CLINICAL

  PEDIATRICS

PEDIATRIC EYE EXAM BASICS: PART 1

OBTAINING AND EVALUATING THE YOUNG PATIENT’S HISTORY

YOU’VE, NO doubt, obtained tons of patient histories, but acquiring such information about a child is different. This is because the child may not know his or her medical background, requiring the child’s caregiver to provide it.

Here, I provide tips on how to get the most accurate patient history, so you can determine the best course of action during the child’s comprehensive exam.

1 SEND THE PATIENT HISTORY FORM IN ADVANCE

Particularly when the patient is a young child or has special needs, it may be difficult for a parent to answer history questions for the first time while attending to the child’s needs in your office.

For this reason, send the patient history form to the parent to complete before he or she presents to your practice for the exam (see “Key Elements of the Pediatric Case History,” middle column). For school-aged children, see pressvision.com/vision_check_list.php.

A colleague, Dr. Nancy Torgerson, has an excellent set of history forms that the parent or child completes prior to coming to the office. They are available for download on her website at alderwoodvisiontherapy.com/patientforms.

2 HAVE STAFF TRIAGE VIA PHONE

The phone triage, during which your staff learns why the parent is calling to schedule the appointment, is a key component of the patient intake process. We have our staff enter this information into our computer database. This data, together with the case history, lets you, the doctor, know precisely why the child is coming to your office.

A pet peeve of mine is to overhear an extern, resident or new graduate ask a patient or, in this case, a parent, “So, what brings you here today?” If you do your homework, you should be able to tell the parent your understanding of why he or she scheduled the appointment. This is also good practice management, as it lets both the child and parent know you took the time to think about them prior to their walking into the examination room.

3 EVALUATE PRE-EXAM TEST RESULTS

Before you greet the child, your staff has already conducted diagnostic testing. Take a look at those results, along with the history obtained in advance. When you walk into the exam room, make a big fuss about the child. It puts most children at ease when you greet them prior to greeting the parent. Also, tell them what good things your office staff has told you about them. Be sure to banter a little bit before you begin any examination procedures, as this helps put both the child and parents at ease and lets them know you’ve done your homework. For example, if the history form indicates the child has difficulty reading, you might say, “So, Billy, I hear that reading is not one of your favorite things.” Your examination will go a lot smoother with most children if they feel that empathy from you at the outset.

GET SET

In recognizing that obtaining a thorough history is an ongoing process, there are some questions that you’ll be visiting or revisiting during the examination. But once you’ve gathered your preliminary information and are ready to proceed with the exam, especially with a young child, say: “Okay, Billy, are you ready to have some fun?” With the flair that there’s going to be a little magic and intrigue during the exam, you put both yourself and the patient in a good frame of mind. OM

LEONARD J. PRESS O.D., F.A.A.O., F.C.O.V.D. is the optometric director of the Vision & Learning Center in Fair Lawn, N.J. He specializes in pediatric vision. Dr. Press completed his residency program in pediatric optometry at the Eye Institute of the Pennsylvania College of Optometry, and he served as chief of the pediatric unit of the Eye Institute. In addition, he’s a Diplomate of the AAO and has written three textbooks encompassing pediatric optometry and is a Diplomate in the Pediatric Optometry/Binocular Vision and Perception section of the AAO. Email him at visionlecture@gmail.com, or visit tinyurl.com/OMcomment to comment on this article.