After enough patient encounters, you’ll suddenly realize you can easily, intuitively and instantly connect with the patient’s wants, needs and favorite foods. OK, the food part probably comes from the faint smell of barbecue they should have avoided yesterday, but the wants and needs are what’re important anyway.  

Playing your part in the critical doctor-patient relationship means listening, observing and, of course, accepting the patient’s crappy vision plan. That relationship (with vision plans, not patients, usually) is always somewhere between symbiotic and vampiric; some days you suck their blood, but most days they suck yours. 

An OD’s Sixth Sense

Here’s what you can do to hone your patient intuition:

First, and above all else, listen. This does not mean simply letting sound waves enter your ears. What does the patient (or parent) really mean? Here are some examples:

If a patient says, “There’s nothing more important than our eyes,” they don’t mean, “There’s nothing more important than our eyes.” They mean, “I haven’t had my eyes checked since I got LASIK in 2004.” Obviously. 

What if they say, “I just want what my insurance covers”? They mean, “I want to buy a 1964 Corvair Monza, but it had better be as fast as a Ferrari 488 Pista or I will give you a crappy review.”

Try this one: “I tried contact lenses once, and they didn’t work, but now I want to try them again.” You guessed it. They really mean, “I am 53 years old, had LASIK in 2002 and my prescription is plano -0.50 x 162 with a +2.00 add.” See how much time listening saved you on the refraction?

What if the mom says, “Billy gets his eyes from me. His father has perfect vision”? What she is really saying is, “Billy’s father has never had an eye exam and wears my old glasses to watch TV.”

Next, you must observe. Does the mom stay on the phone the whole time you are checking her daughter’s eyes? By observation, you have just accurately diagnosed the daughter’s presenting symptom: her eyes roll around all the time. Case solved. 

When you enter the room, is the patient sitting with arms crossed, tapping their foot? They are hyperopic and will lie like dogs throughout the examination just to see if they can fool you. Myopic patients do not lie unless they had LASIK and can barely see 20/40 now. 

Does the patient have four-inch eyelash extensions? Regardless of their refraction, they will insist you declare them legally disabled because they “can’t wear glasses.” And if they drive a late-model Mustang, they will also need a letter to get their windows tinted. 

Some very successful doctors assure me that patients respond best to patience. You know they are now 48 and can’t see their computer, but they want to actually tell everyone their story. Sometimes I get the best patient history from the UPS guy who holds the front door for them. So, you absolutely must pretend you care that they can’t see their spaghetti unless they wear their readers.  


Try to stick to observation and not intervention. I’m 65, and when a 44-year-old tells me their eyes are “old,” it’s all I can do to not laugh and remind them my shoes are 44 years old. Try to nod and smile and make ’em see better.