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.