Timing is everything

Optometric Management, Sep 2000 by Runninger, Jack

The few extra minutes spent reassuring patients are precious.

I know you've retired from practice," an acquaintance phoned me recently. "But would you mind answering some questions for my wife? She's extremely depressed after her appointment today with Dr. X."

I agreed, and he put her on the phone. She told me that Dr. X had been having a bad day because he'd been short three assistants and the office had been a madhouse all day.

"Even so," my friend's wife stated, "I didn't appreciate how he handled my appointment."

She went on to explain that Dr. X had dictated to his assistant, within her earshot, that she may have early macular degeneration.

"When I asked the doctor what that meant," she said, "he replied, `I could give you a pamphlet describing it, but it would only frighten you.' Then he left the room!"

She was so concerned that upon returning home she researched macular degeneration on the Internet.

"Now I'm scared to death that I'm going to go blind," she told me.

Not thinking straight

It's a shame because Dr. X is really an excellent ophthalmologist, and a nice guy. But no matter how harried he was that particular day, he had no right to inform his patient of a scary possible diagnosis and then not spend time discussing it with her.

Sometimes we forget that our purpose in treating patients is to make them better for having come to see us. This includes mentally and emotionally, as well as physically. No matter how brilliant your diagnosis and treatment plan, you haven't made patients better off if your diagnosis unwittingly and unnecessarily scares the bejabbers out of them.

Explaining your diagnosis becomes even more important now that many patients have access to the Internet. Many patients nowadays will look up their diagnosis on the Internet and immediately assume the worst possible outcome.

Marian, the librarian

I know of another unfortunate case where a patient was treated as only a case to diagnose, rather than as a person.

"I went to Dr Z, and he told me that I had macular degeneration and that I'd be blind within 2 years," a retired librarian told me years ago.

"I have no family, and my only interest is in books and reading," she'd told me. "I'd looked forward to retirement so that I could finally catch up on my reading. When Dr. Z told me I'd be blind soon, I seriously considered suicide! But then I decided to get a second opinion, which is why I'm here."

When I took the time, following examination, to explain that even if she became legally blind she'd still have peripheral vision and could still read with magnification devices, she almost cried with relief.

Ten years later, she still had 20/60 acuity with her better eye, and with a 4.00 add and good light, she could still read all but the smallest print.

(An interesting sidelight: Recently, I spoke at a medical auxiliary luncheon honoring retired M.D.s. I saw Dr. Z there for the first time in many years. He told me he didn't get around much now because he had macular degeneration and couldn't drive anymore.)

Give 'em hope

I'm not suggesting that you lie to a patient to give him false hope. However you can make a patient feel much better by putting as positive a spin as possible on the description of your prognosis. For example, you could inform a macular degeneration patient in the following manner:

"I'm happy to tell you that you're holding your own. Your vision is no worse than it was when I last examined you a year ago."

This conveys the same message but is much less discouraging to a patient than if you were to say:

"You're not showing any improvement. Your vision is still just as bad as it was a year ago."

With managed care, we must use our time more efficiently. Nevertheless, as healthcare practitioners, we have an obligation to take sufficient time to treat patients as people, not just as problems to diagnose.

Jack Runninger, our consulting editor, lives in Rome, Ga. He's a past editor of Optometric Management.