I was recently asked for my advice for Ophthalmic Medical Personnel. It was a great question and gave me “cause for pause”. After much thought here it is:
1. Wear your heart on your sleeve when working with patients and strive to see them as a person and to connect with them.
2. Nurture positive and uplifting relationships with coworkers.
3. Never engage in gossip or drama. Both devalue you and contribute to needless strife. It also breaks down relationships which may have taken years to build.
4. If you ever get bored in our field it’s your fault because the learning never has to end. Never stop seeking to learn more.
Whether you’re the manager of a practice or a newbie starting their second week, each of us face a number of challenges in the workplace that can lead to stress, anxiety, and being short tempered. If left unchecked, stress can have negative effects on your job performance, your relationships with your colleagues, and even your physical and mental health. It’s easy to let stress take over at work - for example, if you are short-staffed, or if you have a disagreement with a coworker - but I believe that one of the key habits of successful people is their capacity to stay calm. How can you become a calmer person in the face of workplace difficulty?
1. Know your triggers. The key is to be self-aware enough to recognize when you are getting overly stressed. Practicing deep breathing (even just counting to 10!) or mindfulness will help you get there. Once you’re able to identify what triggers your stress, you can better manage your reactions. If you can, write these down as you’re feeling them to help you develop self-awareness.
2. Avoid catastrophic thinking. A very common thought pattern that can escalate out of control in times of stress is catastrophizing. Catastrophizing is when you assume that the worst possible outcome is the most likely. It’s when you forget to turn something into your boss on time and think, “Well, I’m getting fired and surely somehow this will lead to the downfall o the business, and it’s all my fault.” Wrong. Get some perspective - most things are far less of a big deal than we think they are!
3. Don’t be afraid to ask for help. You know the phrase ‘fake it ’til you make it’? I think this phrase is great…sometimes. While this attitude can be useful, for example in building confidence, one way to lessen stress is to recognize when you are over your head, facing a new challenge, or need some guidance. It benefits you and your colleagues when you ask for help.
4. Pause and think. This applies particularly if you are in a management position. It’s key to think very carefully about each situation and consider it from all sides before making a decision. This will help you stay calm, because it will force you to be objective and to give your emotions a cooling-off period.
The capacity to stay calm in the workplace will become one of your most valuable assets. It shows your manager and colleagues that you’re someone that can be depended on when things get hairy, and it will also improve your decision-making skills. And remember: you’re not a robot, you’re a human being! So cut yourself a break, too.
Way back in 2015, I published a blog post about a creative exercise I used in a staff meeting to discuss an ongoing issue in the office. The issue revolved around staff continually neglecting to keep the exam lanes stocked. Everything came to a head when the doctor reached for alcohol prep pads and exam gloves and discovered she didn’t have any in the exam lane she was using.
How to get the point across to my staff? They had been reminded of this repeatedly but nothing seemed to make it stick. At the following morning’s monthly staff meeting, I asked, "Who makes peanut butter and jelly sandwiches for their family?" Everyone raised a hand. Then I asked, "Who thinks they can make a peanut butter and jelly sandwich and pour glass of milk in a minute or less?" Again, everyone raised a hand. I asked for two volunteers and I told them, "Let's time you both and see who can make a PBJ and pour a glass of milk the fastest." I had set up two stations where they could make their sandwiches. "On your mark, get set... GO!"
But at one of the stations, I purposefully ‘forgot’ to stock it with essential items needed for the task: a knife to spread the peanut butter, and a glass in which to pour the milk. As a result, the staff member at that station had to repeatedly run to the staff kitchen to grab supplies, and finished well after her other colleague.
Finally, they understood the point.
Why was this so effective? Three reasons: it was fun, it was memorable, and it was demonstrative.
It was fun: Part of me wanted to simply admonish my staff for what they were doing wrong. I was exasperated, the doctor was angry, and this was something they’d been told before. But rather than simply getting them into a room and telling them what they did wrong, I decided to engage them in a somewhat silly exercise. This makes a person much more engaged and, believe it or not, more open to what you are saying. Laughter is the best way to get someone on your side!
It was memorable: By necessity, a lot of staff meetings are spent going over administrative issues and other business agenda items. Sometimes these things can feel bureaucratic - dare I say even boring! Now, I’m not saying that your staff meetings need to be entertaining - you all are there to perform a job, not be entertained by one another - but when a lesson is more memorable it is far more likely to stick.
It was demonstrative: I got the staff involved in my discussion. I asked for volunteers and I asked them to complete a task in front of their peers. By getting them involved, I made them active, rather than passive, parts of the lesson.
In my consulting, I work with managers and colleagues to develop creative ways of engaging your staff. When something doesn’t seem to be working, all that means is you need to switch up your tactics! Whenever I visit a new clinic or office, I encourage everyone to not be afraid of trying something out of the box.
Would you like to engage me at your workplace? Drop me an email at firstname.lastname@example.org or give me a call at 386-446-3884 and we can discuss how to make your workplace efficient, effective, and fun. Or, click here to receive a 100% no-obligation quote for in-office training and consulting. I’d love to hear from you!
This is an abbreviated version of my article, "Get Organized! Medical Office Organization Tips." Find the full article in the September/October 2018 issue of Administrative Eyecare Magazine!
Maintaining an organized office is the key to efficiency and sanity. These simple tips can improve efficiency, profitability, and decrease stress for everyone.
In and out boxes: Consider placing them outside each doctors’ office so physicians can be productive during short period of downtime.
Staff Training, Processes and Protocols
Checklists: Critical positions to consider are check-in, check-out, and surgery scheduling.
Standardize each office position and doctors’ preferences.
Job protocols: Write a "how-to" manual for each job. When a staff member is suddenly unable to do his/her job, another staff member can pinch hit. Include all pertinent websites used along with passwords and log-on information. Include screen shots to walk the “pinch hitter” through computerized tasks. Give the manual pertaining to your job to the owner/doctor so it can be kept in a secure place.
Cables: Use binder clips to organize power cords and cables. Label and color-code cables to indicate which cable plugs into which port in which piece of equipment.
Bank deposits: Make daily deposits a priority. Online banking is a good solution, but regardless of whether or not you use online banking, the monies in the deposit don’t do the practice any good sitting in a drawer.
Open-door policy: An open-door policy is great. It says, “I am always here for you.” However, it can adversely impact your productivity and handicap staff from problem solving on their own. Consider scheduling a one-hour “open door” slot each day. Communicate this to staff in a way that conveys that you value maintaining your own productivity. Be careful not to come across in a manner that implies the staff is “bothering” you.
Doctor preference sheets: When possible, standardize physician work-up protocols. If this is not possible, make a spreadsheet listing each physician and all preferred work-up components for each appointment type or situation. Identify with an "X" each component a particular doctor wants performed. Place this document o your server and shortcut to this document on each desktop and tablet.
Magazines: It’s difficult to keep magazines tidy. Placing them in decorative baskets eliminates having to straighten them and helps create an orderly yet inviting waiting area.
Refreshments: Consider placing beverages and snacks on a wheeled cart with brakes. This allows staff to roll the cart to the kitchen to wipe down the spills and replenish the cart efficiently.
As you organize, purge unnecessary items so you are not organizing "garbage." Most people feel in control and satisfied when their space is organized. Organization clears your head, increases productivity, and decreases stress.
It's the same old story. You're short staffed in the clinic and trained techs are difficult (or impossible) to find. Patients are waiting and doctors are running behind. Everyone is stressed!
You're not alone. At least once a week I hear from practices just like yours looking for trained technicians. I rarely have anyone to recommend to them.
There's a solution. Train in-house (PS: It's easier than you think)
My clients requested it and it's here! A peer-reviewed, turn-key, customizable technician training program, ready for immediate implementation. It's a one-time purchase; not a recurring subscription. Utilizes the text "Ophthalmic Medical Assisting: An Independent Study Course" and your technician trainer.
This Technician Training Program Includes
13 Training Video Modules fully narrated by Sharon Alamalhodaei, COMT, OSC and and Dr. Melissa Toyos, MD
Original training videos of Sharon demonstrating techniques
Printed Quizzes and answers
Printed Trainer's Guide
Printed Trainee's Guide
A Technician Skills Assessment Grid
All future updates are provided to you for free
A one hour telephone implementation session with Sharon for your trainer(s)
Holds trainee and trainer accountable for demonstrating proficiency in each skill
You can save, edit, print and share within your practice
Saves money: trainees are productive quickly
SALE Priced til August 31, 2017: $1,450
If you have been an in-office training client of Sharon's, please contact for an additional discount available exclusively to her in-office clients
CustomerService@EyeTechTraining.com or 386-446-3884
1. Learning new things every single day
2. Helping others see better which enriches their lives
3. We never do anything that hurts the patient
4. I love working with seniors!
5. Working with a team
6. Using high tech equipment which AMAZES me!
7. It's fast paced and the work is varied
8. Professional development (certification, sub-specialities such as retina, glaucoma)
9. Think of all the people walking around my town with spectacle prescriptions I helped find!
10. It's the BEST KEPT SECRET!
PS Share the secret!
Edit 7/17/18: Still looking for tips? Find an updated version of this article, with everything you need to know about the COA exam here!
I am preparing for the COA exam - my first JCAHPO exam, the most difficult part of the process for me is not knowing the depth or breadth to study in each content area. I constantly wonder "Am I over-studying? Am I understudying? Am I studying the right things?". - Sharon Alamalhodaei, 1993
Once you have taken your first JCAHPO exam, you have a better idea of how the questions and answers are phrased and the testing process as a whole. Knowledge is power. Unfortunately, when it's your first JCAHPO exam you don't have this knowledge. This, my friends is the real challenge of test preparation.
Strategy #1 Study Material & Prep Courses
Review the suggested reading material for the exam. Click on the link "Study Resources" here
Due to the cost, most people cannot purchase all of the study resources listed, so you must either select a few broad texts or be creative by leveraging as a group and buying and sharing books with colleagues. Even better, ask your practice to build a library of resources which you can 'check out'. If you can only choose a few books here are my recommendations:
1. Ophthalmic Medical Assisting: An Independent Study Course (Newmark, O'Hara) Any edition newer than a 4th edition will do and they are readily available used on Amazon. Unless you have attended a formal accredited Ophthalmic Training Program, this book and the test you can purchases separately is a prerequisite for the COA exam - so you need it regardless.
2. The Ophthalmic Assistant (Stein, Slatt, Stein) Again, any recent edition will do and they are also readily available used on Amazon. The trick with this book is there is a TON of information in it that you don't need to know for the COA exam. So, refer to the test content areas and study just that content in this book. Think "Basic Level Proficiency" and read to that depth and breadth
3. The COA Study Guide, available from JCAHPO is terrific. It's practice exam questions and is only $15. The depth and breadth of questions closely resembles what you'll see on the actual exam.
4. I teach in person COA Exam Prep Courses throughout the country. Check here for more information and to see if I'm coming to your area soon. I also teach an online COA Exam Prep Course which allows you access for 6 months. You can pause and re-review any part of it. It includes a 200 Question practice exam plus individual tutoring with me. A free sneak peak is available here. You can click through a link below the sneak peek to purchase it.
4. Some people like using flash cards to study. ATPO has a set for the COA exam which you can find here: Flash Cards
Strategy #2 Find a new COA
Talk with colleagues who have recently taken the exam. JCAHPO does not permit one to share actual questions on the exam, but these colleagues can help guide you as to whether you're studying the right material and depth and breadth of material.
Strategy #3 Study Buddies
Get a study buddy. It' s much more fun joining forces with someone who is facing the same challenge you are. It holds you accountable for progressing with your studying and you can quiz one another.
Strategy #4 Break it Down
"How do you eat an elephant? "One bite at a time!"
Set a goal date to take the exam. For example, 6 months from now. Then, divide up your study material accordingly. For instance, if you're taking the exam in 6 months (26 weeks) divide up the study material into 20 sections. This leaves a little wiggle room in case something comes up in your life that precludes you from studying that week and leaves a week or two right before your exam for last minute review and memorizations. Then, stick with your study schedule.
Strategy #5 Phone a Friend
Do you have physicians or senior techs who like to teach? Take advantage of their knowledge. Be inquisitive and ask questions about anything you study but don't understand.
Strategy #6 Join In
Join Ophthalmic Tech Facebook groups. One of my favorites is "Ophthalmic Techs on Facebook". Like and Follow me on Facebook and Twitter at "Eye Tech Training". Subscribe to this blog where I post a wealth of information about technician skills and technique.
You CAN do it if you put your mind to it! Please feel free to reach out to me if I can help you. My email is Sharon@EyeTechTraining.com or message me on Twitter @EyeTechTraining or Facebook at "Eye Tech Training"
Automated Visual Field Testing is critically important. It assesses the functioning of the entire visual system including the brain, optic nerves and retinas. Obtaining a reliable, quality test is the job of the visual field technician. This article discusses the two keys to obtaining a quality test.
Key # 1: Instructions
How can you expect to get a quality test if you don't tell the patient what you want them to do? Patient Instruction is critical.
Following are bullet pointed instructions. I recommend you post them to the left side of your visual field screen so you can easily glance at them while instructing the patient.
- Test of side vision
- Makes a map of vision
- Chin in chin rest, forehead against bar
- Look straight ahead at yellow light. Do not look away from the yellow light
- You’ll see flashing lights. Some will be very bright, some very dim
- Sometimes you won’t see a light for a short time - that’s normal
- Push button whenever you see any light other than the yellow light
- Keep chin in chin rest, forehead against bar
- Do not move your head
- Blink whenever you want
- Remember to only look at the yellow light and push the button whenever you see any light other than the yellow light
Instructions for the Visual Field Technician
This test requires a partnership between the patient and the technician therefore, it's equally important the technician also knows what to do. Following are bullet pointed instructions for the technician:
- Place lens(es) in lens holder
- If possible, align handle of lens supero-temporally
- Patch eye not being tested
- Confirm patient cannot see around patch
- Give patient response button
- Position patient
- Height of table ok for pt?
- Chin on chin rest
- Teeth together
- Forehead against bar
- No head tilt or turn
- “Can you see the yellow light in the center?”
- If no, change fixation target small or large diamond target. Pt should fixate in middle of diamond
- Align pupil in cross hairs on monitor screen
- KEEP CROSS HAIRS CENTERED IN PUPIL THROUGHOUT TEST
During the Test
“Push the button whenever you see any light other than the yellow light”
Encourage patient but don't distract from test
- You’re doing great
- You’re almost done
For Fixation Losses
- Remind patient to look only at yellow light
- Is fellow eye fully patched?
- Click ‘Retry to find blind spot”
- Recheck patient's head and eye position
- Goal: < 20% fixation losses
Key # 2: Patient Positioning
If you're not sure how to fix a positioning problem, ask the patient to sit back, pull the patient's chair back and start from scratch with positioning the patient. Here are the important points:
Chin down, teeth together
Forehead against bar
Lens as close to eye as possible without eyelashes touching lens
Head straight (no tilt or turn)
The patient's chair should be aligned straight with the chin rest/VF machine
Pupil aligned in cross hairs
Yes, Visual Field Testing can be boring and arduous for the technician and for the patient, but if you carefully instruct your patient and closely observe the patient's positioning, you will be much more likely to obtain an accurate, quality test. Your patient AND doctor will appreciate your efforts.
In order to become a better Ophthalmic Technician
One must be
Interested in what you're doing.... have passion!
Willing to hear the truth about ones skill level and be objective about oneself.
Willing to practice and reach outside ones comfort zone.
To become great at anything, you must either:
- Be born with innate talent
- Develop proficiency in a teachable ability
Musical ability is sometimes thought of as an 'innate talent'. Ophthalmic Medical Assisting is not thought of this way, rather one develops ability as an Ophthalmic Tech through learning and targeted practice.
The Key Ingredient
Deliberate practice is aimed at improving specific aspects of the skill. Deliberate practice is very different from what many of us think of as 'practice', which is when we aim for vague, overall improvement.
Deliberate practice requires feedback from someone who understands what adjustments need to be made to make you better at that skill; someone who already is proficient who then 'coaches' or teaches you how to develop those skills.
Studies have shown that on average it takes 10,000 hours of deliberate practice to become highly proficient in any given skill. 10,000 hours is approximately five years of full time work in your clinic.
Push Yourself To Success!
You must reach outside your comfort zone as you practice in order to develop proficiency. It's much like aerobic training. If you jog so that your heart rate is only slightly above your usual heart rate, you won't develop aerobic fitness. You must push yourself beyond that which is "comfortable" in order to develop aerobic fitness.
Make a point to reach outside your comfort zone every day to learn skills and to become better at those skills you already have. Success is within your reach. Go and get it!
When I Was a Newbie
I was new to the ophthalmology field. I had a designated trainer who put me on the fast track to proficiency. I became confused, though when colleagues would contradict what I was taught.
For example my trainer taught me to check vision repeatedly during a refraction. Colleagues told me I should only check vision when the refraction is complete. My trainer taught me to isolate letters on the Snellen Eye Chart, but others told me to keep the chart open. Was my trainer correct? Were my colleagues correct? I was confused and began to doubt my trainer. I worried I was doing things wrong.
What I Did Not Know
I did not know that there's more than one way to skin a cat. (I so hate that saying, but it's most appropriate in this circumstance). My trainer and my colleagues were both right.
It's difficult being a new trainee and when you add multiple opinions to the mix it is even more difficult. I encourage techs to avoid giving advice to trainees. Instead defer to the trainer (even if you'd do things differently). It will likely only add to the newbie's confusion, not add to their proficiency.
Learning To Bake a Cake
A new baker follows the recipe as it is written because he doesn't have the knowledge to or an opinion about changing the recipe. However, once the baker has made the cake a number of times, he might decide to add nuts or substitute caramel for chocolate. The cake will still turn out tasty even when those ingredients are changed. However, what would happen if the baker changed ingredients like yeast or flour?
An experienced baker knows what ingredients he can tweak and what he shouldn't change. A new baker doesn't have the experience to know this so he should follow the recipe as it is written.
The Experienced Tech
Once the Ophthalmic Assistant gains experience, she learns what parts of her work up can be tweaked and what should never be changed. She is now an "experienced baker" and can add all the nuts she wants to her cake!
I don't consider test anxiety a bad thing. It means you care about doing well on your exam which is a good thing! The trick is to harness and manage this anxiety for your benefit.
Yes, it's important to study, cram, memorize. But it's equally important to manage test anxiety so you can retrieve that critical information. Some methods for managing test anxiety which have worked for me include
- Nurturing oneself (mani, pedi, etc)
- Recreational TV watching and reading (not text books)
- Getting quality sleep
- Preparation (studying appropriate test prep material)
Choosing Test Prep Material
People learn differently, so a method that works for your friend or colleague may not work for you. Perhaps you prefer using flash cards or online courses. Perhaps you prefer studying alone or maybe in a study group. Be open to trying new methods of learning. Prepare by using whatever method works for you.
Know when to say when. If you're studying and feel like you can't put one more thing into your head without something else falling out, close the books and walk away.
In a Nutshell
It's not a matter of not having butterflies, it's a matter of getting the butterflies to fly in formation.
Edit: You can find an updated version of this blogpost here!
Approximately every five years JCAHPO updates the content for the COA, COT and COMT certification exams. These changes keep the certifications relevant and reflect respnses to periodic surveys about the tasks Allied Ophthalmic Personnel perform day to day in the clinic.
Currently, the core exams are divided into NINETEEN separate content areas including
- Ocular Motility
- Ophthalmic Imaging
- Visual Fields ...and more.
This will change in August of 2016. The exams will be re-categorized into just FIVE content areas which will include the old test content plus additional content areas. These five core areas are:
- Assessments (includes Visual Fields, Motility, Visual Assessment, History Taking, Refractometry and Refinement, Retinoscopy, Pupils, Lensometry, Keratometry, Biometry and Supplemental Testing)
- Assisting with Interventions and Procedures (Includes Microbiology, Pharmacology, Surgical Assisting and Ophthalmic Patient Services & Education)
- Corrective Lenses (Includes Optics, Spectacles and Contact Lenses)
- Imaging (Includes Imaging, Photography and Videography)
- Office Responsibilities (Includes Equipment Maintenance & Calibration, Medical Ethics, Legal and Regulatory Issues, Communication Skills and Administrative Duties)
If you're preparing for a JCAHPO certification exam, now is the time to decide if you want to take the exam before or after August, 2016. To help you prepare, JCAHPO and I have partnered to bring you COA & COT Exam Prep Courses. See a free sneak peek on this website on the 'Online Courses' page. The course content will be updated in time for the August, 2016 changes.
1. You can't refract every patient to 20/20 so don't automatically blame your refracting skills if the patient doesn't achieve 20/20.
2. When offered an opportunity to progress in your career - take it. Even if it's not what YOU think you want to do. It could lead to other opportunities in the future.
3. Don't worry about what your coworkers say or do.. It speaks more about them than it does about you. It's just not worth the energy.
4. Avoid gossip and drama.
5. No matter how much you love your career always strive to maintain a work/life balance.
6. Don't get complacent. Embrace mastering new technology and instruments that are introduced into the practice.
7. Give your boss more than s/he expects of you.
8. Never stop reading.
9. Get involved in the ophthalmology community through continuing education and volunteer opportunities
10. Always remember the patient is a person... not just a set of eyeballs.
10. No... really... take your time on that cell phone call.
9. I'm going to check your pressure. Squeeze your eyes really tight.
8. Those glasses you bought on the internet are PERFECT for you!
7. Tell me more about your hammer toe surgery.
6. Using that coat hanger to keep your glasses on your head is a GREAT idea!
5. It's fine that you came in an hour late for your 11 am appt. I'm on a diet anyway.
4. Your vision is 20/400 OU. Oh, by the way, can I catch a ride home with you?
3. Yes, ALL of your family members should join us!
2. Yes, we really DO take the eye out when we do cataract surgery.
1. Don't tell me which is clearest. I just want to SHOW the lenses to you.
Managing encounters with patients is both an art and a skill. Either you run the encounter or the encounter will run you. This is frequently one of the most difficult skills for new technicians to master. Conflicting Goals?
It seems we have competing interests: On one hand,;we strive to provide a welcoming and friendly demeanor, yet there are real time constraints dictated by appointment templates. Is this a no win situation? I have found there are ways to satisfy both customer service and time constraints.
How to Manage Your Encounter with Finesse
Have you ever worked up a patient who wanted to engage in seemingly endless social conversations? What about the patient who won't stop joking around? A simple yet effective way to get your encounter back on track without offending the patient is to say "Mrs. Smith, the doctor is probably wondering where you are. Let's get finished up so we can get you in to see him." This is TRUE! The doctor probably IS wondering where your patient is. He is probably standing in the back hall looking at his schedule and wondering why he has yet to see Mrs. Smith whose short follow up appointment was 45 minutes ago! The statement will not offend your patient; if anything, it may flatter them... ("Dr. Jones is looking for me and wondering where I am!"). I have used this technique many times over the years and it has worked without fail.
If you don't manage your encounter, it will manage YOU. Take charge (but in a nice way).
More than twenty years ago; fresh in the field, I confided to a COMT that one day I, too wanted to be a COMT. She scoffed and said "You can't possibly have enough knowledge to pass the exam unless you work in a large University Clinical setting or go to a formal COMT level training program." I was bummed but I never let go of my dream. In 2013, I became a COMT and proved her wrong. The day I took and passed my COMT Skills exam was one of the happiest days of my life. Here are before and after pictures of that day...
I am here to tell you that YOU CAN become a COMT if you work hard enough and want it bad enough. Here's how I did it:
- I purchased or borrowed every book I could on JCAHPO's recommended reading list and read them each multiple times. I studied for two full years for the exam. Six months before the exam I gave up all recreational reading material and TV, signed off of Words with Friends and Facebook and spent all of my spare time studying. I even kept a book in my car so if I found myself stuck in traffic I could use the time to read.
- I went to JCAHPO's ACE meeting (the annual CE meeting held in conjunction with the AAO meeting) and took only Master's Level classes concentrating on subject which I felt were my weakest. If you get an opportunity to attend, I highly recommend the course on Clinical Mathematics by Kenneth Woodward, COMT.
- I attended the COMT Review course at the ACE meeting but did not find it helpful. It is a REVIEW course. A Review course is a brief overview of the topics on which you will be tested. It doesn't actually give you the information in the content areas you need to know. In contrast, a PREP course is a long, comprehensive course and actually gives you all the information you need to know to pass the test.
- Every spare minute I studied.I DID find JCAHPO's COMT Skills Review Course very helpful. They had a team of COMT's who helped the group of COMT hopefuls as we went through various skills stations. They had stations on FA's, Motility, Lensometry and more. The instructors were wonderful in explaining the skills and the pathology we were looking for. It was immensely helpful!
- I found two mentors, Jessica Barr, COMT from PA and Sergina Flaherty, COMT from Texas who were helpful in answering questions I had about various pathologies and skills.
- I purchased several JCAHPO's Learning Systems modules and other CE courses on www.EyeCareCE.org. These complemented the Masters Level courses I had taken at the ACE meeting. I especially found the motility courses helpful.
- I wrote all the optics formulas I needed to know for the exam in a notebook and studied that the morning of my exam so it would be fresh in my head.
I scheduled my written exam for a Wednesday afternoon. My plan was to spend Monday and Tuesday cramming and Wednesday morning studying my optics formulas. On Monday morning I sat down to read and thought "If I put one more thing in my head something else is going to fall out!" My brain was saturated. I was also a growing more and more anxious. That was when I decided to close the books. Instead of studying, I spent that Monday and Tuesday nurturing myself. I got a pedi and mani, went to a movie, watched dumb TV and got lots of rest. The helped my anxiety level be manageable. On Wednesday morning, I went to the test site four hours early, found a nearby coffee shop with wifi and studied my formulas. I took my exam and finished in just 1 1/2 hours. I had aced the test! YOU can do it too!!!
Conflict is one of the toughest issues one has to deal with in the office. Business bring people together from many different backgrounds. This is good because varying experiences and capabilities enhance the efforts of the team. However, the differences in and variety of people and experiences can cause conflicts to arise.
Strong leadership evokes respect, authority and a sense of grace. When leadership is lacking, resentments arise. Trust is essential for any work environment. Divisiveness, back-biting and internal politics can lead to distrust causing morale and essential office functions can go downhill fast.
By the same token, a manager's job is not to simply resolve employees' conflicts. It is to ensure that everyone is respected and understood. Staff members should be empowered by management to resolve conflict among themselves in a mature, "grown up" way.
Here are some strategies to resolve conflict:
- Ask yourself "Could this reaction be caused by something else?". For example, perhaps the other person has a sick family member and isn't responding to you as she normally would due to these personal circumstances.
- Restate your position politely and respectfully. Avoid being defensive or seeming to grind your heels in. This provides the opportunity to correct misunderstandings.
- Mentally separate the people from the problem. Realize that most people have good intentions and aren't trying to cause conflict. Give others the benefit of the doubt. Separating the issue from the person helps to maintain good relationships once the conflict is resolved.
- Listen and try to understand the other party's point of view. Listen first, talk second and be open minded.
- Discuss observable FACTS (no opinions or suppositions).
- 6. Explore resolutions together and be open to the fact that a third option (other than your opposing positions) may be the best option.
The keys to successfully resolving conflict in the workplace are to be non-confrontational, open minded and respectful and when this happens, everyone wins!
The administrator called me asking for help. She said her doctors had been getting a lot of glasses remakes and unhappy optical patients. Additionally, the doctors had lost faith in their technicians' VA's and IOPs measured with a Goldmann Applanation Tonometer. The doctors and administrator were befuddled because their 30+ technicians had been doing well but seemed to have faltered over the past year. They asked me to come to their office and spend three days with their technicians. Evaluating the Problems
I began by simply observing each technician as they processed patients. This took a full day given the fact that there were more than thirty technicians, but by the end of the first day I knew exactly what the problems were. What I discovered is that a technician with many years experience had been hired a year prior and had been put in the role of head technician and trainer. Unfortunately, this technician was not as well skilled as she (or the practice) thought she was. She had spent the past year re-teaching all of the technicians erroneous skills.
This practice worked in plus cylinder but the technicians had been trained to 'chase the red' (!) This one error was perpetuated from technician to technician until only spherical patients were getting accurate refractions. Additionally, the technicians were measuring VA incorrectly. They recorded VA as the last line of letters they read all of the letters easily. The technicians were also taught to align the Goldmann applantion tonometer mires into the shape of an 'S' rather than 'just kissing' resulting in erroneously low IOPs.
Light Bulb Moments
I spent the next two days re-training the technicians on VA, refraction and GAT and by the end of the third day, they were all accurately refracting, measuring VA and GAT. The technicians had many 'light bulb moments' and It was a happy ending for everyone except the head technician who unfortunately, was demoted from that position. It was sad, but necessary.
My Two Cents
When you're new to the field, you only know what you're taught. If you're taught incorrectly you won't KNOW you've been taught incorrectly. This is why it's critically important to ensure technician trainers know their stuff. Don't be shy about doing 'working interviews' with even the most seasoned technician. It's the only way to be sure they have good skills.
When you assign a lead tech or technician trainer, TRAIN THE TRAINER. Ensure this trainer gets support from the practice in the form of continuing education and feedback and mentoring from the physicians.
A Happy Ending
In the end, the fixes for this practice were easy, but it took an outside person who could devote the time to evaluating each technician's work up to find the root of the problem. I called the administrator a few weeks later and asked how the clinic was going. She said the doctors were thrilled with the quality of the technicians' work and their glasses remakes were down dramatically and the technicians said they felt more confident in their skills. She told me they estimated my services had saved the practice 'tens of thousands' of dollars. That was great to hear... but the best part for me? Better patient care.
Most refractions are straight-forward but what happens when you're faced with one that's not? Knowledge is power. With the proper training and guidance you can handle even the most challenging refractions. Let's discuss some common challenges you may face and how to meet them head on. First, let's learn an important formula to know when scrutinizing your refraction. Generally, a one diopter change in spherical equivalent should equal approximately three lines of improved VA on the Snellen eye chart. A spherical equivalent is calculated by taking half of the cylinder and adding it to the sphere power, then dropping the cyl and axis. For example, the spherical equivalent of -1.00 +1.00 x 180 is -0.50.
Patient Refracts To a Lot More Plus Cyl AND a Lot More Minus Sphere: Probable Cause: Too much minus sphere, inaccurate refraction. Try This: Decrease spherical equivalent (0.25 sph to each 0.50 cyl) Example: WRx: plano +1.00 x 180 20/30 MRx: -2.50 +3.00 x 180 20/20
Explanation: This refraction doesn't make sense. The spherical equivalent of this patient's WRx is +0.50. The spherical equivalent of their MRx is -1.00. They have only 2 lines of improvement on the chart with 1.50 D change in spherical equivalent. You wouldn't expect that big a change in Rx for only two lines improvement of VA.
What to Do: Decrease the spherical equivalent until BVA is obtained. This is accomplished by removing +0.50 cyl and 0.25 sphere at the same time and checking VA after each change of the lenses. The end point is when you determine the least change in spherical equivalent which gives the best VA. Then, recalculate the change in spherical equivalent vs. the improvement in VA and see if it makes sense.
Patient Refracts to > 3.00 D Difference Between Their Two Eyes. Probably Cause: Anisometropia Try This: With both of patient's eyes open: Show pt changes in sphere of 0.50 or pulling sensation in RF increments so that both eyes’ sph powers are brought closer together. Example: Pt refracts to: -3.00 +1.00 x 180 OD +1.00 +1.00 x 180 OS Show the pt: - 2.50 +1.00 x 180 OD +0.50 +1.00 x 180 OS Ask the patient to compare this Rx with the refracted Rx. “Does this lens look about the same?” Remember to show them binocularly - not monocularly. Recheck binocular VA.
Explanation: Anisometropia means the patient has > 3D difference in refractive errors between their two eyes. Minus lenses minimize images, plus lenses magnify them. Patients who have anisometropia may have a difference in perceived image size known as anesekonia. Our brains can only fuse images that are of similar size, so when the patient has anisometropia they may have double vision or a pulling sensation.
What To Do: Give the patient the Rx which gives them the sharpest vision possible without causing a pulling sensation or diplopia. It's critical to trial frame the new Rx. Be certain to center the lenses in the trial frame so the patient is looking through the optical center to avoid induced prism. With the trial frame on, encourage the patient wander around the office and look outdoors to make sure they don't have any diplopia or pulling sensation in the Rx.
Every refraction is a learning opportunity for the technician. Follow up with your doctor after he or she sees these challenging refractions and ask the doctor why he Rx'd what he did so you can learn from it. With practice and exposure to many different types of special situations you will become a seasoned refractionist. Happy Refracting!
There are many reasons we refract patients. Some are obvious. The patient wants new glasses or contact lenses. Others are not so obvious.
Doctors can detect, follow the progression or improvement of certain eye diseases by measuring best corrected vision. For example, the primary symptom of macular edema is decreased VA so patients who are being followed for macular edema should be refracted to determine what their best corrected VA is since this is a direct indicator of whether the disease is improving or worsening.
The Role of the Ophthalmic Technician in Patient Education
Patient Education is key. When your patient refuses a refraction yet clearly doesn't understand the purpose for the refraction, it's up to the technician to educate the patient. I encountered this with my patient, Mrs. Turner.
"Mrs. Turner, the reason we are doing this test is so the doctor can determine what your best vision is - not necessarily to prescribe new glasses. This is important so the doctor can determine if your cataracts are indeed the cause of your decreased vision." Once I explained this, Mrs. Turner was amenable to having a refraction performed and my doctor had all of the information he needed to make medical decisions which benefited Mrs. Turner.