BLOG: Don’t let your patients settle

ByScott A. Edmonds, OD, FAAO

I attempt to practice what I preach in my practice. Since adopting a primary health care approach to optometry, I spend a lot more time talking to my patients about their general health, diet and exercise.

I have found that in doing the Review of Systems and medicine reconciliation in my electronic health record (EHR), these topics just flow into the eye examination and then become easy to relate to the patient’s long-term ocular health and vision as part of the “doctoring” of a comprehensive eye examination. It is easy to work in advice about diet and exercise and the relationship of these items to maintaining a lifetime of good vision once the topic is on the table.

What I have found, however, especially in people over the age of 40, is that many have a polite resistance to any change in habits or lifestyle due to an acceptance of their current state of being. Even if the patient acknowledges that their current state is not optimal or even desirable, they have just learned to settle with it as a fact of their life.

This interesting human dynamic can apply to a number of issues, including smoking, eating habits and physical exercise. Patients will say things like, “I know that smoking is not healthy, but I really enjoy it and I feel great and don't have any health problems.” Or “I know that I am a couple of pounds overweight, but it looks good on me and it is part of my image.” Many people make an effort to change an unhealthy lifestyle issue but fail and finally give up and learn to “settle” for the unhealthy state. Some even celebrate the problem by building it into their self-image.

I have found that certain patients who have learned to settle for an undesirable modifiable health risks are very difficult to change. You can mention it as part of your general body of advice, but to dwell on it will alienate that patient and may minimize your advice on other issues. Like many things in life, you need to choose what points you can make and when to move on. Your approach to patient care needs to change based on your relationship with each patient.

The most effective time to impact your patients with meaningful advice on the relationship between modifiable health risk and good vision is before they have settled into their bad habits. This is often at the first sign of trouble, with a change in body mass index or when you have evidence that your patient has started smoking. This is the time to educate your patients about health risk issues and the relationship of general health to eye problems that can lead to reduced acuity with retinopathy and age-related macular degeneration or loss of visual field from a stroke or vascular occlusion.

Optometrists are one of the leading health care practitioners – many times the only doctor – that a patient may see during the time where a modifiable health risk factor starts to move into the danger zone but well before the patient has settled into this problem as a part of their self-image and permanent part of their life. Refractive error often leads to reduced and changing vision that brings young and otherwise healthy people into your office and offers you a unique opportunity to provide health education and counseling that may not only protect their long-term vision but may improve the quality of their life.

The profession of optometry started with the measurement and correction of refractive error. As we evolved, we learned that many times we could not correct a patient’s vision by correcting their refractive error due to eye pathology. The public health need required us to learn to manage the eye pathology as part of the quest to correct vision. This led us to change our education and seek legislation to broaden our scope of practice. Our patients have benefited from this evolution.

Today there is a new public health need for our profession to get more involved with our patient’s overall health and wellness. Just as we could not provide refractive care in the face of eye pathology, we cannot help our patients retain good vision in the face of preventable systemic pathology. We need to take that next step in our evolution as a health care profession.