Category: Wellness

Seeing patients means establishing a relationship with them, getting to know them, becoming invested in their eyes and health and over time, their lives. You will share good times, not as good times, major milestones, and more, all while doing your job and duty of making sure they see to their fullest potential and their eyes are taken care of.

That being said, remember, it is your job and duty to educate your patients on what is their best interest for maintaining good ocular health and vision.

Educate.

Mentor.

Be a resource if they have questions.

If applicable, lead and demonstrate by example.

But do not get caught into caring more for your patients’ eyes and health more than they are willing to care for themselves.

Yes, some patients will require you to advocate for them. For example, there will be plenty of individuals who have limited funding for glasses or optical devices. Your finding alternative resources for them will continue to solidify your relationship with them.

Some patients will hear your recommendations for different treatments or care with other specialists and defer or decline. As an example, one of my students was telling me of an elderly patient who they recommended cataract surgery for. That patient declined the recommendation because he wanted the money to go towards his family instead, raising his grandkids, explaining that he’s already lived a good life and he can just make do.

One of the patients I saw during residency had severe NPDR and CSME in one eye and I was recommending he see the ophthalmologist for injections. He refused because he’d had injections in the other eye already and shortly afterward lost vision. He just wanted new glasses and could not understand that glasses wouldn’t help. He left furious when I said I couldn’t help him the way he wanted – he’d already seen all the other providers in the department and we had all said the same thing. I’ll also mention he was, by this point, already a double leg amputee from poor diabetes control. And he was only in his early 50s. One of my mentors casually mentioned that this patient probably didn’t have good chances of living another 5 years considering his health status. That hit me hard.

I’ve given a recent example of a patient coming in with hypertensive crisis who wasn’t entirely convinced of the need to go to the emergency room or ophthalmology same day. A couple weeks ago, we had a different patient coming in with a painful eye that was already blind but who had a new corneal ulcer. Her caretaker wasn’t entirely convinced they needed to go right away for ophthalmology follow up and management because, “What’s the point? [The patient] can’t see out of that eye anyway”.

There will be times when you’ll want to do everything you can for your patients. Short of physically driving your patients to the emergency department, purchasing glasses for your patients out of your own pocket, joining them for all the recommended exercise sessions or dietary classes to help  manage their overall health – in the end, the patients will have to make their own informed decisions to follow and take your advice or not.

And you will need to take care of your own mental and emotional health and well-being by making sure you don’t ‘take these patients’ home’ with you energetically at the end of the day. In the beginning of my career, that was hard. I was super invested in my patients and wanted to make sure I was doing everything possible for them. But after months and years of hearing how these patients never ended up going to see their doctors or ophthalmologists, how they habitually forgot to take their eye drops or systemic medicines… I learned that I had to step back from being that doctor who knew what was best for my patients to understanding that my patients had their own lives they had to deal with and sometimes, whatever I had to say wasn’t the priority for them.

It took time to realize that and come to grips with understanding it, but I want to share these thoughts with you too so you won’t find yourself worrying and losing sleep over what could have been done differently, etc. Be thankful for the patients who listen to you – the majority will. And be patient with those who don’t – everyone has a choice, just like you.

One of the questions I love to ask my students is what their history is coming into the profession. What made them decide to pursue optometry and go through more years of schooling?

The stories have varied, of course. For some, it was a direct relative or close family friend who was in the field that influenced them to consider it. For others, it was having their own eyes examined, getting glasses, and seeing the world clearly for the first time that left such a lasting impression that it inspired them. For many, myself included, we knew we wanted to be a doctor and somehow, by a little trial and error, shadowing and volunteering and working, we found optometry as the best fit for us.

So that’s good for the initial dive in. Is it enough for the long haul? Is your why a good enough reason for you to see yourself doing this every day for the rest of your working life?

Let me be honest with you – for me, being an optometrist just for the sake of that, for seeing patients, working on the rez with some amazing people – it wasn’t enough for me. After a year of residency and two years in the four corners area, I got burnt out. And I didn’t even realize it until I saw one of my elderly grandmother patients who I love – she was thanking me and giving me a hug goodbye (different world back then pre-COVID) and I felt… empty.

The interaction was still warm and friendly. I was still smiling as I walked her out of the office room, but in that moment, I realized my joy for my work was gone.

And I did what any other person would do in that moment. I shook it off and kept working and going at it, thinking this was a fluke. I had a job after all doing pretty easy work in a stunning location.

But then a couple months later, it happened again. Another grandmother patient. Another hug. Another feeling of emptiness, and this one harder to shake off.

Suddenly, the idea of a future working the rest of my days on the rez didn’t seem right anymore. Suddenly, I was realizing that my day to day work and routine was not as fulfilling anymore.

I knew something had to change but I didn’t know what that would mean. I still had bills to pay and a good student loan to work on.

Coincidentally, at the time I was hitting my burnout, things at home were changing and I had to move back to California to be with family. Giving my resignation letter and moving back with no job lined up has to be one of the most stressful things ever, but there it was.

To keep things brief (because I know I could definitely go on longer about this – maybe for another blog post), it took a few years for me to fully fall back in love with optometry. I had to give myself grace as I ‘tried out’ different practices when I filled in, figuring out what I liked and what I didn’t like, what fit and what didn’t fit. And in the end, what fit the best and what gave me the greatest joy was going back to school and being a clinical instructor, helping the next generation of optometrists figure out how they were going to be doctors for their patients.

My ‘why’ is what motivates me in the day to day now, what helps me wake up every day and keeps me going on the days we get slammed with patients and interesting cases. It’s my reason for sharing so many of my stories, writing these blog posts and books – I want to make sure that the doctors who come after me are more than just ready for a 9 to 5 job, but that they thrive in all aspects of their lives too.

Coaches out there will always ask you, what’s your why, what’s your reason for X, Y, or Z, and now I can understand why it’s important. I didn’t get to my why until I was in my 30s, which was fine for me because I also got to figure out what was important to me and what wasn’t along the way.

Give yourself a reason to look forward to each and every day – not just the special occasions that come and go. But also give yourself time to figure out what that reason is, modifying as needed until you find the thing that really makes sense for you. Cheers!

Strangely, I’ve had more instances in the last month where I’ve had to deal with more urgent or semi-urgent conditions that require extra handling and management. Usually, I get these cases every few months but in just the last few weeks, we’ve dealt with a macula-on RD, a hypertensive crisis (the patient was totally asymptomatic, yet his blood pressure was 210/162 when we read it), a kid with super angry looking marginal keratitis that had been cooking for at least a month before being seen, and a couple more things that definitely put me on a good adrenaline rush as I tried to coordinate the best care possible for these patients.

How do you stay calm in the middle of the crazy storm? Thankfully, the instances where you’ll have to deal with patient emergencies is likely not going to happen frequently, but there will be other times where things are just piling up and the stress keeps building around you and you find yourself needing to face it or be swept into the crazy yourself.

I don’t know about you, but engaging in a highly charged environment with energy that matches it means I’m going to be jumping in with irrational emotions and thoughts that will mean someone or something is going to get hurt, something’s going to be misunderstood or lost in translation, and plenty can and often does go wrong because we’ve made rash judgements and decisions.

So rather than jumping in right away unprepared, I take just a couple moments to pause and focus on my breath. Now, I’ve done a lot of meditation and yoga practice so I find that it’s not that hard for me to focus on my breathing, but this may be new to you. I would invite you to check on your breathing now as you read this. When you breathe in, do you feel any sensations? What part of your body is moving when you breathe? Do you breathe into your chest or deeper so that your stomach moves too?

One of the first things that happen physiologically when we’re under acute stress is our breathing goes shallow. As a result, our brains don’t get as much oxygen in the short term to adequately process what’s going on. We’re instead going off on instinct on how to best preserve ourselves in this highly charged situation. That’s helpful when something’s about to attack you. It’s not as helpful when you have to take care of someone else’s immediate health needs.

Even now, when my students come to me for consultations and they’re a bit flustered because their data doesn’t make sense or patients seem upset or something has shaken them out of their routine, I will stop the student and tell them to breathe. And I will breathe with the student a couple times just to get them more centered before letting them continue.

Those couple moments can be enough to reset the mind and make it aware that things are ok, there is no imminent danger, and now you can think a little bit more objectively about the situation at hand. If I’m in the middle of a high tension environment and I can’t step outside to collect myself, I do try to keep part of my focus engaged on my breathing even then, just to help  me stay more calm and grounded. I wrote more about breathing and its relation to stress in my book, Remembering to Breathe – there’s helpful information in there on how to build and maintain and healthy work/study-life balance.

Taking a few breaths for yourself is just as important as what you do next afterward. Get in the habit of periodically checking in on your breath throughout the day. Set your alarm to go off every hour for the next couple days as a reminder to check in on your breathing. Even if you don’t regularly practice meditation (and I don’t anymore, just to let you know), this practice of paying attention to your breath can be the way to begin practicing mindfulness, which is a skill that can translate into other areas of life.

Happy (deep) breathing.

As you know, there are many different factors that contribute to your wellness. There is a physical component, environmental component, financial, intellectual, and more. Today though, let’s address for a few moments your emotional well-being.

Today, right now, what is the number one top stressor in your life? Quickly name the first thing that comes to your mind. Don’t think about this hard. Don’t justify or qualify your thoughts. Simply name it.

Name it and immediately see what emotions come up. Take a few moments here and admit how it feels to have this stress hanging over you. Is there fear? What about anger? Hopelessness? Shame? Guilt?

All of the above?

It is not uncommon  for us to have stress in our lives. Right now, as a student clinician, you have a lot to take in in terms of education. You need to pass your classes and boards and retain all that information for the future. You need to practice your examination skills and techniques and hone clinical thinking. You need to see patients in some very different clinics and learn how to give appropriate and personalized care. You need to deal with different professor and attending doctor personalities and expectations. And all of this is just in terms of your life as a student.

Outside of all that, there’s making sure you stay healthy by exercising and eating healthy. There’s making sure you find your balance to make sure you don’t feel like you’re cutting off the ‘outside world’ and missing out on important events with loved ones. There’s making sure you have adequate money to cover all of your day to day essentials plus more. And then there’s the environment around you – how do you generally feel? What about what’s going on nearby or in the world around you?

There may be stress as related to events passed – recent traumas, childhood traumas, ancestral or karmic too. And there are also the worries and stressed thinking about the future.

Whatever it is, whatever you have named, now that you have sat with how you feel – what do you do next?

You could start figuring out what to do about your stress. Break down the worry and figure out step by step how to remove the stress. That could mean making a schedule to study for exams. Or doing some gentle stretches to work out the tension in your back or shoulders after studying so long. It could mean creating a budge if money seems like it’s going to be tight in the next few weeks.

You could ignore the problem for now and do something else that’s perhaps more pressing and come back to this issue later. That’s fine too, just make sure you do go back to it before it becomes an even bigger stressor and starts spilling into other areas of your life.

What I would invite you to do is to seek out the underlying cause for your stress and dissect it, study it, analyze it until you see what it is about the situation, personal, thin that makes you stressed. That could mean journaling. That could mean taking a hike and pondering. That could mean talking to a counselor. And it all means being honest with yourself and being open to what comes up during these sessions.

I have been on a personal healing journey for most of my life, even before I consciously knew or understood what I was doing. However, after going through burnout time and time and time again, I knew something had to change. In 2012, I started looking at more alternative type therapies of healing – things like reiki and crystals, yoga and meditation. After improving some areas of my life, I knew I wanted to go deeper and asked for my next guide who could help me. In 2017, I started working with a coach who’s helped me uncover more than I could have ever imagined, and I continue to be grateful for our work together today.

It is not my place to say you should or you have to seek out a coach or mentor or therapist, but I do want you to seek help if you feel like you can’t do this on your own. There is no shame in it. I ask only that you consider this another option for you, especially if you are overwhelmed or burnt out. Having someone offer unbiased perspectives and practical tools to help you get to the other side of stress can make a world of difference.

Whatever stress is there that has come up for you today, honor it for the message it is bringing you. And wherever you are on your journey, I honor you for being here. Let me know if there’s anything I can do to help make your path easier for you.