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Saturday / May 28.
HomemicontactDovetailing on Eye Care Perspectives

Dovetailing on Eye Care Perspectives

As optometrists our united goal is to achieve optimum vision for our patients, yet legislation keeps getting in the way.

Putting on my retrospecs and looking back a month or two, I was intrigued to see that Jess Chi and I covered very similar aspects of managing patients with keratoconus. We dovetailed rather nicely. Without having ever discussed the subject, we both wrote columns on alternative approaches to managing keratoconus. It was pure coincidence but showed that even though we are both confirmed contact lens freaks, we are able to be pragmatic in our management of patients.

Pragmatism is a critical part of obtaining successful outcomes.

Over the years I’ve seen way too many patients suffer less than ideal results due to practitioners imposing their dogmatic assertions. In our respective columns, Jess and I discussed how spectacles or soft lenses could be the best way to manage specific cases of keratoconus, whereas many would have insisted on corneal RGPs or scleral lenses.

Conversely, at other times I have had long suffering patients being disadvantaged by being told they cannot wear contact lenses because they have astigmatism. Some of my most successful contact lens wearers have fallen within this category.

Incorrect Assertions

Many years ago, in the 1960s, an ophthalmologist in Pretoria, South Africa – who used to see some of my Dad’s pioneering PMMA hard lens patients – would throw the patients’ expensive contact lenses in the rubbish bin! During the course of the ophthalmological consultation, he’d tell the patients that these newfangled contact lenses caused retinal detachments. In those days my Dad had to source his lenses from the legendary George Jessen (founder of Wesley-Jessen Corporation) in Chicago. As the lenses would be sent over by ship, it would take many months to get patients into contact lenses. As gas permeable contact lenses did not yet exist, it would also take many additional weeks to build up their wearing time. Having their lenses plucked out of their eyes and chucked in the bin did not go down well.

This particular ophthalmologist’s misguided and unsubstantiated rationale – based on coincidental findings – was a good example of why we need to go beyond anecdotal observations and scientifically investigate such theories. In his case the ophthalmologist had noted a few cases of retinal detachment in contact lens wearers. He suspected that the contact lenses were the cause.

In those days when contact lenses were not quick and easy like today, many of those motivated to see it through were, by definition, high myopes.

Back in the 1960s, a -12.00D myope had to wear thick and heavy crown glass spectacles. Contact lenses were so much more functional.

As we now know, the risk factor for retinal detachment was high myopia, not the tiny 8.6mm discs of PMMA!

Bureaucracy Gone Mad

I was shocked to see bureaucracy gone mad in a recent story on recency of practice. I don’t care how the officials spin it, but making someone re-prove their competence – after for example, time out to raise a family – and having to perform like a circus monkey for no or low pay is ridiculous. Paranoid officials enforcing butt-covering dogma under the guise of competency standards is becoming intolerable. Overzealous rules and regulations, resulting from the overly litigious society that Australia has become, have gone too far. Everywhere I go I see evidence of this. Health and safety is out of control. Children are banned from doing cartwheels at school. Trees are cut down in school playgrounds because a branch has fallen on a child, while the playgrounds themselves have been decimated and only the most innocuous play items are still allowed. Sydney also seems to be one large 40kmh zone around schools, which is probably more about revenue gathering than anything else.

I’m surprised that Australians just accept all this imposition and don’t question the rules or fight back. Are Aussies simply too laid back?

Back to recency of practice. How can the powers that be justify such rulings? In one of the cases mentioned, the practitioner had to do many times more supervised clinical hours to re-register than the amount of hours she’d had to complete to qualify and register in the first place! We need to legally challenge these pedants in order to restore some balance. Alas, it’s the only language they seem to understand. The authorities may be well intentioned, but their overzealous implementation of what they believe to be ‘correct’ is misguided.

Now is the time for us to oppose such dogma and restore logic and balance

Burnout

Another topic that’s receiving ever-greater attention is that of practitioner and physician burnout. The aforementioned issues, and the many other registration and CPD hurdles practitioners face – combined with long hours, performance and conversion rate monitoring, quickie consultations, late nights, weekend/public holiday work and long, slow commuting – are taking their toll. Optometry’s expanded scope of practice, increased accountability and rising medico-legal risk compounds this pressure. For those owning their own practice, the growing burden of staff management, combined with financial stresses and tax compliance add to that.

Those who belong to franchises have additional pressures. Colleagues recently told me they had to shell out between $400,000 and $600,000 on refitting practices after being forced to use the franchisor’s shopfitters. Such shop fits are cookie-cutter stuff; it’s all the same. A decent individualised shop-fit can be done for $150,000 or $200,000. It’s just not right.

Surprisingly, what the authorities don’t seem to realise is that all these stressful burdens forced on practitioners are, instead of improving patient care, more likely to reduce patient care. Reduced patient contact time – while complying with administrative issues – combined with having your mind on other things and a touch of burnout, leads to worse patient outcomes!

Stand Up for Your Rights

I’m not alone in making these observations. Colleagues increasingly communicate their frustrations. A number of older practitioners simply say enough is enough and retire from practice earlier than they might otherwise have done. In my case the decision to retire from clinical practice was partly fuelled by such things. There’s more to life!

The same can be said for those who get caught out by the recency of practice issues. They simply decide not to return to practice and seek other things to do.

How can this be good for the professions? How does this make for improved patient care? It simply doesn’t.

Bureaucrats are driving up compliance and resultant time wasting at the cost of patient care.

For those of you who read Art Epstein’s weekly newsletter, you’ll note that he’s also becoming increasingly frustrated and intolerant of such things. Many of his recent columns seethe with angst. In so doing he is also distracted from sharing clinical tips with his readers, hence further derailing the advancement of optometric care.

It’s the old Catch 22, a cornerstone of omnipotent authoritarian systems that are out of control.

Now is the time for us to oppose such dogma and restore logic and balance to our professions.

To quote the mighty Bob Marley, “Get up stand up, stand up for your rights!”

It’s time people.

Don’t give up the fight.

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