BLOG: Steven and others who need us
For a long time, my practice has followed a patient with glaucoma named Steven. He came to us about 3 years ago.
At that time, Steven was taking timolol eye drops, and his pressure was well controlled in the low teens. His optic nerve was stable, and we felt good about the care we were giving him. What we didn’t know is that about 2 years before he saw us, around the time he started his timolol, he began having symptoms of depression. He never reported this to his ophthalmologist because he never imagined it was related to his eye drop. His pharmacist and primary care physician also missed the possible relationship. Eventually, his primary care physician prescribed an antidepressant, but his life was never the same as before the beta-blocker.
We first learned about his beta-blocker side effects last year, when he completed a questionnaire on MDbackline, an automated communication platform that contacts patients with glaucoma annually to ask about side effects, compliance and cost of medication. Detecting that Steven was on a beta-blocker, the system specifically asked him if he had depression symptoms. It then alerted our staff to these symptoms and suggested the possible link to his timolol. We prescribed a prostaglandin drop as an alternative, and Steven was happy to comply. Within weeks, Steven almost miraculously got his life back. After years of feeling gloomy, he began taking walks again. He started going to social events with his wife. In our office, his demeanor was markedly sunnier.
Steven’s story illustrates a growing problem in health care: We simply don’t have enough time to collect history the way we need to. For Steven, the impact was particularly harmful, but how many of our patients accept our treatment at face value, even though it may not be ideal? How many really even know how to take drops? How many might be interested in laser or MIGS alternatives to drops if they understood them a bit more?
In Steven’s case, smart software helped solve this problem. MDbackline is a unique cloud-based system that interfaces with EHR and detects patients coming in for glaucoma visits. Once a year, it contacts them before the visit by email and/or text message and asks them to report in on their symptoms and view educational material. It generates a Visual Profile Report to be reviewed by the clinical team during the subsequent office visit. The report alerts the staff to how much the patient is actually paying for medication, what compliance issues have arisen and whether they are interested in surgery. It also queries about unusual glaucoma risk factors like wearing a tight collar or doing inversion yoga. It highlights in red noteworthy historical elements, like a patient who is paying more than $50 monthly for a medication or a patient who is interested in laser treatment, and it will pick up on side effects specific to their medications, like Steven’s, so we will know about them before they change his life. The purpose is to substitute for a long verbal interaction most of us just won’t have time to undertake.
We become better doctors when we take extra steps to ensure our patients’ well-being. But reconciling that altruism with the crushing burdens on our time requires innovative approaches to everything we do. For patient communication, at least, we have found a ready-made, efficient tool in MDbackline, and Steven is certainly glad we did.
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