Let me preface by saying that I love optometry. I love what I do, and I enjoy clinical care and interacting with patients (shameless plug: check out my last article Tips on Engaging Patients for Effective Exams). That being said, there are some things that make my blood boil during exams! Hopefully you’ll relate to some of these pet-peeves:
Patient comes in with -0.50 DS.
You: So, how has your vision been?
Patient: [takes of glasses and smiles at you] “Oh I’m blind” …
I’m not sure what traumatized this patient at his last visit but he is deathly scared of the NCT. Everything is believed to potentially be the dreaded air-puff: the phoropter, the retinoscope, the transilluminator, the Goldmann tonometer (well…)
Memory Jog When The Attending Walks In
There can be no chief compliant and a perfectly normal HPI, but as soon as your attending comes in asks how the patient is doing he responds, “Oh Doc I’ve been having these really strong headaches and I have blackout vision episodes a few times a day” …
Pain Scale – 10/10 With A Smile
Do you ever get the patient where every test that requires grading the severity of something results in an instant 10? Headaches? “Oh haha, yes 10/10.” Painful eye, 10/10 with a smile…
These patients believe they understand everything or know it all…but they don’t.
“I didn’t wear my glasses because I wanted to make my vision better.” Huh?
I also had a patient with a small CHRPE and I described it to him as a freckle. He responded, “Oh yeah I’ve seen it when I look at my eye in the mirror.” …
The Preemptive Eye Closer/Eye Rollers
Another pet-peeve is when I’m evaluating the health of the back of the eye with a 78D lens or BIO with the illumination set on the lowest setting, and the patient’s eyes roll to the back of their head. It drive me nuts! “Sir, look straight ahead.” “But I am looking!”
Can I See That Again? (1 Or 2)
Performing the JCC section of a refraction is usually the longest part of an exam. No matter what options you give patients, they always need to see the two choices again to decide. My favorite phrases include: “Can I see it again?” “One more time?” “I didn’t get that?” “Ummm.”
“So What Are You Studying For?”
Just making small talk with your patients and you tell them you’ve moved into the city for school, and they ask you “So what program are you studying for?” All the while I’m standing in front of them demo-ing their prescription in a trial frame…
Patient That Comments On The Blurriness Of Everything
This is the patient that thinks they are helping you out by telling you how blurry things are AT ALL TIMES!!! While I’m doing retinoscopy I hear, “Oh it’s blurry, the red is kinda blurry, oh now it’s the green, wait no red, it’s just all blurry.”
I Can Read All Of The Letters! The ABCs
You: Can you read the smallest line of letters that you can see?
Patient: [starts from the biggest line possible and practically recites the alphabet]
“Oh By The Way…”
This 65-year-old patient is golden, has no complaints, unremarkable medical history, no medications. It should be an easy exam, right? When you turn your back to get your 78D lens, the patient drops some game-changing information that alters everything! Like, the patient reports she has lupus and has been taking plaquenil for 10 years. Or better yet, the patient reveals he has uncontrolled diabetes. I had a patient recently who waited until the moment I grabbed by BIO to tell me that he was diagnosed with glaucoma 6 years ago and has never taken his eye drops…bruh…..
Again, I love what I do, but sometimes…well, you know. I hope you guys enjoyed the post. Leave some of your pet-peeves in the comments section below!