Bucks Montgomery Physician Winter 2021 - 5

These types of devices, labs and training methods are
breaking new ground in improving safety, reducing
training time and making previously subjective
judgements into objective evaluations of surgical skill.
There are significant differences between how young and
old doctors approach the task of determining a diagnosis.
Young surgeons tend to weigh every diagnosis equally
and might detect an unusual case that a more senior
surgeon may overlook. The younger physician has more
Fluid Intelligence, using plasticity in handling comparative
information with little full knowledge. 6 Senior surgeons,
in comparison, can be very efficient. Their experience
makes them adept at quickly identifying diagnoses and
planning treatment. This crystallized thinking can
also be a trap. For example, jumping to a diagnosis
while overlooking other components of the exam.
A senior surgeon's cognitive decline can be tempered
with training. One tool is using checklists, thus
compartmentalizing each segment of the exam so there is
no need to recall what has or has not been done.
A momentary distraction, therefore, will not cause loss
of focus, giving senior surgeons more time to think
through their proposed diagnosis and treatment without
relying on rote responses. Every step of the diagnostic
work up should be automatic. The implementation
of Dr. Gawande's systems outlined in his book
" Checklist Manifesto " has led to a very significant
decrease in medical errors at all levels of medicine.7
Be thankful the next time your medical team asks you
to spell your name and give your birthdate. That single
procedure has decreased medical errors, probably
more than anything we have done in the last decade.
Another strategy to maintain focus is to minimize
distractions. Place diagnostic equipment in a convenient
and accessible spot. It could be something as simple as
moving an eye drop onto the slit lamp table and removing
it once pressures have been checked and recorded.
The use of simulators in surgical settings has led to new
qualitative measurements of tremor, orientation, and
composite movements. When these findings are applied
to training young surgeons, it accelerates improved
performance. Extensive studies on senior surgeons'
cognitive impairment and changes in sensory motor
controls have led to guidelines for their improvement.
Putting all this knowledge to work will allow us to meet
and exceed higher performance outcomes with fewer
complications and disabling injuries to patients. After
all, " no accident is no accident. " It is the result of careful

planning, double checking, and flawless execution!
Our approach is that patients already know a great deal
about themselves and their issues. We always encourage
patients to speak up if they notice anything amiss, need
to add more information, or feel that things just do not
seem right. This empowers patients and our entire team
to report any findings, issues or concerns at the earliest
signs or symptoms. We pre-instruct patients on the signs
of retinal detachment, eye infection (endophthalmitis) or
edema so we can intervene as early as possible. We prefer
not to have patients who expect everything to be normal,
but patients who report to us immediately if they note
any variance from perfect recovery. We explain to them
it does not matter if they were just seen, told they were
fine, or we could not find anything wrong, even it was a
day ago, things can change. We give the family or friend
a very simple mantra. If the patient even thinks anything
is remiss or complains to them, they are just to simply
say, " call the doctor. " That way our team can evaluate
the situation and catch any issues as early as possible.
Today's health care consumers have become well
versed to actively participate in their care. The advent
of apparatuses like patient portals display results
of laboratory tests, consults and charting notes
almost immediately. With more knowledge at their
fingertips, patients can advocate for better quality
control and report issues or concerns right away.
Technology is equipping our doctors' skills with more
exactitude, speed, and agility. Improving the medical
system translates to higher success rates, higher standards
of care and enhances the quality of life for all.

Resources

1 Preparing for an Aging World: The Case for Cross-National Research.

National Research Council (US) Panel on a Research
Agenda and New Data for an Aging World.
Washington (DC): National Academies Press (US); 2001.
2 AMA J Ethics. 2016 Oct 1;18(10):1017-1024.
doi: 10.1001/journalofethics.2016.18.10.or1-1610.
3 Competence not Age Determines Ability to
Practice: Ethical Considerations about Sensorimotor
Agility, Dexterity, and Cognitive Capacity
4 Ages of U.S. physicians 2018
Published by Frédéric Michas, Aug 27, 2020
5 Evaluating Surgical Dexterity During Corneal Suturing
George M. Saleh, MRCS(Ed), MRCOphth; Yiorgos Voyazis, MBBS; Julian
Hance, MD, MRCS; et al; Joel Ratnasothy, MRCS; Ara Darzi, MD, FRCS
6 Thoeries Cognitive Psychology Fluid vs. Crystallized Intelligence
By Kendra Cherry, Medically reviewed by Steven Gans, MD
7 The Checklist Manifesto: How to Get Things Right
Paperback - December 1, 2010 by Atul Gawande

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