Your Mind in Your Business: A Positive Sum Approach to Patient Care

You don’t have to look too far in optometry-related social media threads to find the sentiment that our patients don’t treat us well, don’t respect the work we do, or don’t value the services and products we offer. Although this may be true some of the time, it would seem to an outsider looking in that this occurs all of the time. If disrespect were a disease, the diagnostic test we use to recognize it would be highly sensitive and very low in specificity, because we tend to neglect optometry’s contribution to that perception.

What role does the optometrist have in how our profession is perceived and ultimately, how care is provided? Are we helping or hurting our patients in the pursuit of patient acceptance?

RECOGNIZING OPTOMETRY’S BIAS

In 2003, a study conducted at Nova Southeastern University by Hardigan et al sought to examine the learning styles of students in seven different health care professions, including optometry. The Myers-Briggs personality profile of each profession was determined, and the researchers found that the optometry students were more likely to have ISFJ personality types (P < .05).¹ Individuals with ISFJ personality types are known for being warm-hearted, responsible, and reserved (see How Myers-Briggs Determines Personality Types).

Further examined through the lens of the big five personality traits proposed by Fiske, the ISFJ is highly agreeable in nature with low extraversion.² ISFJs are often portrayed as being kind in excess—they’re the type of people to hold the door for everyone else and wait to go through last.

Optometrists’ psychological tendencies affect our relationships with our patients, our colleagues in other health care disciplines, and our industry partners. Our evolution from being purely “refractive jewelers” to now being highly diversified medical optometric physicians has leaned on our tendencies to be conscientious, but conflict averse. We’ve expanded our scope of practice in North America particularly, with the first diagnostic pharmaceutical agent legislation in Rhode Island in 1971; however, with lobbyists in medicine opposing scope expansion, we have stratified our profession and are further diversifying into what is becoming subspecialty optometry. In fact, one in five optometry graduating students pursue residency training in the various specialty segments—and that number is increasing, according to the American Optometric Association.³ As we stratify and diversify, let’s examine how our common psychological traits affect our delivery of care.

CONSUMPTION AND OUTPUTS

Our patients are consumers of optometry’s outputs. The market’s consumption is based on our willingness to trade money for a particular output: contact lenses, spectacles, eye drops, vision therapy, dry eye treatments, etc. On closer appraisal, our outputs can be separated into two categories: products and services, which each driving the market to different endpoints.

People interpret money in different ways. Wealth is money that is in the bank earning interest while you sleep, whereas status is a signal of money that relies on a hierarchy to create value. Wealth tends to be growth-focused and often results in the growth of wealth in others, which contributes to a positive-sum endpoint. Status, on the other hand, generally results in the displacement of others to reflect its value.

Tangible and branded products tend to be status-driven outputs, whereas services are usually not based on any type of hierarchy and are an intrinsically egalitarian output. For example, the eyeglass frame lines in an optometric boutique are usually placed such that the premium niche lines are more visible than the value lines. This is simply because the experience of buying and owning a high-end pair of spectacles is different than that of owning a value-line frame. In contrast, a dry eye consultation service, for example, will always produce the same experience, regardless of the patient’s economic status or buying power.

Stress begins to develop when a system attempts to be in two places at the same time. Optometrists with the ISFJ personality become increasingly stressed the less egalitarian our outputs become and, as such, we can become uncomfortable or even guilty at the idea of selling and caring at the same time. On the other hand, the rise of interest in subspecialty optometry services fits the optometrist’s psychology like a glove, given that the service is more equal in offering; stress is reduced because the associated guilt is reduced. This is not to say there is anything wrong with selling eye wear. However, as new generations of graduates enter the profession, this lean towards specialization reveals a trend that may reflect, in part, a shift in our profession’s psyche.

CHALLENGING THE ISFJ OPTOMETRIST

Given the ISFJ optometrist’s preference for providing egalitarian care, deciding to recommend a dry eye product or procedure can become stressful when, for example, a patient is required to pay out-of-pocket. Do we allow patients to sample the drop and put the decision in their hands, or rely on ourselves as doctors to provide the best therapeutic option based on our clinical knowledge and experience? Giving patients options has become a reflex to pivot away from being accountable, selecting a finite treatment, and standing behind it.

Consider, however, the scenario of giving patients multiple samples to try at home, and a few weeks later, they are no better off than where they started because they’re not sure which sample is best. In that scenario, there is a false assumption that patients understand the nuances of clinical decision-making as well as we do. Instead of making the best choice, patients may lose trust in you as their doctor, leaving their condition less than optimally treated. The ISFJ optometrist cringes at the idea of being accountable, on the chance that their recommendation will fail and possibly lead to conflict. With this anxiety over accountability, our duty to do no harm competes with our angst over managing a potential conflict.

With a clearer understanding of typical optometrists’ psychological traits, leaning into our strengths and recognizing our vulnerabilities can improve both practitioner and practice. (See Lean Into Leadership).

The hustle and grind on social media have become synonymous with success, which we often equate with productivity. The optometry grind generally consists of being a practice owner or entrepreneur, lecturing on the speaker circuit, and being an influencer, in addition to having a bold lifestyle with picture-perfect food and vacations. Anything less is failure.

A byproduct of the closures during the pandemic was that we were collectively forced to pause. For health care workers who embody the conscientious ISFJ personality and tie success to productivity, this created a sense of panic and may have contributed to an increase in rates of anxiety and depression.⁴ The loss of productivity was collectively grieved by many, and some are still dealing with the consequences.⁵

Reopening our clinics resulted in a burst of energy to recapture that productivity and, as a result, physician burnout–especially among generation X, is on the rise.⁶ With 25% of recently surveyed physicians reporting symptoms of burnout since the pandemic, it is critical to acknowledge the role of psychology in that statistic.⁶ Only then can we begin to seek out professional support and modify our work and lifestyles appropriately.

FINDING YOUR HAPPY PLACE

Being unhappy is inefficient. Our experiences shape our thoughts, which formulate our words, inevitably leading to our actions. It is important to recognize our own biases in our self-speak so that we can provide care that is dispassionate and free of personal entanglements. Once seen, our ISFJ traits cannot and should not be unseen. By leaning into the ISFJ personality traits with accountability and curiosity and without expectation, we can remove the dissonance and anxiety that has been growing on our side of the slit lamp. Recognize that the need to make a patient like us or our recommendations is irrelevant and self-generated.