Updating Your Office Procedure
BY GARY GERBER, OD
We've all done it. Your patient is in for what you anticipate will be an uneventful checkup. He reports the comfort with his lenses is great and his vision has never been better. After you apply fluorescein you notice some staining on the inferior cornea of the right eye and make a mental note of it. Moving on to an unremarkable left eye, you complete the examination and evaluation. Because he reported no complaints, 30 minutes later at the conclusion of your examination, you decide to stay with the same lenses. Hey wait a minute. What about that staining you saw?
Most of us acknowledge that contact lenses have gotten much better in the last few years. Improvements in examination technologies, newer lens polymers and solutions, as well as manufacturing techniques, make our lives easier.
However, with all of these changes, many of us are still running our offices with policies and procedures that originated 50 years ago. Just as lens technology has changed, so too should the administration surrounding the care of our patients.
When extended wear lenses were launched, most of us saw patients at 24 hours, one week later, two weeks later and then every three to six months afterward. Given the marginally successful performance of those early lenses, those visits were probably warranted. However, with newer lenses come fewer problems. Having fit hundreds of patients in silicone hydrogel continuous wear lenses and rarely seeing any problems, particularly early on, I question the necessity of a 24-hour visit. While my expertise is practice building and not corneal physiology, I wonder if the newer high-Dk/t lenses we're fitting are delivering enough oxygen so that most eyes need more than 24 hours to exhibit potential problems. Similarly, for patients who do well with the lenses, I might argue that you could eliminate the six-month visit. Here's a case of 1950 procedures being applied to 2005 lenses.
Performing procedures out of habit is another common pitfall. As our fluorescein example illustrates, we're so accustomed to happy patients not having problems that we put our clinical skills on autopilot to cruise through a seemingly uneventful patient encounter.
Other Habits That Die Hard
If a patient you fit with lenses last year reports no complaints to your staff and demonstrates excellent acuity, and you anticipate staying with the same lenses, is it absolutely critical to examine the lenses on the patient before he removes them to do other tests? After all, if he'll be leaving with the same lenses, couldn't you check the fit and acuity then?
Ancient Office Forms
While not necessarily papyrus, the layout and items on our office forms and computer screens often need updating. With so few patients wearing PMMA lenses and using heating units with salt tablets, is it necessary to have check-off boxes that relate to those devices? Take a few minutes to update and streamline how you record your clinical data. These few minutes of redesigning your forms or computer fields can mean significant time savings and also provide you with more accurate record keeping.
Examining Your Practice
I don't want to overstep my boundaries as a practice-building consultant and tell you how to care for your patients. Rather, I'd like to tell you how to care for your practice. If you're examining your patients out of historical habit, I strongly recommend reviewing each patient on a case-by-case basis.
Dr. Gerber is the president of the Power Practice® – a company offering consulting, seminars and software solutions for optometrists. You can reach him at (800) 867-9303 or DrGerber@PowerPractice.com.