Category: Tips

One of the simplest things I did as a student clinician was keep a patient log. Starting with the first patient I saw on my own, I kept track of certain facts about each patient – refractive error, best visual acuity, final prescription, ocular health findings, and – most importantly – any interesting pearls to take away from each patient.

Every patient, especially in the beginning of your clinical career, should have at least one thing you haven’t encountered before or have something that you didn’t understand. Those first few months, there should be a lot of “firsts”.

My first patient ever was a middle aged woman who needed to update her multi-focals. My attending and I spoke about the first instinct of just increasing an add to address her near blur as opposed to going over multi-focal designs, work environment and lighting and lifestyle needs to make sure her glasses were appropriately made. I have since had to adjust prescriptions for dental hygienists with decreased working distances, violin players who perform in in symphonies and need to see both the conductor in the distance and their sheet music up close, office workers who are on the computer long hours out of the day using multiple screens, and elderly patients who still sew and knit by hand.

I remember a male in his 40s, refracting one eye to an easy 20/20 but not the other eye. I did retinoscopy and refraction 3 times trying to get him to see better before moving on. After dilation, my attending took one look and ended up taking pictures – it turned out to be my first time seeing central serous retinopathy in person, explaining why this patient could not be refracted better than 20/60 in that other eye.

I remember a patient who had a moderately high myopic prescription who came in complaining that her vision was blurry with her new glasses. After checking their vision and refraction again, I found no change to the prescription. It wasn’t until another attending asked how the glasses were sitting on her face and demonstrated how adjusting the vertex distance that I realized how much of an impact that small detail could make because she was suddenly able to see much better and things seemed less distorted around her.

I wrote notes on how different doctors came up with a final prescription if an incoming visual acuity did not match refraction results. I wrote notes on how different doctors treated and managed their glaucoma patients. There were notes on how different types of urgent care patients were managed.

All of that went into a small notebook that I continued to add to until graduation, and then I hung onto it for a few more years afterwards even as a new doctor. It was always interesting to see what pearls I could take away.

Keeping a log is extra work, I know, but the ability to look back and see what you did for one patient can truly help you develop an understanding of how you can manage something similar when you see it again later. As an attending myself, I know I have spoken to more than one student about the benefits I got from it. One of them took it a step further and kept his log on google drive and then shared access with his attendings so we could give added input too for his patients. I thought this was brilliant – even if we couldn’t always go in depth about every single patient encounter, there were at least takeaway points from both his side and the doctors’ side for the student to review afterward.

Keep a log. In the end, it will also be a written testament of how much your clinical thinking has developed and how you’ve grown as a clinician in just two years.

My third year summer, I had an attending who charged his clinicians with bringing something to personalize their exam rooms. He said that patients will often remember and go back to their doctors that they could make a connection with, and personal touches in the exam space was one way to help that. So that summer, I brought in a photo of my family that we had taken at Disney World and placed it on my already crowded countertops every day I worked with that attending.

Not one of my patients then commented on that picture, but the idea of making my space welcoming for myself and my patients stuck with me since.

I haven’t talked about bringing pictures or mementos to clinic to my clinicians, but I have commented here and there on the importance of exam room image. It’s one thing for a clinician and doctor to look well-kept and presentable to patients. It’s another thing when multiple of my attendings that third year actually spoke of how the first impression of an exam room could help foster student-patient interactions by instilling confidence in yourself – or not. You can be the best clinician in the world, but if your room looks like a mess with paper towels, used sodium fluorescein strips, and trial lenses all over the space, many of your patients will be put off and consider seeking their eyecare needs elsewhere.

Now when I see patients, I generally keep the desktop areas clear. What equipment is out (usually just my transilluminator, retinoscope, pinhole occluder, near card, and BIO) has its own designated space and I put things away right after each use. I leave all my other equipment in a drawer to pull out as needed. If I have to leave a patient momentarily in the exam room. I bring the room lights back up and make sure the patient chair is all the way down and slit lamps and chairs are all out of the way of the patient’s access to the door. You want to ensure your patient can easily exit in case an emergency occurs.

I know of doctors who, at their private practices, have painted their rooms specific colors to hep elicit a calming effect on patients. If you know of feng shui, then you’ll know that a lot of red colors and tones tend to bring out more aggression and anger – probably not the best emotion you want to evoke during exams.

The idea of being mindful of your work space is part of a greater overall consciousness of making your space your own and making it work for you. Since I have a desk I typically work at that’s not an exam room, I Have continued to keep the practice of keeping my space mostly clear of paperwork and everything put away in its place until needed, including my laptop and phone. My only ‘decor’ are two plants and a turtle a couple of my students have gifted to me in the past, which bring me joy every time I look at them. All of this helps keep my focus on mentoring clinicians and taking care of my patients rather than being distracted by an unkept space.

I keep this mentality at home too in my office. Whenever I sit down there, I always feel inspired to work and write and create because my space is light and clear and inviting. Most of the time, I’ll work in silence, because I’ve learned that’s how I work best, minimizing even sound distractions especially if I’m studying or writing. If I’m doing something more creative though, then the music will be on to help keep my mood energetic and happy.

Wherever you are, try to be mindful of the space around you and consciously make an effort to make it conducive to your study and work needs, for yourself and for those who will be entering your space and interacting with you.

I was super frustrated when I was taking my biochem class in undergrad. It seemed like no matter how hard I tried to memorize these metabolic pathways, I just couldn’t get it down. I was in a study group with two of my friends and classmates and although they were trying their best to break it down for me, it still wasn’t making any sense.

A few days before my that biochem final, it finally hit me. My way of studying for my classes needed to change. Memorizing for the sake of memorizing rather than understanding was not going to work anymore. I was already on course to fail the class and I was getting disheartened.

As I sat in my room, studying on my own, I found myself staring and staring at my notes trying to make sense until finally, it clicked. It was a subtle shift for me but one that impacted the way I studied after that – I realized that if I made a story out of the Krebs cycle and whatever else we were covering that quarter, it suddenly made sense. Compounds could be modified only in a specific chain reaction in order to achieve the desired end result. There was a ‘story’ of sorts in the biochemical reaction where things had to follow in a step by step fashion in order to work. For some reason, translating this cycle into a ‘story’ made it make sense to me for the first time all quarter and I was able to pass the class easily after excelling on the final exam.

In high school and early college classes, it was really a lot easier to just memorize a bunch of things and let it all back out for exams and move on. However, optometry school has courses and concepts that continue to build upon previously learned material. Straight memorization will not cut it and you’re going to be required to put anatomy, physiology, biochemistry, optics, behavioral health, psychology, and more all together in order to help the patient in your chair. The sooner you can solidify your foundation in basic concepts, the easier it will be to integrate it all later when you’re faced with increasingly complex patients in front of you.

But does that mean I recommend you should make a story out of your material when you try to study? If it works for you, great. If not, try something else. I had classmates who re-wrote their notes, color-coded, and organized their thoughts in a more pattern like way. Other classmates thrived in study groups and being able to bounce off their learning points with others. I personally needed a quiet, clear space to concentrate most of the time, but found study groups or office hours to be helpful when I needed extra clarification.

The point is to recognize early on what doesn’t work and figure out what does. You don’t want to go through your whole optometric education, come to boards, and realize that the fundamentals aren’t solid and you were just repeating facts this entire time rather than understanding why. You’ll get much more out of your education this way.

Happy studying!

I knew heading into the last 10 weeks before graduation that I would be working with one of the most difficult attendings on campus. I had heard of classmates going home crying after clinic because of how they stupid they felt, like they weren’t enough, like they shouldn’t be there.

 

After one day working with him, I felt the same. I didn’t cry, but I did feel grossly inadequate in my skills, in my thinking, in everything I did with regards to clinic. And that sense of low self-worth was affecting my other clinic days. Where I had gone in confident in my skills and thought processes, I was now second guessing every single thing I was doing.

 

Looking back, I can see why that doctor did what he did. In his own way, he was pushing us to stand up for why we were doing what we were doing. He wasn’t questioning us just to make us feel stupid. He was questioning us to make sure we had the right foundation and mentality to approach clinical care, to point out where our gaps were and make sure we recognized them too.

 

At the time though, it certainly didn’t feel like that, and I dreaded that one day a week working with him. Each week, I mentally kept track of how many more times I’d have to endure the mental humiliation and discouraging comments. I suffered through it and just sucked it up until the session passed, knowing after graduation, I’d no longer have to work with him.

 

I wish that I had a better coping mechanism then. This was before the importance of mental health was more globally recognized. This was also before I knew how to better stand up for myself and vocalize my needs, before I knew how to articulate that this was not a conducive way to my learning, especially with just weeks left before graduation.

 

So when one of my recent students came to me saying her next rotation was at a clinic she was not looking forward to, I had to stop her and ask her why – because I did not want her to follow in my footsteps of just sucking it in, going to clinic to do what she needed to do, and not get the most of her learning and education.

 

We both knew she’d be getting a lot out of the clinic she was going to. It was another community clinic where the population would challenge her understanding of systemic health and its connection to the eyes and vision. We knew she’d be challenged by the language barriers of that population, with the increased difficulty of being able to get the information she needed to do her exam and convey the results and appropriate management in a way the patient could understand. And like me, she’d be ending her spring before graduation with an attending whose energy she knew she didn’t match well with.

 

So I gave her these tips as a way to center and refocus. I suggested that she get a bottle of essential oils that calmed and soothed her and smell that each day before she left her car to go into clinic as a way to ground her and calm her down before the craziness of clinic started. If she didn’t want to do that, I suggested she write down her why for what got her motivated in pursuing optometry in the first place – to help other people – and keep that reference close and handy whenever she started losing her motivation and confidence in clinic. If she didn’t want to do, I suggested she find some other inspirational quote or prayer to put on repeat in her head and focus on that when she was feeling low. I don’t know what, if any, of these methods she chose to do, but in the end, she graduated and is now working in the real world.

 

The point of this though was to find out what way or ways are best for you to keep you going when the days are rough. If you’re facing waves of exams or boards coming up, or attendings or clinics that are outside your comfort level, or patients or colleagues who push your buttons, it’s good to have some tools ready to get you centered and focused.

 

Put together that playlist of feel good, upbeat music. Have that list of inspirational quotes ready for motivation. Keep that essential oil or crystal or touchstone close at hand.

 

Start building that toolbox now so that when you need it later on, you don’t get lost in the overwhelm and start heading down a downward spiral that’s really hard to get out of.