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Glaucoma Testing, Hearing Testing, Ear Lavage, Alzheimer's Testing
Good for the patient - good to increase your reimbursement.
In these days of patients living longer, there are certain testings that should be done in your office, for many people, but certainly for the patient with symptoms, and, anyone over sixty-years-old.
The first test is Alzheimer’s. How many people do you see who say, “Doctor, I’ll walk into a room and forget why I’m there,” or “I looked up the number in the phone book, but before I could dial it, I was unsure of what the number was, and I had to look it up again.”
Is this Alzheimer’s disease, brain-computer overload, or naturalness for the aging brain? There is an easy way to find out. We use the mini-mental exam and the clock number-face test to help solve the problem. I avoid saying, “Let’s test you for Alzheimer’s Disease.” Instead, I say, ”Let’s examine your forgetfulness.” I find that some people do from poor to fair to ok on the questions on the mini-mental exam, but when it comes to drawing the diagram at the bottom of the page many do very poorly who have Alzheimer’s disease.
Putting the numbers on the face of a clock and making the hands point to 12:30 is a real problem for some of those tested. If you combine the scores on the mini-mental exam, and the clock face test, you will have a good idea of the presence of dementia, or, whether the symptoms are from a normal aging brain.
When they ask about treatment, and when you tell them how poorly they have done, we do not say, “we have got some good “Alzheimer’s disease medicine.” This can strike a sour note in the patient who needs medication.
The better way to say it, in my opinion, is to say, “we have some excellent medication for memory, let’s try it. I’ll see you in a month, and we’ll see if we have to increase it.” They readily buy this plan. We will start in the lowest dose or Aricept or R Reminyl and proceed as indicated. You’d be surprised how happy they will be that they discussed the problem with you. (Some of them have told no one of their memory fears.)
They will be happy to try the medication and they are happy that you will be with them with this problem. Another case where you have helped the patient and increased your reimbursement. Have your office manager learn how to file for psychological exams. Add it to the extended office call your OMT and everyone is happy.
The next test is simple and easy. It is the Glaucoma test. Ask the patient when they had their last test for Glaucoma in their eye doctor’s office. If it has been more than a year, and, they don’t have an eye exam appointment scheduled, do it in your office. All it takes is a Schlotz tonometer, some anesthetic to anesthetize the surface of the cornea, and, a patient who will lie down and gaze upward and slightly behind them. If they test more than 18.75,this means the pressure is over 5. This is the perfect patient to refer to an ophthalmologist. Add glaucoma testing to your office call, and OMT, and everyone is happy!
The next two procedures go in tandem. They are very easy to do, all you need is a pocket otoscope. (I carry mine in my pocket.) Everyone gets an ear exam. If we have significant wax build up, we flush the canals.
The latest equipment is the new Welch Allyn Ear Lavage System. Inexpensive –
($350.00) – ease to use – painless for the patient and good for your reimbursement.
We also follow ear lavage with suction of both canals, and then do hearing testing. We use the Welch Allyn hearing tester that checks hearing at four different decibel levels. Testing is a piece of cake, but, you have to make sure that the patient understands that the sounds they hear will be very subtle, and when they hear a sound, they say “Yes.”
The door to the room must be closed, and the canal not being tested must be closed off with the patients finger occluding the opposite canal. When you find hearing loss of significance, and, the patients wife says,, “I knew he was almost deaf. He turns the TV up so loudly that it drives me crazy.” All of these tests are easy to do – require simple, inexpensive equipment and give good reimbursement. Add these listings to your office call, your OMT – and everyone is happy!
