Saturday, April 6, 2013

Not My Specialty

The diagnosis from the Ophthalmologist in August was “dry eyes”. But I went there with “dry eyes”. I guess I should have pointed that out to him. What I really wanted to know: why the dryness, diminished vision, and reduced pressure (goopey or soft eyeballs)? The Ophthalmologist was looking into the front of my eyes. But I wish he’d looked at the back – the veins and nerves that nourish and control the eye. The vascular system has been malfunctioning due to Dysautonomia for a decades, the organs starved of blood, nourishment, glucose. How does one explain Dysautonomia to a doctor? It is too strange.

Outcome at Ophthalmology: A $300 bill for a prescription for OTC eye drops. In moments like these I think about the Nicole Kidman line from ”Days of Thunder”, when her doctor character admonishes the Tom Cruise character for an inappropriate request. “That’s not my specialty” she intones icily, then exits the exam room. It often feels just like that, as if you had make an inappropriate request, by showing up with a bewildering problem at the doctor. The request in this case was to get help with organs that are suffering the effects of an "invisible" or neurologic disease, rather than an affliction that originates in the eye.

If he would have told me that his diagnosis, besides “dry eyes”, included “adult onset goopey eye”, and “bitch lyin’ ‘bout bein’ blind” then his “diagnosis” would have been complete. Note to self: Do not go to a young doctor again. Do not go to any specialist unfamiliar with neurologic patterns. It is a complete waste of time.

In the future I would ask the Ophthalmologist to measure my eye pressure. I would ask them to image blood flow to the eyes. Maybe they could explain why the right eye goes out, but not the left. But what will these measurements really yield, besides data about a problem that can't be solved.

An Ophthalmologist should be knowledgeable about neurologic conditions involving optical nerves including nystagmus, migraine auras, ischemic stroke, sinus tachycardia, etc. The problem with doctor’s “specializing” in anything, is they become willfully unaware of important peripheral information, which would allow them to assist a patient who comes in with a complex problem. “Not my Specialty” is a tactic doctors use to avoid helping patients when symptoms don't have an simple solution.

Why isn't medicine treated the same as other professions? When one goes to the mechanic, and the mechanic cannot find a problem with the car, the mechanic doesn’t charge you for not helping you. When you go to a lawyer for help with a standard legal issue, unless the lawyer wins the case, they don’t get paid. But when you go to a doctor you are expected to pay in full – even when they decide not to help you.

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