Ophthalmology: The Impossible Becomes Routine

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Reflections on Medicine - May 2008

 

 

By John J. Alpar, MD

Tremendous progress has been made in medicine in the 50 years since I began practice. Procedures that did not exist and were deemed impossible are now everyday occurrences, such as heart/lung transplants, liver transplants, and so on.

Limiting myself to my specialty, ophthalmology, the changes are mind-boggling. They involve not only surgical and diagnostic instrument technology, but also drug therapy and, of course, a much better understanding of disease pathology and a more rational and scientific treatment. Some benefited the patients enormously; some benefited the doctors more. 

An example is cataract surgery. When I came to this country, the common cataract surgical practice was to keep the patient in bed for several days with both eyes patched, sand bags against the head - something that we in Hungary never did. When the patient's eyes healed, in three months time, we fitted them with "Coke bottle" type glasses, which were as handicapping as the cataracts. The surgery carried high risks, even life-threatening risks, especially because of the continuous bed rest, so we recommended not removing monocular cataracts (especially because we were not too successful in restoring binocular vision, even in patients who were able to wear contact lenses) and, if bilateral, waiting until the vision was almost gone.

Today, cataract surgery is a short outpatient procedure with very good vision, without heavy glasses, using intraocular lenses, astigmatic correction incisions, etc. 

Diseases that were incurable, such as macular degeneration, today often (but not yet always) are successfully treated. Diabetic retinopathy, which almost inevitably led to blindness if the patient lived long enough, today has a much better prognosis for the patient to retain vision and live a normal life.

What we didn't succeed with is improving patient cooperation in the treatment. Unfortunately, some of the procedures, especially surgical procedures, are used to improve the lifestyle of the surgeon and not that of the patient. 

One of the major changes I have observed is that patients who are cooperative in their own care and trust the doctors develop unrealistic expectations due to high-pressure advertisements and place unrealistic demands on our time and services. They are ready to sue at the slightest event they deem profitable. The legal profession encourages these lawsuits. The litigation drives many doctors to practice defensive medicine, which is usually expensive, and they often look at the patient as a potential enemy instead of a friend and human being who needs our help.

Another important change for the worse has occurred in the doctor-nurse relationship. Nurses often are trained and employed, especially by hospitals, to observe, make notes, and report on doctors, instead of helping treat patients.

What did I accomplish? I did clinical research, helped develop intraocular lens surgical technology, lectured around the world (more than 500 lectures delivered in almost 100 countries), published 130 articles, wrote a textbook that was translated into several languages, wrote several chapters in different textbooks, participated in drug studies, helped write national and international standards for ophthalmic devices, had six children and 13 grandchildren, stayed married to the same wife and - above all - I never advertised.

Dr. Alpar is a semiretired ophthalmologist in Amarillo.

Editor's Note: This is the latest in a continuing series of essays by members of the  TMA 50-Year Club .

 

 

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