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Reading Time 4:13


Recently I realized how important show and tell can be in taking care of our patients.  We all learned early in our careers to never assume a patient knows how or what they should be doing. For that matter, are they actually doing what they say they are? On our tight schedules, it is so easy to just accept what our patients say.  But, the fact is we can’t trust them to always tell the truth for a variety of reasons.  Leading that list of reasons is that the patient knows what they’re doing is wrong.  They don’t want to confess their shortcomings because they know a lecture will soon follow.  We must also wonder if our patients ever received the right instructions in the first place.  This is especially true with patients who are new to our practice.

All doctors have their own set of horror tales of patient education gone wrong.  It takes time, listening and careful questioning to make certain that our patients understand our instructions.  Even then, it is no guarantee that they may not do something that could affect their treatment and final outcome.

Last week, I had a man come to my office for his exam.  He began by telling me that he works in a dirty environment and that he has dry eyes.  Artificial tears were used to help the dry eyes. The dirty environment meant he needed to wipe his lids while at work.  I could have let it go at that, but I wanted to know more.  Upon further questioning, he said he used the tears when he felt his eyes were dry. There was no routine frequency of use.  When I asked how he wiped off his lids, he offered that he was using alcohol preps!

As I continued the exam, I saw a notation I made on his last exam. I noted that he was a poor responder on refraction with variable results on his last visit.  On external exam his eyes looked irritated. Based on that and my note from his previous visit, I decided to use some artificial tears to improve the quality of his tear film for the refraction.

I opened a trial bottle of artificial tears, but instead of putting them in myself as I usually do, I decided to let him do it instead.  What I saw shocked me.  He ran the bottle along his lids just below his lash line. He administered approximately 4 to 5 drops, none of which even looked like they made it to the eyes.  The tears ran down his face and there was no doubt the bottle was now contaminated.  And that was in a clean office environment.  Imagine what happened to him on a daily basis while at work in a dirty environment.  This was the worst attempt at instilling drops I had ever seen.

I was thankful that I had given him the bottle instead of just doing it myself.  Valuable information would have been missed in how I advised him on his future eye care.  I would have assumed that he knew how to instill drops since he offered that he was doing it on a daily basis.  The treatment I suggested wouldn’t have been successful since the drops weren’t handled correctly.

I took the time to instruct him in the proper way to instill drops and then watched him do it several times in each eye. Yes, it took some additional time, but it made the difference in whether the total treatment plan succeeded. Needless to say, he was also instructed to abandon alcohol preps as a lid wipe and alternative treatments suggested.

I couldn’t help but think of all the patients I prescribe drops on a daily basis. Artificial tears, rewetting drops, allergy drops, and medications are all prescribed routinely.   But, how many times have I stopped to make sure their technique was proper and efficient?

Another Lesson Learned

I also learned another lesson about instilling drops from my own mother.  She has a dry eye as well.  I gave her artificial tears and told her how often to use them. In her case, I had showed her how to instill the drops and watched her do it several times.  A few days later she told me she was having problems.  So when I was at her house, I asked her to show me how she was using the drops.  Her technique was good except for one major thing.  She was trying to do it while standing up.

I never thought to tell her to only attempt instilling drops from a seated or supine position.  I realized that I had never included this piece of information to any of my patients.  But, I have since changed my instructions. I had never considered that a patient would attempt putting in drops while standing. The possibilities of losing balance or falling while instilling drops concerned me.

This is especially worrisome in the elderly patients who are often the ones most likely to need drops. They are also the group most likely to have problems with balance. I now make the suggestion that they only use drops when seated or laying down. Of course, it is possible to put drops in while standing, but it is more difficult.  Having a patient tip their head back can cause problems with equilibrium and could precipitate a fall.  Why not err on the responsible side and give patients instructions that keep them safe?

Show and tell may seem like an antiquated children’s game, but in my practice, it has become a valuable adjunct to my verbal patient education.  We would never think of dispensing contact lenses to a new wearer and not offering instructions in their care and handling. I don’t know of anyone who would expect a patient to learn how to insert and remove their contact lenses on their own.  Maybe we need to think about our instructions in other areas of eye care as well. If there is no time in your schedule for this instruction, then why not consider training one of your staff to become your patient educator.

Have you ever experienced problems with patients harming themselves by doing something wrong? Have any of your patients not gotten the proper results because of an error in the way they used the drops?   What do you do in your office to be certain patients learn proper procedures?  Do you use your staff to help in educating your patients?  Leave your comments and suggestions below.

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