Declining reimbursements and increased specialization can create a toxic, even deadly, atmosphere for patients. The amazing precision of medical technology has surpassed our greatest expectations and yet, despite these advances, patients sometimes suffer from avoidable ailments that, sadly, are often irreversible.

How can we know so much yet see so little?

Doctors in all sectors of health carewhether they are cardiologists, allergists, endocrinologists or optometristshave been hit hard by reimbursement schedules that poorly reflect the high level of service they provide. Doctors undertake many years of education and skyrocketing student debt only to face outrageous malpractice insurance rates and downright insulting reimbursements.

In an effort to even the scalesand make a career in health care a worthwhile endeavordoctors are forced to see more patients in less time, albeit for less money. Sadly, in some cases, this means your patients primary-care physician might not dig very deep or ask important questions that could potentially uncover a hidden problem or condition.

In addition, many doctorsoptometrists includedseek out a niche. Specialization is on the rise. But, is it a double-edged sword? Although it gives patients greater access to specialistswhich is a huge benefit when a patient has a specific problem such as glaucoma, for exampleit can also create an environment where no one is really looking after all of a patients health-care needs. It creates a sort of tunnel vision.

In this months cover story, How to Manage Your Patients with Type I Diabetes, author Daniel Bintz, O.D., recalls an awkward encounter in which his patients mother asked him to talk to her teenage daughter about the importance of managing her Type I diabetes in the face of some social difficulties that she was experiencing as a result of her condition. The patient was afraid that her friends would think she was a freak if she used her insulin pump before lunch. In this case, the patients physician was 100 miles away, so Dr. Bintz was the most accessible doctor with an interest in her case.

Todays health-care system is as difficult for patients to navigate as it is for doctors to endure. Although patients have come to accept that they must be advocates for their own care and can no longer rely on their family doctor to oversee all aspects of their wellbeing, the system puts patients at risk. As an optometrist, where does that leave you? Can you, or should you, dig deep into a patients systemic heath? Is it really your place to provide social or emotional counseling to a patient such as Dr. Bintzs? Another story in this months issue addresses similar concerns, namely how to help patients quit smoking (see The Great Optometric Smokeout).

Whether or not you consider matters like this your responsibility, it is certainly a great opportunity for the optometric profession to offer something that many other health-care providers are not offering, but which patients sadly miss.