The Eye Guy

Frustrations Of A Physician

When listening to the politicians, it appears as if “giving” insurance to everyone will solve our health problems- Don’t count on it.

Following is a communication from an insurance company (most companies do this): “The (Health insurance company) is preparing to send eye exam coupons to diabetic members (insureds). The coupon allows the member to see an in-plan ophthalmologist or optometrist once in 2008 for a dilated retinal eye exam without a referral and with a waiver of the associated office co-pay.” If you have Medicare, no referral is necessary also.

The insurance plan also is encouraging its insureds to have recommend vaccinations, monitoring of kidney disease and other preventive testing.

In spite of this total availability of necessary care, it is very frustrating that almost half of the insureds do not make the effort to have dilated eye exams—in spite of being informed of the need and the fact that no cost is involved. With other diseases there are still many that do not get their exams.

Why is this? No one has good answers. The information from the company has been sent out to patients and physicians for a number of years with only slight progress.

In my way of thinking there is a dual responsibility- for the patient and for the physician.

Using diabetes as our example, recognize that physicians see diabetics a variable number of times per year. I believe that just about every insurance company repeatedly notifies physicians that, among other things, yearly dilated eye exams are essential for diabetic patients. Included in this is a requirement that ophthalmologists and optometrists send a written report of the eye status of diabetic eyes.

Although physicians and companies tell their patients to have an eye exam, no one can force the patient to do this. A certain number of patients do not really realize the importance and some others simply forget to go. Another group will not go out of fear that we will find a problem- this is very common in medicine, even though most of the exams will be normal.
         
What must be done? Physicians must make a special effort to communicate the need for good health care to patients- explain to patients, and their relatives in the office, in words and writing. Many physicians give the patient a form to take to their eye specialist, asking him or her to fill out the form and send it back to the primary care physician. Then it is necessary to have a follow-up system to find out if the patient has undergone the exam. If the report doesn’t come back within a reasonable time, the patient should be called to see if the exam was performed. If not, why not and what can be done to get the patient to have the needed exam? At a minimum, this should be noted in the chart to protect the physician in case the patient develops eye problems that might have been able to be treated if diagnosed earlier.

Some offices have computerized records that help to some degree. Many will notify us in case the patient has not followed certain care and instructions.

Other areas of frustration are the overweight patients, those who continue to smoke or abuse alcohol and those (abut 20% of patients who never have their prescriptions filled. Special efforts are required to convince these patients of the need to participate in their health care.

In spite of the concerns of physicians, time constraints often make it more difficult, if not almost impossible to follow up on these problems and to spend time in the office to educate the patients as to what must be done for their health.

These problems may occur in patients who have health coverage showing that simply providing insurance doesn’t necessarily improve the care for those patients who are not really interested in their health. The challenge for us as physicians is to motivate these patients to take advantage of the care which is available through their insurance or Medicare.

The problems are compounded in those without coverage since many can’t afford to seek care. Much of their care is provided in Emergency Rooms at a tremendous increased cost to the system.

Frank J. Weinstock, MD,FACS is a Professor of Ophthalmology- NEOUCOM, and an Affiliate Clinical Professor at Florida Atlantic University. He lives in Boca Raton and Canton, Ohio

©2008 Frank Weinstock.