One Step at a Time

By Stephen M. Weinstock, MD

Traditionally, the job of a parent is to prepare his or her children for the responsibilities of life and groom them into successful adults (Figure 1). No matter what career or life path they choose, it is the parents’ task to ensure that their children can be happy and content with their choices. You hope this is accomplished by life lessons you as the parent have taught, experiences you exposed them to, expectations you placed on them, and, maybe more significantly, the ways you demonstrated for them how your choices did or did not work for you.

Teaching children, then, deals more with life in general terms than with the specific choice of a vocation. As parents, my wife and I always tried to instill in our children a foundation of self-awareness and confidence that would provide them with the necessary building blocks to become successful and content adults.

FOLLOWING INSTINCTS

I believe it was because I loved medicine, and, specifically, ophthalmology, so much that both of my sons saw a career in medicine as a way to perform enjoyable work and simultaneously to do something positive in the world. They were instinctually drawn to medicine, Rob to ophthalmology and Eric to psychiatry.

Rob’s choice of ophthalmology and his decision to join our practice had an enormous impact on my life. I realized I had a rare opportunity, not only to provide him with a general foundation for success, but also to specifically teach him everything I had experienced and learned about ophthalmology. I had a chance to pass along all the knowledge I had gained to at least another generation and possibly more. That knowledge could then potentially be used and advanced to levels I could never accomplish or dream of myself, simply due to time constraints if nothing else. With a broader and larger foundation to start with, a second generation might have better potential for further achievement, creation, and innovation.

Fortunately, Rob and I have always had an excellent rapport and ability to communicate our feelings, wants, and wishes to each other easily. When Rob performed his fellowship with me, the lines of communication, the mutual respect, and the joy both of us felt as he began that climb to being the best he could be escalated and soared to new heights regularly.

MAKING OF AN EXPERT

We started out slowly, especially in the surgical arena. Rob would do only one small part of a case until he was an expert at it and then move on to the next. He started with the cataract incision, then capsulorhexis, then lens sculpting, and so on. I would complete the rest of each case until he was as proficient as or better than I was at each step. I think it was 2 to 3 years before he was doing cases on his own from start to finish.

As I watched him, I would critique even the smallest movement or decision he made that might improve his technique. Much to his credit and my pleasure, he always took criticism objectively and constructively to refine his proficiency. We taped everything so we could go back and look at it, and we often did.

For lack of a better phrase, we had—and we still have—a mutual admiration society, as we both appreciate the best in each other. I continue to be more proud of his accomplishments as the years go by, and the teacher has now become the student.

BEST DECISIONS

My mentoring role still continues, but it is much less about things on the clinical side and more about the business side of ophthalmology. It is invaluable to be able to convey points of business acumen to Rob and to be there to hash out ideas, goals, objectives, and how to get there with someone you completely trust. This is even more so because we share the same agenda and game plan for the future, which is always guided by what is best for the patient.

I could not have planned our arrangement any better if I had tried. Taking Rob to watch me in surgery early in his childhood was probably one of the best decisions of my life. Now, his children are watching him, and just as he did at their age, they tell him, “Dad, that looks so easy. I think I could do it after a few cases.”

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That Was the Easy Part …

By Robert J. Weinstock, MD

The earliest memories I have of my father are when he taught me to ride a bike around the age of 4. I remember him for awhile running alongside or right behind me, holding the seat as I learned to get comfortable without the training wheels. His calm and reassuring nature allowed me to gain the confidence and freedom to quickly become an avid bike rider. I remember looking back one time, thinking he was still right there holding the seat and running along with me, only to find out that he had stopped and let me go on my own. I was finally riding by myself.

That feeling of accomplishment and surprise still happens 45 years later. We continue to work together, and I continue to learn from him. His trust and guidance help to lead me through the responsibilities and freedoms to charge forward independently and continue to rise and evolve.

I also distinctly remember my father during my college years, when it was unclear to me what type of career path I wanted to pursue. He was completely supportive and in no way pushed me or tried to influence my decision making. I never remember his purposely or forcibly trying to engage me in medicine or ophthalmology. He was not overly concerned about helping me choose a career path or rushing the decision.

THE FREEDOM TO EXPLORE

It was not until I came to the decision on my own terms, after spending a year traveling and working in the Sierra Mountains, that I began to appreciate the perhaps subconscious but effective parenting that my father provided for me. As a parent now of teenagers, I am constantly reminded of the importance of that lesson and how imperative it is to give my children the freedom to explore their passions and come to their own decisions on their own terms.

When I finished my residency and began my fellowship year with my father, within a matter of days, I realized how much there was for me to learn, and I was overwhelmed by the difference between practice in a residency program and what it was like in the real world. There were times of anxiety, stress, and overwhelming feelings of the insurmountable skills and knowledge still to be gained, but my father was always methodical and calculated, delivering not so much information as to to overwhelm me, but just enough to keep me challenged to continually break new ground every day.

One of the most important areas of my education during the fellowship was just learning how to communicate with people, particularly patients and staff. My father’s lessons about tone of voice, eye contact, body language, positivity, and trust and that fewer words are better, all had a tremendous impact on my growth as a practitioner.

STARTING FRESH

During this time, I went back and completely unlearned and relearned cataract surgery step by step. After watching my father operate the first week into my fellowship, I realized what a master surgeon he was, and I understood that the only way to achieve that level was to start fresh and relearn it all. With time and patience, he taught me step by step how to perform world-class cataract surgery.

With that foundation, I was then able to try innovative things on my own such as bimanual microincisional surgery, astigmatic treatments, complex cases, presbyopia-correcting IOLs, intraoperative aberrometry, 3-D heads-up surgery, and intraoperative surgical guidance, to name a few.

It took many years for me to reach the level of surgical competence that my father had, but somehow, during the entire time, thanks to the intuitive communication skills that we have with each other, we never once jeopardized a patient’s care or created a surgical complication due to my training. With his step-by-step methodical training modality, we were able to work together seamlessly in the OR for more than a decade.

FROM SMALL OFFICE TO LARGE PRACTICE

Looking back on this first phase of my career as I now enter more of a leadership role in the practice, I realize that what my father has taught me up to now has actually been the easy part. Along the way, when appropriate, we have also spent a tremendous amount of time growing the practice, running the business, managing the operations, and handling all of the administrative and growth activities of the practice. It continues to overwhelm me that, not only is this man one of the top ophthalmology clinicians and surgeons in the United States, but he has also managed to build one of the largest and most successful practices in the country, after starting by himself in a small office. It is increasingly obvious to me that there continues to be a world of knowledge that I have yet to learn about business administration and financial and operational issues.

Despite my being 48 years old, my father continues to mentor me in these aspects of our practice, especially when it comes to the big decisions that we make involving clinical practice in terms of adding providers, new technology, and new devices and also in increasing the geographic footprint of our practice. I am well aware of the gift that I have been given. The amazing thing is— more important than patients’ outcomes and successes in practice growth and the financial benefits that come along with that—the most rewarding part continues to be the opportunity to spend one-on-one time with my father and experience the open-ended opportunities that continue to be on the horizon.

As I watch my own children now approach a point in their lives when they need to start making their own important decisions, it is all the more valuable and timely to reflect on my experiences with my father and how they have affected my ability to be as successful as I have been.