Remember advertising in the Yellow Pages?

Ophthalmology Management’s recent 25-year anniversary got me thinking about the changes we see over time. Each day doesn’t seem much different from the one before, but a look in the rear-view mirror feels like a scene from “Back to the Future.” We seek, notice and expect medical information and technology to impact how we care for our patients. However, the unnoticed transformation over time of how we providers connect and communicate with patients in our practices comes as a surprise.

For instance, my typical drive to work:

These days, I am sipping organic, fair-sourced black coffee with a splash of almond milk in a reusable BPA-free YETI and snacking on grass-fed, high-fat, all-beef jerky while hoping to not spill anything on my freshly ironed Fig brand scrubs. Contrast this to when I started 25 years ago: I was dressed in a suit and tie, stopping to fill up my gas tank en route, which always made me late, so it was a Diet Coke with a low-fat bar for breakfast, as I hoped someone brought donuts to the office.

Not sure these two versions of me would recognize each other!

THEN AND NOW

When you think of the practice of 25 years ago, it’s like a time capsule. A provider is still in the same 10-foot by 10-foot exam room with the patient in a chair facing the door; the slit lamp still swings into place, and the doctor slides the stool to gaze into the oculars. This doctor-patient interaction is immune to time.

But, the technology surrounding this interaction, the critical analysis due to updated studies and disease understanding, along with the advanced algorithms and options for treatment have drastically changed this timeless picture. Back in 1996, we had a sliding glass door to isolate the “secretary” from the waiting room; now we have an administrative assistant sitting at a concierge desk centered in the waiting room offering patients to place their driver’s license in the kiosk — which is next to the coffee bar.

In 1999, I bought my first OCT. The equipment was so novel my partner would not invest, so I paid for it alone! In 5 seconds, it would find and quantify glaucoma damage similar to what took me more than 6 months of glaucoma fellowship to learn to see. Now, the technology is as common as the eye chart in an ophthalmology practice. It not only eases diagnosis of glaucoma disease, but also finds early retina problems. In fact, now each of my cataract evaluations has a macula OCT done before surgery.

Also in 1999, I paid the Yellow Pages (Ask your millennial docs if they have one handy — or even know what it is!) $175 a month to list my name and phone number in bold under “Physicians”. This was how patients found providers back in the 20th century. Now information is at patients’ fingertips on the smartphones they carry. Forget the Yellow Pages — focus on promoting your practice’s profile on Yelp instead.

Speaking of the internet, consults are spent redirecting web searches and social media platform information, so it is relevant to the patient. Often at the end of visit, I will write on a piece of paper the exact diagnosis or brand of IOL knowing the patient (or the patient’s children’s) next source is the internet. For example, narrow angles can be confused with open-angle glaucoma or macular pucker confused with macular degeneration. In some cases, a patient’s visit to my office is a second opinion, with the first opinion coming from “Dr. Google”.

However, this technological advance goes both ways, with my practice leveraging it to text patient appointment reminders instead of telephoning them. We also utilize texts to send informational videos after surgery. The internet enables us to share the results of diagnostics via the patient portal. Doctors are still connecting with patients, but it happens in a very different way.

OUR NEXT LOOK BACK WILL BE JUST AS ENTERTAINING

I have no idea what 2046 will look like. Waking up each day and going to work really does not seem much different than the day before. But just look at your driver’s license or passport photo taken years ago to realize the impact of time. I tried to speculate how an ophthalmology practice would look in the future and drew a blank (a rare speechless moment). Thinking we know where we are heading would only limit our ability to adapt. The best-case scenario for me is to be around to be asked to write this column 25 years from now. The only thing I am certain about in the future is that when I pull up this article for reference, my future self will laugh as I am heading to work running on a treadmill in the back section of a driverless car. OM

Scott LaBorwit, MD, is a principal at Select Eye Care, with locations in Towson and Elkridge, Md., and is an assistant professor, part-time faculty, at Wilmer Eye Clinic of Johns Hopkins Hospital, Baltimore. His e-mail is Sel104@me.com.

Disclosures: Dr. LaBorwit is a consultant to and speaker for Alcon.