A 31-year-old woman came in with right eye pain, decreased vision and light sensitivity for eleven days. She had been pounding a screw driver with a hammer to try to open a lock. As she did so, a piece of metal broke off and hit her in the eye. She experienced a lot of pain and could see blood inside her eye. It was not clear why she had not sought care earlier or why she finally came in.
Her vision was decreased in the right eye and I could see a hole through the iris (colored part). An x-ray showed a large piece of metal (foreign body, in doctor talk) in the middle of her eye. I called an ophthalmologist and admitted her to the hospital so they could operate on her, take the metal out and deal with the developing infection.
A case like this brings up interesting questions about human behavior. I think pretty much everyone would look at their eyesight as being very important and something to be protected. It seems clear to me that someone pounding metal who gets a pain in the eye and can see blood inside the eye would immediately assume the eye had been injured by a hunk of flying metal. Putting this all together, I would also assume that most people would immediately seek medical care. Indeed, we see people all the time who have an injury of some kind and head immediately to the emergency department – even if it is something minor like a sprained ankle.
So, why did this woman with pain and blood in her eye wait eleven days to come in for care? Most of the time, I don’t ask why an individual would make what seems like an unwise decision. Such questions might be perceived as being judgmental and would not change what I need to do for the patient.
On those occasions when I have asked or the patient volunteered their reasons for a delay in coming in, they give reasons like this: fear of doctors, worry about the cost, having no ride, thinking it is going to get better or thinking it wasn’t really that bad. Such reasoning doesn’t always lead to bad decisions. If you have a cold or a minor sprained ankle, it is very unlikely there will be a bad outcome without medical care. But people use these same reasons to delay seeking care for serious illnesses like heart attacks, strokes, or a serious injury to the eye.