This article is more than 5 years old. Information may no longer be current.
The ‘doctoring’ of the eye examination
The profession of optometry has evolved from a technical role, with the measuring of eyeglass prescriptions, to medical examination and evaluation. As the basic procedures have remained similar, one may wonder how the technical became medical. The difference occurs at the end.
Once the evaluation, testing and examination are complete, the final minutes of the encounter are where the real “doctoring” occurs. This is the time where the doctor sits face-to-face with the patient and his or her family and lays out three critical elements: the problems, the status of the problems and the plan for addressing them.
In the early days, this discussion was refractive. As the profession evolved, the discussion was expanded to include medical eye problems. With health care reform, the discussion will again expand to include primary health care problems that are recorded in the medical chart in a specific manner.
The list of problems is the diagnosis list, often represented by an ICD-9 code, and may look like this – IE: myopia, 367.1; primary open angle glaucoma, 365.11; essential hypertension, 401.9.
The assessment of each diagnosis is the current status of the problems based on this examination. Terms such as stable, progressive, doing well, controlled, guarded and well managed should be noted for each diagnosis.
The treatment plan for each problem should detail both the treatment and follow-up care for each item. For myopia, the treatment can be glasses or contact lenses as noted with a follow-up visit in 1 year. Medical eye problems such as glaucoma may include a reference to continue current medicine, add new medicines, perform additional testing, refer to a specialist or monitor in 3 months.
The optometrist’s doctoring role will be expanded once again with heath care reform. Note that in the example above, essential hypertension is listed. In the past, this has not been considered an item on the optometrists list unless it was directly related to an ocular problem. In the expanded physician role of the optometrist, this and other primary health issues such as diabetes, obesity and high cholesterol are parts of the picture of total primary health and must be coved in the review. These issues must be listed along with the ocular diagnoses and commented on relative to their status and addressed in the treatment plan. This plan can be as simple as “follow up with your family physician” if the condition is stable to, “we will schedule you to see your doctor tomorrow and I will send a report over to that office today.”
The review of systemic medical problems and related medications has been discussed in other entries of my blog. This particular blog operationalizes the expanded role of the optometrist in health care reform.
All optometrists should begin to phase these items into their routine examination procedures. New models of accountable care delivery will require these elements. Most electronic medical records make this easy, and the collection and review of systemic medical data is already in the eye exam templates. With EHR or with standard charting, begin to expand your care into primary medical care now to prepare for the future.