by Dan Roberts
Optometrists and ophthalmologists are human. And like the rest of us humans, they can get tired, impatient, frustrated, despondent, and hurt. Unfortunately, professional decorum requires that they maintain a good front by either bottling up their thoughts or venting them at home–neither of which are necessarily good options.
For that reason, I have gathered comments heard behind the scenes from doctors with whom I have been privileged to associate over the past 20 years. This may not speak for all of them, but I do think it is representative of the majority.
So here are 20 private thoughts which, like them or not, we would probably benefit from hearing.
1. WHAT THE DOCTOR MIGHT BE THINKING:
You’re no spring chicken.
WHAT THE DOCTOR MEANS:
Your sight cells are growing older, and I can’t turn back the years in an aging retina. I can, however, help you try to maintain your current vision for as long as possible.
2. WHAT THE DOCTOR MIGHT BE THINKING:
You’re welcome . . . Just in case you were about to thank me and got sidetracked.
WHAT THE DOCTOR MEANS:
Your appreciation means a lot. Don’t hesitate to compliment me if I have earned it.
3. WHAT THE DOCTOR MIGHT BE THINKING:
I’m going to buy a parrot.
WHAT THE DOCTOR MEANS:
I don’t have time to repeat myself, so if it helps, please take notes, or bring someone with you who can refresh your memory later.
4. WHAT THE DOCTOR MIGHT BE THINKING:
And where have YOU been for the past two years?
WHAT THE DOCTOR MEANS:
It is important that you do your homework and comply with my instructions. If you don’t show up for appointments, or wear your sunglasses, or you cheat on your medications, nutrition, or exercise, I cannot be responsible for your outcome. Showing up on time for your appointments is also important. Remember, you and I are partners in your care, and we each have to row our side of the boat.
5. WHAT THE DOCTOR MIGHT BE THINKING:
What do you want from me?
WHAT THE DOCTOR MEANS:
I’m an eye doctor. As much as I might like to also be your rehabilitation specialist, counselor, minister, financial adviser, benefactor, teacher, and psychologist, I just don’t have the time or training to be all of those things. I will, however, try to provide you with resources for any shoes I cannot fill.
6. WHAT THE DOCTOR MIGHT BE THINKING:
What does your cousin Rita’s lumbago have to do with your test results?
WHAT THE DOCTOR MEANS:
During your visit, please be concise with your questions and stay on topic so I’ll have time to treat other deserving patients. And please don’t wait until the end of your appointment to start asking questions. If you let me know at the beginning that you have questions, I’ll save time for them.
7. WHAT THE DOCTOR MIGHT BE THINKING:
No, sleeping with pickles on your eyelids will not improve your sight. Where on Earth did you hear that?
WHAT THE DOCTOR MEANS:
Don’t believe what you see in the media unless the source is reliable. If the information isn’t based on scientific proof, or at least good evidence, my response to you may be disappointingly negative.
To check the source yourself, look for footnotes or other references to publication in professional journals. Then check to see if the source has a commercial interest. That can be done easily by searching with key words on the Internet. If you find that there has been no peer-reviewed study, or that the information is coming from a source that stands to profit, or if it simply sounds too good to be true, be skeptical.
Or go ahead and ask me about the pickles, but please forgive me if I roll my eyes a little.
8. WHAT THE DOCTOR MIGHT BE THINKING:
Is that how you treat someone who sends you birthday cards?
WHAT THE DOCTOR MEANS:
If I refer you to another doctor for a second opinion, and that doctor confirms my diagnosis, I hope I will see you in my office again, because I don’t want to lose you. I encourage you to double-check my findings; and if the second doctor doesn’t agree with me, you might want to get a third opinion. But at some point, you will need to make a decision. Unfortunately, patients are sometimes caught in the middle and have to make the decision on which doctor to work with and what treatment to get.
9. WHAT THE DOCTOR MIGHT BE THINKING:
I would answer your question, but I would have to inhale.
WHAT THE DOCTOR MEANS:
Please take care of your personal hygiene before your appointment. We have to work in close proximity, so a morning shower, fresh breath, and little or no perfume are much appreciated. And I promise to do the same!
10. WHAT THE DOCTOR MIGHT BE THINKING:
Do I look like Donald Trump?
WHAT THE DOCTOR MEANS:
I may appear rich, but I have so many expenses and debts resulting from my profession that my bottom line after taxes is probably not much different than yours. Here is where my money goes:
- Clinic space rent, utilities, and maintenance
- Staff salaries and benefits
- Malpractice insurance for me and my staff
- Purchase and maintenance of diagnostic and surgical equipment
- Student loan payments for up to 12 years of college
- Continuing medical education
- Professional conference fees and expenses
- Society membership dues
- Subscriptions to professional journals
I am in private practice, while other doctors work under salary. Some of these expenses may, therefore, will be different, but we all have one thing in common. That is, the pressure of maximizing our patient load.
95% of my patients are insured by Medicare or companies that establish their premiums based upon Medicare rates. As a result, I get only about 60% of what I charge insured patients. Many uninsured patients can’t afford to pay at all, and those I just have to write off as a loss.
I’m not complaining, mind you. Okay, maybe I am a little. But the positives of what I get to do for a living far outweigh the negatives. I may not be rich, but I’m definitely ENriched, and that’s what counts.
11. WHAT THE DOCTOR MIGHT BE THINKING:
You get what you pay for.
WHAT THE DOCTOR MEANS:
I do not choose a particular drug or treatment by how much I might make from it. I can ask up to 6% over my cost for a Medicare-approved drug, but that helps keep my treatment costs reasonable. And speaking of treatment costs, I base my fees on four factors:
1. The extent of my training, knowledge, and experience
2. The going rate for such services
3. The economy of the community
4. My business expenses
I have to be both a doctor and a business person. My obligation is keeping the eyes of several hundred people healthy; but equally as important is my obligation to provide for my family. To do both of those things well, I must charge each of my patients enough to stay in practice.
12. WHAT THE DOCTOR MIGHT BE THINKING:
I’m not out to get you.
WHAT THE DOCTOR MEANS:
You might hurt my pride or make me angry, but rest assured that I will never seek revenge by purposely providing you with poor care. Not only could that be grounds for a malpractice lawsuit, but such behavior would violate my personal ethics and my pledge to “do no harm”.
13. WHAT THE DOCTOR MIGHT BE THINKING:
I know your name, but I can’t place your face.
WHAT THE DOCTOR MEANS:
I may not remember you personally, especially in the beginning or if I see you only once or twice a year. Your records, however, will contain everything I need to know to care for your vision.
14. WHAT THE DOCTOR MIGHT BE THINKING:
Ummm…
WHAT THE DOCTOR MEANS:
Don’t expect me to keep all of the research in my head. But I do know where to look it up, so allow me some time to get back to you on that important question. And along that same line, if a commercial for a new drug advises you to “ask your doctor”, please give me a reasonable period of time to look into it before offering my opinion. Sometimes the market changes faster than I am able to keep up.
And just a little side note: Please don’t offer a diagnosis or treatment for your condition. Just clearly identify your symptoms, and let me earn my pay.
15. WHAT THE DOCTOR MIGHT BE THINKING:
If I tell you I’ll be out of the office next week, you’re going to give me that “I’m going blind, and you’re off to the beach again” attitude again, aren’t you?
WHAT THE DOCTOR MEANS:
Yes, those conferences I attend are sometimes in exotic places, but most of the time is spent going from one exhibit, research presentation, or workshop to another, with little or no time left for sunning on the sand. I go to learn and share ideas, and that’s time well spent for both of us.
16. WHAT THE DOCTOR MIGHT BE THINKING:
Why would I use up precious clinic time just so you can pay me to tell you you’re no better?
WHAT THE DOCTOR MEANS:
Even if there is no effective treatment for your disease, you still need me to see you regularly to monitor your condition. It may appear that I’m just lining my pockets, but just because you have the measles doesn’t mean you can’t get the mumps. Regular check-ups are important to your health and preventative care.
17. WHAT THE DOCTOR MIGHT BE THINKING:
There’s a million-to-one chance of a patient losing vision with this treatment, and guess who sits in my chair whose cousin is an ambulance-chasing attorney?
WHAT THE DOCTOR MEANS:
Unexpected side effects and adverse events are beyond a doctor’s control. I understand that it doesn’t matter if the odds are one in 10 or one in a million…if you are the “one”. Our decisions and chosen treatment protocols may not always be 100% spot on, but please know that, as for me, I will always do my best to keep you healthy and safe. And, if that is ever in doubt, I will be happy to refer you to someone for a second opinion.
18. WHAT THE DOCTOR MIGHT BE THINKING:
I’m not a miracle worker.
WHAT THE DOCTOR MEANS:
I regret that miracles are above and beyond my capabilities right now. If your disease is chronic, I may not be able to cure you. Sometimes, all I can do is help your vision last as long as possible.
19. WHAT THE DOCTOR MIGHT BE THINKING:
You’re going to attach WHAT to your eyeballs?!
WHAT THE DOCTOR MEANS:
I may not agree with your decision to try an untested alternative treatment, but I respect your right to do so. All I ask is that you seriously consider my opinion, and if you decide to go ahead with the treatment on your own, please keep me in the loop so I can monitor your condition.
20. WHAT THE DOCTOR MIGHT BE THINKING:
I’m not a candy man.
WHAT THE DOCTOR MEANS:
If I give you free samples of supplements or medications provided to me by manufacturers, I do not do so for promotional purposes. I may be associated with a company as an advisor or consultant, but I am not bound to them commercially. And you might be surprised to know that I probably don’t even know the over-the-counter price of some of the samples I give you. If you ask me about alternative brands or generics, I will give you an honest, unbiased response.
We should do our best to understand the professionals who care for us. They, in turn should provide us with as many resources as we require to understand our disease and treatment. Our cars and appliances come with maintenance manuals and technical support. We should expect no less from our doctors. And it doesn’t have to take time out of the examination. Videos and informational literature can be dispensed by the receptionist or be made available in the waiting room. Of course, the doctor would want to initially preview and select such material, but that would be time well invested.
So the next time you visit your doctor, and you pick up on a slight change in demeanor, or a little role of the eyeballs, or maybe a glint of humor, it may be a good time to take a look at the doctor’s side of things. Doing so could turn a top-down doctor-patient relationship into one of mutual respect and understanding. You might even find that you get a few extra minutes of precious time, just because you’re a pleasure to have around.
(This article has been reviewed by Roy Cole, O.D., F.A.A.O., Director of Vision Program Development, Lighthouse Guild)
Recommended additional reading:
How Doctors Think by Jerome Groopman (Mariner Books; Reprint edition, March 12, 2008)