An advertising slogan once declared ‘It’s good to talk’, but for ophthalmologists and optometrists, regular communication is vital as we try to make sense of the complex world where our patients need our support.
I understand that having conversations can sometimes seem daunting. One aspect of my medical director role that I wasn’t so sure about was the thought of standing up in front of audiences to talk about eye surgery, our clinical services, the state of the NHS or other aspects of our profession. But, when I think about it, it has become a logical next step for me.
I had spent many years ploughing a furrow in my local area as a retinal surgeon and had set up a surgery starting from zero that rapidly developed into a thriving group of consultants performing more than 1,000 vitrectomy (VR) cases per year. I was perfectly happy talking to patients, discussing their problems with them, and then using my surgical skills to try to help their cause. With experience, I hope I developed the ability to remain honest with my patients, offering support but also not over-promising, particularly when faced with challenging problems.
I had the joy of working with retinal surgery fellows who were starting their VR careers. A highly motivated bunch, already fully trained, pushing themselves to acquire a new skill set in arguably one of the most testing ophthalmic surgery arenas. My first trainee joined me as a volunteer from London. He wanted to roll his sleeves up and was prepared to forego any salary, such was his passion for VR surgery. On day one, he watched me operate. At the end of the first case, he looked at me and said, ‘Why did you carry out the manoeuvre that way?’ I was momentarily speechless. By that time, I had spent several years as a consultant doing surgery and never once did anyone in theatre question my methods. I gathered my thoughts and explained to him my rationale. Before long, I was used to passing on tips and helping him earn his spurs. There was plenty to talk about and after his initial challenge, the process of teaching was largely imperceptible. It was much more like a spirited and open conversation between peers. This was definitely the way forward for both of us.
As our department grew and retinal surgery became the solution to more ophthalmic problems, one consultant became two and then three. We always had a fellow (now being paid I might add), and this surgeon was the glue in the team. They also became a valuable source of knowledge, passing on the tips and tricks my consultant colleagues employed when they operated. The process of continual learning in all aspects of medicine was embedded in the team.
Looking back
Now that I am in a more senior role with responsibility for many surgical centres and teams of surgeons in the hundreds, carrying out tens of thousands of procedures each year, I think about the early challenges in my teaching career. Being faced with a new situation, a questioning audience and trying to develop new skills is not really that different to before. I have been invited to talk to optometrists at national meetings, to present at conferences and to deliver smaller dedicated teaching sessions to many professional groups.
For me, the first sentence is the most difficult. Then, quickly, I feel that I am into my stride. I enjoy a questioning audience. I prefer to field the questions that you want answered, rather than the ones I thought you wanted to hear. When it becomes more of a conversation, I feel that we are making progress. My greatest fear is silence at the end, wondering if I had missed the point or if it was all old hat and I was keeping you from lunch.
So, for my optometry colleagues, I want to encourage you to be inquisitive, to engage in conversations with local ophthalmologists, to share frustrations or talk about a testing clinical case, so that we can continually learn from each other. Please sign up for CPD, please ask your local ophthalmologists to meet. Email us about your worrying patients and we will respond. We ophthalmologists need your skills and the sooner we enjoy the two-way street that we share, the better it will be for eye care in 2023.
There is a whole world of ophthalmology out there to get involved in, with teachers standing beside you for support. We might be momentarily surprised by the odd question but usually we are never too stuck for words.
- Nigel Kirkpatrick, MD FRCOphth, consultant ophthalmologist and medical director at Newmedica.