Unsung heroes of dry eye care: Technicians make or break a dry eye clinic
Techs are the first to educate patients about dry eye and are invested in helping them get better.
The other day I was hanging around “Sky Bar,” the tech station at SkyVision. Do you have kids? When I am quietly standing there, I am kind of like the parent driving the school carpool: After a short while you become one with the furniture, and the kids talk around you as if you were not even there. My technician teammates were chatting about dry eye patients at the time. This is not all that unusual, in that at least one-third of our patients are active dry eye patients. You can learn a lot about what it is like to care for dry eye by listening to your technicians because at the end of the day it is your technicians who are teaching your patients about their dry eye.
Why don’t you join me for a little bit and let’s listen in to the conversation?
There must have been a couple of classic dry eye patients in the clinic that day. I saw a bunch of eye rolling and even more head nodding as the techs chatted. It turns out that they were giving our newest technician the low down on the whole dry eye scene. She had just joined us from a practice in which the doctors were just learning about dry eye, and the technicians there did not take part in the process to any degree. This bit of news was met by our experienced techs with surprise, bordering on shock.
“Wait. Your old doctor did everything himself? Are you kidding? He couldn’t have been doing all that much for the patients if he didn’t have you helping. There’s no way he actually listened to all of their complaints. You can’t get through the schedule if you leave that to a doctor!”
How is that for an opening statement? If you think about it, that statement alone supports the concept that the best dry eye protocols are only successful if you have technicians who understand how to talk to patients about their dry eye symptoms. For certain, we need their help doing all of our fancy point-of-care tests such as tear osmolarity, MMP-9 activity and meibomian gland imaging, but the key to caring for dry eye patients is identifying them first. That means listening to their stories.
“So we do stuff before the doctor sees the patient?”
“You bet we do! Dry eye is so common that you can almost tell what kind of dry eye a patient has just by their symptoms. Seriously, can I just tell you how hard it is to explain to someone that we can’t just give them a pair of glasses for their blurred vision until we take care of their dryness? Don’t even get me started on how patients who complain about tearing think we are crazy when we tell them they have to have all of our dry eye tests.”
Ah. After putting together our advanced dry eye diagnostic protocols, we all assume that they automatically happen. Not surprisingly, it is our technicians who shoulder the responsibility to see that they do. Dry eye is confusing to the eye care community, both technical staff and doctors, so it stands to reason that most of it will be even more confusing to our patients. In addition to the technical skills required to actually perform dry eye testing and the knowledge necessary to know when to do the tests, our technicians are also the first-line educators when it comes to the dry eye patient. Indeed, the tech may be the first person to mention dry eye to a patient when he or she explains the rationale for each test (and assures them that yes, it is covered by their insurance). That “pre-education” makes it easier for us to move from the diagnosis to creating an effective, individualized treatment program for each patient.
Indispensable part of protocol
While I was standing there at Sky Bar and the technicians were chatting, one was taking a phone call from a dry eye patient. As a group, these are some of the least compliant patients, and this is a burden that is largely borne by your technicians.
“Dry eye patients are like alcoholics who need help: The first step is admitting that they have dry eye and that the dry eye is causing their problems. Even then, it is unbelievable how many people don’t follow the doctor’s instructions, even after we repeat them, review them and write them down. It seems like the worse their symptoms are, the less likely they are to do what they are supposed to do!”
This is a very interesting observation, and I think it is important to realize that a dry eye savvy tech has done everything possible to ensure that your patient does what you have asked him or her to do. They are just as frustrated by a lack of compliance as you will be, and they will have done a bit more “pre-education” on that follow-up exam before you walk into the exam room. This was the single biggest cause of the eye rolling around the tech station while I was doing the fly-on-the-wall bit, and it explains why so many noncompliant patients start off your part of the exam with an apology.
Our new tech was quite obviously struggling with all of this information. “It sounds like it’s really hard to do all of this for dry eye patients, but you all seem like it’s totally OK. I don’t get it.”
“Are you kidding?! Dry eye patients are the best! There is nothing better than seeing someone whose life is simply a mess, with every little thing affected by their dry eye, and then they get better! They are just the most thankful patients we see, and they really understand how much work the technicians do to help them. Heck, just making the calls for them to get their medicine covered by insurance almost always gets us a box of chocolate!”
There you have it. Your technicians are an indispensable part of every dry eye protocol ever created. They understand your patients, probably to a much greater degree than you do. Even more than that, your technicians are at least as invested in helping your dry eye patients get better as you are. More than any other aspect of the dry eye protocol, more than any point-of-care test or medication, the ophthalmic tech makes or breaks the treatment of dry eye.
Your technicians rock! Buy them lunch some day and ask them about the dry eye care in your office from the tech point of view. You will leave that lunch with a full belly and an equally full heart.
- For more information:
- Darrell E. White, MD, can be reached at SkyVision Centers, 2237 Crocker Road, Suite 100, Westlake, OH 44145; email: firstname.lastname@example.org.
Disclosure: White reports he is a consultant for Bausch + Lomb, Allergan, Shire and Eyemaginations; is on the speakers board for Bausch + Lomb, Allergan and Shire; and has a financial interest in TearScience.