Nov
2
Written by:
Christine Sindt
11/2/2009 8:00 AM
Your patient, who has a long history of glaucoma that is controlled on two medications, has developed Alzheimer's disease. He becomes combative, emotional and "weepy" when he is brought in for intraocular pressure checks and dilated exams.
It is very stressful for everyone involved. His children have asked you if they can stop bringing him in for regular exams, but they said they will continue putting in his medications if you keep renewing his prescriptions.
What do you do?
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2 comment(s) so far...
Re: An Emotional Decision for a Glaucoma Patient
I would like to have more details about the patient. What is his age, how is his general health? How long do you think he is going to live? What do his nerves, OCTs, fields look like? How bad is the glaucoma?
Depending on this information, I would either have them continue to administer the medications and not see him back unless the family or patient noticed a problem (if the patient is not expected to live for a long time ) or I would reduce the visits to once a year with the family's understanding that there could be vision loss related to glaucoma by not following up.
By mvfisher on
11/5/2009 12:50 PM
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Re: An Emotional Decision for a Glaucoma Patient
In this case, we decided that examinations were not fruitful. We could no longer perform pressure checks and all other ancillary testing (OCT, visual fields) and even dilated exam were impossible. After discussion with the family, we felt everyone was on the same page and the family understood the risks of glaucoma progression and of the drops. The decision was made to discontinue office visits and te family would continue the use of the medication.
Would the decision be different if an eldery patient decided not to come back on his own. In a similar case, a 94 year old patient, fully cognizant of the situation, simply decided not to go to the eye doctor any more. The glaucoma field loss had been stable for many years and the nerves, although glaucomatous, were not considered high risk. Would you consider your relationship with the patient and and continue Rxing the medication? If you did not do nursing home calls, would you consider transferring care to another provider?
By Christine Sindt on
11/6/2009 9:57 AM
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