What Went Wrong?

I am leaving Dr. M’s office, my first post-op visit, the day after a trabeculectomy for glaucoma. Suddenly, a brown curtain drops over my right eye. I sit down in the waiting room for awhile, but the obstruction to my vision does not disappear. One of my ophthalmologist’s nurses passes by, and I ask her to please tell Dr. M what is happening. She comes back in a few minutes and tells me that Dr. M’s message is, “Don’t worry, that’s part of healing.”

As a retired physician, I am surprised by his answer; it does not make sense to me. Puzzled, I go home.

Over the weekend, the problem becomes worse, and I phone the doctor on call. He tells me that I have a choroidal effusion, which is not uncommon after a trabeculectomy. He informs me that “this complication will usually clear up spontaneously, but if it becomes worse or other symptoms occur, contact or possibly visit Dr. M.”

I call Dr. M’s office on Monday and leave a message about the advice I received. I ask if I should come in. The receptionist calls me back and says,“Dr. M said if you want to come in you can, but it is not necessary.”

At my next appointment I tell Dr. M that I cannot see out of my right eye. He confirms the choroidal effusion and detachment and tells me that it will get better in a few weeks to months. From that point on, for the next five to six months, each time I see Dr. M he asks me,“How are you?” I answer, “The same.”

He looks at my eye and agrees that the choroidals are still present. Then he tells me to make another appointment and says, “Goodbye. I’ll see you in two to three weeks.”

He is a young, very friendly glaucoma specialist, tall, well dressed, and efficient. He carries his laptop into the exam room.

I become anxious about my situation and look up recovery rates from choroidal effusions on the Internet. What will happen to my eye? The lack of improvement leads me to various specialists, and I conclude that there is no easy answer as to what to do next. One of the people I consult is my primary ophthalmologist, Dr. B, who had originally referred me to Dr. M. He is older than his colleague, more relaxed, and I can connect with him. When he hears my story he says, “I am so sorry that this has happened to you.” Then he muses, “Is there anything we should have done differently?” Then, again, he says, “I am truly sorry this has happened.”

His tone of voice, his serious facial expression, and eye contact leave no doubt in my mind that he regrets my dilemma, that he understands the inconvenience of my not being able to drive, that he knows that I am worried about my left eye, which is also affected by increased ocular pressure. The empathy and compassion expressed by Dr. B are like a magic potion. I have been acknowledged as a patient with a difficult problem who is struggling to adjust to and accept the consequences of that problem.

Why does Dr. M not express any regret about what happened? Expressing regret is not the same as admitting negligence. Dr. Richard G. Roberts, past president of the American Academy of Family Practice, writes: “Even when the care is blameless, a caring professional will show empathy when a patient has an undesired or unanticipated result….”¹

After several months, Dr. M refers me to a colleague, a retinal specialist, without any explanation as to what my options are, nor any concern that no appointment is available for two months.

What Dr. B knows and can teach Dr. M is that the doctor–patient relationship is very important, even for a glaucoma specialist. Yes, as a patient, I want Dr. M to be an excellent physician, but I also want him to acknowledge me as a person, an individual trying to cope with the unexpected loss of vision in one eye. It takes less than ten words to express empathy and compassion: “I am so sorry this has happened to you.”

Reference

1. Roberts RG. The art of apology: When and how to seek forgiveness. Fam Pract Manag 2007;14(7)44-49.