Recently, an article came out in the British Journal of Ophthalmology exhorting physicians to listen to the “voice of the patient” with regard to treatment decisions and how therapies affect an individual’s quality of life, not just his visual acuity. Though it’s a laudable goal, the description of this movement reads partially like a backlash against a “paternalistic” view of medicine where the doctor always knows best.
I found this article to be fortuitously timed in light of our cover story on easing the stress anti-VEGF treatment places on patients’ lives, as well as our other feature on uveitis therapies, which can also seem daunting. I think the idea of listening to patients’ descriptions of their quality of life and the outcomes that are important to them has a lot of merit, but I also think we don’t want the pendulum to swing too far away from the physician. All those degrees are on the doctor’s wall for a reason: In matters of a patient’s condition and therapies, in most cases he or she actually does know best.
There’s a middle ground between being a dictator and a doormat, however, and uveitis expert Sam Dahr, MD, alludes to it in our uveitis feature. Dr. Dahr says a patient’s acceptance of an apparently burdensome immunosuppressive therapy—which, in some circles, connote “poisons” that patients should be wary of—often hinges on how you present the option to him. Dr. Dahr notes that, if you explain the situation to the patient in the right way, acknowledging the small risk of a serious complication but also pointing out the fact that the patient will almost certainly go blind without the treatment, the patient will likely get on board with the therapy. Using Dr. Dahr’s example, maybe if the physician considers the patient’s perspective, but focuses it through the lens of his expertise, they can lessen the burden together.
I’d also like to take this opportunity to acknowledge some changes here at Review. Donna McCune, vice president at Corcoran Consulting Group, has written our Medicare Q & A column for more than a decade and has always had her finger on the pulse of surgeons and their questions about reimbursement. This month’s column marks her final contribution, as she’s leaving Corcoran to assume a new position. Donna was able to anticipate ophthalmologists’ questions and concisely answer them. We wish her well. In her place comes Paul Larson, a senior consultant with CCG and another veteran in the field of coding. Readers will appreciate Paul’s insights into coding. Welcome, Paul.
There’s also a changing of the guard in our Wills Eye Resident Case Series. Allison Huggins, MD, completed her residency at Wills and passes the baton to her successor, Thomas Jenkins, MD. Allison always had an interesting, sometimes vexing, case to share with our readers, and I want to thank her for her hard work and wish her well in her future practice. For his part, Thomas has taken the reins of the column this month and has already provided us with an intriguing case to mull over. Thanks and welcome, Thomas.
—Walt Bethke, Editor in Chief