When I got out of school, I looked 15 years old. I had elderly patients leaving the practice so often, my employer actually framed my resume for people to read before they saw my face. I wore suits for the majority of my first 10 years in practice. I focused on children because they thought I was the babysitter.
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When I got out of school, I looked 15 years old. I had elderly patients leaving the practice so often, my employer actually framed my resume for people to read before they saw my face. I wore suits for the majority of my first 10 years in practice. I focused on children because they thought I was the babysitter. (How bad could I be? The light on my head was really cool.)
I had an opinion on what was best for my patients, but back then I did not strongly voice that opinion. I was more concerned with not having patients leave. I had a checklist of diagnoses that I had to identify and treat without the help of a preceptor to be comfortable. I had the luxury of being an instructor at Indiana University School of Optometry, so that list went pretty quickly. Before long, I felt comfortable with patient care in my suit or long lab coat with a huge nametag identifying me as the doctor. I held my breath and counted to three every time I was asked, “When will the doctor see me?”
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With experience comes comfort in one’s decisions and familiarity with clinical cases such that I firmly believed I was smarter than my non-eye doctor patients. Although I cannot say this about some of my engineering/physics brainiacs when discussing LASIK technology, I think we are all a step ahead of our patients despite their ability to Google symptoms on their iPhones.
I remember when my patients stopped asking how old I was or how long I had been practicing, and started saying, “You look like you are in high school, but you sound like you are 35.” I stopped wearing suits. I reveled in my wrinkles, and learned to sound like the boss lady. Instead of my staff calling the police, I called them myself. Rather than asking for someone to be fired, I fired her.
With experience, we all think faster, assess the situation more calmly, and feel better equipped to be the boss. If I have a patient who is not taking his medication as prescribed or a parent failing to patching her child as I ordered, I feel confident in directing them. If a patient overwears his contact lenses or has a history of retinal degeneration and refuses dilation, I can maturely address his concerns.
Next: We're supposed to be bossy
As doctors, we are supposed to be bossy to some extent. We tell patients when they are ready to wear contact lenses, when to take them out, when to patch, and when they stop their vision therapy. We tell them when to take their medications, when to stop them, and when they need to see another doctor, and what will happen when they do.
But often when we refer, our bossiness stops. We send patients to their physician for a physical due to headaches or to their internist to rule out diabetes. We send them to neurology for an MRI when the nerve is swollen or to a cataract surgeon to perform cataract extraction. We assume that the doctor we send them to knows more than we do about their headache or their diabetic retinopathy or their optic nerve appearance or their endpoint after phaco.
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We may write eloquent letters with our trusty EMR systems that detail our patients’ conditions, diagnoses, and treatments, but they are often let go with the thought that they are better off in someone else’s care.
We are the eye doctors. We specialize in all things ocular and those systemic conditions that affect the almighty eye. Our patients may not be better elsewhere. If you are attentive, you will probably notice when your patient’s many specialists are not communicating or may be prescribing medications that may not work well together. Or if you listen, you will learn that your patient is not being heard by other physicians.
Next: Why being bossy is better for patients
I realize that I am a fast-talking, stubborn Yankee, but I have found that being bossy is actually better for my patients. Now, there is a fine line between bossy and rude, and I implore you not cross it. But you can discuss your patient’s care with another professional without being offensive.
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You can call a cataract surgeon to whom you refer patients and ask about the glistenings you are noticing on the IOLs. A phone call to describe the appearance of the IOL, and the patient reports of subjective visual reduction, demonstration using slit lamp photography, a quick reference to current literature, and finally, an inquiry of what might that be should be an easy phone call.
You can be directly involved in the care of the patient with headaches and a blown nerve rather than just sending him to the ER. You can schedule an MRI prior to the neurologist appointment knowing if radiology finds an abnormality, staffers there will move the appointment to accommodate the newfound urgency.
You can direct a patient to avoid RK and pursue excimer treatment because you understand benefits and risks of surgery. You can discuss crosslinking for keratoconus or scleral lenses for irregular astigmatism because that is your area, and you have attended more CE on that topic than you care to recount.
The challenge is to communicate with the medical specialists while addressing the patient’s needs. If you listen, the patient’s needs may not be what you or the medical team want to address. This is the challenge I often encounter. The rheumatologist rules out arthritis, the cardiologist rules out heart problems, and the internist says the specialists cannot explain the lab results. The patient returns to you reporting no answers from them, and you are left to push them aside or figure it out. Because I love the challenge, I enjoy this development.
I challenge you to figure it out. Follow your gut when it tells you something is being missed. Look at the whole picture, and begin a dialog with the patient’s doctors. Find the etiology of lab irregularities or the source of the pain. You won’t hit the ball out of the park often-but you eventually will, and you will celebrate long afterward. The patient will celebrate with you when you were the only doctor who listened to his concerns.