Between the Blinks #003

Blink Exercise of the Week

A “Sensitive” Topic

Neurotrophic keratitis is one of those diagnoses that can have you chasing your own tail if you don’t think to check for it. The staining isn’t improving the way you expected, the symptoms don’t quite match what you’re seeing, and you start working your way through everything else on the differential. Sometimes, checking corneal sensitivity is the piece that finally makes things click.

The nice thing is that it’s incredibly easy to test. You can use a cotton wisp, a piece of unflavored dental floss, or something more quantitative like a corneal esthesiometer. In our office, we use the Brill Esthesiometer because I like having an actual number that we can document and compare over time, but you certainly don’t need a device to start checking sensitivity.

When I first opened my dry eye practice, I mostly checked corneal sensitivity when I had a reason to suspect NK. If a patient had diabetes, a history of corneal or refractive surgery, chronic topical medication use, herpetic disease, or something else in their history that raised a red flag, I would check it. The problem with that approach is that you’re relying on yourself to think of NK before you test for it.

Over time, I started checking corneal sensitivity on every new patient as part of our regular testing regimen. It takes very little time, and I’ve since found reduced sensitivity in patients where NK wasn’t necessarily high on my differential when they first walked through the door. Those are the patients who made me realize there really wasn’t much downside to having that information from day one.

The risk factors are obviously still important, and they should absolutely raise your suspicion when they’re there. But I’ve come to look at corneal sensitivity the same way I look at a lot of our other dry eye testing. If it’s quick, easy to obtain, and has the potential to change how I approach the patient, I’d rather know it at the first visit than figure out three visits later that I should have checked it from the beginning.

Practice Notes

Step One Starts Before Day One

Whether you’re building a dry eye clinic within an established practice or starting a new practice altogether, it’s probably going to take some time before the schedule looks the way you want it to. I knew that going into my own practice, so I tried to look at the months leading up to opening as an opportunity to get a head start rather than simply waiting for the doors to open.

There’s already plenty to keep you busy during that time. You’re ordering equipment, working on the website, setting up your systems, figuring out scheduling, getting credentialed, and dealing with a seemingly endless list of small things you didn’t know you needed to think about. Somewhere in all of that, though, you also have to make sure people actually know you’re opening.

For me, that meant getting the website and Google profile up as early as I could, talking about the practice on social media, and making sure I had business cards and materials ready to hand out. I also spent time visiting doctors around the area and letting them know that a dedicated dry eye practice was opening nearby. Building those referral relationships is a whole topic on its own, but at that stage my goal was really just to make people aware that I was there and what I was planning to do.

I definitely didn’t have everything figured out before opening, and looking back there are plenty of things I would have done differently. Some systems that made perfect sense before seeing patients needed to be changed almost immediately, while other things I thought were important ended up not mattering nearly as much as I expected. You really don’t know how your practice is going to operate until you’re actually operating it.

I think the important part is accepting that the first few weeks or months may be slow without using that as an excuse to sit around and wait for things to pick up. If you know you have three months until opening, that’s three months to start telling people what you’re building, getting your name into the community, and putting some of the pieces in place that will eventually help fill the schedule. You may not be seeing patients yet, but there’s no reason the work of building the practice has to wait until day one.

P.s. I’m all about transparency: on my first day of seeing patients in my new practice, I had seven patients on my schedule, and one of them was a no-show.

Life Between the Blinks

Those Who Keep the Practice Running

With this edition going out on Labor Day, it felt like a good time to talk about the people we work alongside every day.

Before optometry school, I spent about ten years working as a technician. I’ve now had the chance to see a practice from both sides, first as an employee and now as the person responsible for running one. If anything, becoming an owner has made me appreciate those ten years even more.

As doctors, it’s easy to think of ourselves as the center of the practice because we’re the ones seeing the patients. In reality, there are a whole lot of things that have to happen before that patient ever makes it into our chair. Someone answered the phone, worked through an insurance issue, scheduled the appointment, checked the patient in, did the testing, cleaned the room, dealt with the patient who showed up twenty minutes late, and probably handled a handful of other things I never even knew about.

I also remember what it was like to be on the other side of that relationship. We hope our employees will go the extra mile when we need them to stay a little later, squeeze someone into the schedule, or help out when the office gets crazy. I’ve come to realize that if I’m going to ask that of the people who work for me, I should be willing to go the extra mile for them too.

Sometimes that means giving a bonus when the office has a great month. Sometimes it’s buying lunch, closing a little early, celebrating birthdays, or yes, even throwing the random and completely uninspired office pizza party. None of those things alone create a great place to work, but I think they’re small ways of showing people that you notice and appreciate what they’re doing.

Most of us have had a job at some point that we didn’t particularly look forward to walking into every morning. Now that I own a practice, I have some control over whether the people who work with me feel that way, and I take that responsibility pretty seriously. I want to build an office where we can work hard, have fun while we’re doing it, and hopefully not dread seeing each other again on Monday morning.

Your staff may not have their name on the practice, but they have just as much to do with keeping it running as you do. So, for anyone lucky enough to have the day off, enjoy the long weekend. And maybe buy your staff some pizza when you get back.

One Last Blink

A practice is only as good as the people who show up every day to keep it moving. This Labor Day, take a minute to appreciate the people who make your job possible.

See you next week.

Andrew Zagelbaum, OD