Dr. John Dour has been practising as a GP in Melbourne for 45 years. We sought to gather his opinion on how an effective collaboration between GPs and optometrists can develop and can be maintained.
We asked him specifically about:
What do you consider before making a referral?
There needs to be trust. Over the years, you work out which specialists you learn to trust and which ones to avoid. Like everything else, there are top-class people and there are average people. Over time you get to know who you can trust and it is terribly important because trust is a reflection of yourself. If you send a patient to someone who you know you can trust and is known to do the right thing by the patient, you feel happy and you feel relaxed but if you send a patient with a problem to someone you weren’t sure about then you’re left hoping that the right outcome is going to occur. Trust is vitally important.
How would an optometrist practice owner or principal optometrist go about building that trust with you as the GP?
The first thing is to make themselves known so that you can send them someone, and once you get that feedback, then you can make an assessment. You can usually tell by their report and by the patient’s feedback as to how things have gone and whether they are trustworthy or not. Once that is established you just keep sending them patients. You’ve got to have that initial contact so that you can send someone to them and it begins from there.
Does your practice regularly welcome allied health practitioners and other specialists to visit?
Yes. And in this time, a visiting practitioner or specialist will explain exactly what they do, what the relative costs would be and how they compare. In this case it would be relevant to know how relative costs would compare with ophthalmologists, I think that is important. Bringing lunch also helps! This is arranged through the practice manager.
In our practice we have two days a week that we allocate to either drug reps or new specialists. Last week there was a dietitian in the practice providing lunch.
Having a follow up a few months later is a good idea. At times people will come along and then never come back and they will be forgotten. For example, you may have 10 physio practices in the area, and a physio will visit and tell you what they do and then they walk out of the room, and the next day you’ve forgotten about them. I think there is more to a referral process than that. Having a follow up to ask, ‘have you been happy with the service of the people you have sent me?’ Or if you haven’t yet received any referrals you can ask them again, for the GP to bare this in mind. GPs are bombarded with a lot of input about various things and being creatures of habit you tend to keep doing what you always do.
A relationship such as this is like any relationship
Human beings are susceptible to being sweetened a little bit. In the last couple of years my acuity chart had been misplaced and I was really at a bit of a loss. Every so often you really need one, when you are doing driving examinations for example, and I didn’t have one so I kept whizzing around from one room to another trying to find one so I could finish the consultation. I think bringing in anything for GPs to use in the consult room is a very good idea.
If you can get GPs to be aware of you, they are in contact with patents who require eye examinations all the time, so this will increase referrals to your practice.
Let’s face it, there are a lot of diabetics nowadays. Part and parcel of the care of any diabetic is you check the circulation, you always check their eyes and make sure they don’t develop diabetic retinopathy because then they develop a certain kind of blindness. All of my diabetic patients get an eye checkup every year routinely. That’s another reason to make sure you get on the GP’s radar in your area and inform them of all of the comprehensive range of primary eyecare services you provide, as well as what optometry services have a Medicare rebate and which services may attract a fee. You could talk about the range of equipment and technologies you have available that gets you that comprehensive view of a patient’s eye heath as well as the scheduled medicines you are endorsed to use.
We conducted a ‘did you know about optometrists’ test
with Dr. Dour – he answered yes or no.
Did the GP know optometrists have a range of clinical skills and can perform the following procedures including but not limited to:
- refraction – measuring the optics of the eye
- ophthalmoscopy – internal examination of the eye to help identify eye disease
- mydriatics where required for internal examinations
- binocular vision tests – testing the coordination of the two eyes as a team
- cycloplegics where required
- anaesthetics to perform tonometry
- tonometry – measuring the pressure of the eyeball
- optical dispensing – supply and management of spectacles and contact lens
Did you know therapeutically endorsed optometrists are also qualified to use:
Medicated eye drops to conduct diagnostic procedures.
Did you know optometrists are authorised to possess, use and prescribe scheduled medicines – in the form of topical eye drops – such as anti-inflammatory and corticosteroid eye drops to treat eye diseases such as conjunctivitis, keratitis, uveitis and glaucoma?
Did you know as a general practitioner you can refer your patients to an optometrist for many aspects of primary eye care, including, but not limited to:
- contact lenses
- vision therapy
- colour vision
- sports vision
- children’s vision
- workplace occupational health and safety
- low vision
Optometry and Medicare.
Did the GP know…
- A Medicare rebate is available for most optometry
services.
- Bulk-billing is subject to individual
practice policies.
- Patients are entitled to rebates for
comprehensive eye examinations every three years
(under 65) or annually (65 and over).
Did the GP know there are also rebates for:Â
- visual fields in patients with suspicious symptoms
- corneal foreign body removal
- patients with new symptoms or signs of eye disease,
or progressive changes in existing eye problems
Glasses and contact lenses
Did this GP know…
- Medicare does not pay for glasses or contact lenses
- The Department of Veterans Affairs pays for glasses
each two years for eligible patients
- Â An optometrist can
advise on state-based subsidy programs for low income
earners and Indigenous people
Any further comments or suggestions?
Doctors being able to meet the optometrist face to face is important.
It makes much more of an impact that just sending out a flyer (although I think that is important as well, as not all doctors at a group practice will necessarily be there when an optometrist visits.)
The optometrist can initially talk to the practice manager to see what sort of meeting works best for the doctors – e.g. a morning tea, a lunchtime meeting. Perhaps an education session run by the optometrist for the doctors.
Another way to initiate the referrals is inviting a GP to the optometrist’s practice, after hours, where they can be shown the setting and all the equipment used, and shown what it does – i.e. an on-site education session. Perhaps an optometrist can offer a GP a complementary or bulk billed appointment with the optometrist for a comprehensive eye examination so they can personally experience what the optometrist does.
