A case study in professionalism

Accompanied by his mother, an 8-year-old boy undergoes a comprehensive eye examination by a doctor of optometry. The exam yields a diagnosis of a deepening case of myopia, and the doctor recommends new glasses. During the conversation about myopia control, the mother lets it be known that she and her son had seen another doctor and the encounter had left her frustrated by his earlier diagnosis.

This case study is the latest produced by the AOA Ethics and Values Committee. Available on the AOA’s EyeLearn Professional Development Hub, it’s one of many topical and timely case studies explored by the committee.

“That doctor had wanted to start myopia control as well and had laid out a treatment plan that included orthokeratology lenses, and the mother describes it as ‘too expensive’ and ‘not worth it,’” the case study says. “She (the boy’s mother) states that the previous doctor was just out to get money and said that the child must have this treatment, or he would go blind. She also said the doctor indicated that he would not keep them as a patient if they refused treatment."

How do you respond? Professionally, the case study’s author, Sandra Fortenberry, O.D., writes. Dr. Fortenberry is the new dean at the University of the Incarnate Word Rosenberg School of Optometry.

“In a case like this, professionalism plays a role in not agreeing or disagreeing with treatment plans previously discussed at another office without access to previous medical records,” Dr. Fortenberry says. “Often, the patient’s account of what happened might differ from what happened. Does this lead us to think that patients are manipulative? Of course not! Patients will sometimes misunderstand what directives were given to them by their doctor.

“It is important to accuse neither her nor the previous doctor of any unprofessional conduct,” she writes. “Professionalism in the workplace can have so many implications and a tremendous number of nuances. Ultimately, the doctor of optometry will put the patient’s needs first. In the case listed, the one who benefits most from professionalism is the 8-year-old patient. When an optometrist is competent in their area of expertise and they have invested in the skill set of professionalism, the greatest benefit comes to the patients whom the doctor serves.”

When you don’t see eye to eye

So, what is a professional?

Drawing from a Merriam-Webster Dictionary definition, the case study says it’s someone who has a “calling” that requires them to specialize in a field and study academically over a long period of time. In an interview, Dr. Fortenberry is quick to add that what professionalism looks like can change from generation to generation.

Says Dr. Fortenberry, noting that colleges of optometry have a responsibility to teach students how to act professionally: “For instance, what was professional attire 20 years ago isn’t the same anymore.”

What should doctors take away from the situation in the case study? Before they respond, they might want to carefully weigh their next words—whether they respond at all or speak what they consider truth, Dr. Fortenberry says.

That’s especially true in these politically and culturally charged times.

“In the heat of any situation, it’s hard to take a step back and say: let me look at the overall picture,” Dr. Fortenberry says. “Emotions are tied to the situation in the case study. A doctor of optometry might be thinking that they’re offended by what was just said. But the response doesn’t need to be a personal response.

“That’s because, ultimately, it’s about what’s best for the patient,” she says. “For the doctor of optometry, that could mean taking a step back and saying (to himself or herself), ‘I don’t agree with what was said,’ but figuring ‘I need to get past the situation, so I can deliver the best care to a patient. Sometimes that involves keeping one’s mouth closed. There also are times to say that you’re going to speak the truth even when it’s uncomfortable.”

Professional conduct

Doctors of optometry can draw upon several resources when it comes to professional conduct in the practice of optometry.

In her case study, Dr. Fortenberry points out that doctors can learn from the AOA Code of Ethics, Optometric Oath, and Standards of Professional Conduct. For instance, the Standards of Professional Conduct name the concept of “character” and state that “doctors of optometry should conduct themselves with good character in all their actions to build trust and respect with patients, the public, and colleagues. Good character includes but is not limited to honesty, integrity, fairness, kindness, and compassion.”

Says the case study: “While professionalism covers a wide range of behavior, certain actions can impact patient health and interprofessional communications with colleagues. It may be easier to investigate what is not professional; however, it is vital that professional is given true parameters. What borders on maintaining health compliances and what is simply good etiquette? These are the questions that can fall into the grey areas of professionalism and may fluctuate depending on the region and cultural norms in any given area or culture. Modern politics and cultural sensitivities can lead doctors to tread lightly when it comes to responding to patients’ behavior.”

One thing that doesn’t fluctuate? Patients always come first, Douglas Totten, O.D., chair of the Ethics and Values Committee, says.

“We should always strive to do what is best for the patient,” Dr. Totten, chair of the Ethics and Values Committee, says. “In the case of the myopic child, doctors of optometry should take the time to discuss valid treatment options for the parent even if it takes more time and effort. Our Optometric Oath has in its first line, ‘ I AFFIRM that the health of my patient will be my first consideration.’ In our care of patients, we must be ‘professional’ and always put the needs of the patient above our own. In our personal lives, we need to consider that we each represent our profession when in public, so each of us have a responsibility to behave and act exhibiting a courteous, conscientious and generally business-like manner.”

Dr. Totten adds: “I think as the profession of optometry continues to grow in its role and importance in health care, it behooves us as individuals of this great profession to be role models in our practices, in our communities and in public. None of us stand alone. We are part of a wonderful profession with a good reputation, and we all should play our part to help advance the image of the profession.”