Resources to Remember
I always enjoy hearing from the contrarians.
Sometimes I wonder if we are like Emmet in The LEGO Movie, who tends to greet every new product, treatment, test, and research study by humming “everything is awesome.” Darrell White, MD, has a different take on DEWSIII that we should read. Ocular Surgery News
Always be ready for the difficult emergency cases.
What is an emergency rather than an urgency? Three gurus, Alison Bozung, OD, Chris Kruthoff, OD, and Patrick Scott, OD, discuss all things ocular emergencies. Listen or read it here: EyesOnEyecare
Use AI to reclaim the best parts of your work.
I’m excited to read Steve Vargo, OD’s new book, Human-Centered AI. I was one of many ODs who helped edit it, and it struck a chord with me, especially on burnout. It’s fun to see so many optometrists writing books these days. Bravo.
Articles to Apply
What concentration of atropine are we really prescribing?
A review of 435 children at three US academic eye centers found that from 2016 to 2018, every child started on 0.01%, but after LAMP, and especially after the 2023 CHAMP and PEDIG trials cast doubt on 0.01% in US kids, 0.05% became the most common starting dose and the place most titrations ended up (53.3% of prescriptions at 12 months). It tracks prescribing, not outcomes, but if 0.01% is still your default, the specialists have moved on, and it’s worth asking whether you should too. Optometry & Vision Science
Quotes to Consider
"The safest way to try to get what you want is to try to deserve what you want." Charlie Munger, quoted in Morgan Housel's Same As Ever
My Observations
Howdy folks, welcome to November.
Before the holidays eat up your calendar, I want to give you a nudge: now is the time to start dreaming about 2027.
And I mean all of you, whether or not your name is on the lease, the sign, or the partner contract.
The most successful optometrists I know lead whether they’re officially in charge or not. An associate who shows up in December with clear goals for next year is leading.
Patrick Lencioni argues in The Motive that leadership is a responsibility, not a reward. I’d take it one step further: if it’s a responsibility, you don’t need permission or a title to carry it.
Start by looking back and ask three questions: What went well? What needs to improve? What do I want to be true a year from now?
Then turn that reflection into goals. I’ve borrowed from a few books over the years, and three principles keep showing up.
- Pick fewer goals. The 4 Disciplines of Execution (4DX) calls them Wildly Important Goals. The authors argue that teams chasing too many goals tend to accomplish none of them well. Gino Wickman’s Traction says something similar: set a handful of annual goals, then break them into quarterly “Rocks,” the few priorities that must get done in the next 90 days. Every goal you add dilutes the others.
- Measure the lead, watch the lag. 4DX separates lag measures (the result) from lead measures (the daily actions that drive the result). You’ve heard me talk about tracking the plays instead of staring at the scoreboard. This is the same idea applied to a full year. The annual goal is the lag. The daily habit is the lead.
- Build a rhythm of review. A goal without a meeting attached to it is just a wish. Traction recommends a weekly meeting built around a scorecard. 4DX calls it a cadence of accountability.
So here’s what I’m committing to for 2027. Fittingly, it’s a return to the fundamentals.
Goal 1: Operational excellence. Chick-fil-A has a mantra I love: better before bigger. Growth that outpaces your systems eventually breaks you. My goal is to get really good at doing the right things every day, so our care, our handoffs, and our culture hold up regardless of who’s working that shift. The lag is how consistently we deliver care. The lead is a five-minute huddle every morning, without exception.
Goal 2: Grow our optical. If you read this newsletter or come to my lectures, you know I spend most of my energy on medical care. Somewhere along the way, I started taking our optical for granted. Comprehensive care means both. This year we’re bringing edging in-house, turning over some frame lines and adding new ones, and raising our capture rate. The lag is capture rate. The lead is the doctor's clear recommendation to every patient every time, then reinforced in the optical.
Goal 3: Lower our exam-only rate. I wrote about this metric in September as one of the clearest signs a practice is thriving. Ours is higher than it should be for a practice that preaches comprehensive care. The lag is the exam-only rate. The lead is a clear call to action for every patient who needs care (myopia management, glaucoma, AMD, etc.) beyond the annual wellness check.
What this means for you: Block 90 minutes before Thanksgiving. Answer the three reflection questions honestly. Then write two or three goals for the year, pick one daily habit that moves each goal forward, and put a weekly review on your calendar.
You don’t need a title to do this. You just need to start.