Introduction

How much time should an examination take?  During summer session, you’re allowed 2 hours for an examination, but in the real world, I’ve successfully scheduled appointments every 20 minutes (not including dilation time) in a practice where I served as the front office staff and the technician.

Indications

Many patients are enamored of a two hour examination, believing that it is somehow “more complete.”  However, the work that you perform during your two hour examination is typically no more or no less than what you would perform in a much shorter examination.

Contra-Indications

Patients lead busy lives.  As a result, there is a set of patients who refuse to be examined at the IUSO because the examination takes two hours.  You need to ensure that you quickly and accurately assess their visual needs and ocular and systemic health.  Thus, there are no contra-indications for an appropriately rapid examination.

Materials

A timer, or at least awareness of your time

Setup

Perform a normal examination, assessing the time you take to perform various elements of the examination

Measurement

During the examination, routinely measure how much time it takes to complete each of the following items:

1. History, including chief complaint, ROS, PFSH, medications, and allergies
2. Preliminaries, including VA, EOM, CT, screening VF, and pupils
3. Refraction
4. Anterior segment examination and IOPs
5. Posterior segment examination
6. Assessment and plan

Results

Your goal should be 10 minutes or less for each of those 6 sections.  If it takes 15 minutes for the patient to dilate, your entire examination should take no more than 75 minutes.

Look at those sections that are taking you more than 10 minutes to complete to see what you can do to speed things up.  Ask your consultant, your classmates, and fourth year students for techniques to speed things up.

Using “Zen optometry”, mentally work through your process for each section.  Can you find areas where you’re wasting time?  Can you uncover time-saving tips in your process?  Often, something as simple as always returning your equipment to the same physical location can speed things up, so consider that as a starting point.