A few months ago, I was phone interviewing a prospective student extern from the auspicious Class of 2020. It was going very well; the student had learned in advance details about our clinic, asked intelligent questions, and anticipated and well answered many of my own.
As we wrapped up, I turned to the same closer question I have asked numerous externs and residents over the years: “What is it that you most want to gain from this experience?”
He floored me with his answer because I had never heard it put quite this way:
Previously by Dr. Brown: Remembering the life of Dr. John Keratitis
“Dr. Brown, I want to learn what kind of ocular diseases and conditions I can hold on to and manage myself, and when I need to refer. I don’t want to look stupid when I get out of school and start working with other doctors by over referring.”
Well, knock me over with a Schirmer strip, I thought, he just hit the nail on the head without smashing his own thumb!
Know what you don’t know
Over referring is not the most pressing challenge facing our profession, but it is a drag chute holding us back as we try to take off in a full sprint. I have seen many instances of it firsthand, and I when I hear CE lecturers plead with audience members to take on more medical eyecare responsibility during a red eye lecture (“Look, you can do this!), I know it is still a concern.
To be able to treat and manage ocular disease appropriately, you have to know what you don’t know; what to sweat and what not to sweat; and when to “hold ‘em” and when to “fold ‘em.”
While new ODs possess the requisite knowledge and skills to start practicing independently, they still need more patient care encounters to reliably know the difference.
It’s not just optometry. MDs, DOs, and all healthcare practitioners are in the same boat. Everyone continues to climb a steep learning curve out of the gate. The first few post-grad years are a critical time in young doctors’ lives, and the choices they make and opportunities they pursue during that period will set the course of their careers, for better or worse.
We have come a long way in the 50 years since Borish, Haffner, Eger, Wallis, and a bunch of other “mad men” wearing dark suits and skinny black ties convened in a hotel room at LaGuardia airport in 1968 and changed the course of optometry from pure vision care to mainstream healthcare profession.1
Also by Dr. Brown: How I learned to stop worrying and love tech refractions
Gain confidence by doing
But we are not fully there yet. ODs need to continue to mature and add more skills to our toolbelts and enlarge the size of our comfort zones so we can fulfill our role as optometric physicians in a world where the population is aging and the need for accessible, efficient, quality eyecare delivery systems grows more critical.
Just as family medicine physicians are being now trained to perform procedures and manage patients who were once referred immediately to specialists, so too must ODs enlarge our professional repertoire to avoid over referring and thereby reserve advanced secondary and tertiary services and resources for patients with the most critical needs.
It’s hard to overstate the role high-pathology optometric residencies play in that process. They are the “deep end of the pool,” and new ODs learn to tread water, dog paddle, and eventually swim fast and long using a variety of strokes. They develop the cognitive skills, pattern recognition, and receive the large number of “meaningful reps” needed to diagnose and treat ocular disease successfully.
This happens quickly and in concentrated fashion. By absorbing the mindset and mannerisms of experienced optometrists and ophthalmologists who have learned “what to sweat and what not to sweat,” new ODs gain confidence in their own judgements and learn the fine art of balancing humility with the confidence and swagger needed to manage patients with difficult and complex conditions.
In a less structured way, young ODs who practice in OD-MD settings straight out of school often have the same opportunities to continue learning the nuances of ocular disease management and discern the many shades of normal and abnormal.
1. Bennett I. The meeting that changed the profession. Optometry Cares: The AOA Foundation. Available at: http://www.aoafoundation.org/ohs/hindsight/the-meeting-that-changed-the-... Accessed September 19, 2019.
2. Epstein A. Off the cuff: A pathway to parity. Optometric Phys. Available at: https://www.reviewofoptometry.com/newsletter/op/optometric-physician-sep.... Accessed 9/30/19.
3. Mullen C. A unique opportunity for osteopathic health science centers to develop an innovative optometry degree program and postgraduate residency training. Charles F. Mullen: Opportunities and Challenges in Optometry and Optometric Education. Available at: https://www.charlesmullen.com/opportunity-for-osteopathy-to-develop-inno.... Accessed 10/1/ 19.