“Dr Stewart, thank you so much for having me see Dr Smith. He spent so much time with me!”  Time and time again, this is the feedback I receive from my patients after referring them to a colleague of mine in a tertiary care practice.  While I’m always thankful for kind words from a patient, I started to wonder if Dr Smith was a bit of a magician.

Dr Smith is my go-to person when I don’t know where to go next. Patient with odd complaints and everything seems fine on my end? Unable to control a patient with the treatment plans I use? Patient walks in with something I feel is out of my comfort zone? Dr Smith gladly takes these patients on and makes them feel that each is the only patient he is seeing that day. He asks them about their families, gets to know about their favorite sports teams, and inevitably finds some connection to them which wows them (and me). He also makes them feel completely comfortable with his diagnosis, treatment plan and follow-up plan. Why do I think Dr Smith is part optometrist and part magician?   Because he routinely sees 50+ patients a day, every day. How does Dr Smith make every patient feel as though he spends 30+ minutes with them when I know he is spending significantly less time than that in the exam room? How does he gain such respect and buy-in from each patient in such a short amount of time? How does he provide such personalized, high-level care and stay so efficient? As a clinical site for a number of 4^th year optometry students, how can he be a mentor, teacher and practitioner and stay on schedule? Is he part wizard, or does he sleep at the office?

As someone who enjoys learning, I set out to find some answers.; I asked Dr Smith if I could spend a morning shadowing him in his office. I wanted to be purely an observer; I didn’t want to interfere with patient care or disrupt his students’ learning. I wanted to see just how he can make every patient feel completely at ease, taken care of and as though they are the only patient in the office.

As a practitioner, it can be a tough decision to take time away from patient care and generating revenue. However, I feel this half day spent with Dr Smith has been invaluable in my practice, both financially and personally. By listening, watching and observing, I felt I came back to my office that afternoon energized, excited and ready to make some changes in my communication.

What did I observe from Dr Smith? When I got into my car after seeing 25 patients with him that morning, I jotted down some notes so I would remember what I learned and put a plan into action for myself.

Be present

While in the exam room, it was just Dr Smith and that patient. There were often 2-3 students, myself and a family member in the room, but to Dr Smith, it was him and the patient. Too often we are distracted with our previous patients, the next patient on the schedule, time worries, staff distractions or even our personal matters. Really being focused on the immediate task at hand and being present with the patient in the exam room is so important, and immediately noticed by the patient. We all have multiple responsibilities, but I urge you to put those all aside when you walk into the exam room. Focus on the patient in front of you, and really listen to them. You’ll be amazed at the connections you will build when you minimize other distractions.

Make eye contact

Put down your pen, turn away from your computer monitor and really look at your patient. This is especially important when talking about a diagnosis or prescribing a treatment plan. Talking about potential vision loss from glaucoma?  Your message is much more powerful (and patients are more likely to take it seriously) when you are looking at your patient, and not clicking on your keyboard. It only takes a few minutes to have that face-to-face conversation, but those moments are very powerful and extremely important in communication. 

Utilize staff

When Dr Smith walks into an exam room, he is fully prepared with information gathered from his student interns.  He walks into that room with a plan, and has had time to think about that plan and what he will say before he sees the patient.  In our office, we utilize scribes who do the pre-testing, entrance tests, gather history and chief complaint(s).  They present this information to me before I see the patient, and as I walk down the hall to the exam room, I’ve already started planning in my head what I will do and say. This is extremely helpful when having to have a difficult conversation with a patient as I can quickly have that conversation in my head and think of the kindest, most efficient way to speak. I recently had my first patient present with a malignant melanoma and based on my technician’s information-gathering and “heads up,” I was able to collect myself, take a breath and mentally decide how to proceed before stepping into the exam room. I was able to have an educated conversation with that patient instead of trying to think on my feet. That same patient called after seeing the retinal specialist and thanked me for the calm, informative way I delivered some not-great news. If I hadn’t been prepared before I walked into the exam room, I may have done more of a not-great job of it.

Active listening

To be an active listener, we not only need to hear the words that a person is saying but listen to the complete message being communicated. Is your patient non-compliant with their glaucoma medications? Instead of dismissing them and being frustrated, really listen to what they are saying. Are they having trouble getting the drops out of the bottle? Are they having redness or burning when they use their medication? Are they simply having trouble remembering? Do they not understand the severity of their condition? This is a great opportunity to be an active participant in the discussion and get to the root of their poor compliance. Repeating their words often helps reinforce the message and get buy-in. In one patient interaction I observed, Dr Smith quickly determined that the patient was unable to instill their drops, so he quickly pivoted his communication from why the treatment plan was necessary to a teaching moment. 

Be direct and efficient

None of us have an unlimited amount of time to spend with each patient. We have a lot to get done in a short period of time, between performing the exam, making a personal connection with each patient, going through our findings, prescribing multiple treatment plans and answering questions. Whew! How can we take the finite amount of time we have with each patient and really make it impactful? What I learned from my time with Dr Smith was how precise and exact he was with his words. He was able to convey a lot of information with just a few words and make it clear for the patient. This to me was the most impressive part of my morning with Dr Smith. I immediately set out to cut down my descriptions of everything in the exam room. Does this take practice? Absolutely. Did I get it on the first time? Not even close! There were many times I’d try describing something to a patient quickly and realize as I was saying it that it was not coming out at all like I had planned. But the next patient, I worked harder and tried a different way, and over time have really seen a huge improvement in both my efficiency and patient understanding. Sometimes saying less makes our message that much clearer. Practice on a staff member, on your drive home, or in front of the mirror. Practice makes perfect and this is time well spent. 

Find a mentor

I am eternally grateful to Dr Smith for giving me the opportunity to watch him in action. I try and spend one morning a year with him to learn clinically but also continue to fine tune my communication skills. Is there a colleague in your area that patients compliment on their exams? Our patients truly win when we all share and elevate our expertise.

Never stop learning

It has been years since I started my communications journey, and I am still constantly finding ways to be better. I continuously challenge myself to be more efficient and effective in my communication and am never satisfied. I enjoy working on my delivery, my patient rapport, and the overall experience in my exam room and my office. And just when I think I have delivered something perfectly, a well-placed question from a patient makes me realize the journey never ends.

We as optometrists play such a role in our patients’ health, but if we can’t effectively get our message across, we aren’t doing all we can. By being present, being efficient and always striving to be better, we can all bring some of Dr. Smith’s magic to the exam room.

Yours in success-

Jennifer L. Stewart