7 pearls for beginning and seasoned surgeons

Seasoned cataract surgeons have usually developed rituals and habits in their behavior that have allowed them to approach busy and challenging surgery days with more confidence.

Whether it is a lucky pair of underwear or a ritual meal the night before the big day, I believe many of surgeons perform these rituals to get their heads in the right space.

A cataract surgeon in the beginning of their career will start to develop his own set of habits based on performance feedback from individual patients. Some of these habits are obvious and common sense, some are necessary to insure the best outcomes, and some are superstition.

Below are seven preoperative habits and rituals I have fallen into after performing cataract surgery for close to 30 years.

Take them or leave them based on your individual tolerances.

Click here to find out. 

1. Don’t work out
Having a healthy exercise and work-out routine is good for mind and body. However I have found that working out or doing any strenuous physical work with my arms and hands the day before surgery usually results in less-than-ideal manual dexterity the day of surgery. This is especially true for challenging cases that may require precise intraocular maneuvers.

2. Don’t drink coffee
I found early in my residency that coffee and surgery do not mix well for me. My partner could drink strong coffee with five sugars in it and then go into surgery without any difficulties.

If I drink coffee and then try to operate, the tremors through the microscope look like an 8.0 earthquake. I also try not to drink coffee the day or afternoon before a surgery day because I found that it makes it difficult to sleep well without obsessing about the challenging cases facing me in the coming morning.

3. Don’t obsess
After almost three decades of performing surgery, I still find myself lying in bed obsessing about challenging cases. While I do review how I am going to approach a particular case and have back-up plans in place for potential complications, there is a fine line between reviewing these surgical steps and options while trying to get to sleep and obsessing about them to the point of disrupting sleep.

It is obvious that obsessing about these cases accomplishes little, but some habits are hard to break. Try to get a at least seven hours of sleep the night before surgery. Good luck on this one.

4. Don’t drink
I have found that drinking alcohol the night before surgery clouds my skills just enough to the point that I have set a rule:I don’t drink the day or night before surgery. This habit will obviously differ from individual to individual. For me, though, there is a difference in performance, and I want to be operating at 100 percent-especially if a complication develops.

5. Review your cases
The day before surgery, I will go through each surgical case and make notes regarding potential intraoperative issues. Does the patient have any underlying pathology that will make the case more challenging, such as PXF, IFIS, or previous trauma? Are they monocular?

Some surgeons might prefer to not know this right before surgery for fear that it might make them nervous during the case. For me, a monocular patient is one that I consciously slow down for and make sure that everything is optimal intraoperatively at the end of the case. Surgeons should do this for every eye, but I give 110 percent for the monocular patient.

I also review the intraocular lens (IOL) selection and power. I sign off on these a week or two before surgery, but I also do a final double-check the night before to make sure the IOL model that was chosen by the patient is the one we ordered.

There is nothing more embarrassing and potentially litigious than putting in a monofocal IOL in a patient who chose a multifocal IOL. Double- and triple-checking these orders is a good habit to get into. Having a technician select and order the IOL is not a good defense if the wrong lens is implanted.

Make sure the challenging cases are towards the end of the schedule so if all hell breaks loose, fewer cases will be delayed. Also, give more time for these cases then you believe is necessary. Rarely are they completed in the allotted time, and if you finish before the allotted time is up, your staff will think you are slicker than you may actually be; go over your allotted time and you are considered an incompetent bum.

6. Eat breakfast
If operating in the morning, eat a light breakfast. For me, that includes a one-egg cheese omelet-lots of protein to get me to lunch. Also have a power bar or snack bar available in case you start to run low on energy towards the end of the morning.

7. Stretch
I don’t know if this one is functional or superstition, but before I start my cases I stretch my body and tell myself that I am going to take my time, perform good surgery, and not create any unnecessary complications.

Neck and back issues are the curse of the ophthalmologist. Stretching at the beginning of the morning and after every few cases helps keep my back from tightening up excessively. I have found that the hallway rails in our surgery center are a great place to grab onto, squat, and stretch my upper back. I wish I had learned this habit 20 years ago.

Conclusion 
These seven habits are just a few of the crazy rituals I have instituted for myself in order to make me feel that I am performing at my best during surgery. Each surgeon will-of course-find their own habits and superstitions that work for them.

And in case you are wondering….they’re black. 
 

Richard S. Hoffman MDE: richard_hoffman@comcast.net
Dr. Hoffman is clinical associate professor of ophthalmology at the Casey Eye Institute, Oregon Health and Science University. He did not indicate any proprietary interests relevant to the subject matter.