Two Doctors Give a Specialist’s Perspective on the Ever Changing Field of Medicine
Fifth century B.C. Sanskrit manuscripts describe the earliest type of cataract surgery known as couching and more than 700 years ago the first pair of spectacles was invented. As arguably the most coveted of the five senses, it isn’t surprising that scientists have been working for hundreds of years trying to repair and restore sight. Studies show that most people value sight the most of the five senses; however, until it is threatened by disease, an accident or the process of age, it is usually taken for granted.
Now, hundreds of years and advances later, people continue to work to protect the sense of sight. Two local ophthalmologists, one retired and one currently practicing, have worked and still work toward that goal.
Dr. John Glotfelty, who retired in 2004, and Dr. Kevin Dorsett, both Polk County Medical Association members who have been in practice here since 2001, have seen and been a part of those changes working to make good vision a reality for their patients.
“My daughter-in-law is in medical school right now,” Dr. Glotfelty says. “I told her that anything she learns now will not be applicable in five years or less.”
SPECIALTY CARE & PROCEDURES
Dr. Glotfelty explains that a good example of how quickly things change in the practice of medicine is the advances in caring for the patients, which encompasses technology, treatment and medications.
Having practiced more than 40 years in his Lakeland office, Dr. Glotfelty helped make those advances toward ensuring good vision was a reality for his patients. “When I arrived here in Lakeland, there wasn’t a glaucoma screening program,” he remembers. “We were the second in the United States to have one.” Dr. Glotfelty was instrumental in creating the traveling glaucoma program that visited Polk County mobile home parks administering glaucoma tests.
Also in the 1960s, a screening program was initiated for pre-kindergarten and kindergarteners to prescreen for Amblyopia (lazy eye). “So, of course when these types of programs were brought to the area, the patients were very receptive to us as doctors,” he says.
In the 1990s, Dr. Dorsett came on staff at the Lakeland Eye Clinic. For four years, he and Dr. Glotfelty worked together.
The first references to cataract and its treatment in the West are found in 29 AD in De Medicinae, the work of the Latin encyclopedist Aulus Cornelius Celsus, which also describes the couching operation. In the Western world, bronze instruments that could have been used for cataract surgery have been found in excavations in Babylonia, Greece, and Egypt. Pioneers certainly of their time, they would be interested to watch Dr. Dorsett perform today’s cataract surgery. Now, the surgery can be performed bladeless, another new advancement.
“When I have a patient come in that hasn’t been able to see in years, they don’t realize just how bad their vision has gotten,” he says. “Seeing the excitement and elation in their eyes after the surgery is a favorite part of my job. They certainly have a new lease on life.”
Each year, cataract surgery enables millions of people to improve their vision. It is one of the most frequently performed and successful operations in the world today.
THE BUSINESS OF BEING A PHYSICIAN
Dr. Glotfelty says that when he was a young doctor, dealing with the financial portion of the job was entirely different than now. For goodness sake, an office visit was five dollars. “I can’t tell you how many tomatoes and eggs I took home from patients who ‘paid’ their bills with them,” he elaborates. “The patients felt that were paying their way – they weren’t taking a handout and that was important to them.”
If the doctor knew that patients couldn’t afford the treatment, they would be charged accordingly or not at all, in some cases. But, in the mid-60s things changed when Medicare and Medicaid were signed into law.
“When Medicare and Medicaid came on the scene, everyone then had to be charged the same. It didn’t matter if they couldn’t afford it. It didn’t matter if they had insurance or Medicare. It had to be across the board the same,” Glotfelty explains. “So, fully knowing that our patients couldn’t afford it, we had to bill them the same because of the new law.”
Workman’s Compensation guidelines were also an issue during that time period. “Workman’s Comp had a set fee for each procedure, exam, etc. that they would pay, so again, we had to charge what they said in order to be approved physicians,” Glotfelty adds.
As a practicing physician now, Dr. Dorsett’s issues with payment and charges lies more with the government and its requirements.
“Some old patient notes that Dr. Glotfelty and other doctors made from 15-20 years ago have 3 or 4 patient visits on one page,” Dr. Dorsett says. “Now, there is so much government regulation that is seems like every year we continue to get more and more intrusion. They tell us that we have to use electronic medical records and how to code.”
Dr. Dorsett, as well as many of his colleagues, is clearly frustrated with a highly regulated system that presents a certain barrier from being able to practice in a more personable way because of the number of requirements. “It has gotten to the point that rather than facilitating patient care, it impedes it,” he says. “It is a greater and greater challenge as to how to provide quality patient care in spite of the government.”
He uses the example of attempting to conform to the government’s guidance that the practice use electronic medical records. “When I am in an exam room with a patient using EMRs, I am much more focused on typing than listening and showing concern for my patients,” he explains. “EMRs take more staff, they are less efficient, we see fewer patients and, as I said earlier, we have less patient interaction.”
TECHNOLOGY AND MEDICINE
Another aspect of technology that has affected the world’s population, as well as physicians, is the advancements in communication.
In the 60s, Dr. Glotfelty sans cellular phone, and other doctors on call still needed to be reached during their off hours. This was accomplished with Business Radios, Answering Services.
“No matter where I was, the hospital could reach me,” he says. “It was kept in the car and the hospital answering service would call me on it if I was needed.”
Today, Dr. Dorsett has mixed feelings about the forms of communication available to patients. “The Internet can be a mixed blessing. On one hand, patients are more informed and are able to ask questions they may not otherwise ask,” he elaborates. “On the other hand, misinformation creates a degree of confusion that I feel is detrimental to our ability to communicate and provide appropriate care.”
The world of technology continues to grow beyond our wildest imaginations, even when considering medicine and ophthalmology.
Looking back to 1604, Johannes Kepler described the function of the retina and demonstrated that concave lenses correct myopia and convex lenses correct hyperopia. Way back in 1784, Benjamin Franklin invented bifocals, a corrective product still in use today.
In our modern world, as lasers restore our sight and computers hold our medical records, doctors are working to refine these advancements so that they can continue to provide the best care for their patients, which is precisely what makes the field of medicine ever changing.
story by Anita Whitaker