PROFESSIONAL ETHICS AND OPHTHALMOLOGY

[caption id='attachment_5306' align='alignright' width='200'] Roberto Pineda MD[/caption]

Technology advances continuously challenge ophthalmologists to learn new skills throughout their careers. Professional ethics require that surgeons take sufficient time and effort to master new skills before performing new procedures, Roberto Pineda MD of the AAO Ethics Committee reminded the American Academy of Ophthalmology annual meeting cornea subspecialty day.

“When a decision is made to incorporate new techniques or new technology into a practice, we recommend a formal course of study,†said Dr Pineda, who also is on faculty at Harvard Medical School, Boston, Massachusetts, US. However, the type and extent of training depend on previous experience and existing skill sets, he added.

For example, a skilled cataract surgeon may need little more than a brief course and a little hands-on experience with new phaco machines and smaller instruments to adopt microincision surgery. However, developing an unfamiliar skill, such as implanting glaucoma drainage devices or adding laser-assisted cataract surgery, requires a much more comprehensive planning and learning process, Dr Pineda said.

Whether a new skill will help patients, and whether there is sufficient volume potential to maintain competence are key questions, Dr Pineda said. The process should start with a thorough analysis of the evidence, or lack thereof, including the potential biases of information sources, about a procedure. Any training required for you and your staff should be planned, as should acquisition of all necessary equipment and supplies.

Dr Pineda outlined the steps an American colleague took to learn corneal crosslinking, which is not yet approved in the US. He started his research by reading magazines such as EuroTimes, and peerreviewed articles. He spoke to colleagues outside the US at scientific meetings and arranged to see postoperative patients from outside the US. He began referring patients to Canada for treatment, and followed them afterward. Finally, he performed proctored cases outside the US. “This is a very reasonable approach to acquiring a new technique,†Dr Pineda said.

Preparing for the first case

Beyond adequate training and required equipment, patient selection is important in preparing for the first case, Dr Pineda said. Starting with uncomplicated cases builds skill and confidence while patients with anxiety or demanding styles may not be suitable. He also recommends making a dry run before the first case, and allowing plenty of time to deal with possible complications in early cases. Also consider a proctor, he advised.

Informed consent may also need to be modified, Dr Pineda said. Be open with patients about the new procedure, how it relates to your previous skills and what role, if any, a company representative or proctor will play in the procedure. Do not misrepresent your experience, skill or training in any way, he stressed.

Also, make sure you have malpractice coverage and comply with any hospital, health plan or local requirements for adding a new procedure. “Most hospitals will require formal training and supervision by senior staff,†Dr Pineda said. Afterward, honestly examine outcomes and investigate the causes of any complications. These will help improve performance, Dr Pineda said. “A careful, honest, ethical approach distinguishes the competent ophthalmologist learning a new technique.â€Â