As a retina specialist, I’m a surgeon.
There are basically only two types of doctors. I like to think of us as either “left” brained or “right brained,” but perhaps it’s more accurate to simply classify doctors as surgeons vs. non-surgeons.
The surgeons are more decision makers while the non-surgeons (PCP, family docs, internists, pediatricians, etc.) are the problem solvers (the smarter of the two groups, too!).
One major difference between the two types is our commitment to a treatment plan. Treatment often requires surgery. Surgery cant’ be undone. We must always weigh the risks and benefits of surgery to the patient…and be ready for unforeseen complications.
I am a board certified Ophthalmologist, and I am a surgical subspecialist. Further training allows me to function as a retina specialist, an eye doctor who treats medical and surgical diseases of the retina.
Common retinal problems which require surgery include retinal detachments, epiretinal membranes, floaters, macular holes and others.
Making the decision to operate is not always easy.
I must make the decision based upon my best judgement, weighing all options and goals…and commit.
What are the potential risks of surgery versus the benefits. Are the risks of surgery paramount to the potential benefits? Is surgery worth it?
If there were no complications of surgery, this would not be a big deal, but in the “practice”of medicine unplanned reactions, results and complications may occur.
Sometimes the disease makes the decision simple. For instance, a retinal detachment requires surgery. The natural history of an untreated retinal detachment is complete blindness, that is, without successful surgery, blindness will occur. The risk of blindness from surgery (for example, due to infection) is around 1:10,000.
In this case, not operating would be a mistake. The risk of blindness is almost guaranteed if surgery is not considered.
On the other hand, epiretinal membranes, floaters, and cataracts are less clear-cut. The decision to operate is more complex as a subjective (the patient’s perception or appreciation of a problem) evaluation is integral to making a decision over surgery.
Even though a patient may clearly have an epiretinal membrane, vitreous opacities (aka floaters) or a cataract causing blurry vision, unless the patient is worried about losing more vision, surgery may not be necessary.
Left untouched, none are potentially blinding. Leaving them alone is okay.
Complications in these circumstances are really troubling.
What Does this Mean?
Complications of surgery are what define a surgeon’s practice. Knowing when to operate and how to deal with the unexpected are what defines a good and healthy doctor-patient relationship.
If there were no complications in surgery, you wouldn’t need a “good” doctor. If every surgery turned out as expected, we wouldn’t need to build relationships.
In the next week, I’ll be writing about some advances at our center to make vitrectomy surgery even safer than our current systems… further reducing the likelihood of complications.