Caring for a patient who is severely mentally or physically disabled presents a unique set of challenges, says Vicky Vandervort, OD, FAAO, FCOVD, and Robert Vandervort, OD, FAAO, ABO.
Atlanta-Caring for a patient who is severely mentally or physically disabled presents a unique set of challenges, says Vicky Vandervort, OD, FAAO, FCOVD, and Robert Vandervort, OD, FAAO, ABO.
Drs. Vandervort understand these challenges as well as anyone because their son is severely disabled, and they shared some advice during a session at SECO. Patients who have disabilities already struggle with so much, they say, and the opportunity to address just one problem-whether it be correcting a refraction error or easing eye pain-means the world for these patients and their caregivers.
“If it were your son or daughter in the chair, what would you want done?” says Dr. Robert Vandervort. “Once they walk out of your office, there aren’t many people who will advocate for them.”
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The first step to caring for a patient who is severely disabled? Leave your ego at the door, says Dr. Robert Vandervort. It doesn’t matter if this is your first time or your hundredth time working with a disabled patient-don’t assume you know it all.
When you ask questions and really listen to the answers, it will put the patient’s parents or caregivers at ease. Ask the parent to tell you about her child. How well does the parent think the patient sees-and why does she think that? Will the patient be able to follow simple commands? Does the patient notice people or things in the room? Does he watch TV? Don’t forget to ask how the patient spends his day so that you can better understand his visual demands.
The parents of a severely disabled child or adult have spent years advocating for their son or daughter, and they are looking for a healthcare provider who is willing to work as a team.
Next: How to greet the patient
Dr. Vicky Vandervort says that you should always greet a disabled patient the same way you would any other patient of their age. Respect is key. And don’t assume that the patient can’t communicate-ask the patient or caregiver. It is especially important that you understand how the patient communicates pain. For example, Drs. Vandervort say their son giggles when he is in pain, which often leads to misunderstandings with new caregivers.
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Dr. Robert Vandervort shared an example of a severely disabled patient of his whom he asked to look up to respond “yes” and to look down to respond “no.” While it took a few seconds for the patient to respond accordingly, he was able to. This revelation shocked the patient’s caregivers, who never knew he was able to respond to questions in this manner. Because Dr. Vandervort took the time to ask, he was able to get a lot more information directly from the patient during the exam.
Patients with disabilities can be disruptive in your practice, says Dr. Robert Vandervort, and that may be intimidating to your staff. This is your opportunity to lead your staff by example and treat the patient with the utmost respect at all times, he says.
Next: Performing the exam
Drs. Vandervort say there are two major goals for an examination of a severely disabled patient:
• Are the eyes healthy and comfortable?
• Are there visual or any other disabilities that can be removed to improve the patient’s quality of life?
Similar to performing an exam on a child, there are certain things you just won’t be able to do, but do whatever you can. Be mindful of what may scare the patient. Explain what you’re going to do before you do it, but don’t ask for permission, says Dr. Vicky Vandervort-because you’re in trouble if the patient says “no.”
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Stay focused on what you normally do for every patient and adjust from there. Get whatever you can, and document the lack of cooperation or inability to complete a particular task. Dr. Robert Vandervort says that if there is one thing you want to get from a disabled patient, it is an intraocular pressure (IOP) reading.
A patient may need to be restrained in order to conduct some tests. Many severely disabled patients aren’t going to like anything coming close to their faces. Call in your staff to help, and work with the parent or caregiver to keep the patient safe and comfortable.
Next: Correcting refractive error
“Special-needs patients have enough barriers, so make every attempt to correct significant refractive errors,” says Dr. Vicky Vandervort.
Wearing glasses may be uncomfortable for some patients due to sensory stimulus. She says that even if parents are resistant and say that the patient won’t wear glasses, you should attempt it-this is your area of expertise. Grab a frame from your dispensary to see the patient’s initial reaction. You should see how the frame fits and watch for any interference with the patient’s wheelchair headrest. Watch the patient for any noncompliance with wear, but understand that removal of the frame is not necessarily a rejection of the spectacle prescription.
Drs. Vandervort recommend these frame companies particularly for children with special needs:
If a patient is highly hyperopic, Drs. Vandervort recommend using daily cyclopentolate 1% for a few weeks in order to help with adaptation. Communicate with the parents or caregivers up front so that they know what to expect (remember, it’s all about teamwork).
Working with special-needs patients takes a lot of patience, flexibility, and care, but the professional reward is great, say Drs. Vandervort. Disabled patients may not be able to express it, but you may be able to improve their quality of life more than you will ever know.