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When I was in the United States Public Health Service detailed to the [American] Indian Health Service, they had started to transform the rules of uniform wear. Back in the day, PHS officers would just wear their uniform to work one day a week. When I arrived, the rule was now everyday.

And now in the further transformation of the corps, new memos have been handed down from RADM Steven K. Galson, M.D., M.P.H., Acting Surgeon General. Among them are:

• PPM 07-015 Phase out of the Service Blue Uniform, dated 28 August, 2007

The Service Blue uniform, also known as the Salt & Pepper, will be phased out and no longer be an authorized uniform of the PHS. Although a final date has not been established, the PPM specifies that this date shall not be later than 1 August, 2009. The Office of the Surgeon General recognizes that this policy has the potential to create consternation among officers.

• PPM 07-014 Wear of the Navy Uniform Sweater, dated 28 August, 2007

Presently, the sweater authorized for wear by our officers is that worn by the U. S. Army, utilizing PHS soft shoulder boards as insignia of rank and the name tag worn on the other authorized uniforms. There will be a transition towards wear of the sweater authorized by the U.S. Navy. The shoulder boards used will remain unchanged. Instead of the traditional name tag, this sweater requires the use of a leather patch with the officers’ name, rank and the letters USPHS embossed in gold. This new patch will be readily available at any Navy uniform store. Effective 1 January 2008 PHS officers are authorized to wear this sweater; however, they may continue to wear the Army sweater until 31 December 2008.

• PPM 07-013 Weekly Wear of the Battle Dress Uniform, dated 28 August, 2007

This PPM allows PHS officers to wear the Battle Dress Uniform (BDU) one day a week. I have designated Friday as the authorized day for wear of the BDU. Formerly use of this uniform was restricted for wear in austere settings, typically when responding to events such as natural disasters.

• PPM 07-012 Personal Appearance/Grooming Standards, dated 28 August, 2007

In the past, PHS officers were authorized to maintain a properly groomed beard in accordance to existing standards. Effective 1 January, 2008 beards are no longer authorized. Procedures will be established to accommodate those officers who cannot shave for medical reasons. In these cases there will be guidelines as to how the facial hair is to be groomed. Moustaches will continue to be authorized and groomed in accordance to existing standards.

Wow, so my favorite uniform, the historic Salt and Pepper, is being phased out. I’m glad the Acting Surgeon General acknowledges my consternation about this news. It has been our unique uniform ever since the Navy phased it out a long time ago. I’ll bet that the PHS is now phasing it out to be more in line with the Navy so that other service branches don’t think we’re some kind of weirdos who forgot how to dress properly.

For posterity’s sake, here’s me in 2005 when I was still on active duty in my favorite PHS uniform.

Now, for those of you who know anything about the Indian Health Service, clinics are usually located in very remote places, so many of the US PHS officers and civil service doctors/staff are a pretty relaxed group of people. A good bunch of them are out-doorsy types. Nobody puts on airs. And the people we serve are your humble American Indians whose culture has endured so many wrongs. I’m just curious to hear about what the effect of wearing BDUs once a week and uniforms every day will have, if any.

There are many Native American veterans, particularly Marines. They could be comfortable with others wearing uniforms, but I’m not sure how the majority of the people feel about receiving care from someone in uniform. Is this an issue or a non-issue?

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CooperVision’s newest lens, the Biofinity, is now available at Wal-Mart. They’re selling it for something like $49.87 (it’s a one month lens).
I guess my private practice is no longer the exclusive provider of Biofinity in the Cache Valley area.

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I just was contacted by Review of Optometry. Apparently, they didn’t want any comment from me, but they were hoping that I knew the name of an optometrist in Utah that is vocal about 1-800 type stuff (apparently not me, just any other Utah O.D.). So, Utah ODs if you want to comment on the whole 1800/Wal-Mart story, let me know so that l can pass on your information to Review of Optometry.

But I thought that if by some miracle R.Opt. makes a link to my site, I’d better update more about what I’ve discussed with others about the whole partnership with 1-800 and Wal-Mart since my original post. Of course, this has been a hot topic at Wal-MartOD.com and at other sites like the highly secretive society of ODwire (which I don’t read anymore because, hey, it’s a secret).

So in my last post, you read the e-mail that I immediately sent back to Wal-Mart HQ the moment I heard about the news. The next day I went to work, and to my utter amazement, my vision center manager thought the partnership was pretty cool. Why? Apparently, Wal-Mart currently buys their contacts directly from each company, so this partnership is supposed to make the process faster for the patient. It is also supposed to help lower costs since 1-800 and Wal-Mart can combine their buying power to ask for a deeper discount from the individual contact lens manufacturers.

Then the district manager called and expressed the same opinions, but also added that Wal-Mart would save money by transferring the expensive maintaining of walmart.com’s online contact lens sales to 1-800’s website. She also said that 1800 has a huge brand recognition. If you walk-up to someone on the street and ask them where one could go to buy contacts, something like 40% will say 1-800-Contacts.

So this tells me that Wal-Mart is using 1-800 as their sort of high recognition buying group. In my practice, I order most lenses through a buying group like Lensco, but then some lenses I just purchase through the manufacturer, and hard lenses I get through Valley Contax ( I know Lensco does hard lenses also, but Valley has the I-Kone and my alumni’s C.A.D. design.)

So is it a sin for Wal-Mart to get itself a buying group? Of course not, unless that buying group happens to belong to the Spawn of Satan. Okay, all kidding aside, I wrote the following follow-up e-mail to Dr. Patel:

…I would gladly be willing to recant anything I’ve said about 1800 CONTACTS if they would join the Vision Council of America, prominently display the “Check Yearly. See Clearly.” logo (checkyearly.com), erase from their site any directions for consumers to subvert doctor recommended expiration dates, and withdraw their lobbying efforts for government mandates on 2-year expiration dates.

You should include that as part of your bargain with them.

So, just because 1800 sells contacts online doesn’t make them my enemy. It’s their coaching of consumers to badger doctors about prescription expiration dates and worse, their lobbying for laws to mandate to doctors a minimum 2-year expiration date (which succeeded into become a Utah state law).

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Wal-Mart recently announced in a letter that they are “excited to announce a long term alliance between Wal-Mart/Sam’s Club and 1-800 CONTACTS..”

May Heaven help us, because 1-800 sure isn’t going to. I promptly wrote the following E-mail to Dr. Patel, Wal-Mart’s Director of Professional Relations:

Dr. Patel,
I would advise against any kind of alliance with 1-800 CONTACTS. You’re not the first one to try. Standard Optical, a Utah-based optical chain, aligned with this Utah-based contact lens reseller for a while, and it didn’t last long. You should talk with those in the know about why it didn’t work out.

1-800 is also militant about teaching the general public to force the doctor to make decisions not in their best interest. Everyone inside our industry acknowledges that yearly eye exams are important, but 1800’s own website indoctrinates consumers to mandate to their doctor that prescriptions should expire at the two year mark OR LATER. (see: http://www.1800contacts.com/docAndRx/DocRx-release-1.shtml ). As a Utah eye doctor, I already suffer with practicing in the only state in the nation with a minimum 2-year contact lens expiration date- thanks to 1800’s lobbying power in our Utah legislature.

I had a patient last year, whom if her prescription hadn’t expired, she wouldn’t have come back in to see me for her yearly exam. If she wouldn’t have had her yearly exam, I wouldn’t have noticed an FDT screening visual field defect and reduced vision in one eye that wasn’t there the previous 2 yearly exams. If I wouldn’t have seen her, I couldn’t have referred her to the ophthalmologist who referred her for imaging which found the diagnosis of a brain tumor. A yearly eye exam saved her life, and under 1800’s reign, we are sure to miss these kinds of cases in the future.

If your only goal is to cut costs related to online sales at walmart.com, why not use 1800 as a nameless, behind the scenes
subcontractor? Giving them the limelight is the wrong move for Wal-Mart. An alliance with 1800 disgraces our reputation.

Also, I’ll quote from your FAQ (http://www.walmartod.com/clients/1814/docs/FAQ_Alliance.pdf): “Consumers in that same survey specifically cited cost and “purchasing them is inconvenient” as reasons for over-wearing their lenses.” Wal-Mart boasts about how something like 50% of a town’s population visit their store in any given week. How is stopping by the vision center on their bi-weekly pilgrimage inconvenient? What they meant to say is expensive or don’t have enough money. They expect to buy a box per eye and stretch it as long as possible. The real problem is that people expect a year supply of contacts to be less expensive than glasses just because you throw them away, and most also expect them to be a replacement for, not in addition to, glasses. Change those two perceptions, and you’ll increase your contact lens sales without help from the enemy of 1800 CONTACTS.

Please see my previous blog posts about 1800:
https://optoblog.com/2007/10/09/check-yearly-live-another-year/
https://optoblog.com/2007/07/30/patients-say-the-funniest-things/
https://optoblog.com/2007/03/19/1-800-eat-crap-and-die/

Sincerely,
David Langford, O.D.

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I’ve been having a problem with EyeMed vision insurance, so I’m taking it to the blogosphere since their support fails to find a solution.

When patients come in for an exam and contact lens fitting, their information sheet says $x copay for exam and $0 copay for Contact Lens fit and follow-up. All well, and good. I’m assuming that EyeMed will reimburse me $30 for my time and expertise in fitting contacts. Then when we go to eyemed.com and bill it, and it tells us that the patient owes the $30! What?!!

We call customer support, and they say that on his system, it says up to $55 maximum copay on CL fit and follow up, so we must have misread it.

It said $0 copay for CL fit and follow up in black and white on the patient’s insurance card. It said it on the benefits information when we preauthorized the exam online. What is the deal, EyeMed?

Meanwhile, I need to charge more money to the patient, but they’re going to have a cow about how we’re trying to rob them when EyeMed is to blame!

Please, EyeMed, fix your error on the website and send another letter to let your beneficiaries know that they will be paying for their contact lens evaluation.

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Back in November, there was a guy who came in and sat on a fabric-upholstered chair for a few minutes. After he got up and left, I just had to take this picture.

I’ll go out on a limb and guess that he works in a really dusty environment.

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My mentor in the Indian Health Service, CAPT Jerry Sherer, O.D. F.A.A.O, always used to tell me, “They always come in threes.”

“They” meaning unusual eye conditions that you have to manage within a short period. The other week, I had another example. Usually it’s some variety of red eye, but this time I had 3 cases of keratoconus…all in the same day…and two of them were back-to-back. And no, the individuals were unrelated.

So my question is, why do they come in threes? What is it about the universe that makes them come in threes? Do other health professionals see the same deal with threes? I’ll have to Google these questions and report back later.

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Officemate ExamWriter now comes with the long awaited “feature” of allowing you to scroll up and down with a mouse wheel.

Thank You!!!!

Glass-is-half-full thinking would make me want to curse you for making me mouse-click scroll for the last year and a half, but I’m going to try to stay positive.

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You can find the transcript of the last Republican debate at CNN.com. About 3/4 the way down, you will find the gun-related questions. (Just hit Ctrl+F and search “Gun”).

Here is how the transcript would read if I were running for POTUS:

Cooper: Mr. Langford, 90 seconds.

Langford: First of all, I don’t believe 90 seconds could possibly treat this topic fairly, so please see my campaign website where I have several essays, videos, and podcasts regarding the important subject of the second amendment.

Second, the term “gun control” is liberal terminology that doesn’t belong in the conservative republican vocabulary. Firearms Freedom is a more accurate description of what we’re talking about.

(Applause)

Third, gun registration by the government is the first step towards gun confiscation by the government, so unlike some of the other candidates, I will not tell you exactly how many firearms I own. I don’t want the government tearing down my door and stealing my guns like they did in New Orleans.

(Wild applause)

Cooper: Okay. Okay. Let’s quiet down.

(Swelling wild applause)

Alright, we’d better go to commercial break.

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Kevin, M.D. brings up the point that most doctors don’t e-mail their patients because of privacy laws. Another doctor getting a lot of press for his new practice style, Jay Parkinson, flaunts that he can do whatever he wants since he doesn’t take insurance.

Wow, makes me want to not take any insurance; however, I DO think that we can e-mail our patients as long as HIPAA rules are maintained. It’s my understanding that as long as the data is encrypted, we can communicate confidential information with patients. On my practice website, patients can e-mail me using a form. This form can be optionally encrypted before sending if they have confidential information to share.

This is all done using my public key. Only my private key with its password can decrypt the message. I didn’t go to the HIPAA Security Company store and buy it. It’s totally free if you know how. While I believe this system complies with the intent of HIPAA regulations, I can’t e-mail back a patient if they haven’t made themselves a cryptographic key pair for e-mail. I’ll bet only a very small percentage of people in the world even have one, and I’ll bet the percentage of doctors that have encrypted e-mail is even less than the general population. But I did it. It’s do-able. Sure, I’m a computer geek, but I learned computers the same way I learned eye doctoring; study and practice.

But the obscurity/confusion of how to implement encrypted e-mail communications is not the real reason doctors don’t use it. I don’t get paid to sit around and e-mail patients. I get paid for examining patients at the office. On-line communication tools work well for Dr. Parkinson since that is his mode of practice. But my patients don’t pay me a subscription, so any e-mail that I have with them would most likely say something like, “I would recommend you come in for an appointment.”

By the way, I’ve had this encrypted form feature on my website for over 18 months, and no one has ever used it nor have they used my public key to send me an encrypted e-mail.

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