• 5 Lessons I Learned in Becoming a Surgeon

    Written By: María Fernanda Astete, MD

    My ophthalmology journey started as a medical student when I decided to volunteer as an intern at the eye trauma unit. There I met my first mentors and found out how fascinating the anterior segment reconstruction is.

    After my three-year ophthalmology residency, I decided to specialize on the anterior segment of the eye and joined the cornea team at Hospital del Salvador in Santiago, Chile. This has not only given me the chance to learn different surgical techniques, but also to do one of the things that I enjoy the most: teaching cataract surgery to residents.

    Today, I am an ophthalmologist at the University of Chile in Santiago, and I will soon start my fellowship in cornea and external diseases at Moorfields Eye Hospital in London. Here are some lessons that I have learned from some incredibly inspiring eye surgeons:

    1. Always plan ahead for your surgery.

    Planning ahead for your surgery is one of the most important things to achieve a good result. In order to detect possible "red flags," perform a thorough preoperative examination of your patient. This will let you determine strategies to overcome any possible challenges during surgery. Document all clinical information on the patient's medical records and also plan the extra instrumentation that you may need. 

    It’s a good idea to organize your surgical day based on the complexity level of cases. Start with your easier cases to get comfortable and ready for the more complex cases. Challenging surgeries can be exhausting, so give them extra time, and do not schedule too many of them on the same day. Usually, young surgeons want to be fast and efficient when operating. But remember that our responsibility is with our patients, and the primary goal is to give them a good visual and treatment result. 

    2. Be prepared for surgical complications, and keep calm if they happen.

    Every surgeon needs a Plan B. Even if you think you are dealing with a standard case, be ready to face different situations that might come your way. 

    For example, in cataract surgery, be ready for anterior vitrectomies, iris hooks, endocapsular rings and three-piece sulcus intraocular lenses. This is especially true with heightened risk of complications, such as traumatic cataracts, zonular fragility or brunescent cataracts. 

    In case of a complication, stay calm, take a deep breath, think before making any move and keep your thoughts in order. It is very common to panic and rush through surgical steps after a complication, but this may lead to making the wrong decisions or cause further complications. Instead, take a breath and allow yourself to make wise decisions. Then, with patience and caution, you may continue your surgery. 

    3. Learn from as many surgeons as possible.

    The more surgeons that you watch operate, the better. There is usually more than one way to do things, and there may be a surgical trick or technique that better suits you. By observing their surgical tricks and techniques from more than one surgeon, you can enhance your surgical skills. Even in practice, try to go into the OR with your colleagues. 

    4. Good communication means patient satisfaction. 

    Good communication between patients and doctors is essential to achieve patient satisfaction. It is important to listen carefully to patients, allowing them to express their expectations,  and address their doubts.

    Inadequate communication may lead to unrealistic expectations. Common examples are ocular trauma patients that present with many ocular comorbidities and expect 20/20 vision after surgery or those patients that want to have cataract surgery and have an additional maculopathy. In these cases, you need to be explicitly clear during the consent process. Spend as much time as necessary to explain their diagnosis, prognosis and manage their expectations. Consider putting the discussion on the consent form, and give the patient a copy of the consent.

    5. Recognize your limitations.

    At the start of your career, recognize that there are cases that you are capable of pursuing by yourself and others that may require a little help. Even experienced surgeons face challenges in the OR. Create a network of colleagues in the same specialty and in complementary ophthalmic specialties to help you with those challenging cases.

    Even if you have already finished your fellowship or further subspecialty training, the experience of other colleagues or mentors is an invaluable gift. Some young surgeons may think that asking for a second opinion is a sign of weakness and insecurity. However, there is nothing wrong with asking for advice or even referring the patient to a more experienced physician. 

    Patients will greatly appreciate your honesty, and referring them to another physician does not mean that you are losing a case. It means that the patient has the opportunity to receive the best treatment option. Our biggest commitment is to the patient, and our main goal is to provide the most optimal treatment and visual outcome.

    About the author: María Fernanda Astete, MD, is an anterior segment surgeon Hospital del Salvador in Santiago, Chile, and an ophthalmologist and assistant professor at the University of Chile, Santiago. She is one of the Pan-American Association of Ophthalmology YO active delegates.