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The 10 best things I have learned in my career
Responses of George L. Spaeth at the American Society of Cataract and Refractive Surgery annual meeting in Boston to the question “What are the 10 best things you have learned in your life?”
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 George L. Spaeth |
1. There are no 10 best things. You need to transform the present moment into one that is as “best” as possible.
2. It is prudent to consider the consequences of decisions, acknowledging that a considerable portion of those decisions will be wrong. For example, if I overdiagnose a blebitis, the patient will probably not suffer (good), but if I underdiagnose a blebitis, the patient may well go blind (bad). If I overtreat in the early stages of glaucoma, I make an asymptomatic patient symptomatic (bad), whereas if I undertreat, there is usually plenty of time to start treatment later (good). If I overtreat a patient with advanced glaucoma, I may introduce unnecessary symptoms, but they are a small price to pay for preserving vision (not bad); on the other hand, if I undertreat, the consequences are far more serious, because an already symptomatic patient becomes even worse (bad).
3. It is wise to concentrate on the essentials. In short, do nothing unnecessary. This forces us to think deeply about our fundamental purpose.
4. Our responsibility as physicians is to preserve, restore or improve health. To do so we need to concentrate on health. Health is best revealed by the medical history. We tend to become diverted by surrogate questions such as: What is the visual acuity? What is the visual field? What is the applanation pressure? What is the central corneal thickness? But, for example, the role of central corneal thickness in determining whether a patient is healthy is so tiny as to be virtually immeasurable. Yet we often spend more time taking ancillary measurements than we do obtaining an essential, valid, qualitative history.
5. Listening well is a key to good patient care (and a good life). For example, when a patient says, “I am worse,” the patient is worse. Our job is to figure out why. Careful listening will give needed information about how many years a patient is likely to live, which we must know if we are to give good care. In this regard, age itself is not a good indicator, whereas history is. A 92-year-old healthy woman has a 97% chance of living to be 96 years old. A 62-year-old diabetic male smoker who is overweight and has had a heart attack has a 0% chance of living to be 96 years old and only a 35% chance of living to be 66 years old.
6. Generic labels such as “normal” or “average” are dangerous. They frequently mislead. For example, we have been taught in medical school that average is healthy. But average values are often not healthy. Values that are not average are called “abnormal” but are often healthy. For example, it is not until IOP is hugely abnormal, exceeding five standard deviations above average, that it is reliably a sign of disease. Consider the fact that ophthalmologists routinely use the phrase “normal-pressure glaucoma” to describe glaucomatous optic nerve damage in association with pressure that is average. Clearly, that “average” or “normal” pressure is not normal in the usual sense (ie, healthy).
7. Treasure good assistants; they deserve it.
8. What most people want is to love and be loved. To accomplish this, one must love and be lovable. The idea that “everyone loves a winner” is wrong. People like to be associated with winners, in hopes of riding on their coattails, but people are not loved because they are winners. Reputations are difficult to build and easy to lose, and it is prudent to consider what kind of reputation one wants and then work to achieve it.
9. It is easy to fool ourselves. When I fool myself I provide neither good care for my patients nor good care for myself. All those who for centuries have counseled us to know ourselves have counseled wisely. Patients get poor care when their physicians do not know their own motives, strengths and limitations.
10. We see only what we look for, and we tend to look for only what we know. What we do not know limits what we can see. One of the reasons why knowledge is such a marvelous thing is because the more we know, the more we see and the richer our lives become. But there is a next step. To grow, we must see what we have not seen before. To create and help the world grow, we must see what nobody else has seen before.
- George L. Spaeth, MD, can be reached at Wills Eye Institute, 840 Walnut St., Philadelphia, PA 19107; 215-928-3197; email: gspaeth@willseye.org.
- Disclosure: No products or companies are mentioned that would require financial disclosure.