A 'real doctor' is in the eye of the beholder

Optometrists (ODs) sometimes complain like the comedian Rodney Dangerfield, whose trademark plaintive wail was “I don’t get no respect.”

The reasons for this are myriad, but mostly revolve around optometry’s difficultly in educating the public at large on our extraordinary and wide-ranging capabilities, position as the primary eyecare profession that is most accessible and used most often for entry into the eye health ecosystem, and how we impress our patients and communities with our signature conscientious care, friendliness, and “beyond the call of duty” work ethic.

When you add all that to the misinformation created and circulated by a relatively small but powerful cabal of ophthalmologists who have a vested and monied interest in keeping ODs “down on the farm,” it is no wonder the public-at-large is confused about who we are.

ODs vs other healthcare professionals
ODs perform all the tasks and duties of well-educated, licensed, independent healthcare professionals who seek to heal and teach. This trademark is the source of our professional joy and satisfaction. Still, the term “real doctor” remains a burr in our britches.

Our public relations Achilles' heel is complicated by the initials behind our name— “OD”— which are not as readily associated by the masses with being “a real doctor” like allopathic (MD) or osteopathic physicians (DO).

Previously by Dr. Brown: An OD recalls his career with the VA and the mentor who left him a valuable pearl

Regarding the latter, only in the last few decades have DOs even started to receive the respect and parity they have earned. Still, some arrogant allopaths persist in relegating them to the status of “second class” doctors and citizens of the medical fraternity.

I will not be able to put to death the old, tired, threadbare trope that “ODs are not ‘real doctors’” with a single article in an ophthalmic trade publication. But I can help blunt its sometimes-cutting edge and remind my fellow ODs of what it is truly important and how to better live up to the calling of a “real doctor” who declares the “gospel of optometry.”

***

I am a writer and raconteur, and for me there is nothing more powerful than a narrative arc that bends toward “capital T” Truth.

Blast to the past
So here is an “oldie but a goodie” from the mid-1990s—back when our profession was skyrocketing toward new heights with therapeutic privileges, Blockbuster Video was making hay while the sun was still shining, and logging online to this new thing called “the internet” meant the screech of a telephone modem, followed by a seemingly interminable wait, and then the declaration, exciting at the time but now cringe-inducing, “You’ve got mail!”

Two years into my Department of Veterans (VA) career in Huntsville, Alabama, circa 1995, I had been lucky enough to have met several other doctors, MDs of various specialties mostly, who were about my age, fresh out of training, and—like me—starting families and careers. We bonded over our commonalities, both networked with and referred to each other, hung out together, and in many cases are still close.

One of them, a pathologist, invited me to have lunch with him in the physicians’ dining room at Huntsville Hospital, just across the street from my clinic.

“Come on over—the hospital feeds us for free, food’s great, and I can invite any doctor I want, even if you aren’t on the medical staff.”

I was just starting to accumulate a few coins to jingle in my pocket and could afford my own lunch, but there was still enough poor student left in me not to turn down free food.

Related: One patient connects 2 students who have never met

I donned my white coat, made sure my ID doctor badge was prominently displayed, and met up with my friend in the physicians’ dining room. As promised, the lunch spread was impressive and delicious. The pathologist introduced me to a couple of his MD friends who sat with us, and they seemed truly interested in the new VA eye clinic that I had started just across the street.

Although I was mostly tuned into our conversation, I could not help but overhear some fragments of another exchange at the table next to us because the preening dude bro’ doing most of the talking was a loud and obnoxious general surgeon with whom I had worked with briefly at a local military hospital while he was still on active duty.

He was in private practice by then, was by all accounts a good and very busy surgeon, and was now letting the doctor at the table, presumably another surgeon, or at least someone whom he considered his “peer,” know what he thought of family medicine physicians.

“Detect and refer, detect and refer. That’s all they ever do is detect and refer! You wouldn’t believe the crappy cases they send me!” he complained to his friend.

I looked around to identify the source of the screed, and when I located him, I rolled my eyes and thought, oh brother, that figures.

At that point I already had more than an average amount of experience in the OD-MD world because of my residency and subsequent practice at a co-management center and then the multidisciplinary VA environment. I knew the coded language and secret handshakes and could distinguish signal from noise. Several MDs had already thrown me under the bus a few times by saying one thing to my face and another to a patient or a colleague, so my skin was already calloused and thickened.

I had learned to tiptoe through the interprofessional mind fields and knew where the bombs were buried, but I felt secure in my abilities and was not particularly seeking affirmation from a MD or DO beyond that which I might routinely receive during our co-managing a patient (and I was not even counting on even that).

Related: 30 years of optometry: Highlights with Drs. Bowling and Brown

But at that moment, and upon later reflection on the general surgeon’s arrogant and uniformed opinion, several thoughts occurred to me that were like a series of powerful searchlights cutting through the fog and pointing the pathway way to the truth: a “real doctor” is in the eye of the beholder:

• If you are a consultant in any specialty, you should not “bite the hand that feeds.” Especially not in public. Especially in a crowded lunchroom within earshot of so many people. I wonder what would have happened if cell phone cameras had existed back then and someone had made a video of that exchange and sent it to every family physician in Huntsville or posted it on social media?
• Physicians apparently have their own hierarchy and “pecking order.” Dr. Big Mouth apparently considered himself a shark at the top of the food chain and that family physicians were at best guppies and at worst bottom feeders—which led me to ponder what kind of fish neurosurgeons think general surgeons are.
• From that fact followed this rhetorical question: If MDs argue over and cannot decide even among themselves who the “real doctors” are, then what possible chance did I have of ever becoming a full-fledged initiate into the medical fraternity?
• Rather than that being a depressing thought, I found it quite liberating instead. One less thing to worry about! Sure, I want to get along well with MDs and DOs and appreciate an “Attaway!” as much as the next person. But there is no impediment—certainly not the initials behind my name—to my learning as much or even more than an ophthalmologist in many areas of eyecare and taking good care of my patients, who are the only real “beholders” I am worried about.
• I used to think a D-Day sized, systematic campaign by organized optometry to correct public misperceptions would have a large impact. While there may be a need for adjustments in the methods and scope of our macro-PR methods, I am convinced after 30-plus years of practice that it is the workaday, smaller heroics of individual ODs in the trenches that will have the largest impact over time.

Takeaways
Lest we let ourselves off the hook, remember that some ODs still have the annoying habit of making “distinctions” among themselves, dividing, and sorting according to how and where another one practices while forming a circular firing squad with loose tongues and trigger fingers stumbling around stoned drunk on the noxious fumes of their own inflated egos.

Completely uncalled for! Most of us are doing our very best, trying to provide a wide open and welcoming door for patients to enter the eyecare system and to take care of ourselves and our families. If you are dissing and dumping on your OD colleagues based on such silliness, remember that is the very same way unenlightened or cynical MDs treat you.

Not only should we affirm the truism, “It is not the initials behind the name, but the name in front of the initials that matters most,” perhaps we need another optometry-specific one as well: “It is not the setting of the OD, but the OD in the setting that seals the deal.”

What is a “real doctor?”

If you do not know the answer to that question after reading this article, then I have failed you as a writer and apologize, but I still invite you to read it one more time and see if the lesson sticks.

Read more by Dr. Brown