got a visit from the health department today....

[scograd]

I saw the patient for an exam on Monday evening. Nice patient, I thought everything went very well. Then on Tuesday afternoon the patient came in with photos complaining the the Optomap "made her eyes blow up." Well, the doctor on staff that day was at lunch. The receptionists told her that she can see our doctor as soon as he returned from lunch. The patient "couldn't wait that long". Our staff said they would call up to the 2 offices upstairs (we're in the mall) to see if they could get her an immediate appointment. THe patient still refused and claimed she was going to the health department. From what my staff said there was no redness or swelling visible that day or in the photos.

Well today I got a visit from a very nice lady from the health department. We discussed the latex bubble on the Optomap and the alcohol swabs we use to clean it with. We discussed possible latex or alcohol-related irritations. She told me that everything looked clean and sanitary and that we were following correct protocol. She also noted that the patient refused any follow-up care. I asked her if there was anything else that we need to do, but she said that we were doing what we're supposed to (she gave me the look that the patient is a nut-job).

Even though everything should now work out well this was still not what I needed right now!! We're burnt out enough with the back-to-school crush!!

Anyone else have a similar experience or advice?

[obxeyeguy]

Anyone else have a similar experience or advice?

get some business cards from someone you don't like, and hand them out to these people. Notice the moon the last few nights? Some people....

The only thing I ever experienced was some guy came in and flipped some official looking badge from some government agency and wanted to see the OD's charts on 2 patients. Od was off, and we explained that we could not give them to him, he insisted he had the right, we held our ground, he left. They were not after him, but an MD who say the patients after.

Go have a few :cheers:doc, next week will be better. Still got those lottery tickets?

[orangezero]

only advice I'd give is to lose the optomap :hammer:, if you can.

[harry888]

I've talked to a few people on the state boards, they state that 80% of complaints are frivolous or from those that owe money and are now looking for an excuse not to pay.

Harry

[mlm]

get some business cards from someone you don't like, and hand them out to these people. Notice the moon the last few nights? Some people....

A little off topic, but "moon related". Our clinic's front window was smashed in 3 days ago. Guy took a pipe, broke through the glass with security film on both sides, stuck his hand in to steal one sunglass and had to wrench his hand out because it got stuck in the hole. It has not been a good week...

[GOS_Queen]

get some business cards from someone you don't like, and hand them out to these people. Notice the moon the last few nights? Some people....

OMG! I love it! :bbg::cheers:

[ShuString]

those kind of stories are very common, Don't feel bad about these nut jobs, Everyone gets one or two from time too time. just don't let it rattle ya....lol

[EyeFitWell]

Please assume the appropriate disclaimers, I am neither a doctor nor an allergy specialist. However, I have a latex allergy and I had no idea Optos had a latex bubble. I've had Optos pictures taken numerous times from practice for a new tech to annual eye exams. On one hand, I didn't have an allergic reaction. On the other hand, don't you think we should mention that it's latex? I always ask about a silicone allergy before replacing hard nosepads with silicone. I've dealt with patients who were so allergic to perfumes that I had to wear rubber gloves to adjust her glasses, and she couldn't clean them with anything but alcohol and unscented soap. Granted, this was unusual, but I'm allergic to vasoline, present in chapstick and vick's so who am I to judge? Some people are allergic to latex, probably more of the population than you might think, so perhaps it wouldn't hurt to ask that before performing the Optos test. *Just my humble two cents*

[scograd]

So I got a letter including photos from the patient today..... Funny how her story is completely different from my staff's accounts.....(ie pt says she was never offered a follow-up----she told the staff that she couldn't wait until after the doctor had returned from lunch....) The photos show some periorbital edema vs dermatochalasis. There is NO redness in the periorbital area that actually touches the latex bubble..... This patient has a history of seasonal allergies, so I'm guessing that's what it is.

The real question is do I send her a letter in response to her letter?? Obviously I'm not going to offer any diagnoses any letter...just to reiterate that she was offered an appointment and refused...also that the follow-up conducted by the health department showed no concerns. Equipment is sanitized by approved methods.

[bt5050]

only advice I'd give is to lose the optomap :hammer:, if you can.

although - this post was form 2006 - i thought i might comment on it -

it appears - that some here - are dead set agaist the opto - maps -
I am not saying it is a replacemnt - ( OR EVEN close to ) a dilation - however - i have found - time and time again - PTs love it - esp when they need to read - or not have dilated pupils - for a few hours - or even pts that refuse to have their pupils dilated because a fear of the unknown - other pts stories of how bad it is - or even there own past expcs -

as i stated before - i do believe in the importance of a dilation - however - i look at it this way -

MANY PTS WILL JUST ELECT NOT TO HAVE ANYTHING DONE _ and refuse the dilation - so whats better - NOTHING _ or the use of a opto map ?

[1968]

The real question is do I send her a letter in response to her letter??

No. Although it's tempting to send a letter in order to "set the record straight", there is absolutely nothing for you to gain from sending a response: 1) the patient is not coming back; 2) if she is as irrational as your story suggests, you don't want her back; and 3) the health department has already been involved and appears to have found in your favor. Document everything in the event your Board becomes involved, but until that happens... the less said the better.

[1968]

although - this post was form 2006 - i thought i might comment on it -

it appears - that some here - are dead set agaist the opto - maps -
I am not saying it is a replacemnt - ( OR EVEN close to ) a dilation - however - i have found - time and time again - PTs love it - esp when they need to read - or not have dilated pupils - for a few hours - or even pts that refuse to have their pupils dilated because a fear of the unknown - other pts stories of how bad it is - or even there own past expcs -

as i stated before - i do believe in the importance of a dilation - however - i look at it this way -

MANY PTS WILL JUST ELECT NOT TO HAVE ANYTHING DONE _ and refuse the dilation - so whats better - NOTHING _ or the use of a opto map ?

How 'bout a small pupil BIO?

[orangezero]

although - this post was form 2006 - i thought i might comment on it -

it appears - that some here - are dead set agaist the opto - maps -
I am not saying it is a replacemnt - ( OR EVEN close to ) a dilation - however - i have found - time and time again - PTs love it - esp when they need to read - or not have dilated pupils - for a few hours - or even pts that refuse to have their pupils dilated because a fear of the unknown - other pts stories of how bad it is - or even there own past expcs -

as i stated before - i do believe in the importance of a dilation - however - i look at it this way -

MANY PTS WILL JUST ELECT NOT TO HAVE ANYTHING DONE _ and refuse the dilation - so whats better - NOTHING _ or the use of a opto map ?

And still, dilation is standard of care. I can not agree to allow patients to dictate what procedures I do or do not recommend. I've been in practices where dilation is recommended, "but just sign this form and you don't have to go through all that, and its cheaper to not do it." Not a good place to be. Not a good place for nonpractitioners to try to put practitioners, IMO. Poor image, sloppy care. False sense of well being, false sense of security that the doctor saw everything they were supposed to see and everything is "ok." Expensive, stupid business model.

I'd say a good long look at an undilated pupil with a good slit lamp lens is better than an optomap on most patients, just going purely by statistics.

Why don't we just Bscan everyone? Or do screening OCTs? Or offer random pachymeter measurements? If its only for patient wow factor, those could be much better streams of revenue.

All that being said, if it was a $10,000 device I may look in to getting one. But I do believe they still charge a rather large fee per use that I just can't justify my patients paying when their medical insurance covers the standard of care.


Plus, and this might just be the real reason, the guy at the conference I went to never emailed me my optos picture like he said he would after he took it at the booth :(

[orangezero]

We are really lost when patients are openly encouraged to not value our services and their sight enough to be unable to read for 2-4 hours for one time slot out of the entire year???

jeeze, get an exam and then go see a movie in a dark room. Take a nap, wear sunglasses, clean out your closet, listen to an audio book,

If anything, it should make people realize how utterly important their vision is. Losing a small, small part of it for just a small percentage of one day seems to throw them in a tantrum.

Or perhaps, its because you charge an extra $5 for a dilation and they'd rather spend that on a coffee? who knows.

I've just thought of something. thanks for the motivation...:cheers:

[scograd]

The whole Optomap vs DFE is off-target for the original thread. Just to let everyone know though, yes, I do throughly recommend dilation. I tell everyone that the optomap is a good SCREENING tool, NOT a substitute for dilation. With dilation I can see more of the peripheral retina. Sometimes I may see something with the Optos and still need to dilate to make a good dx. Preferably I like to do DFE one visit, next time Optos, DFE, etc.... that way it is easier for the patient, and I'm seeing as much retina as possible with photodocumentation along the way. Even with Optos I still do undilated 90D on every single patient. I have to admit though, that the Optomap allows me to see more retinas since I still have a huge portion of patients that will refuse DFE or Optos every single time. Some practitioners may disagree, but I feel that patients have the right to decline medical care even if it is against medical advice. I document (have the patient sign a form if it's a complaint like HAs, changes in vision or just are a general pain in my rear (CMA at that point!). I know that could be tricky in a lawsuit, but if you can walk out of the hospital because you don't want to have open-heart sx, then you can damn well decide not to have your eyes dilated (bunch a wussies!!). That's my .00002 cents worth! (August was a real rough month, I'm sick of being an optometrist at this point!!!):angry:

[DragonLensmanWV]

We are really lost when patients are openly encouraged to not value our services and their sight enough to be unable to read for 2-4 hours for one time slot out of the entire year???

jeeze, get an exam and then go see a movie in a dark room. Take a nap, wear sunglasses, clean out your closet, listen to an audio book,

If anything, it should make people realize how utterly important their vision is. Losing a small, small part of it for just a small percentage of one day seems to throw them in a tantrum.

Or perhaps, its because you charge an extra $5 for a dilation and they'd rather spend that on a coffee? who knows.



I've just thought of something. thanks for the motivation...:cheers:

\

Well said - I agree 100%

[bt5050]

\
Or perhaps, its because you charge an extra $5 for a dilation and they'd rather spend that on a coffee? who knows.


Well said - I agree 100%

one again - a bit off subject - but do most charge a seperate fee for exams with or with out dialtion ?

our od - changed about 3 years ago - to include the dialtion in every compre. annual eye exam - and therefore there is no issue - if the pt says "i don't want to pay the extra for a dialation - all the annual exams are teh same - with or with out it - so if the elect not to have it done - they just don't get the full benifit of the exam - but they do pay for it -

he also - will not let them ome back - for the dilation on another day - and count it as a no charge visit - sine they elected to not have it done on the day of their exam - he will charge an office visit charge if they come back - since he feels that they had the optotunity of having it done -

At least he is consistant with eveyone on this - and will nto allow a NC revisit - for a service they did nto want to have - in their apt time -
that is why many hoose to go the optos route - and pts really enjoy us having the unit -

what charges do your offices have for dialatons ?

[orangezero]

I think its probably all over the map. My experience has been that the places that advertise price are much more likely to "need" to have a separate fee for dilation as a way to keep the advertised price low. The ethical trouble with this is the usually unforeseen consequence that patients and staff (and sometimes the doctors unfortunately) have a hard time separating their fee structure from what is considered the standard of care.

As an aside, typically if you are billing medical (and probably vision plans too) its okay to perform the exam one day, have the patient return for dilation, and then submit for a comprehensive exam. Or whatever the code would be.

However, often times its left up to the doctor, owner, or manager to decide what the fees should be. It very well may be the fees are based more off of "office tradition" than anything. I've yet to see two offices that do things exactly the same.

But, if you, your buddy and your next door neighbor all think 2+2=5, then effectively it is for you. Right?

I'm all for offering choice. Any patient can refuse any treatment or procedure. Certainly inform properly, and for goodness sake have them sign a form if the risks are there and they still refuse. Or send them a dismisal letter with options for seeking care elsewhere. But I don't prefer muddying the waters by offering substandard care as an alternative. And potentially profiting more from not doing the standard of care is something to consider in the grand scheme of things as well. IF something goes wrong and the jury is left wondering why you have a more expensive opt out option, what lawyer isn't going to pounce on that?

Patients are looking to us for guidance, knowledge, vision, and health care... not to be ultra accommodating or help them slide by.

Sorry this is off topic, probably should have kept my mouth shut. But still, I think it deserves to be said.

[scograd]

great, now i have to send copies of records to the NJ Board. Which is fine with me, because I have everything documented, but it's still a pain in my rear!!!!!!:angry:

[DragonLensmanWV]

great, now i have to send copies of records to the NJ Board. Which is fine with me, because I have everything documented, but it's still a pain in my rear!!!!!!:angry:

Send them a bill along with the records.:D

[wabmorgan]

The real question is do I send her a letter in response to her letter??

I bet a good lawyer (if there is such a thing) or even a bad one.... would say NO!!!!!

[allanon]

Make sure your staff documented their interactions. She refused f/u care and your staff attempted to provide that care via alternate avenues. My words to her would be "FOAD".

As for optomap, you can get the same wow effect with a digital retinal camera and a big flat panel monitor. If Optomaps were for *sale* I would buy one, but I won't be permanently lining someone else's pockets.

Is that bubble really Latex? If so, HAH!

[Ory]

Is that bubble really Latex? If so, HAH!

I'd actually be surprised if it is. Latex tends to degrade over time. I'd guess it is more likely silicone, which some people do react to as well.

[scograd]

It's silicone...I had to call my rep to confirm for my letter for the state board...it's been sent, so now I'm just waiting for my absolution. I shouldn't be upset or worry about it, because I didn't do anything wrong, but it's still not a fun way to go!