Before he peers into the eye of an 82-year old woman in his Center for Sight operating room, David Shoemaker glances at the monitor, where a sticky note has the woman's name phonetically spelled in large letters. "He never wants to mispronounce a patient's name," says Nancy Cinnater, who's the Center for Sight's full-time medical "narrator."

Using a microphone, Cinnater explains each step of the cataract surgery to the woman's husband, who's in a viewing room behind Shoemaker, looking at an image of the patient's magnified eye. The procedure is videotaped and given to the patient to take home.

It takes about four minutes for Shoemaker to liquefy the cataract, suction it out and replace it with a foldable lens. One of his four assistants holds the woman's hand through the procedure, and when it's over, Shoemaker turns towards the viewing room and gives the thumbs-up sign before moving on to the next patient, who's prepped and ready to go in an adjacent operating room.

The glass separating the viewing room from the operating room becomes opaque at a flip of the switch to protect patients' privacy, an innovation Shoemaker said was inspired by a similar window he saw on a yacht 15 years ago.

Next to the operating rooms, two teams of four nurses and assistants work with patients in the pre- and post-op area, which has the pulse of an emergency room, only calmer.

"It's like a symphony," Shoemaker, 51 says. "Everybody has their role."

Such well-orchestrated precision enables Shoemaker to perform about 150 surgeries in a week, sometimes with as many as 40 in a day. His weekly total is about as many as a typical ophthalmologist may do in a year.

He started the viewing room and taping service 15 years ago, when he says patient trust in medicine was at an all-time low. "The idea was to re-establish trust," Shoemaker says. "It's important to involve patients and significant others in every aspect of care." He says that knowing family is there watching makes a patient more relaxed, and that makes for a better outcome. "You heal better," he says. "Everything we do plays into that."

It's not a conventional way to practice ophthalmology. But then there's not much about Shoemaker that is conventional.

20/20 marketing vision

The Sarasota doctor's eagerness to question accepted practices and adopt promising new ones has made him one of the leading ophthalmologists in the U.S.-and raised a few eyebrows along the way. And many of his innovations are in marketing and business growth. Indeed, unlike many doctors, who are notoriously known for lacking business acumen, Shoemaker has developed the business side of medicine as much as his surgery skills.

The Center for Sight has grown in 20 years to five offices with 170 employees who see about 65,000 patients each year. The Center's modern, $8 million Sarasota office near Sarasota Memorial Hospital includes a surgery center, an eye clinic and a retail optical store. Five vans transport patients who have no other way to get to the facility.

Patients can get eye exams, glasses, treatment for glaucoma and surgery all in the same building. They can also get Botox, a facelift or a hair transplant by one of the Center's plastic surgeons.

"It is very unusual," says Derek Preese, an ophthalmology practice management consultant who lives in Utah. Preese has worked with about 500 ophthalmology practices and says he can't think of any other that offer hair transplants and cosmetic surgery.

"Some specialties may include plastic surgery around the eyes, but that's usually where it ends," says Preese. "Most practices expand by adding more doctors in their specialties."

Shoemaker acknowledges that the services he's added are unusual, but he says that from his perspective, it just made sense.

"It sounds like it shouldn't, I know," says Shoemaker. "But after I do surgery, people are seeing better and the first words out of their mouth are 'what happened to me?' They remember themselves as 10 years younger."

Declining Medicare reimbursements made providing the additional elective services, which are not covered by insurance and are paid in full by the patient, a matter of survival, Shoemaker says. Preese says ophthalmologists have taken a particularly hard hit because most cataract patients are older and covered by Medicare.

That, coupled with technology to make cataract surgery routine, has pressured doctors to do more surgeries and to do them quicker. Although it may go against the grain of what most people consider "good medicine," Preese says, cataract surgery should be done quickly.

"One of the keys to good surgery is to not leave the eye open for long," Preese says. "There's no medical downside to doing it quickly as long as you do it well." Preese has watched Shoemaker's technique at conferences and says he's "one of the best."