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MEMORABLE PATIENT ENCOUNTER

The case of the falsely accused MD
We’ve all had patients whose visits left indelible impressions on us and our practices. Some funny, some strange, others sad, all unforgettable.

Poor refractive outcome? Bad IOL choice? No. Doing “something” to a patient’s mouth so her dentures didn’t fit? Yes.

In my more than 40 years as an ophthalmologist, I have witnessed a groundswell in ophthalmic technology, including phacoemulsification. Throughout the decades, though, I never thought I’d be falsely accused of jaw-tampering — and then be witness to denture-tampering.

This encounter took place in the early 1980s, when cataract patients were still hospitalized. I had (and still have) privileges at the Cumberland Medical Center in Crossville, Tenn.

Ophthalmic viscosurgical devices (OVDs) were not readily available during that period, so implanting IOLs could be hit or miss. Surgery was intracapsular early on, and later, when it became extracapsular, we made a fairly large incision, so there was no good way of maintaining the anterior chamber for IOL implantation.

Since we didn’t have the advantage of viscoelastic, we needed the patient to be completely motionless. So, to attain optimal conditions, the patient was placed under general anesthesia to achieve complete muscle relaxation in an attempt to avoid any external pressure on the globe.

This enhanced our chances for minimum positive vitreous pressure and to attain adequate anterior depth for iris or sulcus IOL fixation. Patients stayed in the hospital for at least a day due to the anesthesia.

Early one morning I was making postop rounds when I entered the room of an unhappy cataract surgery patient. This woman, in her 70s, started complaining about her operation as soon as she saw me.

What I wasn’t expecting was her problem — she said we had done something to her mouth during her cataract operation. I was confident we hadn’t done anything wrong and wondered to myself how on Earth an ophthalmologist could get blamed for something as strange as this.

I tried, and failed, to reassure her that I had not altered her mouth, but she persisted. “Well, my teeth don’t fit since the surgery.” At that point her roommate in the next bed, who shared a night stand with the other patient, chimed in. “Well, my teeth don’t fit me either this morning.”

Sighs of relief and embarrassed looks ensued. Mystery solved, and my practice salvaged. OM

If you have a funny, sad, unusual or otherwise memorable patient encounter to share, please contact chris.bahls@pentavisionmedia.com.