THE EXAM IS MEDICAL, UNTIL PROVEN OTHERWISE

I FEEL the need to vent. So, I hope you will allow me to elucidate some grievances I have at the current state of affairs. Now, if you are inclined not to be bothered by angst, rabbit ear this page, or come back to it on the crazy new invention called the Web.

Here I go.

VISION OR MEDICAL PLAN?

Can someone please tell me how we are supposed to differentiate our approach to a patient who has medical insurance from one who has a vision plan — that is, a plan that allows our patients to receive services, same as our medical patients, and yet, is a separate benefit from health insurance?

Personally, when I do an exam, I look at the entire ocular operating system. My examination is rooted in the desire to find the origin of my patient’s sight-related quandary. (Not in a long while have I had a patient come to see me because he had an ingrown toe-nail causing his eyes to tear.) I am frequented by patients who express that it was “time” to be seen. It is true! I am not referencing those patients who have an immediate concern of pain, discharge, a pink hue that is super contagious and not at all in vogue with the day’s color palate. It is the patients who know something is off (about his or her vision) and look to me for guidance.

PATIENT COMPLAINT

Patients walk in to the office after a mental tug-of-war as to the need to be examined, begrudgingly or merrily, expecting an examination, which is a thorough interpretation of the, “what is happening” in their visual system. However, they use verbiage that we interpret as general, routine or something resembling a screening.

Take a few seconds to think of some recent patients — I guarantee your head voice is echoing, “I thought it was time,” “You know, I just wanted to make sure my eyes were good,” and the, “My wife made this appointment.”

Through the history of our profession, we have struggled to gain the medical acumen to shower our patients in a hailstorm of ocular knowledge. Yet, I feel we leave that at the door when we perceive the plan is to do a “routine checkup,” therefore we leave the “medical” testing and diagnostic tool kit to be used at a later date. A great example to me is how we approach the tear layer, the ozone of the refracting surface. The opportunity to evaluate the root causes of tear-related problems is expansive, and more to the point (of service) with visual disturbance being at the marrow of dry eye definitions, why is there not more utilization within every examination?

EVERYTHING’S COMING UP MEDICAL

I have wondered why our profession is often regarded differently than other medical professions. After all these years of practicing, I don’t have a good answer. The exception is that we treat our patients differently. Does your dentist ask what plan you are on prior to doing an examination? Does your psychologist?

I get the need for a culture when we see an infection, an OCT when the examination leads toward glaucoma, a new deodorant when patients smell, but when the root is “vision,” this is a medical visit until proven otherwise. OM

DR. BLOOMENSTEIN practices at Schwartz Laser Eye Center in Scottsdale, Ariz. He is a founding member of the Optometric Council on Refractive Technology. He is a speaker and advisory board member for: Akorn, Allergan, AMO, Bausch + Lomb, Lunovus, OcuSoft, Shire and TearLab. Email him at mbloomenstein@gmail.com.