• Handling Disagreement: Bridging the Gap Between YO and SO

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    As young ophthalmologists (YOs) maneuver through training, we take on mentors and senior role models who shape our understanding, approach and methodologies. But, what if our mentors disagree or there is no consensus? And how can we identify mentors that will help us, YOs, learn from these scenarios?

    In a recent piece for Scope, senior ophthalmologist Thomas S. Harbin, MD, recounts the controversy when use of phaco in cataract surgery began to get publicity. What Dr. Harbin saw as a concern over premature promotion, others read as disagreement between leading ophthalmologist Edward Maumenee, MD, and phaco proponent Charles Kelman, MD.

    Even in cases of smaller disagreements, my training taught me that there are many ways to peel an orange. Because I was eager to learn numerous approaches to the same problem, I usually chose not to challenge my attendings when they showed me the “only” way to do something.

    Instead, I thought it important to appreciate why they thought a particular sequence or method was best. Through that, I learned that internalizing the framework and reasoning was more important than whether I was performing a coaxial or bimanual phacoemulsification, for example.

    Brian Fowler, MD, had to internalize two disparate approaches during a period when he worked with multiple mentors. While one mentor, Barrett G. Haik, MD, demanded a paced and methodical approach on one day, the next day, James Chris Fleming, MD, demanded an immediate urgency to his workflow.

    Now as an attending, Dr. Fowler said he appreciates that experience. “There is pressure in a busy clinic to move through patients. Dr. Fleming taught me how to do that effectively. But, when I’m seeing a patient and they don’t fit into a simple mold, I have to adopt Dr. Haik’s approach. Typically, I will circle that patient and review them more methodically after clinic.” Essentially, both methods are right, given their own context.

    It might be tempting to chalk some differences up to generational differences. However, vitreoretinal surgeon Steve Charles, MD, a senior ophthalmologist himself, cautions against such thinking.

    “As a leader, if you’re going to be effective, you have to learn what motivates people in other age groups, what means of communication they use, the problems they face, and so on,” Dr. Charles said. “You can’t just say, ‘We didn’t do it that way 25 years ago,’ because that just puts undue pressures on your relationships and … it’s not 25 years ago.”

    Some mentors actively encourage different perspectives. James Chris Fleming, MD, is a senior ophthalmologist who relates to his residents and fellows particularly well. A deconstructionalist by habit, he maintains a sense of curiosity that pushes him to continually incorporate new concepts and entertain new ideas. This trait allows him to leverage many years of experience against evolving technologies and encourages YOs to speak up.

    How have you learned to handle disagreements with or among your mentors? What has it taught you?

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    About the author: James G. Chelnis, MD, is a newly appointed assistant professor in oculoplastics at the New York Eye and Ear Infirmary of Mount Sinai and has been on YO Info’s editorial board since 2012.