Now we’re talking: Interprofessional communication

Excerpted from page 26 of the March/April 2023 edition of AOA Focus

Gary Chu, O.D., MPH, vice president of professional affairs at New England College of Optometry (NECO), knows that doctors of optometry are important partners on a patient’s health care team.

Yet, as he looked around, Dr. Chu also observed that something was missing.

How do doctors of optometry go from practicing in professional silos to being true collaborators on those teams? How can the relationships between doctors be enhanced? How can doctors of optometry educate other providers who may not know what the profession has to offer?

“What I think optometry needs is interprofessional professional CE,” Dr. Chu says, “where optometrists and the primary care doctor are together.”

Getting on the same page

As doctors of optometry see their scope of practice expand—and health care collaborations are more commonplace and public awareness of the profession stretches—they are considering how they can forge and advance those relationships.

It’s a long-standing conundrum, with communication as the key.

Wrote two consulting psychiatrists in a 1989 article in the British Journal of Hospital Medicine: “Efficient communication between doctors who are interdependently involved in the management of patients is vitally important to the quality of medical care. Misunderstandings can result in loss of mutual trust and waste of time and money, and more importantly, they may be detrimental to patients’ health or even life. Good communication increases doctors’ professional satisfaction and sense of purpose.”

The authors’ cure for poor communication?

Clarity, simplicity and courtesy.

A 2019 study published online in the Journal of Multidisciplinary Healthcare considered communications in a teaching hospital in Australia. While it is a different setting, lessons can be learned. Among the findings of a survey of rounding team members was that, though care providers saw the benefits of team collaboration as improving coordination of care, boundaries were among the challenges. Benefits cited in the study included improved interprofessional communication, greater awareness of patient care issues, along with improved patient outcomes. Yet, researchers in the article, “How Do Interprofessional Healthcare Teams Perceive the Benefits and Challenges of Interdisciplinary Ward Rounds,” added this:

“IBRs (interdisciplinary bedside rounds), however, do not guarantee a collaborative approach to care delivery as health professionals can be restrained by the need to hold onto boundaries and knowledge. Challenges include time constraints; coordination of clinicians’ availability; and the length of time taken for discussion. Introducing or consolidating interdisciplinary bedside ward rounds may be challenging as they require clinicians to make a cultural shift from working in silos to working collaboratively.”

Talking collaboration

At a time when doctors of optometry are being drawn more frequently into collaborations with other providers, communication can be paramount in making new and existing professional relationships work. And it comes highly recommended.

Consider the AOA’s Evidence-Based Clinical Practice Guideline: Comprehensive Adult Eye and Vision Examination. Both the first (originally released in 2015) and the second (released in 2023) editions of the guideline rightfully underscore and acknowledge the role of interprofessional collaboration and communication in the delivery of eye care.

“Intra-professional consultation may be needed for optometric services such as treatment and management of ocular disease, low vision or neuro-vision rehabilitation, vision therapy and/or specialty contact lenses. Interprofessional consultation with an ophthalmologist may be necessary for ophthalmic surgery or other aspects of secondary or tertiary eye care,” the authors of the second edition write.

“The comprehensive adult eye and vision examination may also reveal systemic medical conditions or diseases for which the doctor of optometry may coordinate needed care,” they continue. “An interprofessional consultation can be implemented with the patient’s primary care physician or another health care provider for further evaluation and treatment of systemic conditions or related health problems. Information shared with other health care providers offers a unique and important perspective, resulting in improved interdisciplinary care of the patient.”

Consider, too, the American Public Health Association (APHA) policy statement, “A Call to Improve Patient and Public Health Outcomes of Diabetes through an Enhanced Integrated Care Approach.” The statement outlines an interdisciplinary approach to “skyrocketing” incidents of patients with diabetes.

Among the report’s 17 recommendations is a proposal that eye doctors, dentists, pharmacists and podiatrists team up to co-manage the care of patients with diabetes, because their patients’ concerns may overlap.

“Communication is essential between the health care team and organizations that share data for quality assurance,” reads the policy statement, which was shepherded through the APHA’s policy development process by AOA members. “Health care technology allows multiple channels to streamline communications among the health care team, including electronic health records, secured emails, text messages, regularly scheduled virtual meetings, and telephone conversations.”

Seize the opportunity

Former AOA President Andrea Thau, O.D., was not only co-author of the APHA policy statement but she also served as policy chair of the APHA’s vision care section with a diverse membership, including eye doctors, dentists, pharmacists and podiatrists. Communicating on cases benefits patients and presents an opportunity to form deeper professional bonds by educating other health care providers about optometry.

“Communicating with another health care provider is an opportunity for a doctor of optometry to demonstrate their breadth of knowledge and the scope of our care,” Dr. Thau says. “So, whenever you send a report, you’re doing more than just communicating information that you hope the other provider will find useful.

“You’re also letting them know that you are a resource in the community to help patients and letting them know about the services you provide,” she adds. “For example, in some places, there may be people who are ignorant that we provide retinal exams for diabetic patients. You want them to see you as a trusted colleague and a trusted health care resource.”

Dr. Thau describes a well-done report as thorough, clear, timely and clinical. Generating these reports that can be shared with other doctors has been made easier due to electronic health records, she says. But picking up a phone hasn’t lost its luster. When she refers patients, for instance, she might call fellow providers. She might also send along a copy of the report with the patient for their appointment with their primary care physician.

Dr. Thau cites the example of certain medications being taken by a patient that may cause problems in the eye, such as dry eye or blurriness. “It doesn’t hurt sometimes to pick up the phone and call and let them know what you are thinking or finding,” Dr. Thau says. “The person who benefits from connecting is the patient.

“In the end, you can often develop very good working relationships,” she says. “Sometimes friendship and true respect can develop. That back and forth can change things, and they start turning to you for their patients. That’s when you know you’ve made it over the finish line—when they’re coming to you for your opinion and sending you a patient to evaluate.”

Fostering relationships

That back and forth works.

Brad Lane, O.D., MBA, MEd, tells the story of how his relationship with a specialist paid off for a patient.

“When a patient presented to my office with diplopia and ptosis (both associated with multiple sclerosis), I was able to pick up the phone and make the referral to a local neurologist,” Dr. Lane says. “The neurologist gladly took my call, and the patient was seen by the neurologist that evening. I do not think the referral would have been as seamless if I hadn’t communicated with the provider in the past. Working to foster those relationships helped my patient.

“It is important to communicate exam findings with a patient’s primary care provider to help coordinate care,” he says. “Doing so opens the lines of communication and enhances the level of care patients receive.”

He cultivates those relationships—regularly reaching out to primary care physicians, endocrinologists, rheumatologists and other specialists. Each encounter carries with it an opportunity to demonstrate optometry’s value as a member of the care team, Dr. Lane says.

Over the years, he has learned another lesson in interprofessional communications. Others value brevity.

“I have many providers who only want the highlights in the reports I send,” Dr. Lane says. “Basically, they want to know my diagnosis and plan. We are all stressed, and getting to the point is valued. Brevity is appreciated. I just ask doctors how they want a report sent. I collaborate with a rheumatologist with a very specific request of how he wants reports sent to him. We made a template just for him, and he sends us several patients each month.”

Talking and listening?

Diane Russo, O.D., MPH, MBA, associate professor of optometry and assistant director of residencies at NECO, teaches students how to communicate well with patients and other health care providers.

It’s more complicated than it might look. Collaborators, for instance, must be willing to give as well as receive. Dr. Russo breaks down communications into two buckets.

“There’s the actual composition,” she says. “Figuring out what to say and how to say it is, in my opinion, the easier part to some degree. It’s what message you are conveying. That message needs to be clear and concise because providers’ time is short. So, you want to make sure that whatever it is you’re saying is easily understood and that it does not go on and on.

“Then the other aspect that probably, in my opinion, is more of a challenge is delivering the communication,” she says. “It’s how you get information from Point A to Point B.”

Call them modes or channels of communication. Doctors of optometry have far more options than they used to when it comes to ways of connecting, such as phones, electronic health records, Zoom, snail mail, emails, face-to-face conversations and faxes with other providers.

Mode matters, too.

“It’s the other hurdle that creates an administrative burden for really busy doctors,” says Dr. Russo, who practices in a community health care setting where optometry students can practice collaboration (for instance, by writing referral letters that are reviewed by their professors and seeing their professors model collaboration and communication skills).

With that in mind, Dr. Russo teaches “leading with curiosity,” as a way to “tease out” the reasons why a collaboration might be strained, or preconceived notions might get in the way of productive collaborations, she says.

Taking the initiative

Not long after she joined the faculty at the University of Missouri-St. Louis (UMSL) College of Optometry, Erin Brooks, O.D., M.S., joined a local Toastmasters club. A worldwide network, Toastmasters says it can help its members improve their public speaking skills, work on networking in a small and supportive environment, practice writing speeches and making presentations, and build leadership skills.

Dr. Brooks, associate clinical professor at UMSL, had conversations with patients and students in mind when she enrolled, but it has helped in building relationships with other health care providers.

“One of my biggest concerns was that I talked too fast,” she says. “But with Toastmasters I learned so much more than slowing down my speech, which I still struggle with at times. I learned the importance of how to deliver feedback—more as concrete suggestions and surrounding it with praise. I learned how to present ideas and summarize those ideas.”

Communication is the answer

Necessity also is driving the case for growing collaborations, says Dr. Chu, noting predictions of a workforce shortage among ophthalmologists.

“We’re seeing many successful ophthalmology practices here—they have a trusted optometrist whom they work with,” he says. “The more training together, the more education together, and knowing what people’s expertise is only improves communications and is good for patient outcomes.”

Among Dr. Chu’s responsibilities at NECO is industry relations, including interprofessional or collaborative care. Last December, Dr. Chu was preparing a needs assessment or gap analysis on the role of continuing education in fostering successful collaborations among optometrists and other providers. He also was working on a partnership between Boston University College of Medicine and NECO to stage the “first regularly scheduled sessions” for doctors of optometry and primary care providers. The continuing education is meant for providers “to understand how systemic health affects eye health.”

“Among colleges of optometry, we try to create clinical experiences where there is inter-collaborative care,” Dr. Chu says. “But what I am finding is that once you graduate from your educational setting, you go into the real world and all the silos are back. Less of that learning happens then.”