It’s been two weeks…what I have learned….

Today marks two weeks since we reopened to patient care—what a relief it has been to be back at it again!  I have reflected on a number of things over these past weeks and observed some interesting things about the practice that I have been able to learn from.  First off, thank you for understanding my decision to close for two months while the COVID-19 pandemic was at its highest concern.  Mind you, I state, “at its highest concern,” not necessarily at its most dangerous.  I truly still believe that COVID-19 is dangerous and it may be more dangerous now as the public lets down its guard.  Just because “COVID-19” has become a household name does not change that it still exists, and people are still affected with it as we continue to learn more about it.  Rest assured we do not fear the virus in our office, but we are keeping to our protocols in place through the month of June and will reassess the next steps to move forward in July.

What have I learned?

  • Masks are not so bad! While we are wearing them all day long we are also asking patrons to wear them as well. We inform and warn patients to come to our office wearing one and it has been universally accepted.  Thank you for understanding and thank you for helping us protect each other.
  • Our phone interviews have made us more efficient and thorough! Once again, to help minimize the time a patient is in the office (to help minimize any exposure to COVID-19) my team has been conducting the patient history, asking the same questions and having the same conversation, over the phone prior to each patients’ visit.  They are recorded and I listen to them.  Just when we thought we couldn’t get any more efficient—we are always learning better ways.
    • This phone conversation allows patients to access their medications (strength and dosage) as well as their contact lens information at home when they may not have brought it with them to their visit.
    • Having the patients’ information ahead of time helps streamline the visit where there is no check-in and you are brought right back to the examination room to start your visit immediately.
    • My review ahead of time has helped me get a better grasp on how my team is doing with their conversation skills, charting and also help in my understanding of each patients’ needs and wants for the examination. This is quickly revisited by me with the patient in person.

I chose this route because many of my colleagues were doing the same.  I did not really think it would be 1. accepted and 2. as helpful as it has been.  I truly believe it may be something we stick with moving forward.  It only takes 5 minutes and it is so valuable for me to have prior to your visit.

  • We really have an awesome team! I conducted a team orientation on May 18th that lasted two hours.  We went over our new protocols and the steps to reopen.  Everyone was in attendance and attentive.  This participation has really helped aid in the reopening smoothly and successfully over the past two weeks.  I have always been thankful for my team but they really are shining through during these times.  Thank you all for being patient with these stars as we navigate through all this together—it is all new to us.
  • Our technology really rocks! We have always taken pride in the technology we utilize but, to be honest, looking back we weren’t using it to its fullest potential until now—when we are forced to do so.  Eyecare is a different than other medical professions in certain ways.  Specifically, it requires a lot of close contact.  Social distancing of 6 feet is almost impossible with traditional means and equipment.  The slit lamp where I examine your eyes is no more than 4 inches from your mouth and nose to mine.  Extended times at that instrument cause my oculars to fog up and sometimes my diagnostic lenses I utilize.  I usually spend, in total, at least 5-6 minutes using that instrument with each patient.  That has changed.  We have universally utilized our Clarus UltraWideField imaging on all patients and that is reviewed with me on a computer monitor where patients are able to see the back of their eye at a safe distance for both of us.  The photoptor, which determines your prescription (you know the “click machine,” the ‘which is better 1 or 2’ black thing that you look through) would normally require me to be within arms length of you but our automated system allows me to safe distance from you as well.  Finally, to minimize touches and exchange, we have a stout HIPAA compliant/certified email server that allows us to eliminate interaction by utilizing online forms, patients are able to upload a copy of their insurance card and driver’s license securely and encrypted. Our credit card processing system is able to accept NFC/Apple Pay and we always can send an invoice to you as well.
  • Change is good! It may have been daunting at first but so far it has worked out.  While I’ve been known to have extended hours for years to accommodate patients these times have called for some changes.  In order to “slowly open” back the office we have limited hours and spaced our appointment times apart.  This is in an effort to minimize body count in the building and allow us to sanitize our examination rooms, surfaces in the optical gallery, frames and continue to keep a safe environment for everyone.  This is taxing because we have 2 months of backlogged patients, new patients requesting appointments and additional protocols in place.  For now, please continue to be patient with us as we have altered the hours in June to safely proceed forward with more of “our regular” hours in the future.  Thank you for understanding that we may have a week or two wait for an appointment when this is not usually the case.

Once again, thank you for all your patience and understanding as we navigate through this new “normal.” Our efforts are to keep you safe and continue to serve you with diligence with minimal disruption and this is what I have learned so far, I look forward to continuing to learn through the process as well.

#SiennaEyeDoc

We are reopening….

…Very SOON!  Trust me, I cannot wait to get back into the office to start taking care of patients while working alongside my team.  When folks state the term, “unprecedented,” I could not agree more!  This has certainly been an unprecedented time for me.  I do not ever recall, in the history of my 17 year career, where I stepped away from patient care for more than 2 weeks and we’re now going on 6!  When we eventually reopen the doors it will be just short of two months that I decided to cease operations and close the office.  That said, I believe it was the right thing to do.  I’ll be the first to admit that early on I didn’t really take this to be a serious issue much less turn into a pandemic.  I’ve been very fortunate to not know or have any of my family affected with COVID-19 and my deepest sympathies go out to those that have had a different experience.  I’ve always prided myself on making sound decisions based off of science and evidence I have relied on the guidance from authorities that subscribed to the same principles.  As I kept my pulse on the unfolding of the COVID-19 in America and around the world I started to feel uncomfortable with the direction and momentum of the virus.  Ultimately it was the recommendation of the CDC and Governor Abbott’s mandate that influenced my decision to cease operations on March 24th.

As I prepare to reopen the office on May 18th I am still keeping a pulse on the virus.  I truly believe that now is not the time to let up.  As much as I do not want to say it, if we do not closely watch and monitor our actions, we are headed for a second wave.  I am taking every precaution I know for our office to help minimize that risk.  With that, here is what we have planned for our reopening and why it is taking so long.

First off, I am in the process of reassembling my team.  Due to the financial strain on the office closing, all our of team was furloughed with the promise that they would have their jobs back when we reopened.  They will all be screened before each work shift and have all be properly screened thus far as for potential exposure to COVID-19.  We will have an orientation and deep cleaning of the office on May 18th and 19th before we go live with patient care on the 20th.

Secondly, as I mentioned previously we are going to do our part in mitigating a possible second wave.  Yes, we have PPE (Personal Protective Equipment) in place, sanitizing protocols, even some examination protocols will change but we are also going to be spacing the patient schedule out as well.  This means I will not be able to see the same number of patients as I used to.  This is an effort to a.) continue social distancing and b.) properly sanitize between patient interaction.  I ask your patience with us on this.  We have two months worth of backlogged office visits to get through along with the current patients that are due up for their annual examinations.

Lastly, as I have always been dedicated to caring for patients, I am doing the same for you during this time of reopening.  I am making sure that we have every “t” crossed and every “i” dotted.  I am sure that there will be some that do not agree with these measures.  I do not think any of our measures are extreme–just appropriate.  I believe strongly in the actions I am directing my team to take.  These actions are to give you a peaceful, comfortable and a safe environment to visit.  Until now, I have been able to navigate COVID-19 with my team, my family and myself safely and successfully.  I intend to do the same moving forward until, whenever, we get in the clear.

I can’t wait to see you soon!

#SiennaEyeDoc

My top priority, my standard will not change!

From the beginning Gee Eye Care as a practice, and I as the owner and doctor of this practice, have always been here to set customer service as the first priority.  That is never going to change no matter what.  And so along the way some things may have to change in order to maintain that level of service.  We take pride in being able to provide an exceptional experience for our patients and we are trying our hardest to do so.  There are things that drag us down, we are all human after all, and there is only so much positive reinforcement and encouragement that can be shared to maintain morale in the building.   That lack of morale can easily affect and degrade the patient experience that we are trying our hardest to provide.  After months of consideration, factoring in different things I reflect…

I reflect on why my team and I exist for our patients.  We are here to provide services, medical services, optical services, arrange your appointments, send your prescriptions and, for our culture, provide a great experience for you when you visit with us.  What drags things out and drags us down, either on the phone or in person, is the confusion about insurance.  This has a lasting effect in the sense that we are not able to concentrate on the above mentioned to the fullest extent.  I must reiterate that I have been observing and measuring this for a number of months. The amount of time it takes for my team to verify insurance, explain insurance to patients and at times to the end result of not even seeing the patient or the patient getting upset because of the insurance.  One can imagine how this is a kick in the gut when you have worked at least 20-30 minutes (and sometimes up to an hour) on these tasks.  It adds up and it takes away from what is most important, taking care of you—the patient.

I understand that many people view insurance to be beneficial but some are finding it to be just as laborious as we do and share the same thoughts and sentiments.  Once again, insurance is not what we are in the business of doing, it is a courtesy that we provide but ultimately we exist to take care of eyes and eye health.  Insurance has increasingly presented a barrier for that and it has become more and more difficult to work with over the years.

I want to be very clear that I have spent hours and months thinking about what to do because this one facet has started to change our culture of customer service—and that I will not tolerate. I continue to look for ways to maintain our patient experience and customer service as the top priority with excellent care…please stay tuned.

 

#SiennaEyeDoc

Intense…

It’s been a little while since I’ve logged an entry here but frankly I’ve got a lot to say and three blog posts that I have in drafts so stay with me over the next few weeks to months as we finish of 2019 with a bang. 

….Pulsed Light, as in IPL.  I’m excited to discuss what is called Intense Pulsed Light (IPL) today.  I’ve been investigating whether to bring this type of therapy in the office for over a year now.  I actually became quite interested over the past few years but was watching from the sidelines to see how it all panned out for eye care in general and where it might play a role in our office.  Our patients are not new to me bringing in new and innovative technology, you probably see something new every time you come to the office, it is always in an effort to better take care of your eye health.  As the tag line for the office has been and always will be, “dedicated to the health of your eyes,” the addition of this technology and previous technology is to stay “dedicated” for our patients.  That being said, I consider myself a mid to early adopter of new technology and therapies.  I like to stay up on the studies and see how things actually work and if it applies to our patients’ needs.  I want to be clear, I do not flippantly bring in instrumentation and look for ways “to pay it off.”  I’ve always thought of it quite differently, and if I bring in instrumentation it is to address a need for our patients and the cost of which will eventually take care of itself.

So, what is IPL?  IPL has been used routinely by dermatology to treat the inflammation related to rosacea.  Rosacea of the face results in rosy red cheeks, red nasal area and sometimes around the chin.  It is an inflammatory condition that affects mostly lightly pigmented individuals and may be exacerbated by heat, angst, alcohol, to name a few (figures 1&2.). Courtesy of http://www.rosacea.org

Screen Shot 2019-09-30 at 4.22.26 PM(figure 1.)

Screen Shot 2019-09-30 at 4.22.16 PM

(figure 2.)

A few years back eye doctors started to recognize that IPL was effective on patients with ocular rosacea.  This is another inflammatory condition that specifically affects the eyelid and results in dry eye.  Ocular rosacea is nothing new, it has been linked very closely to meibomian gland dysfunction (MGD) and blepharitis for decades in eye care.  This is where I step in and explain the role of IPL in our practice.  Any patient that has seen me over the years has had at least one conversation with me regarding dry eye and MGD.  If you are one of those patients, do you recall me discussing with you the importance of lid hygiene, warm compresses, have I shown you images of your lids?  Have I also imaged your glands with our LipiView instrumentation, have I proposed a treatment like the LipiFlow thermal pulsation treatment?  Those discussions were all as a result of your MGD condition and likely linked to ocular rosacea.  I have been a leader on the dry eye front for a number of years now, I have been on various advisory boards for dry eye medications and devices.  My practice was the first private optometry practice with the LipiFlow instrumentation (4th office overall in the city of Houston).  As a result, we continue to complement our treatment of MGD and dry eye with the implementation of the IPL treatment.  I can say that amongst optometrists with the LipiFlow and IPL technology that I have the most experience collectively with the two technologies having had them for the longest.  With that it should bring a sense of security and confidence as a patient, I am not trying to “pay off my instrument,” we have had it long enough.  Secondly, with the wealth of experience I am able to select the best candidates for the combined procedure to increase successfully outcomes.  Thirdly, this is likely something you’ve already heard about from myself or another eye doctor but has not been addressed because the technology was not readily available.

As to be expected, with all things that are new there is a great deal of excitement.  I can say that this is very true with the IPL treatment and I do not see that excitement changing in the near future.  Everyday, I am validated by my decision to bring this instrumentation in our practice because of, 1. the patients I continue to see with MGD and why, again, I brought it in and 2. the journal summaries I receive via email that consistently point toward this as an innovative and effective treatment for patients with MGD.

Do you think you could benefit from LipiFlow and/or IPL and would like to be evaluated?  Please do not hesitate to contact the office to arrange an appointment with me or just email me a photo of your face to DrGee@GeeEyeCare.com.

 

Screen Shot 2019-09-30 at 4.20.21 PM

 

We don’t have to dilate you…..

Aside

…well, maybe.

A dilated fundus examination (DFE) remains the standard of care for the detection, management and treatment of retinal disease.  Although this can often times be inconvenient, uncomfortable and laborious it still remains as one of the most traditional methods for the examination of the back of the eye.  Things have changed but it took a number of years to get there.  I remember my first encounter with an instrument that claimed to be able to negate the need for a dilation, I was an intern in my final year of optometry school.  I don’t want to date or age myself but that was in 2001 and that instrumentation has improved (17 years later) but it still produces an image like the one below:

This image has always bothered me because it is not how the back of the eye appears.  There is no green whatsoever in the physical examination of the retina.  Even the diagrams/cartoons we study in textbooks and are easily searched on the internet to show no green and those lashes at the bottom could sometimes hide a valuable finding:

Screen Shot 2018-10-07 at 6.57.50 PM

So, the question has always lingered, what is that prior image representing?  Is it a true representation of the retina or simply a shortcut to see more patients by not having to wait to dilate the patients?  While charging patients for an image that may not be truly representative of how the eye appears for the sake of convienence?

I am not here to judge what others do.  I am here to justify why Gee Eye Care has finally now decided to employ the use of ultra wide-field (UWF) imaging and what I have decided to do.  First off, an undilated view of the retina with traditional methods (ie. direct ophthalmoscopy, slit lamp with an auxiliary lens like a superfield or digital wide field lens) usually only yields, at maximum, a field of view of 30-60 degrees.  A dilated view or a traditional image with dilation may yield a view at 100 degrees or more (depending on skill level).  An image very similar to the one below:

Screen Shot 2018-10-07 at 7.00.45 PM

The time has come where we can now produce an image to at least 200 degrees in true color!  I have been waiting on this day since 2001.  Some have questioned why I still dilated eyes at Gee Eye Care.  Truth be told, I was not comfortable with any other technology that would properly be able to replace a dilated view with my own eyes and I was not going to compromise your eye health for a shortcut.  Now I finally can show you why because we didn’t have the technology to show you before and you just had to take my word for it!  I now feel confident in the image I am able to obtain in order to reliably depict the actual retina. It took some time and yes, further investment but I am so excited to present to you the following images taken by me on an undilated patient:

Screen Shot 2018-10-07 at 7.10.27 PM

Starting on October 8th we will be presenting patients with the opportunity to defer dilation and choose this imaging.  However, some patients will be required to be dilated:

  • all new patients
  • children (in order to best determine refractive error changes)
  • certain patients with known or suspected disease that may affect the retina (to name a few):
    • diabetes
    • hypertension
    • acute peripheral retinal degeneration
  • certain patients at Dr. Gee’s discretion

This imaging is available to all, even if dilated, for documentation purposes.  When appropriate, it may be billed to your insurance but the cost will be $30 out of pocket for both eyes.  This option will be presented to you before the examination and you will be given the choice to choose prior to beginning your examination (note, Dr. Gee may need to still dilate your pupils if something is noticed upon obtaining the image).  These images will be reviewed by Dr. Gee and shared with you during the examination.  If you would like them digitally sent to you, please ask and they will be emailed immediately.

Welcome to the new age of eye care.  Dr. Gee and Gee Eye Care has always been proud of being on the forefront of eye care technology and this is no different!

Click here to set up your appointment for the “no puff,” “non-dilated,” “no 1’s or 2’s” eye and health examination!

#SiennaEyeDoc

https://www.mayoclinic.org/tests-procedures/eye-exam/expert-answers/eye-dilation/faq-20057882

https://www.reviewofoptometry.com/article/pointcounterpoint-ultrawidefield-imaging-vs-dilated-funduscopy

Notes:

  • Image #1: reference and link to OptoMap Daytona, taken directly from their website
  • Image #2: diagram taken from Cirrus OCT poster
  • Image #3: photo captured by Dr. Gee
  • Images #4 & #5: photo captured by Dr. Gee on an undilated patient

“Where’s Warby?”

I have encountered a few patients lately that have purchased from Warby Parker. For those of you that are not familiar with Warby Parker, the company began years back as a convenient, cheap pair of mail order glasses. It was really one of the first online marketplaces for eyewear. Soon we would start to see others follow, Zenni Optical, Coastal, Glasses.com to name a few. Specifically, Warby Parker has continued to impress me.
{here’s a place marker for me to pause and explain that most any optical owner out there is gasping by that last statement. Fact is fact and I plan to outline that here. I am speaking specifically only to Warby Parker right now, as an optical owner}

 

I remember my first experience of stepping into a brick and mortar Warby Parker storefront four years ago. I felt like a traitor, a fish out of water, I left with some type of distaste for the brand. “How dare they? First online, now real salespeople to help you out—oh, the demise of the independent optical!” That was then, reflecting back, most of that sentiment was a result of the newness of these other outlets sprouting up everywhere and the “sky is falling” cry of the traditional optical world.

 

Hey, Warby, I can’t beat you on price, I don’t know how you do it. Your lenses are quite good as well. The styles you have are current, likable, I can’t dislike you for any of this. However, I believe there still exists a faction of society that still respects small businesses and exceptional customer service, keeping it local—so to say. I’ll take that. We’ll continue to welcome everyone but cater to those loyal to the small business. It’s really only being fair to those that have decided to spend a little bit more for that level of service. So the saying goes, “you get what you pay for,” we will continue to always provide you a copy of your prescription and if you need a measurement of your interpupillary distance (IPD) we will do that as well.
Beyond that, “Where’s Warby” when someone needs an adjustment, a nosepad replaced, or even a sanitation in our OpticWash? While we’ve been providing theses services complimentary as a form of customer service, now, all our services, these above as well as our no questions asked assurances on breakage and scratches will be reserved for those clients that purchase from our optical gallery.
Menu of Services for Spectacles NOT from Gee Eye Care*:
Plastic/Zyl Adjustment $10
Metal Adjustment $20
Rimless/Drill Mount Adjustment $40
Screw Replacement $15
Reattach a temple (arm) $15
Nylon suspension lens placement $30
Nylon suspension repair $50
Rimless/Drill Mount repair $80
OpticWash Sanitation $10
*these options are all a la carte
-For example: if a plastic frame has a detached temple and there is no screw, the cost will be $30 (for the screw and the labor to attach the temple). If additional adjustment is required a $10 service fee be assessed as well.
-We reserve the right to refuse repair of any pair of glasses not initially dispensed by Gee Eye Care.
-A waiver (dissolving responsibility from our optical staff for any permanent damage) for ALL repairs on glasses not initially dispensed by Gee Eye Care will also be required before any service is initiated.
#SiennaEyeDoc

“Freedom Week”

IMG_1109Last week, my team and I entered into what we called “Freedom Week.”  Yes, it was a week before July 4th but I did not want to tarnish or make light of what the actual meaning of Independence Day was for our Nation.  We simply decided it was a good time to do what we did and here are the results of it.

If you go back to my prior blog post about insurance this may make a lot more sense. Basically, I decided to let my team know there is freedom without insurance and that our patients are more free when there is no insurance.  What did we do?  If you didn’t visit with us last week, here’s how it went:

  • we verified no insurance at all the entire week
  • I conducted myself as I usually would by providing the best care and judgements for my patients
  • at the end of the examination, patients were presented with the table of “allowables”
  • patients were informed of what the insurance would normally reimburse for the services that were provided
  • patients were given the opportunity to pay whatever they thought the services were worth–any or no amount, no pressure, no questions asked

So much effort (sometimes unnecessary effort) is given toward insurance.  The patient is told one thing by the insurance or their HR director, our office staff spends time verifying and getting authorizations that (again, may be accurate or terribly inaccurate) and we ultimately have to file these claims.  Mind you, I stated “effort” not money, it’s resources, efforts that could be reallocated toward taking better care of you as a patient.  Less confusion, less angst, less conflict and more concentration on your problem, devoted time to your care and personalized service.

We are not going to abandon insurance.  But think about the world without it.  Would it be possible?

 

#SiennaEyeDoc

in·sur·ance (why?)

You have to admit, whenever you visit a healthcare facility the word “insurance” is always in the back of your mind.  I mean really, it’s on the mind of the staff, the patient and usually the doctor.  It is the definition of “the elephant in the room” until someone breaks the silence.  But why?  Why do we continue to be dictated by such?  Why does a doctor’s decision to do the right thing for a patient have to be determined by whether “insurance covers it?”  Why does a patient have to decide whether to proceed with what has been determined by the doctor to be the best treatment (either procedural or medicinal) because of “insurance coverage?”  Is it fair for a patient to be cynical and have to think, “my doctor is choosing this route of treatment because a.) he/she will profit more because the insurance reimbursement is more than the other route? or b.) “does my insurance even cover that?”  There was a simplier time you know.

It begs the question, why is health insurance like this?  Automobile insurance does not cover maintenance, oil changes, tires purchases, etc.  They cover accidents, they help fix stuff, yes they have deductibles as well.  Home insurance is the same, it does not cover maintenance like landscaping, heaven-forbid water, electricity and gas bills.  It covers catatrophe, theft, but what else?  Oh, yes, they have deductibles also.  Why is health insurance perceived to cover everything needed for maintenance?

 
This thought took me to the good ‘ol Webster’s Dictionary of “insurance” which states:

Definition of insurance

1  a the business of insuring persons or property
    b coverage by contract whereby one party undertakes to indemnify or guarantee
         another against loss by a specified contingency or peril
    c the sum for which something is insured

2a means of guaranteeing protection or safety 

  • The contract is your insurance against price changes.
  • Frequent hand washing is good insurance against the common cold.

Well, call us crazy but we are going to be doing a few things differently this week….I’ll be back next week with a summary of how things went.

#SiennaEyeDoc

“Insurance.” Merriam-Webster.com, Merriam-Webster, http://www.merriam-webster.com/dictionary/insurance. Accessed 25 June 2018.

The office is Closed! Why???

In life there are experiences that can’t be replaced, replicated or overlooked. That being said, the office has been closed a few days the past two weeks as a result of the World Series. I wanted to write an open letter explaining why and apologize for any inconvenience I may have caused.

Imagine a young boy growing up playing baseball, fond memories with his dad playing catch & trying to improve his game. Some memories that many would tell about him throwing a ball before he even remembered and shortly after learning to walk at a young age. Life, career choices took him a different direction but the love of the “game” has always been there. Now grown and making a living that same boy, a young professional, vowed he would purchase season tickets at the first chance he had to afford them, starting with only one in the outfield on a mini-season and then two behind the dugout a few years later—so that that father of his could experience the “game” with him. At one time attending every home game played, all 81.

Privileged to go to Spring Training with his father and mother, this tradition continues to this day, every year in March for 1 week. Privileged to visit every ballpark in all of Major League Baseball—31 (+1 new Yankee Stadium also). Privileged to see a miracle World Series run in 2005 only to be swept by the other team. Privileged to attend two Hall of Fame Induction ceremonies again all with his mother and father. Privileged to be associated with and serve the team he grew up cheering for as a member of the Astros’ Buddies.

That’s me. Your doctor by day but son, and now father, by night. I don’t get too personal about stuff in the public but I felt compelled to make a statement because I’m not just closing the doors for a few days of leisure (frankly it’s a lot of work) but I’m closing for the experience to do this with my mother and father, wife and son. I want my son to have these memories recited to him when he grows up.

This World Series run is emotional and much like the “game” it has its ups and downs. I wish I could have predicted that we would be where we are now (actually not really because it wouldn’t be the same) as to not have to reschedule and inconvenience patients but an opportunity like this doesn’t come around very often. Thank you for understanding and Go Astros!

We will be closed Tuesday, October 31st through Thursday, November 2nd as we travel to Los Angeles and reopen on Friday to regular business hours. You can reach Dr. Gee anytime via email or text.  DrGee@GeeEyeCare.com or 281.778.9912 (feel free to text)