Residency training: a missing link?

March 1, 2006

I have long thought of this connection as a continuum—from helping one patient individually to helping society as a whole.

Consider the relationship between:

I have long thought of this connection as a continuum-from helping one patient individually to helping society as a whole.

Last year, I had the opportunity to advocate on behalf of Maryland ophthalmologists and their patients by getting involved with the Maryland Society of Eye Physicians & Surgeons. At issue was the ability of optometrists to prescribe topical anti-viral medications and steroids (a sometimes perilous combination) and to use the corneal burr. The State Eye Society gathered a team of attending physicians and residents to testify before the Maryland House of Delegates and State Senate during the 2005 session.

An educational experience

Preparing my testimony was both educational and enlightening. As a first-year resident, I had to educate myself about the recent advances in topical anti-viral therapy, as well as their safety and efficacy profiles. I learned about the epidemiology of corneal HSV infection, the incidence of corneal blindness, as well as the pitfalls of inappropriate steroid use.

Planning for my appearance before the legislators was a rigorous crash-course in politics. The Eye Society lobbyist, a seasoned lawyer in Annapolis, played the role of a pro-optometrist legislator and came up with tough questions cleverly designed to lead our team of ophthalmologists and residents astray or make us contradict our earlier statements. This practice session made the med school days of ratting on the surgery wards seem tame. After that first meeting, we quickly learned a bit of the shrewd "legalese" needed to make our case forcefully and concisely-without saying too much or too little.

In the end, the optometrists' association agreed not to use the burr or prescribe anti-virals. We reached a compromise on the topical steroid issue-optometrists will be able to initiate topical steroid therapy and will refer to an ophthalmologist if the expected result is not seen, thereby protecting patient safety. Despite my small role in this process, I felt privileged to shape policy to help patients in Maryland.

Build a foundation

Residency is too short for us to learn everything there is to know about ophthalmology, but it is the time to build a solid foundation-a foundation that includes all three aspects of the continuum mentioned above. It is not enough simply to become a good clinician, do well on the Ophthalmic Knowledge and Assessment Program (OKAP) test, or land a coveted fellowship position. It is also important to take the time to find other issues that excite you and advocate for them-covering the uninsured and fixing the malpractice mess could be just up your alley.

Organized medicine, from the American Medical Association, the American Academy of Ophthalmology, and your state eye society, offers dozens of ways to get involved in health-related public policy, from membership, to meetings, to lobbying.

It is vital, for our patients and our profession, that physicians are skilled and active in all three elements of the continuum-treating a patient's illness, implementing public health interventions, and advocating on behalf of patients in Washington, DC, or your local State House.