Article Date: 6/1/2004

History Revisited
Some not-so-subtle clues in your patient's history will give you insight into their needs and how to satisfy them.
By Dan Beck, O.D.

Often, you already have a good idea of how you'll treat Mrs. Jones in exam room two before you ever meet her. After all, it's been said that you can diagnose most patients simply by obtaining a thorough medical history.

A good history is also a great tool for getting to know your patients' personalities. Why would you want to know your patients so well? Information that may seem trivial can help you form a profile that will lead to a deeper understanding of your patient's needs and desires and will help guide you in your approach.

Best of all, you don't need to revise your paperwork to get this valuable information. Here are six line items on every office's history sheet that will lend insight into your patients' psyches.

1. Age

A patient's age often correlates to how much he or she complains. I like to call this the bell curve of satisfaction. Children and young adults tend to complain very little, but as presbyopia approaches, so does a new level of dissatisfaction with vision.

The two decades from ages 40 to 60 are usually the peak years for new vision problems. This seems to be directly proportional to the extent of other health issues that arise during that period.

Once patients enter their later 60s and beyond, however, their level of complaining tends to drop back down the curve again.

People who appreciate detail and perform jobs that require precise work usually want a detailed explanation of their vision problems and treatment options.

2. Sex

Although it's probably not politically correct to break down personalities by sex, I've found certain behaviors are almost universally male or female. For example, women usually complain more in the exam room about their vision problems, but they don't get worked up if that titanium frame they want has a $300 price tag.

On the other hand, men often say very little during the examination, but they quickly find their outdoor voices when we tally their bill for their eyeglasses.

The lesson? It may take more time to draw out what's wrong with a man's vision. And when stocking your dispensary, make sure you have a good range of styles -- and price points -- for both men and women.

3. Chief complaint(s)

Often, you can accurately estimate the amount of time you'll need to examine a patient by the length and complexity of his or her chief complaint. Although the technician screening the patient can influence how much is written down, it's safe to say that anything longer than a few lines is going to keep you busy for a while.

Older patients have more vision issues related to medical problems and, typically, they have longer lists. A 39-year-old woman taking no medications who has many complaints could have a complex case or simply very high standards for her vision. Either way, your examination will likely take longer than average.

4. Occupation

Patients' vision needs often are tied to what they do for a living, and their jobs can help give you an idea of their problems and how much chair time they'll need. The classic cliché problem occupation is engineering, and the cliché is nearly always true. Engi-neers are, without a doubt, the pickiest, hardest-to-please patients on the planet. Why? People who appreciate detail and perform jobs that require precise work usually want a detailed explanation of their vision problems and treatment options.

By contrast, people who work outdoors or at jobs that aren't confined to a single work area tend to have fewer visual complaints.

5. Medications

The medications a patient is taking can offer a wealth of information.

For example, people on strong pain and anti-inflammatory drugs often have poor or reduced mobility. Generally, these patients aren't interested in 'active' vision correction modalities, such as contact lenses.

On the other hand, if a patient's taking only vitamins, she's probably more active and may be a great candidate for contact lenses or even LASIK.

How much a patient knows about his medications also tells you something about his personality. People who don't know the names of their medications or why they're taking some of them may seem easy to please, but confusion about medications should be a red flag. You'll need extra time to explain what you're prescribing to ensure compliance, and you should make sure these patients take home brochures about their conditions as well.

As a further precaution, you should verify that the patient's treating physician is aware of all the medications and that the patient is taking them according to directions.

6. Refractive error

Your patient's uncorrected vision often correlates with how easy or difficult to please she'll be. As we all know, myopes (myself included) are picky. Because most of us can't see much without correction, we want our corrected vision to be as clear as possible. I always try to achieve 20/15 visual acuity with my myopic patients.

Hyperopes frequently come in seeing only 20/40 but without complaints about their vision. And patients with simple astigmatism also tend to not perceive much of a problem because many of them have the ability to 'squint away' a couple of diopters of refractive error.

Become a history buff

Every patient is an individual, but each one leaves certain clues in the medical history. If you're perceptive about these clues, you can enter the exam room with better preparation. You can even make patients feel that you understand their needs better, which may help them open up. The information is already in front of you. Start sleuthing!

Dr. Beck practices in Leland, N.C. His column "Street Smarts" appears in "new OD," a quarterly supplement to Optometric Management.


Optometric Management, Issue: June 2004