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The melting pot practice

Visionary Eye Doctors fuels growth through a multilingual practice setting.

Jeannette Miranda, medical and surgical assistant (left), and Zaira Diaz, patient representative (center), can provide better assistance for J. Alberto Martinez, MD, during surgery by observing the procedure on a high-definition monitor.
Photography by Avonlee Photography

The staff members at Visionary Eye Doctors speak your language … whether it happens to be English, Spanish, French, Haitian Creole, Bengali, Filipino, Korean, or Farsi.

“I’m proud of our state-of-the-art technology and efficiency, but I think the main reason the practice sees 20% growth year after year is because we can speak an array of languages,” says J. Alberto Martinez, MD, of his three-location practice in Maryland and Washington, DC. “When dealing with health, patients want to ensure that they’re being understood and that they fully understand what is explained to them.”

Since Dr. Martinez, a South American-born ophthalmologist, started Visionary Eye Doctors in 1995, the practice has continually adapted to the needs of a diverse population. Four cities in Maryland rank in the top 10 of “ethno-racial diversity” in the United States, according to 2016 WalletHub statistics. One of these cities, Rockville, is the home of a Visionary Eye Doctors location. According to U.S. Census data, 20.6% of the population of Rockville identify themselves as Asian, while another 14.3% identify as Hispanic or Latino.

Visionary Eye Doctors works to meet the needs of limited English proficiency (LEP) patients through hiring, staff training, and patient communication — all of which have led to practice benefits.

Hiring

When hiring, “Visionary Eye Doctors focuses on the applicant’s kindness and an openness to learn other languages,” says Carolina Clavijo, practice administrator and CEO. It is important that candidates demonstrate this, because Spanish-speaking patients, for example, comprise roughly 55% of the practice, says Ms. Clavijo.

Carolina Clavijo, practice administrator and CEO, provides staff training.

The practice’s motto is a, “world-class ophthalmology practice providing unique eye care that integrates three elements of patient care: technology, efficiency, and a loving touch.” Kindness is the main component of that “loving touch,” says Dr. Martinez. “I will not have someone work for me who does not treat my patients kindly. Efficiency does not trump kindness. If your heart is not in the right place, you can’t deliver good care.” (See “Visionary foundation,” pg .14)

For example, Jenny Ha, the practice’s research director, says that when she translates from English to Korean, she asks herself, “If this person was my mother or father, what would I say to give him or her the information needed to make the best decision?”

Staff training

Once hired, Visionary Eye Doctors’ staff members receive a Spanish medical terms handout and Spanish scripts. These materials help staff to clearly educate LEP patients on the purpose of specific diagnostic devices, glasses, contact lenses, and surgical options, says Ms. Clavijo. (The practice makes similar accommodations for patients who speak other languages as well, she adds.)

If a Spanish-speaking patient asks what the Oculus Pentacam does, for example, the technician is able to reply, in Spanish, “We’re measuring the thickness and shape of your cornea, so we can ensure optimal surgical outcomes,” Ms. Clavijo says.

Sheyda Moreno, the lead surgical coordinator for Visionary Eye Doctors, adds that the practice also provides bilingual clinical videos for the staff so they can reinforce medical terms while also gaining an understanding of, for example, the need for eye drops prior to cataract surgery.

“I’ve always been fluent in Spanish, but I didn’t know any of the ocular terminology in Spanish,” Ms. Moreno says. “This knowledge enables me to not only effectively communicate in Spanish, but answer patient questions too.”

Jennifer Ramirez, the practice’s clinical director, says new hires who don’t speak Spanish receive a sheet of basic greetings and, if they’d like, Rosetta Stone language-learning software.

Visionary Eye Doctors overview

Founded: 1995

Practice specialties: Corneal, retinal, refractive and pterygium surgeries, specialty contact lens fits, dry eye disease

Practice research: Cataract surgery (laser energy comparison), pterygium

Claim to fame: Local radio show “El cuidado de sus ojos” (“Taking Care of Your Eyes”), Visionary Foundation and pterygiectomies (Dr. Martinez has performed more than 10,000)

Locations: 3 (Rockville, MD, Washington, DC, Damascus, MD)

MDs: 7

ODs: 3

Other staff: 26 clinical, 12 front desk, 2 research, 2 billing, 6 optical, and 7 administrative

Equipment used:
Alcon LenSx Laser System,
Alcon ORA System with VerifEye,
DGH 555 Ultrasonic Pachymeter,
Diopsys VEP and ERG Testing System,
Ellex ophthalmic laser,
Heidelberg Spectralis OCT,
Hitachi slit lamp camera,
Humphrey autorefractor/keratometer,
Humphrey Visual Field Analyzer,
Icare tonometers,
Johnson & Johnson Vision Surgical Platform Catalys Precision Laser System,
Konan CellCheck specular microscope,
Lumenis SLT laser,
Marco Epic 5100 Refraction Workstation,
Nidek AR-1 auto refractometer,
Nidek YC-1800 ophthalmic laser,
Oculus Pentacam,
Optos California Ultra-widefield retinal imaging,
Optovue OCT System,
Sonomed A-scan and B-scan,
TearScience LipiFlow,
TearScience LipiScan,
Topcon KR-8000 autorefractor,
Topcon TRC-NW400 fundus camera,
Topcon SL-D701 slit lamp camera,
Zeiss VISULENS 500 Automatic Lensmeter,
Zeiss IOLMaster 500

Patient communication

To ensure all patients have a pleasant visit, Visionary Eye Doctors focuses on the following:

Language choice. They ask all patients via phone and at check-in, “What is your language preference?” If it’s a language other than English or Spanish, the practice assigns a staff member (or a personal translator from an outside source) who speaks that patient’s language to travel with the patient throughout the visit, says Ms. Clavijo.

“If a translator is needed — which isn’t often, considering the languages spoken by staff — the practice has a go-to company that provides such services, and the practice, not the patient, pays for it,” she says.

Visionary foundation

Roughly eight years ago, Dr. Martinez, who has traveled on many mission trips through various organizations, decided to start his own non-profit surgical mission group, the Visionary Foundation, with a focus on establishing sound local infrastructures in developing countries.

“For the last five years, we have worked in a city in Honduras where there is tremendous need,” he says. “I have someone in the area who prepares the patients for surgery, provides an operating room, and takes care of these patients post-op.”

When a need presents in his own practice, Dr. Martinez says he’ll perform the surgery through the Foundation. For instance, a 10-year-old boy from Chile presented with 20/400 in both eyes and horrible congenital cataracts.

“I said to his mother, ‘SeƱora, your son needs cataract surgery,’” Dr. Martinez says. “She started crying and said, ‘I know, but we don’t have any money.’ The boy was the perfect candidate for my charity, so I performed the surgery. The next day when he returned for follow-up, his mother was crying uncontrollably. I asked her why, and she said, ‘My son looks at me now and tells me I am so beautiful.’ The boy had never seen his mother’s face.”

Cultural awareness. Language skills alone do not guarantee a loyal, growing patient base, Ms. Ramirez says. “It’s not just about language fluency. It’s also about the culture of those who speak that language. Many of us at Visionary Eye Doctors have a personal background in the languages we speak, so the cultures that accompany certain languages are second nature to us.”

The Visionary Eye Doctors team includes: (from left, standing) J. Alberto Martinez, MD; Joshua Albowicz, COA, clinic supervisor; Leslie Sosa, scribe; Carolina Clavijo, practice administrator and CEO; Jennifer Ramirez, COA, clinic supervisor and director of EHR; Jorge Escalante, optician; Fritz Allen, MD; (from left, sitting) Valerie Noriega, CPSS, recall specialist; Jeannette Miranda, medical & surgical assistant; Andrea Standford, COA, senior tech.

For example, when a female patient presents with a head scarf, lead optometrist Babak Hosseini says he “never” extends his hand as a greeting — having grown up in Iran, he knows that a man should not offer to shake a woman’s hand, unless she extends her hand first. Likewise, when Ms. Ha meets a Korean patient, she bows because that is part of the Korean culture, she says.

Supporting education. Visionary Eye Doctors’ staff augment their one-on-one time with patients via bilingual educational videos from Rendia, “flip books” that contain ocular images, brochures on the various services the practice offers, and medication direction forms.

“When a patient needs cataract surgery, for example, I’ll show him or her a video on what a cataract is, what the Catalys femtosecond laser is, and the differences among the various IOLs,” Ms. Moreno says. “If a patient continues to have questions after the videos, I’ll use a small flip book to educate him or her on astigmatism. I’ll provide brochures on the IOL options should the patient want to discuss things further with a spouse or family member.”

A unique component of Visionary Eye Doctors is the versatility of their exam rooms, two of which are connected and can also be used as minor procedure rooms. In addition to the primarily performed pterygium surgery, they can perform a variety of procedures, such as graft rebubbling and scleral graft transplants. To ensure patient comfort during the procedures, “The patient is prepped for their procedure by a team member who speaks the patients’ language or are accompanied by team members who are capable of translating the process,” says Ms. Ha.

Benefits

Due to the practice’s focus on the above, it has seen the following benefits:

Patient trust. “I think the bond of trust that you have to establish with patients for them to give you their eyes is the greatest honor an eye doctor gets,” Dr. Martinez says. “And that trust is more easily established when you have that language and cultural connection.”

Ms. Moreno agrees.

“Many patients who present for cataract surgery, for example, aren’t sure what type of lens they want,” she says. “But, as soon as they interact with someone who shares the same language and culture and can, therefore, definitively educate them on the risks and benefits, these patients always convert to the best option (for their needs).”

Increased patient compliance. Dr. Hosseini says that LEP glaucoma patients who transfer to Visionary Eye Doctors often become compliant with their IOP-lowering drops because, “we can communicate what the disease is and the importance of the drops.”

Fewer patient call-backs. “The ability to communicate with someone in his or her own language has resulted in fewer calls from confused patients,” Ms. Ramirez says. “This not only benefits patients, but the practice as well because time isn’t taken away from daily duties to provide additional explanations.”

Sheyda Moreno, lead surgical coordinator (left), and Allie Blankenship, surgical counselor, explain cataract surgery options.

Joshua Albowicz, COA, clinic supervisor, prepares a patient for corneal topography.

Practice savings. Dr. Hosseini says that having a multi-lingual staff has saved the practice money because they rarely have to use an outside translator service. (To have a translator in the office for an entire day can cost up to $700, Ms. Clavijo says.)

Referrals. “A lot of new patients come to the practice through word-of-mouth referrals from non-English-speaking family and friends,” says Ms. Ha. Dr. Hosseini adds that he gets many referrals from doctors outside the practice who either speak Farsi themselves or have a patient who prefers to speak Farsi. In all, the practice sees more than 7,000 new patients each year, according to Ms. Clavijo.

“Local academic institutions, such as Johns Hopkins Hospital and MedStar Georgetown University Hospital, rely on Visionary Eye Doctors to provide state-of-the art care to patients with challenging ophthalmic conditions. Patients have traveled over 200 miles from Virginia Beach to seek our ophthalmic expertise. Furthermore, we have a pterygium excellence center, which attracts patients from New York City and even France to undergo pterygium surgery at Visionary Eye Doctors,” says Ms. Ha.

Comfortable care

Dr. Martinez says that he is proud of the positive impact that his practice and staff have on patients. “I really think that diversity is a strength. And not just diversity of language and cultures, but diversity in skill sets and thought processes.” OP