Lessons Learned
More Than Book Learnin'
Save yourself some time and trouble: Learn from the mistakes of others.

Jack Runniger, O.D.

"Learn by others' mistakes, because you don't live long enough to make them all yourself." This is a wise adage that I read someplace, and it's why I've devoted many of these Lessons Learned columns to telling you the dumb stuff I did during my optometric career -- so you won't have to make the same mistakes.

Don't learn the hard way

"When one speaks of the art and science of health care, it's the essential melding of the practicality of what works with the scientific rationale," say Drs. Len Werner and Len Press in their excellent new book, Clinical Pearls in Refractive Care.

They also say, "We traditionally refer to these practically acquired guidelines as conventional wisdom, but the contemporary professional literature calls them pearls."

In other words, practicing optometry takes more than just book learnin'. You can either learn what does and doesn't work through the school of hard knocks, or preferably from the lessons that others have learned the hard way.

ILLUSTRATION BY AMY WUMMER

Pearls backed by experience

Among the many "pearls" that Werner and Press mention, I can vouch for the following few because of my own bitter experience:

"If the patient presents with a shopping bag full of unsatisfactory spectacles, you'll probably just add to the collection." When I was new in practice, a CPA came in for an exam with the complaint that no eye doctor in town had ever solved his problem.

"Aha!" I said to myself. "Here's where I dazzle him with my skill. Then he'll go forth into the world and announce that I'm the answer to everyone's prayers!"

To the contrary, after countless hours of sweat and tears, sadder, but wiser, I found that I'd indeed supplied one more pair of unsatisfactory spectacles to his shopping bag.

"The patient's last doctor may have been wiser than you initially thought." Unequal bifocal adds? Under-corrected cylinder? I found that quite often, it wasn't because the previous doctor was a lousy refractionist, but that he had good reasons for what he'd done.

"Be cautious about reducing the net plus power at near with a presbyopic patient." Years ago, an elderly man came to me complaining about new glasses he'd obtained elsewhere. He'd been wearing +2.00 with a 2.50 add, and his new prescription was +1.00 with a 2.50 add.

"I just can't read as well with these new glasses," he told me. "But the other doctor said that if I could get a more satisfactory pair elsewhere, then he'd refund my money."

I prescribed the +1.00 he needed for best distance visual acuity with a 3.50 add to give him the same total plus for near that he'd been accustomed to. This solved the problem, but the former O.D. wouldn't give him a refund and said I'd cheated by using the 3.50 add.

"Follow the generic therapeutic rules." Some of these are:

• Remember, it's difficult to improve on an asymptomatic state.
• If it ain't broke, don't fix it.
• If it's working, keep doing it; if it isn't working, stop doing it.
• Above all, do no harm.

Other places to find pearls

I highly recommend Werner and Press's book as a source of clinical pearls that will save you all kinds of headaches and glorify you in the eyes of many of your patients. Another great source for these pearls is The Fine Art of Prescribing Glasses Without Making a Spectacle of Yourself, by ophthalmologists Ben Milder and M.L. Rubin.

Of course, you can always instead opt to learn the hard way.

JACK RUNNINGER, OUR CONSULTING EDITOR, LIVES IN ROME, GA. HE'S ALSO A PAST EDITOR OF OM.