As you know, I am a glaucoma patient and founder of FitEyes.com. Like many of you, I have often struggled to find an ophthalmologist or glaucoma specialist who was a good fit for me. Simple things like dietary supplements are often an obstacle (with doctors either not being able to intelligently discuss them with us, or even taking a hostile attitude toward their use.) Eventually, I was fortunate enough to wind up as a patient of Dr. Robert Ritch. That circumstance ended up changing everything about my experience as a glaucoma patient and it put me on the right path to controlling my glaucoma. It was nothing short of life-changing. I offer this background to emphasize that I understand both the struggles we patients experience with doctors as well as the wonder of connecting with a truly special doctor. (Dr. Ritch is retired from seeing patients now.)
Many of you FitEyes members have already interacted with Dr. David Richardson and some of you are his patients. However, even though he has been a FitEyes member for years, I had not had the opportunity to interact with him personally in the past. I have heard reports from FitEyes members who have seen him as a patient. I have even sent FitEyes members to see him. And I have seen his regular emails to the FitEyes mailing list. I thought now is a good time for all of us, including me, to get to know Dr. David Richardson better.
A couple weeks ago Dr. Richardson and I carved out some time for a phone call and we ended up talking for a couple hours. I am excited to share what I learned in that phone call because Dr. Richardson is even more unique than I had previously appreciated. In fact, I had not appreciated his unique approach to medicine because, even after knowing as much about him as I did, I was not aware of some of the most interesting facts about his practice.
I knew he had a skillful competency in dietary supplements, which I respect, and that he is open-minded, which I think is one of the most important qualities in any physician. I also knew that for anyone interested in minimally invasive glaucoma treatment, and particularly canaloplasty, Dr. Richardson is widely recognized as a top expert. What I did not know was how unique his approach to patient care is. He describes his practice as "patient-focused care and treatment." His website states, "You deserve personalized care, more time, attention and compassion from your doctor."
What I learned in my phone call with him is not only the conviction and sincerity of these statements, but also the powerful way he actually puts them into practice with his patients. He is practicing in a way I have rarely seen since the 1980's -- and it was rare even then.
Why it is difficult to practice medicine in a compassionate way
Back in the 1980's I did an internship at the medical practice of an early pioneer in alternative medicine. This caring and compassionate doctor took heat from the establishment and his peers (as did any physician involved in alternative medicine in the 1980's). What I saw first hand is that he made many personal sacrifices in order to practice a more patient-focused style of care. One of the sacrifices he made was a drastic reduction in his income because that's what happens when you spend a lot more time with each patient. Practicing the way he did was not an easy thing do to at this time because he was reinventing the medical practice. He spent much more time talking with his patients, discovering the underlying causes for what was troubling them, and answering their questions. He made tremendous sacrifices to practice medicine in a way that he felt was more ethical and that was in the best interest of his patients.
I saw first hand how difficult it is to run a medical practice based on the conviction of spending quality time with your patients. As we all know, many physicians, while answering a patients questions during an appointment, have their hand on the door knob, ready to exit the treatment room as quickly as they can. The common model (and almost the only model of a modern medical practice) requires that physicians see as many patients in a day as they can. This forces them to limit the time they spend with each patient. Most physicians probably don't see any option except sticking to this tiring schedule which limits the amount of rewarding interaction that can take place between themselves and each patient. This personal interaction is possibly the single most valuable thing that can occur during any visit of a patient to a physician, yet it is also the scarcest resource.
Since the 1980's, when I got to know the early pioneer in alternative medicine and I saw his model for spending more time with patients, that style of practicing medicine has not become widespread. Even with the growth of functional medicine and other forms of alternative medicine during past decades, I don't see much evidence that this style of care is readily available to most of us as an affordable option. I am aware that some functional medicine physicians today will spend more time with a patient, but they charge per fraction of an hour and they bill high hourly rates. (Also, these doctors are not qualified to treat glaucoma.)
In my phone call with Dr. Richardson, I realized he is possibly the first physician I have personally spoken with who practices medicine in a style similar to my early mentor from the 1980's -- it is truly a patient-focused way to practice medicine. Importantly, Dr. Richardson has found a way to make it affordable. The patients I have spoken to who see Dr. Richardson have never complained about the cost. He emphasized to me during our call that he focuses on keeping his services affordable. (In contrast to this, many of the functional medicine physicians I know will tell you right up front that they are very expensive.)
To learn more about Dr. Richardson’s fees you can call his office at 626-289-7856.
I know some of us have functional doctors who spend time with us. And I know many of us have ophthalmologists who, after getting to know us, will take time to answer our questions. But I am not aware of any other glaucoma specialist in the world who has built their entire practice on the conviction of providing each patient with personalized care with more time, attention and compassion. (If there are others, we should make a database of them for the FitEyes community.)
In Dr. Richardson's practice, it is not the exception to get your questions answered. It is not something that happens for an occasional long-term patient who has become like a friend. It is something he does as a routine part of his practice. It starts with the first visit, where the patient can expect to be in Dr. Richardson's office for a couple hours, including time doing testing, and with a large chunk of that time allocated for face-to-face interaction between you and Dr. Richardson.
Why this matters for all FitEyes members
One of my goals in helping FitEyes get to know more about Dr. David Richardson is that those of you who are looking for a new glaucoma specialist may decide to go see him -- even if you have to travel to do so. Before Dr. Ritch retired, I did not mind flying to New York to see him, because he was a unique physician who made the trip worth it every time. I think many of us may find the value in traveling to see Dr. David Richardson. I think you should know about this unique resource if you are searching for a new glaucoma specialist.
However, another one of my goals is to possibly inspire other ophthalmologists to follow Dr. Richardson's example. This is where all of us, even if we don't see Dr. Richardson as a patient, may have some interest. The more the world is exposed to viable examples of true patient-focused and affordable models for medical practices, the more other physicians will be encouraged to consider new options for how they practice. This will benefit all patients and advance the field of medicine.
I mentioned that any medical practice where the physician elects to see fewer patients in order to give more quality time to each one presents business model challenges. However, the flip side is that it can be good for the heart and the soul of the physician to practice medicine this way. It is the way medicine was meant to be practiced in my opinion. It can make the critical difference in patient outcomes too.
It sounds simple -- just spend more time with each patient. But everything about modern mainstream medicine works to make that extremely difficult to do in practice. Somehow Dr. David Richardson has invented an approach that works for both him and his patients. Even if you do not have the opportunity to become a patient of Dr. Richardson, his example may inspire your own doctor to reconsider his or her ideas about viable models for practicing medicine in our modern age. If we can find a way to let our current doctors know that this model of practicing medicine works, we may find ourselves enjoying much more rewarding visits to our doctors.
The foundational philosophy of FitEyes is empowering patients. Many of us decided on our own to buy tonometers and then we introduced our ophthalmologists to the concept of home tonometry. The act of doing this not only only empowers us as patients, it helps our doctors learn about the benefits of self-tonometry and this means other patients of that doctor end up benefiting as well. In this way, what starts as self-interest ends up being altruistic. We had to put in a good bit of effort as the first patients to talk about self-tonometry with our doctors; however, the result of that effort is that the entire field of glaucoma care moves forward. If we did not put in that effort, this progress would not happen at all or it would take much longer.
I now see another opportunity for us to help move medicine forward. For those of us who see an otherwise good ophthalmologists who is stuck in this medical practice model that dictates they severely limit their time with each patient, we have an opportunity to tactfully introduce them to the example of Dr. David Richardson. Even if they do not decide to go all-in, as Dr. Richardson has, I think we can begin to chip away at the dominance of this rushed approach to patient care that is all too common now. Sometimes all you need is one good example. Maybe we, as a community, need to help make Dr. David Richardson famous (or at least much more well-known).
The more successful his practice is, the more other physicians may be inspired to practice in this patient-centric way. That's a very good thing for medicine, in my opinion. I would like to hear your thoughts on how to do this. How can we help create a better model for practicing medicine? That's a long-term goal and I don't know exactly what the action items are. However, I do know we have a glaucoma specialist in our midst who already practices medicine in this "enlightened" way. We can either choose to see him as a patient, even if we have to travel, or we can learn more about his practice so that we can have an intelligent discussion with anyone else in the field of medicine who thinks all doctors have to practice medicine in a rushed, stressful way.
If you are already his patient, please share your thoughts and experiences with other FitEyes members. If you have questions for Dr. Richardson, I invite you to post them to the FitEyes mailing list.
The thing I learned in my phone discussion with Dr. Richardson that may have intrigued me the most is that he meditates. Most of you know that I place a lot of importance on my personal meditation practice. I have seen how much it has helped me manage my intraocular pressure, and I have seen it help other FitEyes members equally profoundly. Rarely, I have encountered a glaucoma specialist who sees the value of meditation and encourages the interested patient to continue their own practice. (The more common thing I see is actually either dismissal or hostility.) But I have never previously had the good fortune to meet a glaucoma specialist who has a daily meditation practice of his or her own.
Physician, heal thyself
Most physicians are fiercely hard-working. They worked hard for many years just to become doctors and now they continue to work hard to maintain a successful medical practice. Yet far too few physicians allow sufficient time for self-care. In fact, physician suicide rates are alarming. As is alcoholism and drug addiction. One quality I highly value in my own physician is that of self-care.
We patients have learned the importance of a healthy lifestyle, including good nutrition, dietary supplements and stress management. When our doctor maintains a similar healthy lifestyle, not only does it give us a common framework for discussing health, it also helps ensure that our doctor is offering us advice and treatment from his or her own foundation in health. I hope you appreciate the importance of this.
In my opinion, an overworked, tired, unhappy doctor cannot possibly offer me the same level of healing wisdom as a doctor who feels inner peace, who has worked to develop a higher level of compassion, and who has oriented their medical practice in such a way that nourishing two-way interactions with patients can actually happen on a routine basis.
Tonometry and Self-tonometry
I will finish with a section on tonometry. Most of you have seen discussion on FitEyes about Reichert tonometers, such as the 7CR. Many of you own a 7CR and you know it is a great tonometer. Unfortunately, many ophthalmologists are biased against anything that is not a Goldmann tonometer, and they are especially biased against "air puff" tonometers (for historical political reasons that Dr. Ritch has posted about in the past). This is a shame because air puff technology uniquely enables the measurement of corneal hysteresis, which has proven value in the management of glaucoma.
Reichert manufactures an advanced tonometer that measures two types of intraocular pressure as well as corneal hysteresis. It is called the Ocular Response Analyzer. After becoming very familiar with the advanced features of this instrument, I concluded it should be in every glaucoma specialists' practice (and probably in every ophthalmologists office). Unfortunately, as I said, the majority of ophthalmologists continue to exclusively use the 65 year old Goldmann tonometer.
I am happy to say that Dr. Richardson has a Reichert Ocular Response Analyzer in his San Marino office. Amazingly, he also has an Icare Home that he makes available for his patients to rent!
Our phone conversation ranged from his philosophy on patient care to supplements and meditation to technology. Here is how he described his views on medical technology:
If there's a technology available that I think could benefit my patents in the management or treatment of glaucoma I've made the investment to have it available for them in my office. If I do not have a certain instrument, it's because in my assessment it's not yet proven its value within these goals.
Coupled with his patient-focused and compassionate approach, I think that's an ideal view on medical technology. I will append a list of the medical devices Dr. Richardson has in his San Marino office to the end of this article.
In my experience, Dr. Richardson is the glaucoma specialist who you can truly be yourself with, who you can invest in forming a relationship with, and who will get to know you in a way that can make all the difference in the medical outcomes you experience.
Location and Contact Information
His practice is located near the L.A. area in San Marino, California (about five minutes south of Pasadena). You can see his websites here:
David Richardson, MD | Glaucoma, Cataract Surgeon, California
Complementary and Alternative Medicines For Glaucoma | David Richardson, MD - Glaucoma, Cataract Surgeon California
Caveat: Dr. Richardson is “out-of-network” for all insurances and does not submit claims to insurance. (This was also true for Dr. Ritch.)
To learn more about Dr. Richardson’s fees for your ocular condition you can call his office at 626-289-7856. One of his staff will be happy to assist you. He is used to patients who ask a lot of questions. However, take a look at the Q&A's on his website too:
FAQs about Glaucoma, Cataracts and Canaloplasty | David Richardson, MD - Glaucoma, Cataract Surgeon California
You may also send him an email via: PatientExperience@david-richardson-md.com
When you contact him, let him know you are a FitEyes member. And let's keep changing the practice of glaucoma one ophthalmologist at a time.
Medical Devices Available in Dr. Richardson's Office (this may not be a complete list):
- Reichert ORA
- iCare (as well as iCare home for "rental")
- Probably still have a Schiotz collecting dust somewhere ;-)
Functional Testing (Objective)
- Diopsys PERG (Pattern Electroretinography)
Functional Testing (Subjective)
- Zeiss HFA3 860 with SITA-Faster and SWAP (this is the most advanced HFA available)
- Zeiss FDT
- Virtual Visual Field testing (using a portable Oculus Go)
- Ultrasound Pachymeter
- EIDON stereo disc imaging
- OptoVue AngioVue OCT (with OCT angiography)
- YAG (for peripheral iridotomy)