Why is it so degrading for optometrists to work at Wal-mart?

[Bob_Barker27]

I just see a lot of negative posts in here about Wal-mart. You would think Wal-mart was Hitler or something. Wal-mart provides a lot of jobs, and they offer low prices which obviously benefit the poor and middle class. I have heard Wal-mart pays optometrists a competitive salary. I guess I don't see the difference between working as an optometrist in a corporate setting or a private practice, don't you perform the same role in both settings? It seems like having an optometry office in wal-mart makes it convenient for the customer, and don't customers come first in a service profession? I have seen some posts that state that because eye exams are cheaper at Wal-Mart, and that means the quality of care isnt' as good. Does this mean optometrists who work at Wal-mart are slackers? I just don't understand the anti-walmart and anti-big business mindset many young people have.

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[jefguth]

I just see a lot of negative posts in here about Wal-mart. You would think Wal-mart was Hitler or something. Wal-mart provides a lot of jobs, and they offer low prices which obviously benefit the poor and middle class. I have heard Wal-mart pays optometrists a competitive salary. I guess I don't see the difference between working as an optometrist in a corporate setting or a private practice, don't you perform the same role in both settings? It seems like having an optometry office in wal-mart makes it convenient for the customer, and don't customers come first in a service profession? I have seen some posts that state that because eye exams are cheaper at Wal-Mart, and that means the quality of care isnt' as good. Does this mean optometrists who work at Wal-mart are slackers? I just don't understand the anti-walmart and anti-big business mindset many young people have.

Its not an anti-walmart/big-busineess mindset that is driving the distaste for commercial practice but the attempt by corporate interests to dictate and limit the scope of practice for their optometrists. Its rather simple; because companies like walmart and lenscrafters exclusively sell frames, lenes and CL's they have an interest in providing their customers with a convienent and cheap eye exam. Consequently, it seems that these companies intervene to ensure that the optometrists are only providing the basic service (refraction and check for pathology) and none of the other services such as vision therapy. They have an interest in pushing as many people through for refractions as possible. Furthermore, many optometrists do not find this mode of practice satisfiying because they are mostly limited to healthy patients that require no more than a refraction - it eliminates many of the more interesting and challenging cases that are more likely to present in private practice.

I don't think the quality of care at walmart should be any less, nor are these optometrists just slackers - however, it is more of a conflict of philosophy; professionalism vs. business interest. As a professional, the optometrist is obligated to first serve the public interest before his/her own, whereas business is the opposite.

 

[JG777]

actually, from what i've heard from students who have visited docs who work at walmart...

the downside of working at wal-mart is the fact that you are required to see x amount of patients, or to recruit x amount of patients per day. basically, a quota. so, in this situation, you have to see more patients therefore having less time per patient. this in effect does put a strain on quality of care because, as mentioned, you just have time to do refractions and not really get a chance to perform a thorough eye examination. and if i am correct, i believe that places such as wal mart, target, and the likes are turning towards more to the idea of patient quota. and it is not necessarily that cheap prices of exams = lower quality of care. the cheap prices of exams are there to attract more patients.

another downside is that the idea of "corporate optometry" doesn't allow the optometrist to own anything. the equipment, patient base, the office... isn't yours. so when you leave, you leave all that behind. so a higher salary in corporate optometry sorta hides that. oh and i think you might have to pay rent at wal mart also. so i guess you're just renting it out vs buying your own. considering you went through all that education and paid big bucks in tuition, which seems like a better investment? (the idea of renting an apt vs buying a house- which is a better investment for your hard earned money?)

corporate optometry isn't a bad way to go.. you can make lots of money for the first few years out in the profession to pay your loans. but i guess in general, any mode of practice in which quality of patient care is sacrificed just isn't good health care. whether or not corporate optometry does that, i dunno. if i ever work corporate optometry, i'll let ya know how that goes!

 

[JennyW]

I am in private practice now, though I have had a commercial practice in the past (not at Walmart.) I have done some fill in days for friends who did have Walmart leases. There's a lot of misconceptions about commercial practice being thrown around here.

First off let me say that I prefer private practice but...

In all my years of commercial practice, I never once had a quota. I never once had any "corporate intereference" in how I practiced either directly or indirectly or how many patients I saw in a given day. I have never heard of this from my collegues who still work in commercial locations.

You are right. You essentially own nothing in a commercial practice. The analogy of renting vs buying is not a bad one. But that doesn't mean that renting is a bad thing. In a commercial practice (renting) you don't have to worry about advertising, marketing, equipment maintainence, staffing issues (in most cases) and insurance issues among other things. You can see your patients and go home at the end of the day and leave work behind. For many people, this is the desirable situation.

The one main drawback of commercial practice is that they want you there all the time. Having to hire other doctors and deal with them is sometimes worse than dealing with administrative staffers.

Owning a private practice is really a 24/7 affair. I never fully appreciated this until I did it. It's hard to put a finger on it, but I just "like it more" because it's "mine."

Commerical practice is NOT the evil empire that many claim it to be and I don't believe it will be the downfall of optometry. (It will be for some individual doctors though) For those of you considering it, I would suggest that you limit your searches to places like lenscrafters of Pearle vision or places that are exclusively "eye" places. A friend of mine once said that it was hard to feel "doctorly" when you're working next to the housewares department.

Jenny

actually, from what i've heard from students who have visited docs who work at walmart...

the downside of working at wal-mart is the fact that you are required to see x amount of patients, or to recruit x amount of patients per day. basically, a quota. so, in this situation, you have to see more patients therefore having less time per patient. this in effect does put a strain on quality of care because, as mentioned, you just have time to do refractions and not really get a chance to perform a thorough eye examination. and if i am correct, i believe that places such as wal mart, target, and the likes are turning towards more to the idea of patient quota. and it is not necessarily that cheap prices of exams = lower quality of care. the cheap prices of exams are there to attract more patients.

another downside is that the idea of "corporate optometry" doesn't allow the optometrist to own anything. the equipment, patient base, the office... isn't yours. so when you leave, you leave all that behind. so a higher salary in corporate optometry sorta hides that. oh and i think you might have to pay rent at wal mart also. so i guess you're just renting it out vs buying your own. considering you went through all that education and paid big bucks in tuition, which seems like a better investment? (the idea of renting an apt vs buying a house- which is a better investment for your hard earned money?)

corporate optometry isn't a bad way to go.. you can make lots of money for the first few years out in the profession to pay your loans. but i guess in general, any mode of practice in which quality of patient care is sacrificed just isn't good health care. whether or not corporate optometry does that, i dunno. if i ever work corporate optometry, i'll let ya know how that goes!

 

[JG777]

"the downside of working at wal-mart is the fact that you are required to see x amount of patients, or to recruit x amount of patients per day. basically, a quota."

correction: it was kaiser permanente (the hospital) that i was thinking of that required patient quota. sorry about that incorrect fact.

if you really wanna know what goes on in different modes of practicing optometry, it's good to visit these places and get a first hand feel for yourself.

 

[heretic]

my gf went to see a costco OD recently, and you have to make a completely separate appointment if you want to be dilated (i.e. it's not part of the standard exam), so I don't know how thorough the non-refraction portion of the exam is.

to jenny: although you didn't have a patient quota, did the corporation dictate the # of hrs/days per week that you had to stay open?

 

[JennyW]

my gf went to see a costco OD recently, and you have to make a completely separate appointment if you want to be dilated (i.e. it's not part of the standard exam), so I don't know how thorough the non-refraction portion of the exam is.

to jenny: although you didn't have a patient quota, did the corporation dictate the # of hrs/days per week that you had to stay open?

The corporation and I negotiated how many hours/days per week that I would be at the start of the lease. As I said in my previous post, this was one of the main drawback of commercial practice. They will want you to be there as much as possible. I negotiated 5 1/2 days and was willing to increase the hours if we got busier which fortunately we did. I also was able to negotiate a clause in the contract that I would be there LESS if we weren't busy which I never used.

Jenny

PS: I don't think that having patients return for dilation is indicitive of the level of care your gf received. In my office, I have patients return for dilation all the time. Many times patients aren't expecting to be dilated and appreciate not having to spend half their day in a glare induced fog. Having them return can also reinforce that it is NOT a routine test and emphasizes its importance.

PPS: If you're in optometry school, why is your gf getting her exams at costco?? Why aren't you doing them? Or at least, an upper year student with you assisting??

 

[Tom_Stickel]

I just see a lot of negative posts in here about Wal-mart. You would think Wal-mart was Hitler or something. Wal-mart provides a lot of jobs, and they offer low prices which obviously benefit the poor and middle class. I have heard Wal-mart pays optometrists a competitive salary. I guess I don't see the difference between working as an optometrist in a corporate setting or a private practice, don't you perform the same role in both settings? It seems like having an optometry office in wal-mart makes it convenient for the customer, and don't customers come first in a service profession? ... I just don't understand the anti-walmart and anti-big business mindset many young people have.

Bob,

I worked in a Sam's Club myself after graduation, so I speak from experience. I didn't get told how many patients to see, but I was basically told how much I could charge for an exam. The question is, do we want Wal-Mart setting our fees, or are we better qualified to determine what our services are worth? Also, they do not provide the necessary equipment to practice at your full ability. If you have no interest in treating ocular disease, it's not a bad way to go, and many optometrists don't want to treat disease. It was a job for me, and not a horrible one for the short term.

If you don't understand the anti-Walmart mindset that many people have, then you're not paying attention. The reason Wal-Mart charges low prices is because they don't compensate their workers fairly, they are extremely anti-union, and they have forced thousands (if not millions) of jobs to China. The only way Wal-Mart can sell goods so cheaply is to get them made in China (at least once Mexico got too expensive). Nothing in Wal-Mart is made in America anymore. So Wal-Mart took good manufacturing jobs from America, sent them to China, and replaced those jobs with poor paying jobs with horrible benefits. If you see this as benefitting the lower class, that's your opinion. I see it as people impoverished by Wal-Mart to the point where they can only afford to shop at Wal-Mart. Convenient business strategy, eh? It's called a "race to the bottom." Did I mention that Wal-Mart employs immigrants under the table because it's cheaper, and discriminates against women? If you don't believe me, look at the lawsuits. What's not to like about Wal-Mart?

My question is, taking a good look at Wal-Mart and their corporate strategy, do you really want to work for them long-term? Because if they could replace all their ODs with refracting opticians that they could pay 1/3 of what they pay ODs, they would screw the ODs in a heartbeat.

Last point: they're not customers. They're patients. Customers may always be right, but patients often don't know what's in their best interest. If you treat them as customers only, you're letting your patients down.

Tom

 

[rpames]

Best post in months! Good job Tom.

 

[Bob_Barker27]

Bob,

I worked in a Sam's Club myself after graduation, so I speak from experience. I didn't get told how many patients to see, but I was basically told how much I could charge for an exam. The question is, do we want Wal-Mart setting our fees, or are we better qualified to determine what our services are worth?

I would say if you take a job to work for Wal-Mart and it's their policy to set fees, then you shouldn't complain about it. Nobody forces you to take the job with them, and since you work for them, you really cannot expect to dictate to them what they will pay you. If you want to set your own fees, seems like you need to start your own business or go work for an established partnership.

 

[Bob_Barker27]

Also, they do not provide the necessary equipment to practice at your full ability. If you have no interest in treating ocular disease, it's not a bad way to go, and many optometrists don't want to treat disease. It was a job for me, and not a horrible one for the short term.

Isn't the majority of what optometrists do is precribe glasses or contact lenses for poor vision? I think the majority of "patients" at wal-mart want an eye exam to see if they need glasses or contact lenses....very few of them have a severe eye disease. I don't know anything about optometry equipment, but it seems to be Wal-mart provides enough equipment to screen for the various eye diseases. It seems to me if you don't think prescribing glasses for poor vision is that fulfilling, optometry might be the wrong profession for you. My impression is that the majority of what optometrists do unless they specialize in something, and it's an important role, in my view. I agree that an optometrist might not want to work in wal-mart for life, as I see the best benefit of being an optometrist is the abiliity to work for yourself or with another optometrist or two.

 

[Bob_Barker27]

If you don't understand the anti-Walmart mindset that many people have, then you're not paying attention. The reason Wal-Mart charges low prices is because they don't compensate their workers fairly, they are extremely anti-union, and they have forced thousands (if not millions) of jobs to China. The only way Wal-Mart can sell goods so cheaply is to get them made in China (at least once Mexico got too expensive). Nothing in Wal-Mart is made in America anymore. So Wal-Mart took good manufacturing jobs from America, sent them to China, and replaced those jobs with poor paying jobs with horrible benefits. If you see this as benefitting the lower class, that's your opinion. I see it as people impoverished by Wal-Mart to the point where they can only afford to shop at Wal-Mart. Convenient business strategy, eh? It's called a "race to the bottom." Did I mention that Wal-Mart employs immigrants under the table because it's cheaper, and discriminates against women? If you don't believe me, look at the lawsuits. What's not to like about Wal-Mart?

Your anti-Walmart rhetoric is typical of a Howard Dean left winger with little basis in fact. First of all, Wal-Mart has the right to sell products from anywhere it wants, including China. If you and other left wingers don't like that, don't shop there. Go to some mom and pop store on main street and paid jacked up prices for American goods. The poor in America don't seem to mind goods from CHina, as they flock to Wal-Mart is droves. I can't beat up on Wal-mart if they can provide goods to the poor for low prices. Secondly, you claimed Wal-Mart sent manufacturing jobs to China. Wal-mart isn't a manufacturer , they are a retail store. so it's impossible for Walmart to send manufacturing jobs overseas. Walmart sells goods for cheaper because they buy goods in bullk from the manufacturers who in turn provide lower prices on their goods because they want to be able to sell their goods in wal-mart, America's most popular retail store...it's not the result of some vast corporate conspiracy as you claim. I sure see a lot of women working at Wal-Mart, so if they are discriminating against women, it's not in the hiring process. You say Wal-Mart doesn't not pay its worker fairly, but most of the jobs at Wal-mart are low skilled jobs like cashier and stocking shelves, and I think Wal-Mart pays well enough for low skilled jobs, and nobody forces them to take these jobs. I'm of the opinion of a person shouldn't take a job and then whine about the pay, because there is somebody else out there that would love to have that job and make that salary. You state their are a lot of lawsuits against Wal-mart as evidence that Wal-Mart is The Great Satan. I think a better statistic is to look at how often a plantiff wins a lawsuit against Wal-Mart. I have heard that Wal-Mart never settles and goes to court for every lawsuit, and they rarely lose a case. You seem to forget that lawyers have a penchant for frivilous lawsuits, and lawyers love to sue Wal-Mart because it's very a very succesful company l and the lawyers want a piece of the pie.

 

[Bob_Barker27]

My question is, taking a good look at Wal-Mart and their corporate strategy, do you really want to work for them long-term? Because if they could replace all their ODs with refracting opticians that they could pay 1/3 of what they pay ODs, they would screw the ODs in a heartbeat. Wal-Mart can't do that though, because an optometrist is licensed to do eye exams, not opticians

 

[Bob_Barker27]

Bob,

Last point: they're not customers. They're patients. Customers may always be right, but patients often don't know what's in their best interest. If you treat them as customers only, you're letting your patients down. I kind of disagree with you. People aren't the dumb animals you make them out to be, and the majority know what's in the best interest for themselves. I feel that the majority of patients at Wal-mart just want a simple eye exam and a pair of glasses so they can see. You won't let them down if you provide a poor person a cheap eye exam, trust me. You will make their day. I went to see a chiropractor once and all i wanted was a spine adjustment and he made me do this test where I breathed into this instrument to check the depth of my inhalation/exhalation for some reason. I was charged like 100 bucks for this, and all I wanted was to have my spine adjusted. I'm sure the chiropractor would say this was in my best interest, and I'm sure it was, but it wasn't necessary and I didn't want to spend money for that procedure. I have the impression that optometrists make the majority of their money from the eyeglass sales, so you are going to have to embrace the fact that your patients are also customers. I kind of getting the feeling your main problem is you just want to make more money and the anti-walmart rhetoric is a smokescreen for that because left wingers don't like to admit their love of money.

 

[Tom_Stickel]

Your anti-Walmart rhetoric is typical of a Howard Dean left winger with little basis in fact. First of all, Wal-Mart has the right to sell products from anywhere it wants, including China. If you and other left wingers don't like that, don't shop there. Go to some mom and pop store on main street and paid jacked up prices for American goods. The poor in America don't seem to mind goods from CHina, as they flock to Wal-Mart is droves. I can't beat up on Wal-mart if they can provide goods to the poor for low prices. Secondly, you claimed Wal-Mart sent manufacturing jobs to China. Wal-mart isn't a manufacturer , they are a retail store. so it's impossible for Walmart to send manufacturing jobs overseas. Walmart sells goods for cheaper because they buy goods in bullk from the manufacturers who in turn provide lower prices on their goods because they want to be able to sell their goods in wal-mart, America's most popular retail store...it's not the result of some vast corporate conspiracy as you claim. I sure see a lot of women working at Wal-Mart, so if they are discriminating against women, it's not in the hiring process. You say Wal-Mart doesn't not pay its worker fairly, but most of the jobs at Wal-mart are low skilled jobs like cashier and stocking shelves, and I think Wal-Mart pays well enough for low skilled jobs, and nobody forces them to take these jobs. I'm of the opinion of a person shouldn't take a job and then whine about the pay, because there is somebody else out there that would love to have that job and make that salary. You state their are a lot of lawsuits against Wal-mart as evidence that Wal-Mart is The Great Satan. I think a better statistic is to look at how often a plantiff wins a lawsuit against Wal-Mart. I have heard that Wal-Mart never settles and goes to court for every lawsuit, and they rarely lose a case. You seem to forget that lawyers have a penchant for frivilous lawsuits, and lawyers love to sue Wal-Mart because it's very a very succesful company l and the lawyers want a piece of the pie.[/QUOTE]

Bob,

I'm sorry, I am an unapologetic left-winger. And technically you're right, Wal-Mart is not a manufacturer. But if you don't think they dictate the prices of manufactured goods worldwide, you again aren't paying attention. Also, many manufacturers don't sell to Wal-Mart because they want to. They sell because they have to, and they have to sell at the Wal-Mart price or they will find another sucker who will. And that sucker will be a sweatshop employer in China. I'm not advocating a worker's utopia here, just a recognition of the facts.

Speaking of facts, if you'd done any fact checking, you'd know that the sex discrimination lawsuit against Wal-Mart wasn't about hiring. It was about women not being promoted out of those low wage jobs. And you'd also know that the case involving the use of illegal immigrants as cheap under the table labor has just reached class action status. By the way, do you think the reason Wal-Mart rarely loses lawsuits is completely unrelated to the vast sums of money they have? Not a conspiracy theory, but cold hard fact that money talks in the legal system.

I didn't say Wal-Mart didn't pay its workers fairly, I said it didn't compensate them fairly. And compensation these days, if you've ever had to actually buy health insurance, is more than your paycheck. And part of the problem is Wal-Mart's extremely aggressive anti-union stance, which prevents their workers from even being able to negotiate with Wal-Mart.

I agree with many of your points, but we'll have to agree to disagree on others. From the left,

Tom Stickel

 

[Bob_Barker27]

Bob,

I'm sorry, I am an unapologetic left-winger. And technically you're right, Wal-Mart is not a manufacturer. But if you don't think they dictate the prices of manufactured goods worldwide, you again aren't paying attention.

Bob: I hope Wal-Mart is dictating the prices worldwide, as they typically have lower prices than other stores do. I see things from the consumer's perspective, you see things from the manufacturer who sells goods to walmart perspective.

Tom: Also, many manufacturers don't sell to Wal-Mart because they want to. They sell because they have to, and they have to sell at the Wal-Mart price or they will find another sucker who will.

Bob: I think it makes good business sense what Wal-mart does, it's not illegal or immoral to refuse to buy goods from a company to sell at your store if you don't want to pay their jacked up prices for them. The manufacturers may be forced to sell their goods at a lower cost to walmart, but walmart is the #1 retail store in america, and the manufacturers know they can sale more goods at walmart, thus they logically lower their prices so Wal-mart will buy them. In the end, both Wal-mart and the manufacturers get what they want, and the consumer also benefits due to the lower prices.

Tom: And that sucker will be a sweatshop employer in China. I'm not advocating a worker's utopia here, just a recognition of the facts.

Bob: I disagree with your contention that every manufacturing factory iin China and other countries overseas s a sweatshop. I bet the jobs American companies provide in China are some of the highest paying ones in China, and the Chinese probably line up to work there. American companies providing jobs to China is a good thing, I think, because as that country embraces more capitalism, the people will likely demand an end to their Communist goverment. If you are against all outsourcing of jobs from America, do you oppose other countries outsourcing jobs to America? In my state of South Carolina, we have several foreign companies providing hundreds of jobs, BMW, Fuji Film, Honda to name a few. The jobs we insource from out of the country balance out the jobs that are outsourced. That's what you should focus on, instead of accentuating the negative.

Tom: Speaking of facts, if you'd done any fact checking, you'd know that the sex discrimination lawsuit against Wal-Mart wasn't about hiring. It was about women not being promoted out of those low wage jobs.

Bob: This may have occured in a walmart store or two, but I hardly believe Walmart has a corporate policy to prohibit women from manager positions if they are qualified and want extra responslibity. Did these women win the lawsuit against Wal-mart? or is it still going on? Lawsuits against Walmart doesn't not automatically mean they are guilty as charged. I have the feeling most of these women were just exploiting their sex to make some easy cash from Walmart. Yes, there are greedy women and minorities out there that exploit their race at times.


Tom: And you'd also know that the case involving the use of illegal immigrants as cheap under the table labor has just reached class action status.

Bob: I see mostly whites and blacks working at the walmarts where i live, so i don't think hiring illegal immigrants is corporate policy.

Tom: By the way, do you think the reason Wal-Mart rarely loses lawsuits is completely unrelated to the vast sums of money they have? Not a conspiracy theory, but cold hard fact that money talks in the legal system.

Bob: Lawyers are filthy rich, so I guess when they win a case it's only due the vast sums of money they have, accordign to your logic. Could it be possible the people suing Wal-mart have no case and that's why they lose it? I rather believe the simple truth than a complicated conspiracy theory.

Tom: I didn't say Wal-Mart didn't pay its workers fairly, I said it didn't compensate them fairly. And compensation these days, if you've ever had to actually buy health insurance, is more than your paycheck.

Bob: When I say pay, I think it's understood i mean salary plus benefits. I usualy don't state the obvious. No need to make negative assumptions.


Tom: And part of the problem is Wal-Mart's extremely aggressive anti-union stance, which prevents their workers from even being able to negotiate with Wal-Mart.

Bob: I oppose unions too when they gang up to extort a higher salary from the compnay that hired them at a certain wage. Unions are not really fighting the corporation, they are fighting other workers who are willing to work for the "unfair" wage. I think unions have a mob mentality to them. WHen a person joins a union, he or she is really screwing themselves, b/c the best way to get a raise is show you are a better worker than your co-worker to the company. Unions take your chance to differentiate from your co-workers away from you and they decide who gets what. When companies are forced to hire people at higher wages set by unions or the govermenet than it makes them less likely to hire lower skilled people who really could use the job. Individuaul workers can always negotiate with Wal-Mart. Companies will pay a worker more if he adds value to the company...if he is low skilled and easily replaced, Walmart will not. That's just a fact of life.

 

[aphistis]

Bob,

I'm sorry, I am an unapologetic left-winger. And technically you're right, Wal-Mart is not a manufacturer. But if you don't think they dictate the prices of manufactured goods worldwide, you again aren't paying attention.

Bob: I hope Wal-Mart is dictating the prices worldwide, as they typically have lower prices than other stores do. I see things from the consumer's perspective, you see things from the manufacturer who sells goods to walmart perspective.

Tom: Also, many manufacturers don't sell to Wal-Mart because they want to. They sell because they have to, and they have to sell at the Wal-Mart price or they will find another sucker who will.

Bob: I think it makes good business sense what Wal-mart does, it's not illegal or immoral to refuse to buy goods from a company to sell at your store if you don't want to pay their jacked up prices for them. The manufacturers may be forced to sell their goods at a lower cost to walmart, but walmart is the #1 retail store in america, and the manufacturers know they can sale more goods at walmart, thus they logically lower their prices so Wal-mart will buy them. In the end, both Wal-mart and the manufacturers get what they want, and the consumer also benefits due to the lower prices.

Tom: And that sucker will be a sweatshop employer in China. I'm not advocating a worker's utopia here, just a recognition of the facts.

Bob: I disagree with your contention that every manufacturing factory iin China and other countries overseas s a sweatshop. I bet the jobs American companies provide in China are some of the highest paying ones in China, and the Chinese probably line up to work there. American companies providing jobs to China is a good thing, I think, because as that country embraces more capitalism, the people will likely demand an end to their Communist goverment. If you are against all outsourcing of jobs from America, do you oppose other countries outsourcing jobs to America? In my state of South Carolina, we have several foreign companies providing hundreds of jobs, BMW, Fuji Film, Honda to name a few. The jobs we insource from out of the country balance out the jobs that are outsourced. That's what you should focus on, instead of accentuating the negative.

Tom: Speaking of facts, if you'd done any fact checking, you'd know that the sex discrimination lawsuit against Wal-Mart wasn't about hiring. It was about women not being promoted out of those low wage jobs.

Bob: This may have occured in a walmart store or two, but I hardly believe Walmart has a corporate policy to prohibit women from manager positions if they are qualified and want extra responslibity. Did these women win the lawsuit against Wal-mart? or is it still going on? Lawsuits against Walmart doesn't not automatically mean they are guilty as charged. I have the feeling most of these women were just exploiting their sex to make some easy cash from Walmart. Yes, there are greedy women and minorities out there that exploit their race at times.


Tom: And you'd also know that the case involving the use of illegal immigrants as cheap under the table labor has just reached class action status.

Bob: I see mostly whites and blacks working at the walmarts where i live, so i don't think hiring illegal immigrants is corporate policy.

Tom: By the way, do you think the reason Wal-Mart rarely loses lawsuits is completely unrelated to the vast sums of money they have? Not a conspiracy theory, but cold hard fact that money talks in the legal system.

Bob: Lawyers are filthy rich, so I guess when they win a case it's only due the vast sums of money they have, accordign to your logic. Could it be possible the people suing Wal-mart have no case and that's why they lose it? I rather believe the simple truth than a complicated conspiracy theory.

Tom: I didn't say Wal-Mart didn't pay its workers fairly, I said it didn't compensate them fairly. And compensation these days, if you've ever had to actually buy health insurance, is more than your paycheck.

Bob: When I say pay, I think it's understood i mean salary plus benefits. I usualy don't state the obvious. No need to make negative assumptions.


Tom: And part of the problem is Wal-Mart's extremely aggressive anti-union stance, which prevents their workers from even being able to negotiate with Wal-Mart.

Bob: I oppose unions too when they gang up to extort a higher salary from the compnay that hired them at a certain wage. Unions are not really fighting the corporation, they are fighting other workers who are willing to work for the "unfair" wage. I think unions have a mob mentality to them. WHen a person joins a union, he or she is really screwing themselves, b/c the best way to get a raise is show you are a better worker than your co-worker to the company. Unions take your chance to differentiate from your co-workers away from you and they decide who gets what. When companies are forced to hire people at higher wages set by unions or the govermenet than it makes them less likely to hire lower skilled people who really could use the job. Individuaul workers can always negotiate with Wal-Mart. Companies will pay a worker more if he adds value to the company...if he is low skilled and easily replaced, Walmart will not. That's just a fact of life.

Congratulations on being blessed enough, "Bob," that you can afford to consider the world exclusively from the look-out-for-#1 perspective. You're using an awful lot of assumptions and stereotypes to build your argument, and they don't hold water. And to preemptively disarm the likely knee-jerk response, I'm very much a conservative--but I elect to view the world as it is, instead of ignoring the parts I don't like.

I don't, however, expect you to care about any of this, since you're doubtless aware that being wrong or right on this particular issue is totally inconsequential within what appears to be the limited scope of your personal universe. Que sera sera.

(Incidentally, am I the only one amused by seeing Bob & Tom on SDN? )

 

[Bob_Barker27]

Congratulations on being blessed enough, "Bob," that you can afford to consider the world exclusively from the look-out-for-#1 perspective. You're using an awful lot of assumptions and stereotypes to build your argument, and they don't hold water. And to preemptively disarm the likely knee-jerk response, I'm very much a conservative--but I elect to view the world as it is, instead of ignoring the parts I don't like.

I don't, however, expect you to care about any of this, since you're doubtless aware that being wrong or right on this particular issue is totally inconsequential within what appears to be the limited scope of your personal universe. Que sera sera.

(Incidentally, am I the only one amused by seeing Bob & Tom on SDN? )[/QUOTE

Yah, I thought it added a dramatic effect to the post. I noticed you don't refute anything I say, you just engage in ad hominem attacks on me in a vague rather dull way. Tom can at least engage in a discussion of the issues in a civil way. I'm not sure how I was looking out for #1 when I was defending Walmart because they provide low prices that benefit the poor. The problem with many liberals, excluding ones like Tom, is they just want to demonize conservatives because they aren't too good at debating.

 

[cpw]

Also, they do not provide the necessary equipment to practice at your full ability. If you have no interest in treating ocular disease, it's not a bad way to go, and many optometrists don't want to treat disease. It was a job for me, and not a horrible one for the short term.

Isn't the majority of what optometrists do is precribe glasses or contact lenses for poor vision? I think the majority of "patients" at wal-mart want an eye exam to see if they need glasses or contact lenses....very few of them have a severe eye disease. .

just because very few of them have "severe" eye disese doen't mean we shouldn't dilate every patient to make sure they don't have the 'beginnings" of eye disease. I've stopped counting how many diabetics I've sent out for laser treatment that thought nothing was wrong, came in "just for new glasses", and could see 20/20.

i'll leave the rest of the arguement to y'all. i'm not going to belabor the pros and cons of wal-mart.

Although, I do agree if opticians get the right to refract thousands of ODs would be out jobs.

 

[Loncifer]

Congratulations on being blessed enough, "Bob," that you can afford to consider the world exclusively from the look-out-for-#1 perspective. You're using an awful lot of assumptions and stereotypes to build your argument, and they don't hold water. And to preemptively disarm the likely knee-jerk response, I'm very much a conservative--but I elect to view the world as it is, instead of ignoring the parts I don't like.

I don't, however, expect you to care about any of this, since you're doubtless aware that being wrong or right on this particular issue is totally inconsequential within what appears to be the limited scope of your personal universe. Que sera sera.

(Incidentally, am I the only one amused by seeing Bob & Tom on SDN? )[/QUOTE

Yah, I thought it added a dramatic effect to the post. I noticed you don't refute anything I say, you just engage in ad hominem attacks on me in a vague rather dull way. Tom can at least engage in a discussion of the issues in a civil way. I'm not sure how I was looking out for #1 when I was defending Walmart because they provide low prices that benefit the poor. The problem with many liberals, excluding ones like Tom, is they just want to demonize conservatives because they aren't too good at debating.

Bob,

I am very much a laissez faire capitalist and believe in the free movement of goods and services (this having grown up in left of center Canada). That said, what I believe is most at issue (especially regarding the nature of this forum) is not whether Wal-Mart is an efficient market operator or a bloated bag of greed, but rather whether working as a Wal-Mart OD is overall a good or bad choice.

Perhaps the idea that an OD provides a service, and one no different than the hair salons some Wal-marts have is a little short sighted. When I visit an MD, I may very much want him to simply check my BP and tell me I'm fine; I'll pay him well if he would do just that. However they invariably insist on giving me a good once over (Including the dreaded digital rectal) before sending me on my way. I don't want to start a big OD/MD/OMD rant, but an OD is a health professional, well trained as the FRONT LINE eye care provider to the majority of the population. They have, I believe an obligation to factor this into their decision making.

Oh, and incidentally, up here in Canada it's not just the poor (as you seem so fond of calling them) that shop at Wal-Mart.

Sincerely,
Lonnie Brooks

 

[JennyW]

just because very few of them have "severe" eye disese doen't mean we shouldn't dilate every patient to make sure they don't have the 'beginnings" of eye disease. I've stopped counting how many diabetics I've sent out for laser treatment that thought nothing was wrong, came in "just for new glasses", and could see 20/20.

i'll leave the rest of the arguement to y'all. i'm not going to belabor the pros and cons of wal-mart.

Although, I do agree if opticians get the right to refract thousands of ODs would be out jobs.

Really?

I've been practicing 14 years and I have can count on one hand the number of diabetic cases that I had to refer out for laser where the patient was 20/20 and thought there was nothing wrong, and I work 2 days a week in a VA hospital. I see 100s of diabetics a year.

I once had a case of a woman who had idiopathic choroidal neovascularization and she was 20/20- but even she came in complaining of something.

I've had lots of cases where they just thought they needed new glasses and were much worse than 20/20 and needed laser.

I also don't think every patient needs to be dilated. For patients who don't have risk factors for retinal disease, every 3-5 years is plenty.

Where are you practicing?

Jenny

 

[Bob_Barker27]

just because very few of them have "severe" eye disese doen't mean we shouldn't dilate every patient to make sure they don't have the 'beginnings" of eye disease. I've stopped counting how many diabetics I've sent out for laser treatment that thought nothing was wrong, came in "just for new glasses", and could see 20/20.

i'll leave the rest of the arguement to y'all. i'm not going to belabor the pros and cons of wal-mart.

Although, I do agree if opticians get the right to refract thousands of ODs would be out jobs.

I was not trying to belittle what optometrists do , or suggest all they can do is prescribe glasses. I understand that optometrists are highly trained specialists in primary eye care. Cpw, is it true that optometrists are prohibited by policy or limited by lack of equipment from performing dilation and other procedures in Walmart?

 

[Bob_Barker27]

Bob,

I am very much a laissez faire capitalist and believe in the free movement of goods and services (this having grown up in left of center Canada). That said, what I believe is most at issue (especially regarding the nature of this forum) is not whether Wal-Mart is an efficient market operator or a bloated bag of greed, but rather whether working as a Wal-Mart OD is overall a good or bad choice.

Hey Tom started it . I just feel like most of the charges made against Wal-mart are false or based on isolated instances. I'm not sure why he works there is he thinks it's discrimating against women....I wouldn't work for a company I thought was unethical in some way. As I said in response to Tom, I don't think working at Wal-mart forever would be ideal since the best benefit of going to optometry school is the opportunity to own your own business. That being said, they do provide optometry students good salaries out of school so they can pay off loans before investing in their own business or whatever else they decide to do. If you don't like the polices the company that hires you has, you can either try to get them to change or go work somewhere else. Demonizing the company isn't going to gain you a thing.

Perhaps the idea that an OD provides a service, and one no different than the hair salons some Wal-marts have is a little short sighted. When I visit an MD, I may very much want him to simply check my BP and tell me I'm fine; I'll pay him well if he would do just that. However they invariably insist on giving me a good once over (Including the dreaded digital rectal) before sending me on my way. I don't want to start a big OD/MD/OMD rant, but an OD is a health professional, well trained as the FRONT LINE eye care provider to the majority of the population. They have, I believe an obligation to factor this into their decision making.

My point was that many people who go to the optometrist at walmart for a basic eye exam. You can't force other services on a patient if they dont 'want them, even if it's in their best interest. They might not want to spend the money. Some optometrists don't think it's worthwhile to just precribes glasses, which seems to be the crux of the animonisity towards Wal-mart, if it's true that's all walmart optometrists are allowed to do. I get the feeling some optometrists really wanted to be MDs and just diagnose diseases. I believe some optometry students don't want to tell their friends they work at walmart because they view it as less prestigious in some way. I worked in a trailer as an engineer, but the pay was the same as working in a nice downtown office, so I could care less. My advice is, be appreciative when a company offers you a big salary, and don't expect your first job to perfect in every way.
Oh, and incidentally, up here in Canada it's not just the poor (as you seem so fond of calling them) that shop at Wal-Mart. How should I refer to the poor, financially challenged? I never stated only the poor shop at Wal-mart. I said the poor benefit from the low prices at Walmart.

 

[Loncifer]

I agree that you should 1) not work for an employer you believe to be unethical or, 2) not complain about them being unethical while you work for them. I also agree that someone wanting a refraction to check their spectacle prescription shouldn't have a bunch of things rammed down their throat. However, I think a great many people are mislead into believing that their eye health is perfect after having a refraction done, which may not be true. With opticians performing autorefractions in Canada, I think this is a legitimate concern.

How should I refer to the poor, financially challenged? I never stated only the poor shop at Wal-mart. I said the poor benefit from the low prices at Walmart.

Sorry, it's just whenever I here the phrase "the poor", I think of a Monty Pythonesque "alms for the poor" sort of thing. BTW I think the middle class keep Wal-Mart's share prices up, not the poor. The poor are notorious for shopping locally - they don't own cars.

 

[heretic]

PPS: If you're in optometry school, why is your gf getting her exams at costco?? Why aren't you doing them? Or at least, an upper year student with you assisting??

sadly she lives on the other side of the state right now.

p.s. thanks for your insight about coming back for dilation. i didn't think of it that way, and now I can see the benefits to that approach as well. guess it all comes down to personal preference.

 

[Tom_Stickel]

Bob,
I'm enjoying the exchange with you. And technically, you started it, when you asked why people don't like Wal-Mart .

I'm a little concerned that first you complimented my willingness to debate, then you said I demonize conservatives because I'm no good at debating. Hmmm. Which post exactly did I demonize conservatives? I'm not demonizing Wal-Mart, I'm just saying that I think unrestricted capitalism leads to abuse of workers. I'm not in favor of socialism, either, but I think a healthy balance between management and labor is in everyone's best interest.

If you want to know where I get my material, check out these sites:

http://www.walmartvswomen.com/
http://www.walmartwatch.com/

I'll leave it there, and let this post get back to optometry, except to say that I no longer work at Sam's Club, and I worked there only briefly before becoming set in left wing ways

Tom

 

[Bob_Barker27]

Bob,
I'm enjoying the exchange with you. And technically, you started it, when you asked why people don't like Wal-Mart .

I'm a little concerned that first you complimented my willingness to debate, then you said I demonize conservatives because I'm no good at debating. Hmmm. Which post exactly did I demonize conservatives? I'm not demonizing Wal-Mart, I'm just saying that I think unrestricted capitalism leads to abuse of workers. I'm not in favor of socialism, either, but I think a healthy balance between management and labor is in everyone's best interest.

If you want to know where I get my material, check out these sites:

http://www.walmartvswomen.com/
http://www.walmartwatch.com/

I'll leave it there, and let this post get back to optometry, except to say that I no longer work at Sam's Club, and I worked there only briefly before becoming set in left wing ways

Tom

Tom,
I never said you demonize conservatives. That post was for the dentistry student who attacked me personally without responding to any point I made specifically. I actually complimented you for being civil. I don't think the world has ever had unrestricted capitalism, and I think the goverment has important roles to play such as breaking up monopolies to ensure competition to keep prices low for consumers. My friend is very anti-Walmart too, and I have heard the same talking points from him. I still don't think it's corporate policy for them to prevent women from being promoted, and I'm not aware of Walmart losing any discrimination lawsuit. If there is any legit allegation of discrimination against women in promotions, I think it's isolated instances in a few stores, not the corporate policy of Wal-mart. I don't think you should beat up an entire company for the actions of a few bad apples. It only took twelve unethical people to bring Enron down. Every company has some bad employees.

 

[Bob_Barker27]

I agree that you should 1) not work for an employer you believe to be unethical or, 2) not complain about them being unethical while you work for them. I also agree that someone wanting a refraction to check their spectacle prescription shouldn't have a bunch of things rammed down their throat. However, I think a great many people are mislead into believing that their eye health is perfect after having a refraction done, which may not be true. With opticians performing autorefractions in Canada, I think this is a legitimate concern.

Sorry, it's just whenever I here the phrase "the poor", I think of a Monty Pythonesque "alms for the poor" sort of thing. BTW I think the middle class keep Wal-Mart's share prices up, not the poor. The poor are notorious for shopping locally - they don't own cars.

Loncifer,

I don't know why you refuse to believe the finanically challenged shop at Walmart. Most poor in America do own a car, maybe just a really old one. You can buy an old car for like 200 bucks, and it will get you to where you want to go. America's poor people are much better off than poor in other places such as Africa or the Middle East. As far as you comments on people thinking their eye health is fine after a refraction, that sounds right. Most people probably think their eye health is fine unless their eyes are hurting. I don't see why optometrists can't do a dilation at walmart though and screen for diseases if they want to. I can't seem to get a clear answer if walmart prohibits this or not.

 

[cpw]

bob, as far as I know wal-mart does not 'prohibit' the practice of dilating patients... I do know some docs who've worked for them. I'll ask for their take on dilations there.

 

[PBEA]

I once leased space in a Wal-mart as an OD, so I have some comments to share. I agreed to work as an independent contractor, which legally means I set my own hours, my own fees, etc. That as an independent contractor I practice to whatever extent I deem adequate. Wal-mart did not see it that way. It started when they dictated the minimum number of hours, that I had to commit to. They did not have a requirement for patient volume (presumably because this was a new store). The company tried to dictate what days of the week I would be present, what holidays, etc. Wal-mart tried to limit my prescribing habits (in regards to what type of contact lens, or spectacles)Eventually, they attempted to limit what type of examination I was providing, (ie, DFE). It was at this point, about 6 months into my lease, that I accused them of jeopardizing my license, and walked away from Wal-mart. Thank heavens, I made that decision.

 

[Loncifer]

Loncifer,

I don't know why you refuse to believe the finanically challenged shop at Walmart. Most poor in America do own a car, maybe just a really old one. You can buy an old car for like 200 bucks, and it will get you to where you want to go. America's poor people are much better off than poor in other places such as Africa or the Middle East. As far as you comments on people thinking their eye health is fine after a refraction, that sounds right. Most people probably think their eye health is fine unless their eyes are hurting. I don't see why optometrists can't do a dilation at walmart though and screen for diseases if they want to. I can't seem to get a clear answer if walmart prohibits this or not.

Bob,
I guess after growing up without many frills I may have a different idea of poor than you do. To me, if I can afford a car, insurance, registration, inspections (mandatory for jalopies in many Canadian Provinces), fuel and maintainance then I don't think of myself as poor. Just a matter of opinion, I suppose.

 

[Bob_Barker27]

Yes, by poor, I don't mean people eating dirt for survival. Many poor can pay a small fee to not carry car insurance and still legally drive, at least in my state, I think. Many just don't have insurance at all, as I found out a few years ago when this finanicially challenged guy ran into my car a parking lot when it was parked somehow. You can get a old car that runs for 500 or less.

Bob,
I guess after growing up without many frills I may have a different idea of poor than you do. To me, if I can afford a car, insurance, registration, inspections (mandatory for jalopies in many Canadian Provinces), fuel and maintainance then I don't think of myself as poor. Just a matter of opinion, I suppose.

 

[PBEA]

No doubt there are varying opinions regarding what constitutes appropriate eye care. I think that one absurd extreme is bob barker's approach, which basically amounts to some kind of commidity market. If all we did was check for eyeglasses and contact lenses, then that might be true. Fact is Bob, that you cannot have one without the other. It simply isn't possible to perform only refraction, without considering the exact condition of the eyes and the body surrounding them. It IS a matter of requiring as a function of our ethics and every review board to necesitate complete eye examination. If as a doctor I decide that dilation is not necessary. I decide this, only after taking on the full burden of resposibility. It is the nature of hundreds of ocular conditions that can present asyptomatically. I do not decide to forego dilation, for the sake of Wal-mart or anybody else's opinion. And I certainly don't think this has anything to do with how wal-mart makes it's money selling volume crap.

 

[Bob_Barker27]

No doubt there are varying opinions regarding what constitutes appropriate eye care. I think that one absurd extreme is bob barker's approach, which basically amounts to some kind of commidity market. If all we did was check for eyeglasses and contact lenses, then that might be true. Fact is Bob, that you cannot have one without the other. It simply isn't possible to perform only refraction, without considering the exact condition of the eyes and the body surrounding them. It IS a matter of requiring as a function of our ethics and every review board to necesitate complete eye examination. If as a doctor I decide that dilation is not necessary. I decide this, only after taking on the full burden of resposibility. It is the nature of hundreds of ocular conditions that can present asyptomatically. I do not decide to forego dilation, for the sake of Wal-mart or anybody else's opinion. And I certainly don't think this has anything to do with how wal-mart makes it's money selling volume crap.

I really don't think some people in here really read what I post. I never said that all optometrists do is check for eyeglasses and contact lenses, I said it was the one of the primary things they do. I am not opposing complete eye examintions, in fact, i am skeptical when people say that optometrists are not allowed to do a full exam at Walmart. Doesn't the OAT have a reading comprehension section? I assume you did poorly on that section.

 

[PBEA]

I really don't think some people in here really read what I post. I never said that all optometrists do is check for eyeglasses and contact lenses, I said it was the one of the primary things they do. I am not opposing complete eye examintions, in fact, i am skeptical when people say that optometrists are not allowed to do a full exam at Walmart. Doesn't the OAT have a reading comprehension section? I assume you did poorly on that section.

Hey Bob, I got a perfect score on the OAT reading comp section, thanks for asking. For the record, the "primary thing" that we do is assess the ocular condition. The condition, as it were, ranges from refractive error to life threatening tumor. I realize you are not trying to "belittle" optometry, but you are asking why you "..see a lot of negative posts in here about Wal-mart". If you read my earlier post, this should dispel anymore of your skepticism, and maybe give you some insight into why many OD's disagree with commercial optometry philosophy. Gee whiz Bob, is it beyond your comprehension that a large capitalist corporation like walmart would only care about the bottom-line, and be less concerned with the welfare of John Q. Public? Or are you one of those guys who loves watching FOX "news" channel.

 

[J.opt]

Just wondering, if a doctor chooses not to include a dilatation as a part of a patient’s exam, and the patient happens to have some kind of disease that could have been diagnosed through the dilatation, is the doctor held accountable for any complications the patient suffers?

 

[PBEA]

Just wondering, if a doctor chooses not to include a dilatation as a part of a patient’s exam, and the patient happens to have some kind of disease that could have been diagnosed through the dilatation, is the doctor held accountable for any complications the patient suffers?

How can you have the moniker J. OPT and not know the answer? just kidding (student right). Let me put it to you this way, if somebody presents with an eye related problem (for example, blurry vision), the walmart doctor, performs refraction, slit lamp, oscope, tonometry, etc, prescribes spectacles (which help), does not perform dilation, and sends patient home. In this case how can that walmart doc possibly know that there is not some retinal condition that requires immediate care? The answer is he/she cannot, that simple. To answer your question directly, yes the examining doctor is absolutely culpable 100% of the time. This applies to ALL OD, OMD, ER doctor, nurse, PCP, Pediatrics, etc.,.

 

[JennyW]

How can you have the moniker J. OPT and not know the answer? just kidding (student right). Let me put it to you this way, if somebody presents with an eye related problem (for example, blurry vision), the walmart doctor, performs refraction, slit lamp, oscope, tonometry, etc, prescribes spectacles (which help), does not perform dilation, and sends patient home. In this case how can that walmart doc possibly know that there is not some retinal condition that requires immediate care? The answer is he/she cannot, that simple. To answer your question directly, yes the examining doctor is absolutely culpable 100% of the time. This applies to ALL OD, OMD, ER doctor, nurse, PCP, Pediatrics, etc.,.

I don't agree with this.

You would have to show that you have not met the standard of care, and the standard of care as it now stands does NOT include a dilation at every eye exam. Even the American Academy of Ophthalmology recommends pupil dilation every 3-5 years for certain age groups that are not at high risk for retinal disease. If you do not dilate one of those patients and they have something, that does not always mean that you have breached the standard of care.

I also don't agree that you can apply those same standards to nurses, PCPs and Pediatricians. Pupil dilation is not something that these groups do. At least not the ones where I live.

Jenny

 

[PBEA]

I don't agree with this.

You would have to show that you have not met the standard of care, and the standard of care as it now stands does NOT include a dilation at every eye exam. Even the American Academy of Ophthalmology recommends pupil dilation every 3-5 years for certain age groups that are not at high risk for retinal disease. If you do not dilate one of those patients and they have something, that does not always mean that you have breached the standard of care.

I also don't agree that you can apply those same standards to nurses, PCPs and Pediatricians. Pupil dilation is not something that these groups do. At least not the ones where I live.

Jenny

I agree with you & the AAO. However, most people I see (and, I'm guessing you do too at the VA) are not in a "certain age group". As well, as a new patient, I think it is prudent to establish a healthy eye, mostly because this is my mandate (not to mention that I am uniquely qualified to do so). If an individual presents to me with a problem, or a referral, or somebody wants a complete exam because they have not had one in quite a long time (they have been going to walmart for the past 3-5 years), or there is some pertinent history, etc,etc,etc,etc.....need I continue? I agree that to dilate every patient is not needed, ie the standard of care, or the low incidence of ocular pathology. I was being figurative when I said 100% of the time. However, in the context of a discussion about walmart, or any other practice that marginilizes DFE as unneeded, I would say 100% just to emphasize the point.

I also agree that PCP's , nurses, or Pediatricians do not, (and generally should not) routinely dilate patients. That is why they refer to people that can make an accurate assessment of the problem. I mean am I missing something here?

 

[JennyW]

I agree with you & the AAO. However, most people I see (and, I'm guessing you do too at the VA) are not in a "certain age group". As well, as a new patient, I think it is prudent to establish a healthy eye, mostly because this is my mandate (not to mention that I am uniquely qualified to do so). If an individual presents to me with a problem, or a referral, or somebody wants a complete exam because they have not had one in quite a long time (they have been going to walmart for the past 3-5 years), or there is some pertinent history, etc,etc,etc,etc.....need I continue? I agree that to dilate every patient is not needed, ie the standard of care, or the low incidence of ocular pathology. I was being figurative when I said 100% of the time. However, in the context of a discussion about walmart, or any other practice that marginilizes DFE as unneeded, I would say 100% just to emphasize the point.

I also agree that PCP's , nurses, or Pediatricians do not, (and generally should not) routinely dilate patients. That is why they refer to people that can make an accurate assessment of the problem. I mean am I missing something here?

Presenting with a referal or a problem, or if the patient requests an exam because they haven't had one in a long time is completely different than what was being discussed.

You made the implication that if a person leaves an office without having had a dilated exam and that person has a problem that goes undetected, then the doctor is liable. You also implied that this is true for nurses, GPs, pediatricians, ER docs etc. and I am disagreeing with that. Patients of particular age groups do not need yearly dilated exams. Yes, you are unlikely to find those people in a VA hospital, but since we are in the context of discussing Walmart, you are quite likely to find them at Walmart.

I liken dilated exams to dental X-rays. They should be done periodically on healthy patients who do not have risk factors or symptoms. They should be done more frequently on patients who do have risk factors. I certainly don't let my dentist do X-rays as part of my routine dental visits.

So I guess the point is that you can't judge whether an exam is of high quality or not just by virtue of the fact that the patient is dilated. I know many doctors who dilate every patient every year without fail. They are wasting their time (and the patients) in the majority of these cases. I also know some older doctors who never dilate. Obviously, this is the opposite extreme and I wouldn't encourage it but there is not an epidemic of blindness in these doctor's offices. Simply because patients at Walmart are less likely to be dilated doesn't always mean that this is a bad thing. It's quite possible that most Walmart patients are not likely to need frequent dilation.

I've been practicing for over 10 years. I've done thousands of dilations, and because I used to teach, I've checked dilations on hundreds of students.
I can count on one hand the number of serious problems that I have found because of routine dilation of an asymptomatic patient who did not have risk factors for retinal disease.

Jenny

 

[PBEA]

Presenting with a referal or a problem, or if the patient requests an exam because they haven't had one in a long time is completely different than what was being discussed.

You made the implication that if a person leaves an office without having had a dilated exam and that person has a problem that goes undetected, then the doctor is liable. You also implied that this is true for nurses, GPs, pediatricians, ER docs etc. and I am disagreeing with that. Patients of particular age groups do not need yearly dilated exams. Yes, you are unlikely to find those people in a VA hospital, but since we are in the context of discussing Walmart, you are quite likely to find them at Walmart.

I liken dilated exams to dental X-rays. They should be done periodically on healthy patients who do not have risk factors or symptoms. They should be done more frequently on patients who do have risk factors. I certainly don't let my dentist do X-rays as part of my routine dental visits.

So I guess the point is that you can't judge whether an exam is of high quality or not just by virtue of the fact that the patient is dilated. I know many doctors who dilate every patient every year without fail. They are wasting their time (and the patients) in the majority of these cases. I also know some older doctors who never dilate. Obviously, this is the opposite extreme and I wouldn't encourage it but there is not an epidemic of blindness in these doctor's offices. Simply because patients at Walmart are less likely to be dilated doesn't always mean that this is a bad thing. It's quite possible that most Walmart patients are not likely to need frequent dilation.

I've been practicing for over 10 years. I've done thousands of dilations, and because I used to teach, I've checked dilations on hundreds of students.
I can count on one hand the number of serious problems that I have found because of routine dilation of an asymptomatic patient who did not have risk factors for retinal disease.

Jenny

Are you sure it isn't J.D. after your name and not O.D., or is it O.D./J.D.? All of this is quite ridicluous, you misinterpret what I say, I respond, etc.Have a nice night

 

[Bob_Barker27]

Hey Bob, I got a perfect score on the OAT reading comp section, thanks for asking. For the record, the "primary thing" that we do is assess the ocular condition. The condition, as it were, ranges from refractive error to life threatening tumor. I realize you are not trying to "belittle" optometry, but you are asking why you "..see a lot of negative posts in here about Wal-mart". If you read my earlier post, this should dispel anymore of your skepticism, and maybe give you some insight into why many OD's disagree with commercial optometry philosophy. Gee whiz Bob, is it beyond your comprehension that a large capitalist corporation like walmart would only care about the bottom-line, and be less concerned with the welfare of John Q. Public? Or are you one of those guys who loves watching FOX "news" channel.

If you don't want to work for "a large capitalist corporation" like walmart, don't go work for them. If you work as an optometrist, you yourself are engaging in capitalism, and i bet you are going to care about the bottom line yourself. If making money is evil, then there sure are a lot of evil people in the world. Walmart does't exist to save the world and "be concerned with John Q Public", it exists to make money, and nobody forces you to shop there or work there. Wal-mart does provide low prices, and I know it's tough for you to admit this, but that benefits John Q Public. It seems to me that there must be a lot of unethical optometrists out there, if so many are willing to work for Walmart when it's true as you claim that Wal-mart does not allow optometrists to practice in an ethical manner. Maybe you should be attacking the optometrists that choose to practice in an unethical manner at Walmart, not Walmart. Maybe if optometrists all refused to work at wal-marts, walmart would consider changing their evil ways. Your Fox News comment was a little bizarre and out of place, but in defense of Fox News, they are the #1 cable news channel in America, and I don't think that would be case if Fox News wasn't a solid source of information. Fox News sucess is directly proportional to the liberal bias of the other news networks. See Dan Rather's use of forged memos to hurt a Republican's presidents re-election chances. I could say you are one of these people that gets his information from Michael Moore. I think Fox News is a litle more trustworthy than Michael Moore.

 

[JennyW]

Are you sure it isn't J.D. after your name and not O.D., or is it O.D./J.D.? All of this is quite ridicluous, you misinterpret what I say, I respond, etc.Have a nice night

Ummmmmm, ok.

Jenny

 

[aphistis]

I noticed you don't refute anything I say, you just engage in ad hominem attacks on me in a vague rather dull way.

Congratulations on knowing your Latin. You apparently don't know what an ad hominem is, if you really think my post included any, but nobody can accuse you of not knowing how to spell.

 

[PBEA]

Presenting with a referal or a problem, or if the patient requests an exam because they haven't had one in a long time is completely different than what was being discussed.

Really, I thought Bob had asked why there were negative feelings regarding Walmart opticals? I was merely trying to give my perspective, my opinion.

You made the implication that if a person leaves an office without having had a dilated exam and that person has a problem that goes undetected, then the doctor is liable. You also implied that this is true for nurses, GPs, pediatricians, ER docs etc. and I am disagreeing with that. Patients of particular age groups do not need yearly dilated exams. Yes, you are unlikely to find those people in a VA hospital, but since we are in the context of discussing Walmart, you are quite likely to find them at Walmart.

Nevertheless, given my career experience with walmart, I disagree that the only people seen in a walmart are "without risk factors", or are "....of particular age groups...". If these people go undilated, and something occurs that could have been avoided, I continue to contend that the examiner is culpable. Those that don't meet your convenient description may ultimately fall through the cracks. Same goes for any other kind of doctor that is presented with an ocular problem. If they are unable to make a comprehensive assessment or do not make the necessary referral then they are also potentially culpable.

I liken dilated exams to dental X-rays. They should be done periodically on healthy patients who do not have risk factors or symptoms. They should be done more frequently on patients who do have risk factors. I certainly don't let my dentist do X-rays as part of my routine dental visits.

I agree

So I guess the point is that you can't judge whether an exam is of high quality or not just by virtue of the fact that the patient is dilated. I know many doctors who dilate every patient every year without fail. They are wasting their time (and the patients) in the majority of these cases. I also know some older doctors who never dilate. Obviously, this is the opposite extreme and I wouldn't encourage it but there is not an epidemic of blindness in these doctor's offices. Simply because patients at Walmart are less likely to be dilated doesn't always mean that this is a bad thing. It's quite possible that most Walmart patients are not likely to need frequent dilation.

I pretty much agree with this

I've been practicing for over 10 years. I've done thousands of dilations, and because I used to teach, I've checked dilations on hundreds of students.
I can count on one hand the number of serious problems that I have found because of routine dilation of an asymptomatic patient who did not have risk factors for retinal disease.

Jenny

Thanks for your resume, but I can tell you have plenty of experience by these and other posts you have made. Your point is well taken with regard to incidence in the population. Interestingly enough in my 6 month period at walmart (before I left in disgust) I can recall 3 cases that meet your definition. In the last 3 years, my office has seen about 20 that were emergent, asymptomatic, without risk factor (including age), all of whom received tertiary care by ophthalmology, or other provider. In most of these cases the outcome resulted in preventing blindness in one or both eyes, or potentially decreased morbidity associated with undiagnosed systemic disease. It isn't many, I agree (I don't advocate blanket dilation for every patient), but with this frequency, I'm happy to go ABOVE the standard of care, whenever reasonable. This is not the philosophy that walmart has, and the population they serve undoubtably does not know the difference.

 

[JennyW]

Thanks for your resume, but I can tell you have plenty of experience by these and other posts you have made. Your point is well taken with regard to incidence in the population. Interestingly enough in my 6 month period at walmart (before I left in disgust) I can recall 3 cases that meet your definition. In the last 3 years, my office has seen about 20 that were emergent, asymptomatic, without risk factor (including age), all of whom received tertiary care by ophthalmology, or other provider. In most of these cases the outcome resulted in preventing blindness in one or both eyes, or potentially decreased morbidity associated with undiagnosed systemic disease. It isn't many, I agree (I don't advocate blanket dilation for every patient), but with this frequency, I'm happy to go ABOVE the standard of care, whenever reasonable. This is not the philosophy that walmart has, and the population they serve undoubtably does not know the difference.

That's very interesting. You've had 3 cases at a Walmart in 6 months that were a threat to life or sight, and I've had 3 cases in over 10 years, a significant amount of time having been spent in a VA. You have a strange patient population. What was the nature of these 20 conditions? Or the 3 at Walmart if you don't mind sharing??

Jenny

 

[Bob_Barker27]

Congratulations on knowing your Latin. You apparently don't know what an ad hominem is, if you really think my post included any, but nobody can accuse you of not knowing how to spell.

ad hom·i·nem ( P ) Pronunciation Key (hm-nm, -nm)
adj.
Appealing to personal considerations rather than to logic or reason. The expression now also has a looser use in referring to any personal attack, whether or not it is part of an argument, as in It isn't in the best interests of the nation for the press to attack him in this personal, ad hominem way.

Based on this definition, I used the word correctly. You did not attempt to respond to any of the points that I made specifically using logical reasoning, you just attempted to demonize me as a mean selfish person who only looks out for #1. If that is not a personal attack, what is?

 

[cpw]

alright kids.. this thread needs to kick it down a notch. everybody take a deep breath, a nice long bubble bath, have a BIG glass of wine... and then come back and realize how silly you guys sound calling each other poopy-heads on an internet message board.

 

[Bob_Barker27]

alright kids.. this thread needs to kick it down a notch. everybody take a deep breath, a nice long bubble bath, have a BIG glass of wine... and then come back a realize how silly you guys sound calling each other poopy-heads on an internet message board.

I never personally attacked anybody in here. I do have freedom to express my opinions, and I am sorry if my opinions offend others, but there is really no reason for people to attack me personally when they disagree. I will reserve the right to defend myself when others falsely depict me as a mean person. Did you ever ask those optometrists if they are allowed to do dilation at Wal-mart? Thanks for your feedback on this and my previous posts.

 

[cpw]

I never personally attacked anybody in here. I do have freedom to express my opinions, and I am sorry if my opinions offend others, but there is really no reason for people to attack me personally when they disagree. I will reserve the right to defend myself when others falsely depict me as a mean person. Did you ever ask those optometrists if they are allowed to do dilation at Wal-mart? Thanks for your feedback on this and my previous posts.

I don't remember aiming my comment specifically at anyone. I'm not telling anyone to quit debating. I'm just saying people are reading into other people's posts, people are getting defensive, and it's getting ugly. So, i'm trying to put a stop to it and calm it down. (that's my job)

I did ask my friend about dilation at wal-mart. she was never told not to do it.