Jay talks with Mike and Louie about preferences of clinic vs. OR and how to stay interested throughout your career. They realize that while we strive for excellence in all areas, everyone has a forte.
LC: Things I commonly hear from medical students when I tell them I'm going into ophthalmology include "Eyes gross me out." or "Doesn't it get boring only working on one organ?" How do you usually respond to those sentiments?
JS: I think all of us in medicine have components of our field which give us more of the “ick” factor than others. For example, I discovered during my trauma rotation that broken digits bother me a bit. Having seen good friends of mine vasovagal seeing eye surgery videos, I can honestly state that being grossed out by eyes may be a legit reason to not pursue the field. Still, unless you have a visceral response, it is worth exploring and seeing if your initial hesitancy is really all in your head.
As far as boredom goes, a wise doctor (an internist) once told me in medical school: everything becomes rote after some time. That is to say, every field has its bread and butter that you will see over and over again, and then its zebras that pop up occasionally and stir that old flame in your soul. The real question is whether or not the rote stuff is still interesting to you after the umpteenth time of looking at a retina. And yeah, being able to directly see part of the central nervous system is still exciting!
MV: That's a really great point. As students, and really throughout the entire career, it seems like that is a goal - to get to the point where you know your field well enough that you're really only "stumped" by the zebras. At that point, there's that risk of boredom. But then again I suppose that's where research comes in - with treatments constantly progressing, those things that were once mundane could become quite exciting again!
LC: I never thought of it that way. In that case the rote things in ophthalmology are pretty interesting. Even a simple slit lamp exam can be performed more efficiently, more accurately. I think the procedural aspects of the field will always be enjoyable as long as we're striving to improve our technique.
MV: With regards to your comment, Dr. Sridhar, I'm curious if you feel a difference between clinic and surgery. I've heard a number of residents from various fields say something like, "I can't wait to get through this clinic day and get to the OR tomorrow." For you, do "easy" surgical cases remain exciting because of how much attention to detail is required regardless, or are they subject to this "bread and butter" idea too?
JS: Excellent question, Mike. So the fellows used to discuss this amongst ourselves in fellowship. We concluded that each amazing surgeon we trained with had one arena where they were in their absolute element, be it the OR, clinic, the podium giving a talk, or writing a paper. Now, this is not to say they were inadequate or uncomfortable in the other arenas. Retinal surgeons are generally exceptional people who excel across various facets of their work. But everyone has a forte. It's like saying Michael Jordan's greatest strength as a basketball player was scoring. It doesn't mean he was not a great passer or ball-handler, but his peak was scoring.
That being said I think I am not unusual in preferring OR to clinic. I enjoy talking to and seeing patients tremendously, but there is something uniquely meditative and special about the privilege of performing surgery. We talked about retinal surgery at length before (link), so I will summarize by saying that retinal surgery stimulates because every case is its own challenge.
LC: Thats a really interesting analogy. That's a point I never considered but makes a lot of sense. There are multiple definitions and aspects of what it means to be a good doctor, and it's natural to have a particular strength - whether with clinic, teaching, or research.
To be continued...
-Adapted from a real conversation between The Professor (Jay Sridhar) and The Pupils (Louie Cai and Mike Venincasa).