WWJJD Part 2

The second and final instalment of a fun little project with US-based optoms, Drs Jenn and Jackie. If you missed the first one you can read it here.

You’re having communication problems with your boss at work. She asks things of you outside your normal role as an optometrist, such as sourcing a new computer for the practice, which you’re happy to do, but she is very vague on details that are necessary to complete the task well. When you ask for further details such as budget, size, capacity etc, she tells you to decide on it yourself, but every option you present to her she dismisses. Eventually you approach her to explain that you find it difficult to work with such minimal instruction and would like to have more detail so you can do the task efficiently but she accuses you of having a childish attitude and says she shouldn’t have to spoon-feed you.

JENN: I was reading this scenario and what immediately popped into mind was all the Millennial generation training I’ve been to at optometry conferences lately.  To people in our generational bracket (age 18-35), a lack of detail in directions is extremely frustrating. To older generations (Gen X and Baby Boomers), it’s normal.  I think knowing a little about generational tendencies can help you navigate dealing with your superiors more effectively.  As a millennial I know that we are used to specific instructions, details, and a clear path to what’s considered a great job.  Know that your boss is of a generational mindset where they expect you to be an adult, make a decision, and figure it out without their help. Anything else is you being babied.  Keep that in mind, and understand that the clear path to a great job in many of these encounters is you just making an executive decision, and having reasons that you’ve researched and explored to support the decision you came to when questioned. That’s the surest way to win a Baby Boomer or Gen Xer’s respect!

JACQUI: Yikes.  You would want to get that conversation, and all conversations like that in an email.  If you speak in person, I would send a follow up email to recap what was said and what is exactly expected of you. That way, if you need to defend yourself later for any reason, you have emails to back you up.

You’re a female optometrist having performed an eye test on a male patient. At the end of the consult he asks for your personal number and if you would like to meet up after work for drinks to “get to know each other better”.

JENN: Just in case any optometry students are reading this, know that this is going to happen to you! When it happens, you’re going to feel gross and uncomfortable, but it is not your fault.  It’s happened to every female optometrist I know, and quite a few of the men. There’s no perfect way to handle this situation but here’s my go to:

“Thank you, are you inviting my (husband/boyfriend) too?” and then laugh good-naturedly and reassuringly that it’s not that awkward that just happened, even though it is.

Ok maybe you don’t have a boyfriend or husband, but I think this answer is less awkward than other possible answers, and your patient doesn’t need to know that you are single.  I’ve tried out “It’s company policy we can’t date patients!” and that’s really strange to say, and makes the patient think maybe you’d be interested if you could get around company policy. You don’t want to encourage them in any way.

Sometimes you have to use more than just humor though.  I can think of one situation where I had to tell a patient they were being inappropriate and just let things get awkward. I was doing direct ophthalmoscopy (by the way this was the last time I did that on an adult now that I think about it!) and of course you have to get really close to your patient to see anything. The patient started laughing, so when I was done I asked what was funny (my mistake!!). He said, “I was just thinking when you were so close, what would you do if I just turned around and kissed you.”

I think my eyebrows shot into my hairline. I don’t really remember thinking but I just said, “Well I’m glad you didn’t. I would have probably hit you with this piece of equipment and it’s pretty heavy.”

We finished the exam pretty quickly from there. I don’t encourage threatening to hit your patients with ophthalmic devices, but it did straighten him up pretty fast.

JACQUI: Well, you’ve got an easy out if you are married.  If you are single, I would politely decline, saying you (or blame it on your office) have a policy against dating patients.

You have a full-time contact lens patient who is very open about the fact they don’t ever clean their lenses, they often sleep overnight whilst wearing the lenses despite this particular brand being approved for daily wear only, and routinely keep the lenses for at least double the recommended replacement schedule before discarding. Under slit lamp examination, while the lenses themselves appear very dirty and have obviously been over-worn, the eyes themselves still appear healthy.

JENN: This literally happens all the time.  Let me just save you a headache: I used to do exactly what you think you’ll do.  Diatribe the patient about their care habits, threaten them with horrible pictures and the risk that I’ll refuse to write them a new contact lens Rx. It never makes any difference, but it does lose you a patient. Instead, here’s my go-to behavior for dealing with this patient type.

Say nothing at the beginning of the exam about their contact lens habits. Perform your exam like normal. Do not comment about the contact lens abuse you already know about. Do the refraction; do your slit lamp exam. Now one of two things can happen: you see problems in the slit lamp, and it’s time to have a “Come to Jesus” eyecare moment, or you see nothing.  If you see nothing I would recommend skip the scare tactics and try to relate to the patient more personally:

“Great news! Your eyes look incredibly healthy. I know when you came in today though you told my assistant that your lenses were 5 months old.  Are you trying to give me a heart attack?!” I give them a horrified face. Then I laugh a little which lets the patient laugh and experience the self-awareness and guilt that they should at how crazy they are behaving. Then I’ll hit them in the heart: “Really though, nothing is sadder in my job than having someone go blind from contact lens wear. Please, please take care of yourself and your eyes. I don’t want to see you in here with an infection, ok?”

When patients admit to contact lens abuse, they are expecting you to cajole them; there’s almost a defiance to their admission of this behavior. And when you meet their expectations by reacting with scolding and threats as they expect, they’ve already planned how indignant and self-righteous they are going to feel. By reacting with humor first, and then honest care and compassion you throw them off and hopefully make them reconsider why they are behaving so stubbornly reckless.

JACQUI: Start by telling a fun little story.

“I have a story about a guy that smoked a pack of cigarettes a week He did so his entire life and then “suddenly” he got lung cancer. You are getting away with over-wearing your contacts for now, but your corneas will only put up with that for so long. You won’t get lung cancer but you can get a corneal ulcer that, at minimum, can prevent you from wearing contacts ever again or at most, leave you blind. I’m here to give you good advice but they are of course your eyes. Personally, I use my eyes all day long so I don’t risk it.

And then you can pull out your favorite picture of a patient with acanthamoeba and send that home with them.


Well, that’s it! I hope you learnt something useful and are now feeling better equipped to deal with the myriad of (not always optometry-specific) situations in the workplace.


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