‘Nothing more can be done' may be shortsighted view

Editor’s note: With this issue, Ophthalmology Times continues its occasional practice management column, called Practice Management Issues, that addresses many of the common problems that most physicians experience in their practices. Many of these problems can be resolved with simple solutions. The editor of the column is Frank J. Weinstock, MD, FACS, who also has written many books on practice management.

Take-home message: No physician has the ultimate knowledge and should not be afraid to engage colleagues in the treatment of a patient. Usually, the patient will appreciate the concern and will continue as a patient.

Practice Management Issues By Frank J. Weinstock, MD, FACS

Rootstown, OH :: There have been times in the clinic when ophthalmologists have exhausted every possible avenue to treat a patient with a particular vision-threatening disease and concluded, “Nothing more can be done.”

Weinstock, MD, FACSAlthough situations occur in which physicians feels they have done everything possible, ophthalmologists should cushion that final discussion. Often, there is another physician who might be able to treat an apparently incurable situation. In conditions such as poor vision, it is common for ophthalmologists to discover poor vision, then, tell the patient there is nothing that would help.

With many advances in low-vision correction (glasses, telescopes, magnifiers etc.), it is not unusual for an ophthalmologist who is interested in low vision to spend the necessary time to use low-vision techniques and equipment to improve a patient’s vision-to the extent that reading and other tasks may be carried out to provide a major improvement in a patient’s quality of life.

With diseases, such as age-related macular degeneration, glaucoma, and diabetic retinopathy, it is best to refer patients to ophthalmologists who specialize in the treatment of these diseases.

Referring ophthalmologists also should be aware of specialists who are in tune to the latest techniques in diagnosis and treatment. They should not be afraid to refer the patient.

Fortunately, with capable ophthalmologists, it is rare that other physicians are better. However, no physician has the ultimate knowledge and should not be afraid to engage colleagues in the treatment of a patient. Usually, the patient will appreciate the concern and will continue as a patient.

More informed patient

Ophthalmologists also should realize that with the Internet and patients’ knowledge of others with a similar disease, patients can easily learn about other available treatments, and may become upset if a physician is not aware of these new treatments or doesn’t offer them. Physicians always should address patient questions and their information gracefully. The patient again will appreciate the concern.

Avoid the words, “Nothing more can be done.” It is necessary to be a realist–try to avoid removing any hope.

When referring patients with serious vision problems to specialists, they are given a name–only to be told upon calling that office that the next available appointment is several months away. In the meantime, the patient has serious vision issue, afraid, and feels helpless. To add to their situation, patient calls to the referring ophthalmologist’s office do not produce any satisfactory answers.

It would be helpful if the referring ophthalmologist’s office would take charge and call the specialist’s office to see if the patient can get a timely appointment. If not, try to find another specialist. If one is not found, arrange for a follow-up appointment to care for the acute situation until the specialist is found. Show the patient that you understand his/her situation and that you care.

It is not unusual for patients to make diagnoses or have treatment plans before visiting with their physician. Patients usually find information about their conditions that many physicians may have never knew existed.

With easy access to the Internet, newspapers, and medical sites, patients may discover a website dedicated to their problem with new and different approaches. In these situations, physicians should enlist the patient as a partner, evaluate their information, and put that information into perspective.

If the patient presents information or provides the name of different medical center, physicians should look at it objectively and discuss it with the patient. If the patient insists on going to that center, physicians should offer necessary assistance, such as scheduling appointments, providing medical records, test results, and other information.

In most situations, the consultant physician will agree with your treatment plan and the patient will return to you. If one of my patients wants to stay with the consultant, I always forward whatever information is needed and never get upset with the patient. Although physicians do not want patients to leave, they should be gracious since most patients will return. If the consultant seeing the patient differs from your diagnosis and/or treatment, the patient will appreciate your flexibility.

Frank J. Weinstock, MD, FACS

E: fjstock@aol.com

Dr. Weinstock is professor of ophthalmology, Northeast Ohio Medical University, Rootstown, OH. He is also affiliate clinical professor in the Charles E. Schmidt College of Biomedical Science at Florida Atlantic University, Boca Raton, FL, and volunteer professor of ophthalmology, University of Miami Miller School of Medicine.