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Practice Spotlight: 4 Pitfalls to Avoid in Collaborative Care Relationships

Long-time colleagues share the benefits of their experience.

At Virginia Eye Consultants, where we work on a team of six ODs and 12 multispecialty MDs, our internal and external collaborations go smoothly. But it doesn’t just happen—we have to plan, execute, and avoiding certain pitfalls.

Pitfall #1: Building Referrals, not Relationships

There is a lot of emphasis on building referrals, but the numbers are only good when the relationships are good. Choose partnerships where you can work as teammates focused on delivering the best patient care. If you share that all-important goal and a mutual respect, you have a good basis for a lasting collaborative relationship. Our provider relations’ team visits new practices to learn physician preferences and train staff in our referral procedures. In addition to communicating about shared patients, we send a weekly email to external referring physicians and have several meetings throughout the year.

Pitfall #2: Letting Timely Patient-Related Communications Lapse

A lot of trust goes into collaboration, and any lapse in communication can negatively affect that trust. Agree on communication procedures and stick to them. Using very concise forms, managing ODs send our surgeons and specialists patient data before and after the procedure or specialized testing, and then those physicians use similar forms to update the ODs. Secure texts and emails also help promote the timeliness of communicating patient care. The mechanisms for communication are agreed upon at the start of the relationship and then reviewed to make sure everyone is satisfied.

Pitfall #3: Overstepping on Primary Care

If an ophthalmologist provides services that the referring physician expects to perform (eg, dry eye treatment) or refers patients to another specialist without consulting a primary care OD, that may undermine the relationship. Ophthalmologists always need to deliver the care for which the patient was referred, and then send the patient back to the referring provider. If a cataract evaluation shows the patient needs to see someone else—a retina specialist or oculoplastic expert, for example—first ask the referring OD, whose role as the patient’s primary care gatekeeper includes making all referrals. It’s surprisingly easy to execute. We might say, “Here are the test results. I think before we do the cataract surgery, the patient needs to see a retina specialist. What do you think? Do you have a physician preference? My colleague here could see him this week.”

Pitfall #4: Collaborating From the Physician’s Perspective, Not the Patient’s

Think about how the patient experiences your collaboration, as he or she moves from primary care to surgeon and/or specialist to surgery and back to primary care. Is the path inconvenient, confusing, or redundant? It should be easy, clear, and logical. Make it clear from the start that the physicians are a team. When a patient is referred to our practice, we say, “You have an outstanding physician. I think she sent you here at the right time.” We explain that patients are referred to us for specialized care or surgery, after which they return to their familiar ODs. We also emphasize that the team’s services are complementary, not redundant, so they won’t go through duplicate testing or services. While patients are at our practice, we give them a card with a photo of all our physicians and explain, “If you can’t see me at follow-up, you will see Dr. _______. We work closely together.” Lastly, but very importantly, our front desk staff coordinates all patient visits to make OD/MD collaboration a smooth and effective process.

John Sheppard, MD
  • President of Virginia Eye Consultants, Norfolk and Virginia Beach
  • Medical Director of the Lions Eye Bank of Eastern Virginia
  • docshep@hotmail.com
Walter O. Whitley, OD, MBA, FAAO
  • Director of Optometric Services at Virginia Eye Consultants, Norfolk and Virginia Beach
  • wwhitley@vec2020.com