DR. LAURA PERIMAN
Focus Through the Generations (FTTG) offers insight from four different generations of the nation's top ophthalmologists. Hear from the experts themselves on their varying life experiences in the industry.
Laura Periman, MD is a board-certified ophthalmologist, fellowship-trained cornea and refractive surgeon and Ocular Surface Disease Expert. As Director of Dry Eye Services and Clinical Research in Seattle, WA she combines her clinical care passion, scientific drive and innovative creativity to provide first class Ocular Surface Disease management.
hear from dr. LAURA PERIMAN
Our host, Polly Neely had the pleasure of sitting down with Dr. Laura Periman for an exclusive discussion regarding her life and industry experiences. Get to know Dr. Periman a little deeper in this episode of “Focus Through the Generations”.
Polly Neely: Hi, Dr. Periman, thank you so much for joining us. We're so happy to have you this evening. I'm going to ask you now just to introduce yourself to our audience and tell us a little bit about yourself.
Dr. Laura Periman: Sure, thanks so much for the invitation to be here. It's really awesome to be here with you. Thank you, Polly, and to the rest of the Vision Care Connect team. I really appreciate the opportunity. My name is Laura Periman, I am an ophthalmologist in Seattle, Washington. I am a cornea and refractive trained dry eyes specialist, and we now have a practice where all we do is advanced dry eye care. We're in Seattle, Washington on beautiful Queen Anne Hill.
Polly Neely: You're a pioneer, a pioneer in this industry and in your life. I want to ask you a question. I sent you a few of the questions, but I want to ask you, what do you think is the biggest problem facing ophthalmology today?
Dr. Laura Periman: Oh, wow that's a big question. What is the biggest problem facing ophthalmology today? I think it's the corporatization of medicine is the biggest problem facing ophthalmology today, and by that, I mean, the erosions of practicing with autonomy in the context of big box groups, private equity acquisitions. Also, the health insurance companies and their arbitrary and capricious, artificial, time-wasting, unnecessary, non-medical denials, and prior authorizations and appeals. Yeah, can I tell you how I really feel about it?
Polly Neely: Yes, you can.
Dr. Laura Periman: I'm being polite right now.
Polly Neely: No, I love that description. I've heard it before, and I truly appreciate it. Being in the industry as long as I have, and I think we spoke with someone last week, or this week, I don't remember who said, you know, I remember the days when we were really reimbursed for our time and our expertise and our knowledge and the risk we were taking. And now we're just reimbursed.
Dr. Laura Periman: On a good day. Yeah, if you cross your T's and dot your I's, and don't pass gas in church, then you might get paid.
Polly Neely: Very true, gosh I love it, I love it. On that same note when you were talking about that, what would you say to the millennials and the generation X's that are trying to hang their own shingle right now?
Dr. Laura Periman: Oh, wow. So, I'm very encouraging for new ophthalmologists and seasoned ophthalmologists to go ahead and go solo. Try the private practice thing. There's a lot of smoke and mirrors and urban legends about how hard it is to open your practice, and I bought into that narrative for a long time. I'm like, oh I don't know enough to own my own practice. Well, you can learn it. If you're smart enough to get through medical school, you can learn how to operate a business. It's a steep learning curve. I've made mistakes, no question.
Polly Neely: Sure, but give it a try.
Dr. Laura Periman: There's nothing quite like working for yourself, and the freedom and the latitude you have in making the decisions because doctors do have excellent judgment and we do have the patient's best interest at heart. The best way to achieve that is to be the one making the policies as the leader of your group.
Polly Neely: I love that. I would say if you loved your patients, they'll love you, back right.
Dr. Laura Periman: Yes, we pour a lot of love into our patients.
Polly Neely: And you started your dry eye practice in the middle of COVID, Is that correct?
Dr. Laura Periman: I did.
Polly Neely: Tell me a little bit about that.
Dr. Laura Periman: I thank you for asking about that. So, with the shutdown, a lot of doctors were furloughed, and I saw that as a sign from the universe to go ahead and leave the safety of the group and the nest and go ahead and venture out on my own. So that's what we did. That was a natural breaking point, and I'm so glad I did it. Somehow that forced quiet time at home, I was working crazily trying to get this thing organized off the ground, with all the things you have to do to start a business, but it was time well spent. It was weird because the forced shutdown gave me time to do those formal things, I need to do to get a business set up, educate myself on how to run a business.
‘Asking myself:’ What does this tech structure look like, how do you set up your bookkeeping, what EMR am I going to pick? But I've had the time to do it. So, I worked a lot during the shutdown, as did the rest of my family. My 13-year-old wrote a sci-fi novel and it's going to be published next month, and it’s awesome.
Then, my older girl, she started a volunteer program, called, Students Helping Students Seattle, she saw all this unmet need during the shutdown. She was like, oh my gosh, what are kids doing, their parents are first-line workers, they're having to work. Like, how are they continuing on with their online schooling? She was very concerned about that, so she started this volunteer organization where she matches families with students that need tutoring with high school volunteers. The most commonly requested subject is math. She's matched almost 400 families at this point, and it's all volunteers. She's helped other kids in other communities set up their own volunteer tutoring program, and it's just been a really cool way to stay connected to see a need and fill it, make a difference. So, I'm just really proud of both of them.
Polly Neely: Well, they had a good example.
Dr. Laura Periman: So, you know, I'm not an overbearing mother at all. I'm just like, hey, if you want something you got to work for it. Because I’m not just going to give it to you.
Polly Neely: You lead by example. I'm always a big believer in ‘you know what I say matters, but what I do matters more,’ so I love that.
Dr. Laura Periman: The kids were a little annoyed at me because I've been wanting to start my own clinic for years, they were like Mama, when are you finally going to do it, when are you finally going to do it? I was like, oh I don't know, I'm scared.I'm worried that working too much will be time away from you guys, and they're like we're big girls now, we can handle it, go do your thing.
Polly Neely: Good for them.
Dr. Laura Periman: And they're like, we told you so mom.
Polly Neely: See, now they can say, we told you so to you, instead of you saying it to them. Yes, that's great when the shoes on the other foot. My mother's 96 now, so I can finally say that to my mom.
Dr. Laura Periman: That's adorable. That bodes well for you, 96, that's a good sign that there is good longevity on your side.
Polly Neely: Keeping all my fingers crossed. Let me ask you a question, who or what has influenced you in your life the most would you say?
Dr. Laura Periman: Tough question, who or what has influenced me in my life the most? I'm going to tell you the story about this phenomenal attending physician, I had in medical school. His name is Dr. Douglas Paauw, internal medicine teacher at University of Washington, where I went to med school. And truly the most, I'm going to say enlightened doctor, I've ever come across. This was at the peak of the HIV/AIDS epidemic, right before we had heart therapy for HIV patients. These amazing patients would come in with you know, severe, late-stage diseases and he would just always treat every single one of them with respect, dignity, compassion, and a resolve to keep trying things; but also, the love and compassion to sit with somebody when there really wasn't anything left. So, he's my greatest influence as a physician. I'm getting a little verklempt talking about him because I have just an enormous respect for the man, an incredible, incredible human being.
Polly Neely: What a great influence to have in your life. To have someone who has compassion, empathy, and all of those things, and also has the knowledge to heal if he can, and the want to, if he has the tools. I mean, that's amazing. What would you say is your biggest lesson learned from COVID this year?
Dr. Laura Periman: There's always a silver lining. If you're handed a bushel of lemons, you cut, you squeeze, you add water, you add sugar in your stir. That’s what I've learned from COVID.
Polly Neely: Love it, I've talked to a lot of people who just want to do things, like they want to live again.
They have worked so hard and this year slowed me down enough, like you, it slowed me down to realize what I've missed or what I've longed for. What are the things outside of your practice that you do, and you love, and you've longed for and you've had time to cherish this year and do more of?
Dr. Laura Periman: Yeah, I've been writing a lot of poetry, and yes, I had two poems published this Fall which is really cool and special and meaningful. The publisher asked to see all my other poems and that'll be published this year as well.
Polly Neely: You have to send me all these names and titles. That's awesome.
Dr. Laura Periman: The name of the poetry collection is going to be, The Place Where Stones Smell Glorious. ‘Cause I'm a Montana girl, right? I grew up on a continental divide and just by chance, a raindrop can end up in the Pacific ocean or in the Atlantic ocean just by chance if you're on a continental divide. And I just have always found that to be amazing and poetic. So that's why it's a line from one of my poems, The Place Where Stones Smell Glorious.
Polly Neely: You have great insight. There's a lot of compassion in you, Dr. Periman. Well, I want to end by asking you one thing and we've asked every doctor so far this question, so we're loving the answers that we're getting. How have you seen technology and ophthalmology transition since your career started? And what do you foresee technology being in the industry, or transitioning the industry to come?
Dr. Laura Periman: Oh wow. The arc, the arc of technology over the top of my specialty. Well, I'm going to date myself, but this girl dates back to the days of paper charts.
Polly Neely: I raise my hand. Virtual high five. And there's nothing wrong with paper charts.
Dr. Laura Periman: Yeah, the whole push towards EMR on a theoretical promise. Promise of enhanced efficiency, enhanced patient safety, and enhanced patient care hasn't really borne out. It's nothing but a dead weight around our ankles. Like it slows me down. It's note bloat, like in order to check all the boxes for compliance, you put a bunch of garbage in there that doesn't need to be there. It used to be you know glaucoma follow-ups took up this much space on a page. And now you've got pages and pages of this stuff. Now I'm super tech appreciative, tech savvy. I've got a good EMR, works great, but it's still a problem.
I have found that I had to adjust my thinking and my approach to the patient in response to EMR. And I kind of resent that because it should be quite the opposite. It should be the EMR serves how I think and interact with the patient in addressing their issue and their problems, rather than trying to force it around some arbitrary set of corners if you will. I'm not very flexible as I still can't touch my toes, but I'm not a contortionist. I wish I were, but I'm not. But I'm happy to be flexible and work around things and I've also leveraged the technology that I think was given a huge push in COVID for telemedicine, which is absolutely miraculous. Like people are so afraid that it would not be good for the doctor patient relationship, that it would be unsatisfying. The data shows quite the opposite.
That it's very good for the doctor patient relationship, because we're just looking at each other instead of my back to you, like on the stupid EMR, right? I get the chance through telemedicine to talk to my patient face to face, and get to see them and their full expressions without my mask in the way, Right? So, I can help prepare them mentally about what to expect and their anxiety is lower, and the interactions more fruitful. So, it's like, there's so many layers of good. In fact, just last week telemedicine was an utter save, a home-run case. Nuanced by a long history of dry eye irritation, chronic acute exacerbation of the right eye two days prior, this patient called and their appointment wasn't for another couple of days. I'm like, hmm, that's kind of weird, so we moved the telemedicine up and with just the history you would not have known what the actual problem was.
But 30 seconds into the telephone video call, I saw what the problem was. It was an acute onset of Bell's Palsy, which is where the facial nerve becomes paralytic, and you have this blunting of the nasal labial flow which visibly flattens out on the face when this happens. The patient cannot puff their cheeks out and blow air from out from their lips, or its very weak. It was actually a little bit subtle, I mean, but as soon as I asked him to do this, I saw what was going on and that's the reason why I diagnosed him. I asked him to raise his brows, it was symmetrical, that’s when I said, you know what, I need you to just hang up and go to the ER, this could be something happening in the brain which we have to rule out, some stuff going on acutely. That's a save, and I wouldn't have gotten that far with just a telephone call. But seeing what was going on, I know exactly what this is and this could be very serious, time to go.
Polly Neely: I love that, I think telemedicine, is a total win.
Dr. Laura Periman: Four minutes into it. - Yeah. - I'm like, okay, we're done. I was like I'm going to need to send you.
Polly Neely: I agree, a lot of people would say, well how can you diagnose dry eye over telemedicine? But it's not diagnosing dry eye, it's diagnosing symptoms and the patient, I would say, and, I would love to do this as clinical research, take patient's blood pressures in your office when they come in and take their blood pressure in telemedicine, when they're sitting in their home.
Dr. Laura Periman: Ooh, that would be really good. Get heart rate and blood pressure.
Polly Neely: It would be fun to see the difference and how relaxed the patient is. You already know that you get more information when they're sitting in their home than you do when they're in the office. But imagine what this is.
Dr. Laura Periman: You asked me, where do I see it going? I think it's going to continue to evolve, and I pray for increased efficiencies, but because of the big COVID push, I've been able to start this new Institute with a skeleton crew, a lot of virtual helpers, and with all these amazing apps, job forums, love it. All these telemedicine platforms, Doximity, Advanced Ocular Systems, and can't believe I'm blanking on the name. It’s the one in California, blue and white logo. Oh gosh, it'll come to me in a second. I just had my COVID vaccine, second COVID vaccination on Sunday, I'm still recovering from that. Yesterday was rough. EyeCare Live, thank you, I knew I'd come up with it eventually.
Polly Neely: It didn’t totally get ya.
Dr. Laura Periman: So, all of those amazing platforms are just going to continue to evolve, and I see the technology facilitating some independence, some much needed independence from the evils of health insurance companies. Did I say that out loud? Not our friends.
Polly Neely: They are our friends, but sometimes they're our enemies just like our family. So, it's okay.
Dr. Laura Periman: It's like crazy uncle David at the Thanksgiving table. We all knew he was coming.
Polly Neely: That’ll be the insurance company.
Well, I sure loved having you with us this evening. Thank you so much for joining us. You're such a beautiful, sweet, intelligent amazing woman. Vision Care Connect thanks you so much for joining our program, Focus Through the Generations, and I can't wait for all this to be put together and you can have it and see it.
Dr. Laura Periman: Oh, I can't wait either. That'll be super fun. Tell your younger colleagues, they can follow us on Cedars Aspens, on Dry Eye Master, Instagram, Twitter handles, website, and there's some wonderful young ophthalmologist groups that are very supportive of the next generation. There are all kinds of resources out there, so don't ever feel like you're alone.
Dr. Laura Periman: Thanks so much. It was a lot of fun, appreciate it. Have a good night.
Focus Through the Generations is supported by Bruder Healthcare Company.
Bruder Healthcare Company is the maker of the #1 Doctor Recommended Moist Heat Eye Compress for the treatment of dry eye (DED), meibomian gland disease (MGD), and blepharitis. For more information about the complete line of Bruder products including the newly introduced Bruder Pre-Surgical Patient Prep Kit, please click here.