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Personalized correspondence with PCPs improves patient care
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Like most practices, we care for a diverse patient base, ranging from children to seniors, and managing everything from simple refractive needs to complex chronic diseases. Also like many optometrists, we are constantly communicating with other health care providers.
While I have always felt it important to share my findings with other care givers, I also recognize they are busy clinicians with tremendous time constraints. As such, I believe in correspondence that is detailed, meaningful and, yet, to the point. That being said, I also firmly believe in letters that are personalized – not merely a form letter or chart report, but rather an assessment of that particular patient’s ocular status, needs and sense of accomplishment.
Michael D. DePaolis
While I send more than 500 such letters annually, I am always amazed how many involve diabetes. In fact, last year more than 55% of my professional communications related to patients with diabetes. With most primary care physicians (PCPs) interested in only whether diabetic retinopathy is present, the quick and easy solution would be a form letter. It fact, it could be as simple as a check. Diabetic retinopathy? Yes/No. Just one factor – sort of like an HbA1C.
I have resisted the form letter for one reason. It, like an HbA1C result, does not tell the whole story. The ocular status of the patient with diabetes is often too complex to summarize with a simple yes or no.
This is especially true of type 2 diabetes, where demographics, race, socioeconomic status and other chronic health conditions play a huge role in patient compliance and outcomes. Outcomes – most notably fasting blood sugar and HbA1C – influence patient perception as to whether they are winning the battle. So, while my letters detail a patient’s status with respect to diabetic retinopathy and ocular comorbidities, they also offer my observations relating to compliance and attitude.
Given my sentiments, it is no surprise I was thrilled with the recent type 2 diabetes guidelines offered jointly by the American Diabetes Association and the European Association for the Study of Diabetes. The guidelines emphasize a more individualized approach to diabetes management and consider patient age, overall health, risk for hypoglycemic events, finances, support resources and motivation. They also suggest more personalized target HbA1C levels, recognizing that a “normal” HbA1c level of less than 6 mg/dL is not feasible for every patient with type 2 diabetes.
It is a tremendous step forward, as it creates an achievable – and more realistic – goal for many patients and fosters a sense of accomplishment rather than defeat. In short, the new guidelines attempt to see the bigger picture, something we should all attempt in every correspondence we send.