“Opthomology”

The first rule of ophthalmology is to spell it right. Nobody does. I’m not even sure if I just did. The second rule is that nobody should ever mess with the eye unless he is an ophthalmologist. It’s the eye for crying out loud. We see out of them. The margin of error is small. I’m not exactly a crack addict but compared to an ophthalmologist, my hands shake as if I’m doing a couple of rocks a day.

As those of you who don’t confuse ophthalmologists with optometrists know, an ophthalmologist is a surgeon who specializes in the eye. Optometrists make glasses and there is an intense but one-sided rivalry between the two professions. One-sided because the ophthalmologists don’t care and if they did have been known (unfairly) to call optometrists “Chiropractors for the eyes.”

(Optometrists are not medical doctors but go four years of optometry school after which they are conferred a OD degree. There is a lot of overlap between optometry and ophthalmology. Ophthalmologists usually include retail glasses and contacts in their practice and optometrists manage some diseases of the eye. A better comparison would be that optometrists are like primary care for the eyes. Still, I have known several optometrists and there is some bitterness towards their MD cousins.)

What do I know about ophthalmology? A good deal less than I know about any other specialty. As you know I was a family medicine resident for a year and am currently an Emergency Medicine resident. I think I know enough about these to specialties to offer some tentative opinions. I have rotated on most of the specialties I have described in this series of articles and know enough to at least give you an outsider’s perspective of them. I am not a surgeon, for example, but I have done a total of six months of surgery rotations so I have at least a vague idea of what goes on.

I spent a week in ophthalmology during third year of medical school. Less than a week, actually, because Friday was a holiday, I made some lame excuse to slime out of going on both Tuesday and Monday, and went to one procedure on Wednesday where I did nothing and said nothing (which is all that is expected of you). On Thursday I went to clinic, shadowed the resident for and hour or two until his annoyance reached a certain threshold and he signed my evaluation sheet and allowed me to leave.

Ophthalmologists tie knots with suture threads so fine that it looked like the guy was using spider-web on the eyeball he had popped out of the patient’s eye-socket. You are not going to do much on a rotation like this, even if you want to. “Hey, Mrs. Smith, how about I let this third year medical student jeopardize your eyesight?”  One week is also not long enough to learn anything really useful, at least anything that will stick. I go to an ophthalmologist for my glasses and am as mystified at what he does as my patients are when they look at the squiggly lines on their EKG.

Ophthalmology is very competitive as specialties go. It will make even the best students in your class feel like losers when they don’t match, a common event. You might hear people say, “I’m trying for Ophtho but I’ve got derm as a backup.” The lifestyle is very good in residency but it is a surgical specialty so you will come in early and stay late occasionally, at least this is my understanding. You do have call. Eye injuries are common and every injury is an emergency until proven otherwise. Half of your brain is devoted to visual processing. The eye is important.

On the other hand you won’t be admitting patients to the hospital so how bad could it be? (I know there are exceptions to this but we’re talking generally)

The definition of “stressed” is an ophthalmology resident trying to manage a medical problem on the floor. I’ve seen it happen and it wasn’t pretty. But when it comes to the eyes they are magnificent bastards and everybody breathes easier when Ophtho shows up to give slightly bored guidance on the management of an ocular injury that curdles everybody else’s blood.

Orthopedic Surgery

How do you know a note was written by an orthopedic surgeon?

It’s written in crayon.

Other specialties make a lot of jokes about orthopedic surgeons. Heck, the orthopedic surgeons make a lot of the same jokes that they “tell on themselves” with great relish. I don’t know how it came to pass that other specialties think the orthopedic surgeons are dumb. Maybe it’s because most of them (and you will see this) are big, muscular, guys who look pretty easy-going. Maybe it’s because of the mechanical nature of the job which involves a lot of power tools that would not be unfamiliar to Joe Six-pack building a deck for his wife.

In reality orthopedic surgeons have higher Step scores and grades than most other surgeons and the specialty is a good deal more competitive than, let’s say, General Surgery.

But they do use a lot of tools. And it may be the only medical specialty where leverage is important. An orthopedic surgeon carefully balances precision and brute force. Just watch what is required to replace a hip for an appreciation of this balance. And when they’re done the patient walks as if she were a teenager (after rehab of course), or at least that is a reasonably expected outcome.

It’s a competitive specialty but I think there is a large element of self-selection. People who want to do ortho really want to do it. There is none of the wishy-washiness of prospective general surgeons, many of whom bail out after intern year because it’s not as cool as they thought.