Article

THE EFFICIENT OPHTHALMOLOGIST

Increase your interface with different specialties

It’s good for business and great for the patient.

One of my attendings during residency joked that the human body is nothing more than a life support system needed to hold the eyeballs off the floor.

So, do we have a connection with other specialties?

A few years ago, I was invited to speak at an international meeting of plastic surgeons. At first, I thought I would present on overlapping pathology, such as the indications and techniques for blepharoplasty, treatment of symblepharon for ocular cicatricial pemphigoid or Stevens-Johnson syndrome or the treatment of ocular burns and chemical injuries.

But, as I thought about the commonalities we share, I decided to take the lecture in a totally different direction. I spoke about the fact that our specialties each have many liquidity-based procedures that are elective, and therefore we share a common demographic of patients. At the least, we should co-refer, as this group of patients is already savvy about the opportunity for such elective cosmetic or functional procedures. Further, co-referring opens the door to a boutique, cash-based, multi-specialty clinic, with shared services, staff, overhead and patients. The talk was well received and indeed fueled further discussion and newly created relationships long after the meeting concluded.

Yet liquidity-based elective procedures are not the only reason to co-refer. Though ophthalmology has often been described as a “carve out” specialty, both by generalists and the insurance industry, one of the many reasons I was drawn to field is its relationship with systemic disease. Ophthalmologists are often the first physicians to suspect diabetes, thyroid disease and central nervous system conditions. We investigate potential malignancies and work closely with our colleagues to diagnose and treat auto-immune and rheumatologic disease. Making a connection with other specialties is crucial for the health of our patients as well as the health of our practices.

HOW TO GROW A STRONG PRACTICE

Create the opportunity to meet with your regional primary care physicians. Attend hospital semi-annual medical staff meetings and social events. Present lectures to the ER physicians and nurses about common diseases and trauma they are likely to encounter, and recommend proper treatment for these conditions (i.e., prescribe Polytrim [polymyxin B sulfate and trimethoprim ophthalmic solution, USP, Allergan], not sulfa or a steroid for bacterial conjunctivitis!). Present lunchtime round table or PowerPoint presentations at your regional hospitals on disease states of common interest, but from the ophthalmologist’s perspective. Engage your patients’ PCPs in medical conditions you suspect and are working up, and copy them in on all lab and radiologic studies.

I write a letter every year to the patient’s physicians, including the endocrinologist, for all diabetic patients. I update the doctor when a new, long-term diagnosis is made (such as glaucoma) and include the medicines with which we are treating this condition. As mentioned earlier, meet with area plastic surgeons, ENTs and dermatologists to create a cross-referral network for this demographic of patients who would benefit from liquidity-based procedures such as blepharoplasty, LASIK and premium channel procedures.

FINAL THOUGHTS

Many ophthalmic conditions have a systemic component, either with multi-organ system involvement or from the perspective of creating risk factors for ocular disease. Indeed, part of the fun and mystery of ophthalmology is derived from suspecting, and then proving, that a common thread links multiple symptoms, such as those we see in dry eye (thyroid, rheumatologic) or infectious/inflammatory disease (TB, lupus) and, on occasion, life-threatening conditions (cardiovascular, syphilis, central nervous system disease).

Ophthalmologists, like our primary-care colleagues, enjoy a long-term relationship with our patients. We watch them grow up, and then we watch them grow old. Everything changes, and suspecting systemic disease based on ocular findings is particularly rewarding.

I am certain that you have heard, “You saved my life doctor, by suspecting heart disease when I came to see you for my eyes.” The eye is not just the window to the soul; it often contains many secrets to our systemic health as well. OM