The benefits of proper counseling are as follows:
• It is much easier for the ophthalmologist to earn the trust of the patient if he is appreciated as a physician who is not only knowledgeable but one who cares.
• A patient who is treated as a partner in, rather than simply a target of, the treatment process is more likely to adhere to physician instructions and return for follow-ups.
• A patient who was honestly told the risks of injury and treatment, and the difficulties associated with the option he himself chose, is less likely to "be surprised" if the outcome is suboptimal and is thus less likely to initiate legal action against the ophthalmologist (see Chap. 1.8).
Patient presents with a 6-h-old injury Hit with a fist Visual acuity: NLP
Findings: scleral rupture; subconjunctival blood; total vitreous hemorrhage; no IOFB; retinal detachment; subretinal blood accumulation Patient conscious, alert, denies alcohol or drug consumption
Counseling options o
■ You have an injury from which there is virtually no chance for recovery,
■ Surgery may be attempted, and should you want me to, I will try it, but I am not sure that even stitching the eye together is possible.
■ Another problem is that such Injuries have been found to cause a very severe inflammation, which can Involve your good eye and cause blindness in the good eye.
• The only certain method to prevent this is by removal of your injured eye as soon as possible, but no later than within 2 weeks.
■ Again, remember that this eye probably won't function anyway.
■ You have a very serious injury,
■ I can perform reconstructive surgery (or refer you to a colleague for it). Based on the best available data, this surgery has an estimated 50% chance to improve your vision, and even an unsuccessful surgery reduces the otherwise real risk that your eye will start shrinking in the future.
■ You also have to know that unless your injured eye is removed now, there is a possibility of your good eye later developing a potentially blinding inflammation.
> The chance of this complication is no more than 1/1,500.
- With early recognition - and I will describe to you the symptoms - and proper treatment, however, your good eye has a better than 50% chance of maintaining reading
Patient's likely choice: enucleation
Patient's likely choice: reconstruction
Q Fig. 1.4.3 The "coaching" and "noncoaching" versions of counseling. For further details see Chap. 1.8. Only a condensed version of each counseling option is provided here as an illustration
Was this article helpful?