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Year : 2022  |  Volume : 10  |  Issue : 1  |  Page : 1-2

Why must we own everything?

Consultant, Maskati Eye Clinic, Mumbai, India

Date of Submission11-Jan-2022
Date of Decision11-Jan-2022
Date of Acceptance12-Jan-2022
Date of Web Publication3-Feb-2022

Correspondence Address:
Quresh Maskati
Consultant, Maskati Eye Clinic, Mumbai
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2320-3897.337199

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How to cite this article:
Maskati Q. Why must we own everything?. J Clin Ophthalmol Res 2022;10:1-2

How to cite this URL:
Maskati Q. Why must we own everything?. J Clin Ophthalmol Res [serial online] 2022 [cited 2022 Dec 5];10:1-2. Available from: https://www.jcor.in/text.asp?2022/10/1/1/337199

No, this article is not going to be on Zen or Buddhist philosophy or even on communism. This is a practical piece for those who wish to survive in the big bad world of private practice. At every conference, when you wander around the trade exhibition area, you feast your eyes on all types of diagnostic gadgets, each more high tech and obviously more expensive than the other. There are newer perimeters (since they cost so much, they are now called visual field analyzers), some even handheld and portable! Then, there are nerve fibre analysers, optical coherence tomography (OCT) machines, electrophysiology equipment like visual evoked potential, electrooculogram, and electroretinogram (ERG) (with multifocal ERG thrown in for free as a package deal). For those interested in retina, there are all sorts of fundus cameras, mydriatic and nonmydriatic, OCT-Angio machines, and Ultrasound machines. For the cataract and refractive surgeons, there are various tools to accurately calculate the astigmatism, both corneal and otherwise, higher-order aberrations, sophisticated A scan machines for more accurate calculation of intraocular lens (IOL) power for their premium patients demanding premium IOLs. The cornea surgeons, not to be left behind can drool over fancy ocular surface analyzers with built in infra red Meibography, osmolarity machines, various combinations of pachymeters with topography machines, Schiempflug imaging machines, anterior segment OCT machines, ultrasonic Biomicroscopy machines or ultrasound biomicroscopy (UBMs). By no means is this an exhaustive list – it is only meant to exhaust the reader who has reached thus far!

For the average private practitioner, it is of course impossible for him to acquire even a small fraction of these in his lifetime, so he stares enviously at his colleagues. The ophthalmologist in his lane owns one more machine than him; the ophthalmologist in the next lane owns two more machines than him! Hence, he decides to take one more bank loan to buy yet one more “white elephant,” knowing full well that almost all diagnostic machines never pay for themselves in 5 years. He hopes that seeing a clinic “well stocked” with gadgets will convince the walk in patient to trust his eye surgery to him, as that is where the “moolah” lies.

Unfortunately, this mathematical equation seldom plays out as he expects, making him spend many a sleepless night wondering how he will repay the bank loan and causing him to increase the dose of his antihypertensive pills. His family holidays are canceled or indefinitely postponed, causing much friction between the spouses and even affecting his relations with his 2 young children.

Is there any way out of this maze or “chakravyuha?” There is no easy answer. First, the individual ophthalmologist must change his mindset.[1] He must realize the futility of trying to keep up with his neighbour, who is always trying to be one-up on him. Perhaps the neighbour has a 5-year head-start on him or has a friendlier bank manager who sanctions bigger loans or has a rich father-in-law or all of the above! Once the mindset is altered, solutions are possible. However, they need “collegiality.”[2] What does this term mean? The dictionary defines it as “companionship and cooperation between colleagues who share responsibility.”

  1. Companionship: He has to stop looking at his other eye surgeons in his lane or town as competitors but as colleagues who are all trying to improve their standard of living by offering better service to their patients
  2. Cooperation: He has to meet his colleagues in the lane or town and sit and discuss with them how they can pool the diagnostic equipment they have. Perhaps they could open a neutral diagnostic center where a technician is employed or a junior doctor who can operate these gadgets and churn out reports. They could even pool in their money and purchase some more gadgets which they all believe they will be able to use. Each diagnostic machine will pay for itself if 5 or 10 ophthalmologists are using it instead of one! Also, the expensive maintenance contracts will not seem so expensive if the cost is shared. The neutral center could also allow referred patients from doctors who have not invested in the center, perhaps charging such patients a little more. The responsibility of upkeep of the center is shared by all the investor doctors![3]
  3. There are other options as well. In Goa, an eye surgeon stopped his own surgical practice and invested in various diagnostic equipment. He gets referrals from across Goa for Visual field analysis or OCT or ERG etc. The referring doctors are secure in the knowledge that they will not lose their patient, and he uses the return on investment to purchase more equipment every year
  4. In Mumbai, a radiologist who was a pioneer in ophthalmic ultrasound, set up his own diagnostic center. He now has OCT, UBM, optical biometry with the latest formulae for calculating IOL power for premium IOLs, the only state of the art colour vision testing machine in the city, etc. Many of us happily refer our patients to him. He sees dozens of patients every day, and his reports are extremely accurate.

In conclusion, let us all not try to be the “complete clinic.” Judicious use of our resources and maintenance of collegiality with our colleagues will go a long way in improving our bank balance and reducing our stress levels.

  References Top

Factors to Consider Before Buying a Phaco Machine : Outpatient Surgery magazine, October 2007.  Back to cited text no. 1
Collegiality. Otolaryngology–Head and Neck Surgery. 1996;115:206-212. doi: HYPERLINK “https://doi.org/10.1016/S0194-59989670029-3” 10.1016/S0194-59989670029-3.  Back to cited text no. 2
Schlegelmilch, Bodo B., and Magdalena Öberseder. “Half a Century of Marketing Ethics: Shifting Perspectives and Emerging Trends.” Journal of Business Ethics, vol. 93, no. 1, Springer, 2010, pp. 1–19, http://www.jstor.org/stable/40605325.  Back to cited text no. 3


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