Triage. We all know what that means. If a patient comes in and says “I am diabetic and my glasses hurt my nose,” we all know that we must carefully evaluate the patient for ocular signs of diabetes, and tend to the nose later.

Oh, but that’s actually not what the patient thinks about his needs. I know you’ve had diabetic patients come in for new nose pads when their last eye examination was in 1998. Nose comfort trumps blindness.

So we cannot effectively triage based solely upon the morbidity of the condition. We have to (ugh!) pay attention to what personally matters to the patient. The patient’s opinion actually impacts our triage. That’s because, to the patient, his seemingly important priority trumps our measly triage.

How can we get these two to work hand in hand? We have to make it seem very inconvenient to go blind.

Texting, Blindness & Oprah
Patients (including you and I) will do anything for convenience. We will, for example, type inane messages to one another on tiny little electronic doodads while simultaneously driving 80mph in a 70mph zone. This behavior may ultimately maim and kill us or, more conveniently, someone else we do not know, but convenience (ours) trumps death (yours or, yes, even ours). Convenience even trumps (gulp!) Oprah who has 10 bazillion fans—but less than a half million have signed her “No phone zone” pledge about calling/texting while driving. Love ya, Oprah, but convenience even trumps moguls!

So, we have to find a way to make patients understand that if they do not follow our instructions, it will be really, really, REALLY inconvenient.
I’ve found that there are several techniques to make blindness seem inconvenient to a patient who makes it a priority to, let’s say, upsize a burger meal as opposed to taking his daily glaucoma medications:

  • Use effective anecdotes. “I remember when John Smith decided to overwear his contact lenses and then choked on a chili dog down at the Dairy Barn.”
  • Use pregnant pauses. Look at his eye with the indirect and say “Oh. Wow.” Then do not speak again until the patient speaks. No, I mean it. Do not speak until he speaks. Go to lunch, read a magazine. Wait. Wait. If he speaks next, he will listen. If you speak first…oh, well, I told you.
  • Whisper. Mumble something where the patient hears only the words “sorry” and “blind” and “too late.” Rub your forehead like it’s a genie’s lamp for additional power.
  • Clear your throat while wiping a tear from your eye. If he asks what’s wrong, just leave the room for a moment. Blow your nose in the hallway. Walk in and put your hand on his shoulder. Then explain why he should try free-form lenses.
  • Pre-appoint. I know it’s old news, but I run into doctors every year who still do not pre-appoint. Yes, some of those pre-appointed patients won’t return as scheduled. Some will “no show.” A few will indignantly call you to ask why you sent them a reminder card because they never scheduled such an appointment.

    But, overall, pre-appointing is one of the best ways to give patients the chance to not be stupid about their eyesight. The Hippocratic oath says it best: “Help make patients not be stupid, stupid.”
  • Take a fundus photo. Patients love photos. Slip a copy in between the pictures of your kids, dogs, cats, birds, cars or grandkids (choose the appropriate category), and when it rolls by and they say, “What’s that?” you just tell them.
  • Get angry. Oh, I know that this may not seem to make sense. I heard a great philosopher say that being angry is like you drinking poison and hoping the other person will die from it. (The great philosopher: David Arquette, circa 2011. Hey, he was married to Courtney Cox! Can the Dalai Lama say that?)
    But anger can work. This week I sort of yelled at a non-compliant contact lens patient “YOU ARE THE WORST PATIENT I HAVE EVER HAD!” He looked shocked, but when he came in to get his new glasses he said, “You know, I am probably the worst patient you have ever had,” like this was his own idea.
  • Mail the patient a liability release form and a self-addressed, stamped envelope. Hey, it won’t hold up in court but, then again, he is probably too much of a doofus to actually sign and return it, so whatever.
  • Tweet. Now, I know all you cyberlosers are amazed that someone of my electro-ignorance would suggest such an exciting new communication portal as a way to bring our patients into reality about their eye health issues—but sorry, I meant “twweeeeettt.” You know, like a bird. How many patients have ever had their doctor whistle during case presentation?

    My family physician has never, ever tweeted—not even once! That’s why I doubt he knows anything at all about my cholesterol. After all, he thinks taking green tree extract and using crystals to cleanse my karma is not as effective as all those prescriptions he throws at me, whistle-less, and HE had a heart attack, not me! (So why is he my doctor? I just know he misses me when I am not around, and so I allow him to hang out once a year.)

These suggestions are just a start. Having spoken to millions of patients and thousands of very brilliant private-practice Doctors of Optometry over the full 200 years of my career (facts provided by the Congressional Accounting Office), I can assure you that your patients do not actually want to go blind. That would make choosing what soda pop to drink quite a chore.