When I lecture medical students and primary care physicians on ophthalmology topics, I often interject the line, “Don’t forget that the eye is part of the body.” I say this because the anatomy, physiology and pathology of the eye are so specialized that many students and primary care physicians assume they don’t have the background to understand them with a high level of sophistication. They see ophthalmic knowledge as somehow separate from everything that makes up their sphere of medicine.
As primary care physicians have devoted progressively less attention to learning about the eye, so we ophthalmologists have distanced ourselves from the rest of medicine. This separation has occurred not only at the individual level, but specialty-wide. The American Academy of Otolaryngology and Ophthalmology was established in 1896, making it one of the earliest subspecialty societies, and the American Board of Ophthalmology, created in 1916, was the first specialty board. Although 93 percent of American ophthalmologists are members of the Academy, only 30 percent are members of the AMA. And disproportionately few of us are actively involved in our state medical societies.
Many of us are letting our privileges lapse at local hospitals. We almost never care for inpatients and often prefer to perform surgery at surgeon-owned ambulatory surgery centers rather than hospitals. We don’t attend hospital staff meetings, conferences or grand rounds anymore. As we distance ourselves from our hospital responsibilities, many of us have stopped going to hospital-sponsored social and charity events. As a result, we are interacting less and less with our nonophthalmologist colleagues both socially and professionally.
I have eaten lunch at the doctors’ lunchroom of a Saint Paul, Minn., hospital almost every Wednesday for more than five years. Many of the faces there are familiar to me. However, I am embarrassed to admit that I still don’t know everyone’s name and that I know the specialties of less than half of the doctors I eat with every week. Clinicians representing different specialties will often talk with one another about patients whom they share, and I am almost never involved in these conversations. I believe that this separation from the rest of medicine is unhealthy for both medicine and ophthalmology. Just as we have to remind others that the eye is part of the body, so we must remind ourselves that ophthalmology is part of the larger house of medicine.
We assert that optometrists don’t have the training to prescribe certain medicines or do certain procedures because they haven’t gone to medical school and done a medical internship. At the same time, they claim that we are overeducated and overtrained “merely” to take care of diseases of the eye. The more that we separate ourselves from the rest of medicine, the easier it is for state legislators and the public to disregard our assertions that a full medical education and training are necessary to safely treat eye disease.
Remember that you are a physician first, and an ophthalmologist second. Don’t give up your privileges at local hospitals. Eat lunch with nonophthalmologist colleagues. Attend hospital-sponsored social events. When consulted on an inpatient, look at it as an opportunity and not an inconvenience, and write your consultation report from the perspective of someone with a full medical education. Join the AMA and your state medical society. Don’t forget that the eye is part of the body.