The Dissatisfied

The other day a patient of mine came back to the office for a “glass check”.  A “glass check” visit, for the uninitiated, is one where the patient who was recently prescribed glasses comes back to the office unhappy with her new pair. 

Sometimes this is due to a simple error of the optical lab: a wrong cylinder axis, a minus sphere used instead of a plus sphere or readers-only given when a progressive lens was expected. 

Sometimes it is because the patient has an underlying pathology: cataracts, keratoconus, corneal scar, diabetic retinal issues, or a fluctuating tear film, any of which may be contributing to less than perfect vision. In these cases, the patient is reminded that they have an underlying problem that is affecting the vision.

Sometimes it’s a mis-aligned visual axis. It could be induced prism, or distortion, or image jump or displacement. But if it’s not any of these things, then it is hard to know exactly why the patient just can’t “get used to” her new glasses. Then it can be difficult to reassure the patient and come to a mutual resolution to solve the problem.

Trying to address a dissatisfied or unhappy patient is a challenge in and of itself, regardless of the language in which the conversation takes place. However, when you have to be diplomatic, maintain a positive outlook and convey confidence that the problem will be resolved all in a language non-native to you, the experience can certainly feel overwhelming. 

For the ophthalmology exam in Spanish, I’ve memorized plenty of  “how are you's”, “what brings you here today's” and “look left and look right”, but surprisingly after 7 years of private practice and conducting general eye exams with my patients, I’ve rarely had to address an unhappy patient in Spanish. Given this situation,  I had to think first about what I would say in English and then mentally translate it. But somehow, it all just sounded, to me, unnatural and uncomfortable. Maybe it’s not so much saying it in another language that bothered me.  Maybe it’s simply the frustration and disappointment that comes with not making a patient 100% happy with his/her office experience.  Regardless of the etiology of the patient’s dissatisfaction, I think every doctor feels a certain sense of loss when the outcome isn’t what was expected. 

With this patient’s glasses, I tried to find the root of her problem and then give her reassurance:

D: ¿Qué es el problema con los lentes?

P: Bueno, cuando me los pongo, no puedo ver nada. Es incómodo. No puedo usarlos.

D: ¿Cuándo los compró?

P: Dos semanas atrás. Me los pongo una vez, inmediatamente me los quité y ya no he los usado.

D: Vamos a ver—(comprobando la visión)—bueno, puede ver 20/20 con cada ojo, en la distancia y para leer con los lentes. Y, el óptico hizo los lentes correctamente. A empezar, el poder de los lentes es mínimo. Es sólo a ayudarle funcionar por la noche, cuando maneja el coche, por ejemplo, o cuando quieres ver las letras escrito en la pantalla de la TV muy clara – eso es todo.

P: Sí, pero cuando me pongo los lentes, es borrosa la visión.  Cuando uso los lentes de mi amiga, son demasiado fuertes al princípio para mí, pero cuando estoy acostumbrada de ellos, puedo ver más claramente con ellos. 

D: (mirando la receta de los lentes de su amiga). Oh, no, estos lentes son demasiados fuertes para Usted. No es bueno para la salud de los ojos a poner anteojos con la receta incorrecta.

P: Lo sé, pero, veo mejor con ellos.

D: Bueno, Usted sólo se pusó los lentes una vez. No es bastante tiempo a acostumbrarlos. Pongaselos otra vez y uselos diario, por a menos dos semanas. Si no le los gustan todavía, llame la oficina otra vez.

P: Está bien. Es mi primera vez con lentes, entonces, no sé como debo sentir. Yo trataré...

D: Está bien. Pase un buen día.

P: Igual.

                                                                        *

D: What’s the problem with the glasses?

P: Well, when I put them on I can’t see anything. It’s uncomfortable. I can’t use them.

D: When did you buy them?

P: Two weeks ago. I put them on once and immediately took them off, since then I have not used them.

D: Let’s see (checking the vision), well, you can see 20/20 with each eye, at distance and near with the glasses. And, the optician made them correctly. To begin with, the power in the glasses is minimal. They’re only meant to help you function better at night, when you’re driving your car, for example, or when you want to see letters on your television screen more clearly—that’s all.

P: Yes, but when I put them on my vision is blurry.  When I use my friend’s glasses, however, they are too strong at first but then when I get used to them, I can see more clearly with them.

D: (Looking at the prescription of her friend’s glasses). Oh, no, these glasses are too strong for you.  It isn’t good for the health of your eyes to wear glasses with the wrong prescription.

P: I know, but, I see better with them.

D: Well, you only wore your glasses one time. That isn’t enough time to get used to them.  Wear them again and use them daily, for at least two weeks. If you don’t like them after that, call my office again.

P: Fine. It is my first time wearing glasses, so, I don’t know how I should feel. I will try...

D: Fine. Have a good day.

P: You as well.

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