American Academy of Ophthalmology Web Site: www.aao.org
This Year’s Laureate: Dr. Bird
The board of trustees of the Academy is proud to announce the selection of Alan C. Bird, MD, as the recipient of the Laureate Recognition Award for 2008.
Dr. Bird is recognized as a pioneer in ophthalmic research, teaching and clinical medicine. He is one of the world’s foremost experts on the treatment of retinal vascular disease and genetic and degenerative retinal disorders.
Moreover, his expertise has been widely sought after, and he has made strategic contributions to the U.S.’s National Eye Institute, the U.K.’s Medical Research Council, the Wellcome Trust, France’s INSERM and Deutsche Forschungsgemeinschaft. He has also played a key role in the design and evaluation of numerous clinical trials involving ground-breaking treatments in retinal disease.
In recognition of Dr. Bird’s contributions to ophthalmology, the Academy acknowledges the debt owed him for his commitment to teaching and education, enabling many of his students to leave their mark on the profession.
Academy Leadership Transition
Academy President David W. Parke II, MD, has announced that the board of trustees accepted the planned retirements of the organization’s two senior staff leaders: H. Dunbar Hoskins Jr., MD, executive vice president and chief executive officer, and David J. Noonan, deputy executive vice president and chief operations officer.
In announcing the transition, Dr. Parke noted that the change arises out of a carefully orchestrated succession plan initiated by Dr. Hoskins and Mr. Noonan with the Academy leadership early this year.
“Our profession and the Academy have been fortunate to have benefited from the service of Dr. Hoskins as CEO for 16 years and Mr. Noonan as COO for 37 years. Consistent with their leadership style, they have carefully prepared the organization for the change. Soon we will begin the search for a new executive vice president,” said Dr. Parke.
Q: All of my colleagues are talking about a new surgical procedure. I feel the need to learn it too, but how should an “old dog” learn new tricks?
A: It is an enduring principle of medical ethics to put patients’ interests first, so how can practitioners gain new proficiencies without unacceptable risk?
Within accredited academic medical centers, both patients and physicians are generally comfortable with trainees learning surgical skills, perhaps with the faith that competent supervision by senior clinicians confers acceptable safety. The validity of this assumption is supported by research on the resident “learning curve,” demonstrating that with close supervision, complication rates reflect that of the attending surgeon rather than an inexperienced trainee.
After residency, practitioners who wish to assimilate new techniques bear the responsibility for managing their own learning curve while also protecting patients’ in-terests.
In your practice, a review of the professional literature may be sufficient for minor modifications of existing procedures. For more significant innovations, a program of self-directed study is recommended, including literature, video, didactic and practical instruction courses and, ideally, the assistance of a mentor. A mentor can be an experienced and trusted colleague who will assist in surgery and discuss technical problem areas.
Patient selection for initial cases should be based on anticipated technical difficulty. Candidates who exert additional pressures through anxiety or demanding personalities may not be suitable.
In the process of informed consent, the surgeon should accurately disclose his or her level of experience with the new technique. For minor modifications, it may be appropriate to state that one is modifying a familiar technique, though significant innovations to one’s experience should be presented as such without misrepresentation. The role of a mentor, if any, also should be disclosed.
Carefully evaluate results of early cases, with a view toward fine-tuning techniques. If a significant complication occurs, appropriate disclosure to the patient is ethically mandatory, as is prompt management, either personally or by referral as necessary.
For more information about the learning curve, visit www.aao.org/about, click “Ethics,” “Advisory Opinions” and “Learning New Techniques after Residency.” To submit a question for this column, contact the Ethics Committee staff at firstname.lastname@example.org.
How to Deal With Unanticipated Outcomes
Dealing with an unanticipated outcome or adverse event is one of the most difficult aspects of medical practice, especially if an error contributed to the result. Many physicians want to know how they should respond to these situations, what should be disclosed to the patient and whether an apology is necessary or advantageous.
The Ophthalmic Mutual Insurance Company (OMIC) offers the following advice.
Barriers to communication. While many physicians want to talk to their patients about adverse events, they may hesitate to do so for a variety of reasons. Some fear that disclosing complications may prompt a lawsuit. Others may lack the communication skills necessary to respond to a patient’s anger and grief with compassion rather than defensiveness.
Trend toward disclosure. Regardless of their comfort level, ophthalmologists may no longer control whether or not to disclose medical misadventures. Increasing numbers of medical groups, health care organizations and health plans require that patients be informed of care outcomes as part of peer review and quality management, and as a recognition that patients have a need and a right to know about their own condition.
Building trust. The best reason for disclosure, though, may well be the effect it has on the physician-patient relationship. Communicating with the patient or patient’s family about the adverse outcome sympathetically and nondefensively within the shortest appropriate time period may help dispel much of the patient’s anger, confusion and distrust.
A patient’s belief that he or she is not being told the whole story, or is not being given the opportunity to ask the physician questions and vent feelings, often provokes a decision to seek the advice of an attorney and pursue a medical malpractice claim against the ophthalmologist. Indeed, a number of studies have shown that patients who sued their physician often did so because their doctor did not help them understand the unanticipated outcome.
What patients want. Faced with poor outcomes, patients want their doctor to do three things: explain what happened, say he or she is sorry that the patient experienced the poor outcome and assure them that the proper steps will be taken to prevent the same thing from happening to other patients.
For more information on OMIC and to review their risk-management tools and claims resources, visit www.omic.com.
International Ophthalmologist Education Award
Are you an international member of the Academy? If so, you can qualify for the International Ophthalmologist Education Award.
First go online to apply for the award. You then need to complete 90 continuing medical education (CME) credits over a period of three years. Half of the credits must be Academy-sponsored CME. You must use the Academy’s online transcript service to record both your Academy and non-Academy CME.
If you complete 90 CME credits within three years of applying for the award, you will receive a certificate and will be listed on the Academy Web site, in the Annual Meeting Final Program and in EyeNet.
Efficiency Advice for Physician-Only Practices
Some highly efficient and productive comprehensive ophthalmic practices do not utilize technicians or optom-etrists to assist in examining their patients.
Simplifying office processes can minimize the need for coordination, optimize time and motion efficiencies and facilitate patient flow through the office. Redesigning the office layout can help minimize the distances from waiting room to reception desk to exam room and back. Using Academy patient education pamphlets and videos can convey information to patients in a quick and efficient manner. These are a few of the practical tips you will read about in the white paper Increasing Office Throughput in Physician-Only Practices: Experiences of a Model Practice by Richard H. Lee, MD.
This paper provides tips and strategies that allow practices to function more efficiently in anticipation of increased patient loads that are expected with the aging of the Baby Boom generation.
To view the paper in its entirety, visit www.aao.org/practice_mgmt/boomer.cfm.
Update Your Member Profile
To ensure that your information is current and accurate for Find an Eye M.D., the on-line directory of practicing ophthalmologists, please take the time to visit “Update Member Profile,” located in “Member Services” at www.aao.org.
For more information, contact Member Services by phone, 866-561-8558 (toll free in the United States) or 415-561-8581, or e-mail, email@example.com .
Academy Exhibit at ESCRS and ASRS
If your plans take you to the European Society of Cataract and Refractive Surgeons (ESCRS) meeting, Sept. 13 to 17 in Berlin, or the American Society of Retina Specialists (ASRS) meeting, Oct. 11 to 15 in Maui, Hawaii, be sure to stop by the Academy’s booths and see the latest educational products.
For more information on meetings that the Academy will attend, visit www.aao.org/aao_exhibits.cfm.
Academy Bookshelf Offers Two Classic Works
Two classic ophthalmology works are now available through the Academy Bookshelf.
The four-volume Albert and Jakobiec’s Principles and Practice of Ophthalmology (#0240623) provides answers to a number of practice issues, including in-depth guidance on new diagnostic approaches, operative techniques and treatment options, as well as explanations of new scientific concepts and their clinical importance.
It costs $799 for both members and nonmembers.
Roy and Fraunfelder’s Current Ocular Therapy (#0240624) has undergone major modifications and em-braces evidence-based medicine. Designed for the clinician to focus on a specific area, the format includes a short description of the condition, laboratory findings, differential diagnosis, treatment, CPT codes for billing purposes and more.
It costs $159 for both members and nonmembers.
New Myopia OTA
The latest Ophthalmic Technology Assessment, due to be published in this month’s Ophthalmology, reviews the ways in which orthokeratology is associated with vision-threatening complications, including infectious keratitis caused by Acanthamoeba and gram-negative bacteria.
Reprints of Safety of Overnight Orthokeratology for Myopia (#112065) are $11 for members and $16 for nonmembers.
The Washington Academy of Eye Physicians and Surgeons (WAEPS) presented their 2008 Outstanding Humanitarian Service Award to Mark S. Cichowski, MD. Dr. Cichowski has been participating in medical missions to such countries as Nigeria, Ghana, Haiti, Kenya and Myanmar since 1977.
Paul R. Lichter, MD, received the Lucien Howe Medal at the May meeting of the American Ophthalmological Society. The Howe Medal, first awarded in 1922, is one of the highest honors in the field of ophthalmology and recognizes individuals who have made powerful marks on ophthalmic heritage. Dr. Lichter, a glaucoma specialist, is chairman and F. Bruce Fralick Professor of the University of Michigan Department of Ophthalmology and Visual Sciences. He is also director of the W. K. Kellogg Eye Center.
2008 Joint Meeting Sessions
Congress, CMS, private payers and consumers are looking at pay-for-performance programs and physician profiling as a way to reform health care and physician reimbursement. Ophthalmology is one of the first specialties to realize incentive payments under CMS’ Physician Quality Reporting Initiative, which will likely see an increased bonus in 2009. The Academy is also teaming with federal agencies, including the Federal Trade Commission (FTC), the Department of Defense (DoD) and the Department of Veterans Affairs (DVA) on wide-ranging topics, including LASIK advertising guidelines and research opportunities.
Attend these free sessions at the 2008 Joint Meeting and discover how the Academy is working for you throughout the federal government.
Physician Profiling and Accountability. Physician profiling, the practice of assessing physicians’ performance, is a growing trend. This session will examine profiling and other physician accountability initiatives tied to payment, including the outlook of CMS’ Medicare physician quality reporting and Physician Web Compare plans. (Monday, Nov. 10, 12:15 to 1:45 pm, Georgia World Congress Center, Room A412)
New LASIK Advertising Guidelines. LASIK advertising can be tricky business. Striking the right balance in your ads is critical to delivering realistic expectations for your patients. This session will review newly updated refractive surgery advertising guidelines developed by the Academy and the FTC and will also address informed consent. (Saturday, Nov. 8, noon to 1 p.m., Room B401)
A Guide to Ophthalmic Drug and Device Evaluation. Many ophthalmologists find themselves in situations that warrant guidance from the FDA. Representatives of the FDA’s Division of Ophthalmic and ENT Devices, Office of Device Evaluation and Division of Anti-Infective and Ophthalmology Products will present an overview of the approval processes for ophthalmic devices and drugs. A question-and-answer period will follow. (Sunday, Nov. 9, 12:45 to 1:45 p.m., Room A401)
Combat-Related Research Opportunities in the Department of Defense and the Department of Veterans Affairs. In this session, representatives of the Society of Military Ophthalmologists and the Association of Veterans Affairs Ophthalmologists will discuss combat-related eye and vision research opportunities available in the DoD and the DVA. (Monday, Nov. 10, 12:15 to 1:45 p.m., Room A401)
The Academy is busy on Capitol Hill working for your interests, in such areas as physician profiling and ophthalmic drug evaluation.