2009.03.03 02:31:28

John McDaniel

#1…Is This Thing Going to Blow Air into My Eye?

• After handing the patient the cover paddle and asking them to cover their left eye they asked (very suspiciously) “will this puff air in my eye?”
• After performing confrontations on a very tense patient they noted “I was just waiting for the air that time”
• When occluding an eye in mid refraction the patient jumped back and scolded me for not warning him that the puff of air test was coming.  He didn’t believe me when I told him there was no puff and that it was more likely that his lashes were touched by the occluding mechanism.
• While attempting stereopsis testing a patient refused to put on the polarizing glasses for fear that they might blow air into his eye

I’ve left out any instances that might have even a remote sense of logic – such as pupil testing with a transilluminator or slit lamp biomicroscopy or any machine like an auto refractor.  At least those instances make some sense when people over react to them.

As a result of the ubiquitous nature of this concern I’ve started to rework my natural script when dealing with these inquiries.  Now I pick from a variety of responses, such as:

• “Air?  You wish it was just air!”
• “No, this takes air out of your eye; please don’t ask me how it does that”
• “This machine is new and uses fire instead of air – tell me if you like it better”
• “The air puff comes right after the needle prick so don’t worry about that air just yet”
• “We use electrical shock to the eye now a days, hurts more but scares you less”
• “The machine measures pressure better when cow flatulence is used instead of regular old air”

OK, I confess, even I don’t have the stones to say this to patients but I am thinking it.

After creating a top 10 list I am now in search of the ultimate patient; one patient that embodies all of the top 10 and demonstrates them all during a single encounter.  That dream patient that licks the cover paddle, gives dry eye lectures, takes 34 minutes on the phone to schedule the appointment, cries like a schoolgirl after the drops are instilled, giggles incessantly at the acuity chart, exclaims “that light is so bright, do you really have to do this,” screams “is that going to puff air into my eye” as I pump hand sanitizer into my hand, sits on the doctors stool instead of the patient chair, and that pages me later that same night wondering if itchy teeth constitutes an ocular emergency.

Hey, I can dream, can’t I?

Le Meas,

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

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

2009.01.07 03:14:50

John McDaniel

#5...Just What in the Heck is So Funny About the Eye Chart?

It happens to me every day that I see patients.  In fact, it happens every half day that I see patients.  And it makes absolutely no sense to me.  I realize that I don’t break rocks for a living and that I have no right whatsoever to complain but it drives me a little crazy.  I’ll set the scene for you…

I enter the examination room and greet the patient.  Review some history and find out the main reason they are visiting me today.  Then I hand them the cover paddle (see #10 for the fiasco that is the cover paddle) and say “OK, cover your left eye.  Not that left eye, the other left eye.  There you go.  Now, read the lowest line that you can barely make out on that (me pointing to the chart) chart for me.”  Then it happens; inexplicably and inevitably it happens.  Laughter.

I really don’t get it.  I’ve tried to rationalize why someone might laugh when asked to read the eye chart but I can’t get my brain around it.  Maybe the fact that I am 20/10 (OK, OK, with some modest age gains I am 20/15) uncorrected.  Maybe the blurred letters are funny.  Do they look like a naked George Costanza dancing with pineapples?  Maybe the fuzzy letters look like swear words – I know swear words always make me giggle like a school girl.  Or, perhaps, patients are just recalling a hilarious Ziggy cartoon about an acuity chart.  I don’t know and I don’t think I will ever figure it out.

Le Meas,

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