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Posted on 08-09-2016

Do you remember Art Linkletter?  Those of you younger than 40 may be thinking, “Art Who?”  Art Linkletter was the host of House Party, which ran on CBS radio and television for 25 years, and People Are Funny, on NBC radio and television for 19 years.  He was famous for interviewing children on House Party and “Kids Say the Darndest Things,” which led to a series of books quoting children.
As you might imagine, I have a long list of funny stories I could share regarding doctor-patient encounters.  I thought you might get a chuckle, or perhaps react with an "Are you kidding," from the following.

Grown-ups Say the Darndest Things

First – A patient desired to have a little work done on her drooping eyelids to help with both her appearance and to improve her ability to see.  She was told that in order for her insurance company to help pay for the procedure, tests needed to be done to show that lid surgery was medically necessary and not simply cosmetic.  A simple visual field test called auto-perimetry would contribute to the correct diagnosis.

The visual field test provided us with some surprising results.  This woman, with no supporting symptoms whatsoever, ended up with a visual field showing an unmistakable right inferior homonymous quadranopsia; her right eye could not see any flashing points of light in the right, lower, temporal field, and the left eye could not see any flashing points of light in the right, lower, nasal field.  In other words, when she gazed straight ahead, she was essentially blind to any sight to her lower right side.  The immediate concern was that this patient could well have a brain lesion or space occupying tumor!

Her insurance was an HMO and therefore her primary care physician was immediately contacted so that both a neurology or neuro-ophthalmology consult and MRI could be arranged, stat.

A day later, the patient came back to share how embarrassed she felt because she admitted having faked the visual field testing responses.  She was trying to create a “positive” test so that her insurance would help cover the cost of her lid surgery! 

Initially this caused some great concern and consumed significant amounts of office time for my office AND her primary care physician.  Fortunately, in the end, thank G*d, she was fine and all was well.  And... she did have some sight interference that resulted from her drooping upper eyelids and ultimately had a successful lid surgery outcome.  Makes you really want to shake your head doesn’t it?

                                     You Can’t Please All the People All of the Time

Here's another colorful story - I have always taken great pride in providing an "over-the-top" thorough eye exam.  It has never been enough for me to have a patient simply satisfied with their visit to my office.  My objective is always to have patients enthusiastically want to voluntarily share their experience with their family, friends and co-workers.  Still, the old adage about not being able to please all the people all of the time continues to be true.  My objectives will not change. 

After spending about 15 minutes of testing time with my staff prior to seeing me, then another 25 to 30 minutes of testing time with me, I put drops in this patient's eyes to dilate his pupils (I always ask first to be certain a patient is okay having this important procedure done on the day of the exam; some prefer to return for dilation on another day).  This patient advised he was fine with being dilating. 

After all was done and the patient’s findings were explained to him in detail, he chose to purchase COSTCO or CVS over-the-counter lined bifocals (magnifying lenses of questionable optical quality with no correction for his astigmatism or the asymmetry between his two eyes).

When I encounter patients like this, I ask myself – after the fact, of course – what did I accomplish for the patient by spending all that time with him?  Did I really help him to see better and be more comfortable?  Was I successful in educating him about his eyes or what makes a quality pair of frames and lenses?  Does the patient really understand that he most likely just received one of the most thorough (if not THE most thorough) eye exam he’s ever had?  Does he understand that he is capable of seeing significantly better with a quality, accurately measured and fabricated pair of glasses, and will not achieve that with “over-the-counter” magnifying glasses?  Well… clearly I wasn’t able to communicate well with this patient.  I can’t help but feel as though it was I who failed!

The best (or worst) part of this story was when my staff told me that just before I examined the inside of his eyes (after the dilating drops took affect), he commented about how displeased he was that the exam was taking so long.  I guess he would have been happier with a 15 minute exam; in and out!  “You can’t please all the people all of the time.”

As usual, I am interested in your comments.  Please write to me at info@drcharm.com.  If you'd prefer, I wouldn't mind learning how to become more proficient using Facebook and/or the Anaheim Hills Buzz (I'm a "newbie to both).  If you choose to communicate that way, please make reference to a blog title, and www.drcharm.com.  Thanks.

Be well,
Dr. Harry J. Charm, Optometrist

Anaheim Hills Family Optometry
6200 E. Canyon Rim Rd., Suite 101
Anaheim Hills, CA 92807
(714) 998-2020

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