optoblog.com

Note: This is a little essay that I wrote for a competition. I didn’t win, probably because it was more of a rant than an actual essay. So, here it is. Take it for what it’s worth.

I am an optometric physician. I began blogging when my friend, Josh Bancroft of tinyscreenfuls.com, introduced me to it in October of 2004. I soon caught the vision of RSS and blogs, and finally started my own at optoblog.com. I had intended it to be the start of something: optometrists blogging about all things eye doctor and also giving feedback to the ophthalmic product industry. Unfortunately, no one else bothered to join the conversation (at least publicly, but more about that later). Why are there not more optometrists, or for that matter other medical professionals, blogging?

The ophthalmic industry knows about blogging and even podcasting. Acuvue contact lenses had a miserable but thankfully short-lived podcast aimed at teenage girl consumers. Dryeyeblog.com is written by a doctor of one ophthalmic drug company who refutes the research of another ophthalmic drug company. But most blogs are short lived, or at least infrequently updated like Practicemanagementblog.com and Optometric Office Design News. It seems that organizations in the industry heard something along the lines of Scoble’s book which preaches blogging will make your business grow drastically, they tried it out for a while, it probably didn’t bring in the big returns, and so they abandoned their blog.

It could be their fault, but then again, are there any eye doctors out there listening? Optometrists are traditionally slow adopters when it comes to technology. Apparently the people at Standard Optical haven’t even heard of a remarkable device called a door for their exam room (they use curtains). Have you ever been to some optical shop, and the equipment looked like it was older than your parents? It probably was. Now try to get these doctors to pay attention to what is being said on the internet.

But there are some optometrists that are net savvy, but what are they doing? They finally caught on to bulletin boards. The biggest one I know of is ODwire; however, membership is exclusive. They don’t want their conversations to be seen by the general public. They think it’s a secret that doctors actually want to make money, so they don’t share with the world their suggestions with each other on how to grow their business. They complain about ophthalmic product companies, but can ophthalmic product companies join the private board? I think so, but I don’t know of more than one. I think the secrecy and exclusive membership choke the conversation.

The only other optometrist that I know of who blogs faithfully doesn’t even blog about optometry. She blogs about knitting and has 120 Bloglines subscribers! There are a couple optometry school student (oppie) bloggers. The new oppies are more with it in terms of blogging, but they could do so much more. During the 4th year while out on preceptorship, there is a required 4 week correspondence class. The teacher actually uses the internet to bring together students from all over the country and give one online clinical case presentation each; but what about blogging? Imagine if the only requirement of the class was that you maintain a year round blog about interesting cases you see. Instead of enlightening a small group with just one case report, you could discuss multiple cases with the entire class! Imagine school sanctioned blogging! Think of all the information we could learn.

But that’s another problem. Everyone is afraid of lawsuits. What if the information we share with each other gets us in trouble? I think that’s why more medical professionals don’t blog. They don’t want to be accused of dispensing medical advice to someone for whom it wasn’t intended. Imagine a doctor distilling the virtues of anti-oxidant vitamins, so a person happens upon the blog entry and decides to take them…particularly vitamin A…in megadoses…and dies because the person smokes like a chimney.

In treating a patient, we doctors like to get paid so we can pay for malpractice insurance premiums which covers the risk of treating patients. We don’t get paid for blogging. The last thing we need is the family of some chain-smoking gramma from a different state to sue us out of business.

Aside from medical-condition-related content, what about conversing regarding the ophthalmic product industry? If more optometrists would blog about vendors publically, then maybe the corporations would know how to make their product better. I’ve written reviews of certain products marketed towards eye doctors, like electronic health record (EHR) and practice management (PIM) software, and a VIP from the company responded to my blog entry. These vendors must be surfing around looking for comments about them because I didn’t contact most of them. I am terribly dismayed by PIM/EHR shortcomings and the lack of features that I desire, but at least they have an ear out. But what annoys me about the vendors is most would choose to respond to me offline, well…e-mail. So instead of everyone seeing their counterpoints, only I could read it.

I wish the ophthalmic vendors themselves would start blogs. I would like to read about what they are working on next instead of waiting for a convention or a biased review in an industry rag. I would like to hear from the horse’s mouth why I should use their current products, and it would be nice to know who these people are in the first place. Industry rags have a virtual monopoly on ophthalmic product information dissemination. Blogs could shift the balance of power, but only if optometrists ever get savvy enough to figure out how to use a feed aggregator.

But even if the vendors did start blogging, I worry it would be short lived or just considered a cool new way to advertise. A blog should be viewed like having a telephone: just one more needed way to communicate with people. It’s not the savior, be all and end all of a marketing plan. It is one more useful tool of communication.

So why do I blog? I admit that I haven’t been blogging a lot on my optoblog.com website. I have shifted most of my blogging to my practice website with an audience of potential and current patients. My blog intended for other optometrists and vendors has petered out because, quite frankly, I don’t think anyone is listening. If an eye doctor is walking alone in a forest and stubs his toe, does he cuss up a blue streak? Maybe, but if no one is paying attention, then why make a big fuss? When an audience isn’t there, it takes a lot of internal motivation to keep blogging. I don’t do it for therapy. I was hoping to be part of a conversation, but the problem is all the conversations seem to be behind closed doors (or bulletin boards).

Dr. Neil B. Gailmard, OD, MBA, FAAO, a practice consultant and editor of Optometric Management Tip of the Week says in his latest tip that private practice optometry still has a chance. Actually, when I read the tip, it was more about how it’s still possible for new/recent grads to open up cold. I agree with that because I just did.

He still didn’t convince me that private practice has a bright future. Acquiring financing is not the same thing as making money. Big box stores can sell eyewear for less than I can buy it, and while I can argue until I’m blue in the face that my lenses are better, it still doesn’t change the general public perception. Private practice competitor Luxottica, parent of Lenscrafters, keeps getting all the trendy, hot brand names like D&G, Prada, and even Tiffany’s to plaster on their frames. Vision plans reimburse less for eye exams than Medicare. Big box optometrists charge about as much for exams as what we eventually…someday…hopefully will get reimbursed from insurance. So that smaller cut of cash up front starts to make sense except private practice has 60-75% overhead while they have ~20%.

So, someone blog a compelling argument that private practice is here to stay instead of going the way of the pharmacist.

In the interest of full disclosure, we should tell our patients that two ophthalmologists are using lasers to zap away floaters.

CNN reports on two ophthalmologists, Dr. John Karickhoff of Virginia and Dr. Scott Geller of Florida, who use lasers to obliterate the floaters “to a very great extent.”

I wish I lived in Oklahoma. I’d dedicate my whole practice to this money making machine.

A few list items for your consideration:

1. Optometrists who fit one contact lens during the initial lens evaluation, but on the follow-up visit (if they even have one) write a prescription for 4 or 5 different contact lenses. If you don’t try them on their eyes, why even bother charging for an exam? Once I changed only the spherical power on a toric lens, and it caused the patient to have ghosting, so we went back to the original trial power and no ghosting. I can’t imagine not doing a trial of for each brand of lens that you want to prescribe when even different powers of the same brand can cause problems.
2. Optometrists who don’t dilate anyone, or if they do, they don’t have a BIO. It’s deplorable how many practices I’ve observed without a decent BIO (if they have one). If you don’t dilate, it’s gonna catch up to you. If you dilate, do it right and use a BIO. Go buy a nice BIO. ‘Nuf said.
3. Optometrists who give 5 minute eye exams. Everyone knows it’s not possible to give a good eye exam in five minutes, even your patients. A case history takes 5 minutes. If you’re entire basic eye exam takes five minutes, I have no idea what you’re doing, but it’s probably not ethical and/or legal. Step up your exams to 45 minutes (patient time) and do a thorough job. I like to do initial 15 minutes for case Hx, entrance skills, refraction, and IOP. Then let patient’s dilatation activate for 15 minutes, then return for last 15 minutes for eye health evaluation, recommendations, and patient education. Throw in an extra 10-15 minutes if they wear contact lenses.
4. Eye doctors who prescribe old material contact lenses. We have PC-hydrogel and silicone hydrogel now-a-days. Wake up and smell your retirement, you old fogy, if you’re not prescribing them as your main lenses. They are much more healthy on the eyes. I think people with corneal neovascularization should sue if their doctor keeps them in plastic hydrogels if silicone hydrogels are available.
5. Eye doctors who tell their patients that it’s okay to stretch their contact lenses beyond what is recommended by the manufacturer. I can’t count how many patients were astonished when I told them that all Acuvue lenses are 2 week replacement. They think I’m the liar, when it’s their prior sleazy optometrist who said it’s okay to wear an AV lens for a month. Don’t you realize that what ever you tell your patient regarding disposal frequency, they’ll probably double it?! Do you think you’re doing them a favor? You’re not because I’ve seen the corneal neovascularization, GPC, and the infections to prove that it IS a huge problem.

As if it weren’t enough that I had to buy a piece of software for $6000, I have to pay a yearly maintenance fee or else the software becomes disabled. Last year I remember them telling me it was going to be around $1000. I got my first notice that I have to pay this fee, and guess what. It went up. To $1400.

I think it’s hilarious that in their “Dear Loyal OfficeMate Client” letter (I’m only loyal because the program locks and holds my records hostage if I don’t pay) they say that the “invoice reflects a slight increase over last year’s fee.”

SLIGHT! So they’re laughing all the way to the bank while I’m already at the bank…on my hands and knees…asking for a bigger line of credit.

I have Officemate, for better or worse. I have never been completely happy with it, but when I was doing research a year ago, the cost/benefit ratio for Officemate seemed like the best.

7.0 had been out for a while, and I was dismayed that no one had contacted me about upgrading. I guess because they have thousands of practices using it, they were doing a slow roll-out. I contacted them and asked for the new release, so they gave it to me (because I’m still paid up), and luckily the newer version 7.1 had just been released which fixed some of the bugs in 7.0.

There is no striking new look in 7.1 versus 6.x. It looks identical except they made a new icon that looks cooler. In other software products, usually there is a whole new look/feel to the application when changing version whole numbers. Oh well.

The coolest new feature in my mind is the new Reports tab called Business Analysis. It includes an Insurance Profitability report. In my practice and at this point in time, EyeMed has 58% reimbursement ratio and VSP has 43%. When I installed it, the numbers were 52 and 49 respectively. Your numbers may vary, but I like the tool.

The scheduler also got some new worthwhile features like the Today View and Confirmation, but I still hate it. It’s like they are thinking about what would be easier for the programmer to design and implement rather than what the user would like their experience to be. I don’t think it should be that hard to block off an afternoon or a day. Also, if you schedule someone without first making them a patient in your database, they won’t show up on your Quick List as having an appointment.

The Exam Writer also got some new features. Any e-docs appear at the bottom of the chart. If there is an glasses Rx already entered, the coding will automatically pull up myopia, hyperopia, etc. The spectacle and contact lens data entry are in separate windows. Unfortunately they forgot that sometimes contact lenses do have an add. I also hate, hate, hate the new design of the printed prescriptions for glasses, contacts, and meds. When it was smaller it was better because I had a pre-printed sheet with a “vision report” for the glasses and a pre-printed sheet with contact lens care and wear schedule for the contact lens prescriptions. Now they made the officemate printed prescriptions take up so much room on a sheet (3/4 of a page) that my old pre-printed forms are useless. But that won’t effect everyone.

Was does effect everyone is the confusion the officemate prescriptions cause. They have boxes for “Lens Information” that include Product name, category, material, and tint. I’m sorry, but that is for the optical order printout, not the Rx that I give to the patient in the exam room. The fields don’t even populate because I print it out before they are even sent to the optical.

Does anyone know how to change the template back to the old one for prescriptions?

Anyway, my upgrade process was smooth. I backed up everything before attempting it, and then Officemate backed it up again while converting it. The database back end is still a Microsoft product, but it needed to update the different tables and fields and junk I guess. I keep my database in a MS Server 2003 box with Raid 5. Officemate just requires a mapped network folder to store all the files. If I could do it over again, I would probably go cheaper by having just a file server that could make backups. On the other hand it is nice to have RAID 5 for back-up reasons, but paid a lot of money for that MS Server 2003 and client licenses. (edited to add: I didn’t mean backups, I meant in case of drive failure. I make encrypted backups everyday that I take off site in case of fire.)

I had heard all about 7.1’s ability to interface with VSP/Eyefinity, but I was dismayed that you must pay even more for this feature. I’ve already shelled out too much money for an equipment interface, so I don’t have anything left for VSP integration. I’ll just keep using eyefinity.com for free.

I’ve never used Report Writer. I don’t get it because if I had that much time to go through and enter in the options for the report, I might as well type it up from scratch. Why doesn’t it go through the exam and pick out the information instead of me having to select Established Patient, Reason for Visit, etc. You know, all I really want is something that can tell what diagnosis codes I billed, and ask me if I want to print out a patient information sheet for those diagnoses. That would be useful.

Anyway, the new reports are the only thing in my mind writing home about with Officemate 7.1. What did you think?

US News and World Report did a profile of optometrists and other career paths like pharmacy.

Pharmacy has less school and the same amount of money. Does anyone ever wish they’d become a pharmacist? I know that those ODs in multi-doctor power practices have much more income potential. Heck, I’ve even see figures that some big box store optometrists gross over $225,000 per year; but the majority of corporate optometrists are stuck around $100K per year.

The pharmacy profession, which also averages a gross income of ~$100K, converted to almost exclusively a corporate setting a long time ago. Is that where our profession is going? I see a lot of parallels, except that their schooling is much cheaper, so they have less student loans. Optometry school students on average have close to $150K in student loans since the majority of the schools are private. Idaho, Utah, and Wyoming all have pharmacy schools, so that means students could get in-state tuition. A pharmacy program is longer than a regular bachelor degree, but less time than a doctor of optometry degree. If I was an undergrad again thinking about a comfortably paying career, what would I choose? (Except I forgot to say that pharmacists have to deal with more masked armed robbers than optometrists.)

It seems to me that the only corporate optometrists making a ton of money are the ones who own the contact on the big box location, but they don’t actually work there. They take a cut from the young optometrist actually working there while they do nothing to improve that location. I worked in a location where there wasn’t even a foreign body kit, yet the doctor took a 30% cut from the gross exam fees! Sure, some leases take a percentage from the fees, but this location had a very low flat rate rent, so this particular doctor was making a huge profit from multiple big box locations for doing absolutely nothing.

Hey big box optical district managers, don’t fall prey to thinking that if you give a single greedy O.D. multiple leases that staffing it is not your problem. You will see more turnover and patient care suffers along with patient satisfaction. Frequently you have to settle for a 4 day lease anyway. If you give the lease to the young O.D. who actually works there, and you could probably get a 5 day lease out of him/her and continuity of care from year to year.

If I’m going to send a ton of Crizal Alize with Clear Guard in my office, I would like people beating down the doors to get it.  We’ve got to create national devotion to the brand, and then it would be easier for me to sell.  When we bring up coatings, people start to distrust us like used car salesman.  They don’t seem to know that coatings MAKE the lens valuable.  We need to create devotion beyond reason to Crizal.  Religious, fanatical devotion.

Would it be possible for you to integrate a logo on the lens that people could see, at least up close.  I’m not talking about the tiny marks on a PAL.  I’m talking about it being analogous to how frames have a big ol’ D&G or a Swoosh on the temple.  Why can’t the lenses have a distinguished brand somehow etched in there.  Lenses have probably been analogous to diamonds (and a frame to the ring mount) in the past, so maybe since diamonds are best when clear, we wanted our lenses to be free from things like a logo or branding.

But considering that lenses are the majority expense in a pair of most of the glasses I sell, it would be nice to have the customer be able to show it off.  “Look at my glasses, they have the Crizal logo on there.  I only buy the best.”  With technology, there has to be a way to make lenses with Crizal identifiable to anyone.  I don’t care if it’s a distinctive shape, a big ol’ laser mark, or just gluing a little plaque on there, I want it readily identifiable.

And I’m not talking about the breathe on it and, ooh, it says Crizal.  I want something that screams Crizal at all times.

Also, I’ve seen the faint green AR reflection on all eye glasses in almost every movie and T.V. show that I’ve seen since 1999.  Is there anyway you could let people know that that’s you?  That’s Crizal!

Could you make fun of people walking around in uncoated lenses and show everyone around them being distracted by the glare and inability to see the person’s eyes?

Just a suggestion,
David Langford, O.D.

P.S. If anyone else is reading this, I firmly believe Crizal Alize’ with Clear Guard is the best lens treatment on the market.  Just about everyone should have it.  The problem is not enough people know of it’s value; hence, they just think I’m trying to sell them something when I recommend it.

I’ve been monitoring the mentions of optometrists and eye exams in the blogosphere for a while. I think we suffer from a public relations problem.
One blogger reports about a bad optometrist office encounter. A commenter says, “And why do eye doctors always have bad breath? It’s awful…”

It’s also scary to think that whatever one says to a patient in an exam room could be shared with the entire world on their blog.

But don’t worry. We could always go to ODwire…shielded from prying eyes by an exclusive forum…and complain about “difficult” patients. But would that solve the problem?

I think there is an obvious gap between what we eye doctors take for granted and what the general public knows. I’ve actually had a patient who had know idea that it was normal to loose his near focusing ability after age forty. No idea!

But who has the time, or even interest, to learn more trivia about eyecare stuff? “I can’t see. Fix me up, doc, and don’t try anything funny like an air-puff or getting your face uncomfortably close to my face.”

I think the industry needs better, quicker ways to evaluate eye exams. Yes, there is the “30 second refraction” out there, but who has that kind of cash? Yes, there is the Optomap to reduce the amount of dilated eye exams in low risk patients, but again, how many of us can afford the lease and do we really trust it to not miss something and what about observing the vitreous?

New technology in the consumer world is expensive at first, but then the price rapidly goes down. The eyecare equipment prices always stay steady, if not increase. I just assume it’s because there are only so many people in the world that can buy a digital refractor or a laser scanning ophthalmoscope.

I think we could partly solve our image problem if more optometrists used better technology in their exam suites. For that to happen, prices must come down.

“What’s good for the practice is good for the patient. What’s good for the patient is good for the practice,” say the practice consultants.

Delivering state-of-the-art eyecare costs more than what you pay for an exam at the vision barn. Some people (especially large families where everyone needs an eye exam, glasses, and contacts every year) don’t want to spend the money on quality eyecare. Vision plans sure as heck don’t want to reimburse what it takes, and people over forty get sticker shock when you price their designer brand frames, progressive addition lenses, and quality anti-reflective/scratch lens treatments.

But some people get it. Yes, my glasses help me see, but really they are like jewelry or a fashion accessory that complements my wardrobe. It’s an extension of my personality, or even a personality unto itself. Those people are willing to spend what it takes on eyewear. But I’ll still get a few who wig out on the eye drops.

Can we get a program running in the elementary schools explaining all the parts of an eye exam? That way every single American will know what to expect during an eye exam, so they won’t freak out about its little inconveniences a la air puff, eye drops, and bright lights. And honestly, would one expect to get a prostate exam without “the finger.” A little air-puff and bright light once a year won’t kill you. Suck it up, you pansy. Or go invent something that gives me the same information while being less invasive. And sell it cheap so I can actually get it for my office.

Just had to vent secondary to bad press in the blogosphere. I rambled, but I’m good now.

I signed up for Amazon.com’s referral reward program. When someone clicks through an amazon link and actually buys something (and doesn’t return it), then you get a kick-back for having the link there. I’m switching optoblog.com over to this Amazon advertising because google adsense hasn’t paid me anything, and it’s just annoying.

I’m also doing a “store” on my practice website. I wonder if it will earn anything. After giving a sample of a contact lens solution or a dry eye drop, I’ve had patients ask me, “Where can I buy this?”

Now I can tell them, go to my practice website! Does anyone want to argue for or against the ethics of that?