As he sauntered into my consulting room, he knew I was clearly unhappy with him. “Doctor why aren’t you smiling?” he asked. I pretended I didn’t hear him. “I mustn’t let him get away with it again,” I told myself. No matter what appointment he was given, he had a penchant for coming at his own time. I had tried to explain to him uncountable number of times why he should keep his appointments and use his medications regularly. Whatever I said went into one ear and came out of the other.

“Mr. Man or what do you call yourself?” I asked, feigning some anger to make him believe I was quite serious. “l am fed up with your lackadaisical attitude to your treatment. I feel like transferring you to another doctor because I can’t really say I am treating you,” I said emphatically. “What’s my offence?” Jossy asked, pretending he didn’t know what I was talking about. This made me more furious but I managed to control my temper. I cautioned myself, “Why are you so worried about a man who doesn’t care a hoot about himself?”

Jossy had lost the sight in his left eye owing to this same type of attitude. About 2 years before, he had sustained a blunt injury while playing tennis. He had a bleed in the eye which was successfully treated. During the first four weeks while his vision was poor, he kept all his appointments but once his vision returned to normal, he disappeared until he ran into me about a year later. “I was okay,” he said, when he brought a friend to my clinic. “There was no pain or discomfort and my sight has been good,” he added.

I seized the opportunity of his presence to re-examine him. I was alarmed to find that the vision in his left eye was poor. There was evidence of damage caused by trauma induced glaucoma. I commenced him on treatment and chided him for not having kept his appointment. I remember his friend had asked, “Why do doctors always insist that we must come back again and again even when all appear to be well with us.” I had taken pains to explain why we schedule appointments for certain periods.

To ensure I was well understood, I started with an explanation of why we embark on treatment of any disease. “The first major reason is to encourage healing. If left alone, the body would take care of itself but there could be dire consequences. The disease may become more serious and widespread before resolving,sometimes with awful complications. The second reason is to manipulate the healing process so as to avoid or limit these complications.”

Follow-up appointments are calculated to coincide with anticipated events in the spectrum of a disease or healing process. Previous experience or known pattern of the disease or condition is used to predict when certain positive or negative events would occur. Appointments are consequently given to coincide with these stages. Thus Jossy was given an appointment for two months. He not only missed this appointment, he didn’t show up until about a year after!The glaucoma must have developed about 2 to 3months after the initial blunt injury.If he had kept his appointment the glaucoma would have been recognised at the onset, before any visual loss occurred.

At each follow-up visit, the doctor examines the patient again and reviews the symptoms and signs to decide if there is any deterioration or improvement. This helps him to decide if there is need to adjust the medications.

I am still dazed! How can a man in danger of being irreversibly blind treat himself with such aloofness? I had given him one week appointment but he didn’t turn up until after three weeks.At first, I had thought it was a problem of money.

However, he told me he had no financial difficulties. According to him, “My problem is time. I am too busy; it’s just impossible to get away from work.” To make matters worse, when his medications ran out, he went to the chemist’s to buy more. Sadly, one of the medicines should not have been repeated. Now he is in real danger of losing his only eye.

Jossy, my final advice -to keep your sight, keep your appointments.

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