You majored in English literature in college. Was it always your plan to be a doctor?
Entering college, I wanted to take the prerequisites for medical school, but I did not know if being a physician was right for me. Before deciding to apply to medical school, I interviewed physicians who did not end up practicing but who used their medical degrees in an alternate career, including the first national television news physician for CBS. I recognized that entering medical school would be like stepping onto a speeding train, and I wanted to be sure I could step off if I changed my mind. The University of Virginia had one of the top English Departments in the country, so I took advantage of that opportunity and majored in English literature. It was fabulous and fun.
I actually worried during the end of my third year in medical school. I could not see myself in a career in any of the specialties I had encountered so far. In my fourth year, I took an elective in ophthalmology, and it was crystal clear after that. Good thing, because I do not think I would have made it on the TV news.
What have you found to be a key factor in effectively training residents? Is it the same for fellows as well?
Resident and fellow training is not for the faint of heart, but it is a real pleasure to watch the excitement and wonder of the residents and fellows as they encounter patients and experience the thrill of honing their surgical skills. A key factor for both the trainee and myself is to feed off the excitement and reinforce the sheer joy of understanding or accomplishing something new. Mentors of mine like Joel Schuman, MD; Robert Bellows, MD; Thomas Hutchinson, MD; and David Epstein, MD—plus the camaraderie of the Chandler Grant Society and the American Eye Study Club—certainly encourage that kind of enthusiasm and commitment to patients' care.
I also spend a lot of time helping residents and fellows refine their communication skills. You can be the best at what you do, but if you cannot extract and convey the necessary information to patients, you will fail. For better or for worse, I am known for my high expectations. I feel strongly that insisting on excellence spurs the residents and fellows in their achievements. My colleagues and I have trained an amazing group of ophthalmologists, and I am fortunate to be a part of that exponential spreading of good care. Despite the extreme demands on my schedule and myself, I am certain my participation has made me a better doctor and surgeon.
What are the regulatory challenges facing glaucoma practices? Are there solutions?
Unfortunately, we ophthalmologists are being bombarded on many different fronts, and we must use way too much of our time and energy to deal with the constantly changing regulations that are intended to prove our worth. One overriding goal of many advisory bodies to regulatory agencies is to shift the emphasis and payments from specialty care to primary care. Another is to find a way to measure “quality.”
Fortunately, leaders of the American Academy of Ophthalmology have realized that we cannot allow the rapidly developing nonophthalmic—sometimes even nonmedical—quality-measurement infrastructure to dictate our fate. I am actively involved in the qualitymeasure development process for the Academy's IRIS Registry. I think it is terribly important to our financial and professional future to be able to measure and show the value of the care we provide to patients. I believe the huge aggregate data collected and analyzed in IRIS will benefit real-world glaucoma care in particular, because they can help to answer many questions. The initial foray into the land of big data may seem rudimentary or coarse, but I expect that, as time goes on, it will become possible to drill down into information that will change how we take care of patients.
What are your goals as incoming president of the American Glaucoma Society?
I am honored to be president-elect of the American Glaucoma Society (AGS). The organization comprises a great group of people, all of whom remain entranced in a dark room on a beautiful day to discuss the smallest nuances of glaucoma care! The AGS is in some ways a bit of a support group for glaucomatologists. We come together to commiserate about the challenges of treating patients with this group of diseases and become inspired by colleagues' approaches and exciting research.
My hope for the AGS is to continue expanding the ways in which members can interact and participate in the annual meeting and within the committees that are the engine behind the scenes. The recent survey of the membership will help provide focus. Who are the members? What do they want or need from the AGS? In addition, I want the AGS to remain a visible force in the health care landscape. Any time an issue arises regarding glaucoma care or reimbursement, the AGS should be involved in the discussion. These days, that requires a quick and nimble response from the leadership.
What was your best windsurfing experience?
I consider myself to be a pretty good athlete, but the combination of balance, strength, and endurance that is required to learn windsurfing—not to mention finding the time to get out on the water—has been challenging for me. I have been working on it for a long time. In fact, I took my equipment up to Maine for the Lancaster course during my residency (and had to be rescued twice)! That said, windsurfing is such an engaging pursuit. The best things about it are the total immersion and satisfying thrill of learning a new skill; it is a sport of constant improvement. Being able to take these skills to a beautiful place like Maui, to revel in the scenery, and to mingle with the sea turtles is wonderful.
The exhilaration (and terror) of going fast and the spectacular catapults (when you are hooked into the boom with your harness and things go awry) must entertain the folks on the beach. Windsurfing really is fun.
