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Delegation is a major factor in practice success, yet optometrists often still resist the concept. I started my practice from scratch, so I didn't delegate anything in the early days - heck, I didn't have a staff to delegate anything to! But I always visualized a practice where I would work at my highest level, and I would continually train, challenge and build my staff to work at their highest level. It really was not difficult to grow into a highly delegated practice - I just kept adding tasks and investing in instrumentation. The more I delegated, the more I enjoyed practicing optometry. And I must say that quality of care has never been better.
Of course delegation can include administrative office tasks, optical dispensing duties and fabrication lab work, but I'd like to focus this tip on clinical examination procedures.
Here are the procedures I presently delegate in my practice, along with a few points to consider if you add any to your exam regimen.
Our optometric technicians perform a pre-exam work-up on all patients scheduled for comprehensive exams; it starts with calling the patient in from the reception area, progressing through two pre-test rooms to the exam room, remaining in the exam room to record the doctor's exam data, and finally escorting the patient to the optical area (if needed) and conducting frame selection and lens design. This system allows the patient to build a relationship with the technician, while never being left alone. It offers great continuity of care without any handoffs. It calls for cross training of all technicians in both optical and clinical work, which proves to be very efficient.
Here is our standard pre-exam routine:
These pre-tests, along with the doctor's examination, add up to a very thorough evaluation, often prompting positive comments from patients. Technicians also play important roles in contact lens care, low vision evaluations and special testing like pachymetry and nerve fiber analysis.
- Instill mild mydriatic drops
- Autorefraction and autokeratometry
- Non-contact tonometry
- Goldmann applanation tonometry is in each exam room if needed
- Automated visual field screening
- Lensometry on patient's present glasses
- This is done while patient is in field testing
- Non-mydriatic digital retinal photography
- The images (from this visit and previous visits) are retrieved on the exam room desk top computer
- Corneal topography on all contact lens wearers
- Also retrieved and displayed on the exam room PC
- Visual acuity, far and near, aided and unaided
- Case history
- Blood pressure
- Color vision test
- Stereopsis test
- Dial habitual spectacle Rx or autorefraction into phoroptor
- Play video clip on patient education software
- This is done on the exam room PC while the doctor is paged to exam room
Consider your system of delegation and make sure everyone in your practice is operating at his or her highest level.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week
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Dr. Gailmard offers consulting services to eye care professionals through Prima Eye Group; information is available at www.primaeyegroup.com.
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