For Rachel Bishop, the art of medicine starts with listening to the patient.
Bishop specializes in comprehensive eye care at Wilmer Eye Institute, and serves as medical director of Wilmer - Frederick. Before coming to Wilmer, she served in the U.S. Army, and she was chief of the eye consult service at the National Institutes of Health for more than a decade. Bishop retired from the U.S. Public Health Service in 2019, but she says the military instilled in her a sense of responsibility and integrity that continues to serve her — and by extension, the patients she serves — today.
In addition to her ophthalmology background, Bishop holds a master’s degree in public health from the Johns Hopkins Bloomberg School of Public Health, and this too informs her whole-person approach to patient care.
“If a patient is coming to me for severe dry eye, it’s important to consider all the factors of their health and their environment that might be contributing and to tailor a plan that’s something they can manage,” she says.
A vital component of Bishop’s approach, then, involves effective communication between doctor and patient. She points out that a patient with severe ocular surface disease, for example, may know they have the condition and that the doctor has prescribed medication and other treatments for the problem, but the patient may lack an understanding of the reasons behind a particular treatment, or of other ways they can help guide their own treatment outcomes.
“A doctor might say to the patient ‘Here’s what you have to do,’ but if you don’t take those extra few minutes to demonstrate how you clean the eyelids, or to explain why these drops, or what’s going to happen if they don’t take them, then patients are less invested in their own care, and they don’t quite know how to execute it. Compliance is lower, patient satisfaction is lower, and their own awareness and ownership of their problem is lower,” says Bishop.
She acknowledges that this ‘whole patient’ approach may take more time initially, but says it pays off because it can lead to greatly improved outcomes. “Maybe a patient is coming in for routine follow-up care for glaucoma and I see by their face, by their expression, that something is going on. If I pause and ask that patient, ‘How are you really doing, what’s going on?’ it’s like the mask comes down and they open up. They’re so grateful for an opportunity to say what’s going on with them.”
Sometimes just asking is enough to make a real difference in someone’s day, in their treatment outcome — or even in their life, says Bishop. “Maybe the patient is not coping well because their loved one is really sick and is not doing well, and maybe the patient is never stopping to tend to that. They may not know that there’s a support network for them,” she says.
Having her sensors up for what’s happening in the big picture opens the door to being able to help improve patients’ health overall. “If you’re taking care of a patient with diabetic retinopathy, you’re taking care of their diabetic retinopathy, yes, but better yet, take care of their diabetes. Did they know that there are programs where they can control their systemic disease better? Do they know that there are positive success stories that they can model themselves after? Maybe they come back and they don’t need their insulin anymore. That’s the better way of controlling the retinopathy, because if they drop 40 pounds, and they’re no longer on insulin, their eyes are getting better, too,” she says.
Bishop, who holds a certificate in coaching from Georgetown University, brings this same energy to a pilot faculty coaching program underway at Wilmer, in which she works with fellow faculty members to help them identify and overcome obstacles to professional growth. “Maybe they’re new to academic medicine and they see where they want to be, but they’re just not sure how to get there. Or maybe they’re mid-career or even later and are ready for a new challenge in learning. How do they make that shift? What do they even want? Coaching gives them a chance to dive in and explore that,” she says.
Professional coaching can be particularly helpful for faculty members whose schedules are so demanding that they may not otherwise have an opportunity to consider new goals. “It might be the only time in their week or their month when they are stopping everything else and focusing exclusively on thinking about what it is they’re hoping to work on, to look critically at where they are and at their current priorities,” she says.
Whether it’s a patient or a colleague who becomes more self-aware as a result of her efforts, Bishop says she derives a lot of satisfaction from these relationships. “It’s just one person helping another person reach their potential,” she says.