The view through my retroscope

It’s been a few years now since I escaped from my windowless dark room and looming corporate confinement. I went rogue to develop something I always wanted to do; help people who struggle to see despite their swanky spectacles (or $2 shop hobby glasses) and drainage clogging contact lenses.

 

This realisation caused me to pause and take a look back through my retroscope at some of the more humorous and controversial events of what is becoming an embarrassingly long career. The greying of my patient base and incessant search for an answer to that all-important question “which is better, ‘one or two?’” also made me reflect on the changes that have occurred in the last 30 years.

 

Without doubt, the development of technologies such as retinal imaging has made a significant impact on our ability to prevent vision loss, but has it made our job easier? Sometimes the low-tech solution does the job.

 

On my first day as a new graduate, I was asked to sit in and observe Peter Barry, well-respected and soon-to-retire elder statesman of the practice, to get some real-world experience and mentoring in patient management. The second patient in the door was an elderly (everyone was elderly to me in those days) and very deaf woman who Mr Barry struggled to communicate with, despite stretching his voice to full volume. After a fruitless attempt to get some history, he rose to his feet and headed out of the room. Passing by me on the way, he said to me with a wink “watch this”. A few seconds later he returned carrying a length of plastic pipe and a funnel he had recommissioned from the optical laboratory next door. He placed the funnel into one end of the hose, put the other end to the patient’s ear and bellowed into the funnel, “Can you hear me now?” A big smile lit up her face and she nodded gleefully as they proceeded through the consultation. Needless to say, there was no in-depth discussion on the pros and cons of progressive lenses included.

 

The back room between practice and laboratory was often a gathering place for colleagues and sales reps to gossip and reminisce. One of my favourites was retired optometrist Hec McKenzie, who used to impress me with tales of the pioneering days of boat trips down country to provincial towns carrying the equipment to set up in the back of the local pharmacy.

 

However, the one tale that made a huge impression on me is the tale of this same gentleman having a bad day at the office. Unable to find a satisfactory end-point in the refraction of a particularly indecisive patient, he picked up the whole trial case and emptied it out over the head of the patient and stomped out of the room telling the patient, “Here, pick one yourself” as he departed. To this day, I do not know if this is a true story, but I heard it often enough to gain great comfort from it in moments of need. Oh, how I would have loved to do that one day…

 

At the time when female optometrists in New Zealand could be counted on fingers and my class of 12 graduates was one third women, the NZAO decided to address the “problem” of the increasing number of women in the profession, by asking this very shy and nervous new graduate to investigate the issue and report back to the annual conference.

 

Overcoming the weight of self-importance, I set about this task earnestly, reporting the findings of my research that women graduates were less interested in taking up proprietorship of practices, choosing to remain employed more frequently than their male counterparts, which could potentially affect the future workforce and succession planning in practice management.

 

A colleague, Alan Styles, known for his acerbic wit and cutting analysis of financial reports, rose to his feet amidst the sea of middle-aged men. “The only problem with having a woman partner,” he declared, with his young woman partner seated next to him, “was their fecundity”. The room erupted into howls of laughter while I struggled to control my panic attack and embarrassment at not knowing for a moment what the word meant. By the time I figured it out, the discussion was closed. I still relive that comic moment from time to time, but sadly we lost our esteemed colleague in a motorcycle accident a few years later. The AGM of the Association was never the same without characters like him questioning, probing and engaging in vigorous debate about issues affecting the whole of the profession. Discussions continued around the bar(s) at the end of the day with lots of good-natured banter and collegiality, which ensured the profession was united in moving forward and the workforce remained in touch with the population we served. That’s not to say that professional jealousies weren’t also thriving.

 

Continuing education has always been highly valued in optometry. Before CE became a mandatory part of registration, we prided ourselves in having over 95% membership voluntary attendance at educational events. Employers encouraged, and paid for, employees to attend conferences where lectures and workshops were supplemented by informal sharing of knowledge and challenging cases were discussed. Sadly, with ophthalmology taking over the provision of the continuing education of optometrists and the internet providing immediate and continuous access to information, the value has changed to a time per dollar decision.

 

The commercial business model where key performance indicators are valued more than building long-term relationships, monitoring health changes and problem solving, does not bode well for the future of the profession. This is particularly true in terms of individual professional development and job satisfaction of newer graduates, who often know no other work environment and seldom get the feedback of seeing the end results of their work; both in terms of experiencing the satisfaction of a job well done, having the challenge of sorting problems when results are not meeting the expectations of the patient, or from the subsequent learning that comes from these challenges. That is called experience – a very valuable commodity.

 

The art and science of optometry, and for that matter ophthalmology, have marched on at a galloping rate in the last 30 years, with modern imaging technology for diagnosis and new treatments available. The education of the current generation of optometrist is streets ahead of what we were subjected to and should be valued as a huge resource in healthcare for meeting the needs of the aging population. Sadly, this has come at a cost to some of our basic skills in helping our patients to function more efficiently in their visual environment.

 

Reminiscing about the good old days will not bring them back, and most of us would not want to revisit them either. Though, boy, we did have some fun…

 

Naomi Meltzer has worked in optometry for more than 30 years. She runs an independent optometry practice specialising in low vision consultancy in Auckland and is a MDNZ founding trustee.

 

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