Twelve months of planning went into this, our 5th Annual Dry Eye Report. Our editors and board members studied the topic extensively to uncover the hot-buttons, so to speak. We questioned your colleagues, reviewed the new literature, attended seminars and spoke with manufacturers. Now that all is said and done, if I had to pick one statement that Ive heard more often than any other in relation to dry eye it is this: The signs dont always match the symptoms.
As youve likely experienced in your own practice, a patient can present with significant discomfort, but your exam may not reveal parallel findings. Similarly, a patient can present with significant staining, but no subjective symptoms.
Is the latter patients case of greater consequence? Some might argue that, clinically speaking, it is. However, most would also maintain that its just as important to find an effective treatment for the symptomatic patient as it is to resolve the staining in the patient with clinical signs. Theres a lesson to be learned here that goes beyond dry eye and extends into all patient encounters.
As you know, every patient presents a unique challenge. But when objective measures fail, the challenge is even greater because you have to get inside the patients head and translate what they subjectively feel into what you objectively know. For part of this exam youll have to step out of the doctors coat, beneath which most things can be scientifically explained, and step into the untrained mind of your patient. This requires trust, patience and an open mind. But more importantly it requires empathy on your behalf.
Empathy is not always pleasant, particularly when it requires us to look at ourselves with skepticism. And, Im sorry to say it, but that is how some patients view doctors. Certainly, you have the right not to see these patients, but someone eventually must care for even the most demanding, unreasonable, ornery patients. This was a point I tried to make in my December editorial, which was met with some harsh criticism.
Still, the message Im trying to get across is simply this: Yes, you are an experienced clinician. You know it. Your colleagues know it. And, if youre lucky, most of your patients know it. But, lets face it, they dont all know it. And the reason they dont know it is because they are not privy to all that you know about vision and ocular health. This is why every word you say to them is so important.
Going back to the dry eye example, imagine the symptomatic patient is sitting in your chair. Shes explained her discomfort and youve told her that you found no measurable signs of dry eye, nothing out of the ordinary. Perhaps youve recommended drops, but the patient doesnt intuitively know why, since you told her everything looks fine.
Now try sitting on the other side of the chair. Suppose you made an appointment with your primary-care physician because youve been having chest pains and youre scared. He agrees to run some tests, but the results dont show anything. Meanwhile, youre still having chest pains, which your doctor has failed to explain. How long will you let it continue before you see another physician?
Imagine how different both of the above encounters would have been had the doctor provided just a little more explanation.
The dry eye patient knows she has symptoms. If you simply tell her that you dont see a problem, without elaborating, she may silently blame you for failing to detect her presumed condition and seek care elsewhere. But had you taken an extra moment to explain that many dry eye patients have normal test results, you would have inspired confidence because the patient would understand that you are familiar with her condition.
Ignorance breeds skepticism, which hurts both you and your patient. Before you rush out of the exam room, consider your patients perceptions. Think about how it would feel to be an outsider with respect to your own health. Hopefully, your willingness to empathize will inspire you to educate.
