UPFRONT

Uncertainty

JASON S. SLAKTER, MD

For anyone who has ever had a high school senior waiting for that letter from the Admissions Office determining his/her acceptance or rejection from the college of their choice, you know what it means to go through the agony of uncertainty. In recent years, there is the interminable wait for the day that the students can log on to college Web sites and learn their fate, something that proves difficult for everyone in the family. There are some schools, however, that still send letters by mail. This adds to the seemingly endless anticipation, as you wait for the mail to arrive, then frantically search through the letters and advertising flyers, only to find the longed-for document is still missing. Ultimately, the anxiety reaches a point at which you feel like chasing the mailman down the block to find out if he might be carrying the letter.

While the college admissions process may be a unique event in our lives, we encounter individuals with worries and anxieties of their own every day. We frequently see the concern on the faces of new patients when they present for evaluation, waiting to learn if their symptoms are easily explained and benign in nature or represent the onset of a chronic, potentially blinding disorder. Even patients who have been followed and treated for years experience trepidation over the findings that we may uncover, such as new exudation requiring injection, or, worse, damage to the retina that has resulted in irreparable vision loss.

I find that one way to make the situation more tolerable is to provide a “running commentary” of my findings as I go through the exam process. This eases some of the tension patients experience waiting for my “decision” on their status, even when there may be untoward outcomes or poor prognostic findings. One of the greatest advances in our field has been the advent of digital imaging, which permits us the ability to provide immediate feedback on the results of diagnostic testing. In addition to allowing us to more clearly explain the findings to the patients, we can also avoid the anxiety-provoking wait for test results, a situation too often found in many other fields of medicine.

Of course, medicine in general faces its own significant and growing uncertainties. For several years now, we have been told of impending reimbursement cuts for procedures and diagnostic tests and then tensely awaited news of whether Congress would rescind these reductions in favor of a more logical and sane approach to this situation. Unfortunately, our anxiety has increased dramatically over the last several months related to the new healthcare legislation now under consideration. We are forced to cope with rumors, conflicting press reports and ambiguous legislative proposals that may have a dramatic impact on our ability to practice medicine or survive as independent physicians. I look forward to some type of clarity in this situation, which would go a long way toward alleviating my own anxiety.

As an aside, and to prove that I do draw upon personal experience in preparing the Upfront column for Retinal Physician, my wife did indeed chase the mailman down this past week to obtain my daughter's decision letter for college.