First, let’s look at the language gap again...

In doctor-speak:

Complications = certain types of unintended bad things that they can detect and that occur during surgery or after surgery that could be either due to equipment malfunction, bad luck, improper care by the patient or (gasp) surgical error. Probably one of the first three.

In patient-speak:

Complications = unexpected bad things = bad vision and/or pain after surgery that wasn’t there before surgery.

Bewilderment gives way to tension between doctor and patient over the use of the word "complications". In the medical world it has a relatively narrow meaning and focuses on things the doctor can detect and knows were mishaps that occurred during surgery or during the healing process. Then there are side effects — unintended and undesirable consequences. OK, I’m still following you, I think. Now let’s look at it from the patient’s perspective, where it is reasonable to assume that whatever is causing them to see poorly, or hurt, is something that the surgery caused (after all, the problem was not there before the surgery) that it shouldn’t have caused, and therefore is something that went wrong, and therefore is a complication.

So where’s the problem here?

Well, even if patients grasp the difference between complications and side effects (and if you do... do be kind enough to let us know, because some aspects of this still escape us), somehow things like compromised night vision don’t seem to fall into either group, in the doctor’s vocabulary — they are simply not an important enough part of the vision equation to merit discussion. It all comes back to, again, the standard measures of vision on the world of eye care — that 20/20 business and a few other tests done largely as afterthoughts in a vague attempt to keep you happy. Some part of this we understand. We don’t expect the doctor to know intimately every last molecule in our corneas and whether the laser vaporised precisely the right ones. But if that laser did something bad enough that I can’t see properly, why is that different than, say, a malfunctioning microkeratome that cut a bad flap? In both cases, the surgeon may not have had control, and in both cases, the outcome for the patient is bad. — What it really comes down to is, if the doctor understands it, it’s a complication. If he doesn’t know enough about optics to explain what’s going on, or won’t admit it if he does, well ....

...Which leads us to another controversial point, objective versus subjective symptoms.

When you talk about double vision, difficulty seeing in the evenings, or big starbursts from car headlights, your doctor may be classing all these as "subjective". In this case, this is simply doctor-speak for "I don’t have the right kind of instrument to figure out whether this is real or you’re imagining things". To suggest that these kind of visual phenomena do not have precise optical reasons for being, and that those optical reasons cannot be identified is simply to openly admit incompetence. There is no shortage of theoretical optical knowledge out there and things like contrast sensitivity testing, wavefront scanning and other technologies can identify the specific corneal defects that explain these symptoms. Unfortunately, patients still seem to be routinely given to understand that the things they’re describing simply aren’t part of any vision equation that matters.

Now, let’s step back for a moment and look at the big picture.

If we (for our simple, just-a-dumb-patient, practical purposes) define "complications" as unexpected bad things caused by the surgery, let’s apply the same definition from the doctor’s perspective and think about what he sees: What are all the things that could go wrong?

1. Failure to reach target uncorrected vision. (We can blame this on your corneas. They failed to respond properly, or they regressed in an unusual way, or they did not heal the way they should have.)
2. Intra-operative complications. (These things happen. You were unlucky.)
3. Post-operative complications. (These things happen. You were unlucky.)
4. Inducing loss of best-corrected vision. (These things happen. You were unlucky.)
5. Inducing vision disturbances. (Vision WHAT?)

#1-4 are all well within the average surgeon’s vocabulary. But #5 is just barely starting to get there. It is astonishing how little has been accomplished to this end despite years of negative press and not a few lawsuits. Why? Because in so many cases the vision disturbances in question can easily be explained by known characteristics of the patient’s eyes. The old cause-and-effect. In other words, they were improperly screened and improperly informed and improperly treated. They were given laser surgery in the same way they might be given laser hair removal, with as little thought to whether they were truly suitable candidates, because LASIK is the consumer’s surgery.

But we won’t get into that here, because here we have to do with people for whom it’s too late. If you want to read about proper screening, you’ll have to see the Candidates section.

Next, let’s understand where your doctor is coming from.

No one likes to fail.

Whether or not you are a failure or a success by the yardstick your doctor seems to be using, the fact that you are certainly a failure by your own yardstick cannot but be felt by your doctor. He knows it, and feels it, and it matters to him. I guess.

Sorry... That was my feeble attempt to work up some sympathy for your doctor. Where YOUR vision is on the line, I just find myself altogether without patience or tolerance for any doctor who is trying to minimise the problems that surgery has caused you! Let me try another angle and see if I can manage a little better.

Remember, your surgeon is a professional in his field. He is an ophthalmologist (well, we hope he is, but in fact in the UK he could just as easily be anything from a podiatrist to an oncologist earning extra money for his early retirement). He has training in refractive surgery and specifically in laser surgeries that may be anywhere from the popular four-day course over a long weekend to, in rare cases, a couple of years of fellowship training. He knows what kind of problems may occur during surgery and what kind of problems may occur after surgery and what to do about both.

He may or may not have what’s known as a good bedside manner. It’s something that if it doesn’t come naturally, even the obligatory university course may not quite make up for. But whatever the merits or demerits of his bedside manner training, it may well have been supplemented by training specifically for laser surgeons dealing with unhappy patients. We’ve seen the training materials. We know. This is yet another really bad Americanism that the UK is dutifully importing. "How to soothe and ease towards the door an unhappy customer, uh, patient, in 10 easy platitudes."

Long story short, there are situations he is prepared to deal with very well, and yours is not one of them. You are an annoyance and a problem, even if by virtue of your 20/whatever score you make it into the "successful" statistics. You are unhappy. You don’t fit in.

Do you think I’m being awfully hard on the poor chaps? You’re right. I’m sure there are some much better behaved ones out there. So, where are you? I want to meet you, and I want to send you some patients. In the meantime every last one of you I have had the misfortune to be told about is not scoring very high in terms of patient satisfaction and coping-with-the-unexpected skills — though you’re doing very well in the area of let’s-brush-the-problem-under-the-carpet.

Finally, let’s understand where you are coming from

You’re anywhere from anxious to depressed and probably quite a lot in between. And it’s showing. You want to know what’s going on, what can be done, and what’s going to happen to your vision and when you’re going to start seeing properly. And that’s perfectly natural.

Enough said.

Great. Now that I know that, what do I do???

Decide what you’re trying to accomplish. Then focus on that, figure out what you need to do to achieve it, and don’t let anything else get in the way.

The goal is getting proper diagnosis, treatment, advice and care. To get it, you either need to get your doctor to put all his brainpower, energy and resources to work for you, or, if he’s simply not good enough, you need to find somebody else who is. You must not let communication breakdowns get in the way of this. All too often emotional barriers arise that have this effect. You want your doctor to acknowledge that your vision problems are serious? Fine, that’s nice, and I agree he ought to, but he probably won’t and you must not let that stand in the way of getting proper care. You want to get your point across that this is all his fault? Fine, but let’s wait until after you’ve been successfully diagnosed AND treated. Emotion and blame in post-operative medical visits are thoroughly counterproductive. Remember that. However natural your feelings, you need to get them in check to get the job done.

So, to avoid conflict and maximise the usefulness of your surgeon (or 2nd, or 3rd opinion doctor, or whoever you’re dealing with right now), you need to simply bow to the realities of the LVC vernacular and sensitivities, and start adopting a little strategic doctor-speak and concepts that will help you get through to him so that he puts forth his best for you and doesn’t simply feel negativity emanating from you.

We suggest in lieu of "complications", a few more doctor-friendly phrases like vision quality problem, visual disturbances, strange visual phenomena. For the non-visual problems such as dry eye, headaches, dizziness etc we suggest describing them as conditions rather than complications or even problems. Further, we suggest that you read every page of the rest of the sections under Dealing with your Surgeon.

Remember: It is more important that you get the most out of your surgeon/ophthalmologist/consultant that you can than that you see eye to eye with him on everything including philosophical or semantic differences. The less you press, and the more you start working with rather than against your doctor, the more progress you will make.

Go even further. Pander to your doctor’s ego and his weaknesses. Do what it takes to get the care and attention you need, and worry about YOUR ego and feelings later. Put your eyes first. It will help you to have something to concentrate on.

At the same time be assured that we and others are working hard to change the world. We want to see a day when DOCTORS will feel obliged pander to YOUR needs and concerns.