You are the Doctor!

Imagine yourself in a solo practice in the middle of nowhere, where all of your colleagues can’t answer their phones or texts because they’re busy seeing their own patients. Under these conditions, you would be expected to know how to perform all tests involved in your examination of the patient (or know where to quickly find out how to accurately perform tests you were unfamiliar with), and also how to best interpret the data collected during your testing (or, again, to reference appropriate resources to help you interpret that data).

In clinic, we expect you to come to us with your ideas concerning patient testing and interpretation of test results.  These ideas should be recorded in the patient chart as an eyeglass prescription (prior to the first consult) and a complete assessment and plan (prior to the second consult).

You are responsible for demonstrating good patient care, including accurate and efficient gathering of examination data, problem solving (assessment and plan), and mastery of all record keeping, including communication with outside doctors and prescription writing.  It is best if you come to us and say, “Here’s what I think…” as opposed to, “What do you think…”  This allows us to best offer you feedback on your conclusions and thought processes.

Additionally, as your chart is the legal representation of your patient encounter, I will consider your chart as your “case presentation” to me, and will ask questions based on what you have documented in your patient chart.  Ensure that your chart is complete and well-organized prior to both your first and second consult.

Come Prepared

You are responsible for every technique that you learned in your clinical science courses, including indications, contra-indications, performance, and interpretation of results.  With the advent of 24/7 access to OPT 101 and OPT 106, you can practice/re-acquaint yourself with these techniques prior to your summer and/or fall clinic experience.  If you have down time in clinic, practice techniques that you don’t regularly perform.  It’s also a good idea to have notes on hand that allow you to quickly review techniques that you haven’t performed in a while.  Quick instructions are included in this document that provide quick guidance for some of the procedures you learned in V552/V653.

Additionally, it is assumed that you are familiar with all didactic material that you have been presented prior to your clinical experience.

First Consult

For your first consult, make sure that you:

• Gather all necessary forms and review pertinent patient information.
  • Prior to picking up the patient, identify their insurance plan – this allows you to appropriately select a patient layout in Compulink as well as an appropriate chief complaint.
  • Prior to picking up the patient, review their medical history form.
  • Review prior assessments/plans in the room.
  • You should be able to do all of these steps within the span of about 2 minutes.
• Ensure that all patient data that you’ve gathered up to this point is recorded in Compulink, including:
  • Final Rx
  • Appropriate CPT codes for the examination – this allows your consultatnt to sign off and provide feedback on your coding strategies.
• Ask and record whether your patient has distance or near blur, and is that with or without glasses.   Consider putting this information as the chief complaint if the patient states “Annual Examination” or “Comprehensive Examination”, as those chief complaints simply state that the patient is here.  Examples of how to record this follows:
  • No D or N blur w/Rx (no distance or near blur with Rx)
  • D blur, no N blur w/Rx (distance blur but no near blur with Rx)
  • D and N blur s/Rx (distance and near blur without Rx)
  • No D blur s/Rx, no N blur w/Rx (no distance blur without Rx, no N blur with Rx)
• If there are any findings that you want me to check or comment on please let me know prior to entering the room.

I will read it and sign things, and then ask you for a quick synopsis, including any pertinent findings.

Second Consult

For your final consult, you should provide a written assessment and plan in Compulink.  I’ll quickly review what you’ve written and ask for a quick synopsis, as well as ask you to point out any pertinent data.

If there are any findings that you want me to check or comment on please let me know prior to entering the room.

Dispensing

While the patient is dilating, consider taking them to the dispensary to help pick out frames.  Once they are dilated, return immediately to the examination room.  Make sure to record what frames they liked, and place it somewhere for later reference.

After the examination is complete, return to the dispensary with the patient.  If it is close to the next round and/or you are certain that you will have another patient, please introduce the patient to someone in the dispensary, and pick up the next patient.

After Checkout

After you check out the patient I need to complete the medical record.  I will often complete and sign off on the encounter before you, which will prevent you from altering the chart.  In general, though, you must complete the chart and enter your encounter in Meditrek on the same day you see the patient.