Ten Tips to Avoiding Pitfalls as a New Doctor

Follow these recommendations to avoid common mistakes and confidently practice optometry right out of school.

By Lawrence Yu, OD

Every summer, thousands of new optometrists, just like you, enter the workforce. For this edition of “ODs in Training,” Dr. Lawrence Yu provides his perspective on how to best manage the transition into an experienced clinician.

—Jillian F. Meadows, OD, MS, FAAO

 

You have a brand new diploma and the most up-to-date optometric education. You have the best training and technical skills to diagnose and manage disease, fit specialty contact lenses, manage binocularity deficiencies, and prevent blindness. However, you will soon learn that, in real life, optometry revolves around staff management, insurance coverage, and business principles. An outstanding clinical education does not always carry over into real-life success. This article presents 10 tips that can help you avoid pitfalls you may encounter on your path from new doctor to experienced practitioner.

Embrace the trial frame.

Big refractive changes are scary because vision is a crucial component of everyone’s life. Although you know that your new refraction will provide clearer vision than the patient’s habitual glasses, you cannot predict how your patient’s brain will like it. With large changes, always confirm enhanced vision and visual comfort with a trial frame of the new prescription. Otherwise you will be faced with the new doctor’s worst nightmare appointment: prescription check.

Ask about occupation.

Work accounts for at least 50% of most people’s waking life. Find out what your patients do for a living, and you will find ways to improve their daily lives. If you do not know who your patient is as a person, then you are just making recommendations for a set of eyeballs instead of a lifestyle. Many optical recommendations are based on lifestyle, such as sports sunglasses, computer glasses, or glasses for small, intricate model-making.

Don’t rock the boat!

As a new doctor, you have confidence that your refraction will be the best prescription the patient has ever had. However, you are prescribing glasses, not merely refracting. Do not force a large visual change on a patient who is already satisfied with his or her habitual glasses and only wants a little enhancement. Remember, you are prescribing for a person and a lifestyle.

Do not overpromise with multifocal contacts.

The success of multifocal contacts comes from properly set patient expectations, not from good visual acuity. A patient who sees 20/25 may be disappointed if you promised perfect clarity near and far. A patient who sees 20/30 may be extremely happy because you promised functional vision that may be a little hazy for fine print but adequate for most daily activities. Create your own success by setting the right expectations.

Always explain what it will be like with progressive lenses.

Young (not yet presbyopic) doctors may not fully understand what wearing progressive glasses is like for patients. As many a nonadapting patient has explained to me, “It sucks, and I can’t see anything.” What those patients mean to say is that they cannot see anything without moving their heads to point straight at fixation. It is easy to simply explain to the patient that he is older and requires progressives now, but you need to take the next step, too. Explain what it will be like wearing progressives. It is a larger lifestyle change than most nonpresbyopic people would expect.

6 Do not assume DED does not exist in an asymptomatic patient.

Testing for DED is clinically easy. It involves tests such as measuring tear breakup time and tear meniscus height, and performing meibomian gland expression. If you do these tests on all of your patients, you will discover DED in many asymptomatic patients. This new diagnosis will allow you to make appropriate recommendations, such as daily contact lenses instead of monthlies, visual hygiene recommendations for those who use computer screens at work, and preventive care with artificial tears.

Always review medications verbally with the patient.

For a variety of reasons, patients seem to like leaving the medication area of the welcome form blank. Save yourself from frustration and ask about medications with each patient. Otherwise you will learn that your patient is taking metformin only as the examination is already ending. Reviewing medications at the beginning of the examination allows you to address potential ocular side effects from systemic medications, such as dryness from antihistamines and birth control medications or blurry near vision from antidepressants.

Google it before your patient does!

Are you looking to introduce new services into your practice, such as vision therapy, orthokeratology, or glaucoma care? The hardest part will not be the logistics of setting up fees or procedures for care. Rather, it will be addressing misinformation that patients find on the Internet when they go home after you have offered them care. Instead of taking patient phone calls to address follow-up questions, simply do your research ahead of time and incorporate the debunking of myths about vision therapy, glaucoma, or orthokeratology into your patient education. This will lead to greater interest in your new services and fewer follow-up phone calls.

Bring the financial decision-maker into the examination room with the patient.

Successful health care involves patient education, patient cooperation, and the patient’s money. As a practitioner, you have to convince patients to spend money on their vision and ocular health. If the patient before you does not make any financial decisions in the household, then you will essentially need to repeat all of your patient education to whoever is the boss. Include all household members in any financial discussions, if possible, to smooth out the decision-making process.

Lastly, be confident.

You are a new doctor with the most up-to-date optometric education in the profession. Exude confidence in your interpersonal communication because patients are looking for signs of uncertainty in new and young doctors. Dress to impress, and speak with technique. Avoid using phrasing like “maybe” and “not sure,” and try to avoid saying “um.” Speak naturally but also professionally. New doctors seem to be held to higher standards simply because patients are unsure of the quality of care they can provide. Be confident, take care of the patient well, and you will have that patient for life.

The path from new doctor to experienced doctor will have numerous pitfalls. Practicing optometry means learning from your patients and your mistakes. Use the tips presented above to avoid common pitfalls and smooth your transition from the new doctor with a great clinical education to the superstar optometrist who can confidently provide care and educate patients on their visual solutions. n

Lawrence Yu, OD
• In private practice at South Bay Optometry and Two Trees Optometry in California
• (415) 312-7532; lawrenceyuod@gmail.com