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Using the Review of Systems in optometric practice
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A formal Review of Systems (ROS) has been a suggested part of a comprehensive medical history for several years. Some optometrists used this for a medical office visit but not for routine eye examinations. With the advent of electronic health records (EHRs), the ROS has become a standard feature for routine eye exams and for each encounter.
Since I started using EHR 2 years ago, the quality of my charts has been steadily improving. One reason for this improvement is the ROS.
I see many patients with complex ophthalmic problems. I end up seeing some of them many times over the course of a year. With my paper charts, some of the medical history did not move forward with each encounter. When a patient returned often for something like an adjustment to their keratoconus gas-permeable lens, or for a glaucoma-related IOP check, it was time consuming – and often not germane to the visit – to re-write their full medical history.
As pages in the chart piled up, sometime critical issues, like perhaps this patient is also a diabetic, were lost my clinical thinking. Now with a review of systems at each encounter, the “big picture” is never lost.
The ROS also remind us of the nature of common medical problems and opens the door to more global thinking. A patient with simple hypertension, for example, has a cardiovascular system problem. Thinking of the larger system problem helps make the crossover more logical when seeing vascular changes in the retina examination. A patient with mild asthma has a respiratory system problem, and patients with respiratory system problems may have problems with ocular medications that contain a beta-blocker.
Adding the ROS to each encounter is a big move toward your evolution from a primary eye care provider to a primary health care provider. Making this change in your practice will be essential to your success in health care reform.