patients from hell...

I know now why I can never be a doctor... I don't have patience for the patients from hell.

I mean the kind that whine or have totally unrealistic expectations or the ones that are just non-compliant. I had to deal with one today. If I ever have to deal with people like this on a regular basis, hari kari is an option I am willing to consider.

This patient, a completely non-compliant soft contact lens wearer (using the "I'm poor, so I decided to take some liberties with lens care" excuse), that stretched out her monthly disposable lenses out to about 4 months a pair. Alright, first thing's first- if you can't afford to pay your frickin' bills you probably shouldn't be wearing contact lenses since they are like a constant investment - a somewhat expensive investment especially if you don't have any kind of vision plan.

Second, when you stretch out lenses like that, you WILL cause serious damage to your eyes. There's no argument against this... and this damage may be irreversible. One of the other problems is that you will cause swelling of the cornea (corneal oedema), that can really f**k up your vision for a while. This patient has significant swelling, and since they WILL NOT consider discontinuing wear of contacts, we have re-fit them into a daily disposable lens. The swelling has subsided some, but their vision will continue to shift until the swelling goes down and it won't go down as easily as it should since this person cries that they are too poor to buy eyeglasses but wants LASIK so bad.

Best corrected, this person is not even 20/20. I flipped lenses for about 10 minutes this afternoon before I just hung it up and said, "you really need to stop wearing lenses for about a week." The patient proceeds to give me sob stories and B.S. excuses... but it's falling on deaf ears. I am to the point that I just don't care anymore because they do not care about the fact that they are doing herself harm by not listening to me or 'Doc (who really is like first-generation don't give a f**k, after dealing with this person for years). The swelling is decreasing, but not nearly as quickly as it should. If this person had listened and stopped wearing lenses instead of pissing and moaning last week about not being able to see because their glasses are so out of date (something else I really loathe about some CL patients), the swelling would have subsided and we may have had a good situation.

But that isn't the case and I will probably have to dicker with this patient and burn up trial inventory for a month. Since 'Doc doesn't want to deal with this patient's whining and bitching (this person will sit in the exam chair and cry (yes, sobbing) about being blind - I'm more nearsighted than she is!) he basically is giving her what she wants, but on his terms... that doesn't mean he is making it easy for us to get this patient to see better or making her more compliant.

Because of people like this I don't think I could ever be a doctor or own my own practice. The first person like the one I mentioned that would come along would make me want to kill.

Why?

Let me lay it down for you, oh intrepid reader (and potential non-compliant contact lens wearer)... If you want to wear contact lenses there are some costs you need to consider as well as the kind of doctor you're seeing. First, to do it right is not cheap and good O.D.'s are hard to find - because you won't find good ones at America's Best, Sears, Wal*Mart or any of those other chain places.

The good docs are the ones that are good enough to stay in business independently. They own their own practice, which means they are invested in their revenue stream (i.e. YOU, the patient). The fees usually are higher, but the level of care will be substantially higher and you can skimp on your cable tv or buy a few less DVDs or whatever to save up the cost of a good annual eye exam and contact lens fitting (besides, what good is that crap if you can't see it).

The fitting itself should be absolutely separate from the eye exam (because they are two completely unrelated procedures). The eye exam is to determine your total eye health and secondarily your refractive error (your prescription). A contact lens fitting is the process in which all the data from the exam is considered and a lens fit is designed to best serve your own personal vision needs. It's not as simple as 'here's a pair of Acuvue brand lenses, because you saw the ad on TV and you want to throw them away every payday'.

That's only for soft contacts, rigid lenses are a completely different animal and require considerably more time and money (but, the lenses are not disposable and can last a lot longer, not to mention the vision can be far better). Anyhow, you can expect to spend at least $360 just a good soft lens for a year, and at least $100 for a fitting and any kind of testing that a doctor might do to establish that your cornea is stable enough and has no kind of uneven curvature (irregular astigmatism or worse, keratoconus). Care products will probably run you about $200 a year for good stuff (I endorse Clear Care, Aquify or Opti-Free), because the store brand is no better than tap water and re-wetting drops are almost always a must to maintain comfort and clarity. So, expect to spend around $700 a year for soft contacts... doing it the right way. Oh, and don't forget to get an updated pair of glasses, because not having updated glasses when wearing contact lenses is like skydiving without a backup chute.

If you can't budget that kind of expense into your life... go buy yourself a pair of eye glasses (a good pair will be about half of what contacts will run you) and save your pennies. Contact lenses are a LUXURY ITEM for most people and are only a secondary means to correct vision if you can't afford to pay your household bills or feed yourself... don't even think about contacts.

This is why I am pissed at the patient I ranted about above... I have a 50-year old person that still can't even get their priorities in line telling me how I am going to take care of their eyesight when they couldn't even follow the simple rules of contact lens wear.

I feel much better now... *rant over*