While Doctors Debate, Patients Decide…

“While Doctors debate, patients decide” is a quote from Ophthalmologist, Charles Kelman, MD. Dr. Kelman is the inventor of the machine that is still used today by ophthalmic surgeons to remove the cloudy crystalline lens during cataract surgery.

Dr. Kelman was a flamboyant person who is claimed to have uttered the quip, “While doctors debate, patient decide” when pressed for the benefits of a yet clinically perfected and peer reviewed literature supported technology. Go here to read more about the Charles Kelman, MD story.

This post is not about Charles Kelman. It is a story that I hope my ophthalmic surgeon friends will read with great interest.

On a flight from Minneapolis, Minnesota to Narita, Japan a flight attendant informed my wife and me that she was wearing glasses and no make-up because she had recently had cataract surgery. She had no idea about my line of work.

After first saying that she seemed too young for cataract surgery, I asked this woman who performed her surgery. To my surprise, she mentioned a well-known refractive surgeon in the Minneapolis area.

Before anyone starts with comments about the difference, or lack there-of, between a cataract surgeon and refractive surgeon, please sit-tight. I am in agreement with you and I’ll bring this around to a salient point with this story.

Next, I asked her if he had been her primary ophthalmologist prior to cataract surgery? She said, “Oh, gosh no. I’ve gone to (Insert mid-career, good general ophthalmologist here) for years.” She went on to say that her daughter wanted to have LASIK so she had helped her find this LASIK surgeon and during that process learned that there was a way for her to get rid-of the reading glasses that so frustrate her as a life-long non-glasses wearing person.

I responded that I knew both of those doctors, both were excellent surgeons and that I was curious why she didn’t ask her long-time care-provider about her options? She looked at me sort of incredulously and said, “Why would I ask him that? ‘Dr. LASIK’ had all sorts of good information available for me, my daughter had a great experience in his practice and he just seemed like the place to go.” I knew her doctor fell into the “Doctor Debate” group of those who didn’t believe in giving their patients options.

In my role at Sightpath, I get to travel around the country and visit with doctors in all parts of the country. I cringe every time that I hear one of them say that they are waiting for their patients to ask for the newest technology, are satisfied with the way that they are doing their procedure today and complain about how much time it takes to consult with patients that have higher expectations.

This ophthalmologist in Minneapolis who lost this patient is a guy that I know pretty well. He works in a successful practice and stories like this make me feel bad for him and others with the similar situations. Unfortunately, he may not change until it’s too late.

He’s one of those guys that says “patients won’t pay, my current cataract procedure is good enough and that slows me down too much.” Sad, really.

In the upgraded cataract surgery market, the refractive surgeons are winning. Yes, I will agree that cataract surgery is refractive surgery and that is precisely the point. To say that targeting a specific outcome causes too much work or that patients won’t pay for it is a dangerous dogma to follow unless you’re at the end of a career because the tides are shifting. And like the ocean, it’s a slow, gradual and unstoppable change.


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