BLOG: Planning, judgment, skill and luck
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As I’ve written before, aviation has become a passion of mine since the pandemic, as I’ve earned my private pilot certificate, instrument rating and recently my commercial license.
Along the way, I’ve seen an uncanny number of parallels between safe flying and practicing medicine. One of the more important concepts is how we approach risky situations, like landing in heavy gusts or crosswinds, flying in mountains in adverse weather or handling an in-flight emergency. The approach is just the same as doing surgery on a patient with comorbidities. Our four assets are planning, judgment, skill and luck, and they need to be used in that order to “land and get home safely.”
First and most important is planning. Understanding options for managing a challenging procedure requires advance study. Online videos are a treasure, as is advice from colleagues. Planning for contingencies with OR staff, including special instruments or supplies, can save the day. Having a premade “oops” kit in the OR is essential when you need to perform a vitrectomy, suture an iris or secure a lens to the sclera. Preparation with the right knowledge and tools avoids so much drama.
Next is judgment. Should I even be treating this patient at all? In aviation, we have “personal minimums,” which are absolute guidelines for personal wellness and weather conditions that create objective barriers to unchecked bravado. Pilots like to say that in bad weather, it’s better to be on the ground wishing you were in the air than in the air wishing you were on the ground. We surgeons should understand our own personal limits. Pick easy cases for trying new techniques. When necessary, consider altering the technique to a simpler, safer approach, like converting from phaco to manual small-incision cataract surgery. Doing so is humbling and brave at the same time. And there is never a loss of face in ending a case to get help from another surgeon when a lens drops or other unforeseen conditions exist.
Skill is summed up by the expression “a superior pilot uses superior judgment to avoid situations which require the use of superior skill.” For pilots and surgeons, skill is a gift to be appreciated but never used in place of planning or judgment. Our skill can be improved by watching our own surgical videos. See my 2011 blog, Doctor, Teach Thyself.
Finally, we’ve all heard “it’s better to be lucky than good,” but we can’t rely on luck, so it’s better to be good first. Good means using planning, judgment and leaving as little need for luck as we can control.
The saying goes, “There are old pilots, and there are bold pilots, but there are no old, bold pilots.” The same has been said of surgeons too, but there’s an important difference. As surgeons, we don’t risk our own outcome when we are unprepared. We risk the eyesight of others. That means we surgeons become our best selves when we apply the same planning, judgment and skill that we would want our own surgeon to employ when laying steel to the flesh of our own eyes.
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For more information:
John A. Hovanesian, MD, FACS, an ophthalmologist specializing in cataract, refractive and corneal surgery at Harvard Eye Associates in Laguna Hills, California, can be reached at drhovanesian@harvardeye.com.
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