January 5, 2016
My Professional Treasure Chest
They bring meaning to my work and remind me of the true privilege of being a physician.
Have you noticed that we stopped writing in Christmas cards these days? We are sending them but we hardly write in them anymore. The majority of the Christmas cards that I received from my friends and relatives in the past few years are photo collages of their lives in that year. Their beautiful babies and children are prominently featured and their family vacations are highlighted on the neatly organized and professionally printed card. A few brave souls included close-up pictures of themselves and it is nice to see that they too have put on a few pounds and going gray on their temples. There is, however, not a square inch of real estate on the card where one can write a few words. Perhaps social media has taken over that function. Who writes anymore anyway? We only type. Perhaps I am old fashioned in that way. But it really touches me when folks take the time to write a personalized message on the card. So, there are two Christmas cards that really stand out in my mind this year. Both are from my patients. One featured an artistic rendering of a Christmas in the country scene with snow covered barns, windmill, barren trees against a gray sky. The inscription was simple, red inked Season’s Greetings. What she wrote, however, was golden: “Dr. Cheung, Thank you so much for giving me a much better view in my life.” This card came from an elderly lady with advanced cataract and cornea scarring in both eyes. I successfully removed her cataract in one eye two years ago and restored her vision in the fellow eye this year. The second card came from a young mother who experienced double vision when she looked down at her infant daughter while nursing her. I performed eye muscle surgery to realign her eyes a few months ago and she can now see her world in unison. Her card has a simple and elegant paper silhouette design of a dove above a silver dusted window. In it she wrote: “Thank you for fixing my eyes and improved my life.”
These two cards brought great joy to me and I am sure to keep them in my professional treasure chest. They bring meaning to my work and remind me of the true privilege of being a physician. We all seek meaningful human connections, whether you are a doctor or a patient. These connections help heal the patients and at the same time gratify and invigorate the physicians. I think that technologies have a great potential of bringing people together but the greatest challenge lies in making those connections meaningful. Technology can help us print high-resolution brightly glossed Christmas cards that conveniently fulfill our needs and obligations to send such cards but the effect they have on the intended recipients is pale in comparison to ones that are simple but thoughtfully worded.
In healthcare, I am constantly mindful of how technology can depersonalize the patients’ experience. Take electronic health records (EHR) as an example. EHR is supposed to improve efficiency, reduce cost and reduce medical errors. Sadly, none of that turns out to be correct. Don’t get me wrong, I am not against the technology. In fact, I am one of the early adopters of EHR technology, having used one in my practice for over ten years. However, the way we have to use it, as dictated by our government, depersonalizes the doctors-patients experience. Patients’ unique complaints and symptoms are reduced to a required series of check boxes. Volumes of data are collected but the most relevant ones are buried in the haystack. Doctors spend far more time looking at the computer screens than at their patients, as they are busy checking all the boxes. The human connection is lost. The patient does not feel cared for and neither is the doctor gratified. I am not advocating a return of the paper chart but a different application and emphasis of the EHR technology. Unless citizens and providers collectively make a concerted effort to change our governmental policy on EHR, I am afraid that it will develop in the direction to push doctors and patients further apart rather than bringing them closer.
In ophthalmology, I see great potential in femtosecond laser assisted cataract surgery and I am pleased to be offering this new technology in Kitsap County beginning March 2016. Femtosecond means one quadrillionth (10 -15) of a second. These ultrashort pulses of infrared laser energy cause photodisruption of transparent eye tissues such as the cornea, the front surface of the cataract (anterior capsule) as well as the cataract lens itself. The laser energy creates a very small spot of free electrons and ionized molecules in the eye tissues followed by an acoustic shockwave that expands into a cavitation bubble. Successive and rapid application of these tiny laser spots can effectively cleave the eye tissue in a highly precise manner. Even the most skilled surgeon with the sharpest blade cannot compete with the precision and reproducibility of this laser. The result is a very clean and sturdy entrance wound that shapes like a step of stair in the cornea and a perfectly circular and well centered opening of the anterior capsule.
The femtosecond laser is also used to softened and divide the cataract lens into manageable pieces. Traditionally, this is done with ultrasound energy but the energy can spill over and damage the back surface of the cornea and the supporting structure of the cataract lens. This collateral damage can result in clouding of the cornea, dropped lens fragment or instability of the lens implant. With the use of the femtosecond laser, collateral damages are greatly reduced because less ultrasound energy is needed. The effect on the patient is better visual outcome and faster recovery. Patients with a history of early Fuch’s cornea dystrophy are particularly good candidates for femtosecond laser assisted cataract surgery.
At our surgery center, we use the Alcon LenSx femtosecond laser system. What impresses me the most about this laser system is the ability to customize the treatment parameters based on the unique characteristics of each individual’s eye. A separate scanning laser creates a detail image of the cornea and lens and adjustments can be easily made based on this real-time image. I can then plan each patient’s procedure in much greater details that were previously unavailable. For example, the laser can be programmed to treat pre-existing corneal astigmatism during the cataract procedure. This can greatly improve the patient’s uncorrected vision (without glasses) after cataract surgery.
Not all patients are good candidates for femtosecond laser assisted cataract surgery. A suction cup is placed on the eye for the delivery of the laser energy. Patients with deep orbits or those who are unable to lie flat may pose challenges in using this interface. In addition, patients with small pupils or advanced corneal diseases may be restricted from some or all steps of the laser applications.
As 2015 is drawing to a close, it is high time to reflect on why we are doing what we are doing. Our mission is to help the whole family see a brighter future. It is nice to know from our patients that they have a much better view in life because of our care. It appears that we are on the right track! Surely, technologies can fix eyes and help people see. Technologies, however, cannot be applied appropriately without a sound doctor-patient relationship. When patients feel cared for, they not only see brighter, they see a brighter future. We will strive to do that in 2016 and in the years to come.