If advanced alien life exists it would likely look very different from life on Earth. We’d have to fundamentally reorganize our understanding of what life is, leading to a tectonic paradigm shift in biology, philosophy, religion, maybe even chemistry — you name it. In short, it’d change everything. Thus, the potential discovery of alien life makes a hell of a metaphor for all sorts of fundamental shifts in perspective.
These perspective changes occur in all aspects of life. They can be personal, like having a child, or global, like discovering nuclear fission. The perspective changes happen within individuals — and yet when they occur on a large enough scale, they’re powerful drivers of change.
Dr. Arun Gulani sees such a paradigm shift as necessary in the medical world. And while some discuss the mere possibility of a new future, Dr. Gulani is already there. His surgical outcomes and track record over three decades are legendary. Meanwhile, he publicly shares his patient’s non-incentivized reactions as an accurate gauge of that success, leading to fully transparent accountability. He hopes this will encourage colleagues to follow his direction. Rather than discuss possibilities, he is firmly driven by results — and the only results that matter to him are patients so happy they’re willing to publicly boast about their treatment.
This everyday occurrence led to an analogy that resulted in this article. As Dr. Gulani put it, “Ophthalmologists see UFOs and clap their hands with excitement, subsequently holding one conference after another debating whether aliens exist, while I’m showing them pictures of me drinking beer with Martians everyday.”
Who are the Martians, in this case? Understanding them requires a perspective change, just like understanding alien life would. These Martians are patients who can’t contain their joy from regaining excellent vision, and so gladly trumpet their positive outcomes. For Dr. Gulani, this requires the doctor to focus on nothing but patient outcomes — or rather, viewing the patient as the outcome. There is no separation.
Indeed, as Dr. Gulani explained it, he’s never even considered separating the two, and was genuinely puzzled when asked to differentiate between patients and patient outcomes.
The paradigm shift Dr. Gulani sees as necessary is a patient-defined approach, where the only thing that matters before, during and after a medical or surgical treatment is the patient. Your tools, your knowledge and your facilities all only amount to one gestalt function: improving — or saving — someone’s life. Whether you’re using a scalpel, a micropulse laser or your bare hands to improve a patient’s life is irrelevant. The only relevant point is the patient.
He sees many practitioners tinkering around the edges of their practice, focusing on minutiae while missing the focal point of the patient — and calls on doctors to be the best they can be by making the patient their only concern. To help decrease a doctor’s learning curve, he’s created the Gulani Academy, sharing the knowledge he’s gained over the years. But first, you may be wondering — what makes him such an expert, anyway?
A Bit of Background
Before we dig deeper, let’s establish who the man with the idea is. Dr. Gulani is an ophthalmologist with 30 years of experience in the field and owns his own practice. People from all over the world fly to his clinic because of his stellar reputation — both as a surgeon and as a genuinely amicable person. For reference, his clinic has zero marketing budget, yet his name is known internationally. In the month of November 2020, he had patients from 11 countries and 14 states fly to his practice in Jacksonville, Florida.
How does that happen? Simple: He produces outstanding patient results.
These patients aren’t simple rubes dragged in off the streets. They often come to him after multiple referrals, or after other failed surgeries, or simply because the patient has done their homework and wants to find someone who can do the job right. These are skeptical, intelligent, inquisitive patients who would recognize hogwash and wouldn’t tolerate it. And yet these very demanding and skeptical patients — after having surgery with him — go to their own social media and post not a line or two, but paragraphs, in addition to fun pictures and videos sharing their vision outcomes and experience.
Most surgeons would love to have patients do so themselves. Indeed, many opt for paid and incentivized marketing on social media written by the doctor — not the patient — in relaying their success in a carefully curated case.
In contrast, Dr. Gulani’s social media is uncurated because it doesn’t need to be. And in the most litigious country on Earth, allowing some of the most demanding patients on Earth unfettered access to a surgeon’s social media can be a dangerous game.
Nonetheless, patients sing his praises on Facebook — and it should be noted that these are full-paying patients who voluntarily choose to share their thoughts. When they could be simply enjoying their newly improved vision, they’re taking their own time to share their appreciation for Dr. Gulani’s efforts with others. As internet users know, most people only write reviews for two reasons: because they really loved something, or they really hated something. Well, the results are in, and patients really love Dr. Gulani.
His primary motivation is helping others. In addition to helping patients, he’s passionate about inspiring his colleagues and sharing as much wisdom as possible — because the future he’s creating can be a model for all.
He’s created the first ophthalmic surgery spa to complement his no-injection and no drug surgical artistry, and changes the ambience of the environment to suit each patient. While retreatment rates for most ophthalmic surgeons in the U.S. are between 3-19%, his are exactly zero. And while 12% of surgeons manage to upsell patients to premium services like Toric cataract surgery, every single one of his patients opt for premium treatment. To round things out, he designs his own slick-looking suits, enhancing an already professional appearance with a bit of flair.
He regularly speaks at symposiums and conferences, and gets dozens of emails from surgeons each day asking his advice. He’s often the recipient of praise bordering on flattery, which he receives with the humility of a big brother helping younger siblings: in this case, fellow eye surgeons, optometrists and eye care providers at all levels.
Dr. Gulani’s ability to conceive futuristic concepts and unleash technology with a consistent track record is measured in patient happiness as opposed to “fudgeable” publication statistics.
The Price He Pays
Nothing comes for free, of course, and such is also true for Dr. Gulani. Patients often keep him a secret, only telling their immediate family members — because they’re concerned he’ll get too busy in the future. They want to keep him for themselves. What’s more, his patients — now educated and armed with ophthalmic knowledge — know enough to look for mistakes from ophthalmologists.
Furthermore, his decision to remain in Jacksonville, Florida rather than Beverly Hills or Manhattan stems from a desire to show young doctors that geography doesn’t matter. If you’re the best at what you do, people will come to you. If you really believe in what you do, you’ll trust your patients so much you’ll get on a motorbike with them the day after their eye surgery.
And he could keep all this to himself. Most businessmen would be loath to share their secrets to success with those they view to be competitors. Instead, they would keep their “secret sauce” a secret and reap the rewards. Instead, Dr. Gulani shares his work and experience as he empathizes with his colleagues who are struggling. As he put it, “Many are searching in every direction for the North Pole, while I’m already there with my arm outstretched waiting to help.”
A proponent of analogies, Dr. Gulani shared another expression. “I am giving away gold nuggets for free and colleagues have difficulty accepting them, since they have been trained that it takes years of treasure hunting to finally find a cave whose walls may contain traces of gold. Receiving gold nuggets directly, for free, and in hand sounds far from the expected norm.”
So, the point is this: Dr. Gulani is a man others in the medical community would do well to listen to.
Be Excellent, All the Time
Just what does Dr. Gulani have to say to doctors? Primarily, his message is an exhortation to excellence — to treating the position of being a medical practitioner as both a huge privilege and a mighty responsibility. Few positions hold such prestige and respect, and the general population expects doctors to live up to their positions.
Why, then, do doctors get bogged down on minor details, or overwork themselves, or cut corners on patient treatments to save time and money, or find themselves in bitter rivalries with competitors? Why do doctors become so focused on publications, or schmoozing with industry types, or looking at patients as cash flow?
Dr. Gulani would answer that doctors often lose sight of why they became a doctor in the first place. For most, it’s a laudable motivation. Usually, people become doctors because they have a burning, innate drive to help others. This desire is admirable, and should remain the defining principle of a doctor’s life.
Doctors are people, though, and it’s easy for them to lose perspective. Especially when burdened with adult responsibilities like taxes, attempting to manage a business, or juggle family responsibilities, high-minded thinking is often a casualty of practicality.
It doesn’t have to be that way. When doctors make their patients the central focus of their lives, things just seem to click. The money shows up and the doctor will gain prestige and respect in the industry.
Overbooking an office and running patients through like an assembly line may seem more efficient on paper, but in the long run it’s detrimental to both the doctor and the patient. Doctors burn out and stop losing interest in individual patients — just one more box to tick off before moving on to the next. Patients notice this, and generally don’t appreciate it — and they tell their friends and family.
Dr. Gulani with some of the “Martians,” or very happy patients
Any medical practitioner needs to know that patients are always evaluating and judging doctors. While you’re sleeping, patients are discussing your treatments and writing reviews online. If you don’t give a patient your very best efforts, they’ll know, and your career will suffer as a result.
The solution? Again, it’s simple. Give each and every patient 100% of your focus and abilities. No less should be acceptable to you. After all, what would you want from a doctor treating you?
Doctors Are Rock Stars
In addition to doing right by his patients, Dr. Gulani wants to help ophthalmologists realize their full potential. If a doctor is looking to have patients thrilled with their results and them (not the doctor) willing to brag about their treatment online, they need look no further than the advice Dr. Gulani gives. His aim is to decrease the learning curve for doctors. After all, what’s the point in starting further back from where current progress is?
Performance matters the most in the world of surgery. It’s like a score in a sports match — all the other stats are interesting, and can contribute to the win, but in the end the score is the only thing that matters. So, check out the guy who’s been scoring consistently for decades — because he really just wants to help.
Dr. Gulani has noticed a trend in doctors who visit his clinic and view his work. They exhibit a strong sense of inspiration and excitement on arrival having known of his work and status, on seeing his patients in person their minds shift from skeptical to believing to being completely awestruck — and then they blank out, seemingly uncomfortable as if they are challenging their own beliefs and education of years, and go back to their old habits at home. Crossing the expanse to add new habits and achieve higher levels of excellence can be daunting, for sure.
But let’s admit one thing: Doctors are in the upper echelon of society anywhere in the world. They were in the top tier academically as well, so excellence shouldn’t be something unfamiliar to a doctor. Indeed, for many, it has been a consistent way of life.
Dr. Gulani was always bothered by movies and television often portraying doctors as nerdy, weak, physically unappealing or socially inept, and he strongly believes the opposite is often true. These are people who can use seriously complex knowledge, skills and tools to fix problems that baffled mankind for all of human history until just recently. They represent the cutting edge of technology and society as a whole could not function without them. Dr. Gulani insists that every doctor is a rockstar.
Some anthropologists argue that the first sign of civilization is not cave art, or tool use, or fire. Rather, it’s a healed broken femur found on an archaeological dig. Why a healed femur? Because it represents the care and protection necessary for a person to survive a broken leg, which is universally a fatal affliction for an animal in the wild. Medicine and healing is a cornerstone of civilization. And that cornerstone all relies on the interaction between doctor and patient.
Excellent patient outcomes and their willingness to share their experiences don’t have to be foreign entities like UFOs. Indeed, if you do your job right, they’ll be common and in fact instill faith in an already existing alien civilization.
Experience and Evolution as Scapegoats
Speaking at the podiums of major conferences, Dr. Gulani consistently encourages opinion leaders and teaching surgeons to have the direction and ability to understand and predict the future. As he explained, many key opinion leaders (KOLs), if tracked backwards, keep making the wrong decisions or misleading the industry and then blaming that poor judgement on “experience” or calling it “evolution.” Accountability should not be taken lightly in lieu of a free lunch or paid trip to an exotic conference venue.
Dr. Gulani noted this is the way education currently works in medicine. Doctors, essentially, are taught to think inside the box, he said. They learn to follow one system, to expect one magic bullet after another in the form of new treatments or technologies, and to get patients back to “good enough” rather than “perfect” while learning new ways to lower patient expectations and bail out of poor outcomes.
This trend in education continues into practice, as many will follow the herd, letting trends and publications lead them into a mental box.
You wouldn’t accept a permanently bent spine, so why a permanently bent cone?
Dr. Gulani asserts there’s no such thing as an irregular cornea. Indeed, for him, all corneas are treatable.
With 70% of his practice consisting of patients seeking second opinions, he gave an example of a common trend in ophthalmology: crosslinking keratoconus patients’ eyes. In this procedure, surgeons will use a combination of eye drops and ultraviolet light to strengthen collagen fibers in the cornea, preventing further warping of the cone. The problem? The cone is still bent — it’s stronger, yes, but it’s still permanently deformed.
This quick fix is popular because it’s minimally invasive, but it doesn’t result in optimized vision. Instead of crosslinking the keratoconus, the keratoconus should be fixed and then crosslinked in order to prevent further deformation (Gulani Think Outside the Cone: Kerato-Scoliosis concept).
Similarly, he sees treatments that focus on correcting topography as backwards. If the topography is “fixed” but the patient can’t see, what has been accomplished?
For ophthalmology, every treatment should result in vision. The end. Why take half-measures in something as important as a person’s eyesight? Imagine a mother taking her son with scoliosis to an orthopedic surgeon. The doctor explains that he’ll use a new technology that, like cement, will strengthen the spine and prevent it from becoming more deformed, and expects her to be happy. But why should she be happy? The doctor is not offering to fix the problem and straighten the spine first.
Decreasing the Learning Curve
Many doctors would say that some cases are difficult, and treating the case to perfection is impossible. Dr. Gulani said calling something a difficult case is not acceptable — it simply means the surgeon should engage in creative thinking and do whatever it takes to get the treatment done, with no excuses. A doctor’s brain is by far the most valuable tool they have. Cutting corners and utilizing quick fixes is underutilizing the brain, or is putting money ahead of the patient. Either way, it’s poor practice.
It all comes back to patient outcomes. A healthy patient should be the only acceptable outcome. Anything less, and a doctor hasn’t done their job.
Rather than fuss at doctors, Dr. Gulani has created the Gulani Academy — a YouTube channel as well as part of his website — packed full of information to help ophthalmologists continue to improve, and to share Dr. Gulani’s golden nuggets of wisdom. Other parts of his YouTube channel include patient testimonials and much, much more.
Advice for Young Doctors
Achieving the level of success and respect Dr. Gulani has is no small feat, and many younger practitioners only dream of such status. Yet Dr. Gulani is always happy to provide advice and help others. Here are some pearls of wisdom from him for young doctors.
- Above all else, you must be excellent at what you do. You can’t put lipstick on a pig and call it beautiful.
- Focus on the patient. Nothing else matters except patient outcomes.
- Be yourself. Nobody else is like you, so develop your own idiom. Patients love a personal touch and working with a unique individual.
- You can succeed wherever you are — geography is no limiting factor.
- You can only build a solid reputation on years and years of consistency.
- Look the part. A sharp-dressed doctor commands respect.
- Technology is a tool. Do not let it enslave you — rather, you must enslave technology.
- Be careful of marketing and consultants. Looking like your competition and then competing with them is foolish. Be unique.
- Don’t give a menu to patients. Menus are for waiters. Don’t be so busy trying to sell that you forget patients are ready to buy.
Enjoy Being a Doctor: It’s a Privilege
Passion for what you do is a necessity for success in any field, and medicine is no different. A passion for patient outcomes is what separates a passable doctor for an excellent one — and, as previously mentioned, patients definitely recognize the difference. As Dr. Gulani said, “You can fudge a publication, but you can’t fudge a patient on camera.”
Holding yourself to a high standard and producing results leads to the type of personal satisfaction that can never be replicated. Focus on patients and everything else will follow. Believe in yourself, because you’ve already made it this far. After all, how many other people can do what you do?