As the fall semester of my OD2 year comes to a close, so does my first semester of weekly clinic assignments. To say that having weekly clinical assignments in my second year of optometry school has been a learning experience would be a huge understatement.
I remember how I felt going into my first day of clinic this fall: I thought I had it all figured out. I would do the eye exam like I had practiced during clinical simulations in the summer, I would finish in plenty of time, and everything would go smoothly and according to plan. Sadly, simulations are just that: simulations. Patient care is so much more than just going through the motions – it’s being able to adapt to each individual patient’s needs and style in order to perform as thorough and efficient an exam as possible.
Lesson One: Always Ask “Why?”
One of the most important things I learned in clinic this semester was to ask “why?” Instead of just doing a test because I had learned that I was supposed to do it, I tried to take a second and think about what the test was supposed to measure. I considered why I was doing this specific test on this specific patient. Asking myself “why?” was also important in interpreting the findings I obtained. Why did I find the results I found? More importantly, did these results make sense? As I continue to learn more clinical skills over the next few years, I will try to think critically about every test I do and how it correlates with the results I find.
Lesson Two: Build Your Exam Around a Patient’s Chief Complaint.
Another thing I learned this semester is that the “exam flow” we have been taught is not a rigid set of guidelines, but is in fact, as the word suggests, a fluid process. If someone comes in complaining of a sore, red eye, don’t spend a significant amount of time finding their prescription before even looking into the sore eye! By building the exam you are going to give around the patient’s chief complaint, you make sure that you are addressing the major reason they are coming to see you. This will help keep the patient happy because they will see that you have listened to their problems and understood the reason behind their visit.
Lesson Three: Adapt Your Exam and Be Flexible.
It’s also important to know how to adapt your exam if issues arise such as language barriers or the inability to do certain tests. Always have an idea of alternative tests that can be tried, or even what tests can be done on a different day if they aren’t working on this day. You have to be flexible to make changes in the middle of an exam and schedule another visit if that is what makes sense.
My "Clinical Pearls"
Looking back at my time in clinic this semester with 20/20 hindsight, there are many things I could have done differently. Based on the many lessons and skills I’ve learned, I’ve devised three “clinical pearls” which I will try to follow in my future clinical endeavors.
1. First: Trust your instincts and be confident. We have all worked very hard to get to the stage where we are allowed to treat patients. We have all passed tests showing that we are proficient in clinical techniques. Don't forget to trust your instincts. Just because the results you find don’t make sense at first doesn’t necessarily mean they are wrong. It is more beneficial to assume your assessment may be right and critically think about how the results you have found could make sense for this patient, rather than assume you have incorrectly done the test.
2. Second: Remember that you are always learning. Every time you do something wrong or don’t know how to answer a preceptor’s question, try to remember what you did incorrectly so that next time you are faced with a similar situation you will be able to react differently. I started keeping a list of areas I feel I need to improve on. I am also working on creating a condensed “cheat sheet” of my academic notes to keep with me when seeing patients in case I forget something.
3. Finally, be prepared. Go into every eye exam with at least a rudimentary idea of who the patient is before you even meet them. If they are an established patient, read through their old charts ahead of time so you have an idea of their eye care history and what tests and plans may or may not work this time around.
Clinic has been an overwhelmingly important experience for me this semester and it has helped give a practical component to all of the theoretical information I have been learning for the past year and a half. Every time I finish a day of clinic, I leave feeling as if I have learned a little more about what it means to be an optometrist. Although it is stressful at times, it has taught me many things I wouldn’t have been able to learn in a classroom setting. I look forward to my next clinical placement and the many clinical lessons yet to come.
Maria is a Canadian student in her final year of the four year OD/MS dual degree program. For her MS project, she is working with Dr. Vera-Diaz and Dr. Panorgias examining color vision and early age-related macular degeneration.