Melissa Valdellon

Letting go of expectations

I still remember the first patient I saw as a student clinician. The room was crowded because besides the patient and I, there was the attending doctor and 3 other classmates. We were doing team care for this young patient in his early 30s who came in complaining about irritated eyes.

I remember being so focused on ‘my part’ of the exam, I really didn’t pay as much attention to what was going on. I listened as the patient said he had no vision concerns, all he was worried about was his itchy, irritated eyes. I watched as a classmate did refraction and someone else did anterior segment. I did posterior segment and found nothing remarkable.

And we all got together with the attending doctor who confirmed our findings and did the final consultation. He agreed that the patient did not need glasses even though we had found a small prescription. All he recommended was over the counter allergy drops for his eyes and sent him on his way. Only then did I do a double take. Why? Because we weren’t giving the patient glasses.

Coming from someone who’s needed glasses since I was 6 years old, I obviously did not understand the concept that not everyone who went to the eye doctor would get glasses. Obviously, I knew that some people came in for other eye problems, but this was the first time it really hit me that even though this patient had a minor amount of refractive error, it wasn’t something to prescribe because he wouldn’t benefit from using it for his daily needs. I had to speak to the attending doctor about it afterwards and he was said that in his mind, why would he ask someone to pay good money for something they wouldn’t use? Yes, there were other kinds of doctors who would probably do the opposite and push and strongly recommend their patients to always obtain glasses to give themselves the best vision possible or latest fashion trend, regardless of actual need.

My attending that day, in a way, asked me what kind of doctor I desired to be. At that moment, I realized I had come into the profession with a preconceived idea of what an optometrist does. See a patient and give a prescription and maybe address some dry eyes. It was suddenly hitting me that there was more to my profession than just repeating a formula. What I was truly being asked was if I could provide personalized care to each and everyone of my patients. Sometimes, that would mean giving glasses. Sometimes that would not. Sometimes that would mean not seeing someone and referring them straight out to get other needs taken care of more urgently – it’s happened a few times already where a patient’s blood pressure is checked early in the exam and found to be emergency room level high and we stop an exam to get the person the more pressing care they need.

This exam showed me that some expectations should be let go. Rather than coming into a patient encounter expecting one thing, what is more beneficial is to be curious about what can come out of asking more questions, anticipating your findings, cross-checking to see if your guess matches results and determining why – why is the patient here, why are their eyes working and functioning and behaving the way they do, and why are they here in your chair at this moment?

When you let go of expectations and stay curious, you switch from technician mode who does everything according to a checklist to a patient advocate who partners with their patients in their overall care.

Outside the exam room and school setting, it wouldn’t be a bad idea to let go of expectations in other areas too. Can you identify where such thoughts are causing more stress than worth? Time to let it go… *cue Disney music here*

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