Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

I won’t come back to the ER for glasses again

Sriranjani Padmanabhan, MD
Conditions
June 9, 2014
Share
Tweet
Share

He was a 24-year-old African American man with no history of medical or eye problems.   On an ordinary Thursday evening at 8 p.m., he arrived into the emergency department complaining of a sudden loss of vision in both eyes.

“He couldn’t see a thing on our chart.  Vitals are fine, pupils are equal and reactive, and the rest of the neuro exam is unremarkable,” the emergency room attending briefly explained.  “Can you see him?”

As the first year ophthalmology resident on call that night, I certainly could.

“Great.  I’ll put in for a CT of the head and orbits.  It’ll be done by the time you …”

“Hold on that CT,” I interrupted.  “Let me see him first.”

Not a half hour later, I had whisked my new patient to the eye clinic, settled him in the exam chair, and asked him to read the chart with one eye covered.

“E.”  He correctly stated the 20/400 letter after just a moment’s hesitation.

We got down to 20/200 in each eye, and then he struggled.  I didn’t expect such a poor visual acuity from a young and otherwise healthy man.  I confirmed the normal pupils and as I swung the slit lamp before him, I wondered what pathologies I would find.

But there were none.  His eyes appeared perfectly healthy, if not slightly myopic.  We were discouraged from performing refractions on emergency visits, but I wanted to ascertain a diagnosis, so I went ahead.

After we corrected a moderate amount of myopia, he easily read the 20/20 line with each eye.   I turned on the room light and lifted the phoropter away from his face.  He looked at me with a sheepish smile and shrugged.

“The good news is your eyes look healthy, you just need a simple pair of glasses,” I told him.

I paused.  He looked at his hands.

“But,” I continued. “Something tells me you already knew that.”

ADVERTISEMENT

He sighed.  “You got me.  I knew I needed glasses.  I’ve needed them for a while.  So much for sudden loss of vision.  Sorry, doc.”  He chuckled.  “But I lost my insurance.  It didn’t cover glasses anyway, and glasses are so expensive.  And eye exams are so expensive.  So I figured if I came to the emergency room, maybe I could get both for free.”

My heart sank.  It’s a common misconception that emergency care is free of cost.  I explained to him that emergency rooms are mandated to provide emergency care regardless of a person’s ability to pay, but patients will often still get billed. His little white lie would likely turn into a big invoice.

“I had no idea,” he said, looking forlorn.  “Oh, man.”

It was hard to blame him.  Most glasses were ridiculously expensive.   One company controls a large majority of the frame manufacturing and prescription glasses retail in the United States, and sets prices at an enormous markup.   It explains why one can get simple over the counter plus lenses, or reading glasses, relatively cheaply, but simple minus lenses to correct myopia are only available by prescription and therefore cost several orders of magnitude greater.

I gave my patient a spectacle prescription and pointed him in the direction of a few new online spectacle retailers, who were reliable and much more affordable.

“Thanks doc,” he told me.  “I won’t come back to the ER for glasses again.”

As I signed the patient back over to the emergency room for discharge, the attending told me he would do his best to minimize the patient’s bill.  We were lucky to avoid the CT scan, and we agreed to discuss the decision to image ophthalmologic cases before the tests were actually ordered.  “Communicating,” the attending surmised.  “Patient to doctor, doctor to patient, doctor to doctor.  It goes a long way, doesn’t it?”

I had to agree.

Sriranjani Padmanabhan is an ophthalmology resident.

costs_of_care_logo_small

This post originally appeared on the Costs of Care Blog. Costs of Care is a 501c3 nonprofit that is transforming American health care delivery by empowering patients and their caregivers to deflate medical bills. Follow us on Twitter @costsofcare.

Prev

What would an EMR on Twitter look like?

June 8, 2014 Kevin 3
…
Next

Google Glass has a long way to go in the OR

June 9, 2014 Kevin 9
…

Tagged as: Emergency Medicine, Specialist

Post navigation

< Previous Post
What would an EMR on Twitter look like?
Next Post >
Google Glass has a long way to go in the OR

ADVERTISEMENT

More in Conditions

  • How President Biden’s cognitive health shapes political and legal trust

    Muhamad Aly Rifai, MD
  • The emotional first responders of aesthetic medicine

    Sarah White, APRN
  • Why testosterone matters more than you think in women’s health

    Andrea Caamano, MD
  • How veteran health care is being transformed by tech and teamwork

    Deborah Lafer Scher
  • What Elon Musk and Diddy reveal about the price of power

    Osmund Agbo, MD
  • Understanding depression beyond biology: the power of therapy and meaning

    Maire Daugharty, MD
  • Most Popular

  • Past Week

    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
  • Past 6 Months

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
  • Recent Posts

    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Decoding your medical bill: What those charges really mean

      Cheryl Spang | Finance
    • The emotional first responders of aesthetic medicine

      Sarah White, APRN | Conditions
    • Why testosterone matters more than you think in women’s health

      Andrea Caamano, MD | Conditions
    • A mind to guide the machine: Why physicians must help shape artificial intelligence in medicine

      Shanice Spence-Miller, MD | Tech
    • How subjective likability practices undermine Canada’s health workforce recruitment and retention

      Olumuyiwa Bamgbade, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 57 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
  • Past 6 Months

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
  • Recent Posts

    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Decoding your medical bill: What those charges really mean

      Cheryl Spang | Finance
    • The emotional first responders of aesthetic medicine

      Sarah White, APRN | Conditions
    • Why testosterone matters more than you think in women’s health

      Andrea Caamano, MD | Conditions
    • A mind to guide the machine: Why physicians must help shape artificial intelligence in medicine

      Shanice Spence-Miller, MD | Tech
    • How subjective likability practices undermine Canada’s health workforce recruitment and retention

      Olumuyiwa Bamgbade, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

I won’t come back to the ER for glasses again
57 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...