Cool under pressure


You know the type. When their team is doing well, sports fans are upbeat. Should their players make mistakes these members of the crowd quickly start screaming about how the coach is an idiot, how the athletes are incompetent and overpaid, and how the mother of the offending player is (well, perhaps it is best we don’t get into that).

Once, while attending a Los Angeles Clippers basketball game after work, I was randomly selected to try to win prizes by shooting baskets during the half-time break. Wearing socks on my feet (business shoes not being allowed because they might scuff the court) I was escorted onto the court by the team’s dancers. I was told I had 30 seconds to try to make a free throw (to win a free set of tires for my car), retrieve the ball, run to half court, and try to make a shot from half court to win a free car.

The 30-second clock started. Wanting to do my best to win something, I took my time with the first shot. It went in. Sliding in my socks, I ran to get the ball and then raced out to half court. With a few seconds to spare, I launched the ball toward the basket.

Initially, I thought it was going to go in and remember wondering how I would get both my old and new cars home. Sadly, the shot proved straight but short, touching the net as it passed beneath the rim. No new car for me.

Boos from the crowd
While I was concentrating on what I was doing, it seemed as though the stadium was totally silent. But now, as I was being escorted off the court by the dancers, it was anything but. “You shoot like a girl!” yelled one critic from the stands. “You suck!” opined a second unimpressed Clippers fan. Additional reviews of my basketball prowess came in and all were at high volume and equally uncharitable.

The next day I was in clinic when one of my colleagues came up to me.

“Were you at the Clippers’ game last night?” he asked.
“Yes,” I said. “Did you see me?”
“Yes, I go to every game. I saw you shoot,” he replied.
“After I missed my second shot, I heard a lot of people yelling insults,” I said. “Does that happen every game?”
My colleague smiled. “You bet,” he said. “That’s a lot of the fun!”

Yours truly does not scream insults at sporting events. How would these fans who rain expletives down from the stands like it if people came to watch them work and screamed if they saw something happen imperfectly?
What would it be like, I wondered, to perform phaco under similar circumstances?  “You call that a centered capsulorrhexis?!!” “Hurry up and aspirate that subincisional cortex, you idiot!”

Encouraging words
One of my fellow professors at my university has conducted a study in which subjects performed tasks with and without observers. The subjects knew when they were being watched and when they weren’t, and their brain function was monitored with functional MRIs. Prof. Chib’s expectation was that being closely watched would reduce performance. The opposite occurred, and 5% to 20% improvement was measured. Subjects with an audience showed activation of their prefrontal cortical areas.

So observing eye surgeons is probably not a bad thing-and in the case of a beginning surgeon with a patient and experienced senior surgeon it is probably a very good thing. But while hurling invective and casting aspersions on the performer’s mother is considered by many to be good fun in sports venues, we should be only kind and supportive in the operating room.

Peter J. McDonnell, MD is director of the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, and chief medical
editor of Ophthalmology Times.

He can be reached at 727 Maumenee Building
600 N. Wolfe St. Baltimore, MD 21287-9278
Phone: 443/287-1511 Fax: 443/287-1514


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