He is director of The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of Ophthalmology Times.

Peter J. McDonnell, MD

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 would shut many things down, when I flew to another country to attend the wedding of my friend’s son (remember when we could do things like that?).

After emerging from passport control and baggage claim, I was met at the airport by a young man in his 20s who told me his name, and we started the drive into the city.

After driving a while, the driver turned to me and said, “You don’t remember me, do you?” 

I took a longer look at him. Because I traveled a fair amount before the pandemic and would sometimes be introduced to dozens of new people each day, it is not uncommon for me to fail to remember someone I have only briefly encountered on an occasion. But it is always a bit embarrassing for me when someone knows my name while I draw a blank, as happened this time.

“I don’t expect you to remember me,” he said. “It was 10 years ago that I was in your office. I will tell you the story.”

When he was a teenager, the driver started developing headaches and visual symptoms. His father, a physician, brought him to see some physicians, including my ophthalmologist friend. 

Planning is important — even when “nobody knows nothing”

The diagnosis was made quickly: He had a brain tumor that unfortunately was in a bad location. 

The neurosurgeons could only partially remove the lesion and he would have partial relief of his symptoms but the remaining tumor would cause his death in the next year or 2.

My friend called me about the young man. Fortunately, another one of my friends was our chairman of neurosurgery and he (as far as I know) is the world’s expert in this problem. 

Like many physicians do every day, I made a phone call and helped set up an appointment. 

The teenager flew to Baltimore, Maryland, with his father and my friend. He underwent several neuroimaging studies, and was told complete resection of the tumor could be attempted. The surgery was performed and my neurosurgeon friend was very happy with the outcome.

A week or so after surgery, the teenager and his father stopped by my office before leaving for the airport. 

Eating our own cooking: Ophthalmologists standing behind their products

Looking at the boy, I would never have guessed he had been ill let alone had recently undergone brain surgery. The neurosurgeons skillfully hid the incision behind the hairline and peeled the scalp back to expose his skull. 

That was the last time I saw the youngster until he met me at the airport 10 years later, a big happy and healthy guy who was now a successful businessman.

The funny part of the story, he told me, was when he returned home after the surgery. All the boys in his class came to the airport to welcome their friend home. 

As an expression of solidarity, they had all shaved their heads—they presumed the teen would be bald after his surgery. 

“‘Thank you for coming to meet me, but what happened to your hair?’” he said to the other boys.

The man then told me he volunteered to pick me up at the airport because he felt I had saved his life, he would always be grateful, and he wanted to tell me this. 



Unproductive worry: Conquering fear during a pandemic



The truth is all I had done was connect him to the right surgeon, but it meant a lot that he had appreciated the small thing I had done to help. 

We took a picture together, which I will always keep on my phone. Every time I look at it I am reminded, pandemic or no pandemic, how it is great to be a physician.


Articles

Chief Medical Editor Peter McDonnell, MD, explains why the individuals that we make an impact on as physicians often never forget us.

Oh, the people we meet

Will you take the COVID-19 vaccine? Share your thoughts by 


A few weeks ago, a friendly young nurse stuck me in the shoulder with a needle. I could barely feel a thing. Overall, the experience was so nice that I decided to do it again 3 weeks later.

Of course, I am referring to my vaccination against the 

novel coronavirus disease 2019 (COVID-19)

. My reaction to the vaccine is an appreciation for the many scientists and colleagues who worked hard to produce and test the vaccine so quickly, and excitement at the prospect of once again being able to socialize, share meals, shake hands, and enjoy being with family, friends, colleagues, trainees, and patients.

But a lot of others do not share my take on this. 

The Kaiser Family Foundation reports that 27% of the American public is hesitant to receive the vaccine, and surprisingly to me, this number is higher (29%) among workers in health care settings. 

According to Joseph Varon, MD, more than half of the nurses working in his Houston critical care unit are declining the vaccine.

 The phenomenon is geographically widespread with up to 40% of Los Angelenos and 45% of nurses in West Virginia saying, “no thanks.”

Why are these folks declining the vaccine? Varon says most are doing so “for political reasons.” Others are concerned about the risks of the vaccine, citing instances of anaphylaxis after injection or the tragic death of Gregory Michael, MD, who developed severe thrombocytopenia and died 2 weeks after receiving the vaccine. The manufacturer claimed no evidence of a causal link, and the CDC “will evaluate the situation.”

We live in a free country, and each of us has the right to look at data and interpret it through the lens of our own existence. We should consider the potential impact on others. 

A young nursing home worker might decline vaccination for fear of the risks of the injection exceeding the benefits to themself because the fatality rate with COVID-19 is so low in certain populations. If that same worker becomes unknowingly infected and exposes an elderly resident to the virus, the risk of death for that resident is considerable.

As the late philosopher Red Foxx sought to highlight with his quote the dangers of certain lifestyle decisions, risk is a part of life, and we are all going to die one day. For me, data on the vaccines available certainly make the case that the risk is worth taking.

How about you, dear reader? Will you take the vaccine? Will the workers in your practice?■

Zitser J. Despite having intimate knowledge of the pain and death caused by the coronavirus, a surprising number of US healthcare workers are refusing to get a COVID-19 vaccine. Business Insider. January 10, 2021. Need accessed date. https://www.businessinsider.com/covid-19-surprising-number-of-us-healthcare-workers-refuse-vaccines-2021-1

Manskar N. Pfizer, CDC probing death of Florida doctor who took COVID-19 vaccine. New York Post. January 13, 2021. Need accessed date. https://nypost.com/2021/01/13/pfizer-cdc-probing-death-of-florida-doctor-who-took-covid-19-vaccine

Vaccination offers hope ... if we only take the chance.

Accepting risk

 physicians, I am not the most patient person in the world. I do not like waiting for responses to my emails, so when people email me I try to respond quickly (assuming it is a straightforward question to which I know the answer). I do not like wasting time when meetings start late, so when it is my meeting I always try to start on time. And I definitely do not like sitting in doctors’ waiting rooms, so I have always tried to run my clinics like a well-oiled machine.

Some physicians I know show up in clinic an hour or two after it “starts.” They figure it will take their staff some time to check people in, for the technicians to bring them back to the exam room, for the technicians to do their thing (checking vision, pupils, IOP, etc.) and maybe put in dilating drops. These physicians arrive at 9 or 10 am to see patients scheduled at 7:45 am.



Thinking and rethinking ophthalmology: Are you?

My practice has been to arrive at the clinic when my first patient is due to arrive so that I know that everything gets off to a quick start. Some patients do not need a lot of testing, so I can see them right away. 

Other patients might need testing and dilation, and I will pop in to see them as soon as they are ready, while clearing out every patient as soon as I can with the goal of never getting behind.

One day, I was cruising along in clinic and everything was going perfectly. As soon as a patient was ready, I popped in and did my thing. 

All the postops were doing great, all the corneal ulcers were responding to antibiotics as they should, and any needed suture removals or little procedures took only seconds to perform.

Then I grabbed the chart in the door (yes, this happened before we went electronic) of my next patient. This nice lady was about 20 years older than me and I had performed phacoemulsification/IOL surgery on her second eye after the first eye went perfectly. The technician had recorded 20/15 uncorrected vision and normal IOP. Everything looked perfect. 

“This will go fast,” I thought to myself. “I will tell her everything is perfect. She will thank me and tell me I am a wonderful doctor. I will feign humility, accept her praise and send her on her way. I will be in and out in a minute and everything will stay right on schedule.”



I walked in the room and stood next to where she sat in the exam chair. “How are you?” I asked, and waited for her to thank me. She looked at me and burst into tears.

The sobbing continued for what seemed like a long time but was probably only a few minutes. I gave her a tissue, sat down next to her and held her hand. After a while the tears abated and she could talk. “I am sorry,” she said. “My husband died this week.”

I told her I was sorry. He had never accompanied her on her visits so I had not known him. “Would you tell me about him?” I asked.

The words came pouring out. He was a very successful businessman but always came home at 5 pm to be with her. 

Every day, he would open a bottle of wine, pour 2 glasses and sit in the backyard with his wife and tell her about the challenges he had faced that day, ask her about what she had done that day, and ask her advice about things. He made her feel that she was the most important person in the world to him.

“Boy, he sounds like a great husband,” I said. “Oh, he was,” she responded, “and I will miss him so.”

“I hope that when I die, someone will remember me the way you remember him,” I said. She squeezed my hand and said she hoped so, too.




After a while, she thanked me for listening to her, told me she felt much better and was ready to go. She apologized for taking up so much of my time. I wished her well and we walked together out to the waiting room.

My technicians clearly wondered why I had been in the examination room so long. And we were now running behind. But I did not mind.


Sometimes, physicians may find that falling behind is the right thing to do.

Keeping to the schedule

® reader, Sergio, recently sent me a report on a survey of almost 1300 physicians with the headline “Nearly half of doctors are ‘seriously’ rethinking their careers, finds COVID-19 survey.” 

The article begins with data from the CDC to the effect that 1 in 16 Americans (5.9%) infected to date with 

This rethinking is most common amongst primary care doctors, with 50% of internists and 55% of family physicians described as such.

“Just what the heck is ‘rethinking’” you ask? According to the surveyors, it can mean anything from tweaking your practice to throwing in the towel. The results show:

> 9% of doctors say they are going to retire.

> 6% will “quit medicine and start a new career.”

I find the survey results a tad confusing. The categories strike me as overlapping or poorly defined. 

For example, what is the difference between retiring and closing your practice for good? What is the difference between leaving patient care and quitting medicine and starting a new career? Are some of these people going to become hospital administrators or work in the pharmaceutical industry? 


If so, they would not be retired, rather they would still be in medicine but no longer caring for patients. Will they be one of those characters who spend their days writing editorials in medical publications instead of doing something that contributes to society?

Whatever the details, the authors concludes that if all these doctors quit clinical practice, the loss of such a large chunk of the medical workforce (9% + 8% + 6% + 3% = 26%) would leave the rest of us doctors overwhelmed.

But with these surveys, as with the polls before Presidential elections these days, you never know.

On a positive note, 49% of responding physicians say they plan to make no significant changes and others plan to “change the practice setting.”

One hospitalist from Iowa, rather than bemoaning his job during the pandemic, said this in the survey: “It has actually galvanized me. I think I am privileged to provide inpatient medicine at just the moment in history when the need is so great.”

Certainly we have known from the earliest days of the pandemic—

when Dr. Li Wenliang died in Wuhan, China after first reporting the outbreak

—that ophthalmologists are at risk from the disease. Will that translate into a fear that leads many of us to quit medicine?

The word “ophthalmologist” doesn’t appear anywhere in the article and there is no breakdown by subspecialty, but I am not seeing or hearing of a mad rush for the exits by my ophthalmologist colleagues. 

® is going to perform a hopefully more valid survey of a large group of the smarter and best-looking ophthalmologists.

Are you, dear reader, planning to respond to 



Read more by editorials by Peter McDonnell

Pandemic forces some to reconsider careers.