THE HUMAN SIDE OF OPTOMETRY
We can help patients get their heads out of the sand (medically speaking, that is).
I don't like going to the doctor. I bet you don't either. The memory of "having to get a needle" continues to linger with me even into my middle age. And for heaven's sake, who wants to get any bad news? Here we are, moving about, without complaints, in our humble, happy-go-lucky existence . . . when, as Emeril says, "Bam!" - heart disease or high cholesterol or anemia or who knows what strikes! Who wants to be told they have a cavity?
So, to dodge these unsavory possibilities, we avoid. Am I right? If it doesn't hurt, it isn't too ugly or it doesn't stop you from doing your daily business, you can live with it. It's your friend. It makes you unique. In fact, you start to believe the voice inside your head that says, "If it isn't a hindrance . . . is it really there at all?" The sensible voice says, "Get it checked out," but the instinctual ostrich that resides in most of us demands, at least for a "trial period" to look the other way - as if not looking will make it disappear. The cult of us who follow this philosophy wait until it has grown really big or until it hurts really bad or until something is clearly amiss before making the unwilling trek. And we're medically educated!
Something in common
Why should we think our patients are any different? Just needing glasses for reading after a lifetime of good eyesight could represent the worst of news. Unfortunately, refractive error is only the tip of the iceberg. With so many systemic ailments having ocular signs and symptoms rooted in a systemic cause, the likelihood of the primary care eye doctor having to dispense "the bad news" isn't only plausible - it's more in the realm of probable. Diabetic retinopathy and poorly controlled blood sugar or undiscovered diabetes, cotton wool patches and undiscovered hypertension, unilateral intraretinal bleeding and the possibility of carotid artery disease, arcus senilus or xanthalasma and the potential for hyperlipidemia, the increasing risk of legal blindness secondary to lost vision from age-related macular degeneration and linkage to tobacco use, artery occlusion and the risk of myocardial infarction, unexplained iritis and the risk of collagen vascular or autoimmune disease, visual field loss and the potential for glaucoma, or a stroke or a tumor. Would you want to go to the doctor's?
We're their exception
However, ocular problems are different. Eye pain joins tooth pain and ear pain as being one of the things that will make us jump. Losing your vision . . . well, that's number one. So they arrive for their visit never expecting to hear, "We need to get a blood test." However, that's the way it is and it's a part of the responsibility we've taken an oath to uphold. That person who sits in front of you is the most important person in the world to somebody else.
Primary eye care has evolved way beyond refraction and contact lenses. As practitioners who are often the first to discover the signals of slipping homeostasis, we are gatekeepers. We owe our patients some guardianship. We have a responsibility to watch over them and to alert them when their overall wellness is at risk. Take a minute and think just how much is at stake.
DO YOU HAVE A MEMORABLE EXPERIENCE YOU'D LIKE TO SHARE? DISCUSS YOUR STORY WITH RENÉ LUTHE, SENIOR ASSOCIATE EDITOR OF OPTOMETRIC MANAGEMENT, AT (215) 643-8132 OR LUTHER@BOUCHER1.COM. OM OFFERS AN HONORARIUM FOR PUBLISHED SUBMISSIONS.
BY DENISE WHARTON, O.D. AND ANDREW S. GURWOOD, O.D. PHILADELPHIA, PA.
Copyright Boucher Communications, Inc. Oct 2004
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