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Attention to Detail

Dr. Mark Silverberg
Dr. Mark Silverberg is an ophthalmologist at 29 W. Anapamu Street. He received his medical degree from the University of California, San Francisco and has been with Sansum Clinic since 2001. Dr. Silverberg also specializes in pediatric ophthalmology and is the Director of the Pediatric Ocular and Motility Center. To reach our Ophthalmology Department call (805) 681-8950.

Mark Silverberg, MD, Ophthalmologist

What do Van Halen, Rembrandt, and Medicine have in common? Let's start by reflecting on the heyday of eighties rock, when spandex and big hair were all the rage. Van Halen was arguably one of the most popular bands of the era. Their aerodynamic live shows were electrifying, and at the forefront of each concert was the high-jumping lead singer, David Lee Roth (whose father was, incidentally, an ophthalmologist).

Perhaps one of the most memorable stories about David Lee Roth involved his seemingly frivolous demand that he have a bowl of M&M candies backstage - however the bowl was not allowed to have a single brown M&M. If one were found, he would have a tantrum, cancel the show, and demand full payment for the concert even though he never set foot on stage. Was this a whimsical request of a pampered rockstar? Roth later pointed out, in his memoir, this was actually a vital pre-concert safety test.

Van Halen was the first band to take huge productions into tertiary, third-level markets. We'd pull up with nine 18-wheeler trucks, full of gear, where the standard was three trucks, max. The contract rider read like a version of the Yellow Pages because there was so much equipment, and so many human beings to make it function. So just as a little test, in the technical aspect of the rider, it would say 'Article 148: There will be fifteen amperage voltage sockets at twenty-foot spaces, evenly, providing nineteen amperes...' This kind of thing. And article number 126, in the middle of nowhere, was: "There will be no brown M&M's in the backstage area, upon pain of forfeiture of the show, with full compensation."

So, when I would walk backstage, if I saw a brown M&M in that bowl...well, line-check the entire production. Guaranteed you're going to arrive at a technical error. They didn't read the contract. Guaranteed you'd run into a problem. Sometimes it would threaten to just destroy the whole show. Something like, literally, life-threatening."

Turns out that Roth's pre-show antics were not unlike the operating room staff taking a "time-out" to verify the proper surgical site. As Atul Gawande had stressed in his book The Checklist Manifesto, the ordered attention to detail can truly be a life-saver.

Moving from the hijinks of Van Halen to classic art, there is a fascinating course that is mandatory for first year Yale medical students called "Enhancing Observational Skills." Briefly, each student goes to the art museum on campus, and is asked to stare at a painting for fifteen minutes. The students are then asked to record as many details as they can about the painting. A group then gathers to discuss the findings.

As Linda Friedlaender, curator for the museum, explained to a Wall Street Journal reporter recently, "We are trying to slow down the students. They have an urge to come up with a diagnosis immediately and get the right answer." Does the course actually yield better doctors? A three-year study published in the Journal of the American Medical Association showed that, afterward, they are 10% more effective at making a proper diagnosis. The program has been so successful that it has been expanded to over twenty medical schools.

As any physician knows, attention to detail is a crucial part of our job. Thinking back to our first physical exams in medical school, we are taught to be fastidious observers - from the fingernails of the patient to the texture of his/her hair. However, as many physicians face stagnating reimbursements, increased expenses, and larger patient volumes, it can become more difficult to re-focus our energies on subtle details.

One of the exciting challenges we have is to heighten our attention to detail. It will serve us well and our patients even better. If nothing else, it's a good excuse to visit your local art museum or add a Van Halen song to your playlist.

This article first appeared in the newsletter of the Santa Barbara County Medical Society.



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