Ординатура / Офтальмология / Английские материалы / Practical Ophthalmology A Manual for the Beginning Ophthalmology Residents 4th edition_Wilson_1996

2.Family problems, including disrupted spousal relationships (separation and divorce, impotence, and extramarital affairs).

3.Social problems, including isolation from peers, withdrawal from nonmedical activities, unreliable and unpredictable behaviors at work, and inappropriate behavior at social functions.

4.Work-related problems, including tardiness, absence without explanation, loss of interest in work, giving inappropriate orders

or responses to telephone calls regarding patient care, spending excessive time at the hospital, and demonstrating marked mood

Given all the adverse effects of residency stress addressed above, it may come as a surprise that there is no unanimity' a m o n g medical educators

Stress harms the doctor-patient relationship. Patients can be perceived as unwanted impositions during times of stress. The ability7 to empathize with patients is extremely important for delivery7 of health care with compassion. It can be argued that a stressed, sleep-deprived physician may be ill prepared to have or to show empathy, often finding the patient's complaints frivolous and minute in comparison to his or her own. Because of the sacrifices they make, trainees may become egocentric and feel that ''the world owes us something."

Recognizing the potential sources of stress and its deleterious effects is essential when devising effective coping strategies. There may be circumstances beyond the ability of the individual resident to resolve, for which the resident should consider seeking external help. Residents occasionally fall victim to the common misconception that a physician must have an answer for everything and must be able to cope independently with every problem. This misconception is exemplified bv the adage "Physician heal thyself," which may imply to some that asking for help is an admission of unworthiness and may deter residents and trained physicians from seeking help, admitting fault, and accepting guidance. Although many perceive this aura of infallibility to be essential for the doctor-patient relationship and even to have a therapeutic value to patients, it should be clearly recognized that, like many other medical traditions and mythologies, this perception has not been subjected to scientific scrutiny and could very well be false.

Dealing With Early Discouragement

Discouragement early in residency is common. It stems largely from the psychologic impact of having to assimilate a novel body of knowledge dealing with unfamiliar regional anatomy and physiology and using special terminology,'equipment, instrumentation, and procedures. The typically variable knowledge base among residents at the beginning of the residency can discourage those who feel they are starting behind their peers. Discouragement can be compounded by any of the types of stress described earlier. Throughout the history of medical education, residents have found that such discouragement is self-limited. It generally resolves within a few months as its sources are addressed and overcome.

The most effective method of dealing with early discouragement is a mature, methodical, long-term approach to the process of learning. Comparing and sharing experiences and feelings with colleagues at various levels of experience and training is helpful. The fact remains that the task of mastering ophthalmology can appear daunting to the beginning resident. There are no good substitutes for hard work combined with effective time management.

38Chapter 1: Introduction to the Practice ot Ophthalmology

4.Understand the psychology of illness. Patients or family members may appear frightened, angry, or hostile. Learn to recognize and to deal effectively with these emotions without ever becoming defensive or hostile yourself.

5.Maintain clinical and moral competence to avoid doing harm (Hippocrates: primum non nocere) and to ensure provision of excellent care. Clinical competence is accomplished by continued study and by appropriate consultation. Moral competence calls upon the physician to practice moral discernment (understand and resolve the ethical implications of clinical encounters), moral agency (act faithfully and respectfully on behalf of the patient), and caring in the physician-patient relationship. Know your limits.

6.Communicate openly and honestly with patients. Never misrepre-

sent your status. Introduce yourself by name and identify yourseli as a resident. Provide complete and accurate information about '. treatment options.

7.Safeguard the patients right to privacy within the constraints of the law.

8.Do not allow fees for ophthalmologic services to exploit patients or third-party payers.

9.Always strive to preserve, to protect, and to advance the best interests of the patient. Reflect this in your own actions and attitude by placing your patient's welfare ahead of your personal ambitions and desires.

10.Take thoughtful measures to effect corrective action if colleagues deviate from professionally or ethically accepted standards.

About This Manual

The purpose of this manual is to facilitate your transition from intern to first-year ophthalmology resident. Few beginning residents have the necessary training to function effectively as an ophthalmic clinician, yet most are generally expected to hit the ground running. This manual covers the basic clinical knowledge and essential examination techniques needed to make this task possible. It provides an overview of the subject matter you are about to assimilate, with emphasis on practical clinical knowledge. It should be read within the first feu weeks of residency and then consulted during the following leu months in conjunction with other educational materials. The manual can also serve as a practical guide to medical students and house officers rotating through ophthalmology.

specific issues as they arise.

The sequence of chapters in this manual reflects the orderly progression of a thorough ophthalmologic evaluation. Most chapters include step-by-step instructions for performing many basic procedures and an appendix covers the topic of common eye medications.

Beyond This Manual: Lifelong Education

Chapter 1: Introduction to the Practice or Ophthalmology

The challenge of becoming an excellent ophthalmologist will be affected by the demands of health care reform. Increasing constraints on the time and economic resources available for education are further strained by the need to remain current and fully competent in an everevolving field. The American Academy of Ophthalmology offers the program Lifelong Education for the Ophthalmologist (LEO), a framework of Academy resources that can help members accomplish their continuing educational goals in the face of new challenges and imperatives. LEO recognizes the importance not only of clinical ophthalmic knowledge, but of aspects of health care delivery, practice management, and communications. It emphasizes the use of the best educational materials and technology to help members learn, self-assessment to detect areas of weakness, and self-customized study in those areas. Among other resources, LEO includes subspecialty topic summaries and special courses at Annual Meetings of the Academy.

Other sources of continuing education available to the ophthalmologist include the various American Academy of Ophthalmology publications (Figure 1.1). These include the 12-volume Basic and Clinical Science Course (BCSC), which is an excellent, condensed overview of le central themes in ophthalmology both for resident education and lifelong learning. Other Academy publications include Focal Points: Clinical Modules for Ophthalmologists; Ophthalmology Monographs; and clinical education videotapes. ProVision: Preferred Responses in Ophthalmology™, published by the Academy, is a multiple-choice question series that can be used as a self-assessment tool. ProVision Interactive:

Figure 1.1 The American Academy of Ophthalmology publishes a variety of continuing education materials.