Helping Our Patients Follow Up With the Right Eye Care Professionals.

English: Dilated pupils after an optometrist appointment. (Photo credit: Wikipedia)

Conventional surgery to treat glaucoma makes a new opening in the meshwork. This new opening helps fluid to leave the eye and lowers intraocular pressure. Description: Conventional surgery to treat glaucoma makes a new opening in the meshwork. This new opening helps fluid to leave the eye and lowers intraocular pressure. Credit: National Eye Institute, National Institutes of Health Ref#: EDA11 (Photo credit: Wikipedia)

That's the name for this thing that you look through so the optometrist can tune the settings for your eyeglass prescription. (Photo credit: Wikipedia)

"Slit lamp examination of Eyes in an Ophthalmology Clinic" (Photo credit: Wikipedia)

The Optometrist (Photo credit: Wikipedia)

When it comes to eye health it is important to know which eye care practitioners can provide you the best care. Many of our patients may be referred to an optometrist or ophthalmologist for follow up care after they have been in our office for minor eye injuries, unexplained eye inflammation, or have been newly diagnosed with diabetes. In the case diabetes the patient will be referred to have their eyes screened for signs of glaucoma. Glaucoma is a common eye condition in patients with uncontrolled or poorly controlled blood sugar. Some patients may be referred to an eye specialist to determine if the headaches they experience are a result of pressure from various eye conditions.

Many times eye doctors both optometrist and ophthalmologist will refer patients to our practice to be screened for high blood pressure, diabetes, or even neurological conditions. This is because eye exams can be the place that Symtoms of many conditions first appear.

An eye specialist many times will consult family physicians about a patient’s eye problem if they suspect a medication is responsible for a decline in vision. Blurred vision is a very common side effect of many of the drugs people take for heart conditions, arthritis pain, or even erectile dysfunction drugs. It is good as a allied health professional to help our patients understand the difference between optometrist and ophthalmologist.

Optometrist is the primary care givers for our eyes. If we have ever needed glasses or contacts we have been evaluated by an optometrist at least once. Optometrist diagnoses complex eye conditions such as glaucoma, cataracts, and retinal issues. In some states they even treat they these conditions. Optometrist also follow the eye health of people with underlie health conditions that may effect their eye health such as diabetes and hypertension.

They can prescribe certain medications for eye conditions and provide low vision rehabilitation. They also can remove foreign objects from the eye.

An ophthalmologist is a medical doctor. Many are eye surgeons. They provide comprehensive service that covers the services provided by optometrist. The difference is that those seeking regular exams for glasses or contacts from an ophthalmologist many times have been diagnosed with a significant eye condition not traditionally treated by the optometrist.

Ophthalmologist treat disease related to the cornea and conditions that effect the exterior of the eye such as sclera, conjunctiva, and tumors. They tend to deal with any disorder that affects the optic nerve in any way. This includes optic nerve damage related to brain tumors, MS, or any condition causing intraocular pressure.

Ophthalmologists are frequently surgeons today. They do surgery ranging from common Lasik procedures to complex retinal reattachments. They provide a range of cosmetic as well as vision restoring procedures. Many ophthalmologists may specialize in areas related to neurology or pediatric eye care.  Some devote their careers to the research of serious eye conditions.

Sometimes care is based on insurance coverage and not necessarily the seriousness of the eye condition. If you have vision insurance your first choice for any eye problems will be an optometrist. If you have no eye coverage you may opt to see an ophthalmologist because they are medical doctors and many times their services will be covered, but their testing may not be. If you can afford to pay out of pocket it is best to see an optometrist first. This is for several reasons. Costs are greatly reduces and optometrist can treat a great deal of conditions such like glaucoma and retinal diseases

When optometrist fined your condition out of the scope of expertise then they will referral you to an ophthalmologist. Eye injuries and conditions creating a sudden loss of vision should be evaluated in the emergency room. Any follow up care will probably be referred to an appropriate provider.

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The Role of the Medical Assistant in Risk Management In the Medical Office

We tend to focus on treatment plans for patient's and the role of the medical assistant in helping the doctor implement his course of action. Yet, how we treat our patient's as consumers may be just as important as how we treat their medical issues.


Why risk management matters?

Risk management in the medical office is about policies in the office that promote the daily use of best practices.. These practices are the one’s that assure the safety of staff and patients; in the daily operation of the medical office.

Best practices for a group or individual physicians are there make sure they are complying with legal standard and ethical standards of the profession. Standard compliance limits the chance of legal liability for the physician. Individual medical malpractice suits can be reduced by office having policies that provide checks and balances in patient care to prevent mistakes. Patient policy should also address patient concerns in a timely manner. This prevents minor issues with patient’s becoming major issues that could result loss of patients or lawsuits.






Policies and Prodecures for a Successful Medical Practice

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The change from paper charts to electronic health records is an opportunity for staff to commit to accuracy on a new level.

Source: Wikimedia Commons- NARA




The Devil is In the Details

Minor mistakes in the diagnosis and treatment of patients can lead to law suits. The office manager can not correct mistakes made by the physician in individual patient care , but correct medical record management can reduce errors. Most physicians make decisions based on a review of charts as well as direct patient examination. Poor data gathering on test results, allergies, or past care can result in serious mistakes in patient care. New laws involving patient privacy and patient care require practices update their practices involving patient records. These should mean that medical assistants and all staff involved in adding data or correcting data in patient’s records; should be committed to accuracy.








It is important to know how happy your patient's are with your practice. Using common sense in patient communication can reduce the legal risk your medical office faces.

Breaking Up is Hard to Do

Some practice risk management is straight forward. Placing signs in waiting areas when floors are wet or simply moping when the practice is closed can reduce this simple type of risk. Patient termination is a bit more complicated.

Practices terminate patient care for a number of reasons. Sometimes it is that the patient has been disruptive or refused to comply with care plans. Many times patients are terminated because the physician can not provide the scope of care needed; and the patient has been unwilling to use referrals from the physician. Sometimes the patient has failed to pay their part of bills for services or keep scheduled appointments.

Most states have laws to cover the ways physicians can terminate the patient physician relationship. You must a have policy in place to comply with these laws. You should provide written notice of termination to the patient within the guidelines. It is also good for a practice to publish notices to existing patients the reasons that the relationship may be terminated. These way patients can be aware if they are acting in ways that may cause them to be dropped from the practice.

Having clear policies for patient scheduling decreases missed appointments and having to charge patients for no shows. Letting patients know the payment options and policies for a practice can reduce the need for practices to dismiss their patients due to unpaid bills. If a referral is made for continuing care the appointment should be made from the current physician’s office. Good communication practices reduce the number of patients who are dismissed for disruptive behavior. Good bed side manner and customer service do a lot to keep patients from becoming frustrated and disruptive.

The practices and policies I have outlined above will reduce the risk of the need to terminate patient relationship. They will also reduce the risk of liability over all for the practice. People are less likely to sue practices where they felt they were treated with respect; they are less likely to leave practice if they fell valued as patients. This is true even if a patient feels a mistake in their health care may have occurred. People are less likely to be disruptive in waiting areas if they are seen in a timely manner. Most patients want to pay their bills on time. They simply need to have their questions answered and payment arrangements made they can manage. The golden rule is still the best way to reduce the liability of the practice overall













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Looking at Prescription Drug Addiction in Our Patients

Prescription (Photo credit: Wikipedia)

Drug companies use direct-to-prescriber advertising in an effort to convince prescribers to dispense as written with brand-name products rather than generic drugs. (Photo credit: Wikipedia)

Anyone who pays any attention to the news knows that in general populace addiction to prescription drugs is seen by some experts as being at a record high. Many folks feel like they can hide their addiction because no one really questions you're going to the pharmacy to get just what the doctor order. Prescription drug use and abuse does not have the same stigma for the abusers as 'street drugs."


Many people feel sorry for the prescription drug addict, because the doctor gave them the drugs and the addiction is viewed as some unfortunate medical accident. We seem to overlook the fact' like all addicts, prescription drug addicts lie, steal, and cheat to keep themselves in the prescription drugs they are addicted to.

English: A graphic map showing the rates of accidental prescription drug overdose deaths for the state of Ohio by counties for the years 2004 to 2008. Information obtained from here and here. (Photo credit: Wikipedia)

All medical assistants should has a basic understanding of how prescription pain drugs pose a threat to the patient’s health. Yes, physicals and nurse practitioners prescribe drugs, but medical assistant take medical histories and obtain medical records. You may be the first person to notice that a new patient has be doctor hopping or has gotten multiple prescriptions for different kinds of pain drugs. T

These are red flags in a patient’s medical record. Many times addicted patients return again and again to their primary care physicians with complaints of headaches or back pain that no apparent cause can be found. Many times if these patients are referred to specialists or for further testing, they put up a great deal of resistance. They will balk at the suggestion of physical therapy for pain related to an injury. They want pills and many times will even suggest to the doctor the kind of narcotic that works best for them. You as a medical assistant may be the first to notice this type of behavior.

A busy doctor may be just too busy to notice these types of behavior. It might be helpful to tell the doctor you think a patient might be engaging in drug seeking behavior,  Be sure to back you suspicions with information from the patient’s chart. 

When retrieving records for new patients , be sure the prescriptions the patient’s says they are on, match the patient’s record. Many times the patients forget to tell you about the prescription for pain killers from the dentist. They are bold enough to complain of back pain and get another prescription from you. Many times pain killer addicts use multiple pharmacies;so it may take a little extra work for you to get an accurate picture of what drugs your patient is really taking.

.Those who are addicted to Vicodin, Zanax, or Oxycontin tend to miss a lot of time at work. Many sit at home in a stupor  making up ailments to gain more access to the prescriptions they are addicted to. I am not sure we will actually know how much property damage or death is caused by drivers addicted to prescription drugs. Only those who appear seriously impaired would probably be tested by authorities at an accident scene . Someone impaired on Vicoden does not reek of alcohol.

There is a public awareness of the problem of teens getting high out of their parent's medicine cabinet. Those five  pain pills that are a couple of years old patient’s  have left over in their  medicine cabinet; are not the real problem. The 20 pills  a teen takes regularly out of the  mom’s hundred Vicoden is the source of serious teen addiction..  Patients may deceive health care providers with complaints that they have a chronic pain condition. Over use of painkillers leads to the painkillers not being effective anyway. The dose must be upped on many drugs for them to work for patient pain.

States are now using computers to track the distribution of  controlled substances from pharmacies. Still an addict will not hesitate to cross state lines to bypass these types of obstacles. Even older patients are at risk for pain killer abuse. That sweet Mrs. Jones may have several active prescriptions at pharmacies in Florida as well at the corner drug store.  

Ask about any prescriptions that might have been obtained by the patient on vacation or when wintering outside of your own state.

There are alternative methods of treating people with chronic pain. Acupuncture, bio feedback and just losing a few extra pounds have brought pain relief to thousands of patients. Still there is no magic cure for chronic pain and certainly no magic pills.. We must make sure our  patients understand that just because it came from doctor does not mean prescriptions are a real cure all for chronic pain.

We need to discuss prescription drug addition with teens because once they are addicted from raiding mom’s medicine,t the next level of addiction will have them forging prescriptions or ordering mail order prescriptions off the internet. The cost of most of the addictive drugs is not as draining on our teen wallets as the street drugs. Most teens will not get caught popping a pill at the water fountain in the hall at school. We need to examine our own attitude to the popping a pill for every small ailment. It is better to show your patients healthy ways to deal with pain, Doctors and supporting staff need to show patients  the ultimate solution to pain management does not come in the form of a pill.

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