Reprinted form Review of Ophthalmology

Paying the Price

Mark Blecher, MD
Chief Medical Editor

I have been faced with a bit of an ethical dilemma of late. Perhaps a rather significant ethical dilemma. You decide. A colleague recently asked whether I were seeing a lot of other people's LASIK patients for post-op prob-
lems. When I told him that I don't see these patients, he was surprised. I perform a fair number of LASIKs for my area and have a teaching position at Wills Eye Hospital. You would assume that a number of other people's
unhappy LASIK patients would find their way to me. You would be right. I have, however, a policy of not seeing these patients unless they are referred for a consultation by their surgeon.  At this point, some of you are appalled. My
logic is this: Ophthalmologists of integrity who have an unhappy postoperative patient will stand by their patient and endeavor to solve the problem. I have been that ophthalmologist on occasion, These surgeons will then find their patients other doctors who can help sort out whatever has not gone according to plan. These patients I will see.  Some patients come to you on their own,
because either their surgeon has abandoned them or they have lost faith in their surgeon.  These surgeons, or perhaps the laser center, simply took the money and ran. Either way, neither party has met its obligation.  And doesn't it often seem as if most of these patients had their surgery performed
at one of those cut-rate, never-heard-of-them laser centers? I don't have a problem with the competition. I am a firm believer in the free market. My prob-
lem is with the misleading advertising and the bait-and-switch gimmicks these centers use to attract patients.  The ads always promote a very low price with much fine print.
Often, the low price includes neither follow-up care nor enhancements. It occasionally doesn’t include pre-op testing.  They put the patient in the position of deciding which services are important enough to spend extra money. In these situations, it is easy for the patient to have a less-than-satisfying outcome. In addition, it is not infrequent that these off-price
laser centers use surgeons of limited experience and skill, often from a different part of the country. While there is no national data bank, I'm sure that these centers have a much higher rate of omplications and unhappy postops.  Since LASIK has become such a commodity, I expect and hope that anyone who chooses a LASIK surgeon and LASIK center has done his or her homework. This is especially true of anyone choosing one of the heavily advertised low-
cost centers. Some are very good. But when the decision to have LASIK is made primarily on price, the patient bears particular responsibility for the choice. And sometimes it's a bad one.  If we, the responsible surgeons, actively rescue
these patients from their poor choices, what lesson will society learn? What disincentive will there be for people in your community to avoid these centers? What disincentive will there be for these surgeons who are so expertly being bailed out of their responsibilities?  Most of us know it is not easy to fix a bad
LASIK. The word needs to get out that avoiding a bad result is not just luck. It involves good LASIK candidates, good LASIK surgeons, first class LASIK centers and, to a reasonable degree, some serious dollars. When dollars alone drive surgical choices, the outcome can never be good. It's a lesson the public needs to learn.