It feels like I’ve been discussing the addition of dry eye and allergy services to eye care practices for a while now. So, when I began this month’s column, I asked myself what other strategies I could possibly share with practitioners that I hadn’t already covered. After taking a step back to think for a moment, I realized the question should be: Why haven’t more adopted these ideas already? More to the point—why are practitioners so resistant? After all, with the prevalence of dry eye and ocular manifestations of allergy so high, it’s almost a given that these issues should be part of every primary eye care practice. So, why don’t more of us include them?

The answer, of course, is typical: change, and our resistance to it. More specifically, the uncomfortable confrontation of the inevitable fear that happens before a new action or policy is added. However, facing this emotion head-on is key to serving our patients—and ultimately, our practices and ourselves—better, so we must consider it. 

Obstacles to Overcome
Here are four reasons why many doctors are likely hesitant to include more dry eye and allergy care into their practice:

Getting sucked into the dry eye “treatment fad of the month” vortex and forgoing individuality. My teenage daughter has joked with me for years, “But Dad, all the cool kids are doing it!” In this case, “it” refers to a common adolescent behavior that I can’t relate to but that my daughter wishes to partake in. Some eye care practitioners feel the same with dry eye and allergy and are happy to offer the same range of treatments to their patients as everyone else. Others, however, may feel doing so is effectively forfeiting their sense of autonomy and control over their practice to become “just another eye care practitioner.” 

My advice is to get past this concern and realize that your patients will not see it this way. Going with the flow with dry eye and allergy actually provides nothing but patient benefits—after all, with these being common enough problems, not providing them will, in fact, likely drive patients away. To alleviate some of the shock, try adding certain treatments before others and asking for feedback from patients.  

We’re more comfortable with the devil we know. Few of us can honestly say our practices are perfect, but at least we’re familiar with our imperfections and their effects on our day-to-day operation. However, no one can say for certain what offering a higher or different standard of care might do. Not knowing what’s around the corner can be extremely unnerving and potentially cause practice-building paralysis. 

My advice: acknowledge and accept these fears. It’s true that you don’t know what awaits you if you make changes to your practice. However, keep in mind that you also have no idea what the future will bring. What if forgoing those changes in fact leads to a worse outcome? In this case, the best option is to institute careful planning and education prior to any decisions to mitigate disastrous results and stack the odds in your favor. Plan to be successful, and you will be.

My staff will hate me for this. On the contrary, it’s likely that nearly all—if not all—of your staff members are anxious to learn more and assist patients in a better capacity. Most staff members are excited to break away from routine activities to learn and execute something new. My advice is simply to avoid springing everything on them at once. Share with them some of the changes, let them digest and process the information and then provide them with more.

What if I can’t do this? Fear of clinical failure is a common reason many practitioners avoid change. This is even more the case with the legal ramifications that can come with clinical missteps. However, if we never took any risks in an attempt to design a better solution, refractions would still be performed with trial frames, and penlights would still be used for contact lens exams. It’s likely you have already learned new clinical skills repeatedly in the past and thought nothing of it. Why would now be any different? And as always, help can be found along the way in the form of literature and colleagues. So take a deep breath, and a step forward.