i have this problem with dilated eye exams, i think. IMO
too many people are dilated too often. i'm not "anti-dilation", far from it. i dilate quite a few patients every day.
but i DO NOT dilate every patient at every visit. IMO thats way, way overboard. LOTS of eye doctors are doing this, and defend it vehemently.
i see dilation as being like ordering blood tests. does your primary care provider take blood and order lab tests every time you come in? no, he/she doesnt. not even close! he/she only orders blood tests when:
1) he/she suspects there is some problem that could be found with lab blood tests...some sign or symptom let them to think they need to order a blood test
or
2) you have some condition or situation that puts you at greatly higher risk of developing a problem that could be found/diagnosed with lab blood tests
or
3) its been a long time since your last blood test
you dont start coughing and go to your doc...and he orders blood tests. you dont complain that your knee aches or you have diarrhea or you're losing your hair or you need a vasectomy, etc etc etc ad nauseum...and he orders blood tests. those dont happen. he only orders blood tests when he NEEDS to.
so at some point along the way in the history of optometry/ophthalmology, someone somewhere decided that in order to have a "complete" eye exam, you have to be dilated. so now as part of a "routine" eye exam, many people (and many eye docs) think that you
must perform a DILATED eye exam every time. anything else wouldnt not be the "standard of care". what? why? i dont see the point. "standard of care" by whose definition? some attorney in medical malpractice claims court? this has GOT to be how it all started. somebody's attorney made a trillion dollars suing some eye doc for something he "missed" and the attorney convinced the judge/jury that this problem would have not been "missed" had the eye doc just bothered to perform a dilation. i'm literally sure this is the reason we're all so dilation-crazy.
let me tell you how many times in my career i've dilated someone and FOUND (stumbled upon?) something BAD (retinal hole, tear, tumor, detachment, retinopathy, etc) that i WAS NOT expecting or suspecting BEFORE the dilation started based on the symptoms, signs or risk factors/conditions the patient already had: ZERO. not one time.
now frequently i dilate people based on their complaints/risk factors/clinical signs and i still dont find anything b/c nothing is wrong. for example: a -10.00 myope gets an eye exam and i dilate her and DONT find any signs of retinal problems. ok good! i didnt find anything! i didnt want to! but i dilated her b/c -10.00 myopes are more likely to have peripheral retinal problems...so she had/has a predisposed higher risk for those types of problems vs other patients.
but like this lady ths morning: 50-something year old African-American woman. nothing wrong with her, no real complaints. sees well thru her very-low hyperopia bifocal glasses, just here for an annual, routine eye exam. she had an annual/routine eye exam last year and was dilated at that exam (and nothing was found). and after fairly extensive non-dilated eye testing she was found to still be the picture of perfect eye health. so at the end of the exam she asks "arent you going to dilate me"?
"no", i reply. "you dont need it".
well she literally thought i was trying to "skimp" on the exam and not give her a "thorough" eye exam. i ended up dilating her anyway (she pretty much demanded it) and she left kinda mad. she told me the "last guy" did a more thorough exam. she's been conditioned to think she "NEEDS" a dilation every. single. time. well guess what i found on the dilation? NOTHING. just like i knew would happen before she demanded it. she had no signs or symptoms or predisposing factors that would warrant a dilation. i mean it was just totally wasted time in her case.
i dilate plenty of patients for plenty of reasons, but i'm against dilation for the sake of dilation, or just b/c the AOA or AMA website said that a dilation is needed for a "thorough" eye exam, or b/c a patient "thinks" they "need" it, or even worse just b/c an insurance company deems it necessary before they'll PAY.
i think i'll go across the street and demand my PCP run blood tests. or next time i see him i'll say "arent you going to run blood tests?" naw, i wont. i like Dr. Chang
Comments
Post a Comment