I attended the annual meeting of my favorite ophthalmology group this month. The cataract surgeon gave a nice talk on the team of a patient’s primary optometrist and the surgeon. The strong communication between the team members facilitates the very best outcomes for visual recovery.
He made the point that the family optometrist knows how a patient uses his or her eyes in day-to-day life. The optometrist knows which patients would do well with monovision IOLs, both eyes for distance, or both eyes for near. The optometrist also knows if the patient has a history of mild glaucoma and may need an additional procedure to lower the pressure, or which patients may have a few subtle macular drusen and an elderly relative with significant vision loss from macular degeneration. With a strong team approach to the cataract surgery – and good communications – the patient will get the best result.
The clinical relationship between the optometrist and ophthalmologist was not always this strong. Many of us can remember when an ophthalmologist would never communicate with us or seek our opinion on the care of a surgical patient. Optometrists spent many years building these types of relationships. Slowly, our colleagues in ophthalmology first learned to tolerate us, then work with us and finally value our thoughts and opinions.
Many of us have this type of relationship with most of the specialty areas of ophthalmology: retina, glaucoma, cornea, pediatrics and plastics. We are truly an interracial part of the eye care delivery system.
When I think of my weakest clinical network, it is with the primary care physician. I send letters about patients with diabetes and for other occasional issues, but I cannot think of receiving a return letter or even an acknowledgment of my reports. This relationship must change in the new era of team-based primary health care. Just like the lessons learned by improving eye care by teaming with ophthalmology, optometrists must work on building new relationships with the primary care physician to manage chronic health issues such as diabetes, hypertension, hyperlipidemia and metabolic syndrome.
I have started this process in my practice by collecting the name of the primary care physician for each patient I see. I have built new templates in my electronic health record (EHR) to generate a letter for each patient with a chronic health issue to report on the ophthalmic issues as well as my advice and counseling on the chronic health issues.
The key to better health care is better communication. Most primary care physicians also have EHRs that can capture our reports and build them into their systems. Most states or geographic regions have “health information exchanges” that are working to build the platforms for smooth communication among provides, hospitals and the health insurance system. Most of the new EHR systems for optometry can make communication with the primary care physician a simple step.
We all need to make these changes in our practice patterns, as these are the building blocks that are critical for our future. Good communication with the primary care physician is the first milestone as optometry steps up to assume the full role as a member of the primary health care team.