Which brings up an important point for laypersons:  a good eyedoctor
does not just prescribe artificial tears dor dry eyes based on
symptomology only.  A good doctor will perform a dry eye workup.

Dry eyes have various etiologies such as insufficient tear production,
excessive tear drainage, meibomian gland dysfunction.  And different
causes have different treatments.  Prescribing a wrong treatment
regimen for the particular cause of dry eyes can actually make things
worse (e.g., prescribing artifical tears when the cause is entirely
excessive evaporative loss due to meibomian gland disease.)

Some patients are put on topical steroids, some on hot compresses/lid
massage, some on a tetracycline, others on artificial tears, others on
RESTASIS, others on flaxseed oil, others still on punctal plugs and
other treatment modailities.

A careful workup -- usually beyond what is part of a routine
comprehensive eye examinaiton -- is normally required including things
such as a tear break-up time, fluorescein staining, and Schirmer's
testing, etc.  Follow-ups are also required to gauge response to
treatment and to adjust the treatment regimen as needed.  The various
treatment methods for dry eyes (topical steroids, oral tetracycline)
while normally quite safe can have serious potential side effects.

<rant>

I get some people -- mostly people who have well-vision insurance
through which we are participating providers, but their medical
insurance elsewhere (e.g., HMOs) -- who want me to treat their dry
eyes without peforming such a workup without getting properly
reimbursed because of cost or convenience, or simply not performing a
workup/followups.

o  "Can't you just tell me which drops I should try?" (implied:
without me having to do [read: PAY for] the workup and follow-ups).
o  "Can't I just try RESTASIS?" (implied:  without me having to pay
for the workup and follow-ups)
o  "What do you mean you don't know what is causing my dry eye?  You
just performed an eye exam."
o  "I don't want (have to) to go through my HMO.  It will take at
least a couple weeks to see a specialist -- I will have to go to my
primary care doctor and then he will have to schedule an appointment
with a specialist -- that will be at least two days off work and the
hassle of dealing with my HMO (but I don't want to pay for a dry eye
workup and associated followups).  Can't you just tell me what I
should try?" (implied:  without me having to do [read: PAY for] the
workup and follow-ups).

Laymen should realize when you do things like that, you put the doctor
in an uncomfortable position.  No matter nicely how you state it, some
patients will feel that the "rich" doctor is being "greedy" (rather
than the patient is being frugal) -- "You're already getting paid for
an exam by the insurance" (note: at an already reduced reimbursement
rate over usual & customary fee!) or the patient will feel like the
doctor is accusing them of being "cheap"

And some other patients still will say "That much!  Just for dry
eyes??!!"  These typically aren't cash patients who are used to paying
the normal U&C fees for an eye exam, but those with well-vision
insurance who come in only when the insurance covers an eye exam, want
"only what the insurance will cover" as far as frames/lenses, and pay
a $5.00 deductible.  Perhaps when one gets used to paying a $5.00
deductible when their employers pay for their health/vision insurance,
how much school and what an OD does becomes undervalued?

(BTW, it's not the doctor's job to explain to you how your insurance
works, the intracies of it, why it covers vision and not medical eye
problems, etc.  It's the patient's job to know what it covers.  I mean
-- didn't you at least briefly read the coverage when you signed up
for it?)

Please don't tell me no other ODs ever experience this and I alone
occasionally get patients from the Twilight Zone.

</rant>