2009.02.04 00:59:47

John McDaniel

#2…”That Light is So Bright”

I should be more empathetic on this one but I am not.  I tear up with concurrent blepharospasm like crazy when having fundoscopy and/or BIO performed on me.  That said, this comment drives me a little crazy.  It is the addendum comments that really make me crazy.  When “that light is so bright” is followed by comments such as “do you really have to do this?” or “it burns so bad!” I lose any potential empathy for the patient.  I realize that having the sun essentially jammed onto your retina is not as fun as a water park slide but it isn’t equivalent to water boarding either.

Along with giggling at the acuity chart, telling me they are legally blind without their glasses, or claiming that their replacement schedule for contact lenses is two weeks this is a comment you are more likely to hear than not.  I understand that the discomfort is legitimate but aren’t there worse things that other doctors do to folks?  Is the bright light really the worst thing that has ever happened to you?  For my patients sake, I hope so, but logic tells me that just isn’t the case.  So many things could be happening to you in the name of diagnostic testing that, if considered, the bright lights will not seem so bad.  Think of the “evil” light next time you are scheduled for a colonoscopy, bone marrow biopsy, digital prostate exam, mammogram (so I’ve been told), annual gynecological exam (again, under the category of so I’ve been told), or untold other less than pleasant tests.  Now that light doesn’t seem so bad, does it?

Le Meas,

John McDaniel, OD, MLHR
President/Founder
Waugoo Consulting Group, LLC
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waugoo | john mcdaniel | top ten | optometry | practice | humor

2009.01.15 03:45:06

John McDaniel

#3…Eye Drops are the Devil

There is no gigantic news flash here but I don’t enjoy dealing with dozens of patients daily that view eye drops as equivalent to a colo-rectal exam with a bulldozer.  I’ve never met an eye doctor that enjoys delivering the drops or taking comments/questions from patients regarding the “traumatic” experience.  We all recognize that drops aren’t fun.  Only the most “interesting” patients report to enjoy them (these are usually the same patients that report a strong affinity to entertainment activities requiring lighter fluid, swords, tin foil, and high voltage).  I’ve also noticed a direct positive correlation between how comfortable the patient is with you and the amount of wailing and gnashing of teeth exhibited upon instillation.  You should see and hear my wife howl and kick and scream (and that is just during acuities!).  I kid because she won’t read this.

I doubt that I can say anything new regarding the hated eye drops.  I mean, really, how can anything new be said about something that has been talked about so much, so passionately, for so long?  It can’t.

The most amazing drops related story I’ve ever encountered was a doctor that confessed to me that they (that is the plural meaning the genderless singular in this case – just to be clear) didn’t dilate many patients because they hated the battle over the drops.  They just gave up.  I was stunned.  I was disappointed as well.

The reality is that those “dreaded” drops were the doorway to modern optometric practice.  Without those privileges we wouldn’t be close to where we are today as a profession.  And many heartfelt thanks to all those that fought so hard and so well the legislative battles that produced the diagnostic pharmaceutical privilege we enjoy today.  I know it isn’t funny but it is true.

Le Meas,

John McDaniel, OD, MLHR
President/Founder
Waugoo Consulting Group, LLC
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waugoo | john mcdaniel | top ten | optometry | practice | humor

2009.01.15 03:08:44

John McDaniel

#4…The Simple, Simple Task of Scheduling an Appointment

I would bet that most optometrists aren’t aware of or have forgotten just how arduous the task of scheduling an appointment (especially over the phone) can be.  When I had a private practice I made it a point to answer the phone at least once a month and often times more than that.  It forced me to experience what my phone answering staff was going through.  To say the least, it made me empathetic to the sometimes difficult nature of dealing with phone inquiries.  The worst of these, by far, were calls for scheduling appointments.  Keep in mind that the vast majority of the time the request to schedule is initiated by the patient.  To illustrate the fun and excitement that is patient scheduling, I’ve created an amalgamation of many scheduling calls.  Most are not this bad.  They are, however, close.

Patient: “Yeah, Hi, I was calling to….(5 seconds of silence pass)”

Receptionist: “Hello, miss, are you still there?”

Patient: “Jimmy put that lighter down!  If you don’t stop trying to light your sister on fire I will kick your…”

Receptionist: “Miss, are you still there?  Hello?”

Patient: “Sorry about that. Yeah, I’m still here.  Kids!  What can you do?”

Receptionist: “Sure, I certainly understand.  Did you want to schedule an appointment or did you have a question”

Patient: “I do have a question.  Do you know how to get to the grocery store on Main?  I’ve been looking for it for a half hour now.  Jimmy!  If I have to stop this car…”

Receptionist:  “I’m sorry miss, did you say the grocery store?  I am not sure where…”

Patient: “Yeah – the Pick N Save.  They have apples on sale.  Buy one sack of apples and you get a free tire rotation at John’s Auto Shop.”

Receptionist:  “I am sorry Miss, can I help you with something at XYZ Eye Clinic?  I am really not sure about the grocery store.”

Patient: “Oh, yeah, right.  I forgot who I was talking to there for minute, eh?  Yeah, I’d like to schedule an appointment for Jimmy.  He is a little bit hyper and that is why we call him ricochet.  He’s is on seven different meds to make calm but they don’t work as well as that ear candling thing we saw on Oprah last month.”

Receptionist:  “OK, sure.  Did you have an idea when you’d like to bring Jimmy in?”

Patient:  “What times do have available?”

Receptionist:  “I have an opening for 3PM this Thursday.  Does that work for you?”

Patient:  “Let me think, Thursday huh?  Hmmm….well…  I am going to guess not.  Oh wait, no, I am sure that won’t work.  Every Thursday for the past 12 years Jimmy has fencing practice.  Definitely not.  Fencing is cool to watch; have you ever seen it?

Receptionist:  “No miss, I haven’t.  Is there a day or time that usually does work for you?:

Patient:  “How about Sundays around 9PM?  I know we could maybe make it there this Sunday at 9.”

Receptionist:  “Sorry, we don’t have office hours on Sundays.  We see patients on Mondays from 9AM till…”

Patient:  “Oh Mondays are terrible.  Kids in school you know.  That, and Bill, my ex-husband, spends time with Jimmy Monday nights.  Mondays never work.”

Receptionist:  “How about a Tuesday?”

Patient:  “Tuesdays are good.  Sometimes.  I am not real sure about the next couple though – I don’t have my calendar with me plus I am driving so, you know.”

Receptionist:  “Sure.  I understand.  Would it be easier for you to use our online scheduling system?”

Patient:  “No way – I don’t trust the internet.  I never liked that Al Gore guy.  I mean he is right on with the global roasting thing but the internet is the devils playground, am I right?”

Receptionist:  “OK, sure.  How about a Wednesday?”

Patient:  “You know, before we schedule I should make sure you take our insurance.  You know the insurance requires us to go to only certain optical shops.”

Receptionist:  “Which insurance do you have”

Patient:  “I have no idea.  It is through my husbands job.”

Receptionist:  “We would have to know which insurance it is to be able to let you know if we are on the plan”

Patient:  “Can’t you just check them all for me?  How many can there be?”  I think the name rhymes with ‘Schmelman’ or something like that.  Does that sound familiar?”

Receptionist:  “Not really – but there are dozens and dozens of vision plans and medical insurance plans.”

Patient:  “You mean my medical insurance will pay for it too?”

Receptionist:  “Not if is a routine vision exam.  Only if it were a medical condition such as…”

Patient:  “Jimmy has a medical condition alright!  It is called pain in the arse- disease, know what I am talking about (car load of laughter)!  Seriously, he wears glasses – he has a medical condition.”

Receptionist:  “Do you know the medical insurance provider”

Patient:  “No idea.  That is through his dads job.  Might sound like…well, I am not even sure on that one.”

Receptionist:  “Sounds like the best thing to do would be to find out what insurances you have and give us a call back once you know that and know your schedule”

Patient:  “Can’t you just look up our insurances?”

Receptionist:  “No, I can’t.  Once I know what the insurance providers are I can check for you.”

Patient:  “OK, well since you can’t check the insurance for me I guess I’ll have to when I get home.  I’ll call back later to schedule Gina’s hearing exam then.  Thanks.  Bye.”

Receptionist:  “Goodbye.”

Patient:  “Now, about that grocery store I was looking for…(5 more minutes of “stuff” goes here – I’ll spare you).

And you thought getting drops in an angry 5 year old girl’s eyes was difficult.  Go pat your scheduling staff on the back right now; trust me, they deserve it.

Le Meas,

John McDaniel, OD, MLHR
President/Founder
Waugoo Consulting Group, LLC
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waugoo | john mcdaniel | top ten | optometry | practice | humor

2008.12.24 14:52:38

John McDaniel

#6...The Lay Persons Understanding of “Ocular Emergency”

There is always room for healthy debate as to what actually constitutes an ocular emergency.  Sometimes, however, there is no debate on what can never be defined as an ocular emergency.  As a service to my patients I provide them with a pager number that allows them to reach me when an eye emergency issue develops outside of normal office hours.  The office voicemail message even has a detailed sentence explaining what a “page worthy ocular emergency” is.  Even with all these safeguards many non-emergency pages have come my way.  Below I list a few of my personal favorites and a few that I’ve gathered from colleagues.

• “I want to order contacts now” or “I want to order my glasses now”
• “I decided I don’t like the trial contact lenses all that much – I’d like to get some new ones”
• “I need to get my hearing aid adjusted”
• (On a Sunday over a week before the scheduled appointment) “I can’t make next Tuesdays appointment; I need to reschedule”
• “My dad normally takes my contacts out for me but he is away on vacation – can you do it for me” (this was from a 20 year old patient that had been a contact lens wearer since he was 12 years old and yes, I did take them out for him)
• “What is your opinion on Lasik?” (this was a patient I had never seen before)
• “My friends contacts are not comfortable, can we get her some new trials” (I had never seen the “friend” nor the caller as a patient before)
• Patient: “I failed the drivers exam.”  Me: “did you fail the vision portion of the test?”  Patient: “no.”
• “My son is in Oregon and his eye is red – can you take care of him?”
• “I’m on my boat right now and these glasses are terrible – it is so bright” (the glasses were not sunglasses)
• “Do you take [fill in the blank] insurance?”
• “Do you have [fill in the blank] frame in red in stock?”
• “How’s it going?  I just came across a great sale on a table saw and thought you might be interested”
• “That pain in my right eye is back again and I don’t want to pay another copay so send a prescription to my pharmacy please”

And my personal all time favorite…

• From a rep for a spectacle lens lab that I’d never used before “Hey doc, I was just hoping I could go over some of the reasons you need to switch to [name deleted to protect the asininely stupid] lab; got a few minutes?”

Le Meas,

John G. McDaniel, OD, MLHR
President/Founder
Waugoo Consulting Group, LLC
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waugoo | john mcdaniel | top ten | optometry | practice | humor

2008.12.17 14:13:15

John McDaniel

#7…What Others Have to Say…

In the process of creating this list I asked a lot of other optometrists for their input.  At one point I even put a request on the optcom list for suggestions.  What I got in return was literally over one hundred responses.  Rather than sort through and try to pick out the best ones I’ve decided to share them all.  My favorite one is the last one – still makes me laugh when I think about it.

Oh yeah, I almost forgot…I’ve eliminated the names to protect the innocent.  Enjoy.

• Just got a call from a patient to make an appointment.  She calls back a few seconds after hanging up and asks if we can give her the number to the utility company.  Staff told her to call information, to which she replies "No they charge for that!"

• I love it whenever I tell a kid to open wider and the kid says... AHHHH... Always cracks the parents up. 
  

• How about how patients proceed to tell you how horrible their vision is, “it's gotten soooooo much worse”, yada, yada, yada - then you clarify "is this with your glasses or without?"  It's usually without their glasses!!!!  "So, how do you see with your glasses? "Oh- just fine!!!”

• I once had a patient tell me that nothing was wrong or had changed with his eyes, but he had been placing his eyeglasses on his television set when he wasn't using them and the television set had sucked all the power out of them.

• I once had a patient insist that we gave her 2 left trial contact lenses.  After the tech rechecked that packages and told her no, that she had a right and left one, she said “NO! It says right here on the package LIFT!”

• Doctor: "Patient, please look to the left."   Patient:  "With which eye?"

• There was a patient that was giving very confusing results until I figured out that he was telling me which was “badder.”

• One well-endowed female patient, when viewing her fundus photos on the computer monitor, said the photos 'looked like boobs'

• The first thing patients do when they put in a new pair of contacts is to cover one eye and then the other to compare...(and of course inevitably one eye is a little better than the other so they comment/complain....)....Now, patients NEVER do that with glasses.....

• Yesterday a patient told me that she had a terrible condition called "monovision" but it was OK, her last doctor had fit her with special "monovision contact lenses" and now she was OK.

• As I point to my left ear-- "Please look at my left ear."  Patient asks, "Is your left ear on the right or left?"
• Patients says “You look up my wife in the yellow pages, call her and ask her what my insurance is.”

• Last week I was doing phorias on a patient and I asked if the top line was to the right.  After a long silence I repeated “is the top line of letters to the right?”  Her response was "I can't tell which one is the top"

• You wouldn't believe the number of people who get all confused on BXC when I ask which is sharper and darker, the horizontal or vertical? I usually mention, "horizontal, just like the horizon..."  

• I had a professional pilot get horizontal and vertical mixed up.

• Doctor: "Which is higher... the one on the left, or the one on the right?"  Patient: "The top one."

• After doing BIO on a young boy, he commented with wide open eyes "I think I saw God!"

• Years ago when Alcon's enzyme first came out, it was a pork derivative. I worried if this would violate kosher laws and checked with a classmate who was an optometrist and a rabbi. He said it did not, but tell patients so they could decide for themselves. This worked well as I discussed this with every Jewish or Muslim patient. Finally, I had dispensed the enzyme to an Italian woman who came back yelling at me one week later. I said "What difference does it make"? She said "I am a vegetarian!"

•  Doctor: "Which is better, 1 or 2?” responses...
  • Patient: “Both”
  • Patient: “Well I can see 1 much better but 2 is clearer”
  • Patient: “O F L ...”
  • Patient: “no, that's worse”
  • Patient: “The other one...the one before. The first one, not the second one."
  • Patient: “Can I see it again?" "Can I see it once more?" "Can I see it just one more time?" "Just once more, can I see it once more?"

• Doctor: "Which is better, 5 or 6?”
  • Patient: “2, I liked 2 before."

• I ask a kid "so do things look pretty clear most of the time or are they blurry sometimes?"  The kid responds "they're kinda clear and kinda blurry."
• “My eyes are bleery...I think I rubbed all the medicine out of these, they need more medicine”
• I was on a mission trip in Mexico several years ago and my translator was busy explaining something to one patient while I examined the next.  My Spanish isn't great but I went ahead and tried to explain to that patient to use artificial tears OU qid but accidentally said gato (cat) instead of gota (drop).  The patient was somewhere between alarmed and amused that I was asking her to put a cat into her eye four times daily.
• One of my favorite chief complaints was from a patient who knew that his "bifocular" vision was off. It was!
• Many times during the BCC, I ask, "which lines appear darkest or clearest, up and down or back and forth?" The patient will respond, "the green lines do!"
• "My prescription is getting blurry....I think I must need more axis" ....and to think I was going to just chalk it up to an itchy macula.
• How about patients who take their glasses off before entrance acuity and than have to dig through their purse for five minutes to find them again before the exam can start?
• Q. Do you have any health problems?
  A. No, I'm real healthy.
  Q.  So you don't take any medication?
  A.  No, well, except for the chemotherapy.
• Doctor: “Read the bottom line.”  Patient: “You mean the bottom, bottom?”
• Doctor: “Read the bottom line.”  Patient: “Do you want me to read it?”
• “I really can’t see – I wrote down that it is the 11^th today, right?  See, I can’t see – today is the 12^th!”  That certainly explains everything.
• Doctor: “any history of any problems with either eye?” 
  • Patient: “I was told I had a torn rectum”
  • Patient: “I have Cadillac’s in my eyes”
  • Patient: “I have the stigmatism – is that fatal?”

And my personal favorite for the last one…

• I had an 80+ year old lady in the office once who was convinced that her macular hole was somehow linked to a hole in her head.  She insisted that I feel her scalp where there was indeed a small divot.  Following the 8:30 am exam she asked me if I would like to join her for a beer and then gave me a piece a candy that she took out of the candy bowl at our front desk.

Le meas,

John G. McDaniel, OD, MLHR
President/Founder
Waugoo Consulting Group, LLC
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