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

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

2008.12.24 02:18:35

John McDaniel

At the conclusion of most patient encounters I ask the question “is there anything else I can do for you?”  Recently a patient said “yes, make me feel like I am 14 years old again.”  We laughed and I didn’t think much of it again until later when I had an experience that in fact did make me feel like I was a kid all over again.  Do you want to feel like a kid again?  I can make you feel just like you are 14 years old again.  Really, I can.  In fact, it won’t even take all that much effort on your part.  Here’s what you need to do:

1. Go to Facebook.com
2. Create a Facebook account and profile for yourself
3. Spend an hour or so finding friends out there from high school, college, optometry school, church, etc.
4. Spend a few more hours using the Facebook interface to interact with your friends

You’re welcome.  You say you want to feel even younger?  No problem.  Do the same 4 steps with MySpace.com.  Now you say you don’t want to feel like a 10 or a 14 year old anymore?  Well, you are rather demanding, but OK, no problem.  Go to LinkedIn.com and create a presence there.  You can just start calling me the time machine next time you see me (heck, that is better than what most people are calling me these days!)

Besides fully functioning fountains of youth, these tools (and others such as Twitter.com) are fast becoming the ways people interact on a daily basis.  If you don’t believe this or view it as a temporary fad you are wrong.  I know because I initially didn’t believe it and viewed it as a passing fad.  I was wrong too.  The web is more than powerful search engines and information overload these days.  The web has become the medium by which people interact beyond their daily, physical contact lives.  Sites like Facebook and LinkedIn are just different vehicles for accessing this new paradigm of interpersonal communication.

For several months I was reading about the importance these web-based social networking tools were playing in business today.  The predictions for their future roles were even more grandiose than I could imagine.  I confess I was myopic to this.  It wasn’t until a couple of great bloggers (all optometrists) started to turn my wrong headedness.  The first was Justin Bazan, OD from New York.  I decided to see what a progressive young optometrist could do with a blog and how it might impact his business.  I went to the blog expecting to maintain my status quo opinion that it would be a nice add on with little tangible business impact.  Justin’s blog started to change my mind.  It changed others also as a few other ODs around the country were doing their own blogs.  Three of them jumped onto my radar.  Nate Bonilla-Warford, OD from Florida recognized the power of the format early on.  As did optometrists John Warren from Wisconsin and Dickson Chen from California.  I started to notice something rather powerful that I didn’t expect to find: the ability to positively collaborate and improve the business of optometry and the care of the patient with cohorts around the globe.  What was so powerful about the blog concept (that I had previously failed to appreciate) was that it allowed each practice/doctor to have a lasting, positive impact on their current and potential future patients in a way that allowed their unique personalities to shine.  The cost factor is impressive too as it is essentially just time.  If you’re reading this blog I am probably preaching to choir but consider starting one for your business or just for yourself.  It does take time but the rewards can be well worth it.  I’d recommend starting by looking at some of the optometrist blogs I mentioned above.

I don’t want to leave the impression that blogging, Facebook, MySpace, and LinkedIn are the only facets of this new networking and marketing frontier.  But these are a great place to start.  Remember that these are the media used more and more for interpersonal interactions today.  Why should you care about how people interact?  You have to care because you need to be a participant in the conversation.  Watching these new phenomena from the sidelines is reactive and you should be proactive.  I am not saying that “nifty” Facebook profiles will double your patient load.  I am saying that it can only serve to help increase the demand for your services and goods.

When you get to Facebook look me up; I’d love to be your friend!  Now go clean your room before I tell your mother and get you grounded!  Ahhh, 14 was grand, wasn’t it?

Le Meas,

John G. McDaniel, OD, MLHR
President/Founder
Waugoo Consulting Group, LLC
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web networking | marketing | blog | internet | marketing media

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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humor | waugoo | john mcdaniel | top ten | optometry | practice

2008.12.11 01:51:46

John McDaniel

#8…”Which chair should I choose?”

The patient walks into the exam room and looks left and then right and then left again.  It appears that a major decision making process is underway.  Which chair should they sit in?  If statistics are useful I’d guess that 1 out of 5 patients picks the wrong chair.  It is a difficult decision after all.  If you’re thinking this is a small, rarely occurring problem I have some good evidence that it is not.  My routine discussions with patients are many and one of them gets used every time I take a patient into the examination lane.  It goes something like this: “you can have a seat over in that (pointing) big, comfy chair over there.”  I have observed dozens of eye doctors during patient exam times and have noticed a good number of them have a similar type of narrative if they ever escort a patient into the exam lane.  This decision has always befuddled me so I decided to analyze it from the patients perspective to see just how challenging it can be.  So here it goes…

You, the patient, walk into the room.  You see three seating options for you.  The first you are able to determine is the doctor’s adjustable height “doctor” stool.  You want to sit there because it looks fun but you know better.  This leaves you two potential options.  The option on the left is interesting.  It has lights on it and buttons and dials and switches.  It is actually plugged into an outlet somewhere.  It is a big chair with its very own retractable foot rest.  It is connected to an even cooler looking thing with more lights, buttons, and dials.  The big green power switch really catches your eye.  This thing connected to the fancy chair has a lot of arms with stuff on it too.  One of the arms has something you remember as being the torture tool used during the “which is better, 1 or 2” inhumanity soon to come.  There is also a big black thing that is attached that looks like a very old fashioned camera from the 1890’s.  You then notice that near the top is an arm with a light on it that is turned on.  Finally, your eyes meet the most impressive piece of “stuff” by the big fancy chair.  It looks like a microscope and it looks expensive.  You clench a little because you are certain that this is where the “puff of air” test will soon be coming from.

Now you look at the other option to the right.  It is a $15.95 chair from Sam’s Club.  The choice is obvious now – you sit at this one confident you’ve made the best decision possible.

Congratulations!  You’ve picked a winner once again.  But you are wondering why the eye chart is showing up on the wall behind your chair, aren’t you?

Le meas,

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