Changing rooms

October 16, 2012

When Desiree (my wife who is also an OD) and I built our first office, we decided to design the exam rooms so that they are reversed from the way most optometrists design their exam lanes. In our rooms the patient is seated to my left while I examined them instead of being seated to my right as I was taught in school. The advantage is that since I am right-handed, I could refract with my left hand, write exam notes with my right hand and never turn away from my patient while working. Now that we are using electronic records, it also works very well since I find I can type better with my right hand than my left.

The “reversed room” idea came from a faculty member, Tom Brungardt, O.D., when I was in optometry school, and Desiree and I are both are usually pleased with how this has turned out for us.

However, the first challenge we had occurred when we brought in our first partner who was more comfortable with the old room design. So now our office has rooms that are both “right-handed” and “left-handed.” That is what creates the challenge. When I am forced by patient flow to use one of the other rooms I am terribly uncomfortable, and it takes me a while to get readjusted. Changing rooms is always rough.

Change is always a tough thing to do. When Desiree and I were able to buy our first home I remember, on too many occasions, at the end of the day I would leave the office and start driving toward our old apartment. It took a while before driving to our new home felt right. Another change that required me to adapt.

I am certain you see this resistance to change in your patients. Some patients can tolerate and adapt to the full change in cylinder or axis in their new spectacles. Some can only take a half diopter or a few degrees’ change. Because I have some very observant engineer-type patients who work at NASA, I know prescribing lenses requiring someone to change is something I think carefully about every time I prescribe.

Because we are all human, optometrists have the same discomfort to change that my patients and I experience. I remember Dr. Irving Borish telling me about the strong disagreements that occurred many decades ago when optometry argued over a fundamental change in how we practice. The discussion was about whether or not optometry should be using an ophthalmoscope during our vision exam. Seems silly now, doesn’t it? But it was a significant and difficult change that optometry had to adapt to. But it was a good change, and it was a change that optometry now embraces and defends. Where would we be today without that uncomfortable change others had to make?

We have had many huge changes in our profession, and every change, every step forward, was met with resistance to that change. Take the decision by a few optometry leaders to move optometry to the use of pharmaceuticals. Our older members may remember the unrest and the fights to these changes. To put these changes in perspective for our younger members, I ask them to recall that optometry’s heritage, our identity, was built on being a drugless profession. What a huge cultural change our profession underwent when we made the change to use pharmaceuticals in our profession. Where would we be today if those before us hadn’t gone through those uncomfortable changes?

I think those uncomfortable changes are occurring more quickly these days. Large changes in our technology, changes from written to electronic records, big changes in insurance billing, changes in how patients are getting their contacts online (and some beginning to get their spectacles online), changes in competition from vision plans and on and on. You get the idea.

Some changes have frankly been good and some not so good for our patients. But in all cases they have been changes we must adapt to. Although we may have grumbled, at the end of the day, optometry has always been very good at adapting – eventually.

As our profession faces health care reform together, as we face value-based fee reimbursement together, as we face technological changes to how we integrate our practices into the new world of health care, and as together we face fundamental changes to the way we practice, I want you to know that the AOA, and our new AOAExcel, is here to help our members be protected as best we can and to help our members adapt to the new “room” we find ourselves in.

I know changing rooms isn’t much fun but it is easier when you know you have a friend to help you make that change.

Ronald Hopping, O.D., MPH
AOA president

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