reflections THE HUMAN SIDE OF OPTOMETRY
The Controlling Patient
What can an optometrist do when the patient tries to take over the exam?
ANGELA E. NICOLINI, O.D., ABILENE, TEXAS

Everyone is controlling to some degree. We've either learned this as a basic response to life from our upbringing or from having a life-changing situation rob us of our peace of mind. Or possibly it's just an ingrained human trait, much like our will to live.

PHOTO BY SUZA SCALORA

It's just human nature

We all have minor power struggles every day in our offices. We see patients who are so controlling that they try to take over the eye exam and lead us through it. Here's an example we're all familiar with:

"Which is better, one or two?" I'll ask a patient.

"One," they'll reply.

Then I switch to, "Now which is better -- three or four?"

"One was better."

I have to explain then that "one" isn't a choice this time.

Here's another example of how patients try to control the eye exam:

"Okay," I'll say, "let me put the phoroptor in front of you and let's get started. Can you read any of those letters there?"

"Yes, but they're blurry."

"This is just a starting place. I need to know what letters you see there."

"O, F, L, C -- but they're blurry."

Again I'll say, "This is just a starting place. We have about one hundred more lenses to flip through before it gets clear." Some people do then comply -- others just repeat the same phrase after reading each line.

Do you know this variation?

"Which is better, one or two?"

"No."

"No, neither are better, or no, one is better?"

Now for my last exam-time gem:

"Can you read those letters?" I'll ask the patient.

"Yes." Silence.

"Okay, read those letters."

"Oh, you want me to read them out loud?"

Dealing with denial

We all see this every day -- patients around 40 years of age who dread coming to see us because they don't want to hear that they need the "b-word." I've seen too many who say, "Dr. So-and-So made me get bifocals last time, even though I didn't think I needed them and now my eyes seem worse. So that's why I'm coming to see you."

Usually, I'll trial frame each presbyope to show them the difference between relaxed vision and vision where their eyes feel like they're going to pop out of their heads. If the patient is in such intense denial that even that tactic doesn't work, I let them off the hook with "Well, I guess we'll buy you another year then." They leave my office happy that they succeeded in controlling life -- and the doctor -- by warding off the aging process.

Call in the deprogrammer

So how do we deal with controlling patients? We can try to let go of our own egos and realize that they aren't trying to make us feel stupid or inept. Then we can work on reprogramming their belief systems. (Thank goodness for my minor in psychology!)

DO YOU HAVE A MEMORABLE EXPERIENCE YOU'D LIKE TO SHARE? DISCUSS YOUR STORY WITH RENÉ LUTHE, SENIOR ASSOCIATE EDITOR OF OPTOMETRIC MANAGEMENT, AT (215) 643-8132 OR LUTHER@BOUCHER1.COM. OM OFFERS AN HONORARIUM FOR PUBLISHED SUBMISSIONS.