[friends] informed refusal
I went to the eye doctor today. It was the first time I'd gone in something like 10 years.

When I was a kid, I had an eye doctor that I really liked, named Dr. Guyton. He had a great sense of humor, and a pretty laid back attitude toward treating patients, specifically recommending against invasive procedures if he felt they were unnecessary. Going to the eye doctor was kind of fun. You got to look at interesting things and talk about them. I didn't so much like the glaucoma test, where they puffed air in your eye, but the rest was neutral or pleasant.

Sometime around when I was college aged, Dr. Guyton retired. I went to the same office with my mother for us each to get a checkup with doctor who had replaced him. That appointment did not go well.
I was anxious during the glaucoma test, which meant I kept blinking. The physician's assistant told me that I really needed to keep my eyes open or they'd have to take me into the back to do it. I vaguely knew that going "into the back" meant that they'd be physically touching my eyes. It didn't help that she used a similar intonation to taking Old Yeller out back. And somehow it doesn't seem to me that threats are a very good approach to getting a person to stop displaying reflexive anxiety responses.

I don't remember if they actually did the glaucoma test. Next they took me into the examination room, and the assistant announced that she was going to dilate my pupils so that the doctor could "take a look."

Dr. Guyton never dilated my pupils. Well, he did once, when I was very young to check out... something. I'm not sure what. I had to wear funny sunglasses. As a kid it was kind of fun, like a game. As an adult, I hated the idea of being given a medication to interfere with my natural defensive response to bright light seemed a bit invasive. And I knew it wasn't necessary, because my previous doctor had never done it.

If I'd believed that it was necessary, we might have succeeded in getting the drops into my eyes. As it was, I felt forced into a treatment I saw as unnecessary. I responded by fainting. (It was a somewhat unexpected result, because eye-related stuff doesn't normally fall within my phobia.) The rest of the appointment didn't happen. My mother was upset about the whole thing.

My father seems to understand my emotions on this issue a bit better, and sat down with me later that evening. He said that he wanted to make sure that I understood: I always have the right to refuse treatment.

No, I hadn't understood. No one had ever told me that. It was like having a tether cut. I was given control over my life. Still, it's taken this long for me to go back to an eye doctor.

The impetus was concern that I might have damaged my eyes by some irresponsible behavior as a child. I wanted someone to look at my retina. I understood that this would likely require pupil dilation. I wasn't enthusiastic about the prospect, but was ready to accept it as a necessary protocol if it would increase the chance of catching long term damage sooner and potentially increasing the chance of successful treatment.

Coming up on the appointment, I was pretty anxious, and decided to have Tufts Health Services phone the doctor ahead of time, to let them know about my history of fainting (I traumatized them pretty badly when I fainted after a blood test), and that I strongly prefer non-interventionist approaches, and to maintain control over my treatment.

What happened at the eye doctor
When I got to the office, the assistant who saw me asked how I was, and I said I was a bit anxious, and confirmed that she'd gotten the word from Tufts Health Services. She tested my vision, looked at my pupils ("Nice big pupils."), and then said that she was going to check the pressure in my eyes, and so was going to add a numbing drop to each eye.

I hesitated. I said I was scared, that I'd never had my eye pressure measured directly, and that I'd always previously gotten the air-puff test, which was bad enough. She assured me that I wouldn't feel it at all, that she'd had it done, and it didn't hurt. I still hesitated, asked whether this was entirely necessary.

She said that if I wanted to, they could skip the glaucoma test, but that the doctor would need to dilate my pupils in order to see my full retina and check for the damage I was concerned about: "Your pupils are big, so she'll be able to see most of the retina without dilation, but she'll have to dilate them to see the whole thing." I said that I understood, and wasn't too happy about it, but was willing to have it done. After some hesitation I asked if we could put off the glaucoma test for now.

She said she'd go talk to the doctor, and then the doctor would come in and take a look at me. I waited a little anxiously. When she came back, she said that the eye doctor could check the pressure of my eyes by touching my closed eyelids, and that since my pupils were big and I have light-colored eyes, she could check my retina without dilating my pupils, "So we can do this with no eye drops at all. How does that sound?"

"That sounds great," I said.


***

My relief was tremendous, and the tests that the doctor did was very quick, and totally painless (except for needing to deal with the bright light in my eyes). The glaucoma test consisted of her lightly touching my closed eyelids, for about a second each. After she looked at my retinas, she said that she didn't see any sign of damage at all, which was also a huge relief.

But, in addition to relief I feel a certain amount of anger that I needed to be as stubborn as I was in order to get the least invasive treatment possible. It's great to know that I always have the choice of refusing treatment, but it blows my mind the lengths that are generally needed in order to get the least invasive treatment possible, and even to find out that less invasive procedures are available. The examples I'm talking about are pretty non-invasive to begin with, but I have to assume that the same protocols exist throughout the hierarchy of treatments, in terms of not informing patients of options. For me, that's a very scary thought.