lessons learned

A Tale of Two Chickens

Even when you don’t know the answer, there’s no need to bluff

JACK RUNNINGER, O.D.

This column is an abridged version of a “Lessons Learned” that was originally published in November 1995. (Dr. Runninger has written in some optometric journal every month for 41 years.) He will write his final “Lessons Learned” column in the next issue of OM.

“Do you have a five-pound chicken?” a customer asked the butcher late one afternoon.

“Yes, ma’am,” he replied. He knew the only chicken he had weighed four pounds, but he was anxious to get rid of it before closing time. So he placed the chicken and his thumb on the scale and pressed sufficiently for the scale to register five pounds.

“Do you have one a little larger?” the customer asked.

“Yes, ma’am,” he replied as he whisked the chicken back under the counter. Pretending to bring out a second chicken, he instead brought out the same one. Placing the chicken on the scale and pressing his thumb a little harder, he made the scale register six pounds.

“That’s fine,” said the customer. “I’ll take both.”

As this example demonstrates, bluffing will get you nothing but trouble. But what would you do with the following case?

Is it eye strain?

“I’m having frequent headaches and came to see you to see if perhaps they’re being caused by eye strain,” says Joe Doakes, a 28-year-old patient.

After an examination, you find that Joe has a minor vision problem that may or may not be contributing to his headaches.

“Gee, I don’t know if you need lens correction or not because I’m not sure it will help with your headaches,” seems an extremely wishy-washy approach. Yet you do not want to bluff with a firm statement that a prescription is or is not appropriate when you’re not sure.

Darrell Carter, clinical professor emeritus at U.C. Berkeley, once spoke of his method of handling such cases. I find it works beautifully and heartily recommend it to you.

“I found a minor vision problem, Mr. Doakes,” you say. Then you describe and demonstrate the problem to him.

“I can’t be certain that the vision problem is enough to be causing your headaches. However, I estimate there is probably a 50/50 chance that prescribing corrective lenses will help eliminate them. Are the headaches bothering you enough to warrant my prescribing the lenses on the 50% chance it will help?”

And the answer is...

Almost invariably, I get one of two responses:

“Yes, the headaches are really troublesome, and if there’s a 50% chance glasses will help, I want to get them.”

Or: “No, they’re really not that bad. I just wanted to make sure my eyes are O.K.”

Your decision to prescribe, then, is made for you without the necessity for guessing or bluffing. OM

JACK RUNNINGER, OUR CONSULTING EDITOR, LIVES IN ROME, GA. HE’S ALSO A PAST EDITOR OF OM. CONTACT HIM AT RUNNINGERJ@COMCAST.NET.