Locum life: advice to my younger self

While the practice and location changes, a commitment to caring for the vision of patients remains constant.

OT approached four locum optometrists to find out what guidance they would share with optometrists starting out as locums – as well as some of the memorable moments from their own career journey.

Advice to my younger self... 

I would tell myself that there will always be more work; there's no need to work six days a week – give yourself some down time as well.

My most rewarding day…

My most rewarding day was referring a 13-year-old with papilloedema. It's a tough conversation to have with the parents and the patient, trying to get across that this is a condition that needs to be investigated straight away while answering any questions and keeping everyone calm. The patient had a brain tumour. Times like that make you feel very privileged to be doing this job and help people to get the treatment they need.

The most challenging day…

My most challenging time as a locum came when I was covering after a previous optometrist had left the practice. Evidently the previous optometrist was very popular, so for months most patients were disappointed that she was no longer there and looked me up and down before reluctantly following me to the consulting room. Most people warmed up as soon as I started chatting to them but several remained frosty throughout, while handful were openly hostile to me. Mentally it can be very difficult going to work knowing you're being judged before you've even begun, and trying to win the patient over is a challenge.

An unusual clinical case…

The most unusual case I saw was a lady in her 70s who presented with a shadow in her vision in 2021. It turned out to be a bleeding iris. I referred her as I've no idea what was causing it, and the sad thing about being a locum is that I could never follow it up. It's still a mystery to me…

 

Advice to my younger self...

My advice is: don’t be scared. Everyone has to start somewhere and initially the process can be daunting. However, you’ll soon realise it’s not that bad. To be a good locum optometrist you have to be flexible within the environment. Each store will be different in their own way but once you have worked there a few times it’s easy to adapt. The key is to be a competent optometrist and ensure safe testing.

From my experience, I have learnt to always be honest. If it’s my first time working in a particular store, I do mention this to them and I am never afraid to ask for help or more time. The practice will always support you because patient care is the most important thing. Being able to work with new people and having the opportunity to learn from different directors is one of the main reasons I like to locum. There are many opportunities that arise by being a locum and some of these may never have been available to you if you were only a resident.

My most rewarding day...

I have had several days where I go home feeling like I had a rewarding day. However, through [the locum recruitment app] Locumotive I was able to run a CET (now CPD) event for other locum optometrists where I was able to share my experiences. This was the most rewarding event as I was able to enhance their skills and knowledge from the course I provided.

The most challenging day…

Most optometrists can agree with me when I say that I cannot pick a certain day that has been challenging. This is because each day is different and new challenges are faced. Being late to a new store can be challenging as you have to set up and get a quick glimpse of what equipment is available before starting the day. You see the clinic is fully booked and as the day passes you have to familiarise yourself with the referral protocols. The best thing to do is to stay calm and take one thing at a time. You need to know that you are a competent optometrist and just focus on ensuring you give each patient the best duty of care. These challenges are a learning experience and you’ll overcome them next time.

An unusual clinical case…

Retinitis pigmentosa (RP). I had a patient who attended for a routine eye examination and on previous notes there were no signs of having RP. The patient wasn’t having any difficulties but I could see signs that suggested the likely diagnosis for this patient was RP. It was heart breaking trying to explain this to the patient. However, I felt reassured that I did my best to try improve their quality of life. 

Advice to my younger self...

There are definite tax implications to being a locum and also issues around gaining a mortgage. Don't be afraid, give Lloyd and Whyte, the AOP's affinity partner, a call and sort out your finances and a proper pension right from your registration.

My most rewarding day...

For me, it has always been the patients who make the clinic rewarding. Some of them are very interesting and lovely people to speak to. I found my five years domiciliary work was the most rewarding, knowing that without that eye examination they would not have been able to access eye care.

The most challenging day…

Incompetent, apathetic staff and poor managers are awful to work with. As an expert in the provision of optical services, if the practice team doesn't feel a comfortable fit to your own professionalism, move on and don't look back.

An unusual clinical case….

Not so much unusual but interesting... Just recently I consulted a Russian lady who had had radial keratotomy (RK) undertaken in Moscow in 1993. It was done manually and you could actually see the imperfections of the handmade surgical incisions. I found it immensely interesting as I worked in laser vision correction for a few years and know how far that industry has come since RK was developed by Fyodorov in 1974.

 

Advice to my younger self...

The main piece of advice I would give my younger self would be that it is ok to say no. In the past I would acquiesce to conditions I wasn’t happy with as I was too embarrassed to refuse, whereas experience has taught me that it is normal to negotiate conditions which are mutually beneficial for yourself and the practice.

My most rewarding day....

Too many to mention!

The most challenging day…

The most challenging day was where the average age of my clinic patients was over 85, and almost all of them required dilation and referral for one thing or another. It was a perfect storm, and I didn’t leave the practice until 7pm due to having to finish my records and referrals on the day.

An unusual clinical case…

A 17-year-old gentleman presented for a routine appointment. On observation I noticed a subtle bilateral torsional nystagmus which wasn’t recorded previously. The patient wasn’t aware of it. I called the hospital and they saw the patient the following day. It emerges he had a lesion growing on his brainstem, pushing on his cerebellum. I had a call from the practice a few weeks later as a letter had arrived from the consultant neurologist who saw him congratulating me on a ‘good spot.’