is Runnymede, where the famous Magna Carta was signed," said the English
tour guide to the American tourists.
"When was that?" asked one of the
"1215," replied the guide.
"Geez, Myrtle," said the tourist
to his wife as he glanced at his watch. "We only missed it by 45
I also was a tourist in Merry Olde England
recently and learned an exception to a tenet I've always preached in these
Where angels fear to tread
My wife and I were "elder
hosteling" outside the small village of Wye in southeastern England. One
day, we discovered that we needed something (I'll explain later) obtained only
from a chemist (English for pharmacist).
In discussing this item with Wye's only
chemist, I inadvertently ventured where customers weren't supposed to tread.
Looking down his nose and with a nasty tone, the chemist said:
"This is what you do in the United
States? Barge right into a chemist's private area?"
Exception to my rule
His snide comment wasn't the best way to
build good patient rapport, which I've always maintained is even more important
to a successful practice than technical skill. But then it dawned on me: This
case was probably the one exception to the rule.
If you have a patient who:
a. lives 4,000 miles away and will never be back again,
b. you have the only badly needed service available
within 10 miles, and
c. the patient has no transportation to go elsewhere,
d. You don't have to pay attention to building patient
rapport. In all other cases, it's still important.
A special diet
So what was this much-needed item? My wife
has Sj�gren's syndrome, which has caused her immune system to destroy her
salivary glands, in addition to producing dry eye problems. She can't eat solid
food and exists almost entirely on Ensure liquids. This is what we found we
could obtain only from Wye's "friendly" chemist.
I've learned a great deal about Sj�gren's in
the 6 years she's had it. First of all, it's a difficult disease to diagnose,
and many M.D.s have never even heard of it. Conversely, I've never known an
O.D. who wasn't aware of Sj�gren's as part of our work with dry eyes. This
makes our role in diagnosing it vital.
Sj�gren's "is so hard to diagnose that
patients spend years hunting a medical Sherlock Holmes to solve the puzzling
symptoms," according to an Associated Press news release of Sept. 19,
2000. The release continued, "frustrated by the ignorance, the National
Institutes of Health this week holds an unprecedented meeting to teach health
workers how to spot Sj�gren's and ease symptoms."
One way to learn more is to contact the
Sj�gren's Syndrome Foundation (1-800-475-6473), or at www.sjogrens.org, to
request that they send you their monthly newsletter, The Moisture Seekers.
"I went from doctor to doctor trying to
find out what was wrong," read typical letters I've seen there. "Many
told me it was all in my mind and that there was nothing wrong.
"It was such a relief to finally, after
many years, find a doctor who was aware of Sj�gren's and could diagnose my
Become a hero
According to a Sj�gren's Syndrome Foundation
estimate, up to 4 million Americans are affected by this disease -- many remain
undiagnosed. How can you help?
� Question female dry eye patients (90% of Sj�gren's
sufferers are women) as to whether they also have dry mouth or spells of
fatigue to determine whether to refer them to an immunologist for a definitive
� Polish up on the subject. Know what to look for, and
you could become a hero to some of the undiagnosed Sj�gren's patients who're
frantically visiting multiple doctors trying to find out what's wrong.
Jack Runninger, our consulting editor,
lives in Rome, Ga. He's a past editor of Optometric Management.