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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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