The community of patients that our ophthalmology clinic serves is notorious for providing bogus contact information. This includes phone numbers, addresses, and sometimes even ages. This is likely not intentional–they travel back and forth from their home country frequently. Many of them do not have a permanent U.S. address and provide a relative’s, friend’s, or neighbor’s when asked. This is problematic when we have to contact them.

For missed clinic appointments that is usually not a problem. They can reschedule at their own leisure, and there are usually enough patients to be seen in clinic already. Our surgical numbers, however, are dependent on our ability to reach our patients.

I had 2 patients that I’ve been trying to schedule for pterygium surgery, and none of their provided telephone numbers work. How can I reach them? I have a listed address on the demographic sheet, but should I go to their house to ask them to return to clinic for surgery?

Imagine that your doctor shows up at your doorstep to get you to have surgery. How would that feel? I wonder if he’d be treated like any other annoying traveling salesman hocking his wares.

I guess I’ll find out soon enough…

medicine ophthalmology, rant

Those who have completed their ophthalmology residencies can vouch that it wasn’t easy. There is variability in the efficiency in which a resident clinic operates, but most of them are busy. You have an excessive number of scheduled patients along with walk-ins that consume your day. In addition, there are insurance and scheduling issues to consider. If you are in a small program, your call schedule will be packed.

My medicine counterparts whine to me how dermatology and ophthalmology consults are so lazy because our consult notes until the next day. Most of the time we do our non-emergent consults in the evenings. During the day we have clinic patients to see. The program I am in has a resident rotation dedicated to consults, but it is intermingled with surgical time. We run between clinic patients to see our inpatients, and many of our evenings and weekends are filled with lectures or clinic.

The most difficult adjustment that I’ve encountered in my two weeks of residency is that I am a PGY-2 with intern knowledge. Our medical education is geared toward training us to be internists, not surgeons or subspecialists. We have to relearn a dedicated physical exam for the eye. Right from the beginning, we are (in theory), the experts in our field.

Hopefully, it will be easier as the year progresses…

medicine ophthalmology

I recently started my PGY-2 year. The experience is intense, and I haven’t even finished the first week. I had been anxiously anticipating starting training as an ophthalmologist the last few weeks of internship, and there has been no disappointment thus far.

I feel like an intern all over again, only worse. As an intern in medicine or surgery, I still had an inkling of a differential diagnosis for abdominal pain or any other common complaint. Medical school was grounded on core medicine. But ophthalmology? A foreign language to most physicians. Physical exam? No idea. And the fact that we’re on call an average of Q3-Q4, things have been busy.

Sorry for the delayed updates folks! More to come!

medicine ophthalmology

There are two brothers who are well-known in academic ophthalmology in the U.S. Those of you in the field will know who I am referring to, but I will not mention names. Both of them are incredibly intelligent clinician-scientists. One of them is actually a genius. No, not your everyday “super smart” guy, but a real genius. He apparently is the youngest medical school graduate in the World Record books, and has wunderkind abilities akin to that of Mozart. No joke.

In any case, I had the fortune of meeting both of them during the residency interview season. They are known to be difficult interviewers; some have mentioned that they pose challenging dexterity tasks to their interviewees. One applicant was asked to pour water into a narrow-spout without spillage. Another was asked to throw some knots using 12-0 sutures (without loupes). One of them interviewed me for a spot at his program.

Going into my interview, I wasn’t too nervous about these menial skills. I had poured gallons of anti-freeze into the tiny tanks of cars in my lifetime working the blue collar jobs. Those long hours of video gaming sessions certainly honed my dexterity. What else could he ask me to do? Well, my interview took an interesting turn.

He did not greet me as I entered his office. He did not ask me to sit down, nor did he even look at me directly during my entire interview. His desk had stacks of papers scattered about, along with remnants of silk sutures, styrofoam cups filled with blue water, and 0.3oz bottles. I remember that he asked me whether the U.S. should invade Iran, and that I muttered that I didn’t think there would be any economic or political benefit to the U.S. if that were to happen. He subseqently made several arguments that suggested that I knew little about politics at all (which is probably true).

He followed up by asking me if I really was well-versed in college basketball. Yes! On my application, I had listed that I loved watching college basketball. Indeed, as a Blue Devil fan, I went to my share of basketball games. At the time, I knew who the best free throw shooters in the league were, and which teams had a decent shot at winning. I watched a lot of basketball. Try me! I told to fire away. And then he dropped the bomb on me:

“So, in a single-elimination basketball tournament with 128 teams, how many games will be played?”

Math eh? I didn’t see that coming. It sounded like one of those M$ or Cisco interviews rather than a medical residency one. Well, I gave it some thought:

In a tournament, there can only be one winner. Everyone else is a loser. Every match will produce one loser. So in a group of N teams, there must be (N – 1) losers. There will likely be (N – 1) matches. At the time, I was nervous. I wasn’t confident that my logic was correct. So I quickly ran through some arithmetic in my head: With 2 teams, there will be 1 match, with 3 teams…2. (Team 1 and 2 play, and then the winner plays Team 3, for a total of 2 matches). That logic seemed to work out.

I told him “127″. He asked me why, and I explained my logic. His only response was, “Not good enough.” He then stood up and motioned me out of the office.

Wtf?

I was miffed. During the rest of the interview day, I was thinking about the problem. I scribbled more computations on the lunch napkins, and I was convinced that I was right.

Now that it has been more than a year or so since that encounter, I am still not sure what he meant by his response. Did he want a formal proof? Based on induction alone, I could have shown with brute force the number of games needed for a small number of teams and induced the result for N teams. Or did he want something with a binary tree? Doing so would probably involve some base 2 logarithms which would eventually simplify to (N – 1). To this day, I am still baffled by the genius. “Not good enough?”  I guess I simply wasn’t good enough.

If any of you have any thoughts, please contact me. I’d like to learn something. This sort of stuff keeps me up at night.

medicine ophthalmology

Congratulations to all the matched ophthalmology applicants! You are one step closer to your career choice.  It doesn’t appear that anyone from my medical school class will be at my program, but I’m assuming they’ve done quite well. What do the applicants usually do the evening before match day? I can tell you what I did around this time of year in the distant past…

I was out in San Francisco, just finishing up a preliminary year interview. I hung out with the ‘ole bunch of computing programming venture capitalists playing RockBand (it had just been released) until the wee hours of the morning. It was good to see a vision of what I could have been doing had I continued the programming lifestyle instead of going to medical school (posh apartment, Motrin gumball machine at the office, money, odd hours.. ). After I found out that I had matched, I went out to the wharf where the SFMatch offices were at…somewhere out on Beach St. It’s near the Ghirardelli complex. Great fun… Where were you at?

SF Match Ophthalmology headquarters

medicine ophthalmology