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Silly things patients do during an eye exam that bug the heck out of me!

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Author Topic: Silly things patients do during an eye exam that bug the heck out of me!  (Read 3094 times)
wizer
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« on: June 09, 2008, 11:03:11 am »

I will think of more and expand this list as they come up.

- I ask them which lens is better, "one or two" and they read the chart for unknown reasons.
- I give them the paddle and say cover your left eye and they cover the right
- I give them the paddle and I say cover your left eye and they do, and they close the right eye at the same time and wonder why they can't see anything.
- I tell them both choices are blurry, but to choose the less blurry lens and they say, "Doc, its blurry".
-I put dilating drops in their eyes, tell them to sit in the waiting room for about 15 minutes while their pupils dilate..and they go to the waiting room, and they keep going out to their car, and they leave before I recheck them.

Sometimes if a patient reverses left and right I will say, take both of your hands and put them in front of you, and make an "L" with your pointer and your thumb...good...now, which one is the correct "L"? That's your left hand..."

Here's another one....


They come back for their one week contact lens followup, to check the fit, comfort, and vision, but they neglect to wear their contact lenses to the visit. When asked why they didn't wear their contact lenses to their contact lens followup visit they say they didn't know they were supposed to.

Here's another one that patients do...

At the end of the exam, when I have their new prescription in the "refractor" (the instrument that flips the lenses), I usually ask them to compare their present eyeglass vision to whats in the instrument.

So I have them look at the chart through the refractor, then I pull it away and say, "now put your glasses on, and tell me which is clearer". The expected response is, either its much clearer in the instrument, or a little better, or the same (if there hasnt been much of a change).

Sometimes a patient will say "oh, my glasses are much clearer!". And I say, "huh? The instrument should be the same or better, since it reflects your current situation, which we just tested." Then they say, "oh, I mean my glasses are clearer than having nothing in front of me at all!"  Duh...
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wizer
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« Reply #1 on: June 09, 2008, 11:03:22 am »

I am examining this woman, she's looking through the lens flipping machine. I finish the left eye, close it off and go to the right. She keeps telling me she can't see anything.

I finally peer in, and see that her eye is closed behind the instrument. Duh!


I am positioning a patient behind a machine that has a chin rest and a forehead bar. I say, "put your chin in the chinrest and your head against the bar". They put their forehead on the chinrest. Sometimes I just sit there and stare at them in disbelief before I tell them to please pick their head up because that is not what I meant. This happens periodically.

This next one isnt stupidity, it's just funny as hell.

Once in a while when a patient is asked to sit on the stool, they sit down but lose their balance because they don't plant their butts right in the middle and they are too far back. So they start to flail their arms as they start to fall backwards. It's like slow motion..as they teeter on the edge of balance vs falling backwards on their ass. Only one or two have actually hit the ground...but its the anticipation that makes it so hysterical.

That stool has since been replaced with a chair with arms.
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wizer
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« Reply #2 on: June 09, 2008, 11:03:59 am »

Here's another one.

Patients that don't bring their glasses with them to their eye exam.

Um..hello?

By measuring your prior glasses, I can tell the patient if there has been a significant change in their prescription, perhaps I will adjust the new prescription so that it won't be too big a change from what they had before, and I can predict what may happen with their vision going forward based on the changes that have occurred since their last eye examination.

You would think people would know that.
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wizer
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« Reply #3 on: June 09, 2008, 11:04:19 am »

2 more.

1) I say to the patient, tell me which is better, "ONE or TWO". So I flip it, and they say "that's good". And I say, well, I'm glad that it's "good" but I NEED TO KNOW the better choice, ONE OR TWO? I flip it again, and they say, that's ok but its further away...

Sometimes we go back and forth like that for a few minutes..then I pull the refractor away, and I say to them..look, I need to go in a certain direction, and that path is determined by which one is clearer. Your responses are not directing me anywhere because you are being vague and not picking an answer. I need you to simply answer with a number. Got it? And often they will say yes, so I will flip the machine back, and say which is better now, "one or two"..more often than not they will say...they are both pretty good

Then there's the patient who wears glasses all the time, or at least for all distance...at the conclusion of the exam, I say, ok, you need new glasses, and since you have no sunglasses, I recommend those, for driving, and to protect your eyes from the harmful UV rays of the sun..and they will invariably say, "do they need to be prescription"...um...yes they do...
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wizer
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« Reply #4 on: June 09, 2008, 11:05:04 am »

Ok, this one is really a silly thing that I do, not the patient:

Sometimes I will be examining an old lady..I will gently take her hand, and walk her over to the stool, position it just right, and help her into a sitting position. Just as she is about to settle onto the stool, I have to fight the urge to pull the stool away. That's messed up, I know.

 Sad
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wizer
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« Reply #5 on: June 09, 2008, 11:05:27 am »


Occasionally, when I have a well endowed attractive female in the exam chair...because I am standing over her, and oftentimes she is slightly leaned forward to look in the lens machine...and her eyes cannot look towards me..I play "find the nipple". Its a matter of getting the angle just right and peering directly down into her shirt. Sometimes an adjustment of the instrument is necessary...but it gives me something to do while I am flipping lenses, and no worries...it does not affect my concetration or accuracy in any way.

Nipple discovery is more difficult than you might think...I might have been partially succesful once...otherwise, it's been a complete failure..but like the mouse trying to find the cheese in the maze, it's the anticipation that keeps me going.

Anyway, one day I was examining this old lady...and she was wearing one of those pajama type tops that old ladies wear, and it was wide open...and out of pure habit...I looked...and I was so shaken that I had to cancel patients for the rest of the day.
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wizer
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« Reply #6 on: June 09, 2008, 11:05:51 am »

Here's another...

I just got a new "perimeter". It's an instrument that measures peripheral vision. The patient is seated at the console, with their head against the forehead rest, and they hold a "response" button.

The instructions I give to the patient are: Follow the red light, and for every green light you see, press the button once.

When the test begins, there are 4 green lights arranged in a square around the red light. So, how many times do you think you should press the button:

a) none
b) once
c) four times

I have gotten all three responses from patients. You would think they would know that (c) is the right answer but again, people just aint so bright.

Now I go to the extra step of saying "On the first screen you will see as many as 4 green lights. If so, push the button up to four times. Don't forget to breath, eat, and drink water on a regular basis or you will die".
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wizer
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« Reply #7 on: June 09, 2008, 11:06:13 am »


I hand them the "occluder". It's a paddle, with a curved round cup at one end to cover the eye, attached to a long handle. I tell them to "cover" one eye. As I said in an earlier posts, sometimes they cover one eye and close the other and wonder why they can't see anything. This last patient did something that I have seen a handful of times and it makes me wonder how she has enough brains to pour a bowl of cereal or make ice.

She takes the occluder and instead of holding it vertically, she holds it horizontally, so the handle is going across one eye and the cupped circle is over the other, which of course also prevents her from seeing anything.

Sometimes I just sit there and stare, and wait for them to realize just how stupid they are. They usually don't.
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GoodWitch
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« Reply #8 on: June 09, 2008, 11:03:15 pm »

LOL!!!!  I can practically do my own eye exams! All the Dr. has to do is write down the numbers. I'm well-practiced. I could probably do my own mammograms, too, for that matter.
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wizer
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« Reply #9 on: June 10, 2008, 09:23:22 am »

LOL!!!!  I can practically do my own eye exams! All the Dr. has to do is write down the numbers. I'm well-practiced. I could probably do my own mammograms, too, for that matter.

Well..if the doc writes down the numbers...then the exam is pretty much finished at that point...that's where the lens flipping comes into play..and no, it's not really all that difficult to flip lenses and say "which is better one or two", the key is communication and understanding that patients don't always communicate well, and then when you arrive at a final number, what changes to make so the patient can adjust to the new glasses...rarely is the full Rx given...
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« Reply #10 on: June 10, 2008, 09:36:13 am »

LOL!!!!  I can practically do my own eye exams! All the Dr. has to do is write down the numbers. I'm well-practiced. I could probably do my own mammograms, too, for that matter.

Well..if the doc writes down the numbers...then the exam is pretty much finished at that point...that's where the lens flipping comes into play..and no, it's not really all that difficult to flip lenses and say "which is better one or two", the key is communication and understanding that patients don't always communicate well, and then when you arrive at a final number, what changes to make so the patient can adjust to the new glasses...rarely is the full Rx given...

What bugs me is how they try to make recommendations from what the machines tell them and not from what I actually see. I had one tell me I had no astigmatism in my right eye, and gave me a weaker prescription than what I was wearing. Needless to say, I couldn't see a thing. Then I had to wait 2 weeks for replacement glasses! I tell them now, in no uncertain terms, "Make me read the eye chart with my glasses on. If I can see it well enough, LEAVE IT ALONE." LOL
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wizer
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« Reply #11 on: June 10, 2008, 09:41:28 am »

What bugs me is how they try to make recommendations from what the machines tell them and not from what I actually see. I had one tell me I had no astigmatism in my right eye, and gave me a weaker prescription than what I was wearing. Needless to say, I couldn't see a thing. Then I had to wait 2 weeks for replacement glasses! I tell them now, in no uncertain terms, "Make me read the eye chart with my glasses on. If I can see it well enough, LEAVE IT ALONE." LOL

Yes, I see wrong prescriptions all the time...astigmatism left out of the Rx, astigmatism at the wrong degree, or the patient has none and its given to them...either the exam was rushed, or there was miscommunication between the patient and the doc, or he wrote down the wrong numbers, or a mistake was made during the fabrication of the glasses...there are lots of ways to screw it up.

2 weeks to redo glasses? That's a long time, even if you get antireflective treated lenses which usually take longer to make.

1-3 days turnaround on average should be about right.
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wizer
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« Reply #12 on: July 04, 2008, 11:30:51 am »

This patient I just examined gets not one but two nominations.

1) During the visual field test, one eye is covered by a plastic eye patch, secured with an elastic band. After the first eye is done, I slide the patch over to the other eye, and test that eye. This guy had removed the patch by the time I got back to the instrument, and I said, "lets patch the other eye". So he reaches for a different patch that is sitting near the instrument and says "is this the one for the left eye".

2) This dude wears glasses for nearsightedness. That means his distance vision is blurred. I am his eye doctor, and I know that when I ask him to read the chart, that it will be blurry. I am simply measuring his uncorrected vision. So I keep going to larger and larger letters, finally he can read some of them, but at the end of each line that he reads he says "but its still blurry doc"...um...I know that its blurry, just because you are reading larger letters doesnt change the fact that your distance vision is blurred when you arent wearing your glasses...
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« Reply #13 on: July 06, 2008, 04:15:24 am »

This patient I just examined gets not one but two nominations.

1) During the visual field test, one eye is covered by a plastic eye patch, secured with an elastic band. After the first eye is done, I slide the patch over to the other eye, and test that eye. This guy had removed the patch by the time I got back to the instrument, and I said, "lets patch the other eye". So he reaches for a different patch that is sitting near the instrument and says "is this the one for the left eye".

2) This dude wears glasses for nearsightedness. That means his distance vision is blurred. I am his eye doctor, and I know that when I ask him to read the chart, that it will be blurry. I am simply measuring his uncorrected vision. So I keep going to larger and larger letters, finally he can read some of them, but at the end of each line that he reads he says "but its still blurry doc"...um...I know that its blurry, just because you are reading larger letters doesnt change the fact that your distance vision is blurred when you arent wearing your glasses...

With my left eye, I can't make out the big E on the eye chart. My right eye has glaucoma damage to the visual field. I'm lucky I can still get around LOL
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wizer
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« Reply #14 on: July 06, 2008, 09:01:45 pm »

With my left eye, I can't make out the big E on the eye chart. My right eye has glaucoma damage to the visual field. I'm lucky I can still get around LOL

You're not kidding. Another member on this board has glaucoma too. She is self medicating by smoking lots of pot.

The pot won't stop the glaucoma, it will stop her from caring about losing her vision though.

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