Finding A New Doctor Who’s More Open – Part 4

I don't knowThe essence of the first three parts was that certain professionals who might otherwise guide patients appropriately on the advisability of vision therapy have adopted a willful or unintended ignorance about the field.  In many instances this isn’t the fault of the practitioner, because the substance of optometric vision therapy was not part of their coursework in graduate school, nor part of their clinical experiences in training or practice.  Having never participated in the delivery of successful care through optometric vision therapy, they are left with impressions of the field based on seeing a skewed population of patients who are dissatisfied and seeking second opinions.  In other instances the professional might rely on organizational policies and proclamations based on selective reviews, conceived to position vision therapy as controversial.  In sum, the intent of the professional in dissuading the patient from considering optometric vision therapy is what is called into question.  This very subject of willful or unintended ignorance is what the author Leah Haggler Cohen explores in her pithy volume “I don’t know“.

Consider some of her passages, particularly in the context of Mr. Aramanda’s video:

“How about a school that teaches people to say ‘I don’t know’?  More and more, medical schools are assuming this responsibility.  This is notable because it represents a major divergence from the culture of traditional Western medicine.  ‘Doctors use information as part of the therapeutic regimen’, wrote the philosopher Sissela Bok in 1978.  ‘It is given out in amounts, in admixtures, and according to timing believed best for patients.  Accuracy, by comparison, matters far less.’  … Doctors who are most comfortable saying ‘I don’t know’ tend to describe their relationship with patients as collaborative: They work together to assemble information and decide how to proceed.”

This spirit of collaborative relationship is precisely what defines doctors who are more open.  In her interview with Review of Optometry, Sue Barry describes how she knew it was time to finally abandon the guidance she was getting from her previous doctors.  As well intentioned as they may have been, and authoritative in surgical issues, they didn’t have the courage to say: “I don’t know” when it came to helping her with her visual difficulties.  In a perfect world the eye surgeon would do precisely what Dr. Steven Markow did.

As described in his editorial in Optometry and Vision Development, Dr. Dominick Maino notes that Dr. Markow was the exemplar of a doctor who is open to collaboration.  As Ms. Hager Cohen writes in her book, doctors who are most comfortable saying “I don’t know” work together to assemble information to decide how to proceed.  “The doctor has the specialized knowledge; the patient presents the goal or need.  In this paradigm, the doctor isn’t entirely unlike a reference librarian helping a patron with a research project.”



In this context, the role that Dr. Markow played in Susan Barry’s life bears repeating:  The Story of Stereo Sue would have never occurred had Dr. Markow not listened carefully to the problems she related to him the day she came in to his office to fill a prescription from her ophthalmologist.  He was not afraid to say he didn’t know why she was having the difficulties she related regarding instabilities in her vision.  Although it was neither his field nor his area of expertise, he considered that the challenges Sue faced might be resolved by referral to a practitioner skilled in vision therapy.  His research led him to recommend Dr. Theresa Ruggiero, and the rest is history.  In Ms. Hager Cohen’s paradigm it is possible one day that ophthalmologists, when queried about the advisability of optometric vision therapy, will say: “I don’t know; it’s not my field.  But I know someone skilled in the area, and I’d be pleased to arrange a consultation.”

2 thoughts on “Finding A New Doctor Who’s More Open – Part 4

  1. Len, Your final sentences sum up what would be the ideal for the patient. To have a doctor consult/refer to someone with expertise rather than take an uninformed stab (sic) at the problem or deny such help may exist seems to me very close to violation of their oath to do no harm. Very nice piece. Tom Lecoq

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s