Dr. Jeffrey Lander, Ophthalmologist, Tries Not to Make Any Mistakes

Dr. Jeff Lander

York ophthalmologist Dr. Jeffrey Lander admitted that he has a Type A personality and is a perfectionist. Born and raised in Warren, Ohio, not far from Youngstown, he went through primary school as a mediocre student. He had no direction in the small town that was dominated by steel production (he worked for a summer in one of the dangerously hot mills). But Jeff’s canny sixth-grade teacher, an imposing former basketball coach, wanted his students to excel, so he spent the entire year warning them that they needed to “hit the ground running” when they got into the seventh grade or they would surely fail. 

Dr. Lander told me he was the only kid “stupid enough” to actually believe the teacher. So he studied all summer to avoid flunking out the following year. And he found out that he was pretty okay at learning if he put his mind to it. 

He continued to do well academically through high school in the late 1960s and early 1970s. At age sixteen, his aunt asked him what he was going to do with his life. Having no clear path in view, he ventured lamely that he would, perhaps, study German or maybe go to medical school.

Part of the abandoned Warren Steel mill in Warren, Ohio
as many heavy manufacturing businesses collapsed
  (From "Architectural Afterlife")

“Jeff! Are you crazy?“ she said.

“Okay, I will go to med school,” he replied, reacting swiftly to the tone of his aunt’s stern response. (This was an example, said Dr. Lander, of his inclination to make important life decisions without a lot of conscious thought, “without thinking very hard.” Decisions that usually turn out quite well... though not always.)

There was intense competition for spots in medical school, so Dr. Lander studied his “butt off” in high school. And he did a few things in those important adolescent years of rapid brain change that (it turns out) helped prepare him for his work as an eye surgeon: he built model airplanes, liked to draw, and played the piano (where his “four limbs were doing different things at the same time”). And his church pastor (possibly agnostic, thought the perceptive student) taught Jeff critical thinking, the skill enabling one to look carefully, to see things as they are. This became a lifelong habit.

Though not a Catholic, Jeff decided to go to John Carroll University in Cleveland, since they had a good track record (about 50%) of getting people into medical school (mostly by weeding out a bunch with especially difficult courses early on). The Jesuits (“the intellectual force of the Catholic Church during the Reformation,” said Dr. Lander) strengthened Jeff's analytical bent. 

John Carroll University (From JCU)

He had “laser focus” in college and received letters of early acceptance to two medical schools on the same day: he was offered a position at the prestigious University of Washington, St. Louis, and one at the state-sponsored “free” Medical College of Ohio, three hours from home. It was a no-brainer; he stayed in Ohio.

Jeff wanted to be “the best doctor” possible. So he “did nothing but study” just to land “in the middle of the class.”   Surprisingly candid, he said that his experience in medical school “was  awful.” The academic work came easily but the clinical rotations were challenging. 

The first class of the Toledo State College of Medicine,
later named Medical College of Ohio, in 1969
 (From the University of Toledo)

No attending he worked with, he wryly noted, wrote in their review of him that, “Student Lander was one of our best medical students ever!” Yet he did manage to receive “honors” in a few of the specialties. During his psychiatry rotation, for example, he sat down with a hospitalized patient and she opened up and told him everything. The attending remarked the next day that the woman greatly enjoyed being interviewed by him. But she thought Jeff was a priest and was horrified to find out that he was only a medical student. (He had taken the time to listen to her.) 

Yes, Type A Jeff felt a lot of anxiety in medical school. And he soon realized (among other things) that the brain (his brain) doesn’t work so well without enough sleep.

Anyway, in the late 1960s and early 1970s, as his fellow students were doing their darndest to be “melllow,” to fit in with the times, Dr. Lander clearly saw himself in a different light. He was not calm or easy-going, he said; he was a hard-working serious young person with a defined goal. In time, he concluded that it was okay to be himself.

The young medical school (it was established in December 1964) had an unusual curriculum. For the first two years, they studied a single system (such as the cardiovascular system) from the basic science to the pathology and the clinical aspects before moving to another system (such as musculoskeletal) in the classroom. 

The clerkships came in the third and final year (there were no summers off).  Most other US medical schools had a four-year program, two years of basic science, then two clinical years. Dr. Lander and ten of his classmates chose to take a fourth year of (also free) training. They knew they weren’t yet prepared to be responsible for taking care of patients. 

University of Toledo (previously the Medical College of Ohio)
 (From UT)

His initial plan (in line with the school’s primary care mandate) was to go into family medicine. When the students were (early on) given the opportunity to choose to spend time with (or “shadow") a physician in the community to get a feel for things the primary slots he wanted were already filled (they worked through the alphabet from both ends and "L" was near the middle) and he was matched with an eye doctor. 

That unexpected experience put the ophthalmology bug in his head despite the fact that he had already been leaning away from family practice and toward academic internal medicine, where keen diagnostic skills and knowing “everything”  (“like Dr. House,” he said, but without the edge) were prized. 

A TV physician/role model:
The imposing and intense Dr. Gregory House with his team
(From Cinemablend)

The two-week clerkship in ophthalmology changed his mind. You see, the eye clinic visits were short, the surgeries were quick, you could take morning coffee breaks, and you didn’t have to be up all night. You didn’t have to deal with people who were actually sick. And it’s “impossible to kill somebody,” said Dr. Lander. Since the body of knowledge and the skills to be mastered were limited (though still substantial and exacting) it was an ideal career choice for a self-described seeker of perfection. 

So Jeff decided to go for it. When he and a fellow colleague were casually advised by a resident that they couldn’t possibly get an ophthalmology training position because they were just too competitive, Jeff instantly shot back: ”Just watch!”

So he spent a year preparing to get into an eye program. He matched at Geisinger (his fourth choice of 16). Before starting, he did a required year of a rotating internship (1980-1981) at Mt. Sinai in Cleveland. This was, he said, “a wonderful place.” And he saw “tons of pathology,” when he was in the inner city hospital providing care to the urban poor. (The hospital had to close in 1996 due to economic pressures.)

Dr. Lander fondly recalled a two-month block in neurology with the bow-tied Neurological Institute-trained Dr. Howard Tucker. Jeff “loved” the civilized, academic, mild-mannered, and warm-hearted neurologist. (Jewish Dr. Tucker is still teaching residents twice a week at St. Vincent’s Charity Medical Center in Cleveland. And at age 101, he still–in 2023–holds the Guinness Record as the world’s oldest practicing physician, awarded to him in 2022; he has no plans to retire.) 

Dr. Howard Tucker with his Guinness plaque
(from "The Today Show" 8/10/22)

After the busy internship year in Ohio, Jeff was off to rural northeastern Pennsylvania for his three-year residency at the rural Geisinger Medical Center in Danville. All of his attendings were competent, but they were “oddballs.” Nobody, he recalled, taught him how to refract (for eyeglasses or contacts) and there was pitifully little instruction on actually doing cataract surgery. He felt that he almost had to teach himself ophthalmology. 

(Incidentally, looking back, Jeff feels that medical school information was “so useless” and that everything he needed to know could have been taught in one year.)

Geisinger Medical Center in Danville, PA (postcard)

A break for a social-historical tidbit. Jeff said that his decision about a career in medicine (after the not-so-subtle nudging by his wise aunt)  was influenced by the popular late 1960s and 1970s TV show “Marcus Welby, M.D.” According to encyclopedia.com:

 Much of the appeal of the program surfaced in the way that Welby treated his patients. In 1965 President Lyndon B. Johnson signed the Medicare Bill, raising many questions about the degree and quality of health care offered in the United States. Americans worried that they were going to be lost in the bureaucracy of the medical system and that their health would suffer for it. Marcus Welby allayed these fears of depersonalization (as he) had an old-school work ethic and treated his patients with respect. (from https://www.encyclopedia.com/media/encyclopedias-almanacs-transcripts-and-maps/marcus-welby-md)

Anyway, after Dr. Lander finished his residency in 1984 he wanted to practice in a small town. York ophthalmologist Dr. Gordon Pratt, only 50 then, was diagnosed with a brain tumor and offered to sell his busy practice “for a song,” said Jeff. Dr. Lander wisely kept Dr. Pratt’s office staff in place, and they helped ease him into the work. And he was warmly welcomed into the small tightly-knit eye community since the doctors were “swamped.” 

There was an easy camaraderie among the local ophthalmologists as they gathered once a month at each other’s homes to talk about new developments and to get help with difficult or troublesome cases. This comforting routine of sharing continued for nearly 30 years.  Sadly, this doesn’t exist anymore, said Dr. Lander, and he feels isolated professionally.

Jeff admitted that doing exacting surgery on the eye is stressful. In fact, he still gets nervous and he said that his “stomach goes into a knot” for the first few cases of the day.

“No case is routine until it’s over,” said famed Cincinnati cataract surgeon and innovator Dr. Robert Osher. And Dr. Lander knows that. So when already-prepped patients in the OR ask him at the last minute if he’s relaxed he replies: “Definitely not!” He knows that being slightly on edge and being slightly anxious generally improves performance, the Yerkes-Dodson law, (at least it does for him). 

There is an optimal level of arousal (in yellow) for difficult tasks

He said that one of the ways he deals with stress is through a strict exercise regimen. An optometrist in Danville had introduced him to Dr. Kenneth Cooper’s program in 1987. Dr. Cooper was the Air Force physician who, in 1968, invented the term “aerobics” for the endurance exercise deemed most important for heart health. He recommended a total of 30 minutes of sustained physical activity most days of the week. Dr. Lander, a self-admitted “exercise maniac,” has unswervingly followed this advice since 1987.

Another way for Jeff to cope with the stress of performing the delicate surgeries was to continuously hone his skills, even (especially) as the highly precise procedures evolved. The first major change happened halfway through his residency. And in 1991, the technique still used now, phacoemulsification, breaking up or emulsifying the clouded lens while simultaneously sucking the broken pieces of it out of the eye and making sure the pressures within the eye remain stable, was the new standard. It had to be learned by surgeons already in busy practices, so Dr. Lander took a “weekend course.”

An ophthalmologist doing precise cataract surgery
(From AARP and getty images)

As he adapted to these changes, cautious Jeff didn't want to hurt anybody by missing something critical for a lack of medical knowledge, not simply inadequate surgical technique. So he has repeatedly tested himself with a homemade deck of question-and-answer 3x5 flash cards. (Somehow, I doubt that many other doctors–or any other doctors, for that matter–do this type of reviewing so consciously, so deliberately, so humbly.)

And so, after nearly 40 years in private solo practice, Dr. Jeff Lander would like others to benefit from his experience. He put together a detailed 50-page book on cataract surgery for residents, a book he wished he could have had, himself, while he was in training. A work complete with his own (touched-up) drawings. A how-to-do (but not DIY!) manual  that he will sell on Amazon for, say, “$19.95.”  

But taking out our worn-out lenses (over half of us will develop cataracts by age 75) and replacing them with brand new clear acrylic or silicone versions while making sure that nothing goes wrong (it very rarely does) is only one of the "three legs” of Dr. Lander’s independent practice. 

He enjoys doing general eye care (often with continuity, “like a family doctor” who likes his patients and talks easily with them), of course, does the lens replacement surgery and performs laser treatment for glaucoma, and has a good-sized optical dispensing area with an optometrist, Dr. Howard Hartzell III. He said his practice is purposely diversified, should something unexpected happen in the future. 

His tireless wife (the practice administrator) “works 70 hours a week” running things and keeping the books. His son (diagnosed with what used to be called Asperger’s) also works in the office and is well-liked by the patients. 

Dr. Lander recently cut back on his office hours (just a little bit) but he has no plans to retire (unless his wife decides she’s finished). And, in the future, he would like to have the opportunity to do some clinical teaching to pass on what he has painstakingly learned and tried to get right, to get perfect, for the past 39-plus years in York. 

Well, I thought that was the end of our doctor's story, but no, there is more:

As the post was being put together it was already mid-September; the interview with Dr. Lander was in April. The unexpectedness of life may slow the writing process, but what happens along the way is often material for another tale. And, as Jeff has said to me, sometimes a story is just so interesting the way it turns out.  We may be surprised, and find that we’ve been completely duped, we had missed the point. 

So when I texted Jeff to let him know I would be sending him a draft for review his reply provided an unanticipated twist: he had stopped doing cataract surgery in May.

You see, he had awakened from sleep one day with severe right shoulder pain. As he went to write himself a note his hand did not work. He had a compressed nerve root, a pinched nerve, in the neck. He needed urgent surgery. After that, he took two weeks off and decided it wasn’t safe to do cataract extractions anymore; he would put down his scalpel and just practice medical ophthalmology. His wife was happy with that plan. 

And a friend of his wants to put together a blues band. So Dr. Lander said that he needs to learn how to improvise on the saxophone. He thinks this is going to take a while.

The original Blues Brothers Band (before Belushi and Aykroyd)
 (Photo from "The Echo" by Pepe Botella)

By Anita Cherry 9/24/23