Coping Through Comedy

Williamson, MD: Open, outspoken. It's Ophthalmology off the Grid. An honest look at controversial topics in the field. I’m Blake Williamson.

Welcome to another episode of Ophthalmology off the Grid. I am joined once again by my cohost Dr. Ashley Brissette, and today we’re going to talk about bringing more humanity into medicine.

Most of us would agree that as ophthalmologists, we have great quality of life, but there will always be some bad days. Humor helps us cope with the hard times and allows patients to see our human side. Who better to talk about today’s topic than ophthalmology’s favorite comedian, Dr. Glaucomflecken? Also known as Dr. Will Flanary, listen as our guest talks about the value of being a physician with a sense of humor.

Coming up, on Off the Grid.

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Williamson, MD: Welcome to another episode of Ophthalmology Off the Grid with your hosts. I'm Blake Williamson here with Dr. Ashley Brissette. And last episode, we took you all the way to Milan to talk about a new IOLs, they're just hitting the markets here in the US. But this episode, we're actually going to keep it stateside and talk to a good friend of the podcast. I think this is his second time coming on to talk about something that I find very interesting. Ashley, why don't you talk to us about the topic and our guest today?

Brissette, MD: Yeah, absolutely. Thanks so much Blake, and thank you to Dr. Glaucomflecken, or as he's told us, we're allowed to call him Will for this podcast. Thank you so much for joining us. And this is a topic that kind of started to come up for me, because I think we often talk about how ophthalmology is the best specialty. And I really do believe that I think we have wonderful days, we want great outcomes for our patients, and we have a really, really great quality of life and we're surgeons.

But there's always some kind of bad with the good, and I feel like that often gets kind of brushed under the rug. And so I wondered how can we start to find the humanity in medicine when we're having bad days? How do we cope with bad days? And one way that I feel like a lot of people often cope with it is through humor. And then that's what kind of brought me up to speed with your Twitter and your Tik Tok, is you've done a really, really nice job of finding that fine line between humor and finding the humanity.

So that's why we wanted to talk about this today. And I know you've probably talked about this a lot on other podcasts or on other things. So I just love to hear how you got started in finding the humor and all of it?

Flanary, MD: Yeah. Well, thanks for having me on, and I have talked about this topic, but never with ophthalmologists, which is really exciting.

Brissette, MD: Oh my gosh.

Flanary, MD: Which is great. Yeah. So I've been doing comedy on social media civically for about five years now, and the longer I've done it, the more I realize how much medicine needs people, specifically physicians, to show that side of themselves, to show that they have a sense of humor, that they're just regular people just like anybody else. And I've had the somewhat misfortune of being a patient as well over the last few years.

And I also realized that patients want their doctors to feel that, to seem human. To seem like they have normal fears and anxieties, and successes and failures. And they're just like you, just like you and me. And so I think that using humor just helps break down the walls that have been put up for decades between the persona that doctors are supposed to have and the general public.

And it's a barrier that needs to come down because physicians aren't... We don't need to be the infallible beings that never make mistakes, because that's not us. We do make mistakes and we do have personalities. And so that's kind of what I'm trying to accomplish, at least part of what I'm trying to accomplish with my comedy on social media. I'm also trying to make people laugh, that's another thing that's a goal of mine. Hopefully I accomplished that, but yeah, the bringing humanity into medicine is a big part of it.

Brissette, MD: Yeah, I definitely would agree that you are helping people laugh. So you're definitely accomplishing your goal with that. And I think it's really interesting what you say about actually having us starting to talk about this, because I think in not talking about some of the darker sides of medicine or some of the things that we go through day to day, actually breeds people more fearful to actually show their vulnerability within medicine.

And so I think in finding the humor in all of it sometimes is a way to really then share in our experiences.

Flanary, MD: Yeah. And there're limits to what you can do as a physician and using humor and social media. And that's getting back to the line that you try to balance on, because as doctors, we do have a code of professionalism that we have to honor. So I have rules for myself and I tell people, and I talk about kind of using comedy as a physician. There are things that you don't do and lines that you don't cross, but it's easy not to cross those lines.

It's easy not to make fun of patients or make light of situations you shouldn't make light of because in medicine, there's just so much material, it's just ridiculous. We have these very unique and interesting jobs and experiences that nobody else really has. And so it's really not that hard to find those little moments, those little idiosyncrasies and interesting things that we experience on a day-to-day basis, and poke fun at it.

Brissette, MD: Yeah. And I think it all kind of brings us together in the end because it's a shared laughter. And I feel like some of the content you've been creating lately with your Tik Toks is really created for other doctors, where we can all kind of look back to those times in our internships or even as medical students rotating through and just think back to these shared experiences that we've all had across medicine.

Flanary, MD: Can you tell that I had some traumatic experiences as a med student? Does it come across in some of these Tik Toks? Well, it's been like 10 years and I still vividly remember some of these things because every Tik Tok, every video I've put out there, there's some nugget of truth in there. Something that happened to me that allowed me to expand on that idea.

Brissette, MD: And what's amazing about it is that you have doctors of a younger generation chiming in saying, "Oh my gosh, this is so true." And then doctors of a much older generation saying that, that's true. So it's almost just so pervasive in our medical culture, these things and these topics, and idiosyncrasies as you call them that come up.

Flanary, MD: And all over the world. I hear from people from other continents, other countries that they're like, "Oh, this is the same thing." All neurosurgeons are the same, apparently. So it's been really interesting to hear from people in completely separate parts of the world.

Williamson, MD: Yeah. I remember one time you... Well, I think it was maybe the last podcast. I think it was you that told me this, that speaking about other specialties and trying to decide which one to go into. Someone was speaking to a room of young doctors and said, trying to tell them of ophthalmology said, "Who here likes to do surgery, raise your hand? And then who here likes to sit down, raise your other hand? If you have two hands up go into ophthalmology.

Flanary, MD: Yeah, basically. That's right.

Williamson, MD: I think that was you that... I've repeated that so many times and I'm like, "It's that easy. It's very reasonable."

Flanary, MD: The last thing is are eyeballs gross?

Yeah.

That's the last criteria. If you're okay with eyeballs, there's nothing else in medicine for you. You have to be an ophthalmologist.

Brissette, MD: That's wonderful. And one thing I did want to ask you about, because these have been gaining great feedback in people like you said, all across the US, but across different continents as well, but there's always pushback with anything that we do on social media. I feel like there are always people that are going to have a problem with any kind of content that's put out.

And I hate to talk about it, but unfortunately I know you've been the brunt of that two times, once with your avatar on Twitter, and then a second time with somebody questioning whether we should be laughing if we're doctors? I just wonder, how do you deal with that? How do you manage that when your goal is really to make people laugh and bring humanity, and people see a negative side to it?

Flanary, MD: Oh, it's happened way more than twice. It's something that whenever you have a large enough following on social media and you do something that's a little bit against the grain, which I would say using comedy and medicine is a little bit against the grain. It's just not something a lot of people do. You're going to get some pushback because people aren't used to seeing it. And there's a little bit different, a little bit off the wall.

And what I've learned is not to take all of that to heart. And it was hard, starting out, it's something you got to kind of learn how to do. So initially, whenever I had a smaller following and when I get negative feedback, I'd really kind of focus on it, I'd argue with people and just make a bigger deal out of it than I think it actually was.

And now, I still get a little bit of negative feedback. I don't get as much because I've learned what I can say and what I shouldn't say. So I'm more able to somewhat censor myself, but I just have a better idea of what's appropriate, what's not appropriate and what will get me into trouble. That's part of it, but the other part of it is just realizing that you're not going to please everyone. And if you get far more positive responses than negative, then I feel like I'm doing the right thing.

Williamson, MD: Have you used any of that humor and sort of transferred that to your actual practice with actual patients? If I saw you in clinic or my mom went to see you for cataract evaluation, would she be laughing the whole time during her cataract eval, or does that stop at the workplace?

Flanary, MD: I use it a little bit, but it's very different. It's a lot more “dad” jokey, type corny jokes because as you guys know, our patient population, not quite kind of the Tik Tok generation, the Twitter generation. Older patients, 60s, 70s, 80s, they just have a little bit of a different sense of humor sometimes. And so, I do use humor, but it's not quite the same.

And I have my go-to jokes, like we all do. We all have little things that we say over and over again that either always get a laugh or get a smile out of patients, and which I think is really helpful in a surgical specialty, right? Especially when you're seeing as many patients as we do in clinic, and doing as much surgery on patients that are awake and it's their eye.

And so, having something that can ease the tension a little bit, just kind of put patients at ease prior to surgery, is really helpful to have a few one-liners in your back pocket.

Brissette, MD: Yeah. I know we've got to kick this off, talking about Clubhouse, and I was talking with somebody thinking we should just do a Clubhouse about communication with patients. All these little pearls that we have about how we explain things to patients or how we talk to them about certain things, because like you said, we repeat the same things over and over, day to day and sharing those pearls, and allowing them to better understand what's going on without being fearful is so important.

Flanary, MD: Yeah. That's something you pick up as you go, right? It's like the farther you get into your career you just have... I don't know when I started saying some of the things I started saying, I just started saying them and just saying for years. And so yeah, I totally agree with you, hearing from other people and what they say, I think would be really nice, really helpful.

Brissette, MD: Yeah. I think the majority of this job is communication as well. Just learning how to communicate with people for the good and for the bad. Even when we think about managing say a more difficult patient in the clinic, how do you then communicate with somebody to kind of get them on your level and to get them calm again?

Williamson, MD: Yeah. I'd say that the biggest problem with communication is the illusion that it occurred. That's a good quote, a quote that always stays with me. And using humor as we've talked about, especially to navigate difficult patient conversations, I think is a great skill. I'd be curious if you have any specific one-liners that you use to sort of navigate a situation?

I'll throw one out there that I do all the time. That patient that comes in, let's say for a MIGS procedure, and let's say they've already had cataract surgery and they're pseudophakic, and they come in and they need some help with their IOP. I always like to talk about that this procedure that I'm doing is likely not going to be their last procedure because patients think... Especially if they're pseudophakic, they think like, "Oh, I'm having another surgery. Well, the last surgery cured my cataract, this is going to cure my glaucoma."

And that's the time where I have to talk about glaucoma as a chronic progressive disease for which there is no cure. So I always tell them like, "Oh, actually, this isn't going to cure disease. It's just a treatment. And this likely won't be the last one." And they're kind of like, "Whoa." They kind of tense up and they're like, "Wait a second. What do you mean?" And I'm like, "Yeah, I'm probably going to have to operate on you again after this, maybe even two times."

And they're like, "Oh my God." And I say, "Because I expect you to live until you're 127." And they get a giggle out of that, and their husband or wife, they get a giggle out of it. But really what I'm saying is, I'm kind of impressing upon them that, "I may have to operate on you a couple more times, depending on how you do with this surgery." But I was using humor and telling them that they're going to live forever basically, to kind of lighten what I really was wanting them to know.

Yeah. That's a great line, that's really good.

Brissette, MD: I feel like you can say anything with a southern draw, Blake, and I get away with it, too, so.

Flanary, MD: Yeah. I'll say whenever I'm signing someone up for cataract surgery, talking, going through the details of surgery, and I can tell they're kind of tense or they're just not sure, I'll say, "Okay, we'll do your first eye and then we'll be doing your second eye a week or two later. And then a week or two after that, we'll do your third eye." And then I usually get a little chuckle out of that.

Williamson, MD: Ashley, do you have any of those, any one-liners that you use?

Brissette, MD: I’m not as funny as you guys.

Williamson, MD: I'll tell you one more that I do, that I talk about a lot, and this came up just now, my last patient in clinic. She was like a -12 in both eyes and I did cataract surgery on her, one eye is 20/20, the other eye is like 20/30 minus. And she's one week post-op and I'm thinking she's going to be ecstatic. And you walk in and she was like, "What's wrong with the 20/30 eye?"

And basically, I told her... One thing I do is talk about how we have two eyes and two ears, and how we're supposed to keep them both together, both open in order to work properly. So I said, "Listen, I'm going to touch your ear." And I actually put one hand over one of her ears. And I said, "This sounds completely different than this sounds." And I take my hand off the off of her ear, and she notices that it does sound completely different.

So I said, "See, God gave you two eyes and two ears. He wants you to keep them both open," and they kind of giggle. So I always kind of explain to them that we don't want to be doing the refractive salute of covering one eye and then the other. Just use both eyes together and that's how you're going to see. Again, this is just week one post-op, so certainly down the road, if there's a refractive thing we didn't touch up, that's different.

But just doing that little thing where I'm covering the ear, they just get a giggle out of it and it makes my job so much easier as opposed to obsessing over, "Oh well, this eye has got a little bit of a myopic surprise," and going down that path when you probably don't need to week one.

Flanary, MD: Yeah. I'm actually going to steal that, that's pretty good. I like that.

Brissette, MD: We need to do a whole other podcast about pearls of communications, this is great.

Flanary, MD: And part of it also is reading the situation, especially when you're using humor in a patient, physician interaction. Really, actually using humor in any situation, understanding what the temperature of the room is like, and is it an appropriate time to tell a joke is... And I think that's something that comes with the more you do it and the longer you're practicing, you kind of get a sense for... You're able to read people a little bit. And that's actually, I think a big part of what we do, honestly, especially when we're talking about very sensitive subjects.

Brissette, MD: Yeah, I agree. So can I ask you, we talked about some of the highs and lows of what we do in medicine. How do you manage some of the lows? If you've had a bad day, or if you've had a complication in the operating room, what do you personally do to help manage that, that might help other people out there when they're feeling the same way?

Flanary, MD: I've always found it easier to talk about it. And I really think people, we should all be talking about it. That's the one thing that a lot of people don't do in medicine, because again, as physicians, we have this feeling like we need to be perfect all the time. And so you don't hear a lot of conversation about surgical complications. And whether it's in the resident room with your other residents, or with a colleague on the phone, or with your family, it really can't just do about it and keep it in. You got to talk about it and talk through it.

And I have found that tremendously helpful, in private and also talking about it on social media. And that's actually... I wish people would do that more. And I think you can do that in a way that's still protecting patient information, but also putting it out there that, "Hey, this is something that happens. And if you operate, you're going to have this happen to you. This is not something that never happens." And I think starting those conversations publicly can be really valuable.

Brissette, MD: Yeah, I agree. When we kind of share in these shared moments, it allows other people to open up and be more vulnerable as well. Once they hear that we've all had similar experiences and this idea of perfectionism, I agree with you, it should kind of start to go by the wayside. So I really love that.

Flanary, MD: It's so nice too, whenever you're at a conference, when we used to go to conferences, because I remember as a resident, I would just watch the presentation after presentation of these unbelievable surgeries by Ike and whoever, just doing just outrageous things. And then whenever you'd see a talk where they'd actually show someone who just broke the capsule and then what... That was great.

It was really interesting and then hearing the surgeon talk about what happened, what they did. We need to be talking about surgical complications more, because we can all learn from each other.

Brissette, MD: Yeah. I completely agree. Call the friends, talk about it. If something happens, like you said, if you operate enough, you will have complications. It's something that happens to everybody. And even I find difficult patients encounters, and sometimes it's nice to speak to other doctors and see maybe another way to handle it or what you should do next, or try something next. And I'll often text or call doctors that I know in different States, even you Blake and say, "What would you do in this situation?" And just sometimes getting another opinion from someone can be helpful too.

Williamson, MD: Yeah. I recommend when these things happen, a tall glass of wine or a cold beer, and a good conversation with your retina specialist.

Flanary, MD: Yeah, right.

Williamson, MD: Because nine times out of 10, they're going to be with the one helping you fix whatever you messed up. And besides that, their day is way worse than our day ever is. Yeah, it puts it in perspective for you. When I tell him what I just did and he goes, "Wait, is that it?" And I'm like, "Yeah, that's it." He is like, "I think we're going to survive."

And it's tough, if this happens, man, I'll open up and share that last week I had a patient who was NLP in one eye due to trauma, and I did the cataract on her other eye. She literally drove an hour and a half to see me specifically for cataract surgery and I broke the capsule. She ended up getting a lens of the sulcus and it was fine, but she had some retained cortex and tons of... She had IOP spike. I left some too much Visco in there and she had some corneal edema and it was horrible for me because on day one, she's losing it and notably, understandably so.

And so I didn't sleep very well that night. This is her only eye and the whole thing, and you feel horrible about it. And you look at the video and there's nothing you would have done differently. I don't understand, I don't see why it happened. My technique was the same the whole time. And it's one of those things where I think that would have helped me, firstly, it's just being calm in the moment.

One thing that my dad always taught me is finish the case strong. It doesn't matter if a plane crashes through the OR, get through the case and finish the case as best you can. And then just kind of open up and be totally honest with the family. And that's what I did the next day, I showed them the diagram and showed them the weak spot in the capsule, "But hey, you know what? We still got the cataract in and we still have a lens here and yes, she's swollen. And yeah, she is 20/200," or whatever she was. But each day, it's going to get a little better and with the proper drops and stuff like that.

And so she's improved and this week, she's obviously much better and way more functional, but it's just a tough spot to be in. And I think that just being able to be open and honest and transparent, having a family member in that room is super helpful, to show them what you got going on. And just more than anything, let them know that you have a plan. They could be nervous, that's fine, but you can't be nervous, at least not in front of them. They want to know you know what's going on, you have a plan and that we're going to get better.

Brissette, MD: Yeah, and keep them close and see them frequently for post-op, even if they want to come every couple of days, every day, just seeing them more frequently than you would otherwise. I think the natural tendency is to not want to deal with it and push it away. But anytime there's a complication, bring the patients in more often than you even think that you should and develop that relationship.

And like you said Blake, you kind of get through it with them and you can come up with a plan and you get there together.

Flanary, MD: Yeah. Blake, I really like what you said about making sure that they know the plan, because I think why patients get so upset and scared is just the fear of the unknown like, "What does this mean? I understand that this is not what was supposed to happen, but where do we go from here?" And having an explicit plan, "If this happens, this is what we're going to do. If this happens, this is what we're going to do. These are the two or three next steps."

And it's all just comes back to communication, right? Just telling everything you know, everything even if you don't know if the patient really needs to hear it, they need to hear it. Especially if you're in a situation like that, that's a little bit complicated and just communicate, communicate.

Brissette, MD: Yeah. I agree. And Will, I kind of wondered, so when you started with Twitter, when you started with Tik Tok, what was your intention? And then what have you gotten out of it that you never expected to get out of it?

Flanary, MD: Well, my intention at first was just to entertain myself during ARVO. So I was, just...

Williamson, MD: What are you doing going to ARVO?

Flanary, MD: I was a resident man. I was a resident, I had to do a research project, I was bored out of my mind. No offense to anybody who really enjoys going to ARVO, I'm glad there are those of you out there that enjoy research. We need you guys out there, but I could not stand it. So anyway, I was like, "I got to do something. I'm here for three days."

So, I started this Twitter account and I was like, "What's the funniest word in ophthalmology that I can think of?" I was like, "Oh, Glaucomflecken." I thought Dr. Pseudophakodonesis was just a little bit too much, so I went with Glaucomflecken. But at first it really was just to tell jokes because I had a pretty strong history in standup. I had done standup comedy for quite a while, but I couldn't do it anymore. And so I just didn't have the time. So I use Twitter as a surrogate pretty much for just... Because basically what it is, is like online stand up and in the format in a sense.

So that's what it was at first, was just a way for me to tell jokes, make people laugh, which I've always loved to do. But then as the years have gone by, now we're like five years later since I started my account, I feel a little bit more responsibility to touch on certain things. A lot of the things that we're talking about, communication, talking about humanity and medicine, because I have a large following and I feel like I can bring up these topics while still maintaining my style of humor.

And so that's kind of how I've pushed myself to, I think improve my comedy and make it a little bit more impactful, because I can tell jokes all the way, all day about drusen, which is admittedly not that funny, but whenever you try to use your humor and tell jokes in a way that gets people thinking about important subjects in medicine, I think is really the goal, at least for me at this point.

Williamson, MD: And I think the biggest thing is... The funniest things are the most honest things, right? People say, "Oh, that's true. That's what makes people laugh. So keeping honesty there, front and center for both of the good and bad, I think is what makes it truly funny.

Brissette, MD: One other thing I'd say is its kind of brought all of us together even, it's such been a wonderful way for the medical community to connect and other ophthalmologists to connect, and to get to meet other people, especially now that people aren't at conferences. And so I've seen it as such a wonderful way for us doctors to really get to know each other on a different level as well.

Flanary, MD: Yeah. I feel like there's been a larger influx of activity on certain social media platforms, specifically Twitter and Tik Tok, especially in medicine. It's got to be in part because of the pandemic and none of us can go anywhere.

Brissette, MD: Yeah.

Flanary, MD: And so it'd be interesting to see how that changes, as people feel more comfortable going out like when are we all going to be going back to doing in-person conferences again? Are we always going to have a virtual option? Because so far, the virtual options have worked pretty damn well, in my opinion.

Williamson, MD: Yeah. It looks like AECOS Deer Valley is on, it looks like Hawaiian Eye is on, it looks like they're all on. I'm scheduled to go to them, so I don't know. We'll see.

Flanary, MD: All right.

Wiliamson, MD: I hope they do go. I certainly miss seeing everybody.

Brissette, MD: That is true.

Flanary, MD: That's true, yeah.

Williamson, MD: Well, this has been great. I really appreciate it. So I want to thank everybody for listening to episode two of our journey with Dr. Ashley Brissette as co-host of Off the Grid, and I look forward to what's coming up next for our third podcast soon. And most of all, we want to thank Dr. Glaucomflecken for taking his time away from Twitter and Tik Tok, and the occasional Clubhouse to hang out with us on Off the Grid.

Flanary, MD: Thank you so much for having me.

Williamson, MD: Thank you to Ashley and Will for joining me on this episode of Off the Grid, and thanks to our listeners for tuning in.

This has been Ophthalmology off the Grid. Until next time.