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The Importance of Clear Communication

What does “glaucoma” mean to you? One might think that “glaucoma,” being a medical word, would mean the same thing to all people.

But the fact of the matter is, that is not true. Were we to put together the answers to that question, it would quickly become apparent that glaucoma means different things to different people.

Consider what glaucoma means to a widow who has no children and whose mother, uncle and aunt all went blind from glaucoma, becoming dependent and angry; she is terrified by hearing the doctor say, “You have glaucoma.” Consider a research scientist in a pharmaceutical company working on the development of a new drug found highly effective in the treatment of glaucoma who is told, “You have glaucoma.” It is likely that he is surprised, but not particularly concerned, because he knows that there are effective ways to treat the condition.

Now consider the two examiners. The first considers glaucoma to be what he was told, specifically a condition in which the pressure inside the eye is above 21 mmHg. For him the issue is clear. One measures the pressure, makes the diagnosis and then advises treatment depending upon what the pressure is.

Now consider the second examiner, a believer in new technology. He performs image analysis tests as well as a Humphrey visual field examination, and on the results of both tests, the printout says “outside normal limits.” But simply because a test shows a result which is not within normal limits does not necessarily mean that the person is sick.

The point should be obvious, but is one that we almost always forget. A word, even one we think is as specific as “glaucoma,” can mean something different to different people.

Perhaps the widow has elevated intraocular pressure, but no optic nerve damage and may not even need treatment for her elevated intraocular pressure, because she may never develop any disability related to the process we presently call glaucoma. To tell her that she has glaucoma may be unnecessary.

The pharmacologist may or may not have glaucoma, but certainly one cannot tell whether any treatment is necessary just on the basis of test results alone, no matter how up to date the tests are. Anyone receiving a diagnosis of glaucoma deserves to have it explained - what he or she has and what he or she needs to do - in a way that is caring and encouraging.

Meanings also change over time. To the ancient Greek physicians, glaucoma was a condition in which a person became blind without any apparent inflammation of the eyes, whereas throughout most of the 20th century glaucoma was defined as a condition in which the intraocular pressure was above 21 mmHg, and yet more recently, glaucoma is considered “an optic neuropathy.”

This discussion has been limited to the word “glaucoma.” But it applies to all words. Good health care demands that communications be clear. In fact, a good life demands clear communications. Doctors can be examples in that regard. If doctors become better communicators, they will be happier and their patients with glaucoma and other conditions will be more likely to maintain their health.

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Article by George L. Spaeth, MD, Director of the Glaucoma Service and Research Laboratories at the Wills Eye Hospital/Jefferson Medical College and current president of the Glaucoma Service Foundation to Prevent Blindness.

Last reviewed on October 29, 2017

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