You know what they say about making assumptions, so I don’t think I need to repeat it here. In healthcare settings, however, acting upon preconceived notions is especially careless. It deprives patients of top-quality care and can even put them at risk. Two of the articles in this month’s issue shed light on the possible consequences of jumping to conclusions and making generalizations about your patients.

In “Open Your Eyes to Functional Blepharoplasty” (page 63), we meet a 75-year-old white female, who is under the care of Mary E. Boname, O.D. The patient had a long medical and ocular history. On the visit that is highlighted in the article’s accompanying case report, the patient presented for an emergency visit with a chief complaint of “red eye.” This wasn’t the first time this patient showed up with problems that were made worse by her droopy lids. Indeed, she had significant ptosis and dermatochalasis, which had become a big factor in her ocular discomfort and perceived diminished distance vision.

But medical necessity wasn’t the only thing troubling this patient. On this particular visit, she also expressed an interest in being able to wear eye makeup again. She reported frustration that she had been unable to do so for at least five years. Armed with a central 30-2 threshold visual field test that showed markedly improved visual fields with eyelids taped, Dr. Boname referred the patient for an oculoplastic consult with a local ophthalmologist who performed blepharoplasty.

Today, Dr. Boname’s patient is doing great! Not only is she able to wear eye makeup again, she’s met a widowed gentleman and is in a relationship. In short, the surgery has changed her life in more ways than one.

While it’s true that Medicare will only pay for functional dermatochalasis or ptosis, many older patients are interested in it for cosmetic reasons as well, says Dr. Boname. And, O.D.s are the point-of-entry for many patients who might feel uncomfortable taking that first step. So, don’t assume that elderly patients have no interest in learning more about functional oculoplastic procedures that can also improve their cosmesis.

In “How to Avoid Intraoperative Floppy-Iris Syndrome” (page 55), Leonid Skorin, Jr., O.D., D.O., also warns against making assumptions—this time, about the medications used by cataract surgery patients. As you know, it is essential that you provide a detailed history to the surgeon. One of the key elements of this is, of course, a list of the patient’s current medications. However, when it comes to certain meds, current isn’t all that counts.

For example, the commonly prescribed Flomax (tamsulosin, Boehringer Ingelhein) puts patients at significant risk for intraoperative floppy iris syndrome (IFIS). But, even if your patient discontinues use of this drug, you must inform the surgeon that he was previously prescribed this med, says Dr. Skorin. “IFIS has still been observed in patients who discontinued therapy as long as nine months or even three years before cataract surgery,” he says. That means even if the patient tried it and it didn’t work, the history of taking tamsulosin is critical information for the surgeon. In fact, Dr. Skorin had one patient who developed all the intraoperative changes after taking only two doses of this drug.

Every bit of information that patients share with you is based on their assumption that what they’re providing is what you are looking for. Rarely, will they give you more—even though more is exactly what you sometimes need to keep them safe and make them truly happy. So look beyond age, gender and race when you’re taking histories and counseling or referring patients. It could make all the difference.