new m.d.
A Sticky Situation
This doctor faces the dreaded post-it note.
Roxanne Woel, M.D.

With this issue, OM introduces a new feature recounting the experiences of newly minted ophthalmologists Roxanne Woel, M.D., and Howard Amiel, M.D. Through them, readers can obtain the perspective of a young physician embarking on an exciting career.

After my residency, I scheduled 2 months off. I spent 4 weeks hiking about the hillsides that border China and Northwest Vietnam, and a few weeks settling into my apartment in Providence, R.I. I swam every day at the YMCA. When it came time to debut as a comprehensive ophthalmologist, I was energized and excited.

In the weeks that followed, I consented patients for surgery, offered second opinions, and both made and received referrals from other specialists. My clinical training helped prepare me for the transition from resident to attending physician. Nonetheless, I encountered a few vexing circumstances. Chief among these: how to respond to the innocuous yellow post-it on the chart that reads, "Please call Mrs. Johnson."

Initially, I did what any young physician would do. I called.

"Yes Mrs. Johnson. The visual field is normal. I'll see you in 6 months for a pressure check" or "Your field test results are not reliable, so why don't we repeat the test in 6 months." It took all of 2 minutes, and now Mrs. Johnson was informed.

A few days later, a post-it appeared on another chart. "Please call Mrs. Butler about her drops." I call, but Mrs. Butler never caught on to the invention of the answering machine. Soon, I'm parading around with her chart, hoping to reach her between patients. Before I know it, I've misplaced the chart so I must spend my lunch recess scanning the tech area, the doctor's office and rooms 9 through 11.

More Yellow Pages

The following week, a receptionist hands me yet another chart with a yellow post-it. "Please call Mrs. Cranston's daughter, Liz." She just called and wanted to talk about her mother's last visit. Mrs. Cranston was a nursing home patient, legally blind due to bilateral cataracts. She also had mild dementia and her daughter had medical power of attorney. I called immediately as I would be likely to reach her, and the technicians were still working up my patients.

Unfortunately, Mrs. Cranston's daughter had a list of questions: beginning with "so what is a cataract?" The questions progressed from the anesthesia, to surgical technique, to the recovery period, to dementia and back to the age-old question "Would glasses help?" Now, I'm 20 minutes behind, tying up two rooms, and Liz is still firing questions. "By the way, what is macular degeneration?" Never mind that Mrs. Cranston has pristine maculas.

I want to be available, but return phone calls like these present a dilemma. They are often time-consuming. Patients can be difficult to reach and it is often not appropriate to leave a message. The phone cannot convey body language and facial expressions needed to communicate in a compassionate manner. I cannot present the educational media that is available in our clinic, I am reminded that these calls are uncompensated. And I wonder about documentation. If, on the basis of a his last GDx, I call Mr. Smith and tell him I'm concerned that he has glaucoma, do I need to document that the risk of blindness was discussed? Do I need to document that compliance issues were addressed? And where do I document these in the chart?

Pre-empting the Paper

Now, before ordering tests, I try to preempt the dreaded yellow post-it. I inform patients that I will review the results at their follow-up visit so I can spend time answering all their questions. They seem to appreciate this. I take the time to write out complicated drop regimens to avoid playing phone tag. And now, I mentally limit telephone conversations with family members to 5 or 10 minutes. After an appropriate amount of time, I'll say, "It sounds like there's a lot to discuss. Why don't you make an appointment so we can address the situation in depth."

After receiving a bachelors from Yale University, Dr. Woel pursued an M.D. at Duke Medical Center, and then completed her ophthalmology training at Boston Medical Center. She currently practices in Warwick, R.I.