The surgical interventions may cause too much pain and inconvenience7, the medications may cause secondary complications (cushingoid face after systemic corticosteroid therapy), the therapy may be very costly, and the visual gain may appear to be minimal. The surgeon should encourage the patient to not give up the fight while there is reasonable hope to improve, however small that improvement may be.8 Conversely, he must understand and accept if the patient eventually cannot bear it anymore and wants to discontinue treatment.
According to Murphy's law, any future disaster will strike the healthy fellow eye. Every effort should be made to save as much vision in the injured eye as possible, even if this eye will be no more than a "spare tire".9 This reconstruction is time-dependent: when the fellow eye loses vision years later, it will be too late to improve on the injured eye's condition.
7 Inconvenience is much more than suffering from the actual injury, raising crucial quality of life questions. For instance, hospitalization, however brief, can prevent someone from being able to feed his animals, whether they are pets or means of livelihood. Even if this may appear as a mundane issue to the ophthalmologist who is fighting for vision, this is not mundane but crucially important to the patient.
8 Those who have 20/20 vision in both eyes may have difficulty understanding why an improvement from hand motion to 5/200 means a huge difference to the patient.
9 As have many other ocular traumatologists, the authors treated several patients in whom that minimal vision, saved in the severely injured eye years earlier through persistent reconstruction efforts against poor odds, became the vision when the fellow eye became blind.
make a concerted effort to truly understand what it means to suffer a sight-threatening eye injury learn basic psychology to be able to "decode" the patient's metacommunication and apply this knowledge when communicating with the patient encourage the patient to take every reasonable measure to improve the eye's condition and not give up while there is still hope treat the injured patient, not a traumatized eye or a damaged tissue
hurry the communication; this is not time wasted, even if occasionally more time is spent on explanation than on treatment let your pessimism show even if you consider the situation rather discouraging; even seemingly insignificant signs, such as a drooped mouth, can lead to major anxiety, and convey to the patient that he has no hope since his physician has none underestimate the power of empathy and effective communication: the patient will be grateful when he sees the effort you have put into trying to improve the injured eye's condition force a preconceived treatment option on the patient by "coaching," but instead examine all available treatment options, even if this includes referral of the patient to another specialist
Counseling is as important a part of treatment as surgery. Making the patient a partner in the management process is beneficial to everyone involved. Learning how counseling can be conducted effectively is not easy, but the "return on the investment" far outweighs the difficulties.
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