December 2013

 

CATARACT

 

Cataract editor's corner of the world

Changes in the day-to-day routine


by Ellen Stodola EyeWorld Staff Writer
 

As 2013 comes to a close, we may reflect on the past and make resolutions for the upcoming year. As doctors, our daily routine is stressful. Whether the day was in the office or in the operating room, we must contort our bodies to straddle around a slit lamp, peer through oculars, and hold joysticks or surgical instruments. Repetitive motions can lead to chronic injuries and subsequent pain. One ophthalmologist sheepishly confided that she schedules a massage at the end of each OR day. While that might sound extravagant at first, when considering the alternative of chronic stiffness, a daily massage might be a nice solution to prevent job-related injuries. We asked several ophthalmologists what lifestyle changes they plan to make in 2014.

Bonnie An Henderson, MD, cataract editor

 

Changes in ergonomics and lifestyle can have a profound impact for surgeons in their practice

Changes in lifestyle, ergonomics, and rituals in a medical practice can be extremely important. In addition to medical and surgical changes, doctors must make sure that things are running smoothly on a day-to-day basis, which often involves factoring in exercise and use of equipment and social media.

Robin R. Vann, MD, chief of comprehensive ophthalmology, Duke University, Durham, N.C., and Darcy H. Wolsey, MD, The Eye Institute of Utah, Salt Lake City, commented on changes they made this year and changes they are already planning for next year.

Ways to alleviate pain from day-to-day activities

Dr. Vann said that the day-to-day routine in his practice can start to weigh on the body and cause some stiffness and soreness. Though he said he does not have any specific new equipment within his practice to address this, he has started using a foam roller, something that he used previously for triathlons, to help stretch out after a day in the OR.

"The OR microscope and the slit lamp are very poorly designed ergonomically," he said. Seeing a number of patients very rapidly can often cause scrunching of the neck and raised shoulders, Dr. Vann said, and sometimes this can go unnoticed throughout the day.

Dr. Wolsey said that she often has neck and upper back pain after long days. "Unfortunately, I operate in three different ORs with three different microscopes and three different types of beds, so I have little control over trying to make things as comfortable as possible," she said. However, one thing that she is making a point to do is to pay more attention to how she is sitting in the OR. She has been making a point to sit more upright and not crane her neck forward as much in order to create a more natural posture.

She has requested some equipment, like longer oculars, to make sure she is not stretching in surgery, and she uses the same chair when operating. "Mostly it's me trying to pay attention to my own posture since everything else is so limited in what I can change," Dr. Wolsey said.

Stress-relieving tactics

"One of the things that I've done differently this year, though it's not new to my past, is committing myself to a regular exercise routine and trying to be more healthful," Dr. Vann said.

Dr. Vann explained that the process of converting the Duke system to electronic health records was very stressful this year. He was in charge of a lot of the set up and organization of this conversion.

Although it was not too difficult to get the system up and running in his practice, he was also responsible for the conversion of a total of about 75 people, which included a number of different specialties, like retina, cornea, neuro-ophthalmology, plastics, and pediatric ophthalmology.

"It totally consumed me over the last 14 months or so, and I had to let go of my regular exercise routine," he said. After going live with the electronic records in June, Dr. Vann made it a point to start exercising again. "One of my commitments was within three months of go-live I needed to make sure I was exercising regularly like I had in the past," he said.

Despite going to a personal trainer and doing ballroom dancing one night a week with his wife, Dr. Vann still felt that he needed more exercise in his days, so he decided to sign up for a half marathon.

Dr. Vann has done triathlons in the past but did not feel that he would have the flexibility to train while simultaneously implementing the electronic health records system. He signed up for a local half marathon in Durham, N.C. and completed it in October. "I chose a half marathon because I was afraid that I would be pulled so heavily after we turned on the product that I wouldn't have the free time to do triathlon training." However, he noted that he missed the cross-training that comes with triathlons and intends to get involved with this next year.

Dr. Wolsey said she will usually try to break at the end of the day to relieve stress. In a longer case, she may take a break to stretch her neck, but mostly she will exercise and do other stress relievers after she is finished with patients.

"I'm already very active, so when I'm in the weight room, I work on strengthening my upper back so I'm not slouching, which I think helps," Dr. Wolsey said. She also uses yoga and stretching as a tool.

Social media

Another change that some practitioners are noting is the increased use of social media. Many are actively implementing it into their day-to-day routines. Dr. Vann said that Duke does use social media, although he does not think that a lot of its providers are very actively engaged with it. He said there is a media manager within the department who helps handle social media and using it to get information out and interact with patients.

"Our clinic is on Facebook," Dr. Wolsey said. However, she noted that the use is marginal. You have to be very consistent with it to keep your name in social media, she said. Dr. Wolsey also noted that her mixed practice of refractive, cornea and cataract, with a large percentage geared toward cataract, may not be the best audience for social media because she said many of the cataract patients are less likely to be on social media.

"We do try to keep an active webpage as well," she said, which includes recent lectures and news updates.

Plans for 2014

Dr. Wolsey said she expects that there will be new equipment added to her practice in the coming year. "We are always getting new equipment," she said, and it will be important to learn how it will integrate into the clinic.

She also added that she believes social media, the website and web presence will be increasingly important tools. She hopes to work on her refractive practice in the coming year and believes that social media can be helpful with that patient population.

Dr. Vann said that he already has some plans in place for changes in the new year, but these are mainly practice related. One big change, he said, is acquiring a femtosecond laser and implementing it into the practice. This will take some adapting to see how it fits in with other instruments and day-to-day workings.

"My office is in the same building as our operating room and my clinic, so I don't have to travel around to a bunch of different sites." He said with the added femtosecond laser, he is contemplating activities, such as using an exercise ball, to help stretch out during the day.

"I see far too many ophthalmologists who focus on their professional career and don't take care of themselves," Dr. Vann said. "I have been a real proponent for trying to stay healthy and exercise." He said this helps immensely in the long run.

Contact information

Vann: Robin.Vann@duke.edu
Wolsey: dwolsey@theeyeinstitute.com

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