Viewpoint FROM THE CHIEF MEDICAL EDITOR

What We Owe Our Patients

Larry E. Patterson, M.D.

The new patient sitting before me, a pleasant woman 74 years of age, announced, "Dr. Patterson, I'm here to have my other cataract removed." I noticed on her chart that she recently had surgery on her left eye, and her former doctor recommended cataract extraction on the right eye ASAP. The prior records indicated a BCVA of 20/100 in each eye preoperatively, with 3+ NS OU. I completed my exam.

The problem was that, while she saw 20/20 in the right eye and the surgery appeared to be of excellent quality, she also saw about 20/20 in the left eye, at least with a good refraction. On my most liberal grading day I couldn't have seen more than a 1+ nuclear cataract. Additionally, we had already given her a standard questionnaire where she noted her visual complaints, not surprisingly, as nonexistent.

The only reason she had undergone one operation and not two with her previous doctor was that she had moved from out of state to be closer to her family and was unable to remain long enough to have the second surgery.

When I gently informed her that the left eye cataract was not really bad enough to need surgery just yet and that new glasses alone could improve the vision in both eyes, she was quite pleased with this news, and promptly headed out to the optical dispensary. I hope to see her again for follow-up next year.

Just Because You're a Surgeon …

Sadly this story, or variations of it, is not rare in my experience. While the overwhelming majority of us don't behave this way, there seems to be a minority who are willing to place something else ahead of proper patient care. Maybe this patient does see a bit better in her right eye postoperatively, and the surgeon probably helped her refractive error as well.

But that's not the point. When a patient presents to us, we owe them the best exam and the best treatment possible, even if it's just new glasses. This includes competent refractions.

While I hope my experiences are unique, I suspect I'm voicing concerns similar to those many of us have at one point or another. Personally, I don't want a few bad apples to end up causing all of us grief some day. E-mail me with your comments.