Working at a Veteran Affairs clinic
Before I entered optometry school, I really didn’t know what to expect. I knew that there’d be lots of lectures and tests, but what would my clinical education be like? Would a professor be in the exam room with me? Or a classmate? Or– Would I be alone?
My first patient was a random café owner that had a “white spot” on her eye. I gave the exam alone, and it was the fastest two-and-a-half hours of my life.
She only had a pterygium, but when I first saw it, I was absolutely terrified. There’s a big difference between seeing something in a book and having it sit in your chair! That day, I spent a lot of time asking my staff doctors what to do. Honestly, I wasn’t very confident at all.
Now, as a fourth year student, things are different. My current rotation is a Veteran Affairs (VA) clinic in Bakersfield, California. I am now given much more autonomy to run my exams. In fact, I almost always give the entire exam before presenting my findings to a staff doctor. And that’s how it should be, because I’ll be graduating in half a year.
This rotation has been a completely immersive full-time-job-like learning experience. In a typical day, I arrive at 7:50 am and check my room to make sure everything is ready. If I have a few minutes, I briefly review the schedule. At this point, everything should look familiar since I have already reviewed my patients earlier in the week.
I usually have about 10-12 exams with the majority requiring dilation to check the back of their eyes. At 8:00, I bring in my first patient. I try to do the case history, entrance testing, refraction, anterior segment evaluation and get dilating drops in their eyes within 20 minutes. That may sound fast, but you will get used to getting things done quickly– Especially when you know your next patient is already waiting for you in the lobby.
After my first patient is dilated, I send them to optical to pick their glasses. Then, I bring in my second patient and repeat the initial exam process. After my second patient leaves for optical, I bring my first patient back and check the back of the eye. Sometimes, this only takes 10 minutes, but often I need more time — especially if there’s a lot going on.
When I’ve completed my examination, I present my findings to the staff doctor, who has an exam lane right next door. I then introduce the first patient to him and make a quick escape to finish my second patient’s examination.
This cycle basically repeats over and over again until the late afternoon. Finally, after my last patient, I turn on some music, relax, review patients with my staff doctor and work on charts. With luck, I’ll be out the door by 5:30 and on my way home.
How do I get ready for my rotation?
Try your best to speed up your exams without compromising patient care. The official time VA estimate for an anterior segment slit lamp evaluation is 1 minute per eye. Gonioscopy should also only take 1 minute per eye. This might seem daunting when you’re first learning how to use a slit lamp, but you can do it if you practice.
Also, review common diseases like diabetic retinopathy, macular degeneration, and glaucoma. You’ll see a lot of that and you’ll want to talk intelligently about them.
Finally, relax and be ready for a great time! By this point, you’ve already finished the hardest part of optometry school, and you’ll finally be able to have a social life. It will amaze you to see how much you’ve learned over the past few years, and how much you can help people with the knowledge and skills you already have.
Until next time!
Dave Shin
Class of 2012
Southern California College of Optometry
