By Jennifer Jabaley, OD
Oct. 21, 2015
Every October, I get asked to speak about optometryto high school students at Career Day. And every year, eager teenagers approach me with wide, innocent eyes and say, “Optometry is a great career because it’s a prestigious job with great pay, but low stress, nine to five, with easy contact lens and glasses patients, right?”
And I smile. “Well, most of the time….” But as I’m writing this, we’ve just had an eclipse and a blood moon, and not that I’m overly superstitious or mystical, or whatever you want to call it, but I am in the firm corner of people who believe there is a correlation between lunar activity and human behavior. Which makes me want to grab these students by the sleeve and say, “Want to shadow me for a day? See all the bizarre cases and highly demanding patients that land in my chair? Because it’s not all simple myopes, kid.”
Here arethe patients you don’t hear about when you consider optometry as a career–along with three strategies to effectively deal with them.
The “It Ain’t Rare If It’s In Your Chair” Patient
Fifteen years ago, sitting in pathology class, slides of bizarre fundus photos on display, my friends and I would joke, “We’ll never see that after the test.” Oh, how those words have come back to haunt me. I saw iris bombe angle closure, choroidal melanoma and ocular toxocariasis…all within my first six months of practice.
Of course, the majority of pathology that optometrists see on a routine basis includes expected conditions such as glaucoma, macular degeneration and diabetic retinopathy, all things that we are well educated on and prepared to manage. But there is a documented increased incidence of once relatively rare ocular conditions showing up in our exam rooms. That means we can’t spend our days flying on autopilot.
The “I Googled It” Patient
I love that we live in an age where the internet allows us and our patients to research and understand medical conditions, medication and treatment options. Knowledge is a good thing. But reading one article doesn’t make an expert, and unfortunately, there is a lot of inaccurate information out there. I know I’m not the only one who spends a ton of valuable time talking to patients about misinformation, or suggesting better web sites with reliable material.
The “I Don’t Need to Come In” Patient
Because patients are often using the internet to self-diagnose, they often feel like they now have the tools to know the adequate treatment. I’ve fielded numerous phone calls from patients who say, “Oh, I’ve had this before, I just need that antibiotic, or that steroid, or you just need to bump my contact power by a click.”
Well, until we start video-conferencing, and our computer monitors have built-in biomicroscopes and phoropters to examine the eyes, patients still need to make an appointment and physically be seen.
The “My Contacts Come in a Blue Box” Patient
Many times a new patient will tell me they love their contacts and don’t want to switch brands. But when I ask them what they are wearing, they give me a blank stare and describe the packaging or make random guesses at what brand might sound familiar. There are over a hundred different contact lens options. I want to keep my patients happy, but without previous records and a lack of a crystal ball, sometimes, it’s just not possible.
The “Oh, One More Thing” Patient
It happens all the time. The refraction is done, the ocular examination is done, I’m heading for the door and then it comes:“Oh, one more thing…Sometimes I see double when I’m reading…Sometimes there’s a weird starburst in my vision…Sometimes I get a sharp shooting pain in my eye that lasts a second….”
Really? When a patient brings up a concern after the entire exam is finished, after the chart is filled out, it’s a major hassle. But it happens. All the time. And it derails the day.
So, no, it’s not that simple, I want to tell these misinformed high school-want-to-be-optometrists, and everyone else who thinks our job is all about, “which is better, one or two.” Optometry is often filled with unexpected clinical cases and demanding or difficult patients. These are things they don’t teach us about in school. With practice and patience, we have to develop our own strategies for managing adversity. Here is the blue print I use to manage these patients:
Strategy:Restate What the Patient Says
In my mind, I often imagine that every patient is wearing an invisible “I want to feel important” sign. Some patients show their need for validation by letting you know how much they know,whether it’s their self-diagnosis or their broad understanding of all ocular conditions on WebMD. Some patients need to feel important by having an audience to listen to their story of every illness, or to answer every question they have.
Often, when the clock is ticking, and I know I have patients waiting and I have the desire to speed things along, I have to take a moment and ask myself, would my sister, who has no medical background or expertise, be satisfied with this interaction? Or would she feel like she had been run through an assembly line doctor visit? Simply restating what the patient has said, and acknowledging their feelings, often goes a long way in bridging communication.
Strategy: Set Boundaries
That said, all optometrists have time constraints, and demanding patients can quickly impact our schedule. If talking about an eye injury leads to an elbow pain, and eventually, a story about every part of the patient’s body in unrelated medical issues dating back to 1952, then it is entirely appropriate to interrupt and guide the conversation back to the eye exam.
It is our role as primary care eye physicians to maintain an exam that is appropriate to our specialty. We can engage in conversational banter, but we should not hesitate to set up boundaries to maintain a productive schedule.
Additionally, effectively communicate office policies and standards to patients. For example, medication refills can be provided via telephone call, but new prescriptions cannot. Once they realize you will not bend on certain protocol, hopefully, patients will be willing to follow standard procedures.
Strategy: Refer as Needed
If we have a rare condition that we are uncomfortable treating, or a familiar condition that is not responding as expected, or a patient who is questioning our care and injecting their own ideas into the treatment plan, we have the option to refer. Sometimes all we need to say is that the situation is simply beyond the scope of our comfort or care.
Last spring, one of the former high school students I had spoken to at Career Day, who is now a biology major in college, wanted to shadow me for a day at the office during his spring break. That morning we had a ton of pathology and a plethora of patients who drove us a bit bananas. It might have been a full moon. By lunchtime, the student was flushed in the face and a little bit winded. “Wow,” he said. “I didn’t realize it was going to be like this.”
I smiled. “It never is, kid.” But with time, and an arsenal of tools like effective communication, humor, a positive attitude and appropriate boundaries, you may find that optometry is a great career.
What kinds of patients do you find most challenging? What strategies do you find most effective in managing these patients?
Jennifer Jabaley, OD, is a partner with Jabaley Eye Care in Blue Ridge, Ga. To contact her: jabaleyjennifer@yahoo.com
