Should I be troubled by this odd eye exam?

In My Humble Opinion
1

I saw an opthamologist today about having cataract surgery. Generally, I would say it was an uncomfortable meeting – he did not inspire any warm fuzzy feelings of safety and confidence in me. But I have heard nothing but good about his surgical skills.

What stuck out was this – IIRC, it was the only exam I’ve ever had with no directions about where to look as he shined lights in my eyes and observed my eyes though some kind of scope.

All the other exams I had, the doc told me things like “Look up”, “look at this point”, etc., as my head sat in that contraption and they shined in various lights and looked around.

This guy just looked and moved the lights around silently, where and when he pleased. My eyes were blinking and tearing up, and a couple of times I had to look away because it was painful. I asked him, “Where should I be looking?” He responded, “You’re doing fine.”

OTOH, I had just had the same exam a couple of weeks back by the optometrist who referred me to him, and this new guy had that report. Also, before the surgeon came in, some other technician had done some preliminary exam, complete with eye shining and instructions to me. So maybe the surgeon was looking for something else, maybe even how my eyes react under some distress.

There were other, er, I’m not sure what to call them – disappointments as well. I wanted to discuss the possibility of using the newest technology – so-called accommodating lenses – and he says they are too new, and mentioned some problems, and offered to send me on to another doc if I wanted to go that route as he wouldn’t do it.

And another exchange about anaesthesia when he seemed pretty dismissive and almost contemptuous about questions I had about doing the procedure under a general rather than local one.

What it boils down to is that I’m trying to decide whether my little mental alarm bells have any basis in reality. If I look around for some surgeon I’m more comfortable with, I will undoubtedly set back the clock on getting the surgery I really need – in the last 4 months, my eyes have gotten so bad that I can’t drive or read books. And it’s getting worse fast.

So help me decide if my jitters should be put aside or acted on.

2

I think that you only have one pair of eyes. Your not comfortable with this doctor for whatever reason and I really recommend that you continue to see doctors until you find one that your truly comfortable with and someone that will answer your questions. Trust your instincts, and remember your paying them.

I don’t know about WI but I live in NJ and there are lots of University hospitals in Philadelphia. Philadelphia Magazine publishes a Top Docs issue every year and they list top doctors from every specialty. That’s where I usually look to find specialists.

Do they have anything similar in your area?

It’s understandable to be nervous about cataract surgery and you should really find someone your comfortable with and will take the time to answer all your questions.

3

Here’s a list I found of Top Doctors in Wisconson and there are a few Opthamologists on the list

http://www.mcw.edu/display/router.asp?docid=16710

Here’s another list

http://www.madisonmagazine.com/article.php?section_id=918&xstate=view_story&story_id=224195

4

These are your eyes. Even if it delays things a bit, I’d find a doctor I was comfortable with if I were you. He is probably a perfectly good surgeon but if you aren’t happy with him then it’s time to look for another.

(I’d want to be put out completely too. The thought of eye surgery awake creeps me right out, even if it’s the norm.)

5

IME, the really good, technically outstanding surgeons are complete and utter asshats. I’ve never dealt with anything that advanced rapidly, but I’ve had very good luck with crossing my arms, giving the doc my best “mommy” look (if you aren’t a mother, it’s a lot like your “Thank you so much for your input, now say something or shut up before I think of an excuse to fire you” look, which, when you think about it, is exactly the situation.) and saying “Okay, sweetie. You’re Doctor Hotshit. I get that. However, these are MY eyes” <switch to snotty voice> and you’re gonna have to reach deep down inside and conjure up a little more info and, perhaps, a bit of tolerance for us peons, 'kay?" Then smile politely.

10 to 1, he will blink at you, and then make an effort to act like a civilized human being. The other 1 will announce that he is the very best and he doesn’t have to put up with this shit.

Then you will have enough information to decide.

6

Hi. Will you marry me? I totally want you on my side for anything that comes up, ever.

7

My guy is on the Madison Magazine list. I wish there was an explanation of how the list was created.

Truthfully, I would rather have a really competent asshole than a real sweetheart who makes more mistakes.

It was his odd “browsing” of my eyes that planted a bug in my head that maybe he might be a little careless. Has anyone else experienced that? I’m nearly 50, and I’ve had glasses since grade school, and I can’t ever recall an exam quite like it.

Does anyone know the actual purpose of giving a patient directions like Look Here or look Up? Is it necessary for the doc to get a thorough view of the eye? Or is it more about sparing the patient discomfort by directing their view away from directly into the light? I would be happier with the latter answer, but maybe more interested in getting a general anaesthesia if he’s not much interested in sparing me discomfort.

8

I’m sheer hell to live with, but I might be available as a freelance advocate for a nominal fee. :smiley:

Seriously, to the OP, don’t be intimidated by snotty surgeons. They are well educated and experienced, but it’s your body. You’re Doper. You can do this. Educate yourself on the likely outcome, the success rate of Dr. McPoopyhead, don’t focus on worst-case scenarios, and insist on being treated as a partner in your healthcare decisions.

9

I’ve never gone through anything like you’re experiencing, but when I was doing the prelims for my Lasik, I got that. Every other opthamologist (glasses since 4th grade) I’d ever seen made me look up-down-left-right several times each. The last guy before they zapped me did not. I put on my Bitch-hat, so he explained that the left-right-up-down was to for the doc to get a good look at my eyeball, and since all the other docs had not noted anything else out out of the ordinary, he could concentrate on the flaw, which he could see without the up-down-left-right stuff. Turns out, I have a minor flaw in my lens that is very visible while I’m looking straight ahead – looks like a little canyon, doesn’t affect the procedure or my sight, no big deal.

It’s very possible that Dr McPoopyhead saw what he needed to see, without making you look all around. He should have told you that, however.

(everything, including both enhancments, went perfectly, and I still have the little canyon in my left eye.)

10

I work in an ophthalmology department, but IANAD/N.

Which exam are you talking about, the one where you put a chin in a rest and he looks into a scope-thing mere inches from your face, or the one where you recline in the big chair, he straps on a head lamp, holds a lens in front of your eye, and looks through it into your eye?

Anyway, you’re being evaluated for cataracts. The looking-all-around bit during the latter exam is mostly to examine your inner eye and especially the retina, which has nothing to do with them. (And depending on how bad your cataracts are, he might not even be able to see your retina through them.) My somewhat-better-than-layman opinion would be that since it’s a pre-surgery evaluation he wasn’t that interested in anything other than the cataracts and thus didn’t need you to do the eyeball aerobics.

11

Was he checking your eye with a retinoscope like this?
http://www.lpoproducts.com/Products/LPO64.asp

He was probably checking to see how healthy your eye is and checking your retina but he should have at least explained what he was doing. Lots of medical problems can be diagnosed through your eyes and the more he knows before the procedure, the better.

This is one of the reasons I always go in with my husband when he goes to the doctor or has an exam. I know he won’t ask questions and I don’t have a problem doing that.

I’d still see another doctor and make sure it’s someone your comfortable with.

12

I think this attitude is fairly common among doctors and dentists.

13

My own experience has also been that surgeons in general have bedside manner of a raccoon who smels him some fish heads. That is to say, they are intent on one thing and one thing only and have absolutely no attention for anything else. They also tend to be very ahem secure in their own competence and contemptuous of the ignorance of others. Decisiveness to the point of abruptness is also common.

However, these are in some way occupational hazards – hacking into a living human body is not attractive to the faint of heart or the thoughtful and conteplative.

I have also had very good results with just calling them on it, directly and baldly. Most of them do not appear to be really aware of how they come across to the masses.

14

It’s my understanding that, generally, it’s preferred to do cataract surgery with a local anesthetic and light sedation. Going completely under with a general anesthetic means more time in hospital, longer recovery, and complications that are possible anytime someone has general anesthetic.

I did a little searching and found this journal article abstract:

And another journal article abstract, which states:

15

I would just come out and tell him what you need from him. If he has been doing this for a while many of the things that are new and scary to you are common to him and he may forget that from time to time. I work in insurance and every so often I catch myself being a little less helpful than I could be to people who don’t research it on their own before they sign up for an insurance policy. I just have to remind myself that not everyone researches things the way I do or has time to learn all the details of the insurance world and they need help. I have only been doing this for a little over a year. If I had been doing it for 20 I can see myself being a lot less helpful and expecting more out of people the same way the doctor does, not only because it seems so simple to me but because it is so important I would expect people to have taken some initiative of their own. Just remind him you didn’t spend all that time in med school nor have you been a practicing surgeon and you need a little more information. He will probably be an open book from that point forward.