Article Date: 4/1/2003

lessons learned
You Never Know
Communicating with your patients is often an art rather than a science.
By Jack Runniger, O.D.

"Doctor, take a look at me," said the distressed lady. "I'm so worried! When I woke up this morning, I looked at myself in the mirror and saw my hair all wiry and frazzled up, my skin all wrinkled and pasty, my eyes bloodshot and bugging out, and I had this corpse-like look on my face! What's wrong with me, Doctor?"

"Well, whatever it is," replied the doctor, "There's nothing wrong with your eye sight."

I believe you'll agree that this response fits into the "Things best not said to patients" category. But selecting the right approach to patients' questions or problems isn't always easy. A response that works well with one patient may be entirely wrong for another.

Humor not always the answer

"I'm afraid I have cataracts and will go blind," the elderly Mrs. Angie Oma told me. Despite my explanation why there was no longer a need to fear cataracts, she remained unconvinced.

The examination revealed that she did have some partial cataract, but not enough to warrant a referral for surgery. So, for her peace of mind, I lightly told her she didn't have cataracts, and that we should re-examine her in one year.


"You completely misdiagnosed my mother's problem," her daughter fumed to me over the phone a few weeks later. "We took her to Dr. Mack Ulopathy, and he told us she had cataracts, which you obviously didn't see that she had!"

Trying to explain that any idiot eye doctor could see a cataract during examination and that I had purposely not worried her mother with such a diagnosis only came across as a lame excuse. The "idiot" part was evidently all she heard, which probably confirmed her opinion of me.

The case of the professor

Sometimes comments that on their face would seem to be insulting to a patient, I've found can instead be well received and even productive if delivered in a kidding manner -- and to the right person.

When I examined a music professor at a local college many years ago, I discovered that she had a refractive error of -1.25 -4.50 x 130 OD and -7.25 -1.50 x 25 OS. She was obviously a pleasant and good-natured person, so I took a chance and told her, "Your problem is that you have one bad eye and one damn bad eye!"

We fitted her with contact lenses and she did great with them. She referred many patients to me over the years. Invariably when they came in, they didn't say that she had referred them because of the excellence of our contact lens fitting abilities.

Instead they'd say, "Dr. Pomeroy referred me to you because she got such a kick out of your telling her she had one bad eye and one damn bad eye."

Make your patients happy

An even more bizarre reason for referral happened later. True story:

"Who referred you to us?" I asked Karl Dance.

"My fishing buddy, Frank Rogers. We were fishing on a stream in north Georgia. He came back to our camp site claiming he had just seen a two-headed snake.

"I asked him who his eye doctor was, and he said it was you. I figured any eye doctor who could make his patients see two-headed snakes was the one for me!"

The fine art of distinction

Of course it goes without saying that you must take your testing, diagnosing and treating seriously. But many patients react better when you're not too pompous about the whole thing. Others don't. The trick is in determining which is which.

Jack Runniger, our consulting editor, lives in Rome, GA.  He's also a past editor of OM.


Optometric Management, Issue: April 2003