Having the ability to focus is key to achievement

January 1, 2007

"Concentrate all your thoughts upon the work at hand. The sun's rays do not burn until brought to a focus."

"Concentrate all your thoughts upon the work at hand. The sun's rays do not burn until brought to a focus."
-Alexander Graham Bell

"Often he who does too much does too little."
-Italian proverb

"The main thing is keeping the main thing the main thing."
-German proverb

On a TV series called "The Sopranos," the protagonist, Tony Soprano, runs a small family business in my home state of New Jersey. The business is organized crime, and Tony, a "boss," has a handful of senior associates who oversee various parts of the enterprise (gambling, protection, etc.).

In one episode, one of these associates is discovered by his colleagues to be leading a double life. Although married with two children, he has been leading a homosexual lifestyle. Apparently there is no tolerance for this by his colleagues, who assume that Tony will order that his employee be liquidated ("whacked"). To their chagrin, Tony demurs.

It turns out that this is an excellent employee whose high productivity is at least partly responsible for Tony being able to afford his large yacht ("Stugots"). Defending his refusal to order an execution for what others consider an unpardonable offense, Tony states: "He has focus." Sadly, the father-in-law, acting without Tony's permission, performs the murder.

An ophthalmologist friend of mine was telling me about someone he trained with in residency who for a couple of decades has been a world-famous innovator in cataract surgery. "As a resident he used to say that he would devote his career to refining and advancing cataract surgery. We all thought that was ridiculous," said my friend. "Back then no one specialized in cataract surgery. But he sure stayed focused and did exactly what he said he would."

Academics like me get used to the concept of focusing attention on a specific ophthalmic subspecialty or even a single disease or a particular area of research. Today there are so many journals, so many meetings, and so many subspecialty societies that no one can keep up on everything in ophthalmology. Getting promoted depends on establishing oneself as a true expert in a particular area, and that requires concentrating on a particular, narrowly defined clinical or research field.

It was not always this way. When Ed Maumenee, MD, was chairman of The Wilmer Eye Institute, he did just about everything, including all types of surgical procedures. One day, he repaired a retinal detachment, performed a dacryocystorhinostomy, and removed a cataract. I admire comprehensive ophthalmologists who are able to keep up in many different subfields of ophthalmology, but I doubt there will be many ophthalmologists with such a varied surgical practice (fun as that might be). Today, excellence in clinical medicine requires focus.

The most successful practices (private and academic) are ones that identify their key strengths and opportunities and focus their energies to achieve operational excellence. The most successful comprehensive ophthalmologists have to determine what services (e.g., refractive surgery, multifocal IOLs, glaucoma surgery, etc.) to offer and which to outsource (refer). It's better to eliminate a service than to do it poorly.

The most successful academicians determine where their clinical and research strengths lie, concentrate their efforts on those areas to become acknowledged experts, and learn how to teach their knowledge to others. But this can be a challenge for smart, hardworking, and talented people who find themselves fascinated by and who possess the ability to excel in multiple areas.

The three proverbs from different countries reflect wide consensus that the ability to focus is consistently rewarded. This applies to football teams, criminals, residents, ophthalmologists, faculty members, and department chairmen.