ODhopeful

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Had an allergist as a pt the other day. He has been a diabetic for 20 or so years and I advised him it's important to have his eyes dilated every year to check for diabetic changes inside his eyes. He said he gets his eyes checked with an OMD yearly and never had any changes from diabetes found, but have had other "abnormal things" found. So I asked him what "abnormal things" were found. He then asked me if I was an Ophthalmologist, so I said no, I'm an optometrist. His next response was "then don't worry about it". It took me by surprise, so much that I really didn't know what to say. Just wanted to see what would my other fellow ODs say if you encounter the same situation.
 

KHE

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Had an allergist as a pt the other day. He has been a diabetic for 20 or so years and I advised him it's important to have his eyes dilated every year to check for diabetic changes inside his eyes. He said he gets his eyes checked with an OMD yearly and never had any changes from diabetes found, but have had other "abnormal things" found. So I asked him what "abnormal things" were found. He then asked me if I was an Ophthalmologist, so I said no, I'm an optometrist. His next response was "then don't worry about it". It took me by surprise, so much that I really didn't know what to say. Just wanted to see what would my other fellow ODs say if you encounter the same situation.
I would throw that patient out.

It's fine and dandy if people want to see another doctor that they are more comfortable with for their "diabetic exam" even though it's a waste of their time and money.

But no matter the reason they are coming to see me, I need a complete history. Even if I'm not going to end up managing or evaluating a condition the patient has, I need to know what it is so that I can be sure that the results of whatever exam I do are expected for that particular condition.
 

bobbio

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I would try to educate the patient because he probably doesn't fully understand our abilities and the scope of our training. There are patients out there that think ODs are medical doctors, others think ODs are merely refracting opticians. So a little education probably wouldn't hurt in this case. An explanation of why you asked about the "abnormal things" may then clarify the purpose and importance of that question.

As OD students and ODs on this forum, it's easy to get offended by the patient's remarks comparing us to OMDs because we are familiar with our own training but you have to keep in mind that the patient may not.

By throwing out the patient, I think it only hurts the profession and the patient. They will just continue to think that ODs are opticians that refract instead of seeing us as health care providers that can play a pivotal role in their health.
 

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As ODs we have already encountered (or will) some version of this story. I'm not sure what motivates these comments and this mind-set, but it is out there, instilled in some patients. Optometry will never get the same WOW as the OMD at a cocktail party since we don't do surgery. Many patients equate lack of surgical practice with lack of knowledge, I suppose? Or maybe the local OMD feels the need to instill talking points in his patients as an attempt to maintain loyalty and promote his MD degree over local competition? Anyway, the "why" is not the question here. . .

I have found that the best way to approach these patients is to simply justify everything I am doing as the best care I can provide to them. Even if they just insist on just a refraction, I can justify a DFE if there is even the slightest amount of decreased best visual acuity. There is no magical formula for these patients, but I have found that some variation of keeping the focus on care and providing lots of education has worked for me in the past. The more correct things you can do for & tell these patients, the more likely they are to hear the same things from and have the same things done for them by the "real" doctors that they choose to see in addition to you. Some may not ever change their opinions of optometry, but those who really think might. When you really think about it, it doesn't matter.

Peace.
 

KHE

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I would try to educate the patient because he probably doesn't fully understand our abilities and the scope of our training. There are patients out there that think ODs are medical doctors, others think ODs are merely refracting opticians. So a little education probably wouldn't hurt in this case. An explanation of why you asked about the "abnormal things" may then clarify the purpose and importance of that question.

As OD students and ODs on this forum, it's easy to get offended by the patient's remarks comparing us to OMDs because we are familiar with our own training but you have to keep in mind that the patient may not.

By throwing out the patient, I think it only hurts the profession and the patient. They will just continue to think that ODs are opticians that refract instead of seeing us as health care providers that can play a pivotal role in their health.
I couldn't disagree with this more. The patient referred to in the OP is a physician, at least I'm guessing so because they were referred to as an allergist. ODs are simply not part of that physician club. No amount of "education" is going to change that patient's mindset because it's already made up.

I also would respectfully suggest that refusing to provide care to a patient who flatly refuses to provide an adequate history is not only the prudent thing to do, but it does far LESS damage to the profession than allowing yourself to be put in the position of just doing the refraction or "just checking the glasses."
 

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First off, I agree that would offend me. But this doesn't make sense to me, first why was he seeing an OD and OMD, was he getting his DFE from the OMD and Rx from the OD, well I guess that makes sense if the OMD was retina but if not it seems like a waste of money and resources to see both. Second he was seeing an OD but didn't know it was an OD?? Lastly whey would an eye doctor of either sort, OD or OMD, advise a diabetic to get a DFE but not be doing it. In our clinics all diabetics are dilated whether they want it or not, otherwise you aren't doing a complete exam.
 

Ryan_eyeball

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Had an allergist as a pt the other day. He has been a diabetic for 20 or so years and I advised him it's important to have his eyes dilated every year to check for diabetic changes inside his eyes. He said he gets his eyes checked with an OMD yearly and never had any changes from diabetes found, but have had other "abnormal things" found. So I asked him what "abnormal things" were found. He then asked me if I was an Ophthalmologist, so I said no, I'm an optometrist. His next response was "then don't worry about it". It took me by surprise, so much that I really didn't know what to say. Just wanted to see what would my other fellow ODs say if you encounter the same situation.
I would definitely agree with KHE. Dismiss this patient from your practice. Again you are as medically liable for his eyes as his OMD is. If he can not discuss his medical condition with you than you can not obtain a viable history and chart.

You have to take care of patients but you still have your family to take care for with your license.
 

Commando303

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This is coming from someone who is not an optometrist (or even an O.D. student, yet): I feel it's petty to throw out a patient because you feel insulted by his comment. Get over yourself: your job is to provide care; do that. As for the patient's not providing relevant information, that might be valid: was the information relevant to what was being done? If so, inform the patient; if not, again, be annoyed, complete the service you're providing, and move on.
 
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fonziefonz

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I was always curious, how do you go about dismissing a patient from your practice?
 

Ryan_eyeball

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This is coming from someone who is not an optometrist (or even an O.D. student, yet): I feel it's petty to throw out a patient because you feel insulted by his comment. Get over yourself: your job is to provide care; do that. As for the patient's not providing relevant information, that might be valid: was the information relevant to what was being done? If so, inform the patient; if not, again, be annoyed, complete the service you're providing, and move on.q
I would not be insulted at all, but there has to be a mutual level of trust between patient/doctor and vice versa.

Let's say this patient comes in 3 months later on a sat. morning with a flaming red eye and his OMD is on vacation. Its a herpes simplex keratitis, and the physician starting using Tobradex to self medicate. Do you feel comfortable that the patient is still going to trust you now with full history?

To dismiss a patient you must send a certified letter w/ signature receipt. Also, offer to provide emergency care for a period of time (usually one month) and helpful suggestions on how to find another optometrist or OMD. You can not merely abandon the patient.
 

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I agree with KHE. Before I would throw the patient out, I would explain to the patient on importance of taking down the medical history and if the patient still refuses to cooperate, I would note it down as the patient refusing services and ask the patient to leave. Some patients' mindset you will never change, why create more liability for yourself? It is a difficult and awkward situation, one that all ODs will face. I do not think it has anything to do with pride but patient care management.
 

KHE

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This is coming from someone who is not an optometrist (or even an O.D. student, yet): I feel it's petty to throw out a patient because you feel insulted by his comment. Get over yourself: your job is to provide care; do that. As for the patient's not providing relevant information, that might be valid: was the information relevant to what was being done? If so, inform the patient; if not, again, be annoyed, complete the service you're providing, and move on.q
I think in my 10 year career, I have had 2 patients with this exact same circumstance. This has nothing to do with being offended.

This has everything to do with knowing what is going on with someone. How can you possibly "provide care" without knowing what you're dealing with?

I don't have any problem not doing certain tests or procedures, within reason if another doctor is handling those things. That's really the basis of any co-management relationship. But I gotta at least know what it is the person has. Anything less is grossly irresponsible on my part and on theirs.

It's one thing if the patient doesn't want to tell me about their venereal disease, or their schizophrenia. But you can't go into any eye doctor's office, say "check my eyes, oh and by the way I have something wrong with them but I'm not telling you what it is."

:rolleyes:
 

Meibomian SxN

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Had an allergist as a pt the other day. He has been a diabetic for 20 or so years and I advised him it's important to have his eyes dilated every year to check for diabetic changes inside his eyes. He said he gets his eyes checked with an OMD yearly and never had any changes from diabetes found, but have had other "abnormal things" found. So I asked him what "abnormal things" were found. He then asked me if I was an Ophthalmologist, so I said no, I'm an optometrist. His next response was "then don't worry about it". It took me by surprise, so much that I really didn't know what to say. Just wanted to see what would my other fellow ODs say if you encounter the same situation.
Exam ends as soon as he says: "don't worry about it." Tell the patient you do not feel comfortable treating an arrogant SOB and that to see one of your colleagues in the office or go back to your oMD. And just walk out the room.

Its not petty as some have suggested, it is about self-respect! :thumbup:
 

Commando303

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Exam ends as soon as he says: "don't worry about it." Tell the patient you do not feel comfortable treating an arrogant SOB and that to see one of your colleagues in the office or go back to your oMD. And just walk out the room.

Its not petty as some have suggested, it is about self-respect! :thumbup:
No, it's not about self-respect; it's about self-importance, and it is petty, especially put the way you've put it. Is this how you might interact with your patients (that is, if you're currently practicing)?
 

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No, it's not about self-respect; it's about self-importance, and it is petty, especially put the way you've put it. Is this how you might interact with your patients (that is, if you're currently practicing)?

I don't agree with either of these comments. Like it has been stated before, it is more about liability than it is about your title and self-importance. If I don't know what is going on with his eyes I cannot provide complete care for him. If he doesn't tell me about his eye problems he then becomes a liability for me and my practice. Seems a little risky for me to treat somebody with eye problems when I don't know what is wrong with his eyes.
 

VA Hopeful Dr

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I've been pondering this thread for a few days now and in an effort to remove any potential ego from the equation, let me suggest this:

Exact same situation, but when asked the patient says that he just can't remember what the ophthalmologist said was wrong with this eyes?

Now obviously the original patient is going to be uncooperative with his care, and so I'm OK with showing him the door. But the second situation at this point (no exam yet) gives the same lack of information as the first.

I pose this question because its not unheard of for patients to get a 2nd opinion from a doctor without telling the doctor that they already have an established diagnosis from another provider.
 

ODhopeful

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I've been pondering this thread for a few days now and in an effort to remove any potential ego from the equation, let me suggest this:

Exact same situation, but when asked the patient says that he just can't remember what the ophthalmologist said was wrong with this eyes?

Now obviously the original patient is going to be uncooperative with his care, and so I'm OK with showing him the door. But the second situation at this point (no exam yet) gives the same lack of information as the first.

I pose this question because its not unheard of for patients to get a 2nd opinion from a doctor without telling the doctor that they already have an established diagnosis from another provider.
I often have people who tell me they don't remember what the previous OD/OMD told them was wrong with their eyes. I'm fine with that because I can figure out most problems on my own.

However, in this case, he flat out refused dilation from me, an optometrist, because he thinks I don't know anything more than "better one or two". On top of that, he doesn't even try to give me a complete history.

I just don't think he was trying to get a second opinion in this case because if he was, then he would at least allow me to dilate his eyes. I think this is a simple case of me being an OD and not MD.

I truly believe the "abnormal finding" the patient was referring to was some cataracts because at the end I told him that his cataracts were dense enough to cause the decrease in his best visual acuity and he seemed surprised that I knew what cataracts were and started telling me how he may need to have it removed soon. I believe this is just a case of other doctors not knowing what we know.

In response to those who say that when they hear a patient tell them "don't worry about it, you're not an ophthalmologist" and the first thing that comes to your mind is, I need to hear the whole story otherwise I can't properly care for this patient or I may lose my license, you're delusional because this patient pretty much just spat on your degree and everything you've learned the 4 years in school. Believe me, your first reaction is shock followed by a desire to seriously "throw" this person out of your chair. Anything less I feel like you don't respect yourself any more than the person who just insulted you, regardless if you actually throw them out.
 

JMK2005

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ODhopeful..

So, what did you decide to do? Did you throw him out at that very moment, confront him, or kept silent? The suspense is killing me!
 

ODhopeful

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ODhopeful..

So, what did you decide to do? Did you throw him out at that very moment, confront him, or kept silent? The suspense is killing me!
I kicked him in the stomach and said "THIS...... IS....... EYE MASTERS...!!!!!!" :smuggrin: Just try to imagine the movie 300 where the messenger got kicked into the well.

Just kidding, what I really did was kept quiet and went on with my exam because truthfully I was in shock that someone would be as crude as that to the point I didn't really know what to do or say to him except just continue. I'm sorry I'm a disgrace to the profession of optometry.
 

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One time we referred a patient out for something, though I don't remember what, and I did the follow up call just to take care of things on our end. When I asked if he had seen his dr he told me it was none of my business. And I told him that I just need to make a note that says you either saw someone or you refused to. I don't mind if you don't plan on seeing someone, but it's our responsibility to follow up. And he said "ya well that's none of your business". I was just like "fine sir have a good day" and hung up. I should have told him he was being a jerk.

Anyways. Not relevant but just another example of how crazy patients can be.
 

Ryan_eyeball

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I don't mind if you don't plan on seeing someone, but it's our responsibility to follow up. And he said "ya well that's none of your business". I was just like "fine sir have a good day" and hung up. I should have told him he was being a jerk.

Anyways. Not relevant but just another example of how crazy patients can be.
Document your phone calls to patients, even if they seem trivial to you.
 

KHE

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I've been pondering this thread for a few days now and in an effort to remove any potential ego from the equation, let me suggest this:

Exact same situation, but when asked the patient says that he just can't remember what the ophthalmologist said was wrong with this eyes?
As you say, a clueless patient is a completely different animal than one which is willfully misleading or who witholds information. The clueless patient at least in theory wants to know what's up.

I pose this question because its not unheard of for patients to get a 2nd opinion from a doctor without telling the doctor that they already have an established diagnosis from another provider.
See, I won't play that game either. I've had the situation quite a few times over the years where patients come in requesting a second opinion on "something" but won't tell me what it is. I always tell them they gotta at least tell me what the deal is. The most common one in our industry is "another doctor said I need surgery for cataracts. Do I?" Well, there can be a whole range of reasons why someone would or would not recommend surgery and usually you need to know the reason WHY the other doctor said what they said, not just that they have a catarct.

Sometimes patients come in and say that they want me to check them out and see if I can find the same thing. Like it's a little game. I won't play. I need a complete history.

I guess it's true that once in a great while a patient will intentionally not say anything to see if I come up with the same things the other doctor did. Contrary to what the patient thinks, that's not helpful to their care but in that case there's not much I can do about it I guess.

I kind of get why a patient would not want to say something, thinking that I will be quick to just agree with the other doctor but these interactions have to be based on a mutual trust and understanding. If I AGREE with the other doctor, the patient will likely go to another doc until they find one who DISAGREES. In other words, they doctor shop until they get the opinion they wanted.

Going back to the cataract example, here's a common source of trouble as patients jump from doctor to doctor year to year for whatever reason.

Most 65 year olds have 20/20 vision but also have a certain level of cataract. Do I tell someone like that they have a cataract? It's not affecting their vision, but it technically IS a cataract. Now....here's the two possibilities that usually play themselves out:

If I say something:

"You've got a tiny cataract here. Nothing to worry about, just the joys of being 65."

"Oh my God?? Really? The last doctor never said anything!"

Now there's two possibilities right there in the patients mind:

1) The last doctor was an idiot
2) I'm making it up for some reason

Or if I DO NOT say anything:

"The last doctor said I had a cataract. Do I?"

"Well, technically yes, but it's not affecting your vision so don't worry about it."

The two scenarios there are:

1) You're an idiot because you missed it
2) The other doctor made it up

So it's a damned if you do, damned if you don't.

That was a longwinded posting. At the end of the day though, the moral of the story is this: I need a complete and thorough history. I can agree in some cases to not aggressively test or monitor things depending on the condition if they are seeing another doctor but I at least gotta know what's going on. If not, find another doctor.
 

KHE

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I kicked him in the stomach and said "THIS...... IS....... EYE MASTERS...!!!!!!" :smuggrin: Just try to imagine the movie 300 where the messenger got kicked into the well.

Just kidding, what I really did was kept quiet and went on with my exam because truthfully I was in shock that someone would be as crude as that to the point I didn't really know what to do or say to him except just continue. I'm sorry I'm a disgrace to the profession of optometry.
You're not a disgrace to the profession. You're a new graduate working in a ****ty environment, perhaps the ****tiest of them....Eye Masters.

We've all had the experience of someone being incredibly rude or arrogant to us and are so shocked that we don't do anything. It's happened to all of us, whether it's related to optometry or not.

Of course, you always think of the comeback after the encounter with the patient/waitress/sales clerk/auto mechanic whatever is over. Isn't there some old Seinfeld episode about exactly that?

The point is, you are the doctor. You can do whatever you want, but if I were you, I wouldn't put up with that crap. Not out of arrogance, or some sort of perceived need for respect for yourself or the field of optometry, but because by allowing yourself to participate in an exam like that, you're providing crappy care. And you don't have to be a part of it. Don't allow yourself to be. Chalk it up as a learning experience.
 

RTM

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I kicked him in the stomach and said "THIS...... IS....... EYE MASTERS...!!!!!!" :smuggrin: Just try to imagine the movie 300 where the messenger got kicked into the well.

Just kidding, what I really did was kept quiet and went on with my exam because truthfully I was in shock that someone would be as crude as that to the point I didn't really know what to do or say to him except just continue. I'm sorry I'm a disgrace to the profession of optometry.
You did the right thing, IMO. Respect begets respect. You showed restraint which is respectful. Yes, this guy is very likely a douche, but at least he has no ammo to spread around his office about what a jerk, in his opinion, the optometrist at eye masters was during his last examination. This scenario is all about point of view. Yes, the premise that some people hold that ODs can only count to 2 holds about as much water as a holey bucket, but nonetheless, from that point of view, correct or not, further opinions regarding optometry will formed. There is no reason to give these folks more reasons to dismiss our profession. Bad press is bad press, true or not.

Throwing this guy out of your office would probably make you feel good at that moment, but the reverberations for the profession are negative. This guy will either keep his opinion of optometry of change it, who cares? There are many providers who need gentle guidance regarding optometry. There have been internists, FM docs, ER docs, etc in our hospital who, at first, cringed at the idea of a non-opthalmologist consultation. After a few knowledgable interactions on my part, I am their first call for anything eye related. And if you don't think there is talk, good and bad, in the good 'ol boys club, you're fooling yourself.

Again. . . you did the right thing. You kept your cool, maintained a respectful attitude, and IMO have shined in the face of a real douche bag! :thumbup:

Peace.
 

Meibomian SxN

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No, it's not about self-respect; it's about self-importance, and it is petty, especially put the way you've put it. Is this how you might interact with your patients (that is, if you're currently practicing)?
Self importance? You must be a gltuen for abuse then. Try going to that doctors office of practice and saying something like that, see if he wouldn't show you the door (if not the pavement)!

I do practice, and unless it was an emergent situation then the ignorant doctor patient can get his eyes examined else wear.

Have some dignity for yourself "Commando" :thumbdown:....
 
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Had an allergist as a pt the other day. He has been a diabetic for 20 or so years and I advised him it's important to have his eyes dilated every year to check for diabetic changes inside his eyes. He said he gets his eyes checked with an OMD yearly and never had any changes from diabetes found, but have had other "abnormal things" found. So I asked him what "abnormal things" were found. He then asked me if I was an Ophthalmologist, so I said no, I'm an optometrist. His next response was "then don't worry about it". It took me by surprise, so much that I really didn't know what to say. Just wanted to see what would my other fellow ODs say if you encounter the same situation.
I would tell him that his OMD has obviously not educated him about his "abnormal situation" (since he doesn't even know what its called) and it would be prudent of him to let you check and give him a second opinion. If he declines, then get him to sign a dilation waiver and make money off of his frame selection...why lose the business walking into ur office? no matter how asinine he may be...
 

Commando303

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Self importance? You must be a gltuen for abuse then. Try going to that doctors office of practice and saying something like that, see if he wouldn't show you the door (if not the pavement)!

I do practice, and unless it was an emergent situation then the ignorant doctor patient can get his eyes examined else wear.

Have some dignity for yourself "Commando" :thumbdown:....
Dignity's nice — I swear, it is — but it's not to be an excuse for, yes, self-importance: "How dare this imbecile speak to me with this tenor!? OUT!" Some people can be jerks; in any profession in which you deal with people, you run into a jerk, now and then. Suck up the tears ("Meibomian"), do your job (as best you can, and if it's impossible or unreasonably difficult for you to do so, then, out he or she goes), and get on with your life.
 

Meibomian SxN

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Dignity's nice — I swear, it is — but it's not to be an excuse for, yes, self-importance: "How dare this imbecile speak to me with this tenor!? OUT!" Some people can be jerks; in any profession in which you deal with people, you run into a jerk, now and then. Suck up the tears ("Meibomian"), do your job (as best you can, and if it's impossible or unreasonably difficult for you to do so, then, out he or she goes), and get on with your life.
How can you do your job? Let me guess, you would have grabbed the 90D and squinted to try and find the "abnormal" finding. And that's if that jerk Px even let you touch the slitlamp.

"Those who stand for nothing, fall for anything...."
 

Commando303

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How can you do your job? Let me guess, you would have grabbed the 90D and squinted to try and find the "abnormal" finding. And that's if that jerk Px even let you touch the slitlamp.

"Those who stand for nothing, fall for anything...."
You perform your examination as you would. Besides, you didn't mention an inability to provide service in the event a patient refuses to yield important information; you simply boasted you'd show the door to one who spoke flippantly to you:
Self importance? You must be a gltuen for abuse then. Try going to that doctors office of practice and saying something like that, see if he wouldn't show you the door (if not the pavement)!

I do practice, and unless it was an emergent situation then the ignorant doctor patient can get his eyes examined else wear.

Have some dignity for yourself "Commando" :thumbdown:....
 

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You perform your examination as you would. Besides, you didn't mention an inability to provide service in the event a patient refuses to yield important information; you simply boasted you'd show the door to one who spoke flippantly to you:
Case history is absolutely pivotal in performing any examination. A must have.
 
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The guy has probably visited this board, realized you guys are easy targets and thought it would be fun to jerk you around a bit. :laugh: No one is obligated to tell ANY of us anything so if you think they've omitted something just document and move on.
 

odieoh

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Case history is absolutely pivotal in performing any examination. A must have.
Meh. Of course case history is important. Pivotal? Not always. We do exams on people who are poor historians all the time and you can usually figure out what if anything is going on just by doing the exam. Some people are poor historians because they have the IQ of a slug. Some people are poor historians because they are uninformed arrogant bastards, such as the allergist in question. I wouldn't ever refuse either of these an exam. I might not think highly of them, but I wouldn't refuse them care.
 

KHE

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Meh. Of course case history is important. Pivotal? Not always. We do exams on people who are poor historians all the time and you can usually figure out what if anything is going on just by doing the exam. Some people are poor historians because they have the IQ of a slug. Some people are poor historians because they are uninformed arrogant bastards, such as the allergist in question. I wouldn't ever refuse either of these an exam. I might not think highly of them, but I wouldn't refuse them care.
I have to admit, I'm quite shocked at the number of people who are comfortable performing an exam on a patient who willingly and intentionally withholds information like this.

Yes, some people are poor historians because they're dim and that can make the exam more difficult but there's a big difference, at least to me between someone who is not helpful because they are dim and someone who is intentionally confrontational or misleading or witholding.

Any sort of clinical relationship between a doctor and a patient has to be based on a certain level of mutual trust and respect. It's one thing if a patient doesn't wish to discuss their venereal disease or their bipolar disorder with me, but it's completely another when people have EYE issues and they come to me, an EYE doctor and refuse to tell me about something with their EYE.

I simply can't have it, and I would not see any patient who acted that way. Even if they were nice and polite about it. The patient in this case was an obnoxious dink but seriously, I've refused to see patients for no other reason than being obnoxious dinks so to be an obnoxious dink who won't tell me about their eye problem? Bye!
 

Commando303

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Right, so it isn't so much about this:

I think in my 10 year career, I have had 2 patients with this exact same circumstance. This has nothing to do with being offended.

This has everything to do with knowing what is going on with someone. How can you possibly "provide care" without knowing what you're dealing with?
It is, instead, really ego, after all:

I simply can't have it, and I would not see any patient who acted that way. Even if they were nice and polite about it. The patient in this case was an obnoxious dink but seriously, I've refused to see patients for no other reason than being obnoxious dinks so to be an obnoxious dink who won't tell me about their eye problem? Bye!
Being a person, anyone has the right to be offended, especially when some jerk does something grossly offensive. A health-care provider, however — full-fledged person, and all — should try to put that aside for a bit, and provide the health-care, anyway. Of course, it is your office — I'm sure you can both disagree with me and toss out people left and right.
 

VA Hopeful Dr

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Being a person, anyone has the right to be offended, especially when some jerk does something grossly offensive. A health-care provider, however — full-fledged person, and all — should try to put that aside for a bit, and provide the health-care, anyway. Of course, it is your office — I'm sure you can both disagree with me and toss out people left and right.
Its not about ego at all, at least from the post you quoted. KHE said that he would dismiss the nicest patient if they refused to discuss a pre-existing eye condition. How is that ego driven? If I had the option to do so, I'd have a hard time not doing exactly the same. If someone came to me to establish themselves at my practice, even if they were seeing a bunch of specialists for various problems, I'd want to know what conditions they had and how it was being treated. To do otherwise is opening you up for trouble.

I'm curious now. Why do you seem so involved in this issue, what career path are you on and how far along are you?
 

odieoh

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I have to admit, I'm quite shocked at the number of people who are comfortable performing an exam on a patient who willingly and intentionally withholds information like this.

Yes, some people are poor historians because they're dim and that can make the exam more difficult but there's a big difference, at least to me between someone who is not helpful because they are dim and someone who is intentionally confrontational or misleading or witholding.

Any sort of clinical relationship between a doctor and a patient has to be based on a certain level of mutual trust and respect. It's one thing if a patient doesn't wish to discuss their venereal disease or their bipolar disorder with me, but it's completely another when people have EYE issues and they come to me, an EYE doctor and refuse to tell me about something with their EYE.
[/I]

I simply can't have it, and I would not see any patient who acted that way. Even if they were nice and polite about it. The patient in this case was an obnoxious dink but seriously, I've refused to see patients for no other reason than being obnoxious dinks so to be an obnoxious dink who won't tell me about their eye problem? Bye!
I didn't say I was comfortable doing exams on poor historian patients. But I would rather do the exam than kick them out. The example in the OP's post is a pretty extreme case and I could understand how an optom would be upset by that attitude. But seriously, kicking someone out because they won't tell you something that really you should be able to look at and find yourself? I would be intrigued more than anything. And really I have a hard time seeing how ego isn't involved here, at least a little bit. Are you saying you would see someone who was just plain ignorant about their medical history and was unable to remember anything their last doc told them, but not someone who understood completely but was unwilling to share the info with you? What's the difference? And for many patients how could you sort out which are ignorant and which are withholding? Very few such as this one are going to straight out tell you they know something they won't share.
Really, if there's a some pivotal question about their past history, you can always request records from the previous doc. Yes I think its silly for a pt to withhold info from a doc, but I can see how someone seeking a second opinion may want to do just that. And for this guy who was only there for glasses, its easy enough to document "here for glasses only, follow up with Dr. X for medical needs."
 

KHE

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Right, so it isn't so much about this:



It is, instead, really ego, after all:



Being a person, anyone has the right to be offended, especially when some jerk does something grossly offensive. A health-care provider, however — full-fledged person, and all — should try to put that aside for a bit, and provide the health-care, anyway. Of course, it is your office — I'm sure you can both disagree with me and toss out people left and right.
What are you talking about? I said I would throw out someone who was the nicest person in the world. How is that about "ego?"

It has nothing to with ego, for the 12th time. It has to do with providing reasonable and proper care, and providing care to someone who is intentionally witholding information is neither reasonable nor proper.

I do not toss out people left and right. These are just about the only things that I "toss people out" for and mercifully it's rare:

1) Refusing to provide any information that I, as the doctor feel I need to adequately perform my job of helping you.

2) Any profanity towards the staff and out you go.

That's really about it.
 

KHE

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I didn't say I was comfortable doing exams on poor historian patients. But I would rather do the exam than kick them out. The example in the OP's post is a pretty extreme case and I could understand how an optom would be upset by that attitude. But seriously, kicking someone out because they won't tell you something that really you should be able to look at and find yourself? I would be intrigued more than anything. And really I have a hard time seeing how ego isn't involved here, at least a little bit. Are you saying you would see someone who was just plain ignorant about their medical history and was unable to remember anything their last doc told them, but not someone who understood completely but was unwilling to share the info with you? What's the difference? And for many patients how could you sort out which are ignorant and which are withholding? Very few such as this one are going to straight out tell you they know something they won't share.
Really, if there's a some pivotal question about their past history, you can always request records from the previous doc. Yes I think its silly for a pt to withhold info from a doc, but I can see how someone seeking a second opinion may want to do just that. And for this guy who was only there for glasses, its easy enough to document "here for glasses only, follow up with Dr. X for medical needs."
Again, any health care interaction is a relationship/partnership based on a mutual understanding and a common goal. A person who is just ignorant about their history is just ignorant. A person who is intentionally misleading or withholding is actively sabotoging the relationship/partnership. If that's the game they want to play, they can certainly find another doctor, and no hard feelings. I'm just not going to play.
 

Commando303

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What are you talking about? I said I would throw out someone who was the nicest person in the world. How is that about "ego?"

It has nothing to with ego, for the 12th time. It has to do with providing reasonable and proper care, and providing care to someone who is intentionally witholding information is neither reasonable nor proper.
Well, for the thirteenth time, then, how is the following at all related to providing care:

The patient in this case was an obnoxious dink but seriously, I've refused to see patients for no other reason than being obnoxious dinks so to be an obnoxious dink who won't tell me about their eye problem? Bye!
Also, why is it such a problem a patient not reveal an entire history? As I've admitted, I'm not yet in the field, so I'll grant there are aspects of this — the knowledge that's useful to an optometrist in doing his or her job — I'll not understand, but, at least from the standpoint of a patient, I don't think it would be wrong for me to go into an office and "withhold" a prior determination so I can see what "this doctor comes up with." Fine if you feel that's silly or pointless, but it's certainly an understandable position for a patient to assume, and I don't see it as a basis on which to refuse care.

So, there are two matters:

1. The patient who's shopping for a second opinion and feels revealing the last doctor's conclusion might bias this one's thinking. Why should he be denied?

2. The jerk. We all hate jerks, but it's hard to justify tossing one out on his ass, while claiming the decision has nothing to do with your own pride or ego.

*I'd like to add, I'm not advocating tolerating an obscene amount of abuse — I'm sure I'd dismiss a patient who tried to beat me stupid with my phoropter while demanding I call her Countess. It happens to be, the situation described by the original poster strikes me as an instance of rudeness and snideness, not as "obscenely abusive."
 

OD4eyes

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Hi, I am an optometric assistant and apart of of job is making sure patients complete their forms. Of course this is a simple thing but yet sometimes patients insist on making it difficult. Many times, patients don't even read the form and fill out their name only, neglecting to fill out the medical history questionaire; simple and common questions consisting of yes and no and some fill-ins. It drives me crazy!
Today, an 53rd yr female (new patient) with a NYS plan walked in for an examine and neglected to fill out the form completely. I returned the form and ask her to please finish filling out the form. Her response is "why do I need to fill this out if I just want an prescription for glasses and no other exams? I don't want to pay more."
Annoyed at this patient already, I take the form and ask her if she stills want to have the examine? She says of course I want the exam. I then return the form and tell her that she needs to complete the form in order to be seen by the doctor. Finally, 3 minutes later the form is filled out and listed on the form is her glaucoma medications. Just wanted to share this story because it reminded me of this thread.
 
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KHE

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Well, for the thirteenth time, then, how is the following at all related to providing care:
When I say I would not see someone just for being an obnoxious dink, I mean being a REAL obnoxious dink such as, as I alluded to earlier, swearing at my staff.

Quick example of something that happened recently in my office....

New patient comes in with a small, local benefit plan which still uses SSNs to identify members and to process claims. Patient comes in for exam and doesn't want to reveal SSN to staff, which is not completely unreasonable. The staff however explains that it is HIS benefit plan that uses the SSN as a means of identifying him and if he wants us to submit the claim for him, we need his SSN or we can't submit it.

That's not acceptable to this person and they start getting a little bit more beligerent. Staff asks him if this is a new plan for him (because clearly, anyone who has this plan and has actually used it at any doctors office KNOWS that an SSN is required) and it turns out that this is a new job for this patient and our office is actually the first office he's been to with the new benefit plan.

We've dealt with this before so again....staff calmly explains that they understand his concerns but again, this is the way that HIS benefit plan opperates so in order to be seen, we need his SSN.

Patient gets even more upset and now I hear his raised voice starting to sound through the office so I wander up front and hear the discussion. Of course it doesn't take me more than 6 seconds to realize what the issue is and I flat out say to the guy "Look....this is how YOUR plan operates. The choices are either you provide us with your SSN so we can verify your coverage and we'll see you, or you do NOT have to provide your SSN but then we expect payment in full at the end of the exam."

Now patient REALLY gets upset so I tell him to find another doctor.

I don't need that kind of bullschitt in my office.

So tell me....in your opinion....should I, as a health care provider have just "put that aside and provided care anyways?"


Also, why is it such a problem a patient not reveal an entire history? As I've admitted, I'm not yet in the field, so I'll grant there are aspects of this — the knowledge that's useful to an optometrist in doing his or her job — I'll not understand, but, at least from the standpoint of a patient, I don't think it would be wrong for me to go into an office and "withhold" a prior determination so I can see what "this doctor comes up with." Fine if you feel that's silly or pointless, but it's certainly an understandable position for a patient to assume, and I don't see it as a basis on which to refuse care.
I understand patients seeking a second opinion, but I don't play the easter egg hunt game. If a patient wants a second opinion, I need to know what they want a second opinion ON. Simply saying "my eye" isn't good enough.

If a patient says "Dr. Brown recommended cataract surgery and I want a second opinion" that's fine. I likely need little more information.

If a patient says "Dr. Brown said I have glaucoma. I would like a second opinion." That's fine. I can work with that.

If a patient comes in and says "Dr. Brown said my child needs glasses. Does he?" That's fine. I can work with that.

If a patient comes in and says "another doctor said there's something wrong with my eye. See if you can figure out what it is." Is NOT fine. At least not with me.
I'm not going on an easter egg hunt.


1. The patient who's shopping for a second opinion and feels revealing the last doctor's conclusion might bias this one's thinking. Why should he be denied?
It depends.

2. The jerk. We all hate jerks, but it's hard to justify tossing one out on his ass, while claiming the decision has nothing to do with your own pride or ego.
Again, it depends.

It happens to be, the situation described by the original poster strikes me as an instance of rudeness and snideness, not as "obscenely abusive."
The OP is not a situation of someone being abusive per se. It's a situation of someone being intentionally uncooperative or misleading in an exam. I don't have time for that crap and I won't be part of that, even if they're super polite.
 

Ryan_eyeball

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"Patient gets even more upset and now I hear his raised voice starting to sound through the office so I wander up front and hear the discussion. Of course it doesn't take me more than 6 seconds to realize what the issue is and I flat out say to the guy "Look....this is how YOUR plan operates. The choices are either you provide us with your SSN so we can verify your coverage and we'll see you, or you do NOT have to provide your SSN but then we expect payment in full at the end of the exam."

I had a 64 year old gentleman present for the first time to my office, and was self pay. All my history forms ask for a SSN, but I don't require it unless we are billing insurance, or writing a check. If they want to pay by cash or credit card, then I could care less if they put it on there.

This guy kept going on and on about how we should not require it as a means of ID. I kept thinking just wait one more year til you get your lil medicare card in the mail and see how happy he is. I'm sure he'll be thrilled to know his ID for his medicare is SSN plus an alpha letter.

KHE and his staff handled the situation appropriately. If the above poster still is aggressive the police should be called.
 
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"Patient gets even more upset and now I hear his raised voice starting to sound through the office so I wander up front and hear the discussion. Of course it doesn't take me more than 6 seconds to realize what the issue is and I flat out say to the guy "Look....this is how YOUR plan operates. The choices are either you provide us with your SSN so we can verify your coverage and we'll see you, or you do NOT have to provide your SSN but then we expect payment in full at the end of the exam."

I had a 64 year old gentleman present for the first time to my office, and was self pay. All my history forms ask for a SSN, but I don't require it unless we are billing insurance, or writing a check. If they want to pay by cash or credit card, then I could care less if they put it on there.

This guy kept going on and on about how we should not require it as a means of ID. I kept thinking just wait one more year til you get your lil medicare card in the mail and see how happy he is. I'm sure he'll be thrilled to know his ID for his medicare is SSN plus an alpha letter.

KHE and his staff handled the situation appropriately. If the above poster still is aggressive the police should be called.
Reminds me of last time I went to the dentist. The form stated you must pay the office cash before leaving (they don't deal with insurance) but still asked for SSN, drivers license number etc. I just left it blank, no need to make a fuss.

Would make more sense to me if the form said something like
SSN (medicare patients only) to avoid confusion. Still don't know why they would want my drivers license.
 

QueenieCSS

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I have re-read this thread and I still don't fully understand how you go about dismissing a patient. Can someone let me know the steps necessary in order to cover yourself while still maintaining professionalism?
 

PBEA

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Still don't know why they would want my drivers license.
The FCC has been making waves about requiring ALL doctors to take a copy of the driver's license. It keeps getting pushed, but it looks like it will happen. Otherwise taking a drivers license can be a good habit, in case you have to chase down an unpaid debt.
 

PBEA

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Well, for the thirteenth time, then, how is the following at all related to providing care:



Also, why is it such a problem a patient not reveal an entire history? As I've admitted, I'm not yet in the field, so I'll grant there are aspects of this — the knowledge that's useful to an optometrist in doing his or her job — I'll not understand, but, at least from the standpoint of a patient, I don't think it would be wrong for me to go into an office and "withhold" a prior determination so I can see what "this doctor comes up with." Fine if you feel that's silly or pointless, but it's certainly an understandable position for a patient to assume, and I don't see it as a basis on which to refuse care.

So, there are two matters:

1. The patient who's shopping for a second opinion and feels revealing the last doctor's conclusion might bias this one's thinking. Why should he be denied?

2. The jerk. We all hate jerks, but it's hard to justify tossing one out on his ass, while claiming the decision has nothing to do with your own pride or ego.

*I'd like to add, I'm not advocating tolerating an obscene amount of abuse — I'm sure I'd dismiss a patient who tried to beat me stupid with my phoropter while demanding I call her Countess. It happens to be, the situation described by the original poster strikes me as an instance of rudeness and snideness, not as "obscenely abusive."
Commando, the op scenario is basically the patient dictating what care they will and will not receive. I'm all for including pts in tx decisions, up to a point. You should realize that if you decide to honor a pts wishes regarding their care, that you may end up committing malpractice. The OP is a perfect example, pt has diabetes and other "eye problems", and wants you to provide a refraction only. THAT is malpractice. One way around it would be to obtain a records release from the OMD, making sure that the last visit was within a reasonable time frame, and that the record is legible and complete. You would be amazed at what some docs (OD or OMD) allow as sufficient testing/record keeping. If the record doesn't meet the sniff test, then you are on the hook for providing proper care. If they last visit was 4 years ago, then you are on the hook. NEVER take the pts word for it. They are lying, confused, whatever.