Odd - my new optometrist called me three times???

[poppy]

I saw a new optometrist recently because I was feeling like my eyes might be getting close to a corneal ulcer (stopped bothering to go to docs apart from that). She said my corneas were very rough and that I had marginal keratitis in the left eye (my worst), on top of the other things I have previously known I had. She scheduled a follow up appointment in a week but called twice in that time (the first time I didn't answer as was driving) to make sure I was OK? I went back and had improved a fair bit and was back to my "normal symptoms level", which I thought had been due to daytime use of ointment in the worse eye. She was still concerned over the inflammation in the left eye and booked another follow up. I cancelled this later as I didn't really see what she was going to do to help me. Then she called me a week or two after I cancelled the appointment to check how I was? I said they were about the same since last time and thanks for the call but I didn't really think she could help me. She still wanted me to come in to check on the left eye? I agreed to go in, but I think it is weird and very mixed messages from the medical profession (I experience these mixed messages with non-eye problems too). On the one hand, most docs don't give a stuff about my eyes and on the other I am getting called and asked to come in?

I doubt the optom. is chasing business they are in a very busy and popular high-end chain store and if they were going to pursue business via phone calls they would be calling patients overdue for routine eye tests who are likely to spend up big on expensive glasses in-store. And they would probably get the sales staff to call not waste the more expensive optoms time. Is my optom a stalker (LOL) or is there actually something wrong that warrants real concern? I am so sick of trying to guess what the medical professionals are thinking. Often they actually contradict their own opinions. Sometimes they are definitely blowing off your symptoms and dismissing you, but other times feels like they are concerned but don't want to worry you so they "reassure" whilst at the same time ordering some test or whatever. Gah, reassuring is just patronising, tell me what you are actually thinking for gods sake!

[littlemermaid]

Poppy, as always still thinking carefully about this but here's a small contribution meanwhile 'What should doctors do when they don't know what to do' http://www.huffingtonpost.com/allen-...b_3457682.html Also http://www.kevinmd.com/blog/ is useful on these matters.

At least she's offering to work with. You do need someone. Who can tell when it's Sales or Medical advice or Negligence these days. Up till now in UK we've used the 'Bolam test' of peers as to whether 'treatments' are reasonable or not. Always necessary to declare and specify vested interests.

In this case I would think she considers it professionally negligent to ignore your condition and distress, and may be obliged or contracted to refer after several treatment attempts. Many of us are service fails and patient safety errors when medical data is tracked through primary and specialist hospital treatment. High-street do have sales targets but increasingly in nationals/multinationals, treatment and referral paradigms are scrutinised, ie less 'doing you a favour' and more 'providing a professional service', which is a welcome surprise.

reassuring is just patronising, tell me what you are actually thinking for gods sake!

Good point. I'm considering it as a tattoo.

When confused, I turn again to Rebecca's Coping 101 http://dryeyezone.com/encyclopedia/coping101part2.html and contemplate that we are essentially entering a 2-party contract for professional services and advice.

[Rebecca Petris]

Sounds like a refreshing change from the indifference too many patients face. Wish everyone I knew had a doctor that was concerned enough to call and check on them.

[Mawsky]

I agree with Rebecca, this would be a Huge change for me, I get the feeling that they would just as well never see me again, to be honest I'd love to never have to see them either. Even if they don't have answers this one comes off as concerned and wants to help, or at least find some answers. I would giver her a chance.

[poppy]

Well yes it is nice that she cares (or at least appears to since I don't know the exact motives), but does that make any actual difference to me in my health outcome?

She believes that my left eye that she is concerned about will improve with conservative treatments over weeks such as the usual drops, gels, ointments, lid hygiene etc. That's rubbish. I have been doing this for years. My left eye made an improvement due to constantly smothering it in ointment to the point where I had no useful vision in that eye and that effect is wearing off. She also seems to believe that a course of FML will surely clear this up! When I have spent months on stronger steroids, even preservative free ones, without much clinical improvement as I told her.

I can barely get up the motivation to get up on a Saturday at 7.30 and pay a few dollars of parking to see her, even though the appointment is bulk billed. Honestly, what is she going to do. Refer me again? What a waste of time.

Perhaps my optom is seeing a decrease in dry eye visits (due to the hopelessness of the condition and the many expensive, useless treatments) and is trying to get some of their revenue back from useless visits? I don't understand.

Edit: Hmm... if I cancel my follow up again will she ring me AGAIN???

[poppy]

I liked the article LM posted 'What should doctors do when they don't know what to do' up until the Dr started talking about "reassuring the patient" a number of times that they didn't have a serious problem.

It is almost the worst thing a Dr can do to make me mad and upset (when my problem IS serious to me) and I can't believe that Drs actually think this is in any way helpful.

Much better, as the same Dr in that article suggests he does, to simply state that they don't know what the problem is. But refrain from "reassuring".

A Dr never needs to reassure. If I have had a biopsy for a suspected cancer and it comes back negative, I don't need "reassuring". The facts speak for themselves. However, if the Dr has examined me and performed a couple of tests of whatever, and the cause of my problem is not found or blown off as something I know it isn't, "reassuring" is basically telling me I have to put up with my problem for the rest of my life and never know the real cause nor any effective treatment.

[littlemermaid]

Poppy, have you any idea what your eye condition is? is it better or worse than when you were seen in hospital Eye Clinic? do you have any possibly related Neuro or Rheumatic condition?

Life is, of course, ongoing maintenance anyway, I'm finding. Might indeed be a question of keeping the old eyeballs going as long as required.

However, the woman has a pulse, is intelligent, is currently going out to bat for you. It is possible that she is still keen to help people because she sure has the choice not to. It is possible that, professionally, there has been some progress in training and treatment standards. I think that is the question here. Part of Optometrist professional payment now is indeed supporting people with eye conditions ie checks and maintenance, referral if requested. A good thing.

Spmcc is always very worth a re-read on dealing with ocular rosacea.

Any chance of talking about all this with someone of the preferred no-bull personality and professional approach? Do you have a lot of pain? Pain management clinic or Rheumatology (have they had a look at you?) could be another option because they take a more robust and honest approach.

Can you be assessed in Sydney when you've got corneal erosions and ulcers? Can the Optometrist get you referral to the right public hospital specialist team there as you are untreated in ACT? Managing eye surface and inflammation is an essential skill now, even in the refractive surgery business. We could not get help except self-pay in paediatric quaternary sector (took me 1y of misdiagnosis and wrong treatment to realise this) although there's been more recognition since we started this 6y ago http://www.ncbi.nlm.nih.gov/pubmed/22504838. I know how you feel because whenever I want to talk about what happens to children in the eye service I am squashed.

Have you got your complete Notes to show her? Maybe hospital or GP Medical Records can be forwarded.

Very interested. What would your ideal scenario be? Are you talking to DCRdryeye and Hankm9?

[spmcc]

Hi Poppy,

I've been thinking about your post since you wrote and have been swinging madly between extremes! My instant reaction is just like yours... questioning, Are they drumming up business? Is there a quota to fill? Etc. I know that the only people who actually call to check up on me (ha) are my vets! They know I can easily take my business elsewhere.

But perhaps it's time to do the opposite of what you've been doing. IOW, go to your appointment on Sat and give up some of your stress to this woman. Let her take care of you (physically, emotionally, etc.). Ask for regular and close together (every 6 weeks?) follow-ups. I mean, why not? If she wants to try treatments, let *her* see if they're working. Obviously, it's important to tell her what you know from your experience, but too much (esp incorrect or assumed) info may just confuse her diagnosis and/or treatment.

Basically, I don't see much harm in letting her shoulder some of your burden. Keep an open mind. She may turn out to be just the angel that you need. I'm crossing my fingers for you.

All the best,
Sheila