Difficult Doris

Difficult Doris (not her real name) was back in to see me. I wrote about her last year – she isn’t as sick as she wants to be, she complains all the time and annoys everyone. Her hairdresser hates to see her coming. “Nobody knows how much I’m suffering, Doctor!” she tells me. “I do, Doris, you tell me every week,” I think, but don’t reply.

“That eye doctor made a botch of the operation. I can’t see a thing, now!” was Doris’ most recent complaint. Well, I had to stop myself from administering a good smack! (Deep breath - me, not Doris … count to ten…no point in getting Struck Off for failing to control my temper).

So I settled down to try to explain…

Doris had good sight in her right eye but poor sight in the left. The measurement for the left eye was 6/36 – meaning that she had to be as close as 6 metres to see things ordinarily seen from 36 metres away. Examination showed a cataract in the lens of the eye, near the front of the eyeball. The surgeon removed the lens properly but unfortunately there was a disease on the retina at the back of the eyeball, so even though the cataract was away, Doris’ sight didn’t improve much.

The problem with the retina could not be detected before the operation – after all, if the cataract stops Doris seeing out, it also stops the doctor from seeing in! But Doris didn’t care about my explanation, she just wanted to complain. Her eyesight was bad, she had an operation and her eyesight was still bad, so that must be the doctor’s fault.

The cataract operation is one of medicine’s great successes in recent years. A cataract is a change in the lens of the eye, changing it from being like clear glass to being like frosted bathroom glass. Cataracts are commoner in older people, in diabetics, in people who take steroids and where there has been damage to the eye before. The operation can be done under local anaesthetic and doesn’t seem to take long. Suddenly the blind can see! Well – sometimes. If the cataract is the only problem and the rest of the eye is healthy, then it works wonderfully. If some other part of the eye is diseased, as in Doris’ case, it doesn’t.

It takes years and years to train to be an eye surgeon. The skills needed are needlework of the finest measure, a steady hand and of course good eyesight in the surgeon him/herself. The artificial lens that is put into the eye is tiny and delicate, and any slip can destroy it. The surgeons deserve great praise for their skills and the years of learning, and certainly don’t need Doris’ unfounded whinges.

Doris then wanted praise… “Other people would sue the eye doctor, but I’m not that kind of person!” see told me. Mmm. “In this case, where the operation was done properly and the problem was caused by diseases, not doctors, there would be no chance of showing negligence.” I told her. I think that only made her grumpier.