Practice Management

Practice Leadership: How to Maintain Control in Unexpected Circumstances

By Cheryl G. Murphy, OD

Oct. 4, 2017

As organized and prepared as we try to be, things don’t always turn out as we expect, in life and in practice.

But that doesn’t mean a day of unplanned-for complications has to descend into chaos. The doctor, whether owner or employed associate, must remain in control, giving direction and remaining calm. We must set the tone for staff and patient behavior during unexpected situations.

Recently, we lost lights while I was doing a multifocal contact lens fitting on a patient. They had flickered a few times during my previous patient, but I didn’t think too much of it and kept working. However, there was no way to keep working when the entire office went black…or was there?

It was just before noon on a Thursday, and I was due to end my shift by 1 p.m. I had a multifocal contact lens fitting, a new patient in for a full exam with contact lens re-evaluation and a follow-up left. I was on time with appointments, and it looked like I would even leave a little early, but when we lost power, for a second I thought everyone should just walk out and reschedule.

Instead of expressing this, I confirmed from the exam room with the rest of the staff that they had lost power, too, and that all was safe. They had also lost power, and everyone was fine. I joked with my patient, who had already washed her hands, so she could put the lenses in, that I would check her outside. When she said OK to that idea, I was surprised–and happy.

Improvise a Solution
I only work half days at that practice, so I knew rescheduling her with me would mean she would have to wait another week to try the new contacts, and I didn’t want to inconvenience her by waiting. I also didn’t want her to just walk out with the lenses before assessing her vision, and making sure they fit. First, I checked the fit of the patient’s new lenses by the light of my iPhone.

Then, we then went outside. “Field trip!” I said joyfully, and the patient lightheartedly agreed. We exited the exam room, and then the building. Before we went outside, I paused behind the front desk to explain to staff that the power may only be out for a little while, and that we should stay and see if it comes back on before calling it a day and going home. I also explained this to the two patients waiting in the exam room and gauged their feelings. They said they felt safe and would prefer to wait to see me rather than rescheduling.

Outside I did an over-refraction with the multifocal contact lens patient while she looked at license plates in our parking lot, and then the leaves of trees. I enjoyed it, and so did she. It seemed almost a poetic way to practice optometry. It reminded me of those beautiful fall and spring days when professors in college used to take us outside onto the quad to give their lecture rather than keeping us stuck in the stuffy classroom.

I then had her read her iPhone and my near chart. She read 20/20 OU for near and her distance vision she said was acceptable, and that she thought she’d feel comfortable driving with them on. I had her blink while looking straight ahead at the trees in the distance while I noted the movement of the lenses on each eye with my naked eye. I had her look up to the sky to assess the movement of the lenses in up-gaze. Ultimately, all looked well, and she left with the lenses. We told her what her fees would be, and that we would call her later or tomorrow to schedule a one-week contact lens check and to take payment over the phone for the fitting. She agreed and left happy.

I consulted with staff before seeing the next two patients. The new patient was wearing his previous lenses and needed a full exam and contact lens re-evaluation, and the other person waiting was an existing patient who was just there for a follow-up appointment. I knew with a new patient I would want to gather information properly and check his eye health thoroughly, and for that, I would need my slit lamp and power. I asked him if he could wait while I took the follow-up appointment, and that if the electricity was back on by that point, I’d be happy to see him. If not, I told him I would ask that he reschedule. He also was calm and agreed to wait longer, knowing that if the power didn’t return he would have to reschedule. I thanked him, and took care of the patient there for a follow-up.

No outdoor exam room this time. I brought him into the darkened exam room by the light of my iPhone like an usher seats a patron in a movie theater. This practice happens to be located on the first floor of an old Victorian house, so I did have a window in the room, but it had been covered up for years with not only blinds, but also black fabric to make the right lighting required for an exam room under normal circumstances. I opened the blinds and took off the black fabric from the window’s frame.

After examining the patient’s resolving hordeolum with my direct ophthalmoscope (thank goodness it was charged), and writing up the chart by the light of my newly unveiled window, I was about to happily dismiss another happy patient when the lights came back on. The office cheered. The new patient in the waiting room had told us that his wife texted him from blocks away and said the power had been out there, too, and was now back on.

I introduced myself to the new patient, making a joke that “I never thought of light as such a luxury before,” and he again thanked me for not canceling his appointment.

It would have been easy for me to cancel the day, and under slightly different circumstances, maybe I would have or should have. However, I assessed the situation, gauged the mood and safety of the patients and staff, and remained calm and in charge. In doing so, I not only collected those exam fees for the day, I also made an unforgettable impression on my patients and saved them the inconvenience of having to be rescheduled for me next week.

Take Charge & Retain Patients
It would have been easy for the multifocal patient to get her fitting elsewhere, or the new patient to receive a poor impression of our office and never return, or the follow-up to think we didn’t cared enough to check him again. Each patient is important to me. I never want to put anyone in harm’s way, but I saw no danger in continuing to examine patients as long as I could properly assess and care for them at the high standards to which I hold myself.

As optometrists, our jobs are pretty amazing. We get to help people and solve (or at least offer solutions for) most problems for most patients by the end of their examination. It made me feel good to help those three people on that day and to not cancel the appointment book, or allow my employer’s prospective profits for the day to fizzle out.

Even if you are an employed doctor, staff look to you to set the tone of the office for that shift. So step up, take charge, show patients (and your employer) you care about them and that you value being chosen by them to provide care. Remaining calm and thinking outside the box can help you to handle some dark situations.

Have you ever experienced a glitch at work or unexpected circumstance? How did you handle it? What did you do to take charge of the situation? How did staff react? What clues did patients give off that led you to know how they were feeling, and how did that modify the way you handled things? What rewards did you reap for a job well done?

 

Cheryl G. Murphy, OD, practices in Glen Cove, Syosset and Lake Ronkonkoma, N.Y. You can like her on Facebook or follow her on Twitter @murphyod. To contact her: murphyc2020@gmail.com.

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