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A letter for the Opthamologist
The following is a letter I am thinking of send my eye dr. NOW...
In June of 2008 I sent you a letter appealing to you for your help and I had an appointment with you on June 26, 2008. At that time we went over the letter and you stated that you would do the appropriate testing and then we can make a decision. You stated that you felt the problem was neurological because my eyes themselves have not changed in almost 3 years.
I came back to see you because you said you did not have time to perform the vision acuity test on June 26th. You also explained at that appointment that you felt that my eye problems were neurological and that changing my prescription would not help with any of my symptoms. When I asked if you would be writing a letter to my Neurologist and G.P. explaining that you felt that my eye problems were neurological, you responded that you would write the letter after I had my visual acuity test.
So I returned to your office July 10, 2008 and had the visual acuity test as you had recommended. After the test you advised that I return to see you and have another test in 4 to 6 weeks and that you would write a letter to the Neurologist and the G.P. at that time and I agreed hesitantly. I did feel at that time that my symptoms were not going to change as they have only gotten worse since July 2007.
On August 26, 2008, I saw you again for a visual acuity test and you tested my astigmatism. You reported to me that the visual acuity test from this date did not differ from the visual acuity test of July 10th. You tested my astigmatism and stated that a change in my lenses in my glasses would be very small and probably wouldn’t make much difference but you gave me a new prescription in case I decided to get new lenses. When I asked you if you were going to send a letter to my Neurologist and my G.P., you stated that you didn’t feel that it was up to you to make a diagnosis of a neurological problem because you are not a neurologist. I didn’t ask you to diagnose a neurological problem, I already have a neurological diagnosis of Multiple Sclerosis of which you are well aware. I asked that you confirm for the neurologist that my eyesight has deteriorated and that you feel it is neurological as you stated at my appointment on June 26th. I stated, “You were the one that said that my eye problem was neurological and that a change to my lenses wouldn't help this particular problems and now you say that it is astigmatism and that you can fix it with new glasses?” You responded “Yes, it is your astigmatism” and I responded that “no, you said it was neurological and that is why I came back to see you again, because you said you would write a letter explaining to the Neurologist that you feel that my eye problems are neurological and now you say it’s not?”
You then went on to state, and I quote, “I do think that you have a neurological problem, but then doesn’t everyone?” You also stated that “this is something that you are just going to have to live with.”
I stated, “THAT is exactly the point, there are disease modifying drugs out there that could slow down the progression of the disease and I am being denied because as my Neurologist says, my disease is ‘in-active’!” That is why I came to you in the first place and appealed to you to help me by notifying the Neurologist that you felt that my eyesight difficulties are being caused by something neurological. You stated, “Well, I may think that your Neurologist is wrong but he is the expert, not me.”
I mentioned that I am trying to get a new MRI done through my G.P. and you responded with, “your disease cannot be measured with an MRI” and I responded that “I know that but my Neurologist is a lesion counter and that is why I am being denied the disease modifying drugs!”
At that point you very quickly ushered me from the room and told me to get my prescription from the receptionist and you wished me well and sent me on my way...
My question is if you are not comfortable with notifying my Neurologist or G.P. of my problems and the fact that they are related to a neurological problem, can you please refer me to a Neuro/Opthalmologist for follow-up? You have stated that because you are not a Neurologist you would be uncomfortable stating that my problem is neurological but I feel that I would best be seen by the professional in the field of both Neurology and Opthalmology.
Sincerely.....blah blah blah...
In June of 2008 I sent you a letter appealing to you for your help and I had an appointment with you on June 26, 2008. At that time we went over the letter and you stated that you would do the appropriate testing and then we can make a decision. You stated that you felt the problem was neurological because my eyes themselves have not changed in almost 3 years.
I came back to see you because you said you did not have time to perform the vision acuity test on June 26th. You also explained at that appointment that you felt that my eye problems were neurological and that changing my prescription would not help with any of my symptoms. When I asked if you would be writing a letter to my Neurologist and G.P. explaining that you felt that my eye problems were neurological, you responded that you would write the letter after I had my visual acuity test.
So I returned to your office July 10, 2008 and had the visual acuity test as you had recommended. After the test you advised that I return to see you and have another test in 4 to 6 weeks and that you would write a letter to the Neurologist and the G.P. at that time and I agreed hesitantly. I did feel at that time that my symptoms were not going to change as they have only gotten worse since July 2007.
On August 26, 2008, I saw you again for a visual acuity test and you tested my astigmatism. You reported to me that the visual acuity test from this date did not differ from the visual acuity test of July 10th. You tested my astigmatism and stated that a change in my lenses in my glasses would be very small and probably wouldn’t make much difference but you gave me a new prescription in case I decided to get new lenses. When I asked you if you were going to send a letter to my Neurologist and my G.P., you stated that you didn’t feel that it was up to you to make a diagnosis of a neurological problem because you are not a neurologist. I didn’t ask you to diagnose a neurological problem, I already have a neurological diagnosis of Multiple Sclerosis of which you are well aware. I asked that you confirm for the neurologist that my eyesight has deteriorated and that you feel it is neurological as you stated at my appointment on June 26th. I stated, “You were the one that said that my eye problem was neurological and that a change to my lenses wouldn't help this particular problems and now you say that it is astigmatism and that you can fix it with new glasses?” You responded “Yes, it is your astigmatism” and I responded that “no, you said it was neurological and that is why I came back to see you again, because you said you would write a letter explaining to the Neurologist that you feel that my eye problems are neurological and now you say it’s not?”
You then went on to state, and I quote, “I do think that you have a neurological problem, but then doesn’t everyone?” You also stated that “this is something that you are just going to have to live with.”
I stated, “THAT is exactly the point, there are disease modifying drugs out there that could slow down the progression of the disease and I am being denied because as my Neurologist says, my disease is ‘in-active’!” That is why I came to you in the first place and appealed to you to help me by notifying the Neurologist that you felt that my eyesight difficulties are being caused by something neurological. You stated, “Well, I may think that your Neurologist is wrong but he is the expert, not me.”
I mentioned that I am trying to get a new MRI done through my G.P. and you responded with, “your disease cannot be measured with an MRI” and I responded that “I know that but my Neurologist is a lesion counter and that is why I am being denied the disease modifying drugs!”
At that point you very quickly ushered me from the room and told me to get my prescription from the receptionist and you wished me well and sent me on my way...
My question is if you are not comfortable with notifying my Neurologist or G.P. of my problems and the fact that they are related to a neurological problem, can you please refer me to a Neuro/Opthalmologist for follow-up? You have stated that because you are not a Neurologist you would be uncomfortable stating that my problem is neurological but I feel that I would best be seen by the professional in the field of both Neurology and Opthalmology.
Sincerely.....blah blah blah...
Can't remember if you have kids. Anyway you know what toddlers are about. No reasoning with them, can't understand the world exists outside their needs etc..
This is a super powerful, articulate and educated toddler you have on your hands. Telling him off will make him sulk, telling him your needs are as great as his won't mean anything to him. He has to be a little concerned that his patient may lose her sight (god forbid) and be held responsible for not acting on his findings. That is how you want the letter to hit him. Because its all about him, his career, his feelings, his ego.
That was why I wrote a letter not repeating the inustices and inconsitencies, but stating the possible consequences of his actions, in the voice of the ignorant and insignificant patient he sees you as. You speak to egomaniacs in their own language. They don't understand adult speak. His language - Patient at risk of losing sight, him at risk of losing job, that will get him moving, nothing else.
And some people have the audacity to call me cynical...
You all here know I am completely screwed up by this profession, so get some other opinions too. Just remember there's no rush to ruin things further. So get it right please and then teach me. Do as I say, not as I do maybe? I am the last person to be giving advice on diplomatic relations with medics!
Whatever you decide, just go for it with no regrets. There are no mistakes in life. I think we all end up in the right place eventually. 30 minutes sleep this morning = pop philosophy = time to be quiet.
Thinking of you.
wish
This is a super powerful, articulate and educated toddler you have on your hands. Telling him off will make him sulk, telling him your needs are as great as his won't mean anything to him. He has to be a little concerned that his patient may lose her sight (god forbid) and be held responsible for not acting on his findings. That is how you want the letter to hit him. Because its all about him, his career, his feelings, his ego.
That was why I wrote a letter not repeating the inustices and inconsitencies, but stating the possible consequences of his actions, in the voice of the ignorant and insignificant patient he sees you as. You speak to egomaniacs in their own language. They don't understand adult speak. His language - Patient at risk of losing sight, him at risk of losing job, that will get him moving, nothing else.
And some people have the audacity to call me cynical...
You all here know I am completely screwed up by this profession, so get some other opinions too. Just remember there's no rush to ruin things further. So get it right please and then teach me. Do as I say, not as I do maybe? I am the last person to be giving advice on diplomatic relations with medics!
Whatever you decide, just go for it with no regrets. There are no mistakes in life. I think we all end up in the right place eventually. 30 minutes sleep this morning = pop philosophy = time to be quiet.
Thinking of you.
wish
mypain...I appreciate you offering the help of the Jerry Lewis MS Society...however, in Canada we have the MS Society and unfortunately they have been of no help whatsoever as they will not give me the name of a new Neurologist because as they said " you could be blackballed by seeing a different Neurologist" to which I responded that "I don't see where that would make any difference as I am getting NO help now!" Thanks anyway, I do appreciate you trying to help!
Wish...There are a few things that I can certainly use in my letter that you have supplied in your letter. Overall this is a good letter and I will certainly implement some of what you have said into my letter. Thank you for your help and I will be sure to let everyone know of any response I may get from this eye doctor. I really would like to have a referral to a Neuro/Opthamologist but I am not sure that this guy would do it..he has a darn HUGE ego and I can imagine him saying that a Neuro/Opthamologist wouldn't be able to help me anymore than he himself can. I will give it a try though and see what happens. Thanks again!
Rena
Wish...There are a few things that I can certainly use in my letter that you have supplied in your letter. Overall this is a good letter and I will certainly implement some of what you have said into my letter. Thank you for your help and I will be sure to let everyone know of any response I may get from this eye doctor. I really would like to have a referral to a Neuro/Opthamologist but I am not sure that this guy would do it..he has a darn HUGE ego and I can imagine him saying that a Neuro/Opthamologist wouldn't be able to help me anymore than he himself can. I will give it a try though and see what happens. Thanks again!
Rena
Re your note, is this the latest version.
How about something like this, short and to the point, hell I need to PRACTICE for my own novel length letters, so humour me here, unless it helps.
Dear (not darling) Dr. @&*!***!
I remain very concerned about my clinical condition and with the utmost respect ask you to reconsider my situation, as it is causing me great distress due to a worsening of my symptoms.
I am sorry to bring this up again following my correspondence of June of 2008. I hoped for a resolution at that time, and was grateful for your agreeing to assess me. I accept your subsequent clinical decision to not do the test at the time, although I was very much in need of help with my worsening symptoms.
I feel there has been since a breakdown in communication between yourself and my GP, as I am still without clear direction as to how to proceed.
I was happy that you were able to do the vsual acuity test in July, and wanted to follow up on this with a further appointment. I understood you wished to keep my GP and neurologist informed of your findings. From my perspective there has been a noticeable deterioration in my vision since 2007. On my review on August 26th you explained why you felt it inappropriate to write to my physicians, but that left me in a difficult position. Without your input they had no evidence of my deterioration. I fully understood that you did not want to be seen to be making a diagnosis. I do suggest though that it was within the remit of your position to report on your findings. It would have been a tremendous help to me in requesting the right support from my doctors. I was disappointed you felt unable to assist me.
I have as you know diagnosed multiple sclerosis, and am aware of recent changes in my condition. Of the greatest concern to me is the deterioration in my sight.
My doctors need all the available evidence to establish whether treatment is indicated.
Your report would have allowed them to assess for themselves how my vision has changed. I understand it is their job to make diagnoses and decide on a treatment plan, but I am convinced they would take your report into serious consideration. It would indicate whether my ms has become active. If so, I would hope to be treated for this to prevent further permanent damage to my vision.
This is so important to me I must implore you again to make this report available. I am in very great distress as my eye symptoms are worsening and if this can be prevented by medication for active ms I can worry less about losing my sight.
Please help me, I am turning to you in very great need. if you are not comfortable with notifying my Neurologist or G.P. of my problems and the fact that they are related to a neurological problem, can you please refer me to a Neuro/Opthalmologist for follow-up? You have stated that because you are not a Neurologist you would be uncomfortable stating that my problem is neurological but I feel that I would best be seen by the professional in the field of both Neurology and Opthalmology.
Sincerely.....blah blah blah... and please let me know if I can be of any assistance in removing your head from your backside.... - maybe not the last sentence
How about something like this, short and to the point, hell I need to PRACTICE for my own novel length letters, so humour me here, unless it helps.
Dear (not darling) Dr. @&*!***!
I remain very concerned about my clinical condition and with the utmost respect ask you to reconsider my situation, as it is causing me great distress due to a worsening of my symptoms.
I am sorry to bring this up again following my correspondence of June of 2008. I hoped for a resolution at that time, and was grateful for your agreeing to assess me. I accept your subsequent clinical decision to not do the test at the time, although I was very much in need of help with my worsening symptoms.
I feel there has been since a breakdown in communication between yourself and my GP, as I am still without clear direction as to how to proceed.
I was happy that you were able to do the vsual acuity test in July, and wanted to follow up on this with a further appointment. I understood you wished to keep my GP and neurologist informed of your findings. From my perspective there has been a noticeable deterioration in my vision since 2007. On my review on August 26th you explained why you felt it inappropriate to write to my physicians, but that left me in a difficult position. Without your input they had no evidence of my deterioration. I fully understood that you did not want to be seen to be making a diagnosis. I do suggest though that it was within the remit of your position to report on your findings. It would have been a tremendous help to me in requesting the right support from my doctors. I was disappointed you felt unable to assist me.
I have as you know diagnosed multiple sclerosis, and am aware of recent changes in my condition. Of the greatest concern to me is the deterioration in my sight.
My doctors need all the available evidence to establish whether treatment is indicated.
Your report would have allowed them to assess for themselves how my vision has changed. I understand it is their job to make diagnoses and decide on a treatment plan, but I am convinced they would take your report into serious consideration. It would indicate whether my ms has become active. If so, I would hope to be treated for this to prevent further permanent damage to my vision.
This is so important to me I must implore you again to make this report available. I am in very great distress as my eye symptoms are worsening and if this can be prevented by medication for active ms I can worry less about losing my sight.
Please help me, I am turning to you in very great need. if you are not comfortable with notifying my Neurologist or G.P. of my problems and the fact that they are related to a neurological problem, can you please refer me to a Neuro/Opthalmologist for follow-up? You have stated that because you are not a Neurologist you would be uncomfortable stating that my problem is neurological but I feel that I would best be seen by the professional in the field of both Neurology and Opthalmology.
Sincerely.....blah blah blah... and please let me know if I can be of any assistance in removing your head from your backside.... - maybe not the last sentence
Dear Rena,
I,m not sure how the Canada medical works ,but I do Know the here in the States there is the Jerry Lewis MS foundation. I'm not sure if they can help you but I know they are a Great resource for info. It's worth a phone call.
Good Luck!!
I,m not sure how the Canada medical works ,but I do Know the here in the States there is the Jerry Lewis MS foundation. I'm not sure if they can help you but I know they are a Great resource for info. It's worth a phone call.
Good Luck!!
This is the revised letter to my Opthamologist...I am going to ask again for the letter to the Neurologist and the G.P. OR a referral to a Neuro/Opthamologist since he feels that he is not qualified to write such a letter...I know that other letter was angry (yet truthful) but I re-thought it and hope that I can make it work to my advantage.
Rena
Rena
I think that is a great letter. It is calm, details the steps you have taken, and are asking for no more than he is qualified to give, and in fact stated he would give originally. But at the conclusion, you sort of leave it up to him if he will refer you to a neuro-optho.IMHO, I would request a referral now., or the letter he promised you originally. I don't understand why dr's have to be so wish-washy. They don't want to offend other dr's. Too bad!So they leave their patients hanging instead. I hate the "Good Old Boys" club. Good luck. I hope this has the results you want, but I hope you aren't holding your breath.I hope I don't sound too negative. Wouldn't you just like to pick them up and shake them by the scruff of the neck like a mis-behaving puppy?Saying, "Look you idiot, do what is right!"
If you have a MS diagnosis, can't you change MS dr's and find one who will perscribe the drugs you need to slow down this disease? You have probably explained this, but my mind is't working on all 8 today. Good luck,
Maggie
If you have a MS diagnosis, can't you change MS dr's and find one who will perscribe the drugs you need to slow down this disease? You have probably explained this, but my mind is't working on all 8 today. Good luck,
Maggie
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