Professionalism in an age of shifting expectations – by Amanda Griffiths

A while ago I saw this opinion piece published in the BMJ careers section, and it really got me thinking about how the world of health care has changed during the time I was a student and then have gone on to practice.

Being published in a medical journal, it talks about medicine, but in my opinion it is relevant to any health care setting. You see, General Medical Council executive Niall Dickson made the point that “I think it would be fair to say that a generation ago, a charge of the profession was that it had a degree of paternalism and, some would say, arrogance.” He also said that, “the nature of patient expectations has changed,” he says. “The extent of it is pretty fundamental.”

The number one place I have noticed a shift in patient expectations is when I refer patients to see an ophthalmologist.

Back when I first started as an optometrist in Brisbane in the mid-2000s, there weren’t as many ophthalmologists around. This meant that there was a limited choice of specialists to send people too depending on what they had wrong with their eyes. While there are still only a limited number of specialists in areas such as neuro-ophthalmology and ocular oncology, there is a far greater choice of ophthalmologists for cataracts, refractive surgery, corneal problems and vitreo-retinal issues.

I remember that when I started practice, most of the ophthalmologists were arrogant folk who could get away with it because there wasn’t a lot of competition in the ophthalmology marketplace. I have found that in the last 5-6 years in particular, I have had changed my referral patterns to send people to the “pleasant” but of course equally competent ophthalmologists to avoid patient complaints about how condescending some of those guys who have been around for longer were.

I have noticed that people just aren’t as prepared to put up with seeing a specialist who they don’t like.

patient expectationsI think it’s also worth going back to share my experiences of my practical experience. I can only really remember three of my clinical placements during uni. Two were with optometrists and one with an ophthalmologist. All the practitioners I sat in with were middle-aged men.

For an entire week during one clinical placement I was basically sat over in the corner, only to be spoken to if there was something of interest with a patient’s eyes to look at with the slit lamp biomicroscope, and in the other I was told that I “laughed too much” by a gruff optometrist who took himself very seriously and always spoke in a stern tone of voice to his patients.

The ophthalmologist was known for his, shall we call it, eccentricities, and his pet hate was when students didn’t put the slit-lamp setting back to his inter pupillary distance (kinda how different people need to adjust binoculars depending on how far apart their eyes are) after he’d let us look at the patient’s eyes. He was also known for making medical students cry, but for some reason “went easier” on optometry students.

I think that one of the real issues I had during my clinical placements was that I didn’t see a single practitioner who I wanted to be like “when I grew up.” Being a female in my early 20s, I just didn’t relate to grumpy old men (yep, at that age, I thought that 40-50 was old). I did have, and I still do have a very loud laugh, which usually sneaks out during most of my consultations these days. I do have a bit of a tendency to laugh at my own jokes, but what’s great is when the patient shares a laugh with me too. Over the years I have made sure that I don’t go too far with my often talkative, light-hearted, laid-back approach, because there are times that I need to have serious discussions with patients, and if I don’t have a certain rapport with them, it would go very badly.

For years I modelled my consultation and communication style from my GP, who I think has always done an excellent job of gauging “where I’m at” and what conversations we need to have. She’s always been good at listening out for which symptoms I come in with require investigation, and sorting out a plan of attack that fits with me as an individual.

I think that as a student, sometimes you will see things happen that you don’t agree with. It might be a practitioner who talks down to a patient. It might be that you don’t think someone was treated as well as they could have been. While I’m not going to say that these things are “okay” or give any advice on what to do at the time, I will say one thing. Don’t discount the bad experiences you might have as a student, as they may help show you what sort of practitioner you don’t want to be. And if you have that figured out, it’s not too big a stretch to define what sort of practitioner you do want to be.


AMG croppedAmanda Griffiths is the founder of the website My Health Career. Since starting the website she has been an invited speaker for organisations including the Career Development Association of Australia and Career Education Association of Victoria, myfuture, and the Master of Ceremonies at the HealthFusion Team Challenge. She graduated from her optometry degree with first class honours in 2003, and spent two years as a part-time clinical supervisor of optometry students in a university setting. Amanda has worked as an optometrist in full time, part time and locum roles that have stretched from far north Queensland to Tasmania.


This article concludes the #happynewuniversityyear theme My Health Career has been running for the past fortnight. Other articles are here:

Image: Akarakingdons –

Facebook Twitter Linkedin Email

Speak Your Mind