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Medical Forum / General / Vision / December 2006In denial
What do you do when you get a patient whose in denial about needing glasses? My friend obviously can barely see past her nose but won't wear them, it just seems so stupid and I don't know how to help. > What do you do when you get a patient whose in denial about needing glasses? > My friend obviously can barely see past her nose but won't wear them, it just > seems so stupid and I don't know how to help. > > -- > Message posted via http://www.medkb.com What I would do is enjoy the "Mr. Magoo" live show. Bring a camera when around her. She'll wise up and wear her glasses after she cracks up her car. > What do you do when you get a patient whose in denial about needing glasses? > My friend obviously can barely see past her nose but won't wear them, it just > seems so stupid and I don't know how to help. We simply remind ourselves: "The patient has the disease". In other words, if the patient is not motivated to comply with/use a therapy, non compliance is the patient's problem. If he patient does not meet the legal driving requirements, I report that to the MOT and inform the patient that she must legally use them driving. You can't help; if poor vision does't bother your friend it shouldn't bother you and nothing you can do will make her wear them. Don't get in a car with her if she drives without them. Dr Judy > We simply remind ourselves: "The patient has the disease". In other > words, if the patient is not motivated to comply with/use a therapy, [quoted text clipped - 5 lines] > bother you and nothing you can do will make her wear them. Don't get > in a car with her if she drives without them. Sometimes things are hard. We gave my father a choice of giving up his car or else the doctor would have his license revoked. We sold his house out from under him based on medical advice. I talked to his doctor recently, and he said that if my father got ill then there was an agreement to just let him die. > > What do you do when you get a patient whose in denial about needing glasses? > > My friend obviously can barely see past her nose but won't wear them, it just [quoted text clipped - 5 lines] > the legal driving requirements, I report that to the MOT and inform the > patient that she must legally use them driving. I don't consider a refractive error a "disease". It is not a health/sight threatening situation to the person (assuming the person is an adult and no danger of developing amblyopia).The person is only a danger when driving (if not meeting the dmv requirements) and should realize that she/he places own self and others in harms way while driving uncorrected. frank >I don't consider a refractive error a "disease". It is not a >health/sight threatening [quoted text clipped - 6 lines] >uncorrected. > Well, refractive errors have disease codes (ICD), and would certainly seem to qualify as something that can cause discomfort and/or disability. To say that driving is the "only" danger for uncorrected ametropes is definitely wrong. Consder flying, crane operation, baseball, machine shop work, carpentry, I could go on but you get the idea... w.stacy, o.d. > Well, refractive errors have disease codes (ICD), and would certainly > seem to qualify as something that can cause discomfort and/or disability. I guess I learn something new every day. Never considered refractive error as a pathology/disease as opposed to a condition. Now I have to tell little "Billy's" mom that her son has a disease. Doesn't matter that he only has a quarter cyIinder; poor kid is still suffering with a disease. Is that how you explain it to your patients? How do you keep them from having their jaws drop to the floor? > To say that driving is the "only" danger for uncorrected ametropes is > definitely wrong. Consder flying, crane operation, baseball, machine > shop work, carpentry, I could go on but you get the idea... You forgot shooting a gun and putting on make-up. ;) frank >Now I have to tell little "Billy's" mom that her son has a disease. >Doesn't [quoted text clipped - 4 lines] > > Well, I would think that a .25 cyl doesn't qualify as a significant refractive error any more than a single sneeze qualifies as an upper respiratory infection. But a -2.00 cyl certainly is an ICD 367.21 and can cause a lot of suffering for the patient... > Well, I would think that a .25 cyl doesn't qualify as a significant > refractive error any more than a single sneeze qualifies as an upper > respiratory infection. But a -2.00 cyl certainly is an ICD 367.21 and > can cause a lot of suffering for the patient... If nothing else, 2d of myopia can also lead to IOS (Incipient Otis Syndrome)--not only dangerous but uncomfortable, degenerative, irritating, and frightfully annoying. > Well, I would think that a .25 cyl doesn't qualify as a significant > refractive error any more than a single sneeze qualifies as an upper > respiratory infection. But a -2.00 cyl certainly is an ICD 367.21 and > can cause a lot of suffering for the patient.. Not what I asked. Do you consider ametropia a disease (no matter what degree) and do you tell your your patients that they are suffering a disease? I'm not trying to be confrontational here but curious. Wouldn't that mean that refracting opticians are diagnosing and treating eye disease? A -2.00 uncorrected cyl can cause some asthenopia but I don't consider that "suffering"- I've had patients in the past that have been asymptomatic with this amount as well. Happy new years! frank > What do you do when you get a patient whose in denial about needing glasses? > My friend obviously can barely see past her nose but won't wear them, it just > seems so stupid and I don't know how to help. The same thing you do with people who smoke or use drugs. Be supportive but realize that you can't change them. Ask your friend if they can see a certain. When they say they can't, explain that you can, and glasses might help. Suggest contacts. Suggest refractive surgery. Of course I want to help but I also think she's being a bit stupid. A couple of years ago she said her glasses were -2.50 and she just wears them for driving. I've tried the subtle approach but she seems to have it in her head that glasses should be worn as little as possible, even if they'd help. The reason I asked what the pros do is because I wondered if you has some suggestions for people when you prescribe on how much/when to wear them. Is there anyone here who's the same prescription? > driving. I've tried the subtle approach but she seems to have it in her > head > that glasses should be worn as little as possible, even if they'd help. Sounds like she's fallen victim to the myth that wearing glasses causes further myopia. > reason I asked what the pros do is because I wondered if you has some > suggestions for people when you prescribe on how much/when to wear them. > Is > there anyone here who's the same prescription? -2.50 is pretty common. As a professional, I seldom require anyone to wear -2.50 full time. If they don't create a hazard by driving without correction, there's little reason to insist on full-time wear. -MT, OD >-2.50 is pretty common. As a professional, I seldom require anyone to >wear -2.50 full time. If they don't create a hazard by driving without >correction, there's little reason to insist on full-time wear. What do you consider to be **full time** What reasons would make you insist on it for some who is -2.5 > What do you consider to be **full time** > What reasons would make you insist on it for some who is -2.5 A doctor will never insist that a patient comply with a recommendation, whether wearing glasses, using artificial tears for dry eye, stopping smoking or taking insulin for diabetes. All I can do is inform them of the advantages of the recommendation and the consequences of not following it. Occasionally a doctor may refuse to continue treating a non compliant patient when the non compliance makes further treatment futile. Whether for your friend at -2.50 or someone else at -10.00, all I can do is remind them that they are not legal to drive without glasses and that they will see things like TV, movies, people's faces better with glasses. If she worked at an occupation that has a vision requirement, I can inform her that her employer will require that she wear glasses on the job. I usually also point out that wearing or not wearing glasses will not cause her vision to get better or worse. Beyond the legal requirements, it is her choice whether to use the glasses or not. Dr Judy > > What do you consider to be **full time** > > What reasons would make you insist on it for some who is -2.5 [quoted text clipped - 6 lines] > non compliant patient when the non compliance makes further treatment > futile. Then again, there are the lawsuits. My OD told a patient to take a hike after he said that he wore a daily disposable for a year. The OD can write whatever he wants in the chart, but who is the jury going to believe when infection sets in? My son broke his finger. His doctor said that he wouldn't heal until he stopped smoking. He stopped. I was pretty happy. > Beyond the legal requirements, it is her choice whether to use the > glasses or not. Of course, it is also a choice as to who is your friend. If your friend doesn't listen to you, breaks your fine china and endangers people by driving when they can't see... > What do you consider to be **full time** "All waking hours" is a typical description. > What reasons would make you insist on it for some who is -2.5 I can't think of any and I never insist on full time wear, except where kids are likely to lose them or you work in a chemistry lab or there's some other common-sense reason. -MT, OD > > What do you consider to be **full time** > > "All waking hours" is a typical description. Although they don't work well when bathing, since they fog up. I always wore them swimming, so I could check out the girls. > > > What do you consider to be **full time** > > > > "All waking hours" is a typical description. > > Although they don't work well when bathing, since they fog up. I > always wore them swimming, so I could check out the girls. Dear Dan Abel, Now I see why you have retinal detachment. S.Seagal
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