| doctor_my_eye@msn.com 2004-12-20, 10:08 pm |
| Ahhh, as Christmas approaches, we take out the old Holiday Specials and
repeat them. ;)
DoctorMyEye.com
THE Place To Go When
Refractive Surgery Goes Wrong!
Dr. Kenneth Minarik, O.D.
Post subject: The Wounds of Summer
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Come and sit around, my children, and I will tell you another story of
greed,anger and hypocracy that wears at the fiber of my moral soul.
You remember well that from my earlier postings I told you of my 30
hours away at two consecutive Eye Doctor Trade Show/Conventions, and
that I took 30 hours of continuing education classes. The State of
Illinois requires that 12 of these hours be followed by an examination,
taken after class or mailed to the student doctor.
Well, I waited for the tests to arrive, filled them in quickly, mailed
them off with my additional three hundred dollars in extortion money
(oops "fees") to grade the papers. And I waited for my grades.
Today, they arrived, and I did exceptionally well. I don't think I
missed a question. Oh well, maybe one or two. I had to wait to make
sure I got my passing grade before I got out my massive ACME-Brand
Flame Thrower and went back to visit my private little heck.
O=2EK. Folks, here's the class review you have been waiting for......
How To Manage Difficult Refractive Surgery Patients More Effectively,
taught by John Potter, OD., who happens to also be a Fellow in the
American Academy of Optometry.
First, a few words about Doctor Potter. John Potter is one of the most
dynamic and engaging speakers you would ever want to hear. I think that
is what scared me the most. As I listened to the audience smile, laugh,
and giggle at his every post-op platitude, I kept thinking....."so this
is what Satan's speech to Adam & Eve was really like. No wonder why
they ate the darn apple!"
I present to you some of the choice bits of "knowledge" that I
"learned" from this class:
When a patient has a complaint of any variety, use the "Feel Felt Fine"
Rule. Which is used as follows: "Mrs. Jones, I know your eyes FEEL dry
now, and I have had OTHER patients that have FELT dry eyes, but now
they are FINE."
Doc Potter is the Chief Optometrist in the Chicago Region for TLC, and
they have done 600,000 surgerys so far, so there has been a lot of
feel-felt-fine shoveled around here.
And now, Doctor Potter's Seven Risk Groups for LASIK Failures (with my
response in tow):
(1) Presbyopes with a part time need for a distance RX. (DUH)
(2) Those wanting to DECREASE glare. (Did any of you have the word
glare in your vocabulary BEFORE LASIK?)
(3) Perfectionists who want to see near and far perfectly. (You idiots)
(4) Those with a long history of prescription dissatisfaction. (But
they don't claim to market to contact lens failures)
(5) LASIK on a family member who had a low Rx and now sees perfectly
post-LASIK (Lord knows we couldn't do that twice in a row)
(6)Those with four or more web sites researched about the procedure
(picky, educated idiots...the worst kind)
(7) Those who want to know if there is a coupon for this laser center.
(!)
This is the part of the convention where I went back to my room to
chill out. I felt like a high school kid with a Down's Syndrome brother
that had just sat in a lunchroom full of kids telling mongoloid jokes.
I really felt dirty.
And now, as I type this...I have just put my continuing education
certificates away in my desk drawer for another two years. My children
are sleeping so soundly at the top of the stairs that their snoring is
making me laugh gently under my breath. My wife has some beach towels
gently fluffing in the dryer, and the cadence of their flopping around
adds a rythm to the night air.
I am home now, and in a place of great comfort....but the wounds of
summer remain.
Quote:
Quoting Dr. Minarik
I finally DID get the feel-felt-fine rule just right!
I FEEL that referring patients for refractive surgery is morally wrong,
I shared my story with others that FELT the same way, and last night I
slept just FINE.
Quote:
Quoting Gail Brion
Perfectionist!
Hah! I heard that one from my surgeon. It was phrased "All of the
professors I've done have complained, but they tend to be
perfectionists".
In other words, it is my fault for wanting to see at least as clearly
as I did with glasses before surgery. I just can't understand how
surgeons, trained to help people restore their vision, can use such
blather to cover up the truth about LASIK.
Thank you for sharing with us and letting us know it is not all in our
heads. They really are doing this to us knowingly.
Quote:
Quoting Dr. Minarik
Feel - felt - fine
I feel that I am blessed to know you SE folks, I have felt the warmth
of your support, and my practice has done just fine without referring
people out for LASIK.
Quote:
Quoting ellen
Dr. Ken,
What would you say the percentage is of moral optometrists? those that
don't promote RS, but if asked about it, guide the patient
appropriately? tells them about Surgial Eyes?
I've always wondered how my optometrist can sleep at nights, and happy
to hear you can sleep like a baby.
Quote:
Quoting Moose
'Unethical' or 'Unreasonable Expectations'?
This moose has been thinking about this post by Dr. Ken since reading
it the other day. Yes, it is certainly yet another story of the greed,
anger and hypocrisy that passes for eye care in this country but it is
also more than that.
The title, "How To Manage Difficult Refractive Surgery Patients More
Effectively" indicates that the number of people who are unhappy with
the results of refractive surgery is large enough for some refractive
surgeons and co-managing doctors to put together a course on how to
deal with them (God forbid they should simply provide the wonderful,
clear, crisp vision they advertise).
Doctor Potter's Seven Risk Groups for Lasik Failures clearly shows that
those selling lasik are not doing their job since there are so many
unhappy patients that they can actually put them into individual
groups.
(1) Presbyopes with a part time need for a distance RX. [Any lasik
doctor who does not have enough respect for his or her patients to
ensure that they understand the loss of close vision by demonstrating
it with contact lenses is borderline unethical.]
(2) Those wanting to DECREASE glare. [Unless the doctor made it quite
clear to the patient that glare would increase after lasik then this
doctor is unethical. Now knowing many 20/happy as well as 20/harmed
lasik customers I have yet to meet one in which the doctor provided
information regarding glare pre-op.]
(3) Perfectionists who want to see near and far perfectly. [Again, the
expectation presented in lasik advertising is that one will see as well
after lasik as they did before lasik with correction. If, when wearing
contact lenses, one could see well both near and far it is not
unreasonable to expect to see as well after surgery.]
(4) Those with a long history of prescription dissatisfaction. [Then
why do they market lasik to these patients? There is a radio commercial
running locally in which the DJ is being interviewed as to why she is
going to have lasik at 20/Burry Laser Centers. One of her given reasons
is that contact lenses dry out her eyes. Yet she is touted as the
perfect candidate and her words effectively indicate that lasik is a
good idea for people with dry eyes.]
(5) LASIK on a family member who had a low Rx and now sees perfectly
post-LASIK. [So let me get this straight: LASIK is not a good idea for
anyone who wishes to see as good or better than they did with glasses
or contacts? Who in their right mind would knowingly give up quality of
vision for the convenience of not having to wear glasses? Tell me again
why the lasik industry considers someone who is a crisp 20/20+ with
RGPs prior to lasik is supposed to be happy with anything less than
this after lasik? Are they really saying that those who expect to see
clearly are to picky to be considered good candidates for lasik?]
(6) Those with four or more web sites researched about the procedure.
[An educated customer is a poor customer? A customer expecting to see
as well after lasik as they did before lasik with correction is
automatically considered to be a difficult patient?]
(7) Those who want to know if there is a coupon for this laser center.
[Then why do they offer coupons? Why do they do giveaways? Why does PBS
do fundraisers for lasik giveways? Why is the mailbox stuffed with
coupon slicks for $299/eye? If the refractive surgery industry markets
lasik as if it were a consumer item and not medical care they should
really not complain when people accept them at there word.]
Yes, Mrs. Jones, I know you FEEL that you are not seeing anywhere near
as well as you did before lasik with contact lenses. I have lots of
other patients who have FELT the same way. But their flaps look FINE
and I don't believe you when you say that you are not seeing well
because you can read the 20/Blurry line so please don't bother me
again. And don't forget to encourage all your friends to come to
20/Blurry Laser Centers.
I wonder what percentage of the talk was dedicated to educating lasik
doctors NOT to sell lasik to patients with the unrealistic expectation
of seeing well?
Here we have seven ways of saying "unethical" uttered by one
doctor. How can any refractive surgeon embrace such a mindset?
Thank you to Dr. Ken for his honesty and courage to put ethics and
correctable vision before money.
Quote:
Quoting ellen
I just had a flashback to 2 1/2 yrs ago when the surgeon reluctantly
returned my phone call that I'd made to him, expressing my fears that
an enhancement might worsen existing problems, or add to them. He
listened to me ramble on, noticeably bored and impatient, and then his
exact words to me, which are instilled in my memory were, "you will be
FINE". Chilling...
Quote:
Quoting Pizzo
My co managing OD did not keep me around long enough for the FEEL FELT
FINE routine. He told me I think too much. He got tired of seeing me
with all my problems and eventually refused service to me in a fit of
rage, claiming that my request for my medical records demonstrated a
lack of trust and he feared a law suit. My eyes were on FIRE all the
time, I was blurry, and could hardly read, and the **** tossed me me
out.
- I FEEL he is a poor excuse for a human being, let alone a doctor.
- I then FELT like crying, and I did, often. I was abandoned.
- 19 months later my eyes do not feel FINE
pizzo
"Published LASIK statistics are like bikinis, what they conceal is more
important than what they reveal."
Quote:
Quoting Dr. Minarik
Thanks....and another moral conundrum
One of my recurring themes in these rambling posts (See "Jerry, I
hardly knew Ye") is that the line between who to trust and who is
working in their own best interests gets blurrier and blurrier. The
answer is, that there is no anwer.
To say that all optometrists who co-manage refractive surgery are
unethical is to say all refractive surgery is an ellicit activity. We
go back to the fact that there are some surgeons out there that
pre-screen well, set expectations well, and provide a service to people
who REALLY WANT IT.
Two years ago, my refractive surgery classes were about picking up
flaps and choosing the right steroid. It wasn't until this year, when
my "F-F-F" class happened, that I realized that a defensive posturing
had begun because WAY TOO MANY bad cases are being performed, and
EVERYONE in the audience knew something about Collateral Damage.
It is then that I truly felt alone...
Quote:
Quoting Moose
Clarification
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"To say that all optometrists who co-manage refractive surgery are
unethical is to say all refractive surgery is an ellicit activity." -
Ken Minarik, OD
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This moose agrees with Dr. Ken on this and would like to clarify his
comments. Refractive surgery itself is not necessarily unethical.
Refractive surgery as it is practiced today does, in this moose's
opinion, range from being borderline ethically acceptable to outright
unethical (we all know the problems with everything from lack of true
informed consent, understatement of risk, denial of complications, to a
simply overpromise of outcome).
Surgeons and co-managing ODs who knowingly treat patients that have
been visually harmed by denying the existence of their rs-induced
visual problems and simply classifying them as difficult patients (per
Dr. Ken's original post) are unethical.
The mere fact that there are courses teaching lasik docs how to handle
the patients they have harmed speaks volumes about the ethical problems
within the rs industry. It would have been much better (and more
ethical) for this course to have acknowledged that harm has been done
and to focus on restoring quality vision rather than to blame the
patient for actually expecting the vision that was promised.
Moose apologizes to everyone as it was not his intention to turn this
thread into an ethical debate. The more important task to find ways to
restore correctable vision to those who have been harmed.
Quote:
Quoting Dr. Minarik
This morning's LASIK patient
Ironically, eithne, this morning I had a post op LASIK randomly walk
into my office with her boyfriend. He has been my patient for years,
she is new to the practice. He has no desire to have LASIK, and we
didn't plan on discussing it. When she sat for her health examination,
her corneas were a thing of beauty. She told me that she was a -13.00
Diopter myope in both eyes pre-op. The caps were perfect, she had no
glare or GASH. Her refraction was a pristine -.50 Diopter in each eye,
and she saw 20/25 uncorrected and 20/15 with the little bit of minus.
I don't know if you can understand how happy this woman is. She has
clear, stable vision. Her skilled surgeon picked her flaps up twice
each eye to re-position them because of how much tissue was removed
below the flaps. His work was just stunning. She healed as if nothing
was ever done.Her health insurance paid for her procedure. It cost her
nothing and she is happier than a woman with new twin babies.
In your anger, could you even deny HER this happiness? We will not stop
this industry, but we can heal it.
Quote:
Quoting gerielkins
i guess the frustration exists because it is impossible to tell prior
to the lasik who WILL have a good outcome, and who will not. how many
of us were told we were "good" or "perfect" candidates??
i would not want to deprive that woman of her now corrected vision, but
rather save someone else the horrible experience that so many others
have had.
the bottom line is, that while for many people lasik is a procedure
which has given them acceptable vision,for many others it has cost them
the very same thing.
and there is no way to really know ahead of time where the patient will
end up.
Quote:
Quoting Dr. Minarik
Don't apologize for having an adverse opinion of LASIK...
..=2Eit has caused you great pain and disrupted your life. In my post, I
ask you to imagine the happiness of a former minus 13 who is now
virtually perfect. And now, play another role...mine. How should I
respond to this wave of unrestrained joy after having spent a year
dealing with the wounds shared here?
Quote:
Quoting Dr. Minarik
While the intent of this thread has wandered.....
I have to tell you, my family, some good news. Today I received an
e-mail from Japan, and in it the author noted that my brother had
forwarded the link to this thread to a friend in Tokyo. As it was
passed through their consumer electronics company, a few of the
management people that had considered LASIK have cancelled their plans.
Another bandage for the wounds of summer.
Quote:
Quoting Marina
Thank you so much for sharing, Dr. Ken Minarik!
I'm probably a Difficult Refractive Surgery Patient who belongs to the
Risk Group for LASIK Failures Number 3:
(3) Perfectionists who want to see near and far perfectly. (You I'M AN
IDIOT!)
And I think the "Feel Felt Fine" Rule is nothing but Dirty Dirty Dirty!
Oh, and you have a really nice family. You're a lucky man!
Marina
Quote:
Quoting Dr. Minarik
ptt for a backstory
FINDing a common ground
Quote:
Quoting Dr. Minarik
I feel that our presentation or RSPOCS....
will be wonderfully successful. I have felt that this needed to be done
for a long time. I think that Chicago in Summer 2003 is a FINE place to
heal the wounds of summer.=20
=20
=A9 2004
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