CataractCoach 1195: four times when you should not operate (no surgery for you!)

Any surgeon can operate, but it takes a surgeon with good judgment to know when not to operate.



During my training, one of my mentors, Brad Straatsma MD, explained to me that, “Any surgeon can operate, but it takes a surgeon with good judgment to know when not to operate.” As a young resident in training, this pearl went against the flawed thinking of maximizing the number of surgeries performed in order to increase experience in the operating room. The mark of a great surgeon is sound intra-operative surgical judgment as well as the ability to decide when not to operate.


1. When Patients have Un-realistic Expectations


2. When the the Risks outweigh the Benefits in a Re-Operation


3. When Patients have Unstable and Serious Systemic Medical Issues


4. When Patients would fare better with other Sub-Specialists


Patients must be involved in the decision to operate and they must actually want to have surgery. Patients who reluctantly agree to surgery are the ones who tend to be the most difficult to please after the surgery. Once you do a surgery on a patient, in a sense, you own that patient for life. And the converse also holds true – the patient owns you for life. Any future ocular issues may be perceived as occurring due to the effect of your surgery though that may not be the case. Depending on the situation, sometimes the best surgery may be no surgery at all.