Ophthalmology Rotation Review

I did an elective in Ophthalmology a while back.

Looking back, I know that I did it for a lot of the wrong reasons.  Fresh off my fantastic surgery rotation, I was essentially looking around for specialties that would allow me to be a surgeon without suffering through a miserable surgery residency.

I know.  That's... pathetic.

But it was my thought process, and I'd prefer to be honest here.

I thought Ophthalmology sounded like a good compromise.  The residency is only four years.  After the Intern year, it's fairly relaxed with more or less an 8-5, M-F schedule.  Most programs do "home call" for call, which is obviously less stressful.  Ophthalmologists make pretty good money.  And they get to be surgeons and do surgery, although obviously their surgery is confined to the eye and the orbit and not on the scale of other specialties.  It's very competitive (probably for a lot of those reasons), but I have the scores, so I thought whatever.

I'd looked at most of the other surgical specialties and realized they were the opposite in many of those features.  ENT and Ortho are nice because the specialties are lucrative, but they also have pound you in the ass 5 year residencies just like General Surgery.

I know.  I'm not proud of the fact that this residency situation was my primary reason for exploring Ophtho.

But there were other reasons I was curious.  I think eyes are really cool, and their version of the physical exam is very interesting.  Also, while some call them "eye dentists," I have a profound appreciation for how important sight is to people.  My grandfather has very, very bad eyesight due to age related diseases (AMD and Glaucoma) that were not promptly treated, and it has more or less ruined his quality of life.  I know that heart surgery may be more "important" in terms of keeping people ticking, but I know a lot of people might prefer not to keep on ticking if they can't see well enough to get around and at least read or watch television.

That's something of a philosophical question that I don't want to delve too far into, but I think my answer to that question has something to do with at what age I would be when I lost my sight.  Would I be young enough to still learn to adapt to a sightless world the way hundreds of thousands of the blind successfully do?  Or would I be too old, like my grandfather, and lacking the plasticity and motivation to make that transition.

Digression over.

Anyway, the rotation was fun and interesting.

I was profoundly impressed by how intelligent the residents and doctors were.  They were very, very smart people, and more than once I felt like they might have been a bit out of my league.  I have not felt that way too many times; on other rotations the residents and doctors were obviously far more medically competent and knowledgeable than me, but there is a difference between that and raw smarts.

I think the ophthalmologic exam is very fun.  Using the slit lamp and the lenses and the ophthalmoscopes is a very difficult skill to develop, and once you gain some competence, it's actually a lot of fun.  I like the idea of having a difficult technique be a part of a job.  I think just about anyone can learn to listen to someone's heart, but peering around the inside of someone's retina with a lens is definitely a significant step up.  I really enjoyed the challenge of it.  In all honesty, the challenge of the exam and developing those skills was probably my favorite thing about the specialty in total.

I also liked that the exam was almost the be all end all of diagnostics.  There are a lot of imaging techniques that are very important, but I would say that the actual ophthalmologic exam contributed to 80-90% of diagnosis.  When there was pathology, you could actually look into the eye and find the pathology (for the most part).  It was there for you to actually see.  There are not many other specialties that can say that, at least not to this extent..

I liked that the issues we dealt with on a daily basis were very weighty and important.  I saw attendings regularly talk to people about whether or not to perform surgery to try and improve vision in their one eye that had any remaining sight.  To decide whether or not to do surgery when a person only has one working eye, and that eye functions poorly even with refractive correction (say 20/100) is quite a thing.  What are the chances we can make it better, change nothing, or it gets worse?  Can we improve that eye enough to improve your quality of life, and is that risk worth potentially blinding you if the surgery doesn't go well?

That's quite a thing.

Last, I liked that everyone was happy.  The residents were happy, working reasonable hours.  The attendings were happy, also working reasonable hours and making good money.  It was probably the overall happiest group of attendings and residents I have encountered during my third year.  That's quite a thing too.  I have no intention of being miserable for the rest of my life.

What I didn't like was the surgery itself.  It's all performed under a microscope, and it involves incredibly fine movements.  I experimented on a few pigs eyes, and I have to say I was utterly impressed with the technical skills these guys developed.

Technical skills aside, the surgery just wasn't for me.  It was too fine, to small, not big enough.  When I did surgery, I liked the big, open, romping around in guts and gore cases.  Oh shit, arterial bleed, blood is everywhere, clamp it down, clamp it down.  That kind of stuff.

In the end, I decided that this is not the specialty for me.  If I decide that I want to be a surgeon when I grow up, I'm going to be the kind of surgeon I actually want to be.  I'm not going to pick a specialty that has surgery I enjoy less and say, okay, well at least there's still some surgical action, just because I'm scared of a residency.

I am also glad I did the rotation, because it was a chance to learn something about the eye and develop some interesting skills and perspectives.  If I end up doing Emergency Medicine, or another general specialty, I think knowledge of eye conditions would serve me well, as would understanding the various treatment options and how to do a more than basic exam.