graphic by Karla durangprang
Has a technician crossed the line when he warns a reckless patient of over-wear dangers?
This article originally appeared in the October 2015 edition of INVISION.
Brookside Vision Services, located in a sleepy hamlet in eastern Ohio, was a well-known resource for contact lens fittings. Dr. Omura’s last patient of the day was Patty Bouchard, a new patient in her early 20s. Richard, the technician, pretested Patty and interviewed her about her contact lens wear.
“How many hours a day would you say you wear your lenses?” Richard asked, ready to enter her responses into the computer.
“Oh, all day,” Patty said. “I live in my lenses.”
“So, is that 16 hours a day? Maybe 7 a.m. to 11 p.m.?”
Patty cutely shrugged, and said somewhat proudly, “Overnight.”
Richard checked the empty, tattered box of contacts Patty brought from home. “How often do you sleep in your lenses?”
Squinting in thought, she replied, “I keep them in for a few months, until I start to feel them.”
“And when was the last time you had an eye exam?”
“It was ... 2012? 2013?”
Richard stopped typing and turned to Patty. “Contact lens prescriptions expire in a year, and these lenses are approved for only two weeks. How did you ...?” Richard paused, perplexed.
“My vision has been the same for a long time, so I just reorder online. Once my cousin gave me a box of a different brand, but the numbers were pretty much the same. I just need to see the doctor because I can tell my eyes have really changed,” Patty said. She was clearly pleased to have gamed the system.
But Richard felt like he had identified a criminal. He rushed to complete the pre-exam and report to Dr. Omura.
“She’s not responsible enough for contact lenses,” Richard told the doctor. “She’s just going to keep abusing them and she’ll end up with serious problems.”
Dr. Omura gently dismissed Richard, simply saying, “We’ll see.”
Several minutes later, Dr. Omura emerged and asked Richard to pull trial lenses and put them in Patty’s eyes. Richard was incredulous, but he retrieved the lenses and returned to Patty’s exam room. Her contacts were out and she was texting, her smartphone 6 inches from her nose. As he washed his hands, Richard couldn’t help himself.
“It’s dangerous to wear contacts for so long,” he said. “I saw a patient last week who slept in the same pair of lenses for months and they caused an ulcer. He’s basically blind and has to get a corneal transplant from a cadaver.”
Patty looked up incredulously. “No one ever told me that!” Then she turned back to her phone to search the Internet for images of “eye ulcers.”
Richard felt sure he had set Patty straight. He may even have saved her eyes. After finishing his duties, he left and told Dr. Omura the patient was ready.
Two days later, Dr. Omura called Richard into the practice manager’s office. Patty had posted a negative review online describing how her doctor neglected to inform her of the dangers of wearing contact lenses and she had to hear it from the “assistant.” Richard explained what he had said to Patty in private.
“Why would you scare the patient like that?” Dr. Omura said. “You should have told me what you had said!”
Richard was stunned. “You knew she was non-compliant. She needed to hear it before something bad happened!”
Dr. Omura’s face turned red and Richard knew he had crossed the line — big time.
THE BIG QUESTIONS
1. Should Dr. Omura fire Richard? If not, what should happen?
2. As Patty’s doctor, how would you have handled her non-compliance?
3. How might the practice approach Patty to address and perhaps edit what she wrote?
REAL DEAL RESPONSES
DR. GIGI C.
DR. JOHN D.
ST. LOUIS, MO
SAN FRANCISCO, CA