UPFRONT: Toward Streamlining Retina Practice


On a recent flight, I sat next to a young man who was a computer programmer. We got to talking, and I learned he worked for a company in Madison, Wisconsin, which happened to be called EPIC. Needless to say, the conversation became very interesting after that. One of the first questions I asked was how often he follows physicians in clinic to see how they could make the program easier to use and make our lives better. I was shocked to hear he and most of the others in his group have never stepped foot in a physician’s office except as a patient. I asked him if that doctor spent more time looking at his computer than him. He chuckled. I sighed. It is no wonder that with each upgrade, EPIC programmers make us learn new keyboard shortcuts, move buttons, add more check boxes, change tabs, redo the design, and so on. I explained to him how we use EPIC and some of the things they could do to help us become more efficient in clinic. We will see if it helps, but I am not holding my breath.

Obviously, many of our issues in clinic are not due to EMR but instead emanate from the Joint Commission, which constantly adds checks that we must perform to comply with their increasingly tiresome and usually irrelevant regulations. For example, I have no idea what a fire safety rating is or what it even means, but I have to add it to my surgical huddle. The nurses now spend more time charting than helping in the OR. I hear about it every day, and this is not why I got into medicine.

Our clinics have also been transformed. In my training, clinics were for evaluating patients for the OR, seeing postoperative patients, performing laser on patients with diabetes, and apologizing that we couldn’t do anything for macular degeneration. Now, every new vein occlusion or wet AMD means an exponential increase in visits for that patient. In this issue, we explore exciting new drug delivery platforms designed to deliver durable care with efficacy similar to the treatments we have now — from novel polymer technology that offers the promise of putting a biologic into polymers to new angiogenic pathways that may actually change the vascular biology. Hopefully, one or more of these technologies will help reduce the avalanche of injections we perform daily.

This leads me to the most important article in this issue — physician burnout. All the items listed above contribute to the ever accelerating hamster wheel on which we all run. Over the past 25 years of practice, I have witnessed physicians and nurses move from providing care to trying to do the same thing with a ridiculous increase in outside pressures. I have seen great clinicians and caring nurses retire early due to burnout. It is a very real and increasingly worrisome issue. I hope everyone who gets this journal will read this one article and reflect on it on your own terms. Ruminate over the advice; hopefully it will help to prevent you from becoming burned out. RP

Listen to episodes of Straight From the Cutter’s Mouth: A Retina Podcast with discussion of Retinal Physician articles.