Communication and Collaboration

Few specialties in medicine are as sterile as ophthalmology. From measuring visual acuity “vital signs” some distance from the patient, to performing dilated fundoscopic examination of the retina with a 20 diopter lens delicately balanced between the physician’s hand and the patient’s face, to assessing the anterior segment of the eye with a large metal slit-lamp separating patient skin from physician skin, it is possible to go through the entire day in an ophthalmology clinic without physically laying hands on a single patient. Yet each day, upon entering the examination room, I am immediately aware of the fear, frustration, anxiety, or depression that may affect the patient who is suffering from loss of vision and the secondary concerns of the family members, also present, upon whom he relies for help. I touch the patient and acknowledge the presence of the family members. Despite having already been debriefed by the fellow, resident, or advanced practice provider (APP) who tries to keep one patient ahead of me in a clinic of 40-45 patients, I personally elicit the patient’s reason for seeking care so that I can hear the manner with which he describes the loss of vision and the level of concern associated with the description. While washing hands and quickly pulling out lenses, I listen, looking back and forth from patient to family member to patient, again, for verification of the disease history and for subtle tensions below the surface-such as the patient’s fear that he may no longer be able to support his family or the family’s concern that the patient should no longer be allowed to drive.