The transition from full-time student to new optometrist and “boss” can be an anxiety inducing experience for anyone.
Even practicing optometry as an employee often comes with the responsibilities of a boss or authoritative figure: directing technicians and other employees.
Providing care to older patients, which is the majority of patients when you first start off as a new optometrist, can present challenges with preconceived stigmas.
Everyone will go through this transition and through tough situations with patients and staff.
I work part time as an employee for a private practice and part time as an independent contractor with a practice subcontracted with Lenscrafters.
While I have had numerous good reviews and positive feedback from staff and patients, I have had some negative reviews and tough talks with superiors and staff.
The first thing to remember is that as humans, we tend to remember and recall negative experiences more vividly than positive ones. I keep positive patient reviews at each of my practices to revisit when needed to help put me in a better mood and remind myself of why I chose to become an optometrist.
When you get a negative review from a patient, it is sometimes hard not to let your anger or emotions immediately get the best of you. It is important to know that you will not make every patient you see happy. You do everything in the best interest of your patients, but patients do not understand the complexity of our decisions and not all personalities mesh together.
For example, I had a middle-aged, female patient who came in saying her contacts were not as comfortable as they used to be, but she didn’t like wearing glasses and her back-up glasses were old. She had severe GPC and I told her she needed to be out of contacts for at least two weeks while we treated the condition. I also told her if we don’t treat the underlying problem (monthly replacements, over wearing contacts, using multi-purpose cleaning solutions etc) that this problem could re-occur.
She happened to be an existing patient with the owner of the private practice I work for and complained about her exam with my boss. After discussing the exam with my boss, she offered some tips on my approach to dealing with patients. I have a very direct approach where I say this is what I’m seeing, this is what we need to do to fix it.
Some patients do not like being told what to do, especially not from a young doctor or new optometrist, and thus need to be approached a little differently.
She recommended showing more empathy for patients and working in more pleasantries like please and thank you.
A better way for me to have handled the situation would have been to relate to her and empathize with the fact that she liked her contacts lenses and that it would be difficult to be out of contacts for two weeks. Using the words “we” rather than “I” makes the patient feel like they have a say in the care of their eyes:
“We should consider switching to a different type of contact lens in order to reduce the chance that this happens again” rather than “I am going to switch you to a daily replacement contact lens so we don’t have to deal with this again”.
As a student, I would say that 99% of people were very appreciative of my service and there were only a small handful of patients that said they didn’t want an “intern” performing their exam.
To break through to patients like these, or all patients for that matter, it is very important to gain their trust.
They will be faithful patients and will be more compliant with your treatments if you do. I believe showing confidence during the exam and in your decisions is an important factor for gaining the trust of your patients; however, be honest, and when you don’t know the answer to a question, admit it.
You can say something like: “That is an excellent question, and to be honest with you I do not know the answer. Let me do some research and I will get back to you.”
The same review of studies declared that: “Sixty-three percent of studies that reviewed the actual performance of doctors in a clinical setting found that older doctors were more likely to order unnecessary tests, fail to order necessary tests, or fail to counsel patients appropriately on preventive health strategies.”¹
While confidence is important, it is a double-edged sword. Too much confidence and you may come-off as arrogant and patients may perceive you as speaking down to them.
A boss and mentor had a talk with me and offered his advice on this occurrence. He summarized that as optometrists, we are still the direct primary care providers for eye health and that many patients expect a very warm, humble, friendly, talkative bedside manner. A surgeon can get away with short, brief, and sometimes cold patient encounters, but in the view of the general public, optometrists are still expected to spend extra time talking with the patient, answering questions, and building a professional relationship.
Another big issue that may cause stress and can impact patient and staff relations is time management and scheduling.
You are expected to be able to see 2-3 patients per hour in most settings and sometimes even more.
This is a big transition from the one patient every two hours while in school. It is important to know which tests have to be done now, which need to be done later, and which are not needed at all.
One situation I struggled with was trying to do more than what was possible in the time period allotted.
If you have a patient that ends up needing a cycloplegic exam 10 minutes into your 30 minute exam, don’t hesitate to have them back for that. If a refraction ends up revealing the need for prism, focus on that and have the patient return for the dilation or health check if time doesn’t permit it the same day.
Extra testing such as OCT, pachymetry, photos etc. and dry eye testing are often better seen at a follow-up appointment.
Asking any established doctor what the hardest part of their job is and you will hear “managing and dealing with staff” as a top answer.
Technicians, scribes, and opticians are all crucial for a successful optometry practice.
Technicians, in many instances, spend more direct time with patients than doctors do. There is a wide range of capabilities and knowledge levels of staff, but you always need to remember that they had much different training than you had. Often time technicians were taught by other technicians and have no formal training or assessment of skills.
Dealing with staff mistakes can be touchy situations.
Always remember to praise in public and “punish” in private. When you praise, make sure it is both sincere and specific. It is a well known tactic to start with praise and appreciation before starting a disciplinary discussion. You may even want to talk about your own mistakes first in order to gain the respect of your staff member.
When you “punish”, make sure to never criticize or hurt someone’s pride or intelligence. Call attention to your staffs’ mistakes indirectly and get rid of the word ‘but’ from your vocab. For example, “I appreciate that you entered the contact lens information into the chart. I only had to input the the replacement schedule,” instead of “I appreciate that you put in the contact lens info, BUT you forgot to input the replacement schedule”.
Make sure to listen empathetically to your staff just as you would your patients and hear their side of the story.
Give as much feedback as needed per situation in order for your staff member to understand what was wrong and what needs to be done.
Encourage the staff member to come up with the correct answer or solution instead of directly commanding or telling them. Have the staff member repeat what was instructed or asked in his/her own words to ensure understanding by both parties. Reading “How to Win Friends & Influence People” by Dale Carnegie can give you some useful tools to use when dealing with staff and patients.
Take time and reflect on your performance and stress levels at work and incorporate strategies to help enhance patient experiences and staff interactions. Finding more experienced clinicians and mentors can be helpful when presented with the challenges of transitioning from student to doctor.
Lastly, remind yourself often the reasons why you chose optometry and always strive to be better each day!
Palmer B. Is It Better To See a Younger Doctor or an Older Doctor? Slate. December 2012. http://www.slate.com/articles/health_and_science/explainer/2012/12/are_younger_doctors_better_should_old_doctors_be_tested_for_lack_of_competence.html. Accessed May 4, 2017.