It was recently “Back to the Future Day.” I’m not sure what that means, but I seem up-to-date on the news by mentioning it, don’t you think? But the phrase “back to the future” began to mean a lot more to me once I started working in two starkly different worlds this past month. 

Back to the Past
On Mondays and Thursdays, I work with a traveling nursing home practice. This is immensely important work, and I salute doctors who do this once in a while, part-time or full-time. They are true healers, physically and spiritually. 

But these days take me back to the past. It was humbling to realize my biggest challenge was the lowly—but revered—direct ophthalmoscope. I had barely touched one in 20 years. I felt like an idiot and, yes, thank you for asking, at least a dozen times have begun the procedure like any first-year OD student, blinding myself by shining the light into my eye. On the chart where you state the quality of the view, I’ve had to mark “poor due to miosis—my miosis.” Geez. And have you ever tried to epilate lashes using a hand-held slit lamp? OK, Dr. Shaky-hands, go ahead and try. 

Back to the Future
On Tuesdays and Fridays, I am back to the future in our high-tech private practice with all the bells and whistles. My practice was pretty darn modern back in West Virginia, but here we have these gizmos that show detail in the retinal layers that make my OCT look like connect-the-dots. When patients ask, “What’s that a picture of?” I just say, “How about them Cowboys?” and they seem to forget their inquiry.

We work hard to get to a place where we have a handle on the testing, findings, diagnoses and treatments for everything—from patients who accidently put two contacts on one eye and complain they can’t see right to patients who will only see right if they put two contacts on one eye, and by “see right” I mean their vision sucks less. 

Then some no-account researcher figures out we can spend as much as a nice car costs on some doodad that drags us back to the future, when the definition of “future” is “a time when the doctor’s career-long ignorance is revealed by this new doodad.”

Lessons of the Past
But working in the nursing home, I see that a touch on the shoulder does way more than using secret rays of light to reveal the eye’s mysteries. The world of optometry vacillates between knowing the patient and knowing the vision plan. 

Are efficiency and reduced costs the most important things in the future? Maybe we should put the care back in eye care and see a single patient every six hours like I did when I first started. An eye exam would cost $10,000 to support my high-tech equipment and beer supply. And yes, I had days with only two patients: Mom and Dad. 

As I traverse these two worlds of optometry, I am reminded that, at the end of the day, all the patient wants is someone who actually gives a crap about how they see. Whether it’s back to the past or the future, either way you better make ’em see right. That’s the deal. 

So, quit pushing buttons and ask the patient exactly what they need to see. You can use your fancy doodads to figure stuff out, but at the end of the day, it comes down to whether they can read the hymnbook on Sunday.