Through the Looking Glass…and What Tom Found There

Post Graduation Pontification

The Optometric Oath

With full deliberation I freely and solemnly pledge that: I will practice the art and science of optometry faithfully and conscientiously, and to the fullest scope of my competence. I will uphold and honorably promote by example and action the highest standards, ethics and ideals of my chosen profession and the honor of the degree, Doctor of Optometry, which has been granted me.

I WILL provide professional care for those who seek my services, with concern, with compassion and with due regard for their human rights and dignity.

I WILL place the treatment of those who seek my care above personal gain and strive to see that none shall lack for proper care.

I WILL hold as privileged and inviolable all information entrusted to me in confidence by my patients.

I WILL advise my patients fully and honestly of all which may serve to restore, maintain or enhance their vision and general health.

I WILL strive continuously to broaden my knowledge and skills so that my patients may benefit from all new and efficacious means to enhance the care of human vision.

I WILL share information cordially and unselfishly with my fellow optometrists and other professionals for the benefit of patients and the advancement of human knowledge and welfare. I will do my utmost to serve my community, my country and humankind as a citizen as well as an optometrist.

I HEREBY commit myself to be steadfast in the performance of this my solemn oath and obligation.

On  May 18th, I took the Optometric Oath as part of my graduation ceremony from the New England College of Optometry. My classmates and I stood before the assembled friends, family, faculty and staff and pledged to do our utmost to provide the highest quality eye care that we are trained to do. In addition to our obligation to provide this care, we too must hold ourselves to high standards of morality and ethics. It was a very powerful moment, over one hundred voices in unison reciting this oath, an audible tribute to the change that was transpiring. In the course of those two hours, we were elevated from students to doctors.

For the first few days after my graduation, it didn’t really sink in that I wasn’t just between one clinical rotation and the next. It felt like any day now, I was going to go back and resume what had been my life for the past year as a student. I would see patients, check in with my preceptor, coordinate patient care with them, and educate the patients about our decisions. Days passed, and I was still on vacation. No preceptors to check in with. No patients to see.

But as I get closer to my residency, I remember that there isn’t the same sort of safety net either. It is both exhilarating and terrifying to know that as a doctor now, I am responsible for my patients, and while there will still be a degree of oversight at the VA hospital where I will be completing my residency, it isn’t the same as being a student. I have taken an oath, and I plan to keep it.

I have been using my ample free time between the completion of my clinical rotations and the beginning of my residency to take a step back and assess my life as both a person and a professional. It is certainly a time of many great transitions, as I go from student to doctor, fiancée to husband, unemployed to resident. It is often difficult to see the bigger picture when you are busy getting through the day to day of finishing up as an optometry student, lining up a job or residency, applying for state and national licensure, and to top it off, hurtling towards your own impending wedding. Now I am lucky to be afforded the time to take stock, slow down, and look at the parts of the whole.

On top of all my pontification about the nature of man and what it means to have graduated, I now find myself inundated with paperwork. You would not believe just how much paperwork is involved with applying for licensure to be both a professional, and to be a spouse. Copies of every transcript imaginable must be requested, and these may only be submitted either in person, by snail mail, or if you happen to own a fabled FACSIMILE machine, you can use your second telephone landline to send copies of these forms in. On the wedding front, I pride myself on being an involved fiancée, much as I would love to sit back and let my wife-to-be handle all of the nitty gritty details. If only I had known how many nitty, gritty, itty, bitty details there would be. As a man with a month off until the start of my residency, I am her new favorite person, able to run any errand, fax any paperwork, and write marriage documents in a single bound.*

*That sounded better in my head than when I reread it… But I’m going to go with it.

If I have learned anything during my month long sojourn, it is that when possible, take the time to reflect on what you are doing, where you are, where you want to go, and how you plan to get there. I think it is safe to say I matured a great deal during my time in optometry school, and have learned what I need to be successful; again both as a professional and as an individual. The unfortunate truth is that the demands of being a student can make this self-reflection rather difficult, but I firmly believe that everyone can benefit from a little introspection now and then. It really helps put things in perspective, and gives me a greater focus on what is important going forward.

By the time I get around to writing my next blog post, I will be back into a regular routine, hopefully settling in as a new resident in ocular disease and primary care at the VA Hospital in Brockton. I may or may not be married, too, depending on when this post gets published. So, I will be taking the time I have left before then to continue my quest of self-improvement, which has so far amounted to eating better, running daily, reading for pleasure, and cooking new and interesting things. I may even try to get to the beach one of these days…

Cheers. Here’s hoping to see all of you  here one day too.

Thomas Andrea, OD


The Times They Are A-Changin’

Time has marched inexorably on, as it has a tendency to do, and now I am sitting here faced with my very last day as a student being just two weeks away. Four days after that, I will graduate from the New England College of Optometry as a newly minted optometrist. I will be Thomas Andrea, OD. Between wedding planning, preparations for my residency, and life taking up so much of my time, it’s almost as if this major milestone crept up on me. It raises a whole host of questions, ones that I’ve been too busy to really consider.

Now that I have the presence of mind to sit and consider what is on my horizon, I realize that there’s one major piece missing from our education. We are trained to be excellent clinicians, researchers, problem-solvers… but nobody really tells you how to handle the title of “Dr.” I don’t want to be that guy that goes around correcting everyone if they refer to me as a “Mister” instead of “Doctor” Andrea*. But what are you supposed to do? If anything? And going off of that, should I call myself Dr. Andrea – or will people think that they are going to see a less-bearded, female doctor?  I could be the hip, young doctor that goes by his first name – Dr. Tom. Or does that make me sound like a psychiatrist? I don’t know. Someone please tell me.

*Except for all of my friends. And my fiancée/soon to be wife. They will have to put up with me.

I haven’t graduated quite yet, but since this has been running in parallel to all of my wedding preparations, I have a feeling that once all is said and done, it may have a similar effect. The day itself will be very special, and there will be a great deal of pomp, circumstance, and possibly ritualistic ceremony involved. But after that, I will still be the same person; I just get a couple extra letters after my name. I don’t say that to minimize my accomplishment, or that of any of my colleagues for that matter. I just think it’s funny that my family has certain ideas of what being a doctor means and my reality is not necessarily in line with that. I will still drive my sweet ’05 Rav4, still live in a tiny basement apartment (garden-level is being too charitable when referring to it), but I can’t use my excuse of being a poor grad student.

The reason I point any of this out is that the change from being Mr. Andrea to Dr. Andrea will essentially happen overnight, even if the transformation has actually occurred over the past four years. It doesn’t mean I get a new Benz and a loft in Back Bay though… at least if it does nobody has told me yet. Much like earning that title with hard work over the past four years, these things too will take time and effort. Despite this disparity, I am extremely excited for what my future holds as a licensed eye care provider. The freedom to make decisions and provide care without the oversight I’ve had for the past four years is simultaneously liberating and terrifying. Fortunately, at the VA during my residency, I will still have my attending doctors as a safety net, which is definitely a reassurance. I will not have a carefree, playboy lifestyle, but that’s ok, too. I have come to understand that good things do come to those who wait, and as my fiancée has reminded me during my long road here, those who can delay gratification are those who achieve the most and are thusly rewarded.

Graduation looms, and my tenure as a student will soon be ending. That does not mean my ties to academia will end; in truth, I will continue as a student just under a different name. Every personality test I’ve ever taken has emphasized my need to be a “lifelong learner” and I am embracing that. Even if I go on to become a faculty member, I know now that such a career means I will still be striving to learn even as I teach. I hope that during my next year I will have the opportunity to continue blogging for NECO, but if that is not the case, I will take this chance now to say thanks for reading, and to wish you luck in your future. If any readers ever have any questions, I would be more than happy to answer them to the best of my ability, or at least provide a witty response that is secretly laced with insight.


Big Plans

Ever since I was a kid in high school, I knew I wanted to be a high school biology teacher. Then I got to college and discovered no, I wanted to be a biology professor. And a doctor, of course. So I continued on with my biology coursework, suffered through organic and inorganic chemistry, and found physics to be quite tolerable. I followed what I thought was a logical path, and ended up obtaining a research assistantship in a microbiology lab studying antibiotic resistant bacteria. The grand nature of the research definitely appealed to my inquisitive nature and I, of course, expected to be making weekly breakthroughs that changed the face of microbiology. But the day-to-day reality of mixing up agar, plating it, streaking out lines of bacteria, and then doing statistical analysis on the data we collected at a glacial pace was… less enthralling to me. Despite sticking with it for a year and a half, I was sent back to the drawing board in terms of career paths. I knew with certainty that I didn’t want to pursue a PhD, and I didn’t relish the additional decade of training required of MDs, but I didn’t want to turn my back on my dream of being a clinician and teaching.

Fortunately, my soon-to-be wife enlightened me on the existence of optometry and the rest is history. I am now pleased to announce that I have been matched with the residency in Ocular Disease and Primary Care at the VA Hospital in Brockton! I am ecstatic to have been selected for this position and look forward to the challenges and rewards that await me as a resident next year*. For those who aren’t aware of what a residency means for optometry school, it is an optional addendum to your formal education, typically a year in length, where you are working full-time as an OD, but still under the tutelage of one or more clinical preceptors with expertise in the field you choose to study. One of the many advantages of completing such a residency is that you are not only more marketable due to the advanced training, but that this training is also often a prerequisite for both didactic and clinical teaching positions.

*Side note: It is also nice to know well in advance that I have a job lined up after graduation, so I can take the time between completing my schooling and starting my job to plan my July wedding and/or lie on the beach all day…but probably just lie on the beach all day.

I have elected to complete my residency in Ocular Disease and Primary Care at a VA Hospital. I was fortunate to have had a three-month rotation at this particular VA already during my fourth year, so I am familiar with how the clinic runs and what is expected of a resident there. Initially, the position involves working closely with an OD who oversees you, much like when you are a fourth year student. However, the rate at which you become independent and the nature of your decision-making evolves rapidly into a collaborative process, and the level of responsibility is also increased commensurately.

I will be providing healthcare to veterans at a primary level, meaning that I am the “gatekeeper” of sorts, the first healthcare professional who is often seeing and treating them for any ocular diseases or comorbidities (symptoms/issues that arise from having other health problems, but manifest in the eyes). In addition to this role, I will also support the emergency room personnel by answering any urgent consults for patients with acute ocular conditions, which can range from getting poked in the eye by a grandchild to a full blown retinal detachment. On top of these responsibilities, which will  occur during normal business hours at the hospital, I will also be on call every nine weeks, during which time I will have a real-live, ye olde beeper to carry around with me at all times. That means any emergency visits that occur after hours will result in a phone call to me (or should I say, to my beeper) at which point I will be responsible for triaging the complaint. Luckily, residents are always on call with more experienced ODs who have dealt with similar issues, so we aren’t left hanging if we need to make a tough call. It is admittedly a bit terrifying to know I will be given this level of responsibility, but simultaneously a bit exciting to be able to say “Sorry friends, can’t make it this weekend, I’m on call. Go enjoy your fabulous boating trip without me.

Besides all of the clinical responsibilities that go with being a resident, there are additional didactic responsibilities. These range from weekly participation in Grand Rounds (a sort of professional development meeting where we discuss cases and cover administrative duties) to preparing and presenting a poster on a case of our choosing at the American Academy of Optometry meeting in Denver, Colorado, this year. There is much and more I can say about the educational aspects of a residency, but I may save that for a later post when I have time to delve into the finer points. Suffice it to say, I am overjoyed to know what I will be doing next year, and that it is sure to be the best course I can take towards my dream of combining teaching and clinical care. I also know I’m going to be quite busy, but it is sure to be worth it.

 

 


In Residence

This may end up being a bit of a shorter post this month, as I desperately rub my few remaining brain cells together and catch the sparks on this page.

That’s probably a bit overdramatic, but the month of January was a long month. Unlike February, which is the shortest month… but may also end up being a long month… In any case, I just completed my entire residency application and interview process and after 12 hours of driving and interviewing in one day, I look forward to the week long break I have between the completion of my application and flying down to North Carolina from Boston to take my National Boards Part III. I will officially be done with those by next week, and if all goes well, finished with nearly all of my obligations for licensure and graduation short of completing my final rotation.

In the interest of looking to the future: I received my Special Populations schedule at long last, which details the sites in and around Boston I will be at during my final fourth year clinical rotation. The selection process involves submitting your preferences for the aforementioned special populations you feel you would like to work with, and hinges to some degree on what modes of transportation are available to you. I am fortunate enough to have a car to myself whenever I need it and live outside the city, so points west and south are quite accessible to me. The populations you can mark as your preferences range from pediatrics to vision therapy to low vision. I was lucky enough to end up working with a range of populations that I am interested in gaining more experience with, and will be doing the following:

Monday – Low Vision

Tuesday – Persons with Disabilities

Wednesday – Pediatrics

Thursday – Persons with Disabilities

Friday – WILDCARD*

*Wildcard actually just means I’ll be doing contact lenses at the New England Eye Institute

So, since I have a car, I will be traveling between Brockton, Watertown, Hyde Park and Boston, depending on which day of the week it is. Hopefully I can grow accustomed to the schedule quickly, and don’t end up at the wrong site on the wrong day. As long as I have my coffee before leaving in the morning, it shouldn’t be an issue.

With my final rotation fast approaching, I am now entering the nebulous territory of Job Searching, Population: Me. As I mentioned before, I have completed my application and interview for the VA Boston Residency in Ocular Disease and Primary Care. If I match with any of my top choices, that means I will be completing a yearlong residency program that focuses on (surprise) the treatment of ocular diseases and the delivery of primary care to veterans. I feel that I did quite well on my interviews, but won’t know the results for another month, so now I must occupy myself with the formation of backup plans and fallbacks in case things do not work out. There seem to be new jobs opening up all the time, thankfully, and since I know I will be staying in the area, it helps narrow my search down. On top of that, I am on the lookout for a new apartment, since my fiancée and I have nearly outgrown our quaint basement apartment that could generously be placed somewhere between a studio and a one bedroom.

Big things are ahead, and I am excited for the changes that are in store. I am very interested to see how it is being at a different site every day of the week, working with completely different patient populations. If nothing else, it will undoubtedly keep things fresh. So very fresh. As for the jobs and residency program, I will be in limbo for a little while, but hopefully by my next blog post or the following one, I may know a bit more about what my future has in store. Until then, I will be making the most of my weekends as I prepare to complete my national boards and then get back to that little detail of planning my impending wedding. Happy (almost) spring to all. It is on its way, regardless of what a certain prophetic marmot had to say about the matter.


Resolution

2014.

I’ve known for some time that this was going to be a big year, but it has loomed so large for the past four years that it has taken on an almost mythical property. It’s been the answer to so many questions from friends, relatives, colleagues, teachers. 2014: the year when I graduate from optometry school, become a doctor, get married, start my career and my family. Four long years ago it seemed nigh unattainable, but time has marched on since then, as it has a way of doing. And now, at long last, it is finally here.

January is almost half over, which means my penultimate clinical rotation is over halfway done. Each rotation is three months long, and thanks to some generous time off for the holidays, this rotation feels as though it is flying by. With only a little over a month to go at the East Boston Neighborhood Health Center, it seems my time here has been too brief. I was initially apprehensive about the prospect of working with a different optometrist overseeing me each day of the week, but it has turned out to be a highly beneficial experience, as each one offers a unique perspective when discussing clinical education and patient care.

The notion that over half of my patients on a given day may not speak any English was likewise daunting, but thanks to my own modest Spanish skills, and the far more proficient interpreters that work with us, I have become accustomed to performing complete exams in other languages. It’s been a challenge, but I am proud that my Spanish has come along to the point where if I greet patients en español, my accent isn’t so terrible that they just stare blankly at me. On the contrary, I have gotten myself into trouble greeting patients in that fashion since some then assume a level of fluency that I sadly do not possess. Luckily, one of the first phrases that came back to me when I started conversing with Spanish-speaking patients was “Mi espanol no esta muy bueno, yo hablo un muy muy pocito, lo siento”, which roughly translates to “My Spanish is not very good, I only speak very little, I’m sorry”. It’s come in handy.

As my final rotation approaches, I have also submitted my preferences for Special Populations, which typically consists of several different practices in and around Boston that offer a range of specialized care settings. Since we are given the option to designate which modalities we would prefer to gain experience in, I opted for Low Vision, Pediatrics, and Contact Lenses. Now, designating these is no guarantee of anything, but I would be very happy if  I could work at Perkins School for the Blind at least a few days a week. Perkins is a highly specialized setting where people of all ages with visual impairment come for treatment, diagnosis, and therapy. The patients all have a wide range of needs and goals, and the doctors work with a multidisciplinary team to try to meet the patients’ functional goals. Ultimately this allows them to accomplish the things they want to accomplish, such as activities of daily living, with a greater degree of independence. It is a rare opportunity to get to work in such a unique clinical setting, and to top it all off, it is only five minutes down the street from me, which means I may be able to avoid a half hour to hour-long commute for at least one of my rotations. I won’t know where I’ll end up for another few weeks, but I will be sure to give an update when I do know.

As I alluded to before, this year is set to be a pretty big year for me. I’m 2/3 of the way done with my national boards, 3/4 of the way finished with my clinical rotations, and 7/8 of the way done with optometry school. I’m also three years into my engagement to my wonderful fiancée, whose support and love have just as much to do with me getting through four years of school as anything I’ve done. In only four short months, I will be graduating, just days after turning 27, and then a month and a half later, I will be getting married. So I expect I may be just a bit busy in the next month… or six.

I am very happy that all of these big events in my life are finally within reach, but it is a bit difficult to process that all of these changes will become a reality. I’ve known for five years now that I wanted to be an optometrist, and I’ve known for about eight years (pretty much since meeting her) that I wanted to marry my soon-to-be wife. For these possibilities to stop looming in the future and finally become the present is simultaneously exciting and surreal. Once these major life events are in the past, and I am both a husband and a doctor, I suppose new goals and challenges will take their place in my future. I still aspire to attain a residency after graduation and in doing so, set myself up for a job teaching future optometrists one day. So while I may be achieving the goals I set for myself many years ago, it looks like I’ve already got a few new ones waiting in the wings to take their place. Someday, some year, I might just have to give myself a break. But that year probably won’t be 2014.


Messin’ With Texas

Many months ago now, I received an unexpected email from our Contact Lens professor, Dr. Watanabe. It contained an invitation to apply for an all expenses paid, four-day trip to the Alcon company headquarters in Fort Worth, Texas, to attend their Academy for Eyecare Excellence. Dr. Watanabe had made us an offer we couldn’t refuse, so my friends and I were able to pick a date that worked for us, and RSVP’d accordingly. Time passed, as it tends to do, and suddenly, November 7 was upon us. My friends and I met up at Logan Airport the morning of our flight, and indulged in some gourmet Egg McMuffins and Newman’s Own Coffee. I’d thought I was cutting it close waiting to get home the night before to start packing, but as it turns out, my other buddies had waited until the morning of, so I deserve some points for my stellar planning there. We boarded our flight, and proceeded to make our four-hour trip, arriving three hours later thanks to the difference in time zones. This was my first time having a driver awaiting my arrival with a sign, so that was pretty cool too. After a short jaunt in a party bus from DFW Airport, we reached our hotel in downtown Fort Worth with some time to kill. Once we were checked in and situated in our respective hotel rooms, we met up again for some authentic Texas BBQ.

My memory of the names of all the foods we ate there are a bit hazy now, but suffice it to say we ordered a mountain of assorted meats, and proceeded to devour that mountain. This was, of course, a few hours before the catered welcome dinner started, but we were all fairly ravenous after failing to eat lunch before leaving MA, so it felt good. We had a chance after loading up on barbequed meats to walk it off in downtown Fort Worth, taking in the sites. It was a bit of a culture shock coming from Boston, where everything dates back to colonial times and roads were apparently laid out according to donkey paths or river currents or Paul Revere. In Fort Worth, the streets were clean, orderly, and laid out in a sensible grid that made navigation easy for us yankees. The rest of the night was spent at the welcome reception, enjoying the buffet and even better, the “Make Your Own S’More” station which featured indoor flames for roasting mallows. I was fortunate to meet up with some of my compatriots from the Pennsylvania College of Optometry, and we had time over the weekend to catch up, and discuss the various experiences we’d had since parting ways three years ago.

On Friday, the Academy for Eyecare Excellence kicked off with a trip out to the Alcon campus, about 20 minutes away from our hotel. The facilities there were beautiful, and eventually we got to take a tour not only of the extensive grounds, but also of the manufacturing and shipping areas where products like Air Optix contact lenses and their accompanying OptiFree Multipurpose Solutions are born. We began the day in a very well-appointed lecture hall where experts on ocular surface disease, multifocal contact lenses, contact lens solutions, cataract surgery and more gave talks on their respective fields of interest. I was pleasantly surprised to find something in all of the lectures that related to a scenario I’d experienced in clinic, which showed how far I’ve come since starting out four years ago. It also helped that the organizers at Alcon were dedicated to feeding us every two hours to keep bellies full and spirits high. The afternoon sessions were spent touring the campus and getting some hands on time with the instruments used in cataract surgery, as well as some time observing specialty contact lens fitting. When the day was done, we headed back to the city for an amazing steak dinner, and got in some networking time. I met a number of the lecturers and some of the executives at Alcon, and had a great time picking their brains about their experiences in the healthcare field, which BBQ is the best BBQ, and local Texas brews.

Saturday was spent in the hotel’s expansive conference rooms listening to lectures about treatment options for glaucoma, ocular nutrition, and then about four hours of billing and coding. When I say that I was not thrilled about sitting through half a day of billing and coding talk, that may be understating things a bit, but I could not believe how engaging and relevant the speaker turned out to be on the topic. He did an excellent job of maintaining our attention while giving us insight on how to maximize reimbursement for all the many things we are trained to do upon graduation. This talk was the highlight of the weekend for me, and I had the opportunity to thank the speaker in person at our “Rita and Fajita” dinner that night in Fort Worth’s historic Stockyards district. After an amazing dinner of what I now know to be authentic Mexican food (like Chipotle, right?), we were free to wander the Stockyards and catch a shuttle back to the hotel when we were ready to turn in. This lead to some amazing hijinks that included, but were not limited to: meeting friendly Canadians, wandering into a rodeo, sampling of the local beer selection, attending a Josh Turner concert at the largest Honky Tonk I do believe I’ve ever seen, and generally having a great time with friends. We made it pretty late into the concert, but eventually the day’s activities caught up with us, and we headed back to the hotel to crash.

Our last morning in Fort Worth was a quiet affair. I enjoyed a nice breakfast alone, since I am a freakishly early riser compared to most of my friends. This was followed by a walk around the city to take some pictures and read about the history of the city. Once the texts started rolling in from friends who’d arisen from their normal-person-length slumber, I headed back to meet up with them, and to say our goodbyes to departing friends. From there, we flew back home, leaving behind the mild 60 degree weather in favor of the not so mild cold of November in the Northeast. None of us had thought to pack winter coats, so we had a great time arriving back at Logan to that realization.

All in all, it was an amazing trip that I would highly recommend to all fourth year OD students — or residents for that matter, as the course is offered to both. Not only did I genuinely learn a great deal about emerging treatments, technologies, and general practice management in the eye care field, but I also had a unique cultural experience. This was my first trip to the great state of Texas, and it was a refreshing break from what can be described as a  fairly busy schedule of clinic full-time. So, whether you’re in optometry school now or looking to apply, there are many things to look forward to (like National Boards!) and this weekend conference should make your list.

Stray Thoughts: I figured I would share my list of original observations that I wrote up and posted on Facebook on our ride to the DFW airport, while the TX experience was still fresh in my mind.

Things I learned in Texas:

1. Not everything is bigger, but most of it is covered with bacon.

2. Texas BBQ is apparently the best BBQ.

3. Alcon makes some lovely products, and I make some lovely s’mores.

4. If you confidently walk into a rodeo without a ticket or cowboy hat on, nobody will ask you to leave.

5. Apparently Brian Ludwig and I are the only guys with beards in the Dallas/Fort Worth metropolitan area.

6. There are some surprisingly good dancers at country concerts.

7. Texas exists at the crossroads of both In N Out and Waffle House. Truly mind blowing.

8. Downtown Fort Worth is a ghost town at night, but the party is apparently in the Stockyards.

9. Both the buildings and the landscape are incredibly flat.

10. The people here are incredibly friendly, and frequently referred to groups of us as “y’all,” which I truly enjoyed.


Let’s Take Things Slow

I remember being told my first year at PCO (that’s another story for another day) that the vast majority of doctors have a diagnosis in mind 15 seconds into hearing somebody’s history. They subsequently tune out after that and start planning what to say to the patient and how to treat them. Now, that may be like saying 66% of all statistics are made up, since I don’t have a source to back this up, but I do notice myself falling victim to this trope. Whenever the clinic gets a call in the late afternoon on a Friday (all the walk-in patients with serious problems wait until Friday afternoons, they must be in a club or something) and I hear what the patient is experiencing, I can sometimes have a diagnosis and care package of brochures, drops, or what have you on hand before the patient even arrives.

While my planning could be praised as maximizing the time I have to prepare, my three and a half years as an optometry student have taught me that no verbal history or summary of complaints truly serves as a substitute for examining a patient in person. Holding on to one detail a patient mentions and pursuing it with a laser focus, often to the exclusion of other details or findings that must be taken into account, is a trap I have occasionally fallen into. This fixation on a foregone conclusion can lead me to overlook some simple but important things, rushing to dilate my patient so I can start digging* around for the cause of his or her problems.

*Note to any prospective student readers: no digging in the back of the eye actually occurs. However, digging may occur when people walk into clinic with tree branches sticking out of their corneas…

I have been fortunate to have had fantastic clinical instructors at my third and fourth year rotation sites who quickly see what I overlook. They point out that by doing a thorough exam, I will likely get all of the information I need (regardless of the amount of detail that a patient gives me). I try my best to keep this in mind when a patient walks in at 4:30 in the afternoon on a Friday, experiencing flashing lights and floating spots. Though it’s tempting to just shout out “Posterior Vitreous Detachment, call me in a month!” I might end up missing something important, not to mention hear about it the next time evaluations come around.

So though tattooing “SLOW DOWN” on my index fingers would be one way to keep this constantly in my mind… it might also lead to some awkward handshakes with residency directors and future employers. So instead, I will try to be continuously mindful of the advice my preceptors have given me, and trust that repetition and experience are my best clinical teachers. Doing things the right way, not the quickest way, is incredibly important to being a good optometrist.