As you enter your last two months of residency or fellowship, let me take a moment to pass on some words of wisdom that my mentor gave me, which saved me many hours of work and possibly adverse outcomes in the OR because I listened. You are at an academic institution that has many support systems and information that you take for granted, and will not likely be there in the next phase of your career. So, take some notes, and gather the following items during the month of May, before June hits and you are overwhelmed with your final research project being due, endless parties and good-bye functions and moving preparations.
1. The list of instruments and sutures you use for each procedure, the company that makes them and the catalog ID number for each one. Ask your favorite scrub nurse to give you this list, as they usually have a nice detailed list of the instruments in each set — cataract, trabeculectomy, plastics, keratoplasty, etc. Also, take note of the suture brand, material, length and, most importantly, needle used in the various procedures.
When operating at a new place, it is critical that you have a well-organized list of the instruments and sutures you use. It is not uncommon for things to be done differently from the place you trained and you cannot take anything for granted — not even the blade knives you use for your main wound and your paracenteses or the cannulas you use for hydrodissection and wound hydration. Each detail matters and can greatly affect your outcomes.
2. All of your phaco settings. This is also something that is easy to take for granted, but makes a huge difference in your outcomes if the parameters are not what you’re used to. Ask the surgical rep for the machine(s) you use to e-mail you your specific settings for each step of the case, as well as your special settings for the different grades of cataracts, low-flow settings for floppy iris cases and anterior vitrectomy settings. If they are not available or responsive, then I suggest you take pictures of each screen with either your cell phone or camera and print them out.
I trust that many of you have them memorized, but with as complicated as they’ve become, don’t leave anything to chance. Have a hard copy with you. Also make sure the surgical rep for your new hospital/surgery center is with you the first time you operate at their facility in order to program your settings into the phaco machine for you. They will also need to program the foot pedal with the settings you prefer, as each surgeon has different preferences.
3. All the surgical consent forms — major and minor surgeries. This includes consent forms for in-office procedures such as YAG capsulotomy, chalazion excision, punctal plug placement and lid lesion excision. Do not trust that the physician you are joining has these forms in place. It is not uncommon for an older physician to ignore present documentation mandates and simply not have any consent forms at all for the office. Even if they do have consent forms, the form they have for, say, cataract surgery may not be updated. It may still have language about “aphakic spectacles” being necessary after the surgery (I’m not joking!!).
If you want to avoid some extra work, take all your surgical consent forms with you! Paper copies are great, but electronic copies are the best, as you can add your office logo to them and make changes as necessary.
4. All exam forms – new patient, follow-up full exam, follow-up quick exam, post-op exam, etc. This includes the paperwork that a new patient must fill out. The coding crew at your training institution is most likely savvy enough to have incorporated all the necessary components to meet the highest coding levels into the exam forms. Thus, if you simply “fill in the blanks,” you will have covered your bases for coding standards. Again, do not expect the practice you are joining to have more than a blank sheet with the patient’s name and the date on it for their “exam form.” Be happy if the sheets are even fixed in place so that they remain in chronological order in the chart! That’s why electronic copies are the best.
5. Any educational handouts that you use regularly to explain eye conditions, treatments or pre-op/post-op care. If you have these in electronic form, it makes it even easier to forward them to certain vendors of your choice (e.g., whose drops you are using) to print them on nice color paper for your patients. Since it’s educational for your patients, this is allowable, even under the new pharma code.
6. Your favorite eye model (as long as it’s yours to take!) or eye photo that you use to explain eye conditions and surgeries. A picture is worth a thousand words!
7. All the contact information for your mentors and professors, including e-mail address, cell, pager, etc. An easy way to stay current with their contact info is to build your Facebook friend list for easy access to your colleagues, since some might move and change their phone numbers. There will be many situations that arise while practicing on your own when you will want to ask the advice of someone you trust. They are an invaluable resource and are quite willing and pleased to help you.
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About the author: Natasha L. Herz, MD, is a member of the YO Info editorial board. She is a cornea specialist practicing in the Washington, D.C., metro area.