Are doctors risk takers?

Dvora Pikkel,1 Yael Sara Pikkel Igal,2 Adi Sharabi-Nov,3,4 Joseph Pikkel2,51Risk Management and Patient Safety Unit, Assuta Medical Center, Ramat Hahayal, Tel Aviv, 2Faculty of Medicine, Bar-Ilan University, 3Research Wing, Ziv Medical Center, Safed, 4Tel-Hai Academic College, Upper Galilee, 5Department of Ophthalmology, Ziv Medical Center, Safed, Israel Objective: Risk taking affects human behavior in general and decisions in medicine in particular. We used game theory to assess physicians' risk-taking tendencies. Methods: Physicians were recruited to the study by advertisement. It was explained that they would receive a sum of money for correct prediction of the flipping of a coin. They could try to sell their opportunity to flip the coin for an amount of money they determined. The sum offered by the participants was considered an indicator of risk taking. A demographic questionnaire assessed age, sex, seniority, and area of specialization of the participants. A multivariate analysis assessed associations between risk-taking behavior and, seniority, and specialization. Results: Sixty-two physicians participated, 36 males and 26 females, seniority 1–34 years. Of a possible range of 0–10, the mean score for risk taking was 5.5 – just slightly more than indifference. Negative correlations were found between risk taking and seniority, and between risk taking and age (β=–0.45, P<0.001 for both). Surgeons and anesthesiologists showed greater risk taking than did other physicians (β=0.69, P<0.05); and females less than males, though the latter correlation was not statistically significant. Conclusion: Understanding the tendency of physicians to risk taking may elucidate their decision-making processes and contribute to understanding of causes of adverse events and to the education of physicians. Keywords: risk taking, game theory, seniority, surgeons, anesthesiologist

"It is the left eye, right?"

Dvora Pikkel,1 Adi Sharabi-Nov,2,3 Joseph Pikkel4,5 1Risk Management and Patient Safety Unit, Assuta Hospital, Ramat Hachayal, Tel-Aviv, Israel; 2Research Wing, Ziv Medical Center, Safed, Israel; 3Tel-Hai Academic College, Upper Galilee, Israel; 4Department of Ophthalmology, Ziv Medical Center, Safed, Israel; 5Faculty of Medicine, Bar-Ilan University, Ramat Gan, Tel Aviv, Israel Objective: Because wrong-site confusion is among the most common mistakes in the operations of paired organs, we have examined the frequency of wrong-sided confusions that could theoretically occur in cataract surgeries in the absence of preoperative verification. Methods: Ten cataract surgeons participated in the study. The surgeons were asked to complete a questionnaire that included their demographic data, occupational habits, and their approach to and the handling of patients preoperatively. On the day of operation, the surgeons were asked to recognize the side of the operation from the patient's name only. At the second stage of the study, surgeons were asked to recognize the side of the operation while standing a 2-meter distance from the patient's face. The surgeons' answers were compared to the actual operation side. Patients then underwent a full time-out procedure, which included side marking before the operation. Results: Of the total 67 patients, the surgeons correctly identified the operated side of the eye in 49 (73%) by name and in 56 (83%) by looking at patients' faces. Wrong-side identification correlated with the time lapsed from the last preoperative examination (P=0.034). The number of cataract surgeries performed by the same surgeon (on the same day) also correlated to the number of wrong identifications (P=0.000). Surgeon seniority or age did not correlate to the number of wrong identifications. Conclusion: This study illustrates the high error rate that can result in the absence of side marking prior to cataract surgery, as well as in operations on other paired organs. Keywords: wrong site surgery, wrong eye surgery, side marking, time ou

Diagnosed a Patient with Central Serous Chorioretinopathy? Now What?: Management of Central Serous Chorioretinopathy

The goal of this paper is to provide a comprehensive review of the management options for central serous chorioretinopathy (CSCR). The majority of cases of acute CSCR may be managed with observation and cessation of corticosteroids, if possible, as well as life-style modifications including stress reduction and control of hypertension. The management of chronic disease is more challenging and may include either medication or laser-based treatment. Management of CSCR necessitates an individualized and selective treatment approach. There is overall poor evidence for the use of systemic and intravitreal medications. From this class of treatments, mineralocorticoid receptor antagonists appear to have the greatest potential. Although conventional thermal photocoagulation may be used in select cases, the most promising treatment options at this time for chronic CSCR are photodynamic therapy, either half-dose or half-fluence, and non-damaging (subthreshold) retinal laser therapy