Canadians are made well aware they are receiving a vision test, not an eye exam.Originally Posted by Oedema
The fact that a retinal detachment or diabetic retinopathy wa not caught in a vision test is like blaming your OB/GYN for not catching your cataracts.
None of those people lost vision due to a bad refraction.
Ha! I'm sorry but did you read the link? While there is supposed to be a very detailed informed consent done, I think it's clear that many of those people were not aware of the difference between a sight-test and a full eye exam. In many cases these people had sigh-test despite being excluded by the criteria set by the BC college of opticians for sigh-test eligability. And then there is this guy: http://www.collegeoptom.on.ca/curren....htm#judgement
No, it would be like blaming your OB/GYN for not catching your pelvic inflammatory disease that leaves ends up leaving you barren and infertile.The fact that a retinal detachment or diabetic retinopathy wa not caught in a vision test is like blaming your OB/GYN for not catching your cataracts.
You're right, they were merely inconvenienced by bad refraction/management of binocular vision disorders and lost their vision due to missed ocular pathology!None of those people lost vision due to a bad refraction.
I lived in Texas for many years and frankly I believe is not illegal. A physician may order any test to be performed by an assistant as long as a written prescription exist, it is a patient of the Ophthalmologist and there is supervision. The loophole in Texas is the following: there is nothing illegal for the assistant/contact lens fitter etc to write the name of patient in the prescription pad as authorized by the MD. The patient automatically becomes patient of the MD when he accepts the procedure to be performed and supervison is indirect. Furthermore this individual does offer two types of exams one for eyeglasses alone and one with the MD for eye health. Texas is a pro MD state and the board of optometry has very little say so in anything related to an MD.
You can certainly "turn him in" but I would be very careful as a ruling has been previously been done in a similar case involving contact lens fitting back in the 80s. If you accuse someone of something you think it is illegal you must get the facts very well because your claim may land you in a civil suit. Otherwise why do you think he has not been turned over before? Houston is full of ODs..there is a school there you know.. but there is also an MD school full of MDs. MDs do not take very well orders.... now if this was in California that would be a different story.
Dannyboy
Bro, they went in for a refraction that is done by an automated lane. IF they expected the phoropter to catch an eye problem they may need to see a doctor that specializes 1 inch behind the eyes.
And that's why those opticians in BC that do sight-testing need to start complying with their college regulations. While you and I may be sophisticated to know the difference between a phoropter and a slit-lamp the vast majority of our patients are not.
I still can't believe the force with which optometrists cling to refraction. The sooner you stop refracting, the sooner you will be perceived as real doctors. Take refracting out of optometry schools and put it in opticianry schools.
All medical disciplines diverge into new specialties over time.
Technology has made refracting easier and more accurate. Optometry has shifted into health screening and disease management. Refracting specialists are a natural result of that divergence.
Just look at the refraction dates in these so-called 'case studies'. OD's in BC scaped the bottom and came up with very old news. The fact remains that, sure, there may be the odd optician sight-tested that will still break the comprehensive rules now in place, just as the odd OD and OMD still gets caught deliberately over-billing government for their services.
The bottom line is that none of these case-study patients have taken any court action because of problems of proof. And now 30,000+ BC/Alberta residents have availed themselves of a free sight-test.. and have been entirely satisfied. :D
I wasn't sure if you were referring to my post or not. What I said was he hands them the script and patient then has said script in his or her hand and that as far as I know satisfies Eyeglass 1 law, but again you have to give them the choice, with out choice it's a monopoly and that's illegal. And as to whether he or she is working in Texas under an MD makes no difference as Chip has pointed out it's ILLEGAL Eyeglass 1 is federal and supercedes the state. just my take
Good! Yes and having a lot of medical training as well. He best not be missing anything. If it's malpractice for an MD to miss something, what is a good lawyer going to do with a case like this arrangement when something goes wrong?
Thanks, Dannyboy. It sounds like a localized Texas issue, at least in the US. I'm a bit boggled by the "indirect" supervision of a refraction -- in most MD's offices I know of, the MD and refractionist are in the same office suite at the same time, and this guy seems to have a "supervising" MD who's off-site entirely -- but if Texas law allows it, then it isn't illegal.
I agree that we cannot assume our patients understand exactly what an eye examination covers and which instrument tests what. Ideally, the refracting optician in this case ought to hand a slip to the patient at the end of the exam advising the patient to go to the MD for a comprehensive eye examination for health reasons.
Andrew
"One must remember that at the end of the road, there is a path" --- Fortune Cookie
No, I was just expressing my opinion on the legality of not giving the script or making it contingent on the sale of eyewear.I wasn't sure if you were referring to my post or not. What I said was he hands them the script and patient then has said script in his or her hand and that as far as I know satisfies Eyeglass 1 law, but again you have to give them the choice, with out choice it's a monopoly and that's illegal. And as to whether he or she is working in Texas under an MD makes no difference as Chip has pointed out it's ILLEGAL Eyeglass 1 is federal and supercedes the state. just my take
I also think that MD's are more receptive to a business model that involves opticians in satelite offices and it's a win win situation for everyone. If OD's don't learn to embrace that then they risk being left outta the loop. Case in point was the FCLCA where their was a quote in the federal register about congress being reluctant to pass the law as is but of all the complaints there was no solution presented other than don't do it.
Opticians not refracting may or may not be an option, in Canada for instance you are seeing OD's trying to work with the opticianry college in certain areas so that they can at least come up with a solution to benefit both professions mutually. I suggest that OD's realize that times are changing and maybe rethink how to make refracting opticians work within the eyecare model. Keep in mind optometry isn't as legislatively strong as it was at their peak and they still face opposition from two ends. It's not prudent to continue to stand such a firm ground and not have a contingency plan.
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I have seen several cases myself where patients who turned-out to have significant pathology were "sight-tested"...
I detect vision-threatening pathology in asymptomatic patients almost daily
Refraction is NOT a joke.....it is an evolving skill that takes years to master.
Sight-testing is a tool that opticians are using to survive in a competative optical world. In many ways I don't blame them for it....but to say sight testing is about anything other than economics is untrue.
Anecdotal evidence is the best evidence.:bbg:
I could agree with that as our OD in the office does as well.
Optometry school doesn't focus their entire profession on the skill of refracting, but you are still correct refracting is a skill that is intricate and requires a depth of knowledge to perform.
Optometrists in the UK hodl the equivalent of a bachelors degree and refract, their opticiasn can go back to school and further their education to become an optometrist if they choose.
I believe hong kong has a three year program that gives on the necessary credentials to refract.
Matter of fact it is a minority of countries that do have optometrists with doctoral degrees, and I'm glad to have you guys with such great knowledge but I hope it isn't at the cost of the profession.
Dispensing is a tool that optometrists and OMD's are using to survive in a competitive optical world.
What I am suggesting is that if this is going to happen with or without you, why not have it be with you?
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Harry,
I live in BC, Canada. Wal-Mart is bringing in a "sight-tester" into one of their stores in Kamloops, BC. They are calling it a pilot project. So now we have a massive chain that no longer employs an OD (probably couldn't get one in Kamloops..too many great private practice opportunities), and will have an optician (maybe??) performing sight-tests.
Is this a rosy picture of the future of eye care in your opinion??
It should be just as scary for opticians who would like to see the return of professionalism, as it is for ODs, in my opinion.
Years ago, I had a couple of good friends who were chief OMD at medical schools who on occasion ranted and raved about undiagnosed and miss-treated or untreated pathology by O.D.'s. Of course this was in the days when O.D.'s couldn't even legally dillate, much less treat pathology. Each doctor would claim to see patient's daily that had been under O.D. care with undiagnosed and un-treated or miss-treated pathology.
Now that O.D.'s can get referral fees and collect for surgical-follow up visits this sort of attack on O.M.D.'s is seldom a subject for discussion.
The argument is the same just the ecconomic focus has changed to opticans.
Chip
If it is illlegal he IS "kicking our integrity" Period.
I am all for Opticians refracting, but I am also pro-health. It should be noted somewhere that a health exam of your eye needs to be done annually as well.
Jana Lewis
ABOC , NCLE
A fine quotation is a diamond on the finger of a man of wit, and a pebble in the hand of a fool.
Joseph Roux
I have heard about that and that is the reason why I think that sight testing is here to stay. I don't know what the effect on our industry will be, but I know this, in the state I live in in the US, it's called Pennsylvania often refered to as "Penseltucky" the opposition for my proffesion has always been corporate optical and optometry. Now I practice in a state that does not consider me a professional because corporate opticals and optometry wanted it that way. Now it looks like corporate opticals are lookign to cut there largest expense, LABOR. They could pay a sight tester 1/3rd of what they pay an OD and the sight tester will likely get crappier hours, but for the sight tester this is a step up and an opportunity for my proffesion to expand our scope.
That's why I keep suggesting that instead of fighting it, Optometrists should be finding a way to make it work for their benefit. Who do you think I would rather work for an independent OD or a Walmart? That's a no brainer, but if your h*ll bent on my professions destruction then I gotta go with the mart. Sure it's like eating a bologna sandwich instead of a steak sandwhich, but when your used to eating crap sandwiches it's still a step up.
I keep bringing this up, but opticians are your insulation. If we're in the crapper the next target up the ladder is Optomtery, the more solid opticians are as a profession the more solid your foundation. It seems that the whole house of cards was built on sand. We all knew that going to bed with corporate optical was like going to bed with a wh*re, now your being tested for herpes and crying foul ball. You make your bed you lie in it.
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In the UK the entry to practice degrees for all health professions (yes, even medicine and dentistry) are bachelors degrees. So UK physicans actually hold a Bachelor of Medicine Bachelor of Surgery (MBBS) degree. Only by convention are physicans called "Doctor," while Surgeons go by the "Mister/Miss/Misses" to further distinguish themselves. Confusing yes, it has to do with how medicine and surgery actually come out of two different trade guilds... medicine from the doctors and surgery from the barbers guild.
There's nothing special about a UK optometrist going back to school and becoming an optometrist. Even you as an American optician can do it so long as you collect the pre-reequsites.
As for hong kong their program is four years in length leading to a bachelors in optometry.[/quote]
Harry,
You are correct. Corporate optometry/opticianry has damaged us all. I can't understand why any OD would of thought it a good idea to work in a corporate setting in the first place. Just laziness I guess.
I am glad I practice far from any corporate entities (at least for now).....I despise them and have little or no respect for the ODs that choose to work for them.
Can you blame them though? Most independent OD's pay 2/3rd what a corporate office would. I am glad it's the opposite in opticianry , but even if it weren't I don't think I could work directly for the MAN. I work for a Pearle right now, but it's franchised so I'm kinda on the fence when it comes to who I work for. Even our association with the MAN seems to only get us so much good grace.
Every Jew and Armenian knows this poem and knows it well:"at least for now"
They came first for the communists,
and I didn't speak up because I wasn't a communist.
Then they came for the jews,
and I didn't speak up because I wasn't a jew.
Then they came for the trade unionists,
and I didn;t speak up because I wasn't a trade unionist.
Then they s=came for the Catholics,
and I didn't speak up because I was a protestant.
Then they came for me,
and by that time no one was left to speak up.
-Pastor Martin Neomoller(sp?)
Anyway, it's not you now but how many OD's have you heard say things like I'll be retired before the crap hit's the fan? I have heard opticians do the same.
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The original quote above didn't have anything to do with catching anything except the persons $25 bucks. Taken in the questions I believe should be 1:What does Texas law say about this optician. 2. Where does Eyeglass 1 fit? 3. Why hasn't he or she been turned in for all this? It doesn't matter if the MD's are powerful or not is it the law and are they breaking it? We have MD's in NY and some of them have been taken to court. You must give the patient the rx ( another words hand it to them ) It's up to them whether they stay or not. Thats law. I would go straight to the medical board and file a complaint. Chip i think we may have to find Eyeglass 1 and put it up on this board because apparently most never read it.
You mean the Ophthalmic Practices Rule, commonly refered to as Eyeglass 1: http://onlineopticianry.com/wordpress/?p=126
And if we're such a stickler on the rule notice it applies to OMD's and OD's, in my opinion the rule still applies in this case because technically the script is being provided by the OMD, so to argue that the optician can write the script because the OMD signs it shoudl be the same resoning as to why it shoudl be released. I think the majority here agree that the script should be released and it is unlawful to hold it.
IMO that's the only thing wrong with this scenario. As far as him writing the scripts, that task is being delegated by the OMD that he works for and I don't think anyone here is qualified to tell him how to supervise his employees.
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It's not illegal with an OMD writing off for him. Period. With 15 OD's in any 5 mile radius in Houston, do you not think he has been investigated, numerous times? Ask Sam with ROATx, he's there in Austin and wants to do the same thing....
I'm also pro-health, but you can't make someone go to the Dr or accept treatment. I also believe that people should be responsible for their own actions or in-actions, I don't believe in a nanny-state.
Also on the subject of refraction; We sell OTC reader here ( as do most opticals in this neck of the woods ). Have any of you ever helped someone select the one that works best for them? ( Here, read this with these, now try these..." Am I practicing medicine?
Everyone overly concerned about simple refaction needs to all hop on a bandwagon and ride it to Washington and have OTC readers outlawed. I hate to think of all the lives lost and ruined due to OTC reader usage...Good luck on your ride! :D
:cheers:
One more thing I forgot to ask opinions on...
It concerns Eyeglass I and advertising. I know I've seen adds with something to the effect...." Eye Exam for $xx with the purchase of glasses". Is this illegal? In other words, regular exam is $100, with purchase of eyewear it's half that. You wanna walk with your RX, well, you don't qualify for the discount.
Not much different than 50% off frames with purchase of lenses. Don't buy the lenses, then full price for frame.
Thoughts?
Is this fellow holding the RX?
That is Illegal...yes?
Jana Lewis
ABOC , NCLE
A fine quotation is a diamond on the finger of a man of wit, and a pebble in the hand of a fool.
Joseph Roux
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