optoblog.com

I have a bad habit of not staying in the actual convention approved hotel. This year, it’s not my fault because they were already booked up.
Last year I tried staying in the La Quinta Inn nearest the Portland Convention Center. We stayed there only one night because the room we got had the worst moldy-musty smell ever. We then went over to the GWCO approved Double Tree Lloyd Center and stayed the rest of the time. The only room they had was a tiny closet with a queen bed in it. My wife, two small kids, and I didn’t have enough room.
This year, I wanted to stay in a nice, big, clean smelling room with free high speed internet access. I found it in the Phoenix Inn Beaverton. They offer free wireless high speed access, and since I didn’t have a wireless card for my old laptop, they loaned me one for free. Just one hang up. I have an old Windows 98 machine which didn’t have drivers for a wireless PC card. I just went down to the 24 hour business center, plugged into the wall, downloaded the drivers from the internet, and voila, here I am making this post.
I knew I would be far away from the convention center. I was banking on using the MAX, and I was hoping the hotel shuttle would take me to the Sunset transit center, but the hotel shuttle only operates from 9-5 and only within a 5 mile radius. The good news is that the bus stop is very close, and total travel time to the convention is 1 hour. Not bad.
More tomorrow.

Tonight we’re packing, and tomorrow we’re heading for PDX! I love Portland. Very nice place. I lived in Forest Grove while going to school, but most of my social life was spent visiting friends in Hillsboro, Aloha, and Beaverton. We’d go to Portland all the time.
I’ve got a hotel that includes free high speed internet so that I can update this site nightly. Like I mentioned before, I’m going to blog GWCO. I hope to find lots of interesting things to report about from the CE and the exhibitors.
I know they always have stuff going on the evening of Wednesday, but I never go to that. They also have two classes in the morning on Sunday, but I don’t stay for those either. I’ll just be up for Thursday, Friday, and Saturday (10/13/05 to 10/15/05).
I’m going to tag all of the pictures I take with GWCO2005. I hope everyone else will do the same. I’ll have them posted with my account on Flickr. The most interesting ones I’ll also post here at optoblog.com.
In addition to posting pictures, I hope to find some interesting people who will agree to an interview. When I get some together, I’ll post a podcast on it. Off the top of my head, I want to ask about the latest in contact lenses, practice management and medical records software, and controversies in LASIK. Any topics you’d like to see covered?
If any of you will be taking pictures at GWCO, don’t forget to tag them with: GWCO2005

I haven’t been posting recently because we’re moving. I’m leaving Indian Health Service and starting a private practice in Utah, so I’ve been busy finalizing my business plan, pro forma, etc. and getting ready for moving all our stuff.
Next week is the annual Great Western Council of Optometry meeting (GWCO) in Portland, OR. I went last year and enjoyed it. Actually, this year I was really looking forward to the AAOpt meeting in San Diego, but I can’t due to schedule conflicts. The GCWO meeting is a good choice, though, plus I get to visit all our friends in Portland. My favorite meetings also include the Northern Rockies Optometric Conference in Jackson Hole, WY.
Anyway, I’m going to GWCO and I’m gonna blog it. They do that all the time in techie circles, but to my knowledge it’s not done very much in eye care practicioner circles. Probably because blogging hasn’t caught on much with doctors yet. But it will.
Look for me wearing an optoblog.com t-shirt underneath my hawaiian shirt.

Yesterday I had 5 minutes of my life wasted by a telephone scam.

My optician takes a call from a “Mike Randall” in California. I’m occupied at the moment, but he won’t leave his number. He says he’ll call back in a few minutes.

I’m free the next time he calls. I’ll loosely quote the conversation.

“Hi, I’m Mike from CSI in California. Listen, my boss asked me to call you because– You have a 4100 printer right?”

“Yes.” We do, in fact, have an HP laser 4100 printer.

“A customer nearby your location has been sent a supply of toner for the 4100, but the customer failed to notify my boss that they’d switched to a different model, so we’d like to call FedEx and tell them to reroute the package to your office.

“Okay. . .”

So, how do you spell your last name?

“L-A-N-G-F-O-R-D”

Okay, so I’ll send those on over. What was your zip code again?

That’s when one too many red flags went off. I had never had any contact with this person before. In my government setting (Indian Health Service), my supervisor asks for printer toner by making a requisition. Everything goes through the Supply Department. If we had ever done business with “CSI” (a rather dubious business name), then they would only have the supply department’s contact information, not my clinic number.

“Wait a minute, Mike. You are confusing me.”

“I’m confusing you? Well, let me explain. . .”Then he starts to launch into the same schpeel as before.

I interrupt him. “So, are you going to charge us for the toner?”

“Well, we would offer it to you at a dramatically reduced rate since it–“

“Do you realize you are calling a government facility?”

“Uh, yah. Uh, Health and Human Services, right?”

“Yes, and you see, in the government, everything is done by requisition. I am not the person you should be calling. I have nothing to do with ordering printer toner, and–”

CLICK. He hung up on me. I am positive this was some kind of scam. If he were from a real, reputable company, then he would not have hung up. He was also trying to confuse me. I’m sure if I hadn’t interrupted him, he would have continued with questions like:

“Oh, and I need to confirm your billing and shipping address.”
“Oh, and I need your credit card information to secure shipment for the toner.”

What I still don’t get is: how did he know I had an HP 4100 printer? Afterwards, I was thinking he could have guessed, since it’s a popular printer. If he guessed wrong, he could have danced around it. Now that I’m thinking about it, I wonder if my optician told him on the first phone call. I’ll have to ask her. I’ll bet he told her part of his schpeel and said toner and asked her about the model we have.

Anyway, I thought I’d give everyone a heads up that someone out there has targeted an optometrist for a scam. I’m sure you already have policies in place about your staff ordering stuff from people named Mike with CSI in California.

The is my second installment of Practice Names Never Used. (The first one appeared here.)

Bull’s Eye Center
Dr. Range Bull

One Eyed Clinic
Dr. Cy Clops

Snake Eye Clinic
Dr. Snake Unlucky

Pop Eye Clinic
Dr. I. Yam

Here is the link of Capt. Greg Ketcher, OD talking about his experience being deployed for Katrina. His original two week tour of duty has been extended.
Be sure to check out the pictures he links to.

Eyetel Imaging makes a product they call the DigiScope which they market to your family doctor (PCP). The way it works is your family doctor handling your diabetes medications can also save you a trip to your eye doctor by performing a “ten minute exam.” They dilate your eyes, take a picture, send it to Johns Hopkins, then recieve the results. This supposedly is better patient care because you are giving the patient a valuable service and saving them time. Of course, the family doc can bill for this (CPT code 92250), and if no problems, then don’t schedule with Dr. Eye, just revisit your PCP next year.

The Indian Health Service has been doing “teleophthalmology” for years using the IHS/Joslin Vision Network where remote facilities without an optometrist nearby use a tech to take retinal pictures which are analyzed at Phoenix Indian Medical Center. (Don’t quote me, but I believe optometrists are part of the reading/interpretation of the photos.) It’s a good idea considering Native Americans with diabetes have annual eye exams only 50-60% of the time. (Part due to no-shows, and part due to access to eyecare- not enough or no optometrists at location.)
So if we have a population that lacks access to eye care, a product/system like the DigiScope is a great idea. What if you live in a well populated area with lots of eye doctors around. Do you want your neighborhood PCP to go out and buy one of these?

Of course not! It cuts into our turf! They can’t do that, can they? When I get into private practice and if the local PCP decides to get one of these DigiScopes, then heck, I’ll start steeling his/her hypertensive patients. Yah, my state’s laws allow me to treat with any medication as long as it’s eye-related. Hypertensive retinopathy is eye-related, so I’ll be kicking out the lisinopril Rx’s left and right. I’ll have the patient come back for BP checks and everything. If it gets complicated, sure, I’ll refer to the “Blood Pressure Specialist.” How do you like them apples, PCPs-using-DigiScope?

Another note.
It’s been tattooed on our brains that before dilating, we must screen for possible angle closure by performing pupils, angles, and pressures. On their“Dilating Instructions” pamphlet, they simple ask about history of glaucoma and do a pen light test of angle depth. They cite the Baltimore Eye Survey as their justification for using only these two criteria to determine that it’s safe to dilate, but they actually reference a follow-up to the survey “Incidence of acute angle-closure glaucoma after pharmacologic mydriasis” published in the American Journal of Ophthalmology (Am J Ophthalmol. 1995 Dec;120(6):709-17.) Here is the abstract, and these are the quotes that stuck out to me:

. . .Of the 4,870 subjects whose eyes were dilated on screening examination, none developed acute angle-closure glaucoma. However, 38 patients of the 1,770 who were referred for definitive eye examination were judged to have occludable angles on the basis of gonioscopic methods. Of note, subjects aged 70 years and more were three times more likely to have occludable angles than those aged 40 to 69 years (P [less than] .004). . .These criteria provide 60.5% sensitivity and 93.3% specificity. CONCLUSION: If screening is performed accurately and the results are negative, the risk of dilating a potentially occludable angle was less than one in 333 subjects (negative predictive value, 0.997) in this population.

So if your family MD’s staff don’t properly apply the screening criteria, then roughly 2/100 patients could get occluded angles (the 38 of 1770 stat), but if they do it right, then 1/333. I’ll bet many family docs are willing to take those chances. It’s also interesting their pamphlet tells them to use tropicamide 0.5%. Since diabetics tend to dilate poorly, especially if they have brown eyes, I always use 1%. (I haven’t had a chance to use Paramyd because your federal government in strapped for cash, especially in IHS spending.)

Well, not exactly.
You keep you cell phone in your pocket and use a hands free headset. The new twist is the headset is integrated on your sunglasses or Rx glasses.
Very nice. The RAZRWIRE: a Motorola Bluetooth headset on an Oakley glasses package (O-luminum frame, XYZ optics, fabulous and trendy design) makes for an attractive package for your patients on the go.
Eye doctors in Portland, OR and Silicon Valley, CA should be all over this. Make sure you suggest it to any of your patients who take calls while in your chair. 😉

*Edit* Whoops. Someone brought to my attention that to get this deferment, you had to have had a loan before 1993. So disregard most of my lamenting below. Still, why would an established optometrist need a deferment? I would think they’d give it to us younger, income-deficient USPHS officers.

Holy Cow! All this time I’ve been paying back my student loans when I could have deferred them if they had come out with this sooner!
They have had Armed Forces and Peace Corps deferment for a long time, but the USPHS and NOAA deferment must be recent because the last time I checked the website 3 months ago, they didn’t have this.
I think I’m going to cry. I’ve been paying back my loans for the last 2 years because the IHS Loan Repayment program lately hasn’t had enough money to give more than one new award each year. The awards are based mostly on how remote you are, and while I’m in Montana, 2 hours from the closest Big Box Store, there are others more remote in places up in Alaska.
Getting paid half as much as an established practitioner, and 3/4 as much as classmates who went commercial hasn’t been easy. I like to think that the benefits make up for it, and they do; however, I would have liked to save the money towards starting my own practice. Oh well.
Now that I’m leaving, the Dept. of Education finally recognizes the USPHS.

*edit* The deferment may be used a maximum of 36 months.

Here is what your patients are reading. I can imagine what some future patient is going to ask me.

“Sheesh, doc. Even the local humor columnist got the laser eye surgery. How come you don’t get it?”

“Well,” I say. “I’m not a good candidate because my expectations are too high.” [I expect a good excellent result 100% of the time. There shouldn’t be corneal ectasia in a low risk patient for some undetermined reason. I expect to have great vision for the rest of my life without jeopardizing it with risky cosmetic surgery.]

Too bad this columnist never had the chance to wear the new silicone hyrogels when he was young. So, how come you, doctor, haven’t already got “some new eyeballs?”

*edit* You can follow up with humor columnist Robert Kirby. Apparently it has gone okay so far. It’s lucky to be in part of the 99% group.