I just told my patient to take a hike!

February 1, 2013

Yep, I really did, and I feel better for doing so. Have you ever wanted to do that? I did this patient a favor, and I really should tell more of my patients the very same thing. Why? While this particular young man was really nice, he was overweight and, frankly, he needed the exercise. (And yes, I’ve had the other kind of patient I wanted to tell to take a hike, but that is a whole other story.)

Did you know patients can decrease their chances of becoming diabetic by 50 percent – just by walking a half hour a day?

We all do a lot of good things for our patients, but how many of our patients are overweight or obese? In the United States, a full one-third of the children are overweight or obese these days. In black or Hispanic communities, the number is nearly 50 percent. Did you know that when I started practice 30 years ago the average kid consumed one snack a day – and now our kids average close to three high-calorie snacks a day? How many of us walked to school when we were kids – and how many of our kids walk to school now? I’m glad we didn’t have the computers and video games—that would have lured me away from playing outside when I was a kid. No wonder many of our youngsters are fighting weight and health issues.

I think telling a patient to lose weight, or to quit smoking, or any other lifestyle or behavioral change is a tough thing to do, so my approach with a patient is to talk about the eye health problems that occur with systemic disease such as diabetes or hypertension. Teaching about increased risk of glaucoma, cataracts, macular degeneration and blindness seems to fit my role as their primary care eye doctor and to make the issue very real for the patient. In fact, there are more than 275 systemic diseases with ocular complications plus many more drugs that require monitoring of ocular side effects.

According to the U.S. Centers for Disease Control and Prevention (CDC), “There is a critical need for vision and eye health data….national strategies to improve health should seek to enhance the usability of clinical information collected by optometrists for public health purposes.”

When we educate our patients and do things like this with our patients, what we are really doing is public health, and these public health activities should be shared with the patients’ whole health care team. I think most folks think about public health as being a lot of boring statistics or studies with cohorts or cross sectional studies or about free clinics. But what if you recommend ultraviolet (UV) protection or impact-resistant lenses? Yep, that’s also public health. In fact, everything we do to treat or help our patient avoid or postpone eye disease, systemic disease or injury is part of our role in public health.

Have you ever really thought about it?

Optometry’s essential role in vision care and in the public health of this country is huge. Certainly the American Public Health Association (APHA) recognizes this importance through its APHA Vision Care Section (VCS). The VCS, along with APHA Immediate Past President Mel Shipp, O.D., Dr.P.H., MPH, has done an excellent job of letting the rest of our health care colleagues and the nation understand how integral optometry is to our nation’s health. Every AOA Board member belongs to the APHA and the Vision Care Section. They represent optometric health as integral to overall well-being.

As primary care providers, we are often our patient’s entry into the health care system. We have a responsibility to the whole patient, and I find our patients appreciate it when we demonstrate our role as primary health care professionals by having concern for all of their health needs. I talk about a patient’s health as it relates to their eyes both first and last during my exam in order to emphasize the integral role overall health plays in what I do with a patient. Looking at the whole patient has been good for my patients as well as for my practice. With all of us together caring for the whole patient, we are critically important for the public health of our nation.

So sometimes the best thing for the patient and our nation is to tell that patient to take a hike!

Ronald Hopping, O.D., MPH
AOA president

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