CataractCoach 1195: four times when you should not operate (no surgery for you!)
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- เผยแพร่เมื่อ 10 ก.พ. 2025
- 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.
One of the most important lessons no one ever taught me is when to say no. I learned this the hard way. Now I am so quick to cancel a case. I’ve never regretted canceling a case. I have regretted proceeding when I should have said no.
Excellent teachings Dr. Devgan!
1. Unrealistic patients´ expectations.
2. Risk outweighs benefits, especially re-operations.
3. Bad patient general health.
4. Complicated case, beyond your surgical skills.
“Sometimes the best surgery maybe no surgery at all”. We love you Uday Devgan 💙 Thanks for all your knowleadge
That might be true, but is it better for the person to lose their sight than to have surgery?
Every retina fellow and specialist should watch this and remember the last segment. Great video.
This reminds me of the same lesson my late father Dr Shamsher Singh, also an ophthalmologist, told me many many years ago. His words were “ A good surgeon operates but the best surgeon is the one who knows when not to operate.” I have tried to follow that advice and probably saved many unpleasant situations. Thanks Uday for touching on a very important subject.
Dr Sarbjit Singh
Amen! Well said! You are honest, practical, besides excellent surgical skills - this what makes you Brilliant!
Made sideport incision, used intracameral epi, noticed patient had obvious floppy iris syndrome. Also noticed the patient was restless on the table and could not lay still no matter what. Asked anesthesiologist about converting to general anesthesia, an LMA. She did not think he was medically stable enough. I hydrated the sideport incision, called it a day. I'm out! Patient and wife were very happy with me the next day because I did not take unnecessary risks. They'll try again once medically stable and cleared for general.
Smart decision.
@@UdayDevgan I can operate on snoring patients. I can operate on restless leg syndrome patient. This one patient however, his movements were just too violent, erratic, and unpredictable.
I think that this video is very important to watch for every ophthalmologist, it is sincerely the Uday Devgan wisdoms
Thank you Professeur For all, you’re original !
H.Aaliouet MD ophthalmologist.
a wise surgeon, so good to listen to these suggestions !
Wise and useful tips as always Dr. Uday Devgan. Thank you for sharing your knowledge and experience 🙏
I needed to hear this 🙌 before taking on the complicated case and Now I'm dealing with post surgery stress 😩 😪
Dr. UD......the voice of reason!
Such sage advice - thank you, Dr. Devgan!
The last point about dinner was spot on 👌
We all love you and your insights! 😊
Love your channel, Dr Devgan.
Dr. Devgan,
Your skill of reasoning is outstanding. Makes a lot of sense. I love it. Subscribed and liked.
Im not a surgeon, but some one who has was told last year I had a very small cataract in one eye. Now this year (only last moth in fact) I was told I now have a cataract in my second eye and the optician said Im going to arrange for you to have surgery right away. The sudden decision to rush surgery alarmed me especially since I was told only last year I had a tiny one in just one eye, and now I m feeling very unsure about my next step. I love this website and Uday make a lot of sense though some medical terms I'm not familiar with but find it interesting and informative to listen to..
You can judge your own cataract 'level' by simply looking at street light & traffic at night. If the lights appear to be in a foggy or misty weather thing but your companion doesn't see any fog or mist around the lights, you have cataracts at least in your dominant eye. Now if you close your left eye and the fog thins out or goes away, then the major cataract is in the left eye, as in my situation. If you close your right eye and the fog effect is worse it confirms the left eye is more clouded.
Is the cataract affecting your driving, night time vision, reading, or other visual needs ? You can help yourself by comparing past vision accuiity to current conditions upon an eye exam. Also letting cataracts go too long is an issue. Talk to your doctor again as to the need to operate now or later.
Thank you for your wisdom! God bless! 🙏🏻
Pearls of wisdom
Love your common sense, Dr.
Thank you 😊
Thank you sir for your words of wisdom.
Well said Dr!! Thks!!
Golden advice! Thanks coach
Very useful advice. Thank you.
Fantastic Sir!!
Thank you so much.💯❤️
Great tips sir...thank you for a great effort to share your experience with us.I enjoy each and every one.
Great thanks for sharing this wonderful experience and advices
Excellent advice for all the eye surgeons....
Thank you so much Mr Devgan! You are such an inspiration. Greetings from France ☺
Great advice.thank you
Nice advice sir.
So agree ..Thanks for sharing something, I totally believe in .
Best tip beginner can get. Thank you.
Great Master!
Excellent suggestions
Excellent advices,good videos ,thank you Dr.Devgan
Thanks a lot for sharing the wisdom
I am also a cataract surgeon and my problem is that sometimes I have a patient with a nearly mature cataract, but despite my explanations to not delay the surgery to lessen complications, the patient does not want the surgery... yet. Then, that same patient comes again 2-3 years later with a much more difficult cataract and WANTS me to offer the same level of risk that when his cataratact was much less difficult. Sometimes I had to refuse to operate them, because it is "too late for me, sorry".
I'm a surgeon, but obviously not an ophthalmologist. These rules apply to pretty much every surgical specialty.
Thank you for your wisdom sir
Great tips
Wow you've hit the nail on the head. I'm a rare cases with cateracts. Bilateral conginatal colobomas. I have sight only on the last eye. It's more of a tunnel vision. Trying to find the right eye surgeon has been a nightmare! I'm at the point now the cateracts are taking the vision I have. I've been referred to Will,and the palmer. Just trying to get them to decide who I need to see, cornia ,or retinal doctors. And if they have ever done the surgery I need. I'm not going to be someone's Ginny pig,!
Excellent tips
Thanks for sharing!!!
Is operating on family members one of these times when a surgeon should not operate?
Amazing as usual 👍👍🙏🙏
A great learning video....ofcourse we must learn when not to operate....
Sir i m a big fan of you. U r doing a great work
Great words ..I wish to be one of your students
You are one of my students on CataractCoach!!!
Nystagmus and IOL possible for refractive eyes in 40 year age ?
Hello doctor Uday Does patient with history of ocular HSV considered to be qualified or contraindicated for premium lens replacement
Excellent 👍
I should go see this guy
That’s so right!!! 👏🏻👏🏻👏🏻👏🏻
Great video sir.
Pure wisdom
fantastic
The best thing is to delay the progression of cataract. Consume a lot of lutein, zeasantein and astazantein.
I have a question about cataract surgery that I cannot find any type of video or answer on
Z my eye doctor told me that because my cataracts are dense that the machines he used to measure or calculate what type of lens to replace with was unable to do so because my cataracts are death my question is am I doomed to just have him put just a generic lens in and not get distance vision and will have to wear glasses all the time anyway?
Or is he going to measure the eye after he gets the lens out while in surgery?
I wouldn't mind having to wear readers but I would love because I have never seen far away clear enough if you can answer my question I would appreciate it very much
Sir can I have mid-range vision and reading level vision with spectacles ,if I select Aspherical monofocal IOL for distance vision for a cataract surgery.
Thank you for the wise advice. But; to whom should we refer those kind of patients?!
Wisdom 🙌🏻
I just had my cataract done I was one of the unlucky ones of 20% and I got oedema I was not in the 80% that have no problem so does it really clear up thx
OMG!!! These are all so true but rarely talked about. Is there a way to quote this video in a manuscript?
Professor, I am a relatively young person who will need lens replacement due to cataracts. Would you be able to refer me to someone in the Southern California/Orange County area? Would you do my surgery?
Thank you so much!
It is worth the short drive to come to Los Angeles to see me. DevganEye.com for more info. Call us for a consultation.
Is lense redialing a safe procedure?
Define "safe" in Medicine.
@@charlybrown9024 i think nothing is "safe" in medicine,all is depend on luck ,this is my opinion after 2 years of my above comment.
Beautiful 🤩
Sometimes the best surgery may be no surgery at all……
Golden words
Sir subtitle pls
Man save the shit out of me pls
I was hit in eye 2 years ago i seen good then i gone to oculist and he gave me glases glases ware not good they made me see white now not totaly but it is white
Now i had 4 opinions non of them seen cataract but last one did. how is that posible and what to do i cant do anything it is going in my nerves is it realy cataract i wood say she burned my eye with glasses becos of my mobile phone had high light and glases she gave me blinded me on that eye what can i do to minimize it
And why do people say stay of light thats has no sence eyes need light for vitamins
Equally sound advice for those seeking, as well as those offering surgery...
God help us 😂
Greaat।
I'm 43 female 14 days back I have gone my cataract surgery 😭😭😭😭😭