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BLOG: Primary eye care is not primary care
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“Primary care” is common term in the health care arena. It is considered to be the lynch pin of a better health care system for America.
Doctors who are considered to practice primary care are favored for reimbursement. I discussed this in a commentary for Primary Care Optometry News back in 2013. Optometry has revised the term primary care a bit and coined the term “primary eye care,” which has become a synonym for general optometry. This is unfortunate for the American health care system.
In my last blog, I discussed the addition of vital signs to the basic elements of an eye examination. In spite of this being a published meaningful use core measurement for all providers, this surprised some within our community. Several seemed to be shocked that this fundamental task of primary health care would be expected from primary eye care providers. This blog spawned several good comments and I hope it will open the door to a broader discussion on this critical question: “Do optometrists really want to be part of the primary care movement in health care?”
In reading the comments on my blog as well as other online conversations on this topic, I was chagrined to find some basic misconceptions about the use of vital signs by optometry, how young people access health care, as well as the meaning of the word “primary.” I want to spend some time on these comments and open the door for more discussion.
Here are a couple of comments that deserve more review:
- “Taking vital signs for an eye examination is not a substitute for care by a primary care physician.”
- “Requiring vital signs to be performed by optometrists is wrong for a number of reasons. We do not manage systemic health disorders. We are not licensed to do so.”
The purpose of optometrists taking vital signs is not to do the work of the primary care physician or manage systemic health disorders. The purpose is to identify patients at risk for chronic medical problems and to educate, counsel or refer these patients based on their vital signs in conjunction with the review of systems and the patient’s family history.
There is no question that chronic medical problems such as obesity, hypertension and diabetes will have long-term deleterious effect on the eyes and visual system. Optometrists who are practicing true primary care must address these issues as part of the impression/plan at the end of the exam. This is what I call the “doctoring of the eye exam.”
Here are a few more comments that should be heard:
- “The requested information will rarely provide new and useful information and duplicates what should already be done in their primary’s office.”
- “Requiring us to duplicate the work of primary care medical doctors during a routine eye exam is ridiculous.”
One of the identified weaknesses of the American health care system is our focus on “sickness” rather than “wellness.” The system does not emphasize and often does not pay for routine wellness care. Patients who are developing chronic medical problems are not sick and do not seek medical care. Many of these same people, however, especially those between the ages of 13 and 35, do have refractive errors and see their optometrist regularly. This is why we need to be “primary,” or the first health care provider who can identify patients at risk.
I would agree with some of the participants of this discussion that just the collection of vital signs, without reviewing them in light of the patient’s history and the findings of the examination and then acting upon them when significant, is a waste of time. There is a good reason why the topic for these blogs is “health care reform.” The word “reform” means that we need to change. Just because we have practiced for years without taking vitals or using vitals or have even asked this question, “What do vital signs have to do with an eye exam?” (to quote another of my favorite comments), does not mean that we have been doing it right. As I have said before, "We gotta do a better job!"
I hope that you will consider the thoughts that I have expressed in this series of blogs. Please use the comment section and express your opinions. Try not to think of everything in terms of the immediate reimbursement related to each and every test or thought process that is related to health care reform.
Optometry is a financially viable profession now. If we move into the environment of primary health care and step up to fill the void, we will be even more financially viable in the long run. As you follow the discussion on this topic, perhaps you will think about your practice and your profession in a different light. Maybe you’ll even be “reformed”!