No sooner had Gwyneth Paltrow coined the phrase “conscious uncoupling”—a typically Hollywood euphemism for what anyone else would call divorce—than it had become a cliché. The Internet erupted in snarky comments and riffs on the concept. Even the fusty old Economist joined in the fun, using the phrase to describe Europe’s delicate pullback in its relations with Russia after the Crimea takeover.
I’ll bet you can think of a few professional partners you’d like to consciously uncouple from, like mediocre vision plans that put their interests above your own. But as we turn our attention to comanagement for this month’s 19th annual report on the topic, “conscious coupling” seems to be the watchword. Optometry is more integrated into the fabric of medical care than ever before, and needs to work at keeping those relationships strong.
Consider how far we’ve come on this front. Back in 1984 this publication profiled the Omni model of diagnostic referral centers, a concept that rightfully can be called a game-changer in the history of optometric practice. It was among the first models of comanagement that allowed optometrists to be integral to the delivery of ocular disease care without losing patients to ophthalmology practices.
But, 30 years ago, the language we used to discuss comanagement was a tad belligerent. “Optometry is trying out a promising new strategy in its war with ophthalmology: Cutting off its supply lines,” began that 1984 article. Chalk it up to the antagonism of the times, as TPA legislative efforts were a source of much vitriolic back-and-forth.
Eleven years later, in 1995, we launched an annual comanagement-themed issue to help ODs harness their burgeoning power as primary eye care providers. In another sign of the times, our inaugural comanagement issue focused on how to ensure optometric involvement in the brand-new field of excimer laser refractive surgery procedures.
Again, the tone was perhaps a bit combative. “There’s no question that, down the line, optometrists could be cut out of the picture,” one source observed. “Consumer marketing by PRK companies may eventually drive patients right into their centers, bypassing the independent practitioners.” Optometry survived refractive surgery’s well-known boom and bust just fine, and still plays a central role in educating patients about LASIK and managing their eye care postoperatively.
Over the years, the focus of our comanagement coverage moved to the ocular and systemic health issues that are most pressing in the 21st century: age-related eye disease, diabetes and other systemic health risks. Neuro-ophthalmic emergencies grace the cover of our 19th comanagement report, and I’m pleased that the tone is positive and collaborative, featuring optometrists who have earned the trust of ophthalmologists and internists.
Coming This Summer: The Empire Strikes Back?
What might derail this détente? A controversial website will begin to offer online refractions this summer, and it’s courting ophthalmologists to be “network partners.” Benefits to the MDs include “passive income and/or a steady patient flow into your office” and a chance to “be a part of the biggest change in eye care!” Optometrists get no such invitation, at least on the website.
Will ophthalmologists go along, in a push for greater efficiency—and maybe to strike back at optometry?
Let’s hope not, for everyone’s sake. Just consider the inability of an online vision test to screen for eye diseases. The site’s consumer testimonials are sure to irritate most optometrists—and, I hope, ophthalmologists, too. One early user touts it as “incredibly convenient and incredibly accurate in its assessment of my vision.” Another declares that “this is by far the easiest and fastest way to get an accurate prescription.” Fast, yes. Accurate? Hmm. Thorough exam? Surely not.
Several MDs just helped get Arizona’s TPA expansion law passed. That’s the kind of multidisciplinary unity that deserves, well, some conscious coupling if it is going to last.
As optometric scope of practice victories continue to be won, perhaps its time to beat those swords into ploughshares and work for the common good of both professions. And maybe even the decades-long OD-MD rivalry might one day have a Hollywood ending.