Thursday, January 19, 2012

What I Do At Work part 1

Have you had an eye exam recently? Then maybe some of this will ring a bell. I wanted to explain a bit more about what I do all day.

I call the patient back (sometimes seriously embarrassing myself with mispronouncing names). Some common techniques to deal with this are to
- make eye contact and ask "are you ready? come with me"
- call the patient by just their first name, or Mr. or Mrs. (last name) based on which is easier to pronounce

When I bring the patient back to the room I introduce myself as the technician. I still feel awkward calling myself a technician. I feel like I should be repairing a car or computer or something...
My job is to find out why the patients are here and get some basic measurements. To get a chief complaint I will always ask about blurry vision, pain, flashes, floaters and double vision and whether or not you use any eye drops. General medical history is also important - medications, chronic conditions, etc... This is when you get to find out how talkative the patient is. As they talk I fill out this worksheet:
And don't worry, electronic medical records are coming this year. I'm excited!

As a healthcare professional I deal with people all day long. As an introvert, this is a very tiring thing! But, the patients always keep things interesting and the majority are friendly. I am always amazed when I find myself telling my life story to random strangers - some people just know how to ask the right questions! 

I use a lot of equipment when I do my initial patient work-up. The first thing I will hand the patient is the occulder.
Me, back in the Doc Plot days (source)

Every time we will start by checking your vision, Believe it or not people will complain that we have to do this. I'm sorry but even if you were just here yesterday we HAVE to make sure you can see, you're at the eye doctor!! I turn on the projector and have the patient read lines off the Snellen eye chart. When they can't got any further I have them use the pinholes which can sometimes help (like squinting). Up close, we use a Jaeger reading card:
For patients who see an MD, I manifest refract the patient. That's when you look through the phoropter and I ask "which is better, one or two?" Patients get so nervous about making the right choice! In this post, an optometrist gives advice for refracting. I like his advice to call certain lines of letters "teeny tiny" or "for bonus points." This really works well for kids. Speaking of kids and babies, this video explains how pediatric eye exams are done (surprisingly entertaining).

Then I go on and check your pupils, by shining a light in your eyes and watching to make sure they are round and react equally. By shining my light from the side, I can check angles. Closed angles create shadows and that is part of a check for glaucoma. Then I will have you follow my light to check motility of the eyes. Your eyes should be able to move in all the directions. Finally we do a peripheral vision test. I have the patient cover one eye and look at my nose. Without looking at my fingers, I ask the patient to tell me how many fingers I am holding up in each of the 4 quadrants. 
For older patients we check for cataracts by performing a test called the BAT (brightness acuity test) using a "big flashlight." I perform the glare test by having the patient look through the light and read the letters on the wall. If a patient has cataracts and they are advanced enough, the light shining in their eyes will cause a glare that decreases their acuity. For more information about cataracts, check out this site.
To be continued....

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