How to Find the Right Doctor

Discussion in 'Optometry Archives' started by Ms.Brainy, May 27, 2007.

  1. Ms.Brainy

    Ms.Brainy Guest

    How can I find out in advance that the doc I am going to visit may be
    the right one for my situation and requirements? Practically, I can't
    check them all till I find the right one, so I need to have some
    sorting tools before my visit, but I don't know how to find these
    tools.

    I need badly a cataract surgery and have already seen 3 potential
    surgeons.

    The first was at the UMC. He was rude, didn't want to listen to my
    concerns or answer my questions, but worse of all he wanted to operate
    on both my bad eye (with a thick cataract) and my good eye (that might
    have a beginning of a cataract that does not interfere with my vision
    and I absolutely don't want to touch at this stage). He didn't care
    that I wanted implant for intermedate vision rather than distance.
    Maybe he knows things that I don't know, but he provided no
    explanation. I was appalled by his attitude and dumped him.

    The second doc was probably the best known and most competent in my
    area. He was recommended by my retinologist as the one that he would
    take his mother to when she needs a cat surgery. Until recently he
    was the head of Ophtalmology in UMC, but a couple of years ago he left
    that prestigious position and started his private practice, where he
    probably can make more money. His record is impressive, my first
    visit was promising and he gave me very informative written material,
    but... he was highly impatient when I came back with some questions,
    and he tried hard to convince me that Crystalens should be my choice
    of implant. When I refused, he dumped me with the excuse that I don't
    trust him.

    Then I went to the Eye Center nearby. Again, the appointment was
    hasty, she (the doc) said that she needed a written clearance from my
    retinologist since she is not a retina specialist. I couldn't discuss
    anything else with her before she got the clearance, although I
    assured her that I had already been cleared for the cat surgery. My
    feeling is that she is not competent to treat my delicate condition
    (closed macular hole, re-attached retina with scleral buckle, and
    probably a macular pucker or wrinkled retina). She sent me to a
    retina doc to get the "clearance", but I don't feel comfortable going
    back to her.

    What to do? How and where can I find the right cat-doc? My
    requirements are as follows:

    1. Someone who will give me more than the famous 17-seconds
    appointment, will listen and consider my concerns and wishes, inform
    me about what s/he is planning for me and answer my questions.

    2. Someone who will care about me, the person attached to the eye, as
    well as about the eye itself.

    3. Someone who can evaluate properly my potential corrected visual
    acuity in the bad eye and will make a plan for a lens that will work
    together with the good eye at this stage, as well as in the future if,
    and when, I need a cataract surgery in the good eye.

    3. Someone who is competent and experienced in complex cases like
    mine, with comprensive knowledge of cataracts and retinal conditions.

    4. Someone who will put my well being before his/her financial
    interest.

    At this point I have a pretty good idea of what I want:

    1. Monofocal for intermediate vision (probably aiming at -2D),
    corrected with glasses (probably progressive) for reading and
    distance.

    2. Small incision, no stitches, topical anastesia with sedation.

    3. The best correction at this time for the bad eye only, with a
    future plan for the good eye (now with -4D) -- must work for vision in
    both eyes now and in the future.

    4. Astigmatism will be corrected by glasses, not by limbal surgery.

    5. Procedure with as little risk of complications as possible.

    Is it not reasonable? Is it too much to ask? How can I find someone
    to fulfil my needs without going thru the entire yellow pages? How
    can I make them listen and discuss things with me when they are
    rushing? There must be somebody out there who is caring, competent,
    considerate and polite, but how can I find out in advance?
     
    Ms.Brainy, May 27, 2007
    #1
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  2. Ms.Brainy

    otisbrown Guest

    Dear Brainy,

    You might contact this ophthamologist -- who used
    to post on sci.med.vision.

    I understand he is very concerned that you always
    get the correct treatment.

    http://eyesite.ucsd.edu/faculty/granet.htm

    Perhaps you could ask Neil Brooks to contact
    him, since I understand that Neil Brooks is
    Dr. Granet's patient.

    Good luck,

    Otis
     
    otisbrown, May 28, 2007
    #2
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  3. Ms.Brainy

    Ms.Brainy Guest

    Thanks Otis. Dr. Granet has not posted here since 1996, probably
    because you and others upset and frustrated him. He is a pediatric
    ophthalmologist and I am no longer a child. Indeed, in order to work
    with young children one need much better attitude than what I have
    encountered. Dr. Granet is in San Diego and I am in Southern Arizona,
    and I don't see how he can give me a direct advice, although I am
    always open to hear words of wisdom. I Neil thinks Dr. Granet can be
    of any help, please Neil tell me how to contact him.

    I recall that Dr. Judy wrote something about this subject (how to get
    the right treatment from the right doctor, or something like that. I
    will welcome Judy's word of advice if she will. Or anybody else. I
    am really desparate, my vision in the bad eye is dimishing rapidly.
     
    Ms.Brainy, May 28, 2007
    #3
  4. Ms.Brainy

    Neil Brooks Guest

    Brainy-

    As always, Otis has his head up his a$$. Granet IS a pediatric
    ophthalmologist, specializing in strabismus and ocular motility
    disorders.

    You need a cataract surgeon. Otis is giving you the functional
    equivalent of a proctologist referral for chronic ear infections.

    If he'd even looked at the link he posted, he would have known that.
    But ... Otis is more than a wee bit of an idiot, so ....

    You're right: Granet left because of Otis and another roughly akin to
    him, but without the clear pathological issues.
     
    Neil Brooks, May 28, 2007
    #4
  5. Ms.Brainy

    FKS Guest

    So, you visited 3 surgeons and none of them satisfied you. Sometimes, it
    pays to assess a situation from the other side. Imagine you're a surgeon....
     
    FKS, May 28, 2007
    #5
  6. Ms.Brainy

    Ms.Brainy Guest

    If I were the surgeon, and even if I didn't care, I would at least
    pretend and treat my patients with courtesy and consideration.

    FYI "FKS", cataract is the most common eye surgery in the U.S. and
    it's a major money making tool for surgeons who do it in assembly line
    method. Many patients end up with the wrong implants. I hear too
    many people complaining about the rush attitude of cataract surgeons.
    I have never encountered such rush from any physician in my entire
    life. Apparently it's characteristic to cat-docs.

    My case is more complex because of the trauma that my flimsy retina
    has suffered and my desire to spare the good eye from any tampering as
    long as I can. It's still not clear (at least to me) to what degree
    my bad eye vision can be restored, and there are issues of disparity
    between the eyes now and in the future. All these require more
    attention than the normal cataract surgery, and the assembly line way
    is not suitable in my case. I explained it in my original post, as
    well as in previous posts on this forum. If you didn't get it, too
    bad. I believe that my wishes and expectations are not unreasonable.
    My question was how to find the right surgeon, since I am confident
    that s/he exists.

    At issue are MY eyes and MY vision. I don't have a duty to please the
    surgeon, but the surgeon has a duty to give ME the best medical
    treatment possible.
     
    Ms.Brainy, May 28, 2007
    #6
  7. Ms.Brainy

    Dr. Leukoma Guest

    Try looking for the senior member of a group practice for whom
    "production" is no longer a major issue.

    DrG
     
    Dr. Leukoma, May 28, 2007
    #7
  8. I'm going to suggest a new book, "How Doctors Think" by Jerome Groopman,
    as potentially useful reading.
    http://www.npr.org/templates/story/story.php?storyId=8946558

    It's a general book about medicine in the US today, not specifically
    about any one category of doctors, and it helps to understand how the
    delivery system affects care, and some ways around doctor/patient problems.

    Quite readable, too.

    Kay
     
    Kay Lancaster, May 28, 2007
    #8
  9. Ms.Brainy

    otisbrown Guest

    I think Neil Brooks is referring to a long-running argument between
    Alex Eulenberg -- who supports the concept of the preventive
    second-opinion.

    Alex went on to develop i-see, to further enhance knowledge
    about this preventive second-opinion, and David Granet
    left in a blue funk.

    But that is the true nature of the second-opinion when people
    can not agree on scientific concepts about the fundamental
    eye's proven behavior.

    Otis
     
    otisbrown, May 28, 2007
    #9
  10. Ms.Brainy

    Neil Brooks Guest

    [snip]

    None of that explains why you tried to refer a cataract patient to an
    ocular motility specialist.

    Do you know anything about optometry or ophthalmology?

    Just curious.
     
    Neil Brooks, May 28, 2007
    #10
  11. Ms.Brainy

    Rich Guest

    MARVELLOUS!

    Wonderful description of what happens (unfortunately) in the real world.

    In response to Ms. Brainy's question/concerns:

    I would also suggest people remain aware of the constraints on Doctor's
    time placed (primarily) by insurance companies. (I'm speaking in the
    U.S.) In order to offer affordable insurance (whether paid for by the
    patient, his/her employer, or the government), insurance companies
    require Doctors to diagnose, treat, and record for every patient in a
    VERY short period of time. America's legal system has shaped a Doctor's
    treatment obligation quite differently than years ago. A doctor's day is
    packed with patients, plus many other administrative and professional
    duties.

    If you have the wealth to afford it (and choose to use it this way), you
    could probably book 3 or 4 appointments consecutively (paid for out of
    your own pocket) and get a relaxed, personalized, in-depth
    appointment... but I have never heard of someone doing so.

    Rich
     
    Rich, May 28, 2007
    #11
  12. Ms.Brainy

    Ms.Brainy Guest

    Sounds like a good thing, except that I don't understand what it
    means. Can you please explain?
     
    Ms.Brainy, May 28, 2007
    #12
  13. Ms.Brainy

    Ms.Brainy Guest

    Excellent link, Kay. I am still in the midst of reading...

    Let me just say that this came from a DOCTOR who became a patient. He
    probably has not experienced what most of us do. He and his family
    members would probably get more respect and attention, as well as
    better treatment, from his fellow doctors.

    In great part it's the healthcare delivery system (including
    insurance, HMOs, medicare etc.) in the U.S. which forces doctors to
    shortcuts due to sharp time restrictions. It's not necessarily the
    same in other countries.
     
    Ms.Brainy, May 28, 2007
    #13
  14. I've done it and it's worth it when dealing with complex issues.

    Kay
     
    Kay Lancaster, May 29, 2007
    #14
  15. Actually, I'd say he got pretty much run-of-the-mill treatment from fellow
    doctors; in fact, I'd say I've found better doctors than most he'd seen
    for his hand problem -- and I did have to hunt. He does have a better
    than average organic fertilizer detector for his hand issues than most
    laypeople would, but it really didn't help him a whole lot in getting
    treated properly.

    Do read the entire book, not just the interview -- it's not long, and
    it's easy reading, a long evening for me. He's got some very
    valuable points, and includes the whole insurance* "cost containment"
    and discount stuff that tends to clog up medical care in this country.
    I don't recall anything specifically about ophthamology in the book, but
    the general principles for working with doctors for your health care
    were right on, in my experience. And some good techniques for getting
    your care out of a rut.

    *do not get me going about this... grrrr...

    Kay
     
    Kay Lancaster, May 29, 2007
    #15
  16. Ms.Brainy

    Ms.Brainy Guest

    Kay,

    Where did you get the book?


     
    Ms.Brainy, May 29, 2007
    #16
  17. Ms.Brainy

    Dr. Leukoma Guest

    I'm so glad to see this topic being discussed.

    DrG
     
    Dr. Leukoma, May 29, 2007
    #17
  18. Ms.Brainy

    Neil Brooks Guest

    Brainy,

    I've always scheduled my eye doctor appointments so that I am the last
    appointment of the day. I have an established rapport with my doc,
    which helps, but ... even if it's somebody new ... there may be less
    pressure on their schedule to rush you out.

    When scheduling the appointment, it also may be beneficial to mention
    that you are "a complex case" and ask them to simply allow a little
    extra time. Often, they will simply do this without asking any
    additional questions.

    Can't hurt.

    Where's the nearest teaching hospital?? Who does corneal and
    refractive surgery that AND teaches students there? They tend to be a
    little better in terms of people skills, and are usually up on the
    latest and greatest.

    I do know a refractive surgeon or two in San Diego that I wouldn't
    hesitate to recommend ... if you are willing to travel.

    Neil
     
    Neil Brooks, May 29, 2007
    #18
  19. Ms.Brainy

    Ms.Brainy Guest

    Thanks Neil. My retina-doc used to schedule me at the end of the day
    since he knew that I require information and always have
    questions...:) But he is gone now.

    Unfortunately, I can't set appointments anymore late in the day, since
    I can no longer drive after dark. My cataract is just too bad and the
    glare at night is unbearable and dangerous...

    San Diego is only 6-8 hours drive from Tucson, but I still believe I
    can find somebody here. I wouldn't mind visiting beautiful SD after I
    recover from my surgery, when you enjoy the mild summer and we here
    bake in the heat... But we have A/C!
     
    Ms.Brainy, May 29, 2007
    #19
  20. Ms.Brainy

    Neil Brooks Guest

    Can you get a ride/use mass transit/taxi it? I've had to do any of
    those /or/ even ride my bike to and from appointments.
    What /about/ the U of A Medical School:

    http://www.eyes.arizona.edu/ForPatients/PatientHome.html

    ??

    If it were me, I would likely call/e-mail the head--Joseph Miller, MD,
    MPH, and ask him for direction. Another avenue might be to contact
    one of the /manufacturers/ of the IOL that you like (or even an IOL
    that you don't like) and ask them what refractive surgeon, in Tucson
    (or Phoenix) THEY seek out when they're looking for somebody to trial
    their products.

    The two in San Diego that I would refer you to are widely sought after
    by IOL makers AND manufacturers of new laser refractive surgery gear/
    techniques.

    Good luck!
    I've seen smoke coming from the bare skin off people while standing at
    an intersection on a hot August day, in Phoenix. It's not for
    me ... ;-)
     
    Neil Brooks, May 29, 2007
    #20
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