I have a patient, already blind in his right eye, who just suffered his third retinal detachment in the last 2 months in his remaining, left eye. I am operating, again, to try and prevent his going totally blind.
I trained with a world famous and world class mentor, Steve Charles, M.D. of Memphis, TN. My fellowship lasted a year, where I learned my specialty, and some lessons, that will last a lifetime. Among the lessons learned…”sometimes the disease wins.”
Retinal disease often leads to permanent loss of vision. Sometimes mild, yet often, significant loss of vision. As a young physician I remember tending to believe that I might just be the one “super hero doc” who was better than most. I remember thinking that maybe my surgical results would be better than any others.
As a practicing physician of 18 years, I know, and have witnessed, so many times that outcomes are not what we had hoped…despite perfect surgery and treatment. I have learned to respect eye disease. Doctors don’t always “win” as there is no such thing as a “perfect surgical outcomes.”
Poor surgical outcomes may be defined as results that are less than perfect. In my case, I often perform surgeries that were technically perfect, yet the visual results are disappointing. Nothing went wrong, but it is just the nature of the disease.
In this highly technological age, with advances such as Avastin, laser surgery, Ozurdex, etc., it’s hard to tell patients that we are not perfect and results can not be guaranteed. In fact, it’s hard to tell patients that despite our best efforts and intentions, outcomes may be disappointing.
Medical care, especially surgery, gives us the opportunity to alter the natural course of a disease. For instance, the natural course of a retinal detachment is blindness. The success rate of retinal detachment surgery is about 95%. This means that 95% of the time we are able to reattach the retina and prevent blindness. This does NOT mean that 95% of the time patients we well.
The eye disease still wins 5% of the time.
What Does This Mean? What Dr. Charles taught me, was that I shouldn’t (and physicians as a whole) take poor outcomes on a personal level. This is easier said than done.
With time, I learned how to do this. Perhaps this is manifest in my “explanations” that highlight the potential pitfalls of a particular disease. Through education, I hope to convey my expectations and hope they are aligned with my patients, because I have learned that “sometimes the disease wins.”
With my particular patient above, I saw him Saturday morning. While his retina is now reattached, it must remain this way for before we can have some hope. Right now, his eye disease is winning.