During my 25 years working as an ophthalmic medical technologist, I have encountered unavoidable challenges and mistakes that we may all experience while working in cornea clinic. Rather than ignoring them, I choose to review them carefully and determine the best ways to stop unintended consequences behind each event. Failure to address faults on time leads to a pattern of more mistakes and blame, which ultimately affects patient care.

What could go wrong?

Every ophthalmic practice is different, but the basic elements utilized in clinic do not change. Traditionally, the ophthalmic technician is the first one to greet and interview patients prior to the physician’s exam. This first-hand introduction is crucial to the patient’s experience in the cornea clinic, but what if the patient declines to see you? This could happen if patients are unhappy with previous experience with your work up, due to perception of inadequacy, your style, behavior, or just because you had no affinity. Keep in mind that first impressions do count.

Now, let’s walk through a patient welcoming by an ophthalmic technician and find out the role of affinity.

The effects of building rapport

A common mistake is to call a patient into an examining room and immediately start asking questions without taking the time to introduce yourself or apologize for the wait, if any. Without knowing how a patient feels, it is impossible to build rapport. Also, keep in mind that some patients get frustrated, angry, and hostile, so we must apologize, feel compassionate, and take charge. A fast-moving clinic should not become an obstacle between acknowledging a patient properly in the waiting room and establishing a true patient-ophthalmic technician connection in the examining room. As a member of the ophthalmic medical team, you can greatly influence how the patient feels about the practice, and there is nothing of more value than showing a patient that you care.

Conduct an organized patient interview

You play a key role in the diagnosis and treatment of a patient when you provide an accurate history.

Perhaps you meet a new patient and quickly review past and present ocular history. The patient will feel comfortable with you and conversation gets deviated to a personal level. Because of the conversation, time flies and the exam is not finished and seems to be missing pertinent data. You are in control to redirect the interview back to history. Look for details, ask questions, and stick to them. Take, for example, the following list:

• What brought you here today?
• Have you noticed any decrease in vision or discomfort? Which eye? For how long?
• Any previous eye surgeries or procedures? Elaborate on dates, surgeons, and results.
• Review current eye drops, and inquire about any failed treatments in the past.

The biggest “oops” for the technician who obtains history is overlooking details and not being curious enough to refresh the patient’s memory related to all eye medical history. It is common for patients to get to the physician and have an incomplete medical history. If you don’t pay attention to essential facts while writing a history, this leads to more time for the physician to spend with patients on preliminary questions, which affects clinic efficiency.

Don’t let EMR blind you

Whether you view EMR as time consuming or the best invention in modern technology, during your patient interview, you are already connected to the patient by asking questions and documenting responses on the patient’s chart. But, what happens when you let your clicking get in between you and your patient?

Keep in mind the location of your computer monitor. While you need to focus on typing, one of the most common mistakes that ophthalmic technicians inadvertently make is to place their back towards patients, without acknowledging the patient’s chief complaints. The result is the patients feeling neglected. You, as an assistant to the ophthalmologist, cannot afford to have your care perceived as impersonal by your patients.

One useful rule of thumb is to sit away from the computer at first and maintain eye contact with patients before explaining the need to turn your back momentarily. Even if your practice has the perfect desk setting or uses laptops for EMR functionality where technicians face the patients, the key is still to look up and make eye contact during the interview.

Also, when making entries on medical records, do not leave the monitor on with patient information before leaving the examination room — this is a HIPAA violation.

Recognize the impact of dry eyes

Patients with history of dry eyes experience daily discomfort. The “oops” happens when you fail to do any special testing to evaluate dry eyes. By not asking patients questions like, “Is there is any tearing, discomfort, foreign body sensation,” you are not directing your work up towards dry eye evaluation, which can impact treatment decisions. To avoid missing the opportunity to help the ophthalmologist diagnose an ocular surface condition, don’t forget to use the Ocular Surface Disease Index questionnaire to identify patients in need of a full dry eye work up.

A taste of the past

Ophthalmic technicians of all levels report common trends when discussing their past flaws. These common errors could happen to any ophthalmic technician working in clinic. (See Table 1 on page 15 for some common errors in the cornea clinic.)

Conclusion

Pointing out possible errors helps you to appreciate the impact that some omissions could have on patient care. It is easy to forget and it is easy to fail; however, it is your duty as members of the ophthalmic clinical team to avoid blaming distraction and lack of knowledge as sources of your flaws.

Ophthalmologists have different protocols and preferences — not all advice given in this article applies to all. However, ophthalmic technicians who work with challenging tasks report common trends when remembering mistakes.

Luckily, the human antidote for errors is experience. OP

Martha C. Tello, BGS, COMT, OSC is an ophthalmic technologist and clinical research coordinator with Bascom Palmer Eye Institute in Plantation, FL. She has a Bachelor’s Degree in Leadership and Communication from University of Miami.