gracious, beautiful and intelligent. But she’s been so much more.
“My children have been like my fellows, challenging me. Some of my greatest moments were walking my dog and discussing free will, art and beauty with my children. Having these conversations not to convince someone but to explore a fuller understanding. What a gift,” he said.
A view into the future
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Looking at the future of the glaucoma subspecialty, Dr. Spaeth said, “I think “-isms” of any kind, such as fascism, are dangerous. In glaucoma were are faced with-isms of a different sort. One-ism we were faced with was that glaucoma is any pressure over 21. We have damaged a lot of patients by believing that. Now many people say you need to get pressure as low as 10. But many patients will do fine at 20.
“The only -ism we need is focusing on what will make the patient better. The only guide to follow is, ‘Are we helping the patient, not reaching a number?’ Diet, exercise, lifestyle — we can use these to help a patient’s health as well,” Dr. Spaeth said.
Dr. Spaeth’s long-standing concern with ethical behavior in medicine is in evidence as he looks at the future of ophthalmology.
“Ophthalmology reflects trends in medicine,” he said. “There have always been people who have used the ills of others to further themselves. I’m sure that trend will continue. The use of medicine to attain power or prestige will continue. That tendency has been enhanced by changes in law, the rise of capitalism, acquisition of wealth for wealth’s sake.” he said.
“On the other side of medicine there are those who practice it only to help people. The rewards are consequences of that. There is no problem with making money, but the intent behind the action is what should guide us. So do we use our skills to make money, or is making money a lovely benefit of helping others?” he asked.
Dr. Spaeth credits H. Dunbar Hoskins, MD, the American Academy of Ophthalmology’s executive director, for his attention to these two opposing tendencies in medicine. He also credited former AAO President William Tasman, MD, who as president spoke against comanagement and perceived kickbacks in some areas of ophthalmology. For his own part, during his tenure as a member of the AAO’s ethics committee, Dr. Spaeth was pleased to see its stature grow and to have helped it to become an important committee in the AAO structure.
Dr. Spaeth thankfully acknowledged the physicians on the Editorial Boards of Ocular Surgery News who recognized him as a visionary of the past 20 years. And he offered one final comment on life. “I think we need to make contributions. But the major contribution is trying to live our lives right,” he said.
For Your Information:
- George L. Spaeth, MD, can be reached at Wills Eye Hospital. 900 Walnut St., Philadelphia, PA 19107; (215) 928-3197; fax: (215) 928-0166; e-mail: georgespaeth@aol.com.