Behind the Scenes at TEI: Dr. Andrew Meagher

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 Andrew Meagher, OD ‘15, Resident ‘16, FAAO, assistant professor, Glaucoma Service, at The Eye Institute.

Dr. Meagher:

I'm Dr. Andrew Meagher. I was a graduate of PCO Salus in 2015, and did my residency in '15 through '16. I'm one half of the Glaucoma Service along with Dr. Richard Bennett. I joined the service after recently completing a two-year fellowship that just ended last Labor Day. Together, we have over 40 years of experience in glaucoma. I also spend one shift in emergency, which helps to shake things up. And then a primary care shift with the third years of budding optometrists, and the soon to be second years, on Friday afternoons.

I have a bit of involvement didactically, all virtual now of course, but some smaller scale lectures with the scholars program. And then I work in the glaucoma course for the international students, the scholars, and the traditional program.

Hope Daluisio:

Can you walk us through what a typical day might be for you at The Eye Institute?

Dr. Meagher:

Since I'm mainly in glaucoma, all days Wednesdays, and Thursday and Friday half days, really when I get in and unpack, I start with a review of the schedule to just see what the day looks like, seeing if there's any new referrals and what their background and story may be. And then I look at the existing patients that I already know well and just see how they're doing and what to anticipate.

There's at least one staff resident, primary care resident, with me and so we usually catch up in the morning and I talk to them and highlight some unique or good cases for them to see since they're still learning as well. And this helps augment their specialty exposure. So we love having them around and they're a great help as well. From there, the students rotate through many specialties so I always touch base with all the students, get a number to see how many we have, and make sure they're set with getting into the EHR. And if they have any questions about the cases, especially if it's their first time in the service, try to get them almost down a rabbit hole that we want them to of focusing on the glaucoma. But there's definitely more that comes in along with the glaucoma with each patient.

Once each student gets their patients and starts working them out, there's a bit of a waiting game. We'll wait for them to record in 30, 40 minutes or so. But the ball really gets rolling once they start reporting, especially if they all come out at once. So typically, my role in the service, I like to say I put out the proverbial fires. If they come in and pressure's really high, vision is down from before, or they have any other major complaints that seem awry from what they've consistently been, either myself or the resident, if there's more than one fire to put out, we'll go in, we'll take a look and see what's going on with it.

And then ultimately, since every patient has been very loyal to Dr. Bennett, the chief of the service, he's, what I like to call, the final act. And he'll come in and they're all happy to see him. I've made sure that prescriptions are set, any other needs are met. In some cases, if we have to get them to a specialist for a secondary disease or presentation they have going on, we take care of that there. I always tell the students, patients can have as many diseases as they pleases, and we'll always address those issues when we see them, but don't always just anticipate glaucoma because there's definitely more. So that's the morning.

The afternoon is pretty similar to that. With the reduced schedule, I've been able to have more of a lunch. We like to joke and say, lunch is a privilege at TEI, so we get a small bite in to eat. And then the afternoon is pretty similar to how the morning is. It's typically the same group of students coming through, and we field any questions or anything like that they may have.

When it comes to emergency, for those who are familiar with this service, it's a triage service for both new and existing patients. Anything from a pink eye, to an injury to the eye. Anything that seems urgent and worrisome to the patient they'll come in for. The resident, and this goes for all the clinic, the residents are the pulse of the clinic. They really run the show and it's primarily them. I'm pretty much the overseer, so to speak. So they'll triage the patient. If they think something is odd in the triage, they'll report to me for things like that. 

And then once the patient's finally back and been looked at, if it's another tricky case, which most of them are in emergency, they'll run their game plan by me and I'll either say, no, what do you think of this or that? And we'll bounce ideas off each other if there's more than one way to do something. Or, I try to ensure that they're learning so I have them tell me what they want to do first, and then I'll pose what I would like to do and then we come up with a game plan from there.

You know, the emergency service is nice to have because it does definitely keep you on edge with just anything can really walk through that door. I even got a call about an hour and a half ago of a patient of mine who had come to emergency and I talked it through with the doc there just about what to do because it was a unique case. But it keeps you sharp. It keeps you on top of everything, even if it's not glaucoma-related where my bread and butter is.

Hope Daluisio:

How is it working with those students and residents that might be seeing these cases for the first time?

Dr. Meagher:

It's exciting. Because I remember seeing some of my first cases and you study so much and you read about it, and then to actually see it, it really does a good job of bridging that gap that you typically don't always get in primary care, where you're just seeing routine eye exams. There's a lot of disease at the clinics so sometimes that isn't the case, but a lot of the students, even with the mask, you can just tell in their eyes that they're excited to see something and learn about a new condition that they haven't seen themselves in person.

Hope Daluisio:

What is something that you do as a TEI doc that patients, or people outside of The Eye Institute, might not know of?

Dr. Meagher:

I like to talk about my hobbies to see if other people have that interest and share those hobbies. So I like to hike. I like to snowboard, I'm going this weekend. I like to fish in the summertime, and I'm looking into mountain biking. In some of my spare time, even before quarantine, but it also happened more during quarantine, I started to make my own beef jerky. I recently started making hot sauce. One of my admin coworkers, one of his family members grows ghost peppers down in Carolina and they have a whole harvest. They bring up a box each year. So I've been taking those and making hot sauce, somewhat from scratch, but reading recipes online to get a sense of what to put in, what not to put in it, and I've been bottling them. 

And since I usually get them in late fall, I've been able to actually gift those hot sauce bottles as a holiday gift for those that I know who like little spice because the peppers are no joke. I wanted to get a bit creative. I've always been into like really building or creating things. I always loved Legos as a kid. And even now I think when I'm helping my nephews back home build Legos, I might have more fun at it than they do. I think that can translate as an adult into like woodworking and building things there. I live in an apartment now, so it's probably frowned upon to open up shop here, it might break my lease. So that's something I'm aspiring to get into once I do buy a house.

Hope Daluisio:

Do you think it's important to be personable and talk to your patients, and sharing those types of things? Do you think it makes them more comfortable?

Dr. Meagher:

Absolutely. I think any common ground, and I find common ground all the time, and it's on many different things with my patients. I think it just grows a stronger connection, especially in glaucoma, since we typically see patients at least four times a year to check the pressure. So we're seeing them frequently and it reminds me of that first year during my fellowship, I wasn't as much of a familiar face. And I come in the room and I get the look from the patient like, what'd you do with Dr. Bennett? And seeing that evolve over the last two years to, oh hey, you're Dr. Bennett's lackey. I say I'm like the Robin to his Batman. It's been nice to see that connection grow. And any topic that comes up, it's spur of the moment. It might be something they're wearing, something they mentioned. I always love to find that common ground because I do feel like I've grown a lot of bonds with these patients.

Hope Daluisio:

What would you say is the most rewarding part of being at The Eye Institute in your position?

Dr. Meagher:

Being at The Eye Institute and at Salus University, it's twofold. So the first part is similar to what we just mentioned with the connection with the patients. And this community that we have, I feel honored to serve them. And a lot of them have a lot of tough eye problems to deal with, and so I want to make it, one, I want to get them the right treatment either through me or through a specialist. But all in all, when I hear patients say at the end of the day that their needs are met, they felt cared for, that we listened and that they really understood everything, I know that I'm not just teaching the students, I'm educating and teaching the patients as well. And I know that I've done a good job when I do that. 

And with the reduced scheduling, back when we opened, I think it was June 16th was my first day back. It was just us doctors, there were no students there yet. So it was one-on-one, kind of non-traditional for academia, but one-on-one, we call it direct care. Where the schedule was so reduced that although I wanted to keep it short because of COVID and everything, I still, throughout the exam, was able to connect more and really get to know my patients a lot more, just from it being us two in the room. So having that time spent really allowed more time to converse and to get to know them. And that all comes down to me wanting the patients to never feel like a subject of just a pair of eyes. I want them to know that I'm viewing them as a whole person. 

When I consider treatment, I'm acknowledging that if for an eye drop, for instance, that's an expense each month that they now have to use, and this is going to be something that they need to do daily. And I want to make sure that it's as undisruptive as possible. On the other end of that, with the teaching aspect, for some time I've definitely gained a sense for when a student may not be fully understanding something.

Even with the masks on you get a bit of a deer in the headlights. And I always look at that as a great opportunity to ensure that by the end of this exam, or the end of the day, that they fully understand it and that they're smarter and more knowledgeable because of it. I've heard the phrase a few times at the end of a quarter rotation, I've learned so much Dr. Meagher, and that's really the most rewarding and really priceless to me. I feel like it's what motivates me, and gets me up each day. Because of that, I never really dread coming into work. And it's pretty safe to say that I never have a case of the Mondays. So overall I feel really fortunate to be in this position.