Scott A. Edmonds, OD, FAAO, focuses his blog on the role of the optometrist in health care reform – moving from primary eye care to primary health care. He is the chief medical officer of MARCH Vision Care, the co-director of the Low Vision/Contact Lens Service at Wills Eye Institute in Philadelphia and a member of the Primary Care Optometry News Editorial Board. 

Disclosure: Edmonds is a consultant for March Vision.

BLOG: Can you point me to the phone booth?

It seems like just yesterday when there was a phone booth on every street corner. Of course if it wasn’t a phone booth, it was a mailbox.

If you need a phone booth today, you might have to search around for quite a while. I am no longer sure what Superman does to make his change from Clark Kent. It seems that the only thing we can depend upon is change itself. And yet, people generally don’t like change. Optometrists in particular do not like change.

Change in health care is more dramatic than changes in other aspects of the world. The change happens at different rates for each provider and each patient. With the accelerated pace of these changes, it seems the clinical “standard of care” is a moving target.

I remember working with my dad to teach him the “slit lamp exam” when it became the new standard of care for optometry in the late 1970s. Even more challenging was the transition from direct ophthalmoscopy to indirect ophthalmoscopy as the standard for the fundus examination.

Today the challenge for optometry is moving from our traditional role as primary eye care providers to the new role as primary health care providers. This may seem like a subtle shift, as we have always been aware of our patient’s general health. The medical history has always been part of the backdrop for eye care. However, once you take the vital signs and include a discussion of risk factors and systemic medical issues as part of your care plan, your role and responsibility become much broader.

Primary Care Optometry News Editor Dr. Mike DePaolis makes some excellent points about our broader responsibly in his recent editorial on obesity. Johnson & Johnson has created a diabetes institute and linked it with their vision care division to provide us with new recourses to step up our role in diabetes care. Third party carriers and CMS have again changed our standards by adding the measurement of vital signs as the new standard of care for optometry. The trend for this change in our practices is coming at us from many different directions.

Optometry is not alone in this change. A simple trip to your local pharmacist will demonstrate the change in their profession with a move toward primary health care. What was once was a sign to educate patients about the importance of screenings for blood pressure and diabetes has moved to a kiosk to allow one to self-measure their vital signs. Just last week when I stopped in for a pack of gum, I saw that the kiosk had been replaced by a full service wellness center where I could just walk up and get a full physical examination. Ironically, the new mini-clinic is in the exact same location as the old phone booth!

Don't be surprised the next time you visit your primary care physician and you find that your examination is provided by a physician assistant or a nurse practitioner. Even a visit to a specialist is often supplemented or replaced by one of these new professionals. The care is as good as or better than with the traditional model, and the new care givers will have more time to get to know you, answer your questions and actually return your call if you need after-hours advice.

In my practice, I provide specialty medical care that often requires a referral. This referral has traditionally been from a primary care physician (PCP). About a month ago, I started to notice that the official referral no longer comes from a PCP but rather from a nurse practitioner. All of the numbers and required fields for payment are in the name of this new primary care practitioner and there is no physician information anywhere on the paperwork. Interestingly, the referral came in with the correct information for my visit and it came before the patient was seen. This avoided the usual call and long delay of my care while my staff had to work to secure the correct referral with the patient fuming in the waiting room.

The movement to increased access for primary care services is everywhere. This change is long overdue. We, as Americans, can no longer accept a health care system that requires one to be sick with a bona fide medical diagnosis to obtain health care. Optometry is a key player in this new delivery model. It is time to step into that old phone booth and make the change!