My cataract surgery: Postop perspective from an ophthalmology practice business consultant
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“The only thing worse than being blind is having sight but no vision.”
– Helen Keller
“I would like to see the day when somebody would be appointed surgeon somewhere who had no hands, for the operative part is the least part of the work.”
– Harvey Cushing
Just before 2020 — a very bad, rotten year — came to an end, I did a very good thing. Or rather, Dr. Michael Gordon of San Diego did a very good thing, brilliant really, and performed cataract surgery on me with essentially perfect results.
I was just along for the ride. Mickey did all the work. Just as he did 35 years ago when he performed radial keratotomy on the same eyes (–6.0, eight incisions, 3 mm optical zone).
After two reasonably comfortable trips to the OR, and barring any unlikely eye ailments, my 66-year visual acuity journey is now complete: from keen pediatric vision to a goggle-eyed myope at age 10, back to clear vision with RK, onward to presbyopia and progressive hyperopia in the middle years, and now back to clarity. What a ride!
After more than 40 years as a worldwide ophthalmology business consultant, I have finally had a chance to experience firsthand the most elegantly engineered, most common and most commonly successful surgery provided on the planet. It was as if I had been an earthbound astronomer for 40 years and then hopped on a NASA Mars mission to see the heavenly bodies up close for the first time.
Here, in no particular order, are some observations from my up-close experience. I hope at the very least this month’s column will give you a few pearls to pass around to your practice and ASC staff and at the very most will remind you of the underappreciated miracle of your profession.
Cataract surgery experience
1. It was early March 2020. After decades of sailing fun in the sun, and an inordinate amount of squinting at my latest driving examination, it was finally time to schedule cataract surgery. COVID-19 was a good excuse to put off the inevitable, and it gave me time to reach out to about 50 of the smartest cataract surgeons I know for their opinion. You know what comes next: I got back about 50 very strong, but different, opinions about the “right” way to operate on 35-year postop RK eyes. The smartest recommendation I heard was, “Pick a surgeon you trust and let them perform surgery the way they like.”
2. Along the way, as I told clients about my upcoming procedure, they would say something along the lines of, “Good luck. RK, huh? I’m sure it will go great.” But they said it with that somber tone that is usually reserved for patients about to undergo quadruple bypass. It gave me pause: “Hey! Until now you always said cataract surgery is nothing, a breeze, nada, zip.” I started to worry a bit.
3. Even when your surgeon is an old pal, you spend vastly more time with clerks, technicians and surgical counselors than you do with your doctor. These staff make or break a patient’s cataract experience, and this probably goes double for patients who have not had my 40 years to contemplate surgery. I can report that even in one of the best and most caring old-line practices in the country, there were brief moments here and there that disappointed. It does not take much: a technician’s lack of confidence when taking a history, delays in returning phone calls, forgetting to call in a prescription, sounding bored. If you are a managing partner or administrator, set higher standards. Never stop polishing customer service. Remember that the better you are as a surgeon, the higher patient expectations rise for the entire organization.
4. I had no concerns about how my home care would go after surgery. My home and work partner, Corinne Wohl, reassuringly said, “I’ve got this, honey. My dog had cataract surgery a few years ago, and I know just what to do. I’m going to take great care of you.”
5. Then there is the paperwork. I have signed fewer documents buying a house. Will somebody please try to find a way to consolidate this process, write clearly and boil it all down to three initials and a signature?
6. Transport is another aspect of cataract surgery you never think about until it is your turn. Even if you have an in-town surgeon and driver, you have at least 14 round trips between preops and surgery and surgical clearances and pharmacy runs and postops. All up, it was about 350 miles and a 280-pound CO2 footprint.
7. Did I mention the eye drops? Prescriptions in hand, I popped into my neighborhood mom-and-pop pharmacy. A few hundred dollars later, I was all set for both eyes. Then I did the math. Counting up the drops per medication per day over a 75-day course of treatment, I would be instilling 576 eye drops. With just a couple of weeks left on my remaining Ilevro (nepafenac ophthalmic suspension 0.3%, Novartis) as of this writing, I have gotten really good at instilling eye drops. Too bad my visual fields are normal and my IOPs are 14 mm Hg. I would be all set to manage glaucoma. In hindsight, I am convinced that these medications are all placebos; these eye drops are just for desensitization and operant conditioning to get the patient ready to have what seems like a 50-kilo femtosecond laser head descend on their eyeball (more on that in a minute).
8. With 2020 being the year of COVID, I had to undergo testing a few days before each eye was operated. A 2-hour line of cars. And then an experience that is not just a “test” but more like a “procedure” all on its own. In hindsight, my COVID testing took more time and was more uncomfortable than cataract surgery.
9. The early morning of surgery was pretty trippy, even before I was escorted to preop. I was checking in with the unit clerk when Mickey came around the corner. The clerk stood. Then my clerk and my surgeon faced each other, bowed deeply and gave each other a soft “namaste.” Mickey disappeared. The clerk sat down and told me, “We always do that — it’s our little ritual.”
10. Things got more trippy in preop. More paperwork. A gown. (Why do they open in the back? If I am coding in the OR, don’t you want access to my chest?) My anesthesiologist popped in wearing what looked like a tall chef’s cap — all the better to put her patients at ease, no doubt — and asked if I had any questions. I wanted to say something smart-alecky about her hat, but because she was going to have my life in her hands, I simply gave her an exaggerated smile.
11. Why an unusually broad smile? Twenty minutes earlier, I had been given 5 mg of Valium. I would have preferred 10 mg, which Google says would have been a more appropriate dose for a strongly built 6’1” male. Maybe 20 mg for good luck. In fact, it would have been kinder to have started Valium about 10 days before surgery on the first eye because that is when the anxiety started to build.
12. As it turns out, I had nothing to be anxious about. Except for the previously mentioned ginormous femto laser head. At the start, the light show was kind of fun (it would have been better set to music — Janis Joplin’s last acid track would have been good). Then a twinge. For a while I was able to ignore the discomfort and imagine I was James Bond undergoing some fiendish torture. I am told I got a bit squirmy at that point, which I will have to take on faith because I am psychologically blocking at this point. Probably just latent PTSD that will surface at some point in the future.
All in all, my cataract surgery was a splendid, miraculous experience. However, something just does not add up.
Here I am writing this month’s column, just after New Year’s Day, with perfect distance vision for the first time in 20 years. At my desk, overlooking San Diego Bay, I can see the miles-away details of downtown, and with dime store readers, I can finally read the fine print on my phone. Colors have a clarity and brightness that I did not notice being robbed by my yellowing lenses.
What does the doc get? After all the stress, liability, practice expenses and taxes, surgeons like you, surgeons like Mickey, only clear about $180. I could not buy an oil change for that. There is something very wrong with this picture. And it is worse for our friends and colleagues in Canada, where under new payments they might clear half of that.
Considering what it costs you over a lifetime to buy gym memberships for your muscles and lungs, shoes for your feet, college tuition for your brain, stents and statins for your heart and aids for your ears, the bill for taking care of your eyes is cheap. Too cheap.
Final thoughts
For Mickey Gordon, having another go at my baby blues after 35 years is perhaps akin to an obstetrician delivering one of his very first patient’s grandchild. Thirty-five years on, Mickey is the same surgeon I met when my career in ophthalmology was starting. Back then, I described him to others as “an ophthalmological Einstein, with the hands of a 14-year-old girl and the good intentions of the Dalai Lama.” The description still fits. Hats off, and a large thank you to your colleague Dr. David Geffen and your entire staff. Simply brilliant stuff, this business of eye care. I will never look at it the same way again. Quite literally.
- For more information:
- John B. Pinto is president of J. Pinto & Associates Inc., an ophthalmic practice management consulting firm established in 1979. He is the author of several books on ophthalmic practice management, including John Pinto’s Little Green Book of Ophthalmology: Strategies, Tips, and Pearls to Help You Grow and Manage a Practice of Distinction, UP: Taking Ophthalmic Administrators and Their Management Teams to the Next Level of Skill, Performance, and Career Satisfaction (with Corinne Wohl), Simple: The Inner Game of Ophthalmic Practice Success, and Ophthalmic Leadership: A Practical Guide for Physicians, Administrators, and Teams. Available now for purchase at healio.com/books. Receive 20% off with promo code PINTO20. He can be reached at 619-223-2233; email: pintoinc@aol.com; website: www.pintoinc.com.