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Educate patients on importance of dilated eye exams
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No doubt, occasionally patient requests put us in a bit of a predicament. For instance, consider the following scenario. It’s your last patient of the morning and a quick medical record review reveals that she hasn’t been in for an exam in almost 3 years. A closer look indicates that her chief reason for this visit is to obtain an updated prescription and supply of disposable contact lenses. What’s a bit disconcerting is that she has a history of retinal lattice degeneration in both eyes and has disregarded previous annual examination recalls. To make matters worse, she informs you that she is too busy to undergo a dilated examination today.
Moral, legal obligation
We’ve all been there. On one hand we’re first and foremost caregivers and advocates – always striving to address our patients’ needs. In this sense there really is no controversy. We simply examine the patient and dispense the appropriate contact lenses.
On the other hand, we have both a moral and legal obligation. A moral obligation to provide comprehensive services — and not just those that our patients deem necessary. We also have a legal responsibility to meet or exceed the standard of care for every patient encounter. Given this perspective, the patient must be dilated. It’s the only way to assure the patient of adequate ocular health and minimize your practice’s legal exposure in the event of a retinal detachment.
How do we handle this predicament? Ideally, we should engage in a lengthy dissertation regarding the significance of retinal lattice degeneration, its relative risks and the necessity of periodic dilated examinations. However, given that the aforementioned patient is in a hurry — and has a history of ignoring recalls — your efforts may be wasted.
Given this scenario we have two options. One approach is to discontinue care for the patient, being certain to comply with proper legal protocol to avoid abandonment. Though an option, it seems a bit rigid, adversarial and inconsistent with our mission as primary eye care providers.
The alternative is to strive for a mutually agreeable solution. For our patient who’s requested no dilation, we can concentrate on history (absence of flashes/floaters), biomicroscopy (rule out a Schaeffer’s sign) and ophthalmoscopy alternatives (small pupil BIO and 90-D evaluations). We can also insist the patient return in the near future for a day's-end dilated examination.
Importance of dilated exams
As eye care providers we recognize the importance of dilated examinations. Legislatively, we’ve toiled for the privilege to perform these services and millions of patients are the benefactors annually. It’s understandable why we like to routinely dilate. However, our patients don’t necessarily share these sentiments. From their perspective, dilated examinations can be annoying and inconvenient, so it’s equally understandable why patients don’t like to be dilated.
Fortunately, for most patients, the answer lies in education. An educated patient is more likely to take ownership of his or her eye health. With ownership comes a proactive approach to prevention and management. And what epitomizes prevention more than periodic dilated examinations?