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Patient Asks about Femto Laser Cataract after seeing an AD and You dont have it- How do you handle the situation?

Dr D.P.P "Be honest and truthful to the patient by telling him that the Femto laser is used only for making incision or cuts in the cornea and cataractous lens after which you still have to use the same phaco emulsification instrument to remove the cataract. After this you will be placing an IOL which would be the same for both methods. Final vision will depend only on the IOL PLACED and not on the incision done by the femto laser. Also tell the patient that you would have to charge extra 40000 rupees for using the femto laser machine. Finally, assure the patient that in your hands the outcome of the surgery is the same whether it’s femto or phaco

Dr-SP-I say In this system there are 2 machines used. 

       1.femtolaser to mark and make cuts and second is the phaco machine that actually removes the cataract. This increases the surgery time. And does not give you any benefit in visual out come.

Dr QM Certainly, I can do it for you.. however you must realize the machine costs crores of rupees; hence the cost of the procedure will be ?2.5x instead of x for a regular cataract surgery.. I will operate you at a colleague’s Center.. I purposely did not install one myself as otherwise I would be recommending this procedure to all Cataract patients with hardly any additional benefit just to pay the bank interest.

      2. The current procedure I do has been around for decades; long term side effects of femto are not known

      3. If you were my father, brother I would opt for regular surgery but choice is yours

How to Maintain Hospital Inventory

Good morning sir, can you guide young ophthalmologist in maintaining hospital inventory specially IOL and ot medication, visco and other essential. Do we have any software which can track them - in form of excel sheet seperate category - date wise entry and exit - bar code and automatic entry - alarm system for expiring and less product

How to handle patients who feel Consultation Fee is High

A general question to all. how to handle patients who question the consultation fees, refuse to pay and try to dictate charges at the hospital? Should one oblige them in fear of them bad-mouthing or stay firm and refuse to see them if they refuse to pay Also should consultation fees be charged prior to consultation or after consultation is done? Since many a times they get away without paying once consultation is done.

Paying Salaries during the Lockdown.

This question to Hospital owners, how are they going to pay salaries to salaried consultants if the lockdown continues for more than 15 days. Any precedence set for such events. Naturally, if elective surgeries are blocked for 2 months most hospitals won't be able to pay salaries. 

Dr.D.P. For small clinics, it’s going to be difficult to pay salaries if the lockdown is going to be for more than 15 days. Until then we can afford.... beyond that everyone has to share the burden..employer and employee. But I hope ???? things don’t go that level. Only when an establishment can generate revenue can it pay. With zero revenue for a prolonged period no establishment can survive and keep paying salaries, taxes, rent, bills etc. It’s time for the government to chip in

Handling Economic Impact of corona Virus

Handling the Economic Impact of Corona Virus on Ophthalmology Practices

Date 25th March - 7 to 8 Pm

Participants -90+ OPD Members

The meeting started with an Introduction by Dr Senthil and the following is the summary of the Discussions

Moderators Dr Senthil  Dr Mahipal Sachdev, Dr Ashok Grover, Dr Kamal Kapur, Dr Vinay Garodia, Dr Elankumaran and others.

1)  Payment of salaries to Staff

Since in March we have worked for 20+ days most institutions should have reasonably broken even- hence we should be paying full salaries to staff for the month of march. Regarding April- since the situation is very fluid- we have to wait - as to see how this proceeds and decide.

2)  Payment of rent

We need to go to our agreements and look at the force majure clause on the agreements and request the landowner for payment of reduced rent or ask our lawyers to give a representation to the landowners.

3) Payment of EMIs and AMC CMC for Equipment.

AIOS is preparing a draft letter to be sent to manufacturers and the letter will be shared - to all members, we can modify and approach the companies for deferrement of EMI payments and also an extension of AMC and CMC for 3 or more months for this year alone.- The draft letter has been circulated in all the groups and is also available in the resources section of this website.

4) Regarding OPD closure.

Most practitioners have closed OPD and are only catering to seeing emergency cases. Usage of Telemedicine as per the guidance of the MCI is also advocated.  Whenever advising patients using telemedicine a clear disclaimer should be mentioned and also if we are not able to do a detailed examination of patients due to COVID- we should mention in case sheet that we have not done a full examination ( for Example a dilated Retina Examination- if not done- should be mentioned in the case sheet) 

Telemedicine Guidelines of MCI is uploaded in the practice resources section of this website

5) Emergency cases Surgery.

Only Emergency cases should be operated - we should take utmost precautions while operating on these cases. Also whether we should do a COVID test for these patients and the feasibility of testing is questionable.

6) Disinfection of OT

Though we are not operating for a long time- we should maintain our disinfection / sterilization procedures and clean up the OT as and when possible. 

We will update you on the site regarding similiar zoom meetings which will happen more frequently and request you to stay in touch.

Also please do post your comments and any questions which you may have which shall be answered by our experts.