Health care professionals need to know more than sciences to be effective healers. This approach involves employing a mosaic of skill sets beginning with communication, psychology, sociology, understanding the role of religions, and a healthy dose of good old common sense. Our healthcare system has become so compartmentalized to each part of the body, and I truly believe in the importance of taking a more holistic view of the whole body (person) while focusing on the eyes.
The COVID-19 Pandemic taught all of us many things. One of the sectors that the pandemic put a spotlight on was the healthcare industry. The pandemic showed the resilience of the US healthcare system, but it also pointed out some important areas in need of improvement.
In our interview series called “In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The US Healthcare System”, we are interviewing doctors, hospital administrators, nursing home administrators, and healthcare leaders who can share lessons they learned from the pandemic about how we need to improve the US Healthcare System.
As a part of this series, I had the pleasure to interview Dr. Millicent Knight, OD, FAAO, FAARM., FNAP.
Dr. Millicent Knight is Senior Vice President, Customer Development Group at Essilor of America with a diverse and extensive background in the eyecare industry, including hospital-based ophthalmology/optometry with hospital privileges, owner of two optometric practices and a former member of Vision Source. Dr. Knight has also received wide-ranging industry and academic recognition including “Optometrist of the Year” by both the National and Illinois Optometric Associations, Vision Monday’s Most Influential Women in Optical, a Women in Optometry Theia Award for Leadership, and a 2020 Pleiades Award by the Optical Women’s Association.
Dr. Knight holds a Doctor of Optometry degree, and two Bachelor of Science degrees and is a Fellow in the American Academy of Optometry, the American Academy of Anti-Aging Regenerative Medicine, The National Academies of Practice, and a Kellogg Leadership Fellow.
Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a bit about your backstory and a bit about what brought you to this specific career path?
I knew I wanted to be an eye doctor when I was eight years old. After a teacher recognized my vision problem in the second grade, I began vision therapy at the Illinois College of Optometry which helped me better see and understand my classroom around me — literally! I skipped third grade after completing vision therapy once my vision was no longer hindered.
But improving my vision didn’t prevent me from encountering future adversity. When I began optometry, there weren’t many people that looked like me as a young Black woman. A pre-optometry advisor in college told me he didn’t believe I could be an optometrist, especially without a letter of recommendation which he would not provide. But, I sent my applications anyway and was accepted into each of the schools I applied to. Even when I was beginning to start my own practice, banks were resistant to loan money to a young, Black female doctor — even though I met all the financial requirements. Throughout my journey to become an optometrist, I had to keep myself motivated, surround myself with positive affirmations, and remain focused with my family as my main support system.
As I started my own career, and began establishing my mission, I never lost sight of the reason I got into optometry in the first place — helping others see. As I began caring for patients, I quickly developed my philosophy that eye care should look at the whole body, while focusing on the eyes. When I started my own private practice, it was important to me that my associates and I continue our education and become certified health coaches to provide a holistic and individualized approach, ensuring the patient’s eye health was evaluated while also prioritizing their overall health and wellness.
Optometrists diagnose, treat and manage many patients with chronic inflammatory diseases, like glaucoma, diabetes, and dry eye disease. The inflammation they present with is not isolated to the eyes, but often part of a larger systemic inflammatory response. Many of my patients would ask for a more complimentary approach to their treatment plan. Specifically, I recall one patient who, in addition to her prescription medication, wanted natural recommendations that she could institute for her dry eye disease. As a part of her treatment plan, I prescribed an inflammatory detoxification program. After one month, not only did her eyes feel and look better, her years of joint pain also subsided. Philosophically, I believe you have to meet patient where they are and develop a true patient-doctor partnership.
Can you share the most interesting story that happened to you since you began your career?
I participated in many volunteer eye care missions across the world, and throughout those trips, one patient in particular continues to stand out to me. She had very high myopia (near sightedness). Upon completing her exam and providing her prescription glasses, she did the most unusual thing. She reached for her three children, and one by one examined their faces. Suddenly I realized she was really seeing the details of their faces for the first time!
I now work with my company, EssilorLuxottica, as well as other companies within our industry to bring greater awareness to the growing epidemic of visual impairments around the world — like presbyopia and myopia, and their long-term eye health consequences.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
The biggest lesson I learned was to ask the right questions, and two funny instances come to mind.
The first time I learned this lesson, I saw an elderly gentleman for a comprehensive eye examination, and asked him to cover his left eye, and to read the chart. I started with fairly small letters, and he indicated he could not read them. I showed him larger and larger letters, and still, he could not read them. Finally, I showed him the big E on the chart, and asked if he could see that? He said, “I could see all of them, I just can’t read.”
The second was with a child I was managing with vision therapy. It required her to wear a patch over her better seeing eye, and force her to use the other eye, which turned in and had sub-optimal vision. She was not improving, so I asked her if she was really wearing the patch, and she responded, “yes.” The next day her mom called the office, and said she put her daughter on the school bus and reminded her to be sure and wear her patch. The bus driver then told the mom, “you know, as soon as you leave the bus, every day she switches the patch to use the eye she prefers to see out of!” She really was wearing the patch.
The lessons I learned…ask the right question, and patient care can have many stakeholders.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
“God bless the child that has his (or her) own.” I recall in college hearing Billie Holiday sing this song. It was a motivator for me to stay focused on my goals and achieving one’s goals opens the doors to options.
Are you working on any exciting new projects now? How do you think that will help people?
Essilor is in the midst of an exciting project this summer to raise awareness of presbyopia (farsightedness due to aging) and the solution that Varilux progressive lenses can provide. Increasingly, people are starting to notice the signs of presbyopia at a younger age — as early as 35 — in part, because of the increased number of screens we’re using every day, and the length of time we are using them.
People in this age group might notice they need to hold their phone at an arm’s length to read a text or kink their neck to see their laptop screen, but not everyone knows what to do about this. Many think they can tough it out by squinting, but, a lot of life happens 1–2 feet in front of you and frequent squinting will do more harm than good — including contributing to premature wrinkling around the eyes. Varilux lenses provide a comfortable and seamless vision experience that allows users to see near, middle and far distances with one pair of glasses lenses.
I’m confident raising awareness of Varilux progressive lenses will help improve patients’ lives and ultimately their daily quality of life.
How would you define an “excellent healthcare provider”?
A doctor that looks at the whole person, not just parts. One that asks questions, and then actually listens. Patients often know the problem, and in some cases even have the answers, they just need reassurance. An excellent health care provider is a patient advocate and seeks to partner with their patient for optimal health outcomes.
That also means supporting them mentally and emotionally — seeking treatment can be an anxiety-inducing, and being a patient advocate and partner means acknowledging that aspect of the patient experience. We especially see this with our presbyopic patients who have gone their whole lives without vision correction, and now are suddenly noticing their vision deteriorate. It’s our job to ease them into a proper solution, like Varilux progressive lenses, instead of relying on coping mechanisms like putting their neck in uncomfortable situations or stretching their arms out.
Ok, thank you for that. Let’s now jump to the main focus of our interview. The COVID-19 pandemic has put intense pressure on the American healthcare system. Some healthcare systems were at a complete loss as to how to handle this crisis. Can you share with our readers a few examples of where we’ve seen the U.S. healthcare system struggle? How do you think we can correct these specific issues moving forward?
Of course, many optometry practices struggled with their finances this year. Patients were postponing routine check-ups and new safety protocols meant that even fewer patients could come through the doors. Moving forward, practitioners have an opportunity to learn from this crisis and create those true partnerships with bankers, lawyers, HR specialists and other experts who can support their practice from a business standpoint. The American Optometric Association (AOA) and many state optometric associations also offer resources for government programs and loans, and there are many resources available for doctors to take courses on business management that can help set optometry practices up for long-term success.
Of course the story was not entirely negative. Healthcare professionals were true heroes on the front lines of the crisis. The COVID vaccines are saving millions of lives. Can you share a few ways that our healthcare system really did well? If you can, please share a story or example.
Eyecare professionals were on the frontline during the pandemic continuing to help people see their best sight. The AOA estimates that optometrists treated ~60% of patients with urgent eye issues, who may otherwise have sought care at our already overburdened emergency rooms. Some of these patients had more serious systemic diseases that were diagnosed through the eyes. Though their frontline may look slightly different from other healthcare frontlines, optometrists continued to help preserve one of the most important senses we have, and triage patients into the broader healthcare delivery system. Many even advocated and took the necessary training to provide COVID vaccines to patients in order to help with the vaccine distribution and lessen the impact to the emergency healthcare system.
As a partner to eyecare professionals, it was very important for Essilor to support the practitioners during this stressful time. That included providing PPE, office and patient care guidelines and resources, and more. We made it a priority to be flexible and meet people where they were in terms of comfort level, offering virtual options if a doctor was uncomfortable with our reps visiting their offices, and training our sales professionals on what to expect with new office protocols, and how to be even better partners to their customers. And with fewer patients coming in, we were able to provide free educational courses to those staff and doctors who could use this time to shore up their skill sets.
Here is the primary question of our discussion. As a healthcare leader can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
- Corporations should respect the doctor-patient relationships in the interest of patient safety and compliance. The doctor-patient partnership is absolutely critical to ensure patients receive a personalized healthcare experience. In June, EssilorLuxottica made a commitment to the AOA and the Health Care Alliance for Patient Safety (APS) to support legislative efforts to increase patient access to care and protect the integrity of the doctor-patient relationship.
- Educate policy makers on the delicate balance between maintaining high quality standards of care, and consumer conveniences. With these collaborations, private practices remain strong, and patients receive high quality experiences, wherever they chose to consume their care.
- Improve cultural competencies and decrease implicit biases in health care. If you are the doctor — be the doctor, and delegate data gathering to competent technicians, so your time can best be spent listening to the patient and providing valuable solutions.
- A health care system should involve both traditional and non-traditional inter-disciplinary collaborations. This approach can offer the best treatments and outcomes, based on the individual patient’s needs. For example, The Mayo Clinics employ combinations of holistic, homeopathic and allopathic treatments in the healing processes for patients. Each medical professional should understand what skills and services other health care stakeholders can provide to the diagnosis, treatment, management and maintenance of wellness for the patient. To illustrate this, optometrists are highly skilled with slit lamp and fundus evaluations and can detect certain changes in the eye that correlate to certain disease states. The AOA estimates that there are over 267 diseases that can be detected through the eyes. Often, these routine parts of an eye exam provide an opportunity to detect aberrations, and refer to the best specialists for the condition, and at an early onset of the disease, so that it can be treated with better outcomes.
- Health care professionals need to know more than sciences to be effective healers. This approach involves employing a mosaic of skill sets beginning with communication, psychology, sociology, understanding the role of religions, and a healthy dose of good old common sense. Our healthcare system has become so compartmentalized to each part of the body, and I truly believe in the importance of taking a more holistic view of the whole body (person) while focusing on the eyes.
Let’s zoom in on this a bit deeper. How do you think we can address the problem of physician shortages?
I believe we can do better in exposing children to the field of optometry from an earlier age. Programs like KidZania, which Essilor supports, is doing great work allowing children as young as six years old to “try on” the concept of a career in optometry.
You will recall, I made the decision to be an optometrist at the age of eight, after being cared for by my vision therapists. This exposure is especially important for children of color, who may not have family members, neighbors, or practices in their communities with professionals that look like them. It is difficult to aspire to be what you don’t see. It’s important to support that pipeline so that the next generation of optometrists are competent and dedicated to their communities and good health outcomes.
With that goal in mind, we at Essilor partner with groups like ASCO (Association of Schools and Colleges of Optometry to increase the numbers of quality motivated candidates into optometry schools with a focus on a diverse pool of future doctors. We also offer a summer internship program for optometry students, which provides a close look into the industry and patient care. We continue to support academic programs that teach both didactics and clinical training with cultural competency at the core. It is critical to understand the individuals you’re taking care of to make the best recommendations and foster compliance.
How do you think we can address the issue of physician diversity?
When I was starting out in my career, I hardly saw anyone who looked like me. As a young, Black female, I was told by my pre-optometry advisor in college that he did not believe I could be an optometrist. Because of that, he refused to write a letter of recommendation, but I decided to apply to optometry school anyway — and I was accepted into all of the schools that I applied to. I encountered another set of hurdles because of my age, race and gender when I tried to take a loan from the bank to upgrade my newly purchased practice. Even though I met all the financial requirements, the business had been in the community for almost 40 years, and the original doctor was staying on as an employee, they were still reticent to provide a loan that would allow us to better service the patients.
Throughout my career, I’ve seen the demographics of optometrists begin to change. There’s an increasing number of females entering the profession, but there’s still need for greater racial diversity and cultural sensitivity to ensure that we as eye care providers are able to best provide care for whomever comes through our doors.
As a member of the board of trustees of the Illinois College of Optometry, I worked with our leadership to set up cultural sensitivity pre-clinical courses and to ensure that these changes were incorporated throughout the institution. We wanted to ensure the board, administration, faculty, and the students understood the value of connecting with the patient population from a place of respect, therefore earning the patients’ trust in the doctors and the institution. The best way to build that trust is feeling that person and entity is culturally sensitive to you.
Cultural competency and addressing implicit biases are important to address throughout the eye care industry. I am proud to see a number of initiatives already in the works. The biggest hurdle has been in acknowledging that we have a problem in this area. Addressing it with compassion, understanding, and involvement from everyone lends the best opportunity to address the core issues.
How do you think we can address the issue of physician burnout?
I think it is incredibly important to invest in your people — they are the biggest asset to your practice. When I was building my practice, I envisioned premier, concierge-type services in a relaxing environment, but I quickly realized my staff were not equipped to provide something that they had not experienced. So, I held a retreat at a 5-star restaurant — we all enjoyed a seven-course meal together, hearing from the chefs how they created the premier experience for their patrons, which was the theme of the evening. Afterwards, there was a huge change in how they approached patient care. You have to support your people first with the tools to grow, before they can really buy into your vision. No pun intended.
It is also crucial that you take care of yourself as the leader of the practice — prioritizing getting enough sleep, healthy meals, and exercise help you to be more focused and effective. Making time for self-care and managing personal business will not only make you a better practitioner, but also will set an example for your entire practice. Make it clear to your staff, whether that’s with healthy snacks in the office or daily team huddles, that you are there to support them and create a healthy work environment. BTW, patients can tell when individuals on the team, or the team itself are not functioning in a healthy manner. It spills over into the type of care provided to the patients.
What concrete steps would have to be done to actually manifest all of the changes you mentioned? What can a) individuals, b) corporations, c) communities and d) leaders do to help?
As individual practitioners, it is important to meet patients where they are. In training, I learned the term “bio-individuality,” making sure that treatment is specific and customized to the individual. For me, that is a crucial starting point for optimal patient care.
Corporations can focus on research and education,
- Providing funding for research and white paper development that can become the foundation for great clinical practices. Key opinion leaders within their industries should also feel empowered to share clinical research with peers.
- Developing training and educational modules that support the health care providers in delivering the best products, procedures, and services to patients.
- Educating the consumer on the importance of regular eye care, and early eye examinations for children, especially for diagnosing myopia as early as possible. In addition, optometrists diagnose over 250,000 cases of diabetes each year through eye examinations. Remember, there are over 267 diseases that can be detected through the eyes according to the AOA.
- When you educate the patient, you don’t have to sell. Patients are already looking for what they can do for themselves. You just need to give them the tools to do so.
In communities, we should change our approach to medicine from doctor-patient relationship to a doctor-patient partnership. This helps develop the trust necessary to secure compliance, and long term follow through. This plants the seeds for a long-term partnership where the doctor knows the patient, and family (in many cases) well, and can make health recommendations based on current findings viewed from a historical reference point.
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂
One of my top priorities would be to increase widespread education around eye health as a window into our overall health. As we all are living longer, it is more important than ever to educate ourselves on how to properly protect our eyes, because at some point, aging-related issues like presbyopia will impact everyone. Protecting the quality of our central vision from free radical damage from both over exposure to UV and harmful blue light rays is also important in defending against macular degeneration.
Our vision allows us to fully engage with the world around us — making it a crucial element in our overall wellbeing and quality of life. Not only protecting our eye health but supporting it with solutions that make the most sense, like Varilux progressive lenses, is one of the best investments we can make in our own visual comfort and livelihood.
If I were 10 times bolder, I would gather together a consortium of top health care thought leaders interested in integrative medicine from around the world for more effective sharing of science, research, health care data, and best practices. Let’s not forget how interconnected we are. If nothing else, Covid-19 has taught us that we have no borders effective enough to keep microorganisms out. We are interconnected as one human race. Collectively, we have the resources to cure our societal ills.
How can our readers further follow your work online?
Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.
Thank you for your time!