Co-management clash between O.D.s and M.D.s

Optometric Management,  May 2000  

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* Co-management is under fire in a recent paper issued by the American Academy of Ophthalmology (AAO) and the American Society of Cataract and Refractive Surgery (ASCRS). The groups express opposition to routine co-management in a joint position paper, "Ophthalmic Postoperative Care," which contains guidelines for co-managing ophthalmic surgical patients.

The joint position paper states, "Although [postoperative care] may be ethically ceded to another healthcare provided it is anticipated that this will be an exceptional, rather than a routine, occurrence." Suitable reasons for co-management include surgeon unavailability due to illness, travel, leave, etc., and patient inability to travel to the surgeon's office.

Ophthalmology's concerns

Kenneth D. Tuck, M.D., president of the American Academy of Ophthalmology, says that many ophthalmologists are concerned about co-management. "This statement provides clear, comprehensive, voluntary guidelines intended to assist ophthalmic surgeons in their efforts to ensure patients receive appropriate post-operative care," he explains.

What this means to optometry

Although the paper has a disclaimer stating that guidelines are voluntary, it has raised concerns. According to the American Optometric Association, ophthalmologists' reactions fall into two camps:

1. Some surgeons say they won't change their co-management philosophies.

2. Others fear the proposed guidelines will prevent them from co-managing their surgical patients.

The AOA issued a bulletin on March 1 explaining that the ophthalmic surgeons in the second category were misled by the joint position paper's incomplete contents.

The AOA contends that in the short list of "justifiable circumstances," patient choice isn't included. Also, co-management as an "exceptional" occurrence requiring justifiable circumstances isn't supported by law nor by the Academy of Ophthalmology's ethics code.

The Academy's input

American Academy of Optometry President Anthony J. Adams says,

"We believe co-management relationships are essential where they add value and confidence to patients and their families, and assist in the long-term continuity of care for the patient. Our standards of conduct clearly call for our collaboration with other members of the health care community in resolving health needs of the patient."

Final thoughts

The groups agree on one point: Co-management decisions should reflect a patient's best interest.

The AOA concludes:

* Co-management decisions should be considered on an individual basis, and not on inducements that offer blanket promises.

* Decisions should be based on the patient's best interest.

* Decisions should always include proper, complete documentation and communication between providers.

To see the joint position paper, visit http://www.ascrs.org/advocacy/ jointpositionpaper.htm.

Copyright Boucher Communications, Inc. May 2000
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