Behind the Scenes at TEI: Dr. Jeffrey Nyman

In our new podcast series, we will be talking to doctors from The Eye Institute to get an inside look at what goes on behind the scenes and what a typical day in the life is like for a doctor at the clinic. In this episode, we met with Jeffrey Nyman, OD, FAAO, director of Emergency Services at The Eye Institute.

Dr. Nyman:

Hi, I'm Dr. Jeffrey Nyman, and I am the most senior of staff members here at The Eye Institute. I am currently the chief of the emergency service and a primary care practitioner in one of the primary care suites, and have been doing both of those jobs for the better part of the last 40-plus years.

I have a primarily clinical teaching and clinical delivery role at The Eye Institute at Salus. I also teach some didactic courses related to clinical care, clinical optometry. I teach the emergency course. That doesn't sound surprising, probably after that introduction. I also teach in some other clinical problem-solving types of courses. I would consider myself a mentor to many of the people who currently are on our staff, and certainly to the students and residents in particular, who I have a significant amount of interaction with in my role as emergency director.

Hope Daluisio:

Can you walk us through what a typical day is like for you?

Dr. Nyman:

A typical day when I'm on patient care here might be, for instance, a Monday morning, I staff the staff support in the emergency department. So I am supervising generally a resident, sometimes two residents, and generally some fourth-year students and maybe some third-year students also as well in the emergency service.

Obviously, because of the nature of emergency care, it's kind of unpredictable as to what's going to happen. Generally on a Monday, it can be very busy because people hold off on coming in with emergencies over the weekend sometimes, particularly in the COVID era when we can't get the building open off hours. We used to be able to do that, and hopefully we'll be able to do that again once we move along in fighting the COVID a little bit more.

But we might see anywhere from a few patients to 20 patients on a given morning in the emergency department, ranging from what are I would call urgencies for the patients to really true, serious ocular emergencies. The mix is unpredictable, and I guess that unpredictability is something I like about emergency care. It helps keep me on my toes and it allows me to probably utilize the full breadth of my teaching ability with the residents and more senior students to help them advance in their clinical education.

Hope Daluisio:

You definitely sound like you get to be on your toes a lot. You never know what a typical day will be like. Is that something that you knew was going to happen when you were going into this field or were you surprised by it?

Dr. Nyman:

I would say that, at the time that I started in optometry, it was a different profession. The optometry up until the late 1960s and early 1970s was a drugless profession. So optometrists mainly dealt with eyeglasses and visual training exercises, which are still a very important part of our scope. But in the course of my career, which began in 1972, I graduated from what was then called The Massachusetts College of Optometry in 1972 and became involved on the faculty there and also in the community health center movement that actually is a very important part of their overall clinical educational program up in Boston. 

I spent about five years there and then came down to Philly when The Eye Institute was first opened. As I said, I've been here as long as The Eye Institute has been here. Our goal at that time was to become a state-of-the-art, comprehensive eyecare center, which includes not only optometric care, but ophthalmologic care, social services, occupational therapy, all of the various forms of vision and medical eye care that are available in the modern day world. I think we have continued to grow on that premise and we have developed a program that provides a variety of levels of care and a tremendous amount of educational opportunity for our students and residents.

Hope Daluisio:

What is something that you do as a TEI doc now that patients or outsiders might not know?

Dr. Nyman:

I am the director of the Emergency Service department and I feel a very important part of that is to educate our residents, in particular to deliver care not only when the building is open, but for off hours, that I pretty much oversee all of the after-hours care that goes on in The Eye Institute. I communicate with our residents at any time of the day or night, and participate in the care of the patients who are calling with off-hours problems. 

Some patients get to know that because they might say, "Hey, the resident told me that we're never going to consult with you," or something like that. But I don't think most people know that that's part of what I've been doing for the last 40 years. It is actually a very rewarding part of being a doctor here. 

Overall, it's part of what I set out to do. You asked if my expectations at the beginning of my career could have foreseen what I was doing, but I've always felt that that's what I wanted to do, provide the best care that I could be capable of providing under the laws that govern the practice of optometry. When I first started, I helped expand the laws that govern the practice of optometry.

In fact, PCO here in The Eye Institute, in our faculty, was one of the main reasons optometry actually made it to the level of care that we now deliver nationwide. We were a prime mover in helping legitimize the educational background that is necessary to do the types of things that allow us to get licensure for treatment of eye disease and various other aspects of optometry that we've expanded into over those 40 years. So I'm very proud of that and it's a very rewarding part of what I do.

Hope Daluisio:

It seems like you have seen it all, done it all, and have definitely had a very extensive career so far. Like you were saying that it's a very rewarding job, rewarding position, how is it working with the residents?

Dr. Nyman:

I can't overemphasize how much I get out of working with the residents. Because the residents are a special group. They're a small group of people who are doing post-graduate work here to better themselves in the various areas of optometry. They're a very, very important part of our overall clinical operation. Not only in terms of the patient care delivery, but also particularly as they move along in the residency, in our education of our student body. 

Because, in this type of a field, the medical field, everyone needs to be a part of the system. We need the people like me who have been around for a long while and have experience. We need younger people who are less experienced, but up-to-date and involved in all of the modern-day techniques and technologies. And we need an enthusiastic group of residents who are willing to take a year and devote it to just bettering themselves, and at the same time, providing some of those things that I just mentioned, the education for the students, the care for the patients that is a very, very important part of our overall operation here. 

Working with them has been a highlight of my career. I've mentored pretty much every resident that has ever been through this organization. Many of them are actually on our faculty. I'm kind of proud of that as well. So that's a real enjoyable part of my experience here at The Eye Institute. 

Obviously working with the students is the main thing that I do, although because of my emergency role here, I do work with the residents and across the board. All of them, no matter what department they're in. It's a little different, but with the students that I work with in the clinic, at least in The Eye Institute, it's kind of a, it's not familial, but it's almost like a familial relationship.

When they come into clinic here, I meet them in their first year because the first year is when they rotate through our clinics. And we want to get them involved as early as possible and make them feel like they are a part of the operation, even from day one. And so, I take a special amount of consideration to make sure that I engage the students when they first come in, and that I help them make it through the various stages of being an optometry student. 

Which has been extra challenging, obviously for them in the pandemic when everything has changed so much. But even before that, to develop relationships which are more than just perfunctory with my students, to make them feel that I am here to make them what they want to become. That's what I want to do, and as I've gotten older and recognize that I'm not going to be here forever, I feel even more of an obligation to just be able to let the younger generations know what I know. Hopefully, that'll give them a foundation in which they can build their knowledge base and their clinical abilities to be better than I am, better than I was, and better than they are now. And to continue to improve themselves and the profession. 

The other part that I have to add in here is that I worked for a while in a private practice and have had experience in that sector. As you know, we're a very big practice, we have 45 or 50 examining rooms. This is a huge operation. But I've always felt that we could organize our care in such a way as to make the patients feel that they're a part of something that is a little more individual. That's such a individually-oriented patient care, individually-oriented than in a big practice. 

And it's a challenge. It's been a challenge. We've gone through many changes, but I have many patients who have been coming here for 40 years. I feel I've developed a tremendous bond with my patients. I know if you were to talk to a lot of the students in residency, they kind of know that because a large percentage of the people I see are return visits at this point in my career. I've shown the students, I think in that regard, that even in a big environment, an organizational approach like this or the teaching clinic, that you can still develop a strong bond with your patients and a long-lasting bond that allows you to be part of their lives for most of their lives. 

Obviously, one of the things I like about optometry also is that the vast majority of people that we deal with, we can help. This is a profession in which the outcome is often good. I'm not saying there aren’t people who we have to give bad news to, but overall, we have a lot of positive feedback from what we do on a daily basis. I think it just makes you feel better that you can help someone. 

If you look at our overall healthcare system and what's happened to it, there's a lot of impersonal care going on throughout the healthcare system. People who do not develop a relationship with a doctor. If you have a good relationship with your healthcare provider, I think you feel more trust. You feel more comfortable. Even if you're sick, even if you have problems that are not going to get totally better, that relationship is a very important part of the healing process. I try to make that part of my teaching. 

I would like to add one other thing also that you may not know - I have a twin brother, but he retired two years ago. He and I were both chiefs of one of the primary care units that was here for many, many years. And so, that was another kind of nice thing for me to be able to work in an environment with my twin brother for 30, 35 years. One of the big contributions my brother made to our program here was that he taught the course in, I think it was called patient communications. Which is an overview, but he taught that to the freshmen optometry students for the entire time he was here. Of course, it's still being taught. My brother is a very empathic and caring individual. He really emphasized the need to be that type of person, how to conduct a good patient interview, but also one in which you express empathy and concern for your patients. I think it was always a big part of how our students ended up here, because even though it wasn't the first year of their career, it was one of the most important things we could tell them. Which is, "Your communication with the patient is perhaps the most important thing that you do, is to communicate well with your patients."

Hope Daluisio:

Is there anything else you'd like to add?

Dr. Nyman:

I would just like to say that Salus University under its current leadership and past leadership has really grown into a phenomenal organization. I hope that people who listen to this who may be thinking of, for instance, coming into our field, will get a good feeling about what we do here. It's really an amazing place. I didn't really tout our care so much, but we provide a large section of North Philadelphia with a very high level of eye care. Which, prior to our existence here, really was lacking in this area, in my opinion. And so, I feel very proud of that as well.

To learn more about The Eye Institute, you can visit SalusUhealth.com/TEI. Stay tuned for our next episode, where we'll go behind the scenes with Andrew Meagher, OD ‘15, Resident ‘16, FAAO, assistant professor, Glaucoma Service, at TEI.