How can it not be...is it really a choice?...
In the 21st century, how can this possibly be (and has been) viewed as a separate and distinct mode of practice? Suddenly a whole person exists, therefore we can now miraculously choose to adopt a medical model? There is no choice.
Adding to the confusion, I believe we are now being fooled by the corporate propaganda machine to limit our practices, aka to “specialize” - with dry eye, myopia control, and most currently aesthetics. We are already highly specialized! Are we being programmed to forget there is actually a whole person sitting in front of us? This is not the primary eye care medical model.
Primary medical care is also about empathy and true care for our patient, a whole person. This person should have existed beginning day one of practice.
So what really is primary medical eye care?
Don't be misled…
Clinical skills, diagnostics, interpretation, differential diagnoses does not equate to the medical care model. These are simply starting points we are privileged & expected to provide competently.
Our job and the majority of our time is to think and make decisions based on what we discover in order to create medical care, and oftentimes with diagnostic data a technician can provide.
What we ultimately do, how we do it, how we speak & communicate, can then lead the way to appropriate treatment & management. Not referring away! This is true care and defines the medical model.
Take as a simple example, utilizing an OCT in practice then debating if the imaging reveals true papilledema vs drusenoid pseudo-papilledema then referring off to neurology or neuro-ophthalmology. This is not primary medical eye care.
If making a diagnostic and final management determination is within your scope of practice (as an OD it almost always is), then a referral has nothing to do with empathy and taking personal responsibility. It has nothing to do with the medical model. This individual is being passed off unnecessarily. The question becomes why?
The answer is based on clinical knowledge and experience. Consider no one has a monopoly on knowledge and we must create the experiences. We are therefore obligated to provide something greater than a referral. We are required to go above that referral and provide what is necessary knowledgeably & promptly for our patients. This is because we can. This is proper management and equals true care. This is primary eye care within the medical model.
And yes, this level of practice takes commitment, hard study, risk, years of experience, and work - every single day. I've said it many times - there are no shortcuts or gimmicks and no fake it till you make it. But remember, each and every one of us signed up for it! Learn how to take care of the whole person. Allow yourself to have the experiences. Don’t waste it. We owe this to our patients.
- JRM
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