Dr. Mai's Optometry Blog

Besides blog.drmai.info I am also a featured guest blogger for the AOSA and have also been asked to contribute to optometrystudents.com

In case you did not realize, the AOSA and AOA both have blogs where leaders post their thoughts and experiences. Here is my first blog as an AOSA blogger. I think I am the only non-former AOSA trustee or cabinet member to be invited to blog so I feel very honored!

How to refract like an OD and not a student. I realize that many optometry students and optometrists are masters at refraction, but hopefully some of my insights can help!

I decided to make this it’s own post from the comments section. This is a comment from a reader concerning career success (slightly edited).

From Joe M. – An engineer and father of an optometrist

I would like to state that I am not a Doctor of any kind and the father of a Optometry student and a son that is a DC. I have a engineering EE /ME back gound and more importantly business owner and CEO for over 35 years. First let me say that success is not simple to achieve and or maintain. And most believe that a degree entitles you to instant success and or big $$$ , well you are dead wrong. Trust me when i say I’ll take Lucky over Smart any and every day but we have to help your own luck by working longer, harder and smarter. If anyone expects the make 150- 200K plus to start working 40hrs a week on your first job you better have come from a very wealthy family and buy into a business or joining a family business or rethink your plan and get real. The system has provided you access to the tools of your craft , that is optometry, now it is up to you to use them to achieve a successful life.

I will tell you most times that success takes longer and is harder then planed and will not be in the same form as envisioned at the beginning.. . Get a second job to generate your play money or saving for the future. And some day you will not need the second income. BTW did you ever study about the 80 -20 rule? if not google it , if so then you know that 20% of the OD make 80% of the MONEY. What do you want to be… a 20 % guy or a 80% guy? I also will tell you yourself will be the only source of your failure in any thing you do. Keep working at your goal, always stay positive, and GOOD LUCK along the way.

I received this email yesterday from a distraught 4th year optometry student (I left out the name):

” I came across your blog for optometry residencies. I have matched a program for next year already. They accepted me even though I had not passed Part 1 boards. I re-took them in March and failed again. Can they take my residency spot away? Please let me know if you have any advice.”

You need to pass all parts of NBEO to practice optometry. If her residency programs begins in July, and the soonest she can retake her boards is in August (with scores released a couple of months afterwards), I told her to contact her residency program, to keep her head up, and best wishes.

In all things, begin with the end in mind. This allows you to focus on the big picture when a world of minutiae tends to get people hung up.

That’s also my buzz word (and enemy) of the quarter: Minutiae. There are many ways to study for a big test, but I believe firmly that the worse way is to feel like you must know EVERY thing. I have been telling classmates that if you try learning everything, you miss important concepts or at least fail to reinforce them.

There is a principle called the Pareto principle (aka the 80/20 law) that about 80% of the effects come from 20% of the causes. For instance, Pareto was growing peas and found out that 80% of his peas were being grown from only 20% of his plants.

Which means that 80% of his plants, which he had to care for and watch over just as closely as his 20%, weren’t doing much good in the big picture. The same is true with studying for a boards exam. When I look at a new drug/disease/any concept, I like to do the following:

What are 2-3 things I will take away from this (sort of like, which plant out of these five will give me the greatest return of intellectual investment)? And then I move on. If I can nail those 2-3 IMPORTANT concepts, then knowing anymore than that is just gravy (but unnecessary)

This is not an excuse to be lazy. I will spend the SAME amount of time studying, but just ensuring I hit big ticket items first always.

Today I donated money to the AOA-PAC, I believe it is important to in keeping optometry active in the legislative arena.

Not optometry related as much business related.

Last weekend I went to Las Vegas, and in particular ate at a Restaurant called Bouchon‘s in the Venetian hotel. It was awesome, except pricey, but price isn’t the biggest factor when picking a restaurant in Vegas.

My friend Elaine orders a dish, but she ends up not liking it too much. The waitress notices immediately that she doesn’t like it and without prompting suggests that Elaine pick something else. Elaine doesn’t mind it so much and says no thanks.

Without us even asking, they take the entire dish off the bill. And Elaine gets free dessert.

Also, besides the fact that they had people watching the table nonstop to refill our waters when the glasses were even half empty, get this.

I went up to use the restroom and throw my cloth napkin without even thinking about it on the table. When I come back the waitress apparently had stopped by, and folded it into a neat pretty fan-looking thing! Wow I was impressed.

They say you can only win two of these three categories of price, quality, and service when running a business. Most private optometric practices will never win the price war, so don’t fight it. But if you can “wow” someone in the other 2 categories, they’ll keep coming back.

On campus today at noon, the professional eye care resource co-operative invited students to join them for lunch. This was the second time I joined the group for lunch, and they’ve always been an incredibly friendly group of people. PERC is an optometric co-opt comprised of individual practitioners who all gross over 1 million dollars annually.

Right now there are over 100 optometrists in the group, with the majority of them in Southern California.

This is the first of many optometry clinical encounters where I learned something.

1. Very first patient ever in my life. (I don’t count seeing classmates/friends as first time experiences). 66 year old male contact lens patient who wants multifocals CLs. But he’s doing a modified monovision of sorts where he has a multifocal in one eye and a distance toric lens in the other. I fit him with the CIBA Air Optix Aqua Multifocals in his non-dominant eye and the CIBA Air Optix Toric Lens distance contact lens in his dominant. He LOVES the vision, reads happily and can see distance great and the over-refraction (loose lens in multifocal eye, and the distance I did a sphero- cyl OR through the phoropter) was about plano-ish in both eyes.

The clinical pearl is that modified monovision can be an excellent option for patients with a little bit of astigmatism (he had 1.25 D of cyl.) Especially if the patient loves the feel of a particular contact lens multifocal but a toric multifocal option isn’t available.

2. Very first primary care patient ever in my life . 83-year old Spanish speaking only patient comes in with one eye barely open. Chief complaint from his son (translator) is that his left eye is always nearly closed. 20/30 in his open (OD) eye, and light perception only (OS) in the eye that he barely keeps open.

Turns out he has a full-blown retinal detachment secondary to diabetic retinopathy that my partner Chad and I spot which our staff doctor confirms and congratulates us on. So what about the eyelids closing? The patient was able to lift that eye when he desired.

The retinal disparity caused by the retinal detachment between each eye made him voluntarily (and then just out of habit) close his non-seeing eye. This was not a case of ptosis.

3. Second contact lens patient ever. Female keratoconus in her 20s who has lost one gas permeable lens and needs a new one. Chad and I are at it again. Getting a crazy cover test of 20 exotropia in entrance testing. our staff doctor comments when we first meet with him with this clinical pearl:

“Don’t do a binocular test on an essentially monocular patient” (at this point she had just one CL on, and she can see hand motion only in the eye without the RGP.

Other clinical pearls was the patient was getting inferior dimple veiling on the cornea. To fix this we steepened the lens.

We steepened it to allow for better centration so that the lens would not slide down and we also reduced the optic zone diameter to decrease chances of air bubbles.

That’s it for now!

My AOSA Trustee Dave sold me on going to optometry’s  meeting, so I went last week to the AOA optometry’s meeting in Orlando and boy was it an event. The Gaylord Hotel was enormous with multiple pools, bars, and a large convention center. There’s just something about a huge auditorium with two big screens showing the speaker and powerpoint presentation that is just cool in my opinion.

Highlights:

- Optometry super bowl (hosted by Essilor) . It was like a sporting event, people were chanting and screaming for 2 hours for their representative to show everyone who was the biggest nerd of all in a knowledge bowl optometry trivia match. Unfortunately, our guy Andy didn’t make it past the first round. Dr. Kevin Alexander, our president, was there and told us if we won the bowl he’d give the winner a full-ride scholarship – so I’m going to go for it next year!

- Went to a seminar by John Rumpakis, and A. Kabat about day to day dilemmas. It was similar to my case analysis classes and there were probably 500+ students in attendance.  Val and I were the only students to walk up to the presenter A. Kabat after the lecture to get his opinion on why he used Azasite for something in conjunction with oral doxycycline – though I forget what the condition was (ocular rosacea?).

- John Rumpakis and Ryan Parker had a presentation on private practice and the transition from student to doctor. They did something really ingenius to get participation by putting up their cell phone numbers for us to text questions and while the other person was talking they would read the text messages and answer the questions. They might have answered 20-30 in total and 2 of them were mine! I asked them who they thought would win, Lakers or Celtics, before the actual game and they were split. I also was confused at how Dr. Parker got his practice breaking even 2.5 months after starting cold without stealing patients from his former partner – he kind of shyly answered the question but Dr. Rumpakis called him on it and said he basically stole the patients lol. I guess in optometry, you gotta do what you gotta do.

- The receptions were a ton of fun. I met a bunch of other students from Berkeley to SUNY and thought everyone I met was super nice and easy to talk to. The future of the profession looks bright, I know this because nice people finish first in my opinion =).

- Practicing optometrists at the AOA convention love the profession and think it has a bright future. I kept hearing from the young and older docs “Congratulations! You joined a fantastic profession.” To be honest, it makes me feel great to hear such things.

- Some believe optometry  is oversaturated. “Get out of California, come to my neck of the woods.” Others (some of the hotshot consultants) think saturation is no big issue.

From optometric management

Clink on the link above to read an article about bringing a new grad into an established practice.

In psychology there is something called the self-serving bias. To quote from Wikipedia:

“A self-serving bias occurs when people attribute their successes to internal or personal factors but attribute their failures to situational factors beyond their control.” (wikipedia)

Not my fault, the DOG ate my homework!

This is prevalent in optometry school and no doubt with many other professional/graduate  schools. When it comes to test-taking, it seems to happen on every other test that there is a question that students miss yet inevitably blame the instructor for writing a poor test question.

Students sometimes start to think they’re always right, and refuse to listen and learn when they’re wrong. At my friend’s work, she laments often about coworkers who EVERYONE knows is at fault for a particular problem, yet that coworker is too prideful to admit they made a mistake and the politics of the matter makes life difficult to get things done.

So what’s the point of this post? It’s really just to say “don’t take yourself so seriously.” At SCCO they try to teach confidence in the clinic, to make a decision and stick to your guns. This is the right approach, but while learning always remain open to accept criticism for your mistakes.