Helping Your Doctor Help You
Chat Highlights
April 19, 2006

On Wednesday, April 19, 2006, Dr. Rick Wilson, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Helping Your Doctor Help You."

Moderator:  Greetings, Dr. Wilson. Tonight's topic is "Helping Your Doctor Help You."  What's the most important thing patients can do to help their doctors help them?

Dr. Rick Wilson:  Ask questions until the instructions are well understood and follow the instructions exactly as given.

Moderator:  That's pretty straight forward. How many of your patients do that?

Dr. Rick Wilson:  Doctors call whether a patient follows the prescribed plan "compliance."  As we have discussed in the past, non-compliance is a big problem.  About half of the people with glaucoma don't know they have glaucoma.  Of the half that do know they have it, 20 to 40 % have dropped out of treatment or are taking just a fraction of their medicines.

P:  It must be frustrating for you as a doctor to see people drop out of treatment or be non-compliant to the point of hurting themselves.

Dr. Rick Wilson:  Dropping out of treatment is dangerous for the patient; often the doctor may not realize the patient hasn't returned.  If the doctor realizes it and sends a reminder card or two, but doesn't take the time to follow up with the lapsed patient, it may be quite a while before the patient shows up again somewhere, with further loss.

P:  Do you think compliance suffers when more than two kinds of eyedrops are prescribed?

Dr. Rick Wilson:  More than one kind of drop and any drop over two times per day is a marker for non-compliance.

P:  Isn't it also up to the doctor to be forthcoming with the instructions?  I have always found that if I ask nothing about treatments, then I get told nothing about treatments, what to watch for, when to return, etc.

Dr. Rick Wilson:  Yes, you are correct.  However, the doctor may not want to suggest symptoms to the patient.  Since managed care and insurance companies have reduced the visit fees substantially, the doctor has to see more patients to stay solvent.  Therefore, the time per patient suffers.

P:  Many of us must change doctors every few years because of insurance changes.  The offices often lose track of our files.  What records should we keep ourselves?

Dr. Rick Wilson:  It is good to keep a copy of photos of your optic nerves and visual fields, and write down the IOPs (intraocular pressure), along with whatever medications you are taking at the time the IOPs were measured.  That can be very helpful if the last doctor can't produce the records.

P:  Should I get copies of every test performed on my eyes?

Dr. Rick Wilson:  If you feel you may have to change doctors, that doesn't hurt and may be important.  It is a hassle for the doctor's personnel, but if you are nice, they shouldn't mind printing out another copy for you.

P:  Sometimes a patient doesn't know what questions to ask and relies on the doctor for information.

Dr. Rick Wilson:  A statement like the following usually works:  "Doctor, I'm new to this and don't know what questions I should be asking.  Can you help me with the essential questions and answers?"

P:  Aside from patients being non-compliant, how big a problem are patients who engage in second-guessing, self-diagnosing, and self-medicating?

Dr. Rick Wilson:  Most doctors are happy that their patients are becoming educated about the disease.  Sometimes, however, a little knowledge is a dangerous thing; people start making decisions about their therapy that may not always be the best.  Knowledge helps when it enables the patient to understand the decision-making process and participate in it.  Further, by understanding the necessity for a certain treatment, the patient is more likely to follow the prescribed therapy.

P:  Because of this Website, I knew enough to ask about my corneal thickness.  My doctor had never measured it. I think we patients have to get informed and make a list of questions before every visit.  Do you like lists, Dr. Wilson? Or are they a pain?

Dr. Rick Wilson:  We discussed lists in a chat not long ago.  What I like is to have patients think out beforehand what questions they most want answered.  I don't mean enough to cover three legal-size pages, but, say, about five questions.  Make two copies, one for the doctor and one for yourself on which to write the answers.  The list saves the doctor time, as he or she can move through the questions rapidly, while the patient writes down the pertinent information.

P:  Because of your suggestion, I took a list of questions to my doctor.  Otherwise, I would not have done that.

Dr. Rick Wilson:  How did it work out?

P:  It worked out great.  The doctor checked off the questions as he answered them.  He wasn't annoyed at all, which was my biggest fear.

Dr. Rick Wilson:  Glad to hear it.  Some doctors will not want to take the time, but most will run down the list with you.

P:  On another Website, a glaucoma patient said that his or her doctor seemed evasive when questions were asked about possible vision loss. In my experience, communication with a doctor is essential.  Feeling "cared for" is also important.  Are young doctors being trained in those skills?

Dr. Rick Wilson:  You are correct that a feeling of trust and being cared for is incredibly important to the continued well-being of patients and their comfort level with their disease.  Patient sensitivity and communication training have always been a part of medical school training. I think it is getting more emphasis now.

P:  I think patients sometimes interpret a doctor's answers as being evasive, when the fact is that sometimes the doctor simply doesn't know what's going to happen.

Dr. Rick Wilson:  You are right that patients get the idea from medical discoveries highlighted in Reader's Digest, Redbook, etc., that doctors know most things about disease and have a greater ability to fight disease than is realistic.  Remember, we still don't know the cause of glaucoma or exactly how it damages the retina and optic nerve.

P:  I found the following statement about glaucoma on the Internet:  "There are also things that can cause it like a bad diet, wearing contact lenses, too much reading or reading in low light, and other normal activities using the eyes."  Is that true?

Dr. Rick Wilson:  Diet, wearing contact lenses, and reading too much or in low light has nothing to do with glaucoma.  Reading actually pulls on the drain of the eye, opening it more than if the person were looking in the distance.  Unreliable advice on the Internet or from friends is a serious problem.

Moderator:  I just received a newsletter from two optometrists in a nearby community that says: ". . . consider taking nutritional supplements that contribute to healthy eyes.  You'll want to look for ingredients such as beta-carotene, lutein, zinc, selenium and vitamins B, C and E. A normal healthy diet is sufficient for most people, but for extra protection from conditions such as glaucoma and macular degeneration, we recommend you take supplements with additional vitamins and minerals."  Please comment.

Dr. Rick Wilson:  Vitamins formulated to match the AREDS (Age-Related Eye Disease Study) vitamins have proved to help in retarding the development and progression of macular degeneration, but not glaucoma.  I do tell my women patients to take a multivitamin with minerals and the men to take a multivitamin without iron.  On balance, taking a low dose aspirin once a day, with your internist's blessing, MAY be helpful in older patients.

P:  How important is it for patients to tell their eye doctors what vitamins and supplements they are taking?

Dr. Rick Wilson:  When it comes to surgery, it is important to know what anticoagulants, including vitamin E, the patient is on. In terms of IOP, few supplements have much effect.

Moderator:  Dr. Wilson, thanks again for your time and answers.  We'll see you next week.

Dr. Rick Wilson:  Have a good week, all.

On April 26, Dr. Wilson discussed "Pain" in the Chat room. Click here for highlights of that meeting.

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