Perspectives of a New Grad with Dr. Justine Blumenstock

|| Perspectives of a New Grad with Dr. Justine Blumenstock || 

[00:00:00] Dr. Justine Blumenstock: Like I said in the beginning, you adjust to being a, not only a doctor, but then having staff that all looks up to you and you have to tell them where to go, what you need, and so that you automatically are. You know that that higher up office person, and then when you try to train and manage them, oh my goodness.

[00:00:23] It’s just like, it’s this whole new world of how do I keep these people on track. It’s like you’re teaching them this, this course of how to do all things optometric and it’s especially hard when you have a new hire. 

[00:00:40] Dr. Christopher Wolfe: Hello and welcome to the Crystal Podcast on I Code Media Today. I’m gonna have a great conversation.

[00:00:44] I know it’ll be great with Dr. Justine Blumenstein. Just kidding. Blum Andal. Uhhuh. Yep. Dr. Justine Blumenstock. She, um, she is in our practice. I’ve had the pleasure of practicing with her for a little over a year now. And, um, please enjoy our conversation. We’re gonna talk a little bit about, um, her experience coming out of school, uh, and then, um, some of her experience in, in terms of training new, um, new staff members as well, because she’s been really critical, critically involved in that, in our practice, uh, in addition to the patient care that she’s providing.

[00:01:22] So I wanted to talk a little bit about that with her. As always, enjoy our conversation. Subscribe to the podcast, write a review, share it with your friends, and [00:01:30] support those. Who support us.

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[00:03:11] If you’re not utilizing Maca Health for your patients, check it out for yourself by contacting your Maca Health representative. So Dr. Justine, um, This was, it was obviously an internal joke, but everybody, uh, likes to mispronounce Dr. Justine’s, uh, name. So, you know, tell me a little bit about the last year of, of kind of hitting the ground running.

[00:03:35] So you got kind of this very good clinical experience in your training. Uh, you were trained amazingly, but what has been kind of eye-opening to you in terms of translating that training from school into practice? 

[00:03:50] Dr. Justine Blumenstock: I think the biggest thing is that you learn so many detailed, very detailed oriented facts and knowledge of, of everything, uh, down to a t in school, and then what is applicable in practice.

[00:04:07] Plus everything you now have to do, uh, within the practice itself. And, uh, that, that for me was the most eye-opening. That you’re not just an optometrist and having to apply all of those. Skills that you learned, all of the knowledge that you’ve learned over the past four years of school. But now you have to have to manage, uh, in ways your team that’s helping you.[00:04:30] 

[00:04:30] You have to, you know, just manage your patients who, uh, have this go wrong and that go wrong and kind of be there, uh, Their therapist in a way as well, you know, and, and be a conversationalist. Um, and then do the same for your staff in ways too. Uh, so I think you know that all together. And then in turn with, uh, what is, is relevant to clinical practice that is a little bit, uh, you know, lost in translation in the academic world.

[00:05:01] Um, so those were things that I had to. Filter through. 

[00:05:06] Dr. Christopher Wolfe: You know, we’ve talked a little bit about this, but can you think of like specific instances where in, you know, you, you felt like, well, okay, not that you’re doing it wrong in your training or wrong in clinical practice, but what was sort of an eye-opening experience to you where you were like, oh, I mean, I, I can think of a number of them just in our communications back and forth, but for you, where you were like, oh, yeah, okay.

[00:05:29] Yeah, let me, let me, I can do it this way. Like what? Gimme an example of that. Is there something that sticks out in your mind? 

[00:05:35] Dr. Justine Blumenstock: Well, I think one of the biggest things that you and I have talked about are the clinical guidelines that are set forth, and, and that’s just a great structured, uh, thing to follow that, especially for retinal holes and retinal tear follow-ups and all that.

[00:05:50] Like that is the simplest thing to use to know how to manage those. And I’ve even heard some of my peers, you know, my similar age are like, well, I just kinda bring ’em [00:06:00] back when I, when I feel is appropriate, uh, in, in a. You know, it’s a thought out process. It’s not like they’re. But it has some guesstimation in there and that takes all the guesswork out of it.

[00:06:11] It’s structured guidelines. Um, so that’s a, a great instance of things that maybe are more, much more clinically relevant than, you know, what we learn in school, you know, of them and what to look for and how to identify. But you know, the specifics on management. You need a plan for every diagnosis, for every patient.

[00:06:30] And then just communicating with the patient and being very, Precise and definitive. Here’s the treatment, I’m the doctor. And so I don’t, I don’t think we got hardly any of that or any of that kind of emulated to us. We were kind of set free. And you’re the doctor now, so you make the clinical decision, but how do you emulate or how do you exude to the patient?

[00:06:57] Um, kind of that, that confidence and how do you make those decisions? Quickly. Uh, I think that’s something that’s a little on the job learning the first year for sure. 

[00:07:09] Dr. Christopher Wolfe: You know, I, I remember obsessing over, um, and it becomes easier and easier, but I remember obsessing over when I was first outta school, like when I was gonna have a patient back for some something, right.

[00:07:19] Maybe it was a corneal ulcer, maybe it was, uh, retinal tear and I was, or maybe it was glaucoma or an anterior ischemic neuropathy. And I remember like, [00:07:30] Like being very focused on what’s gonna go wrong, like anticipating when I would walk in with a patient that something would go wrong. And I actually think that was a very good, whoever taught me to do that, um, it was a very good skill because I was constantly going through like, all right, if, if I don’t, if this doesn’t work.

[00:07:49] What’s the next thing? If this doesn’t work, what’s the next thing if this doesn’t? And so, um, it becomes like you’re constantly expecting things to not go the right way. And when they, when they do go the right way, it’s great. But then also it, it immediately gives you this, um, ability to know, okay, if it’s not going well, I already know what the next two or three things are I’m gonna think about and do, which I think is really helpful.

[00:08:12] Did you go through any of that as well? 

[00:08:16] Dr. Justine Blumenstock: Well, maybe not to the point of obsessing over it, uh, but for sure, doubting, you know, mm-hmm. Is my treatment method, right. Am I bringing them back in the right timeframe? And then I think it’s kind of learning, not being afraid to ask, uh, you or Lindsay for help the other doctor in our practice, and being open to learning from, you know, Decisions that you need to reevaluate and kind of learning by the experience there.

[00:08:49] I, I haven’t had too many that I wasn’t able to reach out to another doctor, which is wonderful. That’s why I loved working. Uh, and I still love working in your guys’ practice so [00:09:00] much. You just are surrounded by peers that can help you. And I feel that for, if I were out of practice by myself, I would’ve done a lot more of that had I not had the references that I did.

[00:09:13] Dr. Christopher Wolfe: You mean you would’ve, you would’ve reached out to a lot of other people. 

[00:09:16] Dr. Justine Blumenstock: Or had a lot more obsessing, but I need to go, oh, yeah, yeah, I need to go look at this and look it up. And that’s what I would’ve done, I presume. Do you 

[00:09:26] Dr. Christopher Wolfe: feel like you refer more, uh, like, uh, was your, was your tendency to want to refer outside of the practice, um, greater than, than it wound up being?

[00:09:37] Like, did you, did you think coming out of school, like, ha has your referral patterns changed because you have some of those, uh, those resources? 

[00:09:46] Dr. Justine Blumenstock: A hundred percent. I think, uh, you know, every retinal thing that was like, oh, there’s something there. We gotta refer them. You know, and just not knowing those guidelines, like I, I said before, that was something that you just.

[00:10:01] Get more comfortable with, as you have said to me, you treat it, you follow it, and you’ll get more comfortable as you have followed these treatment courses. And that’s true. Another thing too, you know, for all of the, those who don’t practice glaucoma patient care, to the fullest extent, getting comfortable with gonioscopy.

[00:10:19] Doing it all the time, and you know, for how many times I pull 

[00:10:23] Dr. Christopher Wolfe: out you the Kool-Aid, you finally drank the Kool-Aid for 

[00:10:26] Dr. Justine Blumenstock: how many times I pull out my gonio lens or put it in my plan just to make [00:10:30] sure that I will do it the next time. That’s how I keep myself on track with, you know, keeping up my skills with gonioscopy and practicing to the fullest extent that we can.

[00:10:40] So, As far as things that could get referred out, and I know there are other, uh, other optometrists who aren’t comfortable with it. How are you gonna get comfortable? Well, you know, you 

[00:10:52] Dr. Christopher Wolfe: gotta do more of it. You gotta do more of it. Yeah. I think the, um, the other thing that’s interesting is glaucoma care. I think there’s so much uncertainty in glaucoma care that, and you brought this up that, um, I feel like.

[00:11:05] Now I’m, I’m so much more certain than I was when I was first outta school, and I, I felt like I, I had all this stuff, right? I knew all the things. Um, and, and yet you’d still sort of toil over things. And now I, I feel like you get to the point within glaucoma care where you, you’re looking at risk, you know, you’re assessing risk, you’re assessing, you know, progression, you’re assessing progression rates.

[00:11:27] And so the answers seem much more clear. Uh, have you gotten there yet? 

[00:11:35] Dr. Justine Blumenstock: I would have to say no. I would say I am definitely still learning and do I understand the foundation and feel confident in my foundation of glaucoma care and my foundation and I guess my skills for glaucoma care. Yes. That. Mm-hmm.

[00:11:50] That’s a yes. As far as decision making, I don’t think I’ve had enough experience putting, starting, initiating treatment with patients. [00:12:00] Um, I think I’m still, most of my patients that I’ve seen are either suspects and we’re still doing testing to confirm, or their patients I’ve, I’ve accumulated that are already on treatment.

[00:12:12] Um, so the. The amount of patients that I’ve had to initiate treatment with are not very much in this last year. A few, yeah. So I think that comes with experience in time that I will gain more confidence as I track and follow glaucoma progression and I’m the one initiating treatment. So I think there’s still room for growth for sure in that area.

[00:12:36] And it’s always good to, to keep up on your. You know, continuing education with glaucoma, the new treatments that they have for glaucoma and even macular degeneration. We see those, uh, new injections for, uh, geographic atrophy. Like those are things that they didn’t even teach me in school two years ago, and it’s changing.

[00:12:55] So it just shows you the importance to keep up with, uh, your knowledge and your skills and all that. I 

[00:13:01] Dr. Christopher Wolfe: think, um, I think the, the hardest part when, when you think about glaucoma, um, especially from a continued education standpoint, and I do this as well, like when you present a glaucoma case, um, there are some, some cases or some continued education where you’ll talk, they’ll talk about conundrums in glaucoma.

[00:13:19] But the reality is, is that so much of glaucoma is like, um, boy, we could watch or we could treat. We could be more aggressive or we could, [00:13:30] mm-hmm. You know, or we could slow things down a little bit. There’s very few cases that you experience in clinical practice where it’s like, this is glaucoma, this is a, you know, where the patient walks in and it’s, I guess, In primary care, like in comprehensive care, like we practice where you’re, you’re, you’re detecting glaucoma at very early stages and you’re trying to figure out how quickly is this gonna, uh, be progressive as opposed to like, when you learn glaucoma in a glaucoma clinic and those patients are referred into you and it’s like, it’s obvious like, this patient has glaucoma or this patient does it.

[00:14:01] Maybe they’re a sus a suspect, but you just rarely get those like, Um, completely, you know, notched out nerves and bad visual field defects at first, right? You get ’em. But, um, but oftentimes it’s like, well, this one, this is really subtle. And, and I think that’s what, um, glaucoma care in primary care, uh, is all about.

[00:14:22] And, and that’s the tricky stuff because it’s not the obvious, you know, nasal step that’s within five degrees of fixation and no inferior or no inferior rim. You know, that’s, That’s the, um, that stuff is the easy stuff, but that’s kind of the classic textbook thing we think about within glaucoma. And so I, my point is to you is just that.

[00:14:40] You know, it, it, it’s gonna take a long time. It’s gonna take a long time of, of knowing, okay, well this patient is progressing and this is definitive progression and we are gonna start treatment now, as opposed to, ah, I’m not sure about this. How does the field look? Uh, the thing I always say is, if you’re unsure about the field, if the field looks bad, I.

[00:14:57] Do more fields, right? Uh, and, and, and [00:15:00] it will, it will, it will declare itself over time. You don’t have to in, in primary care. It’s, but it comes to down to talking to the patient, right? Mm-hmm. Doing more fields, uh, getting more information is, is nine times outta 10 with glaucoma? Okay. To do, you don’t have to make a decision right now, but what you have to be able to do is, um, articulate the importance.

[00:15:20] Document the importance document, the conversation you have with the patient. And then, um, and then you have time, right? You have time to make the right decision, uh, for, for the patient. And I think that’s really challenging. It takes a long time to, to get there. Uh, in my experience from a comprehensive care practice, you know, in a referral practice you can make, a lot of times you can just make a snap decision.

[00:15:43] We’re gonna do this, and then somebody else has to manage it ongoing.

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[00:18:35] So, uh, so what do you think about, um, staff training and, uh, and how have, how have you really kind of changed your thinking or maybe enhanced your thinking about that, uh, over the last year? 

[00:18:47] Dr. Justine Blumenstock: Yeah, I’ve had. As you know, but for everybody else listening, I grew up, my father’s an optometrist and him and my brother own a practice.

[00:18:56] So I’ve been around, you know, this office setting my whole life. I worked, uh, as a, you know, 15, 16 year old in the practice and it just, You have a glimpse of it, you think, you know, I helped manage a little bit, uh, and train a few people. I did some billing and coding myself, which, you know, were the worst few years working in the practice for sure.

[00:19:19] But, uh, you know, then you come back and like I said in the beginning, you adjust to being a, not only a doctor, but then having staff that all looks up to you and you have to tell [00:19:30] them where to go, what you need, and so that you automatically are, you know, that. That higher up office person, and then when you try to train and manage them, oh my goodness.

[00:19:41] It’s just like, it’s this whole new world of how do I keep these people on track? It’s like you’re teaching them. This, this course of how to do all things optometric. And it’s especially hard when you have a new hire. Um, you know, recurrent training is one thing and everybody should, should brush up on their skills and that’s why c p O is so nice.

[00:20:04] It gives you, you know, that that marker, that measurement and something for them to work towards, uh, the next level of things. But for a new hire, I think we forget. Just how vast this optometry world really is. And you have to think back to like, when did I not know anything about glasses or prescription?

[00:20:25] Yeah. And it’s just, it’s kind of mind boggling. And uh, yeah, baby steps are for sure what comes to mind. You start from nothing and. It’s a lot of 

[00:20:35] Dr. Christopher Wolfe: work. Yeah. I mean, it is. It, I think that’s the, what we’ve really seen over the last year and, and we, we’ve got a good team, but I think, um, like really trying to pick apart, if you were gonna teach somebody who has no idea about optics, has no idea about lenses or lens geometry or, you know, measurements and all this, and like really teach them the craft of optician rate.

[00:20:57] What would you, how would you do that? And, [00:21:00] and, you know, even just like describing what you’re supposed to see within the miers of a lensometer, uh, and showing them that stuff, I think, um, that, that could be super helpful. And how many of us really take the time to sit down and do that? Uh, it’s a challenge.

[00:21:16] Dr. Justine Blumenstock: I agree. Yeah, there’s, there’s just so much and, and I think we’ve worked through that. Having a new hire that’s not, uh, familiar with, with optometry at all, just over these past six months, starting from nothing. It’s just insightful because it, it is, it’s so beneficial to have someone who has prior experience, but, you know, turnover in some offices.

[00:21:39] I know that’s always a struggle, and so it’s like, If you find a good personality, you can train them. Now the time and and effort you have to put in to train them is is a lot. So yeah, 

[00:21:49] Dr. Christopher Wolfe: it can be a lot. Alright, so I’m gonna be respectful of your time. The last thing I wanted to pick your brain about is to kind of vision cast for yourself.

[00:21:58] You know, the next five years within, um, within, you know, you’ve sort of built a pillar in our practice for vision therapy and, and some binocular vision things, which I, I like, I like understanding binocular vision stuff. Uh, I do not want to do vision therapy. Um, and I, I made that completely clear to. Is that gonna be, do you still foresee that after this year of kind of trudging through and, and kind of starting to build all of this, is that something you still want to do in the future?

[00:22:28] And, um, and [00:22:30] in five years, where do you see yourself? Yeah, I 

[00:22:33] Dr. Justine Blumenstock: think that having a, an understanding, having an experience working with. Vision therapy is just great. It’s a great asset to have as a doctor. It just, uh, fills out my portfolio, not only in comprehensive care with glaucoma and retinal management, cornea, and then, you know, vision therapy.

[00:22:51] I think that’s a great asset to have. Um, yeah, moving forward I have a lot of, uh, experience. To be had. We’ll say that. Mm-hmm. There are a lot of, uh, areas in my care, just like we’re talking about glaucoma. I would love to, uh, experience a little more glaucoma. I do think that I will keep vision therapy in my back pocket for sure.

[00:23:13] Um, I like the, the balance between, you know, what is clinically applicable and doable for patient. Kind of the ease of the at-home vision therapy and there are for sure. Uh, There are for sure binocular vision diagnoses that do not fit that realm. Um, and so knowing where you want to draw the line and kind of having distinct wish that for myself, that uh, there are certain binocular vision cases where I am absolutely fine referring those out to, um, someone who wants to manage that.

[00:23:48] Ope or, um, you know, the inotrope that has had surgery in the past. You know, those are just things that I like. What more can I do? Does that fit my at-home model? [00:24:00] Um, and so having recognized that this first year and just gotten, gotten the experience at your practice just in all areas of care, it has been wonderful.

[00:24:10] I think it would be great to learn more. Um, And be more involved in myopia control. I think that’s something that’s so up and coming and you guys do a great job. You and and Lindsay do a wonderful job at instilling that in your practice and that pillar was already made for you. Um, so I think that would be great to implement into my.

[00:24:28] Uh, my areas of practice. And so I see myself diving more into that, exploring more my vision therapy and just becoming more confident in myself as a doctor. And I think the one area which, which you have helped, uh, definitely grow in me is just, you know, being forthright and confident with my, uh, timeline for follow ups and my plan of attack, like, That is something that you have, have been so instrumental in showing me how to do and yeah, you’re just, you’re just a great provider to, to watch how you show your patients and they trust you so much and it’s just been wonderful to, to be mentored by you and I can’t thank you 

[00:25:12] Dr. Christopher Wolfe: enough.

[00:25:12] Well, thank you. I appreciate it. Yeah, you’ve been awesome too. Um, yeah, totally, totally. Awesome. I say that all the time.

[00:25:22] Any other last thoughts about, about, I I know I said I was gonna be respectful of your time and I am, but I want to, I want to get one more. Um, [00:25:30] you know, I’m trying to get, I feel like I am far enough away from my training that, uh, I, I don’t have a pulse like I used to have on young doctors coming out.

[00:25:43] What could I do better? Or what could, could the profession of people, you know, my age, um, kind of middle of our profession, established at practice. What can we learn for how we communicate, how we take people under our. Our wings that, um, we can do better. What, what are you guys, I mean, again, you’re trying to make a broad brush.

[00:26:03] I’m not, I’m not asking you to make a broad brush, uh, statement about people in your generation. I’m just saying like, when you think about what’s important to you as, as a doctor so you can help care for patients, what do we need to keep in mind, uh, for docs like you coming into our practices, um, that, that is important to you, that makes your job easier, 

[00:26:25] Dr. Justine Blumenstock: right.

[00:26:27] I. With the new hire that knows nothing about optometry, just consider how we’re a new doctor that has known nothing about the clinical world on your own. We’ve always had someone who’s precepting or around other doctors that, that help us. Um, and so. Not to say to spoonfeed us, but that we will have no clue what you’re talking about when you tell us about a o a guidelines.

[00:26:52] Like I think, I think you were shocked when I didn’t know that and I was like, no, I, I don’t think I remember being [00:27:00] told about that. So just like those examples of, of our relationship and how that’s grown and just, you’ve been great. I think after you kind of saw initially where my footing was, it’s, it’s not necessarily that we’re.

[00:27:12] Competent in AR areas. We are some of the time, but we also just don’t, don’t know, haven’t experienced that. Um, so that’s one thing you did a great job at kind of adjusting back and being like, no, so you look at this and here are the guidelines. You can look at these. Um, and so taking a stepwise through that, kind of growing those growing pains.

[00:27:34] And then the second thing I think is that I, I have been, um, gracious enough to have the experience. Of being in practice, uh, in a practice setting and communicating with patients. And so I feel like I, I wasn’t all that, um, inexperienced in talking with patients and repertoire and, and things of that sort, but, you know, my, my definitive plan and, and diagnosis and planning and that all took just a bit and I’m still working on, uh, laying out my recommendations.

[00:28:05] But for those of my peers who are not even comfortable or not quite to the level that I am of, of speaking with the patients, I think that’s another thing to recognize that that takes time and sometimes a lot of time for patients who aren’t even comfortable in social settings. Um, and so that’s not something that I necessarily have had to, to worry about too much, but.

[00:28:28] It might take a few [00:28:30] years even to work on communication skills first and then being a little more, uh, you know, just direct and definitive on, on patient communication and plan. Um, And I think that’s the second thing, and that’s, that’s definitely necessary in a, in a good practice to have those follow-up times and have your patient come back and know the importance of, of why they’re coming back and what’s wrong.

[00:28:55] Um, so finding the line between that and time management, you know, that’s the third thing. Yeah. Like time management. You just get, I can’t imagine how, how some people see. 25 plus patients a day. I’m sure they’re, uh, the way they care for patients is different than a comprehensive 14, 15 patient a day practice.

[00:29:14] But, you know, those are all things to just keep in mind that we haven’t necessarily had that experience before. We’re still learning. Um, But I think that’s where my generation or this generation of optometrists and your first few years out, like that’s, that’s where you’re at. You’ve got a lot of experience to, to keep learning and, uh, grow.

[00:29:36] But you are at the start line, not the, you’re not in the middle or at the end, for sure. 

[00:29:42] Dr. Christopher Wolfe: Well, Dr. Justine Blumenstock, thanks so much for doing this today and thanks for so much for, you know, all the. Awesome experiences over the last year. It’s been tons of fun to get to know you and, um, I look forward to many years of, of friendship in the future.

[00:29:56] Um, and, uh, [00:30:00] and yet, yeah, thanks for being on. I, you know, there’s no, there’s no real re like usually I can ask somebody like, where do we wanna get ahold of you? Do you want people to get ahold of you anywhere? Dr. Justine, 

[00:30:09] Dr. Justine Blumenstock: you just talked to Dr. Chris Wolf and he will send it to me. 

[00:30:15] Dr. Christopher Wolfe: Awesome. Thanks for doing this, Justine.

[00:30:16] Appreciate it. 

[00:30:16] Dr. Justine Blumenstock: Thank you. Yeah, take care. You’re welcome. See ya. Thanks.

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