It’s spring semester of your second year of optometry school; you’ve finally made it to the most exciting and important step in your optometric journey: clinic. On your first day, you gather all of your things — your lens set, retinoscopy handles, prism set, BIO and your trusty tonometer tip — and head into the University Eye Center. You find your room and clean your machines. Your classmate opens the EHR and, by the luck of the draw, you have a patient.
A 30-year-old, white female walks into your room, sits in your exam chair and is ready for the fun to begin. Upon a gross anterior segment examination, you find a resounding case of corneal neovascularization—and you panic. The fear sets in. You’ve only had two weeks of ant seg classes. Are you supposed to know what’s causing this? Does she abuse her contact lenses? Does she have limbal stem cell deficiency? Or could she have a severe case of Fuchs endothelial cell dystrophy? Your head is filling with possibilities. Your hands are sweaty; you’re visibly shaking— what do you do next?
I’ve found that this is a common fear among second years and newbie student clinicians, but with a little less of the drama. We practice on young, healthy, relatively normal eyes in all of our labs. Except for the few cases of strabismus or corneal scarring, most of my classmates are only battling varying amounts of ametropia and astigmatism. I so desperately want to learn how to be a good clinician, how to identify diseases and oddities on my first day in clinic, but the only way to succeed in achieving this is by seeing abnormalities in person. Pictures can only be so helpful. The eyes in them aren’t blinking or photophobic or constantly moving to find something to fixate on. It’s scary to find something even slightly different than normal on a real, paying patient.
As much as I was hoping to see something cool in clinic my first day, I also found myself hoping that I didn’t see anything at all. What if I misdiagnose them? What if I find something vision-threatening and they need emergency treatment? What if I see something so bizarre that I can’t even begin to explain it to my scribe? The fear can be all-consuming, but it’s comforting to know that everyone has been there, even the most well-renowned doctors saw corneal arcus for the first time and started shaking.
The most important thing to remember is that we’re not alone in the clinic. We have so many resources and minds to help us make the correct diagnosis and treatment plan for our patients. And when in doubt, don’t be afraid to ask for help — that’s literally what all the precepting doctors are getting paid to do. In the end, the fear will make us all incredibly knowledgeable and competent doctors of optometry someday very, very soon.
