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Guy with thick accent (Indian?) holding up $9.99 sunglasses: Do you have anything cheaper than this?
Optician: Over in jewelry there are more sunglasses.
Guy: Yes. Cheaper?
Optician: I don’t know for sure, but probably a few might be cheaper.
Guy just stands there.
Optician pointing to jewelry: Over in jewelry.
Guy: Where?
Optician: Look right over there. Jewelry.
Guy: Sunglasses?
Optician: Yes, a different selection over in jewelry.
Guy: Cheaper?
Optician: You’ll have to look and see.

I did an eye exam almost 3 years ago. The patient paid their copay. A couple weeks later the insurance paid the rest, a whopping $15. Almost three years later the insurance said their payment was made in error, so I have to remit to them a check for $15 or else a future EOB would have $15 deducted.
Whatever, they can deduct it, but I ain’t sending a check. Do they expect me to send the patient a statement for $15 for an exam from three years ago? Never mind the patient has probably moved, and even if they haven’t, they will probably shrug off the statement like I did from the insurance.
A month later the insurance takes $15 from one of my EOB payments. Luckily I don’t bother billing the patient because a week later, they sent me a check for the same patient’s three-year-old visit!
Make up your mind, insurance company!
[UPDATED: Today BCBS sent me ANOTHER letter saying that they overpaid me for this patient when they repaid me! Eat poop, BlueCross!]

I had a patient who has a really big head and his regular size glasses were making an indented, red scar in front of his ears. Of course I recommend the largest style frame we have called FatHeadz. He finds one he likes, and it fits his head perfectly. The optician enters the order, but the lab calls and says they can’t make it. It turns out he has a small PD; therefore, they don’t make a lens blank large enough for his combo of large frame, small pd. Poor guy.

Tags: @optotrician, insurance, jewelry, pre-auricular scarring, sunwear

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There is a different vaccine nurse at the table in front of the V.C. every day!

I observed a guy with the biggest mustache I’ve ever beheld. Imagine walking around with a dresser comb under your nose all day. Then, later the same day I saw another guy with what is now the biggest mustache I’ve ever seen! Just think of a blond Yosimite Sam.

It is my experience that youth who have trouble with the NCT and dilation drops tend to be unsuccessful at learning to insert contact lenses. But a teenage boy surprised me recently when after 20 minutes of trying, I had him take the contacts home to practice. He returned for a followup being successful!

This week I had a day where 100% of my exams were contact lens patients! Crazy! (It’s usually ~50%.)

Tags: @optotrician, contacts

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I would like to propose that someone perform a series of studies regarding living a low carbohydrate/high fat diet and its effect on inflammation-related eye disease.

I read The Art and Science of Low Carbohydrate Living: An Expert Guide to Making the Life-Saving Benefits of Carbohydrate Restriction Sustainable and Enjoyable by Drs. Stephen Phinney and Jeff Volek. An interesting conclusion is how our bodies become carbohydrate intolerant as we age, which pushes many people into metabolic syndrome, diabetes, and hyperlipidemia. It turns out that carbohydrates, by taxing our insulin response, cause inflammation.

Hence, the American Heart Association’s war on fatty food is misguided (see Good Calories, Bad Calories by Gary Taubes) because dietary fat is only bad in the presence of too much carb intake.  While there are some high omega-6 oils which increase inflammation, it is easy for people on Very Low Carbohydrate (VLC) diets to intake the good fats like olive oil, canola oil, high-oleic safflower oil, butter, animal fats, and coconut oil. In VLC diets, your daily Caloric intake is approximately 80% fat, 15% protein, and 5% carbohydrate.

Recent research, CE lectures, and trade articles have been advising us to tell our patients to increase their omega-3 fatty acid intake via Fish/Flaxseed oil pills.  With the latest research coming from Dr. Phinney et al, wouldn’t it be more responsible to educate them regarding the New Atkins/Paleo/VLC diets?

VLC diets are already proven to tighten diabetes control which we know decreases incidence of diabetic retinopathy. Logic tells me that Atkins/Paleo/VLC will soon be proven to reduce incidence and/or severity of macular degeneration, dry eye syndrome, and any eye condition related to inflammation.

So, anybody want to do some studies?

I’d start by visiting this helpful website and reading these books:

DISCLOSURES:

In 2010 I lost 35-45 pounds using the hCG diet, but could never keep off the last 10 lbs, so in 2012 I switched to the New Atkins. Now I easily maintain a 50 lb weight loss (221 to 170), and my body doesn’t even crave things like pizza and popcorn.
Also, if you click on the links above and actually buy a book, I get a tiny referral bonus from Amazon.

Tags: AMD, DES, diabetes, diet, disease, nutrition, patients, weight

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A urologist posted a sign at his office, and some people are going nuts.

So…I’m not sure I would pick that fight because I just want money in exchange for services, but if I felt that a certain person or entity were actively fighting against me obtaining patient volume and deserved fees, then yes, I would have to push back.

This doctor also put some literature in his waiting room about the negative effects of Obamacare and its timetable. Holy cow, imagine the left’s vitriol if you stuck a Bible in your waiting room! I put NRA magazines in my waiting area, and guys love them! I also put National Geographic in there too. You know, just to keep it balanced. I think it’s the doctor’s right to put any decent reading material he wants in the waiting room. No one is forcing them to read it. They can take their business somewhere else if they want.

I’ll bet 80% of my patients don’t even know what magazines I have in my waiting area since I don’t like to keep people waiting.

I’m still participating in Medicaid until it doesn’t make it worth my while. I don’t really agree that there is such a thing as government sponsored-medicaid, but for now I think of it as getting my own tax dollars back.

Anyway, I reserve the right to express my political, economic, and religious views to anyone who will listen, inside or outside the clinic. Just because I’m a doctor doesn’t mean I can’t be active in causes I believe in. However, I don’t think people pay me to preach to them. I’m pretty sure they came in for an eye exam. Plus I don’t have time to go off on political or religious rabbit trails because I hope the next patient is almost done with their paper work.

I don’t care what a patient’s political/religious/etc philosophy is. I don’t care if I have to speak to them in English or Spanish or through a family member interpreting, I just want a fee in exchange for a service, and I want to perform as many exams per day as possible.

Tags: doctors, Free Speech, Government, insurance, patients, politics

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Older female to college-age male: “You are a menace to society. You need to get married.” (I think she was quoting Brigham Young, but it turns out no one can substantiate that quote.)

Loud Lady at Flu Shot table: “No, I can’t take flu shot, but she nayd tetanus and diphtheria. Is thayt included in the flu shot?” (It turns out the flu shot nurse also does other vaccines.)

Tags: @optotrician, single, vaccines

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Is there anything I can do to not get that gunk buildup by the nose pads?
An ultrasonic cleaner will take out the gunk. To help it not build up, try cleaning your glasses daily under the sink with dish soap that doesn’t contain lemon.

Yesterday I didn’t have to bill a single insurance. I love no insurance days.

New phones chirp like the phones in IHS used to. They also chirp louder and more frequently if no one picks them up quickly.

Lately people are confusing the non-contact tonometer with dilation. “Okay, I’m going to put some drops in your eyes to dilate them.”
“Didn’t we already do that with the puff of air?”
“No, that was just an eye pressure measurement.” (I already explained that when doing it, BTW.)

AlwaysCare website is down, probably due to hurricane Isaac since the call center is apparently in Baton Rouge. Earlier in the day, the website just timed out. Later it has this message: “AlwaysAssist website is currently having technical difficulties.. Please check back later to access any information. Thank you for your patience. For immediate assistance, please call [toll-free and local numbers] in Baton Rouge. ”

Of course all circuits are busy when you try to call that number. I think it’s ridiculous that they don’t have redundant servers across the country available. I guess these hurricanes inconvenience everybody…

Tags: @optotrician, air puff, eye drops, insurance, patients, phones

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Optoblog revolutionized optometric blogging with eye doctor-related comics and poetry. Now we have “@ the Optotrician” which contains quick anecdotes and conversations that actually occur at a vision-center/eye-clinic/optical/eye-doctor-office.

This is à la Love the Liberry blog that I discovered when it was linked to by Mental Floss the other day. It’s so awesome that I’ve already read the archives back to 2007.

By the way, if you would like to be a contributor to optoblog, please see this page.

Without further delay, here is the inaugural post of @ the Optotrician:

Teenage Girl: Hey does anyone have a dime? Do you have a dime?

An asian male (from Asia), 20s, doesn’t want the full glasses power I found written in his Rx. He wants less so his eyes don’t get worse. I explain it’s debatable whether that would help, hurt, or make no difference for his future glasses magnitude, but he insists. I am fine with it as long as he is legal to drive. I show him a +0.75 shift, and he is satisfied with that.

What’s the deal with optometrists in India not prescribing cylinder? I’ve seen several Indians (from India) that have 0.75 diopters or more of astigmatism, and their glasses from last year are spherical.

Guy in 20s: Can I charge my phone here?

Man walks right past sign posting prices of eye exam. Asks optician, “How much is an eye exam?” This happens thousands of times a day.

Tags: @optotrician, Jokes, off topic, optometrist, patients

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When I went to renew my Utah optometrist license, I was greeted with this pop up:

Since my photo is grainy, it says,

“Under Utah law a contact lens prescription expiration date shall be two years from the commencement date unless documented medical reasons require otherwise.”

Here is the excerpt from the Utah Code regarding “Contact lens prescription”:

58-16a-102. Definitions.
(3)
(b) A prescription may include:
(i) a limit on the quantity of lenses that may be ordered under the prescription if required for medical reasons documented in the patient’s files; and
(ii) the expiration date of the prescription, which shall be two years from the commencement date, unless documented medical reasons require otherwise.

I would say it is pretty standard practice to make youth Rx’s one year, but my advice to other Utah eye doctors would be to make sure you have a check box in your chart documenting how the youth’s Rx is still changing which requires yearly monitoring, history of eye infections and need to yearly monitor eye health, etc.

I am not exactly sure when this law came into effect, but I have known about it since 2006 after I moved to Utah. From intermittent observation of outside Rx’s brought in to my vision center or patients coming in for an exam, I would say about half of the area eye doctors know about this law. Either ignorance or they document every little thing as an excuse to yearly monitor contacts. I don’t want to slight The Vision Council’s campaign of “Check Yearly. See Clearly.” but the law is the law.

What would you say is sufficient medical reason to change an adult’s contact lens Rx to less than two years?

1. Seasonal allergic conjunctivitis? What would you change before two years after recommending Pataday/Alaway, ClearCare, and daily disposable during the worst weeks?
2. Contact lens-related dryness? What would you change before two years after recommending Oasys/Biofinty and ClearCare/Optifree PureMoist and Refresh Contacts?
3. Mild corneal neovascularization? What would you change before two years after recommending a silicone-hydrogel, adhere to manufacturer replacement schedule, and no overnight wear?

I would be careful because if you get too knit-picky, your patients will go elsewhere for exams.

Tags: contacts, doctors, Government, law, optometrist, Organized Optometry, patients

3 Comments

• @benjaminkorman I think you mean wood, coal, & gasoline have so many Calories. Looks like I'll need to remove those from my diet. #
• @SGgrc duplicati + google drive = cheap storage!!! #

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• Lutein and zeaxanthin may reduce risk of cataract? http://t.co/sDnAmT6X #

Tags: tweets

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