Philosophy

I recently read some blog posts that made me think about the philosophy of ophthalmology. When patients come to see me, I feel that it is my job to figure out if there is anything wrong with their eyes and address their complaints. However, there is a subtle nuance to this that I don’t usually think about. One of the limitations to my ability to detect eye abnormalities and to address the issues that patients may present with is my knowledge. If I am a competent ophthalmologist, this will approximate, to some extent, the knowledge in the field of ophthalmology. This is probably best illustrated with an example. If a patient comes to see me and reports blurry vision, I am limited in my ability to address the blurry vision by what is known to me and the field of ophthalmology. So, a patient may see 20/20 on an eye chart and still say there is blurry vision. At that point, if the eye examination is totally normal by our current standards, I am left without any answers for the patient. However, the correct framing of my thought is this: “From what I can see, everything appears to be normal. I have no doubt that you do notice some blurriness, but I can’t detect the blurriness or find any likely reason that you have that blurriness. Therefore, by the limitations of the field of ophthalmology, your eye exam is ‘normal.'” This is importantly distinct from saying, “Your eyes are completely normal. Everything is fine.” If everything were truly “fine,” the patient would not have any complaints. Some people may want to dismiss this as “all in the patient’s head,” but that may be just plain wrong. The truth is that the field of ophthalmology will change over the years. Perhaps we will be able to detect in the future what we cannot detect now, and perhaps we will even be able to treat it or cure it. It doesn’t change what I can do for the patient now, but I want all my patients to know that I understand their concerns. Even if I cannot do anything about them and have to reassure them that I don’t anticipate that things are going to get a lot worse, I should never say or think “it is all in their heads.” Because, many times, what the patient is detecting may just be something that is poorly understood now that will seem obvious to future generations of eye doctors.