Be proactive when co-managing patients

Key Points

Salt Lake City-Co-management relationships with ophthalmologists differ from community to community, but it's often best for the optometrist to take a proactive role in the pre- and postoperative decision-making and care, according to Paul C. Ajamian, OD, FAAO, at the annual meeting of the American Optometric Association.

"Make sure patients are aware that you're in a co-management relationship with a surgeon, and that they're in agreement with doing that. Most patients want to see their OD for post-op care, once you explain how it works," he noted.

A two-way street

The doctor-to-doctor relationship also needs to be fostered. Let the surgeon know about any pertinent findings that may affect outcomes, such as blepharitis or medication use. It's better to recommend delaying surgery for a few weeks while you treat a problem such as dry eye rather than send the patient in with a condition that could affect the post-op acuity, he said.

Optometrists also must learn the surgeon's preoperative and postoperative protocols.

"You want to look like a team," said Dr. Ajamian, adding that the optometrist should spend time in the surgeon's office and be present during at least one surgery session to become familiar with the medications used and instructions given to the patient.

"It means a lot to patients when you can tell them exactly what will happen on surgery day because you witnessed it yourself," he explained.

"The best marketing you can ever do is to scrub in with your patient. Patients appreciate the effort and may be more comfortable if they sense that their optometrist is more than a passive bystander. If the surgeon doesn't welcome you, there's something wrong," he added.

Remember that co-management is a two-way street, and the surgeon has responsibilities to the optometrist, Dr. Ajamian said.

First, the surgeon must provide a consent form indicating the patient's willingness to have the optometrist provide postoperative care. The surgeon is expected to inform the optometrist if problems arose during surgery. If you've been briefed, you won't be caught off guard if a patient returns to you with 20/200 corneal edema; you will be able to reassure the patient that you can manage the situation.