Re: How do you select an eye surgeon for cataract surgery?

On 3 Jun 2006 05:44:11 -0700, "Dr. Leukoma" <drg@xxxxxxxxxxx> wrote:


Anon E. Muss wrote:

Medically necessary or mandatory ones -- ones that if they are not
done incur relatively high odds of morbidity/mortality -- such as
retinal detachments, coronary artery bypass, acute appendicitis, etc.
would be ones I recommend.

Cataract surgery should be easy to lump into that category, since a
cataract ultimately causes visual morbidity. As I said, only the
timing is elective, and some patients do not outlive their cataracts.

Visual morbidity, like pain, can be very subjective in its impact on
an individual patient although visual acuity is objective. Two people
who have the same visual acuity can have vastly different subjective
impact -- one of these people can have no complaints, the other can be
suffering tremendously.

Sure, I can look at the two different patients after a careful and
detailed history and think I would "recommend" person A get cataract
surgery and patient B shouldn't.

I really don't come across to my patients this "cold" and objective
like I appear here. I empathize and I make it pretty clear which way
I think they should go, but I am careful not to give them anything
that would appear to not give them ultimately the choice of whether to
have an elective surgical procedure.

Perhaps a good analogy would be how an OB/GYN manages labor pain. From
my limited experience, they don't say, for the most part, "I recommend
you have an epidural or spinal block". They say, "Do you want an
epidural?" They allow the patient to decide what their pain tolerance
is and ultimately let the patient choose whether they want the pain
medication.

I'm sure if the patient is screaming in agony, then they will up it
from an offering to a recommendation.

If I had a patient with cataracts who was terrified of surgery but was
bumping into walls because he couldn't see, I would tell that person I
"recommended" cataract surgery. Or if I had a person who absolutely
refused to give up driving, had 20/80 vision, and was hesistant to
have cataract surgery, that they "needed" or I "recommended" cataract
sugery.

I would also be careful to fully document in the chart the reasons why
in great detail.

I feel like you have really stretched the definition of 'elective' and
'medically necessary' beyond their common usage.

Point taken.

Even ones I don't recommend, such as nearly all cases of refractive
surgery, I may say (after the patient decides after being explained
the pros and the cons), "that's exactly what I would do if I were in
your shoes". I am a big believer in refractive surgery for the right
patient -- our office has comanaged at least 300 such patients.

Hmmm. That would seem to be a significant business for your office.

It is. It is just another option for my patients. Most of the time,
choice is good.

With the advent of great refractive surgery procedures, in particular
PRK and LASIK, I think it is a disservice to not offer these
procedures to potential candidates in the same way it would be a
disservice to not offer contact lenses as an option to my spectacle
lens patients.

I tell my patients that 15 years ago if you came into my practice and
you were a -5.00D myope, you had 3 options: (1) Do nothing, (2)
spectacles, or (3) contact lenses.

[Although there was RK, I never recommended it (note: although I don't
"recommend" elective refractive surgery, there are many times I
strongly "DO NOT RECOMMEND" refractive surgery), and I tell them why.]

Now, I tell them they have one more option, "refractive surgery". I
discuss the pros/cons, risks/benefits, and potential complications of
all of their options and ultimately let them decide as long as they
are a good candidate.

Is this a national trend for optometry do you think?

I would think so. And in my area, anecdotally other ODs tell me the
option of refractive surgery options has been a win:win situation for
their office and patients.

It definitely has been a win:win situation for my office and patients.
.

Relevant Pages

  • Re: How do you select an eye surgeon for cataract surgery?
    ... the patient who choses NOT to have cataract surgery in most cases. ... In a real sense, every surgery is elective. ... strongly recommend against not having those treated. ... "elective" aspect is how much vision loss is tolerable to the patient. ...
    (sci.med.vision)
  • Re: How do you select an eye surgeon for cataract surgery?
    ... you would be on stronger legal grounds recommending cataract ... patient whom you "non-recommended" having LASIK and the patient didn't ... the patient who choses NOT to have cataract surgery in most cases. ... strongly recommend against not having those treated. ...
    (sci.med.vision)
  • Re: The Placebo Effect
    ... unnecessary elective surgery - nonemergency procedures performed as ... Heart patients here are six times more likely to have a ... have been hampered by a lack of consensus among doctors concerning the ... the Medicaid and Medicare programs - at a cost of $4 billion. ...
    (misc.health.alternative)
  • Fibromyalgia - recommend USANA which is also in Physicians Desk Reference
    ... recommends to his patients are at bottom of page. ... Fibromyalgia/chronic fatigue is a disease of exclusion. ... I recommend that all my patients take the basic nutritional support I refer ... Minimal support for Cellular Nutrition: ...
    (alt.med.fibromyalgia)
  • ANESTHETIC AWARENESS Waking up during surgery
    ... TheStar.com - Health - Waking up during surgery ... Patients who regain consciousness during surgery, ... Her article Lifting the Fog Around Anesthesia, ... Carol Weihrer recalls waking up during eye surgery nine years ago. ...
    (sci.med)