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Q:Do OMIC's underwriting requirements permit me to see my pre-operative LASIK patients for the first time on the day of surgery?
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A:Although this is less than ideal from a patient safety perspective and could increase the liability exposure or hinder the defense of a claim, OMIC's underwriting requirements do not prohibit the surgeon from seeing a LASIK patient for the first time on the day of surgery. OMIC does, however, require that the surgeon determine the patient's eligiblity for surgery by performing and documenting an independent evaluation prior to surgery. As part of the independent evaluation, the surgeon must personally examine the patient's eye and ocular adnexa, perform a slit lamp exam, and carefully review topographies, pupil size, pachymetry, refractive stability, eye health history, and prior records. The surgeon must also carefully analyze the patient's expectations and, when appropriate, discuss monovision during the informed consent discussion. To facilitate adequate informed consent, each patient must receive a copy of the consent form prior to the day of surgery so that he or she has time to review it and prepare questions. The patient should not sign the procedure-specific informed consent document until after the informed consent discussion with the surgeon has taken place and the surgeon has answered all of the patient's questions satisfactorily.
Under the best circumstances, the surgeon will personally evaluate the patient's eligibility for surgery before surgery is scheduled. If this is not practical, OMIC's risk management staff recommend that the surgeon at least obtain and review the medical records, especially the topography, before the day of surgery. This would allow the surgeon to rule out contraindications for surgery, discuss alternative options, and address any other issues that could affect the surgical outcome. By the day of surgery, the patient is mentally and financially committed and physically prepared to undergo the procedure, making it more difficult for the physician to alter, postpone, or cancel the surgery as necessary.
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