Judith Tate: “Clinical competence is only one part of what makes us effective practitioners”

Over time, though, something shifted. Nearly 13 years into practice ownership, I’ve become far more aware that, while fundamental, clinical competence is only one part of what makes us effective practitioners. The longer I work with patients, the more I realise that the skills shaping outcomes are often the ones we are not formally taught.

I’ve moved away from simply completing a process and towards truly listening to and seeing the person in front of me. That sounds obvious, but it requires intention. It means creating room for patients to speak.

I’ve learned that the patient journey begins long before I pick up an ophthalmoscope. It starts the moment someone walks through the door, or even when they first call the practice. In our clinic, I encourage my team to acknowledge every person who enters. Even when we are busy, a simple greeting makes a difference. That first interaction shapes everything that follows.

There is always a story behind the presenting complaint, and often the first question is not the destination

The patient

When a patient sits in my chair, I begin with a straightforward question: ‘How are you today?’ I try not to let it become automatic.

Over the past year and a half, I have added another question at the end of my routine history-taking: ‘Is there anything else you are worried about with your eyes that I haven’t covered?’ I am continually surprised by what emerges when that space is offered. Concerns that have been sitting quietly for months suddenly surface.

With patients, trust is not built in a single 30-minute appointment. It accumulates over years. I see patients who have been with me since I opened the practice – some of their records are inches thick.

I’ve moved away from simply completing a process and towards truly listening to and seeing the person in front of me

Development personally and professionally

Clinically, experience has also changed me. Early in our careers, we rely heavily on protocol. As we mature, we begin to recognise patterns and integrate them into our thinking. Technology plays a vital role and I value it, but it does not replace judgement. Over time, you learn to see the patient as a whole.

When I encounter uncertainty now, I do not feel the same surge of anxiety I once did. It comes from having navigated similar situations before and knowing when to monitor, when to investigate further and when to refer.

I have seen this particularly with dry eye management. When I explain the reasoning behind warm compresses and lid hygiene, compliance improves significantly. Sometimes I reframe it not as another task on an already crowded list, but as eight minutes of intentional pause in a busy day. One patient recently told me it had become the best eight minutes of his day.

In recent years, my own family has faced significant health challenges. That forced me to confront and gain perspective on boundaries and time management. I had to accept that one unhappy patient or one difficult day does not define a career. Delegation, which I once struggled with, became necessary.

Through this experience, I have discovered that resilience is not about relentless endurance, it is about adapting, recovering and allowing yourself to grow through difficulty. For me, that now includes simple practices such as a weekly family movie night, time outdoors, and quiet reflection at the end of the day. I have also learned skills completely unrelated to optometry, such as weaving and crocheting. The rhythm of repetitive movement is grounding.

Over time, I have come to understand that our communication, empathy and ethical clarity are just as important

Reflections and refinement

If I could offer one piece of advice to younger colleagues, it would be to protect your integrity. Integrity builds long-term trust. It shapes how you communicate, how you set boundaries and how you respond when things are not straightforward. In a profession where many feel stretched, those core values matter.

We are trained to measure vision precisely, to detect pathology and to manage risk. Those skills are vital. But over time, I have come to understand that our communication, empathy and ethical clarity are just as important. We are more than the sum of our test results.