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Speaker: Resist urge to run from cases with poor outcomes
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KOLOA, Hawaii – Physicians must resist the urge to avoid complicated patients, a presenter said here.
Marguerite B. McDonald, MD, FACS, described a LASIK case, performed with a LADARVision laser and an Innovatome microkeratome, in which the cornea was perforated, and the steps she took to correct it.
“After ectasia developed and stabilized, refractive lens exchange with a toric IOL and LRIs to debulk the cylinder and intentionally make the patient hyperopic is a great approach because the surgeon can go back later and did wavefront-based ablation in the peripheral cornea far away from my perforation in the central – and a very thin – cornea,” McDonald said.
Marguerite B. McDonald
“Of course, topographic-guided PRK, which is now available, is also something we can use in cases that are too highly aberrated for wavefront capture,” she said.
The most important lesson to take away from these sorts of cases, McDonald said, is to resist the temptation to avoid the complicated patient.
“Spend as much time with them as they want,” she said. “Come up with a plan, turn to others for help and utilize all the resources at your disposal to make the patient well. Do this and you will certainly increase the respect and loyalty of your staff and colleagues in your practice.”
Terry Kim, MD, amember of the “Refractive Surgery Complications: You Make the Call” panel, seconded McDonald’s point.
Terry Kim
“I’ve seen 2 cases of referrals due to problems with perforations with a microkeratome,” Kim said. “Both of them ended up in a class action lawsuit, but one thing I’ve realized is that one of the patients – the physician had totally dissociated himself from the patient, and that is usually why people sue. It’s not actually the complication that occurred, I’ve found, but the reaction of the physician to that patient.
“For many of us,” Kim continued, “it’s a natural reaction not to want to see that patient. You’re nervous. You have to force yourself to be more engaged, to have that patient come in and see you spend chair time with them.” –by Daniel Morgan
Disclosure: McDonald is a consultant/scientific advisor/receives honorarium to/from Abbott Medical Optics, Alcon Laboratories, Allergan, Bausch + Lomb, FOCUS Labs, NDC, NexisVision OCULUS, OCuSOFT, ORCA Surgical, TearLab Corporation and TearScience. Kim receives consulting fees from Alcon Laboratories, Bausch + Lomb, Ivantis, Kala Pharmaceuticals, Ocular Systems, Ocular Therapeutix, Omerus, PowerVision, Shire and TearScience; and has ownership interest in Ocular Therapeutix and PowerVision.