The Great American Profession

Posted on January 21, 2011 by

In the entire history of health care, optometry is a relatively new profession.  There are two widely accepted interpretations regarding the origin of the optometry.  If you ask any optometrist, they will tell you that optometry began sometime in the late nineteenth century when opticians started refracting and writing spectacle prescriptions.  As time went on optometrists gained more and more rights that broadened their scope of practice to include examining and diagnosing eye health and treating ocular disorders and diseases with medicine.   And, if you ask any ophthalmologist about the beginnings of optometry, they will tell you that it started with greedy opticians who sold eyeglasses without having a prescription from an ophthalmologist.  These miserly troglodytes started to pretend to check eye health, too, and lobbied Congress to pass legislation that would allow them to bill for medical procedures and further cut into the ophthalmology industry.  Both versions of optometry’s history are entirely accurate and representative of modern optometry.  Optometrists can 1. diagnose you with binocular internuclear ophthalmoplegia and 2. gouge you $700 for eyeglasses.  This is why they 1. are called doctors and 2. love to be open on Saturdays.

Regardless of which account you are more inclined to side with, one thing that is true is that optometry has more privileges now than it had in the past.  Whether these privileges were given, stolen, or won is a matter of perspective, but every entity’s history is always a matter of perspective.  The United States’ history is fundamentally a story of giving, stealing, and winning, but it is not because of this parallel why optometry is the great American profession.  Optometry is truly American because it embodies everything we know about American politics.

Optometry has always been a legislative profession, meaning that optometrists can only do whatever the state and federal legislatures say they can do.  As such, optometry is both liberal and conservative.  On one side you have the liberal tree huggers.  These are the people who fight for optometry civil rights and lobby Congress to continually define the optometric profession.  Led by the American Optometric Association (optometry’s de facto leadership), these hippies have fought for  optometrists’ right to use diagnostic and therapeutic drugs, and they continue to fight to further expand optometry’s privileges (i.e. treat more eye diseases, perform minor surgeries, etc.).  These radicals are the people who want health care reform to expand optometry’s scope of practice so it is more on-par with ophthalmology (read:  board certification).  These professional-socialists are typically optometry students, academic elitists, researchers, and optometry intellectuals.

On the other side you have the fiscal conservatives.  These are optometrists who, above all else, want to protect their income.  They are against health care reform and further government intervention in their profession.  They are known to side with organized ophthalmology and support the stifling of optometry’s growth if it means less taxes and higher income.  They like to use terms like “ivory tower optometry” to describe industry intellectuals.  These are people who disagree with “big optometry” (the AOA) and question the constitutionality of professional regulation and board certification.  In response, these conservatives formed the American Optometric Society (optometry’s Tea Party?), which holds rallies and conventions and slanders the AOA’s board of directors as being Nazis (that last part isn’t true).  These liberty fanatics are typically rich, old, and own more than three private practices.

And that, in a nutshell, is why optometry is the great American profession.

Posted in Uncategorized | Tagged , , , , , | Leave a comment

This is Your Prescription

Posted on January 17, 2011 by

I don’t think I’m a rude doctor, but maybe I am.  I’m always very responsive and accommodating to patients, regardless how rude, idiotic, or brainless they are.  And while outside the office I may have the social skills of an alley cat, I assume that I am warm and polite at work, as there has never been a complaint about me.

But maybe I need help with my patient education.  I can answer any question the patient may have about his or her condition or treatment in a way that is easy to comprehend.  However, there is ONE question that I seem to not be able to answer sufficiently for each patient who asks it, and this is the question that is asked by almost every patient.  I suspect there are two reasons why my answer is almost never good enough:  1. I always give the most truthful answer and 2. the patient doesn’t know what they’re asking in the first place.  This question is:  So, what’s my prescription?

This is what typically happens at the end of each exam:

Patient:  So, what’s my prescription?

Me:  It’s minus-four-twenty-five, minus-one-twenty-five, axis one-seventy-five in the right eye, and minus-five-twenty-five, minus-one, axis one-eighty in the left eye.

Patient (perplexed, but acting like he gets it):  Oh.  Is that bad?

Me:  “Bad” is a relative term.  There are people who see better than you, and there are people who you see better than.

Patient:  Oh, but I mean, what’s my prescription?

Me:  I just told you.

Patient:  I mean, am I like twenty-something…?

Me:  You’re count-fingers at five feet.

Patient:  What does that mean?

Me:  It means that you can count my fingers from five feet in front of you, but not farther.

Patient:  Am I legally blind without glasses?

Me:  There is no such thing as being legally blind without glasses.  I can tell you that you’re twenty-twenty with glasses.

Patient:  What am I without glasses?  That’s what I’m trying to get at.  Twenty-what?

Me:  Well, I don’t have an eye chart big enough to measure your Snellen visual acuity, but you can count on it being worse that twenty-four-hundred.  If you really want to put a number on your “prescription” just say you’re “worse than twenty-four-hundred.”

Patient:  What does that mean?

Me:  It means that at twenty feet away, you cannot see the size of a character that subtends five minutes of arc at four hundred feet.

Patient:  Oh OK.

Maybe I should stop telling patients the truth.

Posted in Uncategorized | Tagged , | 5 Comments

“Good With Kids”

Posted on January 14, 2011 by

There is a feeling in the community in which I work that I am an optometrist who is “good with kids.”  I don’t know how the hell this rumor began.  I don’t see how any parent would want to tell another parent that I am kid-friendly.  Although I am nice, I am not exceptionally friendly when I meet a kid.  I don’t make cute noises at them, give them lolipops, dumb down my diction, or give them excessive praise because they know what the letter “E” looks like.  I don’t smile really big or make them laugh on purpose.  I’m not a clown and the office isn’t a circus.  Perhaps it is the children who are telling everyone that I’m “good with kids” because I talk to them like adults, which means I treat them with some dignity.

This is not to say that I don’t like pediatric patients.  Pediatric exams are my favorite exams because I get to do all that binocular vision shit that I love and which earned me the COVD Award when I graduated from optometry school.  I like pediatric exams because they won’t refute your diagnosis and treatment.  My love for NRA/PRA is as big as the day is long.  Vertical phorias excite me more than a new Liz Phair single.  I like it when I can make an out-of-control kid calm down with plus lenses and yoked prism.  Vision is behavioral and behavior is visual, even though “experts” would disagree.

I thoroughly enjoy pediatric exams, although I would never suspect anyone of ever thinking that I do.

Posted in Uncategorized | Tagged , , , | Leave a comment

The Two Stooges

Posted on January 10, 2011 by

When I was a fourth year student, I did a three-month externship at a VA hospital that was not near my optometry school.  It was in a college town in the middle of nowhere during the dead of winter, and it was very, very cold.  There were two things that I did to help me cope with the freezing temperatures.  The first was to drink myself into oblivion at the numerous dive bars and lounges that dotted this town.   This was a popular option among the university students.  The alcohol warmed me up and desensitized me mind to the cold.  It made listening to Lil’ Jon acceptable and fun, and it made undergraduate girls want to say hi to me and take their clothes off.  The other option that I had was to stay in my rented room and sit near my space heater.  Unfortunately, this was the option that I chose 80% of the time.  This was because I had to study for the national board exams.

There really isn’t much to write about regarding the copious amount of hours I spent studying for that damn test, but there is one story from that dark period that has stuck with me.  I spent a lot of time studying with the television on, and during that time MasterCard was running a series of wildly popular television commercials.  The basic outline of each commercial of the series went like this:

  1. Someone purchases three or four products with his or her MasterCard.
  2. As each product is purchased, a monetary value is placed on it and made known to the viewer.
  3. A sentimental moment happens, which usually involved tears, laughter, children, and/or crying or laughing children.  The viewer is told that the monetary value of this moment is “priceless.”
  4. The commercial ends with the pitch, “There are some things money can’t buy, but for everything else there’s MasterCard.”

There was one commercial in that series that I suspect inadvertently became collateral damage to the drama between organized ophthalmology and organized optometry.  The commercial depicted clips from the Three Stooges.  It showed Larry, Moe, and Curly acting like buffoons, as they were wont to do.  They were engaged in a number of physical activities and were supposedly injuring each other.  The items “purchased” were “cracked cranium,” “bruised cornea,” and “dislocated jaw, fractured wrist, and mild concussion.”  The cost to treat these ailments was a $10 co-payment (considering how at-risk the Three Stooges were, they apparently were able to get a good health care plan).  The “priceless” moment was “no hard feelings,” and the commercial ended with the usual pitch, but with the following addendum:  MasterCard, accepted by optometrists, neurologists, and orthopedists.

Being that I was a dorky optometry student on my way to becoming a dorky optometrist, I was excited every time I saw this commercial.  It was delightful to hear optometry get a shout-out on national television.  However, a few weeks after first seeing the commercial, my delight turned into confusion, and then into rage, because MasterCard changed the commercial to say, “MasterCard, accepted by ophthalmologists, neurologists, and orthopedists.”  And then a few more weeks later, my rage turned into embarrassment (for MasterCard) because they changed the commercial again to say, “MasterCard, accepted by health professionals everywhere.”  I assume that MasterCard felt like an innocent guy who was just asked by two threatening sisters who he thought was prettier.  First he picked one, felt bad and then picked the other, felt bad again and ultimately responding with, “We are all pretty.”

I’m sure the advertising people responsible for that commercial drank themselves into oblivion afterwards.

Posted in Uncategorized | Tagged , , , , , | 1 Comment

The Optometry Dichotomy

Posted on January 6, 2011 by

One of the burdens responsibilities of being an eye doctor (or any professional, I suppose) is maintaining competence.  To ensure its citizens that their optometrists aren’t practicing witchcraft at work, each state has their own optometric licensing requirements.   For my home state of California, this requirement is to (theoretically) accumulate fifty hours of continuing education every two years.

There are a number of ways to get these education hours.  Many pharmaceutical companies offer free CE courses and entice you with free dinner if you listen to their drivel for an hour or two.  Some lecturing optometrists and ophthalmologists also employ the free-food-with-class technique if you’re willing to listen to them brag about themselves for a few hours after work.  Personally, I get my continuing education exclusively from the American Academy of Optometry’s annual meetings.  The AAO claims to have the best optometric education due to the fact that the organization’s primary focus is academics (it’s even in the name), but that is not the reason why I choose to attend these meetings.  I go to these meetings because I’m too lazy to chase other CE lectures around the rest of the year.  For a single fee, I can attend as many lectures as I can handle over the four day course of the AAO meeting.  This buffet-style offering is perfect for gluttons who want to take care of their CE requirements in one sitting.  Every year I accrue twenty-five hours of CE at the AAO smorgasbord.  Yes, this is a disgusting amount of lecture hours to sit through in four days, but I’ve found that time passes by quickly when I’m leveling up in Angry Birds on my Android phone.

Last November I attended the meeting in San Francisco and, just like every year, I interacted with colleagues from all parts of the country.  And, just like every year that I’ve attended the Academy, I noticed the obvious trend that is taking place in this profession.  Optometry has traditionally been an industry for white males, but every year I notice an increase in the number of women at the AAO meeting.  This, I suppose, directly coincides with the increasing number of women that have been entering optometry schools and the subsequent increase in the number of women becoming optometrists.  Additionally, every year I notice an increasing number of Asian attendees.

These trends have created two interesting dynamics:  1. It makes me wonder if I’m becoming the 21st century male nurse and 2. it makes me feel like there should be some social commentary about a profession comprised mostly of old white guys and young Asian females.  I don’t mind No. 1; being outnumbered by females isn’t a problem for me.  If anything, it’s something I can laugh about with sexists and Lesbians.  No. 2, however, raises some interesting issues.

A few years ago Review of Optometry published an issue with a cover page headline addressing the fact that there are now more women than men enrolled in optometry school.  This issue resulted in some interesting conversations, both moronic and thoughtful, with people I know.  When my employer at the time (who could be classified as an “old white guy”) first saw that issue cover, he remarked, “This is fucking terrible.”  When I asked him why he said, “Isn’t it obvious?” and then he walked away.  This was one of the moronic conversations.  One of the more thoughtful conversations I had was with an associate professor (who, I suppose, is a “middle-aged white guy”).  We were talking about this at a shitty bar in Tampa, Florida, and he expressed sincere concern.  He said, “From what I’ve seen, women like optometry because it’s a job where they can work part-time, make a decent living, and still have enough time to raise kids.  If optometry is moving toward being a part-time profession where you can work at your leisure, who’s going to educate, do the scientific research, lobby in Washington, and do all the grunt work that has been moving optometry forward for the past three decades?  These things require big commitments, not part-time ones.”  And then he proceeded to hoover three kamikazes.

His statements struck me as being both borderline chauvinistic and surprisingly insightful.  First, his sentiments were inaccurate because not all women optometrists are concerned with making babies and, conversely, not all optometrists with family aspirations are women.  However, many women do make their career choices with the intention of raising a family in mind.  What surprised me was that I’ve never considered the possibility that these choices can impact any particular industry.  Because optometry is, for the most part, a small, upstart profession, each optometrist can certainly effect its direction.  If less people are involved in academics, then optometry will be less academic.  But, no one can dictate what an optometrist can do after he or she receives his or her degree.  This is why the trajectory of the optometric profession begins in the schools; it will be determined by who they admit and how they educate them, whether they are male or female.

Almost every continuing education lecture at any major conference is focused on the latest advancements and current trends in eye care.  But if you really want to learn something about the state of optometry, take a look at who is lecturing and who is sitting next to you.  This should only take a minute, and you can spend the rest of your time playing smartphone games.

Posted in Uncategorized | Tagged , , , , , | 1 Comment

Myope Manifesto

Posted on January 4, 2011 by

Last week I met someone at work who said, “I’m hella blind.”  Like most people who live in California would do, I immediately assumed that this person was from the San Francisco Bay Area.  Bay Area folks are known for their excessive use of “hella” as an adjective (a word which Microsoft Word insists, via a squiggly red line, doesn’t have a right to exist), but I’m not sure why this came to be.  Do Bay Area people say it because they think it’s cool, or does the rest of the country refuse to say it because we consciously don’t want to suck.   “Hella” is quite possibly the worst slang term to ever have been muttered.   It sounds like it’s supposed to be a play on the term “hell of a,” but it somehow evolved into a loony way of saying “very”.  No good thing has ever come from the use of this word.  It’s no coincidence that No Doubt broke up shortly after they released their single Hella Good in 2001.  The only person who can successfully incorporate “hella” into his vernacular is Oakland rapper E-40, and that’s mostly because no one knows what the hell he’s saying anyway.

Being that I’m an eye doctor by trade, I can confidently say that this person was not blind and that this person was indeed from the Bay Area (specifically, a theoretical place called “Fremont”).  When explained to this person that she was just moderately near-sighted, she asked, “Does that mean I can’t see near?”  To this I said, “No, near-sighted means that you are NEAR.  SIGHTED,” to which she said, “Right.  So I can’t see near?” to which I said, “No, near-sighted means that you that your sight is NEAR,” to which she said, “Is that why I can’t see things that are far away?” to which I said, “Yes,” to which she said, “That’s so confusing,” to which I said, “No it’s not.  You’re just a fucking dumbass.”  (I didn’t say that last part.)

She was noticeably distraught that her vision wasn’t perfect and she insisted that she was “hella blind.”  It wasn’t until I told her that my vision was twice as worse as hers that she felt better.   I don’t understand Bay Area people.

However, my encounter with this dolt ironically shed new light on how I view my own visual condition.

As anyone who is near-sighted can profess, being near-sighted is not fun.  For me, I can’t see anything clearly that is beyond fourteen centimeters from my face without my eyeglasses or contact lenses.  It’s annoying to not see the alarm clock when I wake up in the morning.  It’s a hassle to put on my contact lenses every morning after brushing my teeth.  It’s cumbersome to wear eyeglasses when I’m exercising at the gym.

But at the end of the day, I really don’t mind it at all.

I don’t mind taking off my contact lenses or eyeglasses when I get home from work, even though without them the world is an utter blur, because sometimes I don’t want to see the world when it’s “in focus.”  Sometimes I don’t want to see the things that make me happy, or the things that make me sad, or the things that piss me off.  Sometimes I don’t want to have any emotive reaction whatsoever to anything at all.  Sometimes I just want to see the real world from my own eyes, from a perspective that is uniquely mine, because sometimes a blurry view offers a fresh new focus, which makes for a clearer mind.

The world is full of shit, and sometimes I want to get away.

And that’s hella real.

Posted in Uncategorized | Tagged , , | Leave a comment

Dr. Optometry, O.D., Doctor of Optometry

Posted on January 3, 2011 by

During my fourth year of optometry school, I had an internship at a clinic that was about 30 miles away from the main campus.  As such, I took turns carpooling with a classmate named Jeff, who (before we started carpooling) I called “the whitest guy I’ve ever met.”  The half-hour drive to and from work everyday produced some interesting conversations.  Particularly, there were two significant legacies from those adventures.  The first was that Jeff introduced me to a book called The Da Vinci Code by Dan Brown.  Dan Brown has since become one of the world’s most famous novelists, less so for his writing ability and more so for his insistence on being the Catholic Church’s own WikiLeaks.  The second thing was that Jeff made me listen to a new band called Maroon 5.  You may know them today for being the band that real rock bands make fun of, but back then they wrote cutting edge macabre songs, mostly about strangling women named Jane.  Nevertheless, they are one of my favorite bands today.

One time on one of our trips home from work, Jeff asked me if, after graduation, I was going to refer to myself as an “eye doctor” or an “optometrist.”  This question didn’t strike me as particularly important or interesting, and neither of us had any strong feelings on the matter.  I suspect the only reason he asked it was to fill the quiet void that was present after listening to Harder to Breathe.  However, I didn’t realize until a year later how important this question was to a whole bunch of optometrists in America, and by “a whole bunch” I mean those who graduated from optometry school before 1985.

Now, before I go on, I want go on record and say that our most brilliant optometrists are senior doctors who graduated before most of today’s new grads were born.  With that being said, a lot of senior optometrists love the fact that they are “doctors” and they can’t get enough of it.  They call themselves “doctor” whenever they can, oftentimes to a point that is redundant, unnecessary, or even inappropriate.  Here are a few gems I’ve witnessed over the past six years (note: their real names aren’t used):

  • A senior optometrist was on the phone with a primary care physician, whom he referred a patient to regarding unexplained retinopathy.  The optometrist said, “This is Dr. Beauregard, I’m your patient’s eye DOCTOR.  He has some retinopathy and he needs some things checked out.  You need to check his platelet count and clotting times…  Trust me, I’m a DOCTOR… You can talk technical with me.  I’m a DOCTOR…”
  • A senior optometrist was on the phone with a restaurant.  He said, “Yes, I would like to make reservations for two at 8pm… DOCTOR Henry Wang… Yes, Wang… DOCTOR… Not mister, DOCTOR… Did you get that?”
  • A senior optometrist’s business card:  “Dr. Kevin Steinberg, O.D., F.A.A.O., DOCTOR of Optometry, Optometric DOCTOR, Fellow American Academy of Optometry, Ocular Disease DOCTOR”
  • Me, upon meeting a senior doctor:  Hi, I’m <my first name>.  Senior doctor:  You can call me DOCTOR Langston.

I suppose this can happen in any field where people have doctorate degrees, but I have an irking suspicion that this occurs more in optometry.  Moreso, I don’t see this among the newer grads as much as I do with the senior docs.  I could speculate for a long time as to why this happens.  Is it because that’s how they taught optometrists to behave in the 1960s? Is it because ophthalmologists are the traditional “eye doctors” in most people’s opinions? Is it because optometrists are dorks who read quasi-intellectual novels and listen to critically panned rock music?

Or, maybe I’m just being unnecessarily critical.

Posted in Uncategorized | Tagged , , , , | Leave a comment