When "You're Normal" Fails to Reassure

As a WebMD Health Professional I see trends in health care and among health consumers. I don't create the trends, mind you, I only observe them. This is especially true when I moderate the WebMD Vision & Eye Disorders message board.

One worrisome trend is a familiar experience encountered by many WebMD visitors: "I sense something is wrong but my doctor tells me everything is normal." This has been the most frequent comment sent to me over the past few months - more and more patients aware that something in their vision is just not right yet the eye doctor's exam produces nothing.

In this situation, "You're normal" is not only not reassuring, it can be very frustrating. You've lived with those two eyes all your life and you know when something has changed. Where does that leave you?

Here are some thoughts on how to approach this good news/bad news scenario:

1. A "normal" exam can't be all bad. Imagine a worst-case scenario: you are fearful of a retinal detachment or an intraocular tumor (or both!) A comprehensive eye evaluation checks for all kinds of vision-threatening problems. Subtle, early changes can be identified. When the doctor finds nothing worrisome that is valuable information.


2. Don't jump to conclusions. A "normal" exam does not mean "missed diagnosis." If nothing else, it is a superb baseline for future comparison. All of the findings are recorded in the exam notes and will be kept indefinitely.


3. Keep communications open. Politely probe for the doctor's reasoning that explains your symptoms. Beware of cliches like "You're just getting older" or "We really don't know why everything looks blue to you." This is 2007 and we have some workable answers for most eye problems. No, there's not always a remedy, but good doctors usually can offer an accurate explanation. Failing that, a more extensive workup would be advised.


4. Ask for a follow-up plan. Don't be brushed aside. Ask specific questions regarding if/when you should return. Ask about any warning signals.


5. Consider a second opinion. This is not necessarily going over your doctor's head. In fact, your doctor can help arrange a consultant exam. Most busy doctors welcome the expert opinion of a more experienced practitioner when the diagnosis is elusive.

Follow your instincts. Get ready for this: You may be right and your doctor may be wrong. In my own practice I have witnessed the power of persistence. Patients with unexplained symptoms are more likely to get to the bottom of their problems by partnering with the eye doctor, clearly and emphatically describing those genuine concerns without resentment or hysterics.

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• WebMD Video: Eye Test Finds Early Signs of Macular Degeneration
• WebMD Video: Detecting Early Glaucoma - Advanced Tests Help Save Eyesight

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