UPFRONT

Routines

From the editor-in-chief

Jason S. Slakter, MD

At 5:00am the alarm rings, and 30 minutes later I am in the car driving on the Long Island Expressway on the way into Manhattan. At 6:05am, as I pull down the ramp and park my car, the supervisor of the parking garage waves good morning, asking “What time will it be today, doc?” I reply, “I should be back around six this evening … if I'm lucky, that is.”

At 6:10am I have a cup of coffee from LA Gourmet in hand, and five minutes later I am at my desk ready to start a new day. I never realized how regimented my daily routine had become until a patient happened to mention a new restaurant that had opened just around the corner from the office. He asked whether I thought it would be a good place to catch a bite to eat for lunch after his visit, and I realized that I did not even know the place existed, since it was not on my regular route to and from the parking garage.

When you really stop to think about it, most of the things we do in our daily lives fall into clear patterns and routines. The way we get to work, the food we eat at breakfast, the sections of the newspaper we tend to read first, the supermarkets we shop in, and even some of the conversations we have with staff and colleagues at work are repeated day after day in the same manner.

It has often been said that one of the most effective ways of keeping life interesting is to introduce variety, and sometimes even the smallest changes can have a profound impact on how we perceive the quality of a particular day or event. When you start to focus on making these changes, it can be remarkable how much of a difference we may notice.

That is not to say, however, that following routines in our lives is all bad. It allows us to focus our thoughts and creativities on other areas without the distraction of the more mundane activities. It also allows for a certain level of comfort for those around us, both at work and at home, in being able to predict to a certain extent how we might behave.

From a professional point of view, over the last five years, perhaps the most “routine” procedure that retina specialists find themselves performing is the intravitreal injection. In meetings just six years ago, there was heated debate about the safety and practicality of performing repeat intraocular injections of therapeutic drugs for chronic retinal conditions. Today, however, it is not unusual to perform 20 or 30 injections a day, without really giving it any thought.

This issue of Retinal Physician includes a prominent article that might refocus our attention on the methodology and procedures used to deliver intraocular drugs. As will become obvious from reading the roundtable discussion, there is no single right answer or approach, but instead we see a variety of well thought-out yet differing opinions, by some of the key leaders in our field, on the various steps involved. I strongly feel it benefits all of us to read what they have to say and look at our own practice patterns to determine whether adjustments should be made or techniques altered to provide optimal care for our patients.

Sometimes, changing routines isn't so bad.