Practice Management

4 Steps to Increase On-the-Job Learning

By Suzanne LaKamp, OD, FAAO

May 31, 2017

An OD’s education doesn’t end with graduation from optometry school and the continuing education we are required to take. Essential lessons can be learned every day as you serve patients, and interact with other doctors. The more you learn about patient-doctor, doctor-to-doctor and doctor-staff relationships, the more you understand what is needed to best serve patients and succeed in your career.

After graduation from optometry school and completion of a residency, new optometrists are prepared to care for patients. We’re equipped with breadth of knowledge and training, but we don’t yet have the many years of experience that will build us into great doctors.

Applied knowledge can be more important than facts learned from a textbook or case report. New ODs can transition more successfully into the role of doctor with the guidance of fellow doctors. Experience comes with time, but as an associate in a shared OD-MD practice, I’ve found that we can expedite that process by learning from our established colleagues, and by learning from our interactions with patients.

In school you get knowledge, and some experience, but after graduation, by working with the doctors in the community where you practice, you gain invaluable combined knowledge and experience.

Whether new to practice, or a seasoned optometrist, every day in practice offers ODs a new chance to learn and become a better doctor. Here are four ways, specific to the life of an OD, that you can optimize every-day lessons to do better for your patients and practice.

Little On-the-Job Lessons Can Mean Big Money
An example of a simple lesson I learned, which helped me contribute to the profitability of my practice, was the importance of trial-framing prescription glasses, especially if there is a significant change from the previous prescription. You can never go wrong in trial-framing. Also, loose lens over-refraction for new contact lens fits also helps reduce errors in prescriptions. Reducing prescription errors also reduces the cost of remakes. Patients want the best possible vision. Patients will not return to a practice that cannot meet their visual needs, whether that is surgical laser vision correction or corrective lens wear.

Use Interaction to Improve Doctor-Patient Communication
One of the most important lessons I learned on the job is how to effectively communicate with patients when delivering difficult news, whether that’s poor healing after surgery, the missing of a refractive goal, or another disappointing outcome or diagnosis. I am fortunate to have worked with some of the finest doctors I know, and have been able to shadow numerous ophthalmologists and optometrists throughout my career.

For example, when scribing for me, my supervisor in the practice, a more experienced doctor who mentored me for the first three months with the practice, pointed out that my delivery was overly blunt. Patients are eager to get 20/20 vision or better. Once the patient hears about a less-than-ideal result, it is easy for that patient to shut down with disappointment or surprise. My supervisor explained how to couch the language so the patient is given an accurate understanding of the result of a refractive surgery, but isn’t overwhelmed by the disappointment.

A Key Question to Ask Other Doctors: How Would You Do It?
To stay open to learning on the job, doctors must always be curious and constantly willing to challenge their way of practicing.

I like to ask the other doctors I work with: “Dr. Brown, what would you do differently for this patient?” I open myself to potential criticism to learn how other doctors think, and whether our processes align, but it’s worth it to become a better clinician.

Doctors in the same practice may share care for a patient. It is important to let other doctors know that you respect their diagnosis and treatment plan. You could say something like: “Dr. Smith, I saw your patient, Mr. Jones, in the clinic today, and he had elevated pressures. I started him on Istalol once daily until he returns for his next scheduled post-op. Is there anything else that you would like to add, or you would like for me to do differently?” By asking the other doctor’s opinion, it not only shows respect, but allows you to learn. It invites the other doctor to provide helpful feedback.

For associate doctors, like myself, it is important to always seek feedback from the other doctors and support staff. This can be a quick verbal exchange, one-on-one meetings, or having your patient encounter audited by another senior doctor.

When new to my practice, I spent time shadowing each department. I also spent time with each doctor, observing the patient interaction. I then got helpful feedback from my supervisor and fellow doctors, who sat in the room with me during patient exams.  The training was invaluable. The constructive criticism formed me into an even better optometrist, and a better fit for the practice culture. All of my charts were also audited, not just for accuracy, but to ensure that my methods of patient care met the clinic expectations. It is good practice for all clinics to perform regular chart audits.

Encourage Patient Feedback
Patients, who are familiar with the practice, and who feel comfortable with a doctor, can provide essential feedback. It takes courage for patients to address problems they are having with your care. Whether the doctor forgot to answer questions fully, or prescription glasses are not working well, there are patients who will take corrective action or follow-up. Mistakes can then be addressed, as well as making sure the patient is cared for. Some patients may wait months, out of fear that the encounter may be negative.

Experience has taught me to encourage my patients to reach out immediately if there are any problems with a pair of glasses, or any other aspect of their care. I always tell the patient to contact me if they aren’t happy with their new prescription. We do this to give the patient comfort that their problems get the doctor’s attention. This eliminates long waits in the event that a remake is needed.

We encourage patients to provide feedback, especially after surgery. The practice sends out weekly surveys. Fortunately, the majority of patients are happy with their surgical experience, and the comments and positive reinforcement ensure that we continue to do things well. Negative comments are immediately addressed, and treated as learning opportunities for our practice to improve.

We use a rating system of 1-10 on our weekly patient surveys, and also include open-ended questions for patients to more freely express themselves.

It is my custom to ask patients if they have any questions or concerns before they leave the exam room. Our excellent support staff members are also great about listening to our patients, and will report feedback, whether it’s good or bad. As much is it’s humbling to hear negative feedback, it is more useful than the positive comments for improving and growing as a practice. Learning of a patient’s bad experience can be an opportunity to change your practice’s patient experience into a better one.

 

 

Suzanne LaKamp, OD, FAAO, is an associate at Durrie Vision in Overland Park, Kan. To contact: dr.suzanne.lakamp@gmail.com

 

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