Richard L. Lindstrom, MD , 2025-05-01 14:15:00
Medical practice is inherently stressful for the clinician providing the care, the patient receiving it and each of their families.
I will focus my comments on the physician in this perspective and share a few thoughts after 5 decades serving as a busy clinician and surgeon.
Stress is a natural response to any challenging situation, and serving as an ophthalmologist, especially as an eye surgeon responsible for another person’s vision, is inherently stressful. Experts teach that there are four core ways to manage stress. The four A’s of stress management include avoid, alter, accept and adapt. As a practicing ophthalmologist, it is impossible to avoid or alter stress and equally impossible to know when we will encounter an especially stressful situation in the clinic or operating room. We can, however, accept that stress is part of our profession and do our best to adapt to this fact.
For me, preparation and planning are core to stress management. This includes both mental and physical factors. Quality education and training come first. It is also important to be honest and insightful regarding which patient problems each of us is prepared to manage expertly and which are best referred to a colleague. I have seen (more than once) a poor outcome in a case the surgeon was not well suited to manage result in a medicolegal challenge but even more devastating totally derail a physician’s career and in some cases destroy a happy family. One more case is not worth the risk. When in doubt regarding the training, skills and experience to manage a complex case, it is wise to refer the patient to a more qualified colleague.
Mental preparation for a surgeon includes careful preoperative planning for each patient. One of my senior partners asked me, in the fourth decade of his practice as a busy consultative surgeon, when he might expect to feel no anxiety the night before a full day of surgery with challenging cases. My response, in my fifth decade as a consultative ophthalmic surgeon, was never. I believe this mild anxiety before surgery is a positive and typical of what is experienced by the best professional athletes. It encourages us to plan and prepare so we can perform at our highest level. A proper plan for every patient and anticipation of potential unexpected complications are part of our duty as a surgeon. This includes arriving in the operation suite early and checking oneself to be sure that all devices and drugs that might be needed are readily available.
Physical preparation is also critical. For me, that included no alcohol the night before surgery, no caffeine the day of surgery and going to bed early the night before with a solid 8 hours of sleep. There is also a need to dissipate the stress after a busy day in the clinic or operating room, and for me, that included some quiet time to reflect and review the day, a walk or boat ride outside, exercise, sports, and time with family and friends. Stress relief is critical to sustain a long career without burnout or even depression.
As busy clinicians and surgeons, we must be robust to unexpected complications and heartbreaking cases in which we cannot retain or restore a patient’s vision. A quote I like from the sports world comes from the famous football coach Lou Holtz who said: “I don’t think we can win every game. Just the next one.” For a surgeon, I would modify that quote to: “I don’t expect every case to be perfect. Just the next one.” When unexpected complications occur, we must manage them to the best of our ability, rapidly dissipate the associated stress with a moment of reflection and then move on to the next case, mentally and physically prepared for a quality outcome.
We cannot avoid or even alter the fact that serving as an ophthalmologist is stressful. However, we can prepare mentally and physically to manage this stress in the best interests of our patients, our families and ourselves.
For more information:
Richard L. Lindstrom, MD, can be reached at rllindstrom@mneye.com.
Sources/Disclosures
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Expert Submission
Disclosures:
Lindstrom reports having disclosures for Minnesota Eye Consultants and Unifeye Vision Partners.
