Top 10 Lessons I've Learned So Far in Ophthalmology Residency
It’s been nearly 5 months since I’ve started, and i’ve finally found a moment to breathe after flying home for Thanksgiving. All in all, ophthalmology residency is everything I had hoped for and more. I previously said there was truly nowhere else I’d rather be, and I still believe that statement 120%.
In many ways, I’ve become more mature and confident, especially in my exam and my ability to explain “dry eye” syndrome to patients. However, in many other ways, I’m starting to finally grasp how large of a chasm that exists between me and where I need to be.
Anyways, this is a list of the top 10 things I wish I could have told myself when I started.
First and foremost, be a good person. You don’t have to be the world’s best doctor to make a positive impact on a patient’s life. Actually, you don’t even have to be a doctor to have a positive impact on another individual’s life. When you first start, you have no control over how much knowledge you have (minimal), your diagnostic accuracy (trace), or your ability to perform procedures well (nonexistent). You do, however, have complete control over the attitude and bedside manner you bring into the patient’s room. Likewise, you have the ability to make the patient encounter a positive one, even if you don’t have all the answers.
Seek out the uncomfortable. This is advice that was given to me by one of my favorite attendings. Residency is the time and place to feel uncomfortable, as there are seniors and attendings there to watch over you and save you should you make mistakes. Don’t shy away from doing procedures. Either do it now with someone watching or you’ll have to do it for the first time alone.
Just keep trying, even if you fail over and over. For the trickier aspects of the physical exam - scleral depression, gonioscopy, retinoscopy - it’s common knowledge that it will take time to master these skills. It’s important to keep attempting these techniques (in appropriate indications of course… ) and accepting that you will fail a lot. However, that doesn’t mean to be complacent with failure. You have to keep asking yourself, “why is this not working?,” “why is my view like this?” “what am I doing wrong?” It’s one thing to accidentally succeed and another to deliberately create the conditions for success. The former is not reproducible, the latter reflects actual mastery.
When things get hectic and you feel overwhelmed- stop, take a deep breath, and work on one task at a time, starting with the most important. This is advice for when things get crazy, either in the ER, on call, or in a busy clinic. No matter how many things you have to do, you can only finish one thing at at time, so you might as well do it well. Yes, everyone is having “an emergency,” but it is up to you to determine what are the the most critical things that will actually affect patient outcomes. And if you do those things in a prioritized order, there is nothing more you can do. This advice pertains more to the “feeling” of being overwhelmed. If you are actually overwhelmed with a certain situation, you should definitely call a senior.
Don’t reinvent the wheel. There have been residents for hundreds of years going through the same feelings and training experiences as you. Find people who are successful, and just copy them. This goes for exam techniques, how to perform certain steps in procedures, how to study, how to manage complex diseases — literally everything. While certainly there is room for innovation in medicine, when you are literally starting from the bottom, stick with the tried and true.
Don’t feel bad for what you can’t control (like wait times). I hate keeping patients waiting, and seeing 2, 3, or even 4 hour wait times in the ER gives me an enormous amounts of anxiety. There would be an overarching pressure to keep moving, and when I first started, I often felt like I was rushing through whatever I was doing in order to get to the next patient. However, this mindset actually helps nobody. It leads to a higher chance of delivering worse patient care to the patient you are currently with, which is ironic because this was the patient you were so worried about one encounter ago! You can only do one thing at a time, so do it well and do it efficiently
Don’t feel bad for what needs to be done! This goes for patients, particularly younger patients, who are very photophobic or can’t tolerate certain parts of the exam. In urgent situations, you have to examine the patient to determine the acuity of the problem. As long as the patient (or guardian) understands and has consented to the exam, it is your duty to perform the exam to the best of your ability even if it means causing discomfort or even in some instances, pain. You have to be the bad guy sometimes.
Be humble.. haha this is a more light hearted one. There are instances when a medical student will ask you something you don’t know (actually that’s most of the time for me) or even corrects you - and you can’t help but feel irked on the inside. Yes, you “should” know this and it certainly is unpleasant being corrected, but that negative feeling is a reflection of your ego/pride. In the end, the goal of our profession is to provide good patient care. Whether we are corrected by our attendings or our students should not matter.
Don’t let your work become routine. When treating dry eye or a corneal abrasion for the 100th time, it’s so easy to immediately start putting in the orders and typing the note. But now is not the time to feel like anything is routine, as we are complete beginners. This attitude will guarantee that you will miss the more uncommon diseases. Always have in the back of your mind, what else could it be? What more is there?
Lastly, and most importantly, go easy on yourself. You’re not as bad as you think you are, and you’ve come a long way.
Happy Thanksgiving!
Louie