The Doctor-Patient Relationship and External Stresses
Chat Highlights
June 15, 2005

On Wednesday, June 15, 2005, Dr. Rick Wilson a glaucoma specialist at Wills, and the glaucoma chat group discussed "The Doctor-Patient Relationship and External Stresses."

Moderator:  Welcome back to chat, Dr. Wilson.  Tonight our topic is "The Doctor-Patient Relationship and External Stresses."  What are some examples of external stress that might affect the doctor-patient relationship?

Dr. Rick Wilson:  There are many.  The important ones that easily come to mind are financial problems -- both paying for the doctor’s services and the effect of the illness on loss of work or disability -- transportation difficulties, family problems, anger about being kept waiting so long to see the doctor, impolite staff, and so on.

Moderator:  Let's start with transportation problems.

Dr. Rick Wilson:  Many cities offer transportation for the disabled, especially if they are elderly.  However, often the van is not on time or arrives early to pick up the patients and the driver threatens to leave them at the office or hospital if they don't leave promptly.

P:  When is it appropriate for patients to speak to their glaucoma specialists about getting a second opinion?  Do most of the doctors follow the same routine for prescribing glaucoma medications when the intraocular pressure rises and the medications don't seem to be effective?  Should a patient resort to getting a second opinion only when in doubt about a surgical procedure?

Dr. Rick Wilson:  I think it is appropriate to get a second opinion if the suggested therapy is not working out, that is, not effective or causing too many side effects.  Many general ophthalmologists and most optometrists are not thoroughly aware of the idiosyncrasies of each medicine and the duration of effect.  I often see inappropriate medical regimens.  Laser treatment is often suggested inappropriately when there is little chance of success.  If you do not fall into the “good-candidate” category that we have discussed before and a laser is recommended to you, then a second opinion could save you from undergoing a needless procedure.

P:  What if the relationship becomes strained after seeking other opinions?

Dr. Rick Wilson:  If you do get a second opinion, be sure it is from a glaucoma specialist, that is, an M.D. who has served a glaucoma fellowship in a respectable institution.  The American Glaucoma Society website at www.glaucomaweb.org can help you find a member.

Moderator:  But what if the doctor-patient relationship becomes strained?

Dr. Rick Wilson:  If your doctor is experienced and confident, he or she should not mind your getting another opinion.  I would rather that the patient who is unsure that the course I have charted for him or her is best get outside reassurance.  I am happy for them to seek other opinions.  I think the best way to broach the subject is to say something like, "Doctor, I have complete confidence in you, but my daughter in California wants the reassurance of a second opinion.  Do you mind if I see Dr. so-and-so?”

P:  Both the doctor and the patient have external stresses.  In a perfect world, they would be left outside the door, but that's easier said than done.  Do you have any suggestions about how the patient can get the most benefit from a visit, such as getting answers to questions?

Dr. Rick Wilson:  In order to get the most information in the shortest amount of time, write down your questions succinctly and hand the list to your doctor, so he or she can quickly and directly answer them.  A short introduction like "I am sorry to take so much of your valuable time, but I would feel so much better if I could get the answers to these questions.  Can you help me?"

P:  How do you deal with an angry patient or family member?  Do you and your staff have any specific training on how to handle someone who is upset?

Dr. Rick Wilson:  No, I wish we had the time to do role playing, etc.  The staff's directive is to swallow their anger and be as nice as possible.  If the patient is truly unruly, they come and get me.  I have found for my part that patient and honest answering of questions and a sincere effort to help usually win over the patient.  I have only had one patient in my career whom I asked to leave the practice after she threatened my wife.

Moderator:  Yikes!  That must have been scary.

Dr. Rick Wilson:  It was.  The patient did have mental problems, and I asked the police to become involved.

P:  Do you ever suggest a second opinion if you sense there is a strain between you and the patient or the parents of a patient?

Dr. Rick Wilson:  I often suggest a second opinion.  I think there is no better way to show the patient that you are confident in your assessment and plan.

P:  If you get a second opinion, does your primary ophthalmologist need to know about it?

Dr. Rick Wilson:  If you do not want to tell him, you don't have to.  The second-opinion doctor will want to send a letter to the first doctor, because he can then bill a second-opinion consultation, rather than just a new patient visit.  You can, however, request that a letter not be sent.

P:  Is it normal to feel a special bond with your glaucoma doctor?  I feel a special bond with all my eye doctors.

Dr. Rick Wilson:  Glaucoma, as you know is a scary disease that causes patients to worry about their futures.  Everyone wants to trust their doctors and have confidence in them.  If you have a doctor whom you feel you can trust and is your friend, it makes a huge difference.

P:  What kind of patient behavior, other than hysterical or antagonistic, causes stress for you?

Dr. Rick Wilson:  Patients who ask the same set of questions over and over.  I was raised in the Army and my father made sure we always were ahead of time wherever we went.  So for me to be an hour behind in seeing patients is stressful.  If I am delayed by helping someone who needs more time, that's fine.  But to answer the same question several times is stressful.

P:  I remember when I first had lots of questions for my doctor, he sat down in his chair to answer them to indicate he was not going to rush through them, even though it was taking a lot of time.  That was great.

Moderator:  I, too, have had that happen.

P:  If a patient is unhappy with something a doctor said or did, is it okay to write a letter, so the doctor understands how the patient felt?

Dr. Rick Wilson:  Yes, I get such letters frequently, and they help.  Some patients are venting about a perceived slight by the staff or difficulty getting an appointment.  I need to know about that to improve our service.  Often, I receive additional information to review before I see the patient again and to make the chart complete.

P:  How do you deal with non-compliant patients?

Dr. Rick Wilson:  My first effort is to educate them about the disease.  I tell them there is no way for them to tell they are being non-compliant and hurting themselves until several years later.  I then encourage compliance and offer the names of several patients they can talk to if they wish to do so.  I have solicited patient volunteers before. I then try continual encouragement and try to get the family or friends involved.  If the patient is losing vision and is still non-compliant, I strongly suggest that they see another specialist, who might be better able to help them.  The prospective loss of our relationship sometimes forces them to make a more serious effort to be compliant.

P:  We have taken our daughter to a few doctors for second opinions, and reluctantly returned to the first one.  Now he says he does not trust us, which is why he can't treat her with surgery.  Do you think you could take a stab at what he means?

Dr. Rick Wilson:  It sounds like his feelings are hurt.  Without knowing more, I can't comment further.  You may call me if you think I can help.  Have a great week, everyone.

Moderator:  Thank you, Dr. Wilson.

On June 22, Dr. Wilson discussed "Help, I'm Losing My Vision" in the Chat room. Click here for highlights of that meeting.

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