"So
many people walk around with a meaningless life. They seem
half-asleep, even when they're busy doing things they think are
important. This is because they're chasing the wrong
things.
~Morrie Schwartz,
"tuesdays with Morrie"
A few
years ago, I stared at the growing stack of invitations, fliers, and
letters in a pending file. Fliers to LASIK seminars. Invitations to dinner
with refractive surgeons and LASIK
center directors. Letters to get in on the ground level and invest
in LASIK centers.
Out of
curiosity, I accepted an invitation to dinner. I was wined and
dined. Take that back. I was WINED and DINED. Beneath
the glow of dimmed chandeliers in an elegant restaurant, the compliments
were blushingly effusive. I was made to feel so very special. It was
seductive.
The pitch
came at the end of this dinner:
"Dr.
X, for every patient you send to our laser center, we'll collect the
$5000 and we'll make sure you get back $2000."
"That's an extravagant
amount," I said. "Isn't
that a kickback?"
"No,
we call it a co-management fee," was the quick reply. "You and
I will manage the patient together. A "kickback" lands us
both in jail. Hehehe."
That
night, I told my husband, "I didn't take it personally, but now I
know what it's like to be
propositioned! Optometry has never been paid that well for
equivalent services. Call it anything. A bribe is a bribe is a bribe. Do they really think that doctors are that easily
bribed?"
Call me
naive, but I was shocked, when within a year, so many doctors were climbing
aboard the LASIK bandwagon. This was an experimental surgical procedure,
very seat-of-the-pants, without a track record. The referral guidelines
were sketchy. The scientific literature was sparse. Yet, knowing so
little, they were enthusiastically referring patients to laser
centers -- up the proverbial KAZOO.
~~~
With
dismay, I witnessed the suspension of previously sound professional
judgment, leading me to question:
Had the
eye professions gone bonkers? Were they not hearing the incessant
LASIK ads as sheer, unadulterated HYPE? Hype that trivialized the
possible sight-impairing and sight-threatening complications? Had my peers succumbed to a selective amnesia,
forgetting basic cornea knowledge? A cut and partially vaporized cornea
is compromised, no matter how you slice it. Are we so easily bought? Are we that "bunch of
schlocks" that a professor-mentor had exhorted us NOT to be?
Doctors
are human. Oh, so human. And their inner
children were being enticed with instant gratification. Some
resisted. Some sat on the fence. Some yielded.
LASIK
coincided with a difficult time in my life. My father was gravely
ill. Feeling down and vulnerable, I seriously considered
leaving my profession, perhaps returning to teaching college
psychology.
I felt ashamed to be a
fellow member of the eye professions. A growing number of its
members were failing to profess, i.e.,
failing to fully
inform their patients. I felt embarrassed by the flagrant disregard
of The
Hippocratic Oath by those who were putting their own interests
ahead of their patients'. I was appalled by the whole sordid
"back-room" dealing that I had experienced... as if I were a
hooker! So ashamed, embarrassed, appalled -- and incredulous, I
avoided the subject whenever it came up among peers.
Experiencing
a sympathetic reaction called "Fight or Flight," my non-confrontative,
peace-loving self chose to flee. I wanted OUT! And fast.
My father
loved living. His passions were reading and traveling, both
sight-intensive activities. He lived life to the fullest, and at the end of it, I saw
him fighting to keep every ounce of quality in his life. His valiant
fight inspired me not to easily give up on what I loved so deeply:
I truly
love those I serve; we have consciously cultivated a solid base of
quality-minded patients who want the personalized care we offer and are willing
to pay fair fees for it. It has taken years to assemble the best
team of conscientious, like-minded staff members and doctors
ever. Together, we have created a caring and joyful country practice in
an impersonal, urban setting. High-tech, from pouring most of its
profits back into it, yet beautiful and welcoming, our office is a great
place to be. I love my profession, or at least I did a lot more before LASIK came
along.
LASIK had
become a
fly in the ointment.
~~~
When my
father crossed over, it was his faith in me and my faith in "I can
do all things..." that motivated me to do my best to flick the fly
out of the ointment and make a positive difference.
Not
wishing to dwell on negative energy and resort to finger-pointing and
blaming, I sought to clearly identify the fly in my ointment. If I were
to flick it out, I needed to know what the fly was. Was LASIK the fly?
No, it's just a procedure. Were doctors the flies? No, in an imperfect
world, good and bad exist in every profession. Besides, judging others is a fruitless
endeavor; I leave that stuff to a Higher Power. Not my job. And then it came
to me, clear as day:
The fly
in the ointment was THE FAILURE TO FULLY INFORM: the ads and
infomercials were not fully informing the public; many refractive
surgeons and referring doctors were not fully informing patients; and
refractive surgeons were not fully informing referring doctors of their
mounting failures. Real risks and complications were being
downplayed, even trivialized. Financial incentives for referring
patients was not common knowledge.
As
professionals, we have a moral obligation to FULLY INFORM to the
best of our ability, with the patients' best interests in mind.
Especially when it has to do with our primary sense, sight.
~~~
I began a
personal campaign to persuade my peers to FULLY INFORM, to think twice before casually referring their
patients to LASIK surgeons. Whenever I attended meetings,
conferences, or classes, I'd bring the subject up with my peers,
asking them to review their basic eye anatomy and pay attention to the
corneal nerves -- the "feelers" of the eye, its biofeedback
mechanism -- before they sent in their next patient.
Reminding
them of the neurotrophic function of these nerves (they help in the
maintenance of a healthy cornea), I reviewed how the microkeratome
-- "the world's smallest buzz saw"
-- sliced these microscopic
nerves, millions of them, that do not grow back to its original state and function.
I'd offer
the reality check, "Christopher Reeve still does not walk."
Bless that courageous, inspiring man who
struggles with dignity and fortitude.
Quizzing
my peers, I found that, for many, their knowledge was woefully
lacking. They were not FULLY INFORMED themselves, yet were
referring patients. Some had no idea what "Sands of Sahara"
was, much less knowing what to do about it if it bit them in their face.
Bringing up
consequences that might broadside their pocketbooks, I hoped to make them
think twice about their casual referrals:
"The
surgeon's name is on the informed consent form, is yours? You do know that the surgeons have
protected themselves from lawsuits with that informed consent form, but
you're left yourself wide open for lawsuit for FAILURE TO FULLY
INFORM. You can be held
accountable. Complications, especially corneal transplants,
can be expensive. If the surgeon's consent form is
"iron-clad," you're the next logical person to sue."
I'd
get replies like, "Geez, I never thought of that!"
Unfortunately,
thought-provocation didn't seem to achieve my desired end of slowing
down their rapturous, under-informed referrals. In a
short time, referring doctors were insisting on having their names added to
informed consent forms.
I'd toss
out highly touted percentages of failure, which we belatedly know by
personal experience as underestimations:
"For
the one, two or three patients out of every hundred you refer to LASIK
surgery, the complications are not minor inconveniences, but profound
losses in vision acuity, quality and even sight itself. Are you prepared to face that
patient who will need a corneal transplant? Are you aware that when
surgeries fail, patients, families, networks of friends, colleagues
and co-workers suffer? And all that for an elective surgery? What are you going to say to the patient who says, "Doc, I
trusted you to do right by me. Why didn't you tell me this could
happen to me? Why did you make the complications seem so trivial and
unlikely? I would have thought twice..."
What
about the losses in everyday function that are not even counted by the
1-3% statistic? Those who no longer can work as they once
did. Who no longer read or travel as before LASIK? Who no longer
drive safely at night? Those who are now plagued with glare, aberrations,
starbursts, and halos (a combination of post-LASIK symptoms
so common, it has its own acronym, GASH)? Those who suffer from dry eyes who now
spend a $120 a month, $1200 a year for prescription artificial
tears? Would they have chosen this surgery if they
had known that these complications would be theirs for keeps?
A
common response was one of resignation: "X, if I don't send them
in, someone else is going to do it anyway" or "Everyone else
is doing it, and I don't want to be perceived as being behind the
times." I'd gently remind them to review The
Hippocratic Oath and The
Golden
Rule.
Those
overtly milking the LASIK cash cow responded with, "Hey, the
money's too good not to refer," or "This is making a
nice nest egg for my retirement." To them, I was
unapologetically pointed, "Hippocratic is not spelled
h-y-p-o-c-r-i-t-i-c."
In spite
of my mild-mannered demeanor, when I smell a rat, especially a hurtful
rat who has done a
magnificent job of rationalization, I have no problem revealing that
rat-ness to him/her self. I practice The Golden Rule; darn it, if
I'm being a hurtful rat without awareness, somebody tell me, so I can
snap out of it!
~~~
Carrying
the "FULLY INFORM" campaign on to the Internet, I
e-mailed anyone and everyone in the eye
professions.
I suspect
my e-mails were often deleted as
SPAM. I have a quick finger for it, myself. For others,
I suspect my e-mails were uncomfortable, unwelcome reality checks, but not
uncomfortable enough to give up hefty fees.
At first,
the positive, supportive replies were a trickle; now, it is a steady stream. This
has been a faith-restoring and heartening experience. I am in
honorable company after all; there are many who have refused to make
light of our professions' duties and obligations. Thanks to the
Internet, we are finding each other. I especially like the replies that go: "I thought I was the only one who felt like
you...You're right. We did take an Oath, "First, do
no harm... What can we do?... Let's work
on
this together."
A
grassroots effort to FULLY INFORM was born.
~~~
Many of
the refractive surgeons were not talking up their complications.
There was a FAILURE TO FULLY INFORM referring doctors who were
feeding them patients. Staying mum
about their less than stellar results was good
for business. Using the Snellen eye chart worked in their marketing favor.
A
post-LASIK patient may have a significant decrease in visual acuities under low
light conditions, but still be able to handily read a high-contrast eye
chart, i.e., stark black letters
projected on a
stark white background.
Case in
point: In March 2000, back in my home state, I interviewed a post-LASIK patient,
Mary Doe, who related
this experience to me:
Grrrrrr.
Hearing
John's story, thanks to Mary, gave me the push to do more. With
crystal clarity, I had a moral obligation to FULLY INFORM her, FULLY
INFORM him. I know, as any
eye professional knows, the following:
John's
and Mary's refractive surgeon knew darn well that LASIK surgery had
decreased John's
ability to see in low light conditions, i.e., there was a reduction in
contrast sensitivity.
No only
was the surgeon being a complete a**, he was being totally dismissive of the patient's
accurate reporting of a very real and common symptom of LASIK.
Yet, he led John to question his sanity.
A
CONSCIOUS FAILURE TO FULLY INFORM.
Like Mary,
John no longer drives at night. Just as John can no longer see his
white shoelaces on his white sneakers in a dimmed room, both can't
easily see dark-colored cars and objects on dark roads (your
kid hurrying home on a bike? your pet? your spouse jogging? your parent
taking an evening stroll? you crossing a street?).
Forget looking for matching socks in the morning. He no longer sees numbers
well (print on colored paper is difficult), which is essential to his job. He's thinking about going on
disability, and taxpayers will be paying to support him.
John's life has been complicated, let alone his eyes and
vision. But that
surgeon will count him and Mary as unmitigated successes. And the
failure rate will remain under-estimated, deceptively
misrepresenting the true numbers to the public, a failure to fully
inform.
~~~
These
days, we are busily FULLY INFORMING one another and the FDA. We write, share, and collect our case reports on the LASIK
failures. We're sending copies to one another, as well as forwarding
copies to the FDA, along with our individual accounts of our
personal experiences of backroom deals-making.
The
FDA is listening.
URL: http://www.surgicaleyes.org/ubboard/Forum27/HTML/001173.html
These
days, we share tips on how to help post-LASIK patients who now seek
our care. We learn from them and from
caring doctors (like leukoma and DavOD) who generously and anonymously
give of their time and expertise to answer questions and
contribute to a growing resource of fully informative accounts at http://surgicaleyes.com.
Whenever
one of us has access to the media, thanks to the power of the Internet, we
strive to FULLY INFORM the public, e-mailing summaries of case
reports, existing studies, and articles on complications. We suggest
interviews with complicated post-LASIK patients (with their permission and
willingness,
of course) and refer to actual patient accounts at http://surgicaleyes.com.
The
national, state, and local media are reading, listening, and using our
information to FULLY INFORM the public in their articles, newscasts, and
magazine shows.
~~~
I am
pleased to see that a number of my peers who were initially tempted are finding their way back to
what attracted them to our profession in the first place: the caring and
helping of people and the preservation of sight. My faith in my
profession is being restored.
Many are no
longer sending their patients in for LASIK, realizing first-hand that
LASIK is not ready for prime time. We are all
seeing more and more LASIK failures. Sobering failures.
Many are discovering true "bigness,"
admitting to the casualness of their early-on referrals and
now educate their patients with the intent to FULLY INFORM.
They are apologizing to their patients, and are doing all
they can to assist traumatized post-LASIK patients.
Many have
come to realize, the hard way, that they "bit off more than they could
chew," especially when their post-LASIK patients returned
with unexpected complications, some irreversible.
Many more
are taking classes like "How to Treat Post-LASIK
Complications." A hardbound text on the subject is now on the
market, filled with photos of complicated REAL cases. Nothing
hypothetical or maybe about those damaged-for-life eyes. We are
also preparing ourselves for the long-term effects that will arise for
many with age. For some of us, it's Humpty Dumpty time again. We
wrangled with the
down-the-road problems of RK -- remember that failed "miracle"
eye surgery? Been there, done that. And here we go again.
Many more
are finding out that, when they consciously strive to FULLY
INFORM, a common phenomenon occurs:
Patients do think
twice. Consciously thinking about what
their sight is worth to them, patients make more carefully
thought-out decisions, instead of headlong, emotionally-charged ones.
Pondering the risks and the gamble involved with a cautious eye to the
future, they come to a full awareness that this is an elective,
experimental surgery with the possibilities of significant eye-
and life-complications and long-term problems...
They take
that critical look before leaping.
AND
once FULLY INFORMED, most patients are willing to wait for a less risky
procedure, which will
happen! It's just not here quite yet.
For a certain percentage when conventional means do not correct impaired
vision, LASIK may make perfect sense. Remember, this is not
about a procedure; it is about FULLY INFORMING.
There are
those occasional patients who have been brainwashed by the hype and do
not wish to be fully informed, period. They are those who will listen
and still decide to do it. We wish them nothing but success and
well-being, and let them know that our door is always open for them.
Patients
ultimately make their own decisions. And we respect that right. This is America. There
will always be those who live on the edge, sky-dive and climb Everest.
The difference is they do so with full knowledge of the possibility of
injury or death, no matter what the safety precautions. Nature has
its unforgiving quirks, its vagaries.
Not FULLY
INFORMED with the knowledge of the possibilities of injury or (sight)
death, LASIK patients are not as prepared. Eyes are Nature's
masterpieces. Even with the best equipment in the most experienced
of surgical hands, eyes can also be as quirky as Nature.
Common
laments of those hurt by the FAILURE TO FULLY INFORM include: "Why
wasn't I FULLY INFORMED that this could happen to me?"
"Why were the complications trivialized, glossed over?"
"I had no reality on the complications." "I trusted
my doctor to have my best interests in mind, and since, I've learned
about the financial incentives to refer. Why was this
incentive-to-refer not disclosed to me? I would have thought
twice!"
~~~
Fully informing the patients is
simply the right thing to do!
Those of
us who are choosing to FULLY INFORM are
making a difference, one person at a time. One reporter at a
time. One news article at a time. One web page at a time.
You will
see more and more websites like this one, as more and more of my peers
are recognizing the need to be heard, to FULLY INFORM.
But all of
this is not enough. And not in time for many.
The irresponsible
TV and radio ads, paid by those who wish to sustain their $100,000/day
incomes, continue to lure, day in, day out. A percentage of
under-informed patients WILL pay the steepest of prices with their
sight and well-being by those who FAIL TO FULLY INFORM.
Sadly,
those with complications who were casually referred and/or poorly
informed are the most embittered. Their primary sense has been
compromised, serving as a daily reminder of a broken trust -- a sacred
trust -- for the
rest of their lives.
You are
invited to join us. Please join us in being proactive in FULLY
INFORMING the unwary public. We need your help. We
share the same public. They need us to help.
They are
us.
Writing
this, I
have done my best to keep my word impeccable. I am not too proud to
beg on behalf of the gift of sight. Thank you for your attention.
Kindly
yours,
Dr. X
P.S. For
those who have already done it, stay positive. We do not wish to
rain on your parade. We wish you no ill, ONLY continued success. Be aware. Stay
informed, as several long-term problems are avoidable with early
intervention. Many of us doctors are back in school, taking
classes to stem the tide of LASIK complications. Much of what we learn
is news to us as doctors, and therefore news to you, as patients.
Success has been attained in containing the sight-devastating
"Sands of Sahara," which can "melt" the
cornea. Success has been attained with aggressive dry eye syndrome
treatments to avoid corneal scarring, abrasion, and erosion, but better
results are obtained when started early, when the symptoms may seem
subtle and non-threatening. Sight is a cherished gift; do your best to
preserve it the best way you can.
P.P.S.
Feel free to publish this. Make copies, hand out them
out. Share its URL. No permission is needed. Posted
without a motive to derive financial gain, this is a public service to
FULLY inform, plain and simple.
This is a
grassroots effort that's
worth getting involved with,
as it's about sight.
For Heaven's
Sake.
________________________________
_______________________________
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