Schedules and Staff

I think this post could also appropriately be titled “Growing Pains.” As it turns out, having a growing practice requires at least as much adjustment and attention as having a quiet practice that needs to grow more! I should know, because when I took over this practice four years ago, it definitely fell in the latter category.

At least when your practice is quiet, you have no trouble giving patients what they want. You can spend as much time as needed with each patient without worrying that it will back up your schedule. If someone wants to get an appointment last-minute, or maybe even RIGHT NOW, that can probably be arranged.

Busy practices are a little more tricky to manage, especially when patients are perhaps used to that practice being a little slower and quieter. This fact was made obvious to me last summer when the back-to-school rush started in June and barely teetered out by September! Instead of getting folks in the same day or next day, we were booked out a solid week. I was grateful to be so busy, but I was sad not to provide my patients with the convenience to which they were accustomed.

As a result of last summer’s experience, my staff and I put some serious thought into how the practice was running and how we could increase our efficiency to allow more patients onto a day’s schedule without negatively affecting each patient’s experience in our practice. In other words, we brainstormed ways to help more people each day without increasing wait time, decreasing patient/doctor interaction, or generally decreasing the quality of care that we value so highly.

Starting sometime in Fall 2014, we ramped up our schedule to accommodate more patients each day. We identified times that we often were ahead of schedule, and we squeezed exams into those times! Although we sometimes found ourselves with a stack of charts waiting for us at the end of packed days, we were happy with the results and felt like patient care had been unaffected.

Fast-forward to January 2015. Apparently boosted by large numbers of patients whose insurance benefits reset at year’s end, our schedule was bursting at the seams on a daily basis. Add in some staff turnover, and we were hurting to keep up with both our schedule and our paperwork. Although we felt good about our overall effort, we definitely recognized situations where higher wait times or lack of organization hindered our ability to exceed our patients’ expectations.

So here’s the growing pain: fighting the balance between not wanting to make patients wait a week to schedule an exam and not making patients wait 10-20 minutes in our office for their scheduled exams. It’s not a situation I take lightly, as I both value the convenience that I like to offer our patients and respect my patients’ time and need to get out of my office in a reasonable interval.

In response to this lengthy preamble, I present an exciting new development in our office: my staff of one has now doubled to two, at least for the busy summer season. Although having an assistant in my small exam room with me and my patients makes for tight quarters, it allows me to focus on giving great care while my assistant takes care of the charting that normal cramps my schedule. In the two weeks since we started this experiment, I’m happy to say that wait times are generally non-existent! We are fine-tuning our new roles within the office, and I’m excited to see how we handle the summer load and maintain a shorter time of being booked out compared to last year.

A note for those who like to drop in for appointments: scheduled times are always welcome and recommended to make things more predictable for everyone and to decrease the amount of time you have to spend waiting in our office. However, I am confident that our new office team will allow us to more effectively handle walk-in appointments without inconveniencing our scheduled patients. Be prepared to wait a few extra minutes if you don’t have a scheduled appointment, though 🙂

This has been a long time coming, and I’m grateful to our many patients who have helped us grow the practice to this point. Rest assured that we will continue to look for new ways to increase efficiency and maintain the high level of care and service that we love to give to you, your family, and your friends!

Dr. G

Test Driving a Cataract

Gratefully, I have not yet reached the point of requiring or even thinking about requiring cataract surgery. Most of us (human beings) will need to have the cataract conversation with our optometrist sometime in our early to mid seventies; and, well, let’s just say I still have an 8-month-old baby at home. Recently, however, I had an experience that gave me a brief and unsettling glimpse at what may lay ahead for me in a few decades.

With my family out of town, I decided to head up to the mountains for some late-season skiing. Although recent snows made for a great day on the slopes, they also contributed to some slushy driving on the way up.

Unfortunately, I did not check that my windshield wiper fluid was up to an adequate level; and with all the muck being thrown onto my windshield from fellow cars, I soon found that my wiper fluid ran out completely. I did my best to wipe the windshield immediately, while the muddy water was still wet; but I was soon left with a frighteningly opaque film that made it difficult to navigate the road, especially when hit with glare from the sun.

As soon as I could, I pulled over in a safe area to grab some snow that I could use to wipe off the mud. Although this got me back down to ground zero, within minutes of returning to the road I was back in the same predicament, and I knew there would be no stopping until I got to the next town. Obviously I’m here to tell the tale, so all’s well that ends well, but I can tell you it was not a comfortable experience at the time.

By now you’re probably asking yourself what in the world this has to do with cataracts. Well, on pretty much a daily basis, I use the analogy of a dirty windshield to describe cataracts. If that windshield is dirty, it doesn’t matter how good your prescription is – you can’t see as well as you should. Glare definitely becomes an issue. And because that windshield (cataract) gets worse bit by bit, sometimes it seems like you’re doing fine, and all of a sudden you realize you’re in trouble.

I didn’t realize just how apt this windshield analogy was until I lived through it myself. If you or a loved one has ever been told they have cataracts, an annual comprehensive eye exam is vitally important to ensure that vision hasn’t gotten worse than you think!

 

Why the Vision Exam is so Confusing

I’ve always said I feel like I should have a mental health professional stationed outside my office to help repair my patients’ damaged psyches following the vision test.  I say this not because of any self-professed deficiency in my exam technique, but rather due to the nature of the exam itself: it is at times frustrating, confusing, or both.

The reason for vision-test-related frustration is mostly two-fold.  First, the best way to refine and pinpoint a glasses prescription is to rule out all of the power options that DON’T work.  For example, to arrive at a prescription of -1.00D (D stands for diopters, but that’s another conversation), I would want to confirm that neither -0.75 nor -1.25 looks as good.  That’s already two different sets of “Which is better, 1 or 2?” right there.  And sometimes – especially for younger patients whose focusing muscles can mask their prescription somewhat – both choices look pretty identical, so we go back and forth a few times and have tough decisions to make.

The second cause of eye exam stress is that certain parts of the test are confusing and/or counterintuitive – I’m looking at you, astigmatism test!  To test for astigmatism, we introduce a lens called the Jackson Cross Cylinder (JCC).  Without getting into too much gory detail (too late?), as we use the JCC to test astigmatism, the goal is actually to EQUALIZE the BLUR between the two choices.  We don’t even care of either/both choices look clear; we just want them to look the same.  I try to prepare my patients beforehand that both choices may look blurry, but inevitably I’ll get patients who uneasily state “they both look pretty bad.”  Yup, they do.  Once I’ve gotten the measurements I need – again, trying to bracket by finding what DOESN’T look better – I remove the JCC and the image is magically a lot clearer.  Hopefully I can get to that point before my patient has a heart attack.

Most patients who have been through this crazy dance before take it in stride and accept that, in the end, they can expect to see well; but I don’t blame anyone who doesn’t look forward to the vision test.  It’s like what people say about most standardized tests, except even more true – you can’t study for it.

Better equipment, better prescriptions

Anyone who comes into my office will know that I’m a bit of a gadget freak.  I believe in technology and its ability to improve the quality of an eye exam.  From a health perspective, I love what the Optomap Retinal Exam allows me to see in the back of a patient’s eye, without even needing to put dilating drops in their eyes.

My love for things that are gadgety and automated extends to checking glasses prescriptions as well.  Whereas many offices are still using equipment that hasn’t been considered cutting-edge for twenty or thirty years, I’m fortunate to have a fully 21st century office.  First, an automated machine measures the power and curvature of my patient’s eye and gives an excellent starting point to refine for the glasses prescription.  At the touch of a button, this measurement imports directly to a small computer in my exam room, which controls the machine that sits against my patient’s face to flip lenses and finalize the glasses prescription.

To be honest, when I first started using the automated refraction equipment, I thought it was really just a dolled-up version of the older equipment.  However, I’ve come to greatly appreciate its accuracy and efficiency when determining my patients’ prescriptions.  By starting with a more accurate initial measurement, not only is the end result more accurate, but it also takes less time to arrive at that prescription.  Not to mention the fact that both the patient and I are saved from the endless “1 or 2” questions (not eliminated, but definitely reduced!).  Also, the computerized controls allow me to refine certain aspects of the prescription more exactly than I could with older machines and their less precise dials.

None of this is meant to take away from other doctors and what they are able to accomplish with their equipment.  I’m just very grateful for my equipment and absolutely believe that it gives me the best opportunity to give my patients glasses and contacts that they will love!

Why We Image Everyone

Anyone who’s been to our office since January 2012 should know that we have a machine called the Optomap, which allows me to examine my patients’ retinal health through a wide-field digital image, generally without the need for dilating drops.  I am a huge fan of the Optomap and absolutely believe it allows me to give my patients a better exam than I could without this technology.

Because of my personal belief in the Optomap, as well as a desire to streamline patient flow, we typically take Optomap images on every patient.  This gives every patient the opportunity to discuss the pro’s and con’s of the procedure with me before deciding yay or nay, without my having to send patients back and forth between rooms to have images taken (roughly 2/3 of my patients choose the Optomap, so that would be a lot of shuffling!).

Along with the benefits of the Optomap, I also discuss that using the images adds $30 to the cost of the exam, and anyone who prefers to avoid this extra cost may opt out of using the images and have their eyes dilated instead.

Every once in awhile, I encounter a patient who gives me the stink eye after my Optomap explanation.  I can tell what they’re thinking, whether or not they actually express it verbally: “You’re trying to force me into using these pictures you already took just so you can charge me extra!”

My blanket answer to anyone who may feel this way: I’m absolutely not trying to force you. I do believe in the technology and would love for all of my patients to choose it, but I try to make it very obvious that dilation is still an option for anyone who doesn’t want the additional charge of the Optomap.  I do want the opportunity to explain the benefits of the procedure before you reject it off-hand, because I believe it’s in your best interest to use the images.  And again, as stated above, it is more efficient in our office to take images on everyone instead of shuffling patients back and forth between rooms.  If you come into my office knowing that you’re 100% not interested in the Optomap, we will be happy to save you and us the two minutes it takes for imaging.  Just let us know!

My Optometry Turn-ons

When I first graduated from optometry school, I assumed that as I practiced I would find an aspect of optometry that particularly interested me and could turn into somewhat of a specialty.  Now that I’m a few years removed from optometry school, here are a few things I’ve realized I’m passionate about:

1) Communication.  I feel strongly that every patient leaving my office should understand the current state of their eyes and their options for correcting any problems with their eyes.  I try to be very clear about all this during the exam, and if anyone sends me an email after their exam asking questions, I typically send a pretty detailed reply to make sure nothing is left unsaid or under-explained.

2) Good prescriptions.  Whether for glasses or contacts, I want things spot-on.  I was extremely picky about my vision growing up – probably to a fault – and I am picky about my patients’ vision.  This is why if you come in saying you recently got a glasses prescription somewhere else and only want contacts from me, I’ll still remeasure your glasses prescription to make sure things are as exact as I want them (we use the glasses Rx to determine the contact lens Rx).  And yes, I am aware of the fine line between a thorough exam and causing my patients a nervous breakdown from having to answer “1 or 2” too many times 🙂

3) Having options.  My prescribing philosophy is to offer each of my patients any and all options that I would consider for myself if I had their eyes.  If I’m offering you a separate pair of glasses specifically for the computer, it’s because if I had your prescription, I would probably want those glasses.  If I think you would benefit from part-time or full-time contact lenses, or from LASIK, I try hard always to bring up these options and how they could help enrich your life.  Before I had LASIK, I had prescription glasses, prescription sunglasses, and daily disposable contacts for part-time wear.  I had options for whatever came my way.

4) Technology.  I love my optomap because I think it gives me a better view of the back of the eye and a more perfect comparison from year to year to check for change.  I love my computerized refraction system because it makes the process of checking glasses prescriptions more efficient and more precise.  I truly believe the exam I can give you with my technology is better than the tradition exam with all manual equipment and dilating drops in your eyes (which isn’t to say there is never a reason to use dilating drops, just fyi).

Why Buy Brand Name Contact Lens Solution?

I recently read an article extolling the virtues and explaining the science of Clear Care contact lens solution.  Within the article, its authors made the point that store brand (generic) versions of solutions are not and should not be considered interchangeable for  name brands.

Growing up, I was always taught that generic medications were the same as their brand-name counterpart, and I think a lot of people believe this to be true.  In the world of eyes, at least, such is not always the case.  Following are three reasons to buy brand name contact lens solution:

1) Inactive ingredients often vary between brand name and generic solutions, and these variations may result not only in decreased eye comfort (more irritating preservatives, etc) but also decreased efficacy for the intended task (not as effective for disinfection, etc).  One comparison would be to drink a glass of apple juice and assume you’re getting all the nutrition that you would receive from an apple – the main ingredients are the same, but sometimes the little details make a big difference!

2) Often overlooked in contact lens care is the importance of regularly changing your lens case.  Almost without fail, whenever a widespread problem with contact-lens related eye infections develops, it is found that a ridiculously high percentage of affected individuals had cases that were many months or even years old.  Brand name solutions typically give a new case with each bottle of solution, whereas many store brands do not.

3) With brand name solutions, you always know what you’re getting.  The formula doesn’t arbitrarily change, so if it works for you now, it should work for you next year (assuming you’re using it properly!).  Store brand solutions don’t have this reliability – if the company selling the solution finds a different manufacturer that they prefer for whatever reason (probably cost), they can switch whenever they want and you’ll never know.  But you may wonder why the solution all of a sudden stopped working well for you…

For more information about proper use of contact lens solution, read my previous post on the subject.

What’s in a frame: How to choose the right glasses for you

Over the years, I have come to realize that I am a lot pickier than about 98% of the general population – including opticians and other eye care professionals – when it comes to picking out the right pair of eyeglass frames.  Following are a few of my cardinal rules for finding a great fit for you.

1) Size matters!  Sometimes height (you don’t want to cut off the reading power of your bifocals), but always width.  Many of today’s trendy styles are rectangular, and I feel like I’m always fighting to get my patients into frames that aren’t wider than their face.  A frame that’s too wide will put undue pressure on the bridge of your nose and the tops of your ears, even when adjusted as well as possible.  Additionally, especially if you have a stronger nearsighted prescription, choosing a frame that’s too wide for your face will result in really thick edges on your lenses.  Not only are thick lenses cosmetically unappealing, but they can also result in more dizziness or distortion when looking through your new glasses.

2) Adjustability can matter.  I love the look of chunky plastic frames as much as the next person (and I had a couple pairs before my LASIK surgery), but keep in mind that the thick plastic arms and lack of nosepads severely limit the extent to which these frames can be adjusted to fit your face.  Does this mean you shouldn’t consider plastic frames?  Absolutely not, but you’d better make sure they fit really well to begin with, as opposed to expecting that you’ll be able to adjust away a poor fit.

3) Weight can matter.  If you’ve never experienced problems with glasses becoming uncomfortable on your face, you can disregard this section.  If you HAVE had problems, or in general don’t like having glasses on your face, go for as light a pair of glasses as you can.  Rimless is great but can be expensive and is not available in all opticals.  Half-rim glasses are a good compromise, as are plastic frames or some of the newer titanium frames.  If you know you’re really hard on your glasses, titanium and/or some of the newer styles with flexible bridge and arms would be advisable, especially over a half-rim or rimless design.

Hopefully that helps get you started!  Obviously certain other styling elements should be considered, like fair-featured individuals generally not going for fat, black frames, but I won’t get into that here.  In a future blog, I will plan to go over considerations for which bells and whistles to choose for your lenses once you get the right frame; until then, happy shopping 🙂

 

 

Related articles

• Choosing the best eyeglasses for your face shape (fashionflu.com)

Help me help you

Every so often, a patient returns to my office within just a few months of their comprehensive eye exam, complaining of blurry or uncomfortable vision with their new glasses.  Of course I am happy to double check my measurements and see if some change is in order, but I often find that the situation could have been prevented a couple of different ways.

First and foremost, whenever you have an eye exam, bring as much information as possible regarding your current and/or preferred vision correction.  As an optometrist, my goal is not only to give you the clearest vision possible, but also to make it as easy as possible for you to adapt to your new glasses.  If I have no idea what correction you’ve been using, I also have no idea if I’m making a big enough change to give you a headache.  I have known people who almost seem to hold back information – because they don’t want to feel like the doctor is simply copying a previous prescription – but that sort of thinking can come back to bite you in the end.

If you do ever find yourself in the 2-4% of patients who have problems with their new glasses, my recommendation is first to stop by the optical department before ever seeing the doctor.  I would venture to say that at least 50% of glasses re-checks I see involve problems that could have been solved by the optical department through measuring or adjusting the glasses.  Especially if you are wearing a bifocal or progressive lens, stop by the optical first.

At the end of the day, prescriptions are variable, and mistakes can be made.  If your eyes were quite dry or irritated the day of your exam, your vision may change once your eyes are feeling better.  If your doctor saw 20 other people for exams the same day as you, statistics would suggest that at least one number on one person’s prescription was slightly off.  I definitely subscribe to the theory of “measure twice, cut once,” but no one is perfect.  If you can’t wear your new glasses that you paid good money for, please come in and let us help you!  The last thing we want is for those beautiful glasses to go in a desk drawer until next year.

LASIK Misconceptions

Having had LASIK myself, I try to bring up this option for vision correction with any and all patients who seem like good candidates.  After many such LASIK conversations, I’ve become aware of several widely held misconceptions or misunderstandings about the procedure.

1) Current-technology LASIK is completely blade free!  Many people are walking around swearing they’ll never have LASIK, simply because they saw a video ten years ago showing a little blade creating the flap for the procedure.  It’s all done with a laser now.

2) Not all LASIK is created equal.  Notice how above I said “current-technology” LASIK.  You know that radio commercial that advertised LASIK for $299 per eye?  I can almost assure you that’s for outdated technology – old lasers, still using the blade for the flap, etc.  These discount centers also often have many hidden costs, charging more for higher prescriptions than lower, charging more to upgrade to current technology, etc.  When comparing similar procedures and benefits between centers, the “discount” LASIK often doesn’t save much if any money.

3) 20/20 guarantees may do more harm than good.  We all want to feel like we “got our money’s worth” and have the best possible vision from our LASIK, but keep in mind that the possibility of developing complications increases every time you have another surgery.  If your surgery center has made a legally binding guarantee for 20/20 vision, they will be more likely to perform additional surgery where it is not truly warranted, thereby putting you at unnecessary risk.  Everyone heals differently, so even though statistics show that quality LASIK centers are able to give 20/20 vision to probably 95% of their patients, guarantees don’t really make sense.  Go with a great surgeon using the latest technology, and you’ll have the best chance of a fantastic outcome.

4) LASIK is designed to give great far vision, not so much close vision.  If you already have fantastic far vision and need help up close, you’re a better candidate for glasses or contacts.

That’s about it for now – feel free to post with any questions you may have about LASIK, or check out my prior post about refractive surgery.