Seeing patients means establishing a relationship with them, getting to know them, becoming invested in their eyes and health and over time, their lives. You will share good times, not as good times, major milestones, and more, all while doing your job and duty of making sure they see to their fullest potential and their eyes are taken care of.
That being said, remember, it is your job and duty to educate your patients on what is their best interest for maintaining good ocular health and vision.
Be a resource if they have questions.
If applicable, lead and demonstrate by example.
But do not get caught into caring more for your patients’ eyes and health more than they are willing to care for themselves.
Yes, some patients will require you to advocate for them. For example, there will be plenty of individuals who have limited funding for glasses or optical devices. Your finding alternative resources for them will continue to solidify your relationship with them.
Some patients will hear your recommendations for different treatments or care with other specialists and defer or decline. As an example, one of my students was telling me of an elderly patient who they recommended cataract surgery for. That patient declined the recommendation because he wanted the money to go towards his family instead, raising his grandkids, explaining that he’s already lived a good life and he can just make do.
One of the patients I saw during residency had severe NPDR and CSME in one eye and I was recommending he see the ophthalmologist for injections. He refused because he’d had injections in the other eye already and shortly afterward lost vision. He just wanted new glasses and could not understand that glasses wouldn’t help. He left furious when I said I couldn’t help him the way he wanted – he’d already seen all the other providers in the department and we had all said the same thing. I’ll also mention he was, by this point, already a double leg amputee from poor diabetes control. And he was only in his early 50s. One of my mentors casually mentioned that this patient probably didn’t have good chances of living another 5 years considering his health status. That hit me hard.
I’ve given a recent example of a patient coming in with hypertensive crisis who wasn’t entirely convinced of the need to go to the emergency room or ophthalmology same day. A couple weeks ago, we had a different patient coming in with a painful eye that was already blind but who had a new corneal ulcer. Her caretaker wasn’t entirely convinced they needed to go right away for ophthalmology follow up and management because, “What’s the point? [The patient] can’t see out of that eye anyway”.
There will be times when you’ll want to do everything you can for your patients. Short of physically driving your patients to the emergency department, purchasing glasses for your patients out of your own pocket, joining them for all the recommended exercise sessions or dietary classes to help manage their overall health – in the end, the patients will have to make their own informed decisions to follow and take your advice or not.
And you will need to take care of your own mental and emotional health and well-being by making sure you don’t ‘take these patients’ home’ with you energetically at the end of the day. In the beginning of my career, that was hard. I was super invested in my patients and wanted to make sure I was doing everything possible for them. But after months and years of hearing how these patients never ended up going to see their doctors or ophthalmologists, how they habitually forgot to take their eye drops or systemic medicines… I learned that I had to step back from being that doctor who knew what was best for my patients to understanding that my patients had their own lives they had to deal with and sometimes, whatever I had to say wasn’t the priority for them.
It took time to realize that and come to grips with understanding it, but I want to share these thoughts with you too so you won’t find yourself worrying and losing sleep over what could have been done differently, etc. Be thankful for the patients who listen to you – the majority will. And be patient with those who don’t – everyone has a choice, just like you.