REFRACTIVE 34 EWAP SEPTEMBER 2022 want to do.” Dr. Ibach said that it may be challenging when first starting out to build the relationships and the trust. “Comanagement is definitely a two-way street,” he said, adding that he sometimes hears concerns from optometrist colleagues that they’re worried that they will not get their patients back if they refer them out. “As an optometrist, we have to communicate that on the front end that I want to see a patient back and lead in the postoperative care.” For a surgeon who’s starting to do comanagement, it’s a lot easier if you have the policy of “we’re going to try to get as many patients back as we can,” Dr. Ibach said. It’s hard to pick and choose which you want to keep from cataract surgery. For refractive surgery, it’s a little different, Dr. Ibach added, because patients have the goal of being less dependent on glasses and contacts. “For us not having an optical, it has been a bridge to doing more comanagement and building our referral network because there is no threat of us doing a patient’s glasses or contacts after cataract surgery,” he said. Dr. Ibach also stressed the need to convey to patients the importance of still having routine eyecare. Some patients think if they have LASIK/PRK/SMILE that they don’t have to see the optometrist. “As a surgical practice, stressing the need for routine eyecare is important,” he said. “That’s only going to continue to build relationships and get optometrists to want to refer those patients because they’ll know they’ll still get to see them.” Another tip for ophthalmology practices starting is to protect each other, Dr. Ibach said. Make sure to protect the relationship with the patient and optometrist and protect the character of the doctor, he said, adding that it’s also important to make sure to put the referring network and doctor in a good position. This includes not pointing the finger at anyone if there is a complication or issue. If you need to adjust an approach or do something differently, he said phrasing is important. Saying something like “We’re going to take a different approach,” or “We have some other technology and that’s why we’re doing something different,” is more appropriate than saying another doctor is in the wrong. Derek Cunningham, OD Dell Laser Consultants Dr. Cunningham has experience in a referral-based practice that uses comanagement. He also said that Dell Laser Consultants has been using comanagement for about 20 years. “That allows our surgeons to do what they do best—stay in the OR,” he said. “That allows our community [ophthalmology and optometry] primary caregivers to do what they do best, which is to see patients.” He added that this approach works for all parties involved. Dr. Cunningham highlighted how well this model seems to work for the patients because they are referred with the trust of their primary eyecare doctor. The first thing that happens when a patient is referred in is the patient is assessed by a specialist who will handle initial evaluations and any post-surgical issues, and that allows for one surgical opinion at a time, someone who specializes in that specific procedure. Then the surgeon will evaluate the patient independently. The process helps to make sure mistakes are not made and allows for an independent set of eyes to review the data, review the systems, make sure there are no errors, and give an independent recommendation. Patients find it reassuring when they’re seeing multiple doctors who are validating the decision for them to have whatever surgery they’re having, he said. “It’s allowing for an extra level of care and reassures the patient that multiple opinions agree on the surgical plan. “In a center like ours, no patient ever goes into surgery without having a standardized protocol for their postop and long-term eyecare,” Dr. Cunningham said, adding that the postop plan is important to have in place, and communication is key. When choosing to implement comanagement, there may be some initial adjustments and obstacles. Dr. Cunningham noted that the one “stumbling block” his practice has noticed in the 20 years that they’ve been practicing shared care is that patients can be sensitive when there are inconsistencies between their community doctor and the practice they’re being referred to, particularly in communication and language. “One of the things we learned early on is that we all had to have the same language in terms of how we were talking about disease states and surgical procedures,” he said. “You don’t have to agree on things, but we have to talk about them in continued on page 46
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