In my neck of the woods, Retinal specialists won't see you unless you were referred to them. THen they demand the doctor's office call and make the appointment for you..
In my neck of the woods, Retinal specialists won't see you unless you were referred to them. THen they demand the doctor's office call and make the appointment for you..
"Some believe in destiny, and some believe in fate. But I believe that happiness is something we create."-Something More by Sugarland
This is true - and every letter of termination that I ever saw gave the patient 10 days or more to secure the services of an alternative examiner.Originally Posted by chip anderson
In the US, at least, there's a qualified examiner on every corner. There is no inconvenience presented to the patient if the terminating examiner makes himself available for a limited amount of time that is long enough for the patient to get another doctor. That fact is normally disclosed in the certified letter of termination.
That's interesting and I've seen that, too. Funny thing is that there's an OMD in our area that won't let the referring examiners schedule appointments. For some reason, they require that the patients make their own appointments. The fickle sort those OMDs are.
I know you have a hard time seeing reality because of your bias against ODs, so I will elucidate . . .
Reality is Optometrists are providing medical care - even if the term physician is or is not used.
Since they are providing medical care, a diagnostic test may be indicated by symptoms or history. In this case, the diagnostic test is the standard of care. If the standard of care is not followed for whatever reason, the doctor is liable for medical malpractice (this liability is significantly reduced if the patient refuses the test, but still the liability is not eliminated).
An optometrist CAN NOT just refract and send out the prescriptions without providing an exam. That would not be living up to their licence, or the standard of care. Their licence would be revoked and they would be sued out of exsistance in just a couple of years.
Pretty much all the OMDs I know don't want to do refractions and primary-care exams all day. These exams take too long, it and won't pay back the student loans on a 5yr residency. In my little neck of the woods there is 1 OMD for a population of about 70K. You think a patient can just call book an exam "for glasses" before Easter? You think the OMD books his own patients? No! The ODs keep his book full. It's like that in most places here in the 'interior'. I don't know much about East of the Mississippi or the left coast.
Regardless of your or my opinions, that is the reality.
Now that you are informed, I trust we will see no more of this needless OD bashing?
BTW, scograd(s) arent' self-refering, so you can like them, it's OK:)
Just let the patient go, and your doing the right thing!I sent a letter to a 14yo parents to terminate the dr-patient relationship after she complained of numerous concussions from cheerleading, yet the parents refused dfe (dilation) at 3 differents times (exam and cl fu's).
Well, the RN mom and the Pharmacist dad sent a letter back stating how they have the right to refuse care and that refusal should not affect continuity of care (they used some former lawsuit or some law not in the state optometric law book).
Has anyone ever heard of this??? They still want to keep coming to the practice to see my husband, but I think that's crap. It's not like we're the only optometrists around.
They seem to think that my liability is lessened by them saying no to dilation, but when there is a RD, I know the first thing any OMD is gonna say looking at my records was that I should have dilated.
If refusing to see a patient becasue they refuse your professional advice is illegal or unethical, what's the point of even being able to terminate the doctir-patient relationship??
The best thing is they made a huge stink when the closest CL trials that I had were the correct rx in one eye and a .25 less minus for the other eye (they needed what was best for her then.... 20/20-- in one eye, 20/20 in the other!!- big whoop!)
And by the way, IMO I would also pose this question to the doctors at www.ODwire.org in the Optometric Economics forum. Talk to doctors about doctor problems ;) (full disclosure, i was an optician before od school)
Just so in the future you dont get assinine comments from an optician like Chris Anderson, who isnt a doctor and doesn't see patients but instead sees customers.
My 2 cents.
The post about how much the fee is for "complete work-up" kind of makes me think of a situation back in the '60s. We had no retinal specialists in the state at that time. All the doctors I worked with sent such patients to Houston to see Alice McPherson. They usually left seeing 20/80 and came back seeing 20/30+. When they died (usually from age) they were still seeing 20/30.
Later patients began being sent to New Orleans (there was a center there with a great reputation for cardiac repair?) so I guess it was assumed the retinal department would be on the same par. A little later a similar situation existed in Memphis and some patients were sent there.
The patients sent to both New Orleans and Memphis came back, raved about how wonderfull the office was at each location, how high tech the equipment was, and how many hundreds of pictures of the retina were taken.
Oddly it seemed these patients returned still seeing 20/80 (or in some cases ennucleated) but they sure were impressed with the high tech equipment there.
Chip
Note: No O.D. bashing here no one involved in the above was an O.D.
....that's what I say. We've sent letters to a couple of patients. Other doctors in our area have done the same thing. We have been the recipient of some of these displaced patients. It's a great chance to make some very loyal customers, or a complete nightmare and you realize why they were sent packing.
I think I'm gonna win the award for having patients with the most unbelievable parents ever! Just had a 12 yo that was brought here by her 17 yo sister for a new wearer CL exam, no parents in sight!
Father said exam was okay, but I refused to do the CL I&R without a parent here!
Granted, I know it was easier for the sister to bring her here since their mother is in the hospital and the kid broke her glasses, but I'm already on the line for doing an exam without a parent, I'm not pushing my luck with cls!
I just want to hide away in an igloo until I manage to get rid of these crazy patients...... (who knows, maybe I'm the crazy one!)
If it were me, I'd choose a grass hut instead.....brrrrrrr.;)
-Tony
What a tough streak of luck there, the moon and sh*tty way galaxy must be lined up with your storefront. I will ask the good man upstairs for a day of CASH pay patients for you.I think I'm gonna win the award for having patients with the most unbelievable parents ever! Just had a 12 yo that was brought here by her 17 yo sister for a new wearer CL exam, no parents in sight!
Father said exam was okay, but I refused to do the CL I&R without a parent here!
Granted, I know it was easier for the sister to bring her here since their mother is in the hospital and the kid broke her glasses, but I'm already on the line for doing an exam without a parent, I'm not pushing my luck with cls!
I just want to hide away in an igloo until I manage to get rid of these crazy patients...... (who knows, maybe I'm the crazy one!)
Easy with the bartender refusing talk their John, that cuts deep.:D
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Thanks harry, I really feel like I need it now!!
Not to mention the bashing that I got on odwire.....Optiboard is wayyy better!!!:p
Everyone's always welcome here. Big hugs! lol
I believe it is always the patients right to determine what course of diagnosis and/or treatment they desire. Even with lengthy explanations and discussions of risks, they still refuse proper care (DFE, VF, etc). I think often these patients are afraid to know their situation. Do all they will let you do in the office, and move on. Can't win them all.
Important to thoroughly document your examine records of all discussions with patient/parents. I have the patient/parent sign the examine record acknowledging the refusal of services and make sure all is dated. If they refuse to sign, I will ask an assistant to sit in with the discussion.
Sometimes patients will deny they were properly informed and options were provided. Lawyers love poor documentation and a patient with a vision loss. Minimize your exposure.
Just an thought for the long haul....
That's a sensible line of reasoning and similar to the one we practice in our office. As long as the patient is returning for care and all is proceeding in a positive direction, I also think that the patient has the ultimate right to govern the level of their own participation.
Doctors also have the right to govern the level of their own participation. The difficulty presents when outcomes worsen and a sensible plan is not pursued. At some point, the continuity of care ceases and a line must be drawn. Either the patient concedes to an appropriate plan or care must cease. Referral contingencies should be put in writing and the patient should be made to realize that taking their care completely into their own hands will leave them without a doctor's advice.
Doctors cannot be held responsible for poor outcomes due to the negligence of their patients. Patients come in many varieties and there are countless patients that are more than happy to accuse their doctors when the outcomes of care are not pleasant.
Sorry to hi-jack this thread but I have to ask....
1. Should a patient be able to obtain a refraction only, if they so desire?
2. Should lens duplication be available to a patient that simply wishes to upgrade frames/replace broken glasses?
I believe the public (should) have the right to both 1 & 2. If not, then all over the counter readers should be outlawed too, along with over the counter meds.
thoughts?
dang, I'm starting to sound like Barry!
The parents are trying to intimidate you. This is the dismissal letter I occasionally send:
Our practice will no longer be able to treat you as a patient, as it has become clear that the trust and confidence required in a doctor-patient relationship no longer exists. It would be in your best interest to obtain care from another optometrist. We will assist you in finding a new care provider if you desire. We will provide you with emergency eye care only for the next thirty days should a genuine emergency eye problem arise.
Sincerely,
----------
You have the right to refuse care providing it is not an emergency. With the above letter you have notified them of your position. Tell your staff that these people are not to be given an appt again. End of story.
You can use the "New Thread" button. :)
Yep. Provided that it is not a substitute for ocular health care.
Yep. Provided the Rx is still valid.
In most places in most circumstances neutralization and duplication is legal whether or not the Rx is current. I am sure some boards of optometry will be outlawing the practice as soon as they can.
Chip
That's a great idea! Thank you for suggesting it.
I will contact my State Board on Monday. :D
Chip,
You've got me thinking......I think states should also pass legislation to prevent opticians from owning land or voting.
This is the correct way. We also include a copy of all of their records. I do not offer emergency eyecare to patients that have been released. There are many OD's and MD's in our area and we happily refer the released patient to them. If you are the only show in town you might have to see the patient in an emergency, but some patients think that broken glasses or a contact lens that has rolled back into their brain is an emergency.
Good luck and don't sweat it. You don't have to see a single person if it is not your wish to do so.
OMG!! A contact can roll back into your brain?!?!
They should outlaw those things!
Save your brain, wear glasses the way the good Lord intented;)
The tone of this thread is beginning to remind me why I don't go to ODWire, someone please put a merciful end to this and lets get back to what this board is all about.
Thanks!
John
glad to see I'm not the only one who has put the ban on odwire.....it's become a vicious, brutal free for all if you don't conform to certain "standards"!
Not in TN.
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