what’s truly important…

At the risk of sounding cynical, and if I do then so be it, I’d like to pose a question that has been on my mind for several days now.  My question was spawned by a series of experiences occurring late last week, and brought to a head today when a parent informed me of their decision to forego their child’s recommended Vision Therapy program because his pediatrician “got mad at them” for considering it. Got that?  The doctor got mad because the parent found a treatment that might help their child.

My question: Who cares?

Sadly, this situation is common.  Parents hoping to better understand what is best for their children seek advice from someone whom they perceive to be an expert on the topic.  Makes perfect sense. Who better than a trusted clinician who earned a doctorate in children’s health and medicine would be better suited to answer questions about nurturing development and correcting inadequacies?  There is a fine line between offering strong advice and bullying though, and it seems the line becomes more and more blurred in some circles.

Unless I’ve missed something, a doctor’s role is to treat the needy, sick and injured.  Becoming angry in front of your patient when they discuss something you may not support is nothing short of an intimidation tactic, or a grownup form of bullying.  Anyone taking an objective stance would simply state they do not recommend or believe in the VT, and advise against it – which would be unfortunate, but respectable.  I am confused as to what some doctors outside of Developmental Optometry hope to achieve by becoming enraged in front of their patients when Vision Therapy is discussed.  Doesn’t make sense.  I also don’t understand why we care.  Why does their emotional response have to be the finish line for this decision?

When I was 23, I was involved in a pretty serious high speed car accident, as I have mentioned previously. Although I had hit my head and was sore for two weeks from bruising, my main injury was to my spine.  Both my GP and the Orthopedist recommended surgery, if not at 23, definitely before turning 30.  At the time, I had a good friend who had just graduated from Chiropractic School who advised me of less invasive treatment options.   Much to their credit, both my GP and Orthopedist understood my desire to exhaust all other avenues before travelling the surgery route, which from what I understand can be more damaging than corrective. During both follow up visits, my doctors expressed their concerns with waiting on surgery and one even asked that I “do my homework” on Chiropractic before starting treatment (for those who are unaware, western medicine has similar biases against Chiropractic and Vision Therapy) and said they were available for further consultation if needed.  There was no anger, there was no intimidation, there was no bad mouthing, there were no guilt trips – just professional medical advice.  After all, it was my choice and my body. Not theirs.

Just for argument’s sake, let’s implant the “getting mad” reaction to other areas of life:

– Your car begins to run poorly and  your usual mechanic says you can either buy a new car, or learn to live with your now poorly running car.  You ask about the shop down the street who told you they may have a solution, and your mechanic gets mad at you for asking.  Would his anger stop you from heading down the street to utilize the mechanic with a solution?  Probably not.

– When applying for a bank loan the banker informs you 28% interest is the only rate available worldwide.  You mention you’ve considered a different bank and spoken to different bankers and have learned that you may have other options. Hearing this, the banker becomes angry at your thought.   With this unusual response, you may suddenly question his degree of integrity or wonder about his motives. Either way, its probably all the motivation you need to walk out the door.

– Heaven forbid your child is diagnosed with a serious illness.  Your doctor advises you get their affairs in order as there are no further solutions available.  You seek a second opinion from another doctor who discusses different treatment options and even suggests a long life ahead, full of growth and happiness.  Upon sharing the new opinion with the first doctor, you are surprised when the first doctor gets mad at you and advises there is no evidence supporting the second doctor’s treatment – which you discover later is untrue. Even if you can overlook the possible impropriety, why on earth would the first doctor get mad when you propose a potential solution?  Shouldn’t your new found hope be cause for a celebratory hug, a victory lap around the office, or even a high five with a smile?

Not everyone supports Vision Therapy, an unfortunate fact of life, but one I can live with.  But just like your mechanic or banker, when you turn to a trusted professional for advice, the expectation is (or at least it should be) that professionalism is always present. There is no reason to get mad or bully patients.  Just like we advise our kids to turn the other cheek when faced with a bully, we should follow our own advice. If professionalism waivers when dealing with professionals, maybe parents should assess the true value of the opinion and question why anger is part of the equation in the first place.  You can draw your own conclusions.

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Posted on September 30, 2013, in From My Perspective.... Bookmark the permalink. 7 Comments.

  1. These same doctors who decry vision therapy would presumably accept the validity of PT, OT, education, and psychology. Or perhaps they feel these aren’t ‘real’ either. What this attitude reveals more than anything is a frank disregard and lack of knowledge around vision. Nothing more complicated than that. It’s silly. Not sure if it’s worth becoming cynical over, but I do very much empathize with your sentiments, Robert.

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    • Robert Nurisio COVT

      Agreed, Dr. Boulet. Cynicism is unproductive, but is an occasional product of my frustration. A patient discounting our findings based purely on the idea that they don’t wish to upset their pediatrician, is something I am sure we’ve all experienced. They don’t realize the possible medical benefit has been removed from the decision, and unfortunately, is purely based in emotion. Sad but true.

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  2. Thank you for identifying what truly is – BULLYING pure and simple!
    We decry it when we see it happening on the playground, but it can be just as damaging and harmful when it happens in an exam room.

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  3. Can you clarify a point for me, Robert. You wrote: “I am confused as to what some doctors outside of Developmental Optometry hope to achieve by becoming enraged in front of their patients when Vision Therapy is discussed. Doesn’t make sense. I also don’t understand why we care.” — Was that tongue-in-cheek, or did you really mean that we shouldn’t care about the visceral reaction that some MDs have to vision therapy (or chiropractice for that matter)?

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    • Robert Nurisio COVT

      Thanks for reading, Dr. Press. The catalyst for this post was a patient informing me that their pediatrician had yelled at them and inferred they were bad parents for even considering VT, as he considered it a waste of time. As for the visceral reactions, my hope is that they can be taken with a grain of salt, and not as “law of the land” as my patient this morning felt it was. Had his point been made tactfully or respectfully, perhaps more consideration would have occurred on the parent’s end. Because of his badgering, mom and dad have chosen against VT because they “didn’t want to have face their pediatrician again”. As I said, I don’t understand why we (meaning parents) make that perspective the finish line for this decision. The “who cares” comment/question is 100% cynical in response to the doctor’s anger. Let them get mad, it doesn’t change the fact that VT is effective. This doctor’s attempt to bully these parents became the tipping point against VT. Unfortunately, the parents were not able to tease out the facts from the negative behavior.

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