Article Date: 1/1/2004

o.d. to o.d.
A New Referral Relationship
Consider changes in your referral procedures that take advantage of optometry's expanded scope of practice.
BY WALTER D. WEST, O.D., F.A.A.O., Chief Optometric Editor

Much has been written about the changes in optometry and the ever-expanding scope of practice. Many optometric practices now look more like ophthalmology practices, not only in office design but in the way that their staffs schedule patients, render services and the way that optometrists delegate clinical and administrative tasks. As optometrists, we continue to go to great lengths to enhance our clinical skill in diagnosis and patient management.

In an effort to provide the best level of care to our patients and to ensure that each and every patient remains part of our practice, we've worked diligently to develop co-management relationships. The concept is really simple. The optometrist examines a patient and then refers him to another doctor if he requires:

► a consultation for the confirmation of a diagnosis and/or a second opinion

► a level of treatment, surgery or diagnostic testing that, for any number of reasons, is beyond the scope of the individual optometrist's practice.

The real question

However, with all of the clinical skills now evident in optometry, I have to ask, "Why are O.D.s almost exclusively referring to M.D.s?" Why are O.D.s not referring everything possible to another O.D. and referring only to an M.D. when necessary?

Some optometrists have the clinical skill and diagnostic acumen necessary to offer a second opinion and to consult on the best course of action in a patient's treatment plan. Some optometric practices are even equipped to provide almost any additional diagnostic testing that a patient could need.

And I don't mean referring patients just to those optometrists in referral centers who are associated with ophthalmologists or the teaching institutions. I mean to any optometrist who as a professional colleague can offer, in a given instance, a professional opinion that enhances the level of care a patient receives.

It only makes sense

Curious, isn't it? Not too many years ago, a referral to an ophthalmologist from an optometrist meant the loss of a patient. The only reason that so many healthy, professional and mutually beneficial co-management relationships between optometry and ophthalmology exist today is because both sides worked at it.

As a result of working to develop this co-management relationship, the patient benefits, the optometrist benefits and the ophthalmologist benefits.

It would seem that with a little time and far less effort, optometrists could develop an understanding among themselves that would allow for the same mutually beneficial relationship to be established for co-management. By working together in this "new" co-management relationship, the patient benefits, as do both optometrists.

Something to think about

If it's so easy, then why doesn't the optometrist-to-optometrist referral relationship exist more often? Do we as optometrists in some way feel threatened by referring to another optometrist? Does referring to another optometrist in someway communicate to the patient that we're not as good as the optometrist we're referring them to?

Or are we afraid that the patient may like the other optometrist's practice more and stay there rather than return to us for future care? Could it be that the other optometrist might try to steal the patient from us or try to sell them glasses?

Or could it be that even though we individually see ourselves as physicians and providers of primary care, we continue to view each other as "only optometrists?"


Optometric Management, Issue: January 2004