How I Practice Social Media and Health

Blog Improves My Medical Practice

This blog has taught me that doctors need to communicate.  When I started this website, I was going to use this as a teaching tool for retinal diseases.  I’d use social media to help readers locate this site.  There have been some surprises along the way.  For instance, I’ve discovered patients love doctors who communicate.  It a different form of “medical blogging.”

Chicago 2009

My wife, Amy, is an attorney (hold on, not a bad thing).  She is an avid student of how attorneys use the Internet.  She surprised me with a gift to attend a Ken McCarthy seminar in Chicago.  That weekend, I became addicted to the power of the Internet and the potential effects on how I, and other docs, could practice medicine.

A Tangible Resource

I use this website everyday as a resource for my patients.  Many of the articles you read here are the same discussions I use in the office.  During an appointment, I’ll refer a patient to the appropriate articles for further reading.  I’ll also encourage my patients to email me (or comment on this blog) if there are any questions.

I am one of the few doctors that openly encourage email.

Why I Email

First of all, I do not like voicemail and I do not like the hassel of returning phone calls.  I love email and so do most of my patients.

Email is convenient for both parties.  Email is easier than making a phone call, being placed on hold, explaining why you have a question, pleading with the receptionist to make sure to deliver the message…etc.

Email allows my patients to ask questions easily, personally and with guaranteed delivery.

The Difference Between “Website” and “Blog”

In my mind these two terms are now interchangeable.  Nowadays, most websites are becoming blogs.  There is a big reason.

Originally, the typical doctor’s website was no more than a business card.  It contained little information that rarely changed.  It was akin to an ad in the phone book.

Blogs, on the other hand, are interactive.  The readers (i.e. you) can communicate with the author (i.e. me) by leaving a comment or question.  This opens up a dialogue.  This is the biggest (but not the only) reason why blogs have become so popular.

While still offering the same static type of information, the ability to communicate makes blogs a natural tool for both patients and doctors.

What Does This Mean?

Having a blog makes a big statement about me.  It means I am a doctor willing to communicate.  It changes the typical unilateral exchange of information between doctor and patient.

It transforms the typical office visit and makes it more open ended.  While the examination takes place in the office, the visit may continue indefinitely.  This, in my opinion, is a good thing.

By providing resources and allowing communication outside the walls of the office, my patients actually learn more about their eye problems, take better care of themselves, and make my job easier.  I get fewer phone calls, better compliance and have been able to build stronger relationships with the people I meet.

(Remember what Sy Syms used to say?  “An educated consumer is our best customer.”)

By opening up communication, I am encouraging better learning.  Doctors should do more of this…communicating that is.

Thank you, Amy!

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My Opinion

What Haitians Don't See

The recent Haitian disaster underscores the quality of eye care that is available to us in the United States and other, more developed, countries.  With over 80% of the country living at poverty level, a country such as Haiti can not afford to train doctors, nor afford the technology that allows us to practice modern techniques.  Yes, there are still places in this world, even before natural disasters, that just don’t “see.”

Training Doctors is Long and Expensive – In the U.S., training a physician takes years.  It also takes an infrastructure to support this level of sophisticated, specialized training.  After high school;

  • 4 years of college
  • 4 years of medical school
  • 1 year of internal medicine (internship)
  • 3 years of residency training (ophthalmology)
  • 1 year of fellowship training (retina subspecialty training)

In the “old” days in the U.S., training stopped after the one year of internship.  These were General Practitioners.  After one year of internship, many docs went into practice as “GP’s.”

In the late 60’s and early 70’s residency training became popular and, in the American system, doctors began specializing.  My internship, residency and fellowship are bundled together and represent my “training.”  Internship year is considered the hardest; long sleepless nights and weeks without a day off.  As you rise through the ranks of residency, life gets somewhat better; but you are still training.

I got my first real job as a 31 year old retina specialist.  By then we had 2 children.  It was at this point we stopped living paycheck to paycheck.

Technology Has Defined Modern Ophthalmology – In the United States, we are spoiled by the availability of health care providers and the level of technology we expect.  In ophthalmology, we enjoy the latest in health technology, including injections of anti-VEGF, cataract surgery with implants that allow us to read, sutureless retina surgery, etc.

Our instrumentation is second to none; microscopes abound, diagnostic lenses, computerized scanning, Optical Coherence Tomography, digital fluorescein angiography and don’t forget all the lasers.  There are lasers for vision correction (cornea), glaucoma surgery, after-cataract surgery and retina.

“Blindness” – The main topics of this web site are diabetic retinopathy and macular degeneration.  These are the two leading causes of blindness in the adult world.  Not listed is cataracts.

What Does This Mean? This means we (those of you able to read this on your computer, regardless of country) are extremely fortunate.  We live in countries that can afford modern medicine.  Haitians, before the earthquake, never could afford modern medicine.

In the United States, we have an infrastructure that is rich enough to subsidize the training of specialty physicians.  It took me 9 years after college to complete training.  Despite my tuition and working for low wages all those years, it still took subsidies to get my training.  Through Medicare, state and federal funds, extra money is pumped into teaching hospitals/training programs to allow this level of training.  Haitians never see this level of infrastructure.  Over 80% of the country is at poverty or below.  Over 80% of college grads leave the country.  Most Haitians live on less than a few dollars per day.

It is expensive to train a doctor.  The equipment costs to set up a retina specialists office/operating room exceeds half a million dollars.

There are many groups that travel to Haiti (my residency program used to be one of these) to deliver eye care.  Eye care ranges from providing glasses to curing “blindness” with cataract surgery.  There is no regular eye care in Haiti.  Most of our tools and instruments require a level of technology that is simply not available to impoverished countries, but without these tools, we are limited in our ability to help.  Most Haitians never see access to rudimentary eye care.

Haitians still go “blind” from cataracts.  Cataract surgery is hard to come by in Haiti.  If you are blind, you can’t work.  It is a vicious cycle.  Many “missions” traveling to Haiti are to offer cataract surgery to the thousands that need it.

Without the infrastructure to support the training and the means to provide technology, Haitians are unable to “see” modern medicine.  We “see” differently.


Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist
Fairfax, Virginia

How I Practice

Medical Insurance Pays for Your Eyes. Vision Insurance Pays for Glasses. The Difference?

When it comes to eyes and vision, there is often confusion as to what services are covered.  Most companies provide medical insurance; the traditional health insurance guarding against catastrophic medical bills, doctor’s bills, etc.  Many more companies will provide a prescription plan and vision insurance.

Vision vs. Medical Insurance – Vision insurance typically will “pay for”  glasses or contacts and an “eye exam.”  In a nutshell, vision insurance pays for the services and goods required to obtain proper glasses or contact lenses.  It probably does not cover a dilated eye exam.  Check with your eye doctor or your insurance plan to verify.  Vision insurance does not usually pay for any “health related” vision problems such as diabetic retinopathy, macular degeneration, cataracts, glaucoma, etc.

Medical insurance pays for the health services necessary to diagnose and treat health related eye problems.  Patients with medical eye diseases are covered by medical insurance.

Get a Dilated Eye Exam – If you have either macular degeneration or diabetic retinopathy, the only way a complete, and thorough, eye exam can be performed is by having a dilated eye exam.  It is imperative that your eye doctor get the chance to look at your retina with the pupil fully dilated to allow an unimpeded view of your retina.  While there are special cameras allowing a picture of the retina “without dilation,” this does not substitute as a thorough eye exam.

What Does This Mean? Simply put, if you have medical insurance, and have a medical eye problem, you should be able to have a complete, dilated eye exam that is covered by your insurance.  Your eye doctor should be able to fully examine and treat you for any medical eye problem.  Patients with diabetic retinopathy and macular degeneration require routine, dilated eye exams. These are health issues, not “vision.”

If you have vision insurance only, and not medical insurance, you may need a complete dilated eye exam, but check with your doctor to make sure what is covered by insurance.


Randall V. Wong, M.D.

Ophthalmologist, Retina Specialist
Fairfax, Virginia

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Social Media and Health

My Opinion About Medical Blogging

“Blog” is short for “web log.”

The term blog commonly refers to a web site that is run by one person and represents that person’s commentary, or opinion,  on a particular subject.  Blogs became very popular several years ago because they were “interactive.”  People could read an article, or “post,” and leave their own comment!  The interactive component made blogs an instant success.  Spam, however, has quickly quieted this advantage, but blogs remain very popular (according to Technorati, there are well over 112 million blogs!)

Blogging software is slightly different than web-page software.  Basically, blog software allows great flexibility, efficiency and convenience for the owner.  For example, I am able to write and “post” with a push of the button.  I don’t have to spend much time worrying about the mechanical aspects of the site nor the appearance.  It allows me to make most of my time, writing and providing content.  (For more technical aspects of how I created this blog, there are a few posts on the subject heading “Creating This Blog.”)

The ability to easily add new content, is perhaps, the best advantage of blogs.  I can write, click and post.  It is that simple.  I can do it from any internet connection and from any computer.

Content is what brings you, the readers, back for more.

“Medical Commentary”

The content of most blogs, is the individuals personal opinion about a subject.  It is the modern day “soap box.”  Most medical blogs are a physician’s view of politics, health care, etc.  It occupies a very “grey” area for most doctors.  “Blogging” to most doctors means giving medical advice.

Medical bloggers such as kevinmd, dr. rob and dr. val commonly write and inform about health policy, politics, etc.  There is usually no medical advice.  These are a few of the physician pioneers that have entered the blogosphere.

“Credible Sources of Information”

Technically, is a blog.  It uses blog software, is written (at this time) by one individual and contains content.  I add to this content 4-7 times per week.

My goal, is not to provide my commentary on diabetic retinopathy or macular degeneration, but to provide useful information about these diseases to my readers.  My goal is to inform and teach.  My goal is to provide a credible source of medical information on the internet.

May be this will be a new form of “medical blogging.”  I hope it catches on.  More and more doctors should do this.  It is our responsibility.


Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist

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