BLOG: A set of rules for practicing by

ByJohn A. Hovanesian, MD, FACS

In this issue of OSN, our cover story discusses expansion of optometric scope of practice in some states and how this may impact future patient care. The debate over this subject makes me think of several principles I use to guide my own decisions in the practice of medicine, and they might be a useful lens through which we can view this discussion. Here are some principles I practice by:

Focus on the top of your game. Think about the most complicated conditions you treat and ask how you can improve your effectiveness in treating them. For me, that’s cataract surgery. Keeping up with all the new technologies and techniques not only takes significant effort, but it calls upon all the previous skills I’ve spent my career refining. For non-surgeons, keeping abreast of the latest contact lenses, the newest dry eye treatments and the most recent glaucoma medications builds upon a similar background and presents constant opportunities for practice expansion. Disciplining ourselves to keep our training current fuels our “habit of learning.” That makes us better doctors and keeps our work more interesting.

With every encounter, ask, “Who is the best person to take care of this patient?” Frequently, I find myself sending challenging patients to my colleagues for consultation, even in my own subspecialty area of cornea. That’s because two heads (or more) are simply better than one, and the more background and experience a consultant has in the patient’s problem area, the better the referred patient will do. With the rapid expansion of knowledge in medicine, we need to recognize our own limitations. That’s why doing surgery on volunteer trips to the developing world is so challenging — because working in rural areas with fewer resources requires us to call on all our background medical training, not just the narrow range of surgical skills we have refined in the operating room. Doctors performing surgery in underserved rural areas need more training, not less. Fortunately, evolving surgical tools and trends are helping today’s experienced surgeons make all our procedures simpler and faster with more portable equipment, allowing well-trained surgeons to treat more patients in more places than ever before.

Keep learning how to communicate. The biggest challenge of my career has been learning how to be a better communicator, mostly with patients but also with staff and other doctors. We can’t overdo communication about our patients’ needs. We can never stop learning how to do it better. Honesty is paramount, and every patient is entitled to know how much experience and training we have in the area of their need. Every doctor we collaborate with deserves not just a “data dump” of many faxed pages from our EHR, but a thoughtful communiqué that gives him or her what’s really needed to take the best care of the patient.

Remember that you are profoundly privileged. Whatever part of the visual system we treat in whatever manner, our patients give us their most sincere expression of trust when they enter our care. The fate of their most treasured gift — their sight — is placed in our trained hands without reservation. We honor their trust when we act with humility and unselfish commitment to their future, putting their needs above our own desires. And we should be grateful for the opportunity to serve.

Laugh with every patient. Old people love jokes about aging. Every married person loves one-liners about marital harmony. And everyone loves a doctor who is willing to poke fun at himself. Laughter dissolves tension, lowers our pedestal and elevates our likeability. It’s magical medicine because it treats the doctor, too. Dispense it in every encounter.

In almost any field of work, it’s possible to construct logical arguments to defend almost any predetermined course of action that we’d like to take. But what makes the practice of medicine special is that we ignore politics, our personal economics and our egos when we start and end with the best interests of the patient in mind. Shouldn’t that guide our scope of practice too?

Disclosure: Hovanesian reports no relevant financial disclosures.