Mental Health and the Private Practice Optometrist

According to the World Health Organization, mental health, a “basic human right,” shapes one’s ability to make decisions, cope with distress, and contribute to the community.¹ Physician burnout is defined as “a state of emotional, physical, and mental exhaustion caused by prolonged stress in the workplace.”² Declining mental health and physician burnout are intimately related.

In this article series, I will consult with Amrita Kataria, MA, LPCC, LMHC, a licensed mental health therapist in Los Angeles, California, who specializes in anxiety and depression, for tips on how to better maintain mental health as private practice owners. Here in part one, we will examine how private practice owners around the country manage online patient reviews and how these reviews can affect our mental health. First, let’s delve a bit deeper into the particulars of burnout in general.

UNDERSTANDING BURNOUT

Physicians, including optometrists, who report burnout are more likely to have higher absentee rates, make more medical errors, and receive lower patient satisfaction scores, resulting in overall lower quality patient care, higher emotional exhaustion, and depersonalization of care.² Causes of physician burnout include poor work-life balance, increased workload, lack of autonomy, and insurance company authorizations and regulations, among others.²

Most reports on physician burnout apply to those working in hospitals or larger institutional settings. After a deep literature dive, there is little reported on burnout specific to private practice owners; in fact, private practice ownership is viewed as somewhat of a solution to physician burnout and even as a way to improve mental health.³ Interestingly, a cursory social media search yields daily posts from fellow optometric private practice owners asking for help managing their mental health and juggling their personal lives as the challenges of practice ownership arise. So, is private practice ownership really a solution to physician burnout? Likely not.

A total of 63% of physicians reported at least one manifestation of physician burnout in 2021—specifically emotional exhaustion and depersonalization—and about half of those physicians were in a private practice setting.⁴

YOUR ONLINE PRESENCE

The online presence and reputation of a physician’s office has been growing since 2012,⁵ largely because the information is free and easily accessible to potential patients. Therefore, in order to infuse a physician’s reputation with success and growth, building a positive online presence is of utmost importance for today’s private practice owner.

When choosing a physician, almost two-thirds of patients view online reviews as “somewhat or very important,” which is less than they weigh other factors, such as word of mouth.⁵ A factor of higher importance is whether the physician participates in the patient’s insurance (~90%). Still, almost one-third of patients passed over a physician due to negative online reviews, and factors such as photos, younger physician age, shorter wait times, the physician’s biography being available on the website, and no malpractice lawsuits help determine why patients choose physicians based on online presence.⁶ Jo et al analyzed the language used in 16,700 reviews and found that positive reviews contained words such as “friendly,” “caring,” “kind,” and “helpful.” Negative reviews most often contained words such as “waiting,” “waited,” and “rushed.” The words “best staff” showed a statistically significant association with positive reviews.⁷

One obvious pitfall of online physician reviews is that they can represent the extreme emotions of reviewers and, therefore, offer either overly positive or overly negative experiences, with 96% of reviews falling in either the one-star or five-star categories.⁷ Reading a negative review may leave a practice owner or physician feeling exhausted, hopeless, or doubtful of their skills, especially those with new practices. The reality is that you can be the best physician around and still garner a negative review. Sometimes it’s just unavoidable. So, what do you do when that happens?

I spoke with several private practice owners and asked Amrita Kataria for her feedback. Below are three main takeaways from those conversations.

TIP NO. 1: USE THE REFRAMING TECHNIQUE

Amrita Kataria encourages practice owners to re-frame negative comments into constructive criticism and use them as opportunities to learn and grow. In other words, turn a negative into a positive, which may include a change of policies based on multiple sources of feedback, not just one review.

For example, if numerous patients are complaining, on and offline, about a policy, it may require an investigation into how you might change that policy to accommodate the majority of your patients. This can ultimately lead to positive growth in your practice.

“As difficult as a negative review can be, I try to approach it as an opportunity to positively stand out,” offers Jennifer Wademan, OD, owner of Bidwell Optometry in Folsom, California. “When I can respond transparently and empathetically to a concern, I have found it builds trust and credibility with both existing and potential patients. I value feedback; frequently, it can identify areas for growth, and it publicly shows I value the patient-doctor relationship,” she adds. Kristyna Lensky Sipes, OD, owner of Stanford Ranch Optometry in Rocklin, California, agrees. “Showing patients that you are willing to admit when things didn’t go well shows your practice is relatable and makes people feel like they matter,” says Dr. Sipes. She also cautions that not all negative reviews warrant a change in policies or the way you practice. “Set clear boundaries on where change is warranted and what is considered constructive,” she explains.

TIP NO. 2: FOCUS ON YOUR INTERNAL LOCUS OF CONTROL

It’s easy to take negative reviews personally. “A negative review can really hurt my self-confidence and self-esteem as a new practice owner. Oftentimes, negative reviews leave me feeling hopeless and lead to me doubting my abilities to take care of patients. I work very hard behind the scenes, putting in long hours, sacrificing family time and sleep. Harsh words can be so discouraging and frequently feel unfair,” one OD, who wished to remain anonymous, told me.

Amrita Kataria suspects this line of thinking exists in many high-achieving, successful practice owners. She encourages them to focus on their internal locus of control (LoC). The LoC can exist as internal or external and determine “whether or not the person perceives a causal relationship between his own behavior and the reward.”⁸ Individuals who believe they control their life’s outcomes have more of an internal LoC; those who believe that things happen to them based on luck, fate, and other external factors have more of an external LoC. However, we can strengthen our internal LoC, says Amrita Kataria.

Kesayavuth et al reports that fostering an internal LoC encourages learning to assume responsibility for the outcome of a situation and taking potential failure as an opportunity from which to learn and grow.⁹ Amrita Kataria explains that an example of fostering an internal LoC is to create a positive internal dialogue, such as: “I have created a healthy, safe environment for my patients. My focus is on education, an attribute that sets my practice and myself apart from others. Negative online reviews are not in my control and do not affect my self-worth.”

She recommends waiting 1 to 2 days before responding to a negative review, allowing time for personal feelings to dissipate. If this is not possible, she suggests delegating the response process to a staff member or office manager.

Jennifer Shaba, OD, owner of the Dry Eye Healing Institute in West Bloomfield, Michigan, has a staff member call the patient to rectify the situation “in hopes of changing the negative review to a positive one.”

Curious if one’s mindset changes over many years of ownership, I asked Inna Lazar, OD, owner of Greenwich Eye Care in Old Greenwich, Connecticut, her thoughts. She responded, “Early in my career, negative feedback felt personal and could significantly impact my peace of mind. Today, negative reviews don’t unsettle me as they once did.”

TIP NO. 3: AVOID CATASTROPHIZING

Although it can feel like a disaster, especially the first one, avoid catastrophizing the result of one negative review. It will not cause the demise of your practice. After taking some time to reflect on the criticism you receive, decide whether you can change your policies based on the feedback provided. If there is truly no constructive criticism to be taken from the review, it’s best to move past it.

In the case of an unfair review, consider responding with a generic reply, such as “please call the office for further assistance with this matter.” Or, if you would like to reply, consider an apology for mistakes made. If there is truly a case for defamation or false information, consider seeking legal counsel and reporting it to the platform administrators.

Always avoid acknowledging any presence of the patient in your office to abide by HIPAA; however, generic information about your policies can be reiterated in your responses.

Carly Rose, OD, owner of Eyecare on the Square in Cincinnati, Ohio, believes in a mutually beneficial relationship and no longer spends energy trying to please everyone. “If you aim to be for everybody, you will be for nobody,” she says, explaining that she has set a boundary of not allowing an unhappy patient who leaves a poor review back to her practice.

LEMONS INTO LEMONADE

Although negative reviews can consume our mental space, shifting our perspectives and creating a learning opportunity from them can assist in curating professional and constructive responses.