What’s That For?!

So after trying to pick the golf ball off my sweater this morning, I still go to work.

As I am giving pre-operative instructions to my patient who is scheduled next week for cataract surgery, I get to the point in the discussion where I inform them what medications they should or should not take the morning of surgery.

In the good old days, I could just glance down at the list on my paper chart and know exactly what medications a given patient was taking.  (Or at least the ones they remembered or told us, but patient’s memories don’t improve with computerization anyway.)  But good old Uncle Sam has shot to hell the good old days of practicing medicine, and I must now click on a different tab to bring up medications.  The computer does not always respond right away, so sometimes there is a delay before any useful information can be gleaned from among all the “meaningful use” crap clogging up the health record system.

And instead of waiting for the computer to unfreeze, I ask the patient what medications they are on.

Generally speaking, they should only take “essential” medications such as those for heart, breathing and blood pressure the morning of surgery with a little sip of water.  Not every patient knows what their medications are for, so I like to review the list with them.  And some medications should still be taken even if they don’t fall into those categories, such as anti-seizure medications.  Others, like Flomax, should be stopped a week before surgery.

I am still waiting for the list to pop-up and I couldn’t understand what the patient answered as to what medications he was taking.  Three sets of ear tubes as a child and multiple infections have left me with a modicum of hearing loss.

So I ask him again what medication he is taking.

He answers again, but I still can’t quite understand what he is saying, and what I think he said, isn’t a drug I am familiar with.

Still no answer from the Obama-care computer.

And then I make a fatal mistake.  I am embarrassed to have to ask the patient a third time to tell me the name of his medication.  I am also impatient because my computer is useless to me at this moment.  So I think that trying a different tactic might help facilitate me finishing this discussion and moving on to the next embarrassment patient.

If I don’t know what the name is, I can still make a decision based on what he is using it for.

So I calmly ask him what he takes this medication for.

Fortunately, he either didn’t hear me, thought I was a complete idiot, or wisely chose not to answer.  At this moment, the computer manages to find the list of medications and display to me that my patient is taking Viagra.

And I, his eye doctor, just asked him why he was taking this.

EPIC FAIL.

So what would you say in this instance?

I stammered, as my tech tried not to laugh out loud, “I guess you can skip taking that the morning of surgery.”

Stamping out blindness is never easy or for the faint of heart.

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Quantum Peep

As I was surfing Facebook tonight, because, well, I have no life and this what I do, I came across an advertisement for the Quantum Vision System, which guarantees “perfect vision in just 7 days” or your money back!

Holy Eyeballs, Batman!  Why did they never teach me this in my residency?  Shoot!  I’ve been wearing glasses since third grade.  I could have been glasses free before the end of the marking period!  (Forehead slap, which makes me thirsty for a V8 for some reason.)

Naturally, I had to investigate this miracle for myself.

Disclaimer:  I have no financial interest in this product.  I am not telling you not to try it for yourself, or confuse you with double negatives.  It might work for you.  All I am doing here is to provide my thoughts on the promotional video.  You may reach whatever conclusion you like from that.  You can see the promotional video on Youtube.

Not far into the video, the alleged doctor asserts that “if you fall asleep in your contacts they can slide around in your eye and damage your optic nerve.”

Seriously????  That’s a violation of basic anatomy right there!

 

 

And then, when talking about LASIK surgery, he says:

I wouldn’t let an amerature touch my eyes either!  So, apparently anatomy isn’t the only class he skipped.  Spelling AMATEUR isn’t important when you are saving eyesight and lives!

There was a rumor back in medical school that anyone who applied to an ophthalmology residency, but couldn’t spell ophthalmology, didn’t have a chance to get in.  Those applications went straight into the circular file.  Optrometry Optometry schools must not screen their applicants similarly.

And if that isn’t enough, how about recalibrate?

Maybe recolaborate is a military strategerizing term.  Or it could be a quantum term that only Einstein understands.

Again, I’m not suggesting you shouldn’t try out his $37.00 “risk free” vision system.  But if it had been me, I’d have charged maybe $49.00 and hired a proofreader to give me some more credibility.

And, I’m not the only blogger to stumble upon this:

My Eye Pod writes:

Here is “Dr” William Kemp, who claims to be an optometrist in Virginia, but does not exist as far as my research can tell (no Twitter account, no LinkedIn profile, no Facebook page, no practice website, no Virginia Optometric license, etc). . . The video presentation is rife with typos (“lense”, and “amerture” for example), impossible claims (reading the serial number of an airliner from the ground), and absolutely hilarious reinactments. But that’s not all! He also claims his method can help you remember things better, have improved brain function, reduce stress and even “detect all lies”! WOW, WHO WOULDN’T WANT ALL OF THAT!?

And Eye Exercises for Computer Users writes:

The promotional video lasts very long. I thought I was only 30mn long. I could not pause it. I left it playing for about an hour and when I came back, it still is playing! . . . Don’t hurt your eyes and watch that never-ending infomercial. Many scammers who gave reviews all over the place are unethical affiliates who starve to get commissions from selling you this ebook. The product seems to come with a money-back guarantee. But here is the catch: if you would buy it from an affiliate link, you won’t get that feature.

I guess I’ll have to go back to my glasses, which I will do just as soon as I squint and feel around to find them!  It might take me seven days!

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Money 4 Nothing

That ain’t Twerking . . .That’s the way you DO it!

And my chicks for free!

The Daily Post asks . . . If you’re like most of us, you need to earn money by working for a living. Describe your ultimate job. If you’re in your dream job, tell us all about it — what is it that you love? What fulfills you?

For those of you who follow my blog, you know that I am, by profession, an ophthalmologist.  An eye doctor/surgeon.  And while I do like my job–I really enjoy giving cataract surgery patients the gift of better sight–there are certain things about my job I do not like.

I really do not like our government and its bureaucratic intrusion into my practice.  I wish they would just leave me alone to do what I was trained to do.  Dealing with insurance companies makes me want to stick needles in MY eye!  Obamacare is just worse and more of it!

I loathe computer medical records.  Electronic Health Records.  EHR.  Errrrr!  Meaningful use = meaningless abuse.

I really don’t like having to get up at a set time every morning and living my life to a schedule.  Didn’t bother me years ago, but as I have aged, I really look forward to sleeping in on weekends!  I could get used to doing that every day.

I don’t like call.  As I have turned 39 for more than a few years, the ER calls in the middle of the night really bother me.  I no longer can fall back to sleep right away which affects my next day’s performance.  I already work a very busy schedule and additional add-ons are just additional stress right now that I could do without.  It is what it is, though.

So, in a nutshell, right there is my dream job . . . making the same amount of money I currently make (more would actually be better since I still live paycheck to paycheck with my doctor’s salary) but not having a set schedule, no call, and still do what I enjoy doing.

I enjoy running.  Can’t see anyone paying me what I make now to simply run.  And I am certainly not an elite/Olympic runner.  If I have to compete to get paid, I will starve.

I enjoy golfing.  And while I could make more than I currently make being a great professional golfer, I am not a great golfer.  I’m not really a good golfer.  I’m not worthy of playing with Tiger Woods.  I’m not really worthy of playing with Tiger’s woods, or even carrying his clubs.  I have probably lost a few balls in Tiger’s woods and if not, I certainly could manage that.

I also enjoy bowling, but I don’t think my current 192 average is good enough to keep my salary level where I am.  Nothing more pitiful than a starving bowler.

I’ve always dreamed of being the head coach at Penn State, and that would certainly pay better than my current gig.  But as passionate as I am as a fan, I do lack the X’s and O’s to actually be a football coach.  And looking at the hectic schedule that our new coach is living–travelling on the recruiting trail–I don’t think I would enjoy that schedule.

I am thinking Penn State University president.  The job may still be open, but I think they will be announcing a new president shortly.  I have not the experience nor qualifications, but there would be no bigger promoter of the University that I know of.  I can cut a ribbon without cutting myself.  I think.  I could ask people to donate money.  I’m not sure how I could handle dealing with our State Legislators, since my opinion of monumental idiots lawmakers in general is not very high.  The schedule probably isn’t as flexible as I’d like, so I think this is a no-go as well.

I could be a professional blogger if somebody wants to pay me what I’m currently making.  Yeah, I don’t see that happening.

Professional lottery winner?  I’m so there.  I just need to win the freaking Power Ball!

I’ve always thought stand-up comedy would be great.  I’m currently the entertainment for our annual office Christmas party, but that’s a once a year gig.  Not sure I could pull it off on a regular basis.  Maybe if I had a team of joke writers.  But the whole stand-up thing is not my style.  One of the things that drew me to eye surgery in medical school is that you can do it sitting down.  I guess I could be a late-night show host–a little actual standing followed by sitting behind a desk drinking coffee.  I could drive around like Jerry Seinfeld and drink coffee with other comedians.  I could drink coffee with just about anybody, especially if I’m getting paid well to do it.

I do dream of being a “professional” writer some day.  I have several novels in very stages of completion.  I blame my day job for the lack of time needed to actually finish and publish these projects, but we all know that is just an excuse.  And I have heard that publishers can be downright nasty with deadlines which would annoy me.  Sometimes the muse inspires me; sometimes the muse perspires me.  You just never know when the words will come.

It looks like for now, I’ll have to stick with taking out cataracts.

That’s not working.  That’s the way I do it.

Lemme tell, eye docs ain’t dumb.

Maybe get a blister on my little finger.

Maybe get a blister on my thumb.

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You’re Not Getting Older . . .

You’re arms are just getting shorter!

Got Bifocals???

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What’s Your Emergency?

In honor of 9-11, I am going to digress on a topic of emergency medicine today.

As an ophthalmologist (or pretentious eye doctor depending on how you pronounce it) I occasionally get paged when I am on call.  Perhaps less so than an orthopedic surgeon, pediatrician, or cardiologist, but more so than your busy dermatologist or geneticist.

After business hours at night, on weekends and on holidays, our office is closed.  The answering machine at our office clearly states
that our office is now closed.  There is an option to leave a message.  Then, the recording tells our patients that if this is an emergency, to call the answering
service.

As an intern many years ago, I was introduced to the wonderful world of being on call.  I was awoken at 3 a.m. by a patient who asked if it would be okay to take an aspirin tablet that had fallen on the floor.  I.  Kid.  You.  Not.

How bad does your headache have to be to take this?

Does the five-second rule apply here?  Is there fuzzy stuff on the tablet, or does it look clean?  Can you rinse it off quickly and pop it in your mouth before it melts?  Might we just consider the possibility of throwing it away and taking another one that has not contacted the floor?

Labor Day weekend, I got a call at 7:30 am Sunday morning to refill a prescription.  The patient normally sees another doctor we were covering.  She didn’t know the name of the drop but thought it began with a P.  It had a green cap.  That actually was helpful, since it narrowed it down to pilocarpine, used for some forms of glaucoma.  But it comes in an array of strengths ranging from 1/8% up to 4%.  Of course she didn’t know which one she was on, but she knew she was going to run out before Tuesday.  And guess what, after several calls later, her pharmacy was closed anyway.  So much for sleeping in.

Seriously?  I take a baby aspirin daily ever since I had an episode of atrial fibrillation.  When I notice there are only about 7-10 tablets left in the bottle, I put it on the grocery list for my wife to pick up more.  She usually shops at least once a week, so I get my new bottle before the last tablet is gone.  Is that so hard?

Granted, you can’t see the drops in your medicine bottle, but you can generally tell, particularly if you have been using drops for years, when you are about to run out.  Plan ahead people.  Don’t let those pesky holidays creep up on you.  Buy a calendar.

Once, on Good Friday, a lady called complaining of itchy eyelids.  Now while that could sound like an emergency, most eye doctors will tell you it is not.  Uncomfortable perhaps, but not generally vision threatening.  This lady was the patient of another eye doctor as well.  Apparently, I am the only April Fool who takes call on holidays anymore.  Or I’m not smart enough to sign out to someone else.  Whatever.

So I ask her how long her eyes have been itching.

On or off.  For about a year.

This is an emergency????

Has she seen anyone else about it?

Oh yes.  She saw a dermatologist who prescribed a cream for her face that worked.

Did she call her dermatologist back?

His office is closed today.

Imagine that!

But he told her previously that she could use it on her eyelids as well, but she wasn’t sure she should.  The eye doctor I was covering for told her she could use it as well.  Apparently, she wasn’t convinced and needed a third opinion.  On Good Friday.  That has the weight of the Father, Son AND the Holy Spirit behind it as well.

Let me think about this one.  Hmmm.  The cream worked for the rash on your face.  Two doctors, including an eye specialist told you to use it on your eyelids.  Your eyelids are itching?  It’s Good Friday.  .  . I got nothing.  I don’t know what to tell you (although I know what I’d like to say) but maybe, just maybe, you should try the medication.  It’s a shot in the dark here, but if your eyes are bothering you enough to call a professional on a holiday, then I’d go for it.

I don’t want to sound insensitive.  It’s not that I don’t care about your itchy, watery eyes that have been bothering you for months.  Just don’t call me on a holiday or on a Saturday afternoon when Penn State is playing football.

I’m sure every job has its moments.  I imagine that most grocers have received phone calls at three in the morning asking whether or not it is okay to drink
milk that is one day over its expiration date.  Don’t you wonder about that?  It’s only one day.  But you don’t want to get sick.  It smells okay, but you just can’t
be sure, can you?  Better call and find out right now!  Oh, and I just noticed I’m running a little low on toilet paper . . . could you send some out in the morning?  Thanks!

Today is 9-11.  What’s your emergency?

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Get The Dead Out

Being an eye surgeon, I was drawn by curiosity to a recent arrest article regarding a woman who poisoned her boyfriend.

With Visine.

You read that correctly.  It doesn’t just get the red out anymore.   I wonder if her boyfriend’s nickname was Red?

It was done in the kitchen, by Miss Scarlet, with a bottle of eye drops.

But like every great criminal mind, she was tripped up by the most unlikely of modern technologies.

He failed the drug screen.

He tested positive for eye drops.  (His blood actually looked white, since it got the red out.  Just kidding!)

And why did she do this?

So he would pay more attention to her.  I imagine he’s paying a lot of attention to her now.  So are the police.

Don’t you think the closet filled with 10,000 empty Visine bottles would have clued him in to something being wrong?  I made that part up.  I don’t know if she had a closet full of empty bottles.  Maybe there were only 9000.  In the basement.  Who knows?

Had she been successful, and the drug failed to show on a tox screen, the pathologist would have been baffled . . . “Don’t know what killed him, but he’s got the whitest eyes I’ve ever seen on a corpse!”

Seriously, Visine contains tetrahydrozoline, which basically constricts blood vessels.  As an eye doctor, I discourage its use.  You are much better off treating the cause of the redness, be it dry eye, infection, inflammation or allergy.  Constricting blood vessels isn’t usually a good thing, and probably explains his symptoms of high blood pressure, nausea, vomiting and breathing difficulties when ingested.

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Glasses Half-Empty?

Frank and Ernest are living the EyeLife . . .

Oh, [bleep] my glasses are empty 

That sucks.

We will never, never be

anything but loud and nitty gritty, dirty little freaks

So raise your glasses!

Sorry.  Went a little Pink there.

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Happy Labor Day!

Speed Bump is Living the EYE Life!

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Patients are a Virtue

Perhaps it might be deemed unprofessional for a doctor to talk about his patients in a public forum–and certainly, if I were to divulge personal information it would be a violation of ethics and a HIPAA violation–but studying the doctor-patient relationship in general can be enlightening.  And amusing.

Early on in my career–as a medical student as a matter of fact–I was interviewing a patient admitted to the hospital.  I had on my short white coat, stethoscope jauntily draped across the back of my neck, a blank history and physical form which I needed to complete and the patient herself.  I was tanked up on my second gallon of coffee for the day and steeling myself for what was then an intimidating encounter.  After all, I was a third year medical student–NOT A DOCTOR.  But I was expected to act and perform like one.

As part of the history and physical, we ask questions regarding general health, that may be completely unrelated to the problem for which a patient is admitted.  It is called a Review of Systems.  The textbooks and mentors try to teach us to be thorough–you never know what seemingly unrelated symptom may provide a clue for the real diagnosis.  And the best way to be thorough is to be systematic.

So as I went down the list of questions . . . do you have headaches?  Do you have sinus problems?  Any vision problems?  And so on.  I came to the auditory system.

“Do you have any trouble hearing?

The patient responded, “What?”

I kept my nose down in my notes.  Bedside manner is a fourth year elective.  Actually looking at the patient at this point in my training might have made my head explode.  I repeated the question, louder.

“What?” she responded again.

I asked her a third time, even louder than before.  Now remember, I had already asked her questions in a normal voice and she answered.  She was obviously joking around with me, but I hadn’t realized that at this point.  Fortunately for me, she started to laugh and I realized what she was doing.  I hope it made her feel more comfortable, because it didn’t do much for my confidence.

Another patient–in my internship year–called at 2:00 AM  (that is early in the morning in case you didn’t know) and told me that he had dropped an aspirin tablet on the floor.  Could he still take the pill?

I’m pretty sure the three-second rule applies here.  Apparently germs and dirt need more than three seconds to invade any object dropped on the floor.  Was it covered in dirt or lint?  Could it be washed quickly and then taken before it dissolves in your mouth and not in your hand or in the sink?  Do you have enough in the bottle to simply sacrifice this one tablet and take another?  Do you know what freaking time it is?????

As an ophthalmologist, I don’t get many of those calls anymore, but I still deal with people.

I had a patient with cataracts and I asked him if he had any trouble driving at night?

“No.”

His vision was actually not good enough to pass a drivers test for night driving, and after looking at the cataract, I couldn’t believe he could see well enough to drive at night.

With a sudden spark of inspiration, I then asked, “Do you drive at night?”

With a perfectly straight face, this gentlemen who had just told me he had no trouble driving at night now tells me: “Oh, no!  I gave it up.  I can’t see well enough to drive at night.”

It’s all in how you ask the question.  I guess it isn’t a problem to just give up driving.

Another gentlemen told me that he was able to read without any problem.  His distant vision was fine, but he was at an age when reading glasses or a bifocals would have been necessary.  I queried him again.  Again, he insisted he could read and he reads the newspaper every day–without glasses.

So I went out to the waiting room and brought back a newspaper.  I asked him to read it for me.

This man stands up out of the chair, unfolds the newspaper, and lays it on the floor.  He then stands over it and starts reading the paper.  I guess he doesn’t have a problem after all!

Another patient, a diabetic, was losing vision progressively from diabetic retinopathy despite numerous laser treatments.  I always ask our diabetic patients how their blood sugars are doing.  Each visit, she answered, “good.”

Finally, exasperated, I asked her, “what does your medical doctor say about your diabetes?”

There was a long pause, and a deep sigh.  She then said, “He yells at me every time I’m in there.”

I guess her sugars weren’t as good as she thought they were.  Maybe there’s a reason your doctor’s yelling at you.

But most encounters go well.  It’s always nice to give patients a good report, especially when they have diseases which could adversely affect their vision.

“Everything looks good,” I’ll say cheerfully.

The patient then squints at me and blinks his eyes a few times.  “I can’t see anything!  I can hardly see you!”

Thanks to the dilating drops and the bright lights we shine in your eyes, if you didn’t have trouble when you come in, you have trouble when you leave.

But that will go away shortly.

You just have to have some patients.

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Fr-eye-day Humor

From http://www.sightreadingsuccess.com

A woman contemplating cataract surgery asks her surgeon, “Will I be able to play the piano after my cataract surgery?”

The surgeon smiles and answers, “I don’t see why not.”

“Well, that’s great,” the woman replied ecstatically.  “I was never able to play before!”

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