I began my day as I ordinarily do. I opened the patient’s chart, referral notes, and imaging on a viewing station ringed, panopticon-like, with our clinic’s exam rooms. I scanned the chart and began noting the basic information I would recite to Dr. Murtaza Adam, the physician whose clinical team I now captain as his primary scribe, when he came out of the room he was currently in—“New patient referred for a possible BRVO in her left eye; acuity 20/40; IOP normal.”

The door to one of our exam rooms slid open and Dr. Adam exited, putting the finishing touches on a chart while wheeling the laptop cart closer to the viewing station where I was poised to begin my presentation. As soon as he looked up from the computer, I launched into my soliloquy. “Anyway,” I said, scrolling through her OCTs, “she probably has it.” He agreed. She needed to begin treatment with anti-VEGF injections.

“Hey, why don’t you go into the room and show her the pictures and talk to her about treatment,” he offered, taking a surprising departure from our normal routine. Usually, I would document all the findings he gave me from her images as I follow him into the room and then sit silently tinkering with her chart as he counsels her. “That way,” he added, “you can get her numbing, and then I can come answer any questions she has and do her exam once she’s ready for her injection.” He summarized the spiel he would give in this situation. “Cool?” he asked, and then, after glimpsing my nod of affirmation, he found another scribe to take him to see another patient.

I shuffled toward my patient’s door with some apprehension. Having only been a technician at Colorado Retina Associates for about 4 months at that point, I typically fielded the various questions patients had about their conditions by deferring to Dr. Adam. I had not thought of delivering diagnoses as part of my purview, even if I was only their emissary.

I was still rehearsing my intended monologue when I knocked on the exam room door and went inside. Mostly, I relayed Dr. Adam’s synopsis, hiding my inexperience with this kind of conversation (I hope) behind the authority of the medical jargon he had just reviewed with me. I arrived at the part when I needed to explain what treatment entailed. The words “injection,” “into,” and “the eye,” strung together became, for this patient, a catalyst for panic. She gasped, started breathing rapidly, pulled her knees into her chest, and began rocking. I spent a few minutes trying to assuage her anxiety, promising that we always take care to numb the eye thoroughly, that these injections are highly routine for us, and so on. Ultimately, I punted: “I’ll go find Dr. Adam and we’ll all talk through it together.”

After I numbed her eye and Dr. Adam performed her injection, she looked at us wide-eyed and relieved, incredulous that the experience was actually that easy. She left, and Dr. Adam, laughing, told me that she was the most nervous he had ever seen a patient get about beginning treatment. “You’ve now handled the worst, though,” he told me. “Next time will be easier.”

A WELCOME CHANGE

As a first attempt at counseling a patient regarding a new diagnosis, this was certainly a baptism by fire, but the practice has since become standard in our clinic, and my teammates and I have delivered diagnoses and detailed Dr. Adam’s treatment plans for numerous—and significantly less petrified—patients since then. We’ve observed myriad benefits.

First—and most critically from the standpoint of clinical operations—having technicians counsel patients before preparing them for treatment allows the physician to be available for other patients who would otherwise be waiting for her, meaning patients are directly interfacing with their caregivers in two (or more) rooms at once rather than just one. The ability to provide our patients with more face-to-face attention without compromising our high standard of care represents a meaningful win in a healthcare system that demands continuous streamlining to keep pace with the ever-increasing number of patients coming through our doors. We do not yet have any formalized data collected, but this effort appears to contribute to our perpetual goal of reducing wait times, and patients have appreciated the experience.

Moreover, technicians, who commonly outnumber physicians in a practice, will often accompany patients for the entirety of their visits. Working with the same technician throughout the entire process of screening, injection preparation, and the exam provides continuity and, by extension, the time to cultivate a trusting relationship. It is hard to overstate the value of those relationships, particularly in a clinical setting in which patients face the prospect of needing to come in for treatment every several weeks for the duration of their lives.

Second—and more personally—the opportunity to practice navigating the more nuanced conversations centering around diagnoses and treatment plans represents valuable training for technicians, who often have professional ambitions toward being physicians, nurses, PAs, or other caregivers themselves. Even if we do not plan to pursue any of these routes, participating in these conversations demands a high level of clinical fluency and pushes us to deepen our knowledge of ophthalmology. This learning, in turn, makes us better equipped to answer the questions that patients will inevitably direct toward us at the stages of their visits when we are the sole representatives of the practice, such as during intake workups.

A MEANINGFUL ENDEAVOR

Anecdotally, and speaking here only for myself, I also simply enjoy the endeavor. Having these discussions with patients feels like the most meaningful impact I can personally have in their care, and it is rewarding to have a chance to be the first one to elucidate the reasons for their symptoms and articulate what we can do about them. That moment, the one of transition from uncertainty to clarity and action, is a special one to help facilitate. NRP