Dr. M, 48, was an ophthalmologist working in a practice which was affiliated with a large medical center. He had been with the practice for just over a decade, and was quite happy there. The physician was well liked by patients and co-workers alike, due to his compassionate nature and the fact that he took the time to speak to patients at length. Unlike some of his colleagues, Dr. M was more concerned with the patient he was examining than with the backup in the waiting room, and so although this would push some of his appointments later, his patients generally didn’t complain about the wait. It was more important to Dr. M to take the time to get to the root of his patients’ problems, than to rush them through like clockwork.

On this particular morning, Dr. M was seeing Mrs. F, a patient who had been referred to him a month before. Mrs. F, 54, had been diagnosed with ocular toxoplasmosis which was causing visual changes and floaters. The physician had prescribed a number of different oral antibiotics over the past month, but Mrs. F had experienced various adverse effects including gastrointestinal problems and migraines. He had hoped that the most recent attempt at finding a tolerable antibiotic would work, but the patient was back again, complaining of unacceptable gastrointestinal upset from the last attempted medication.

“The side effects are terrible, doctor,” said the patient. “I just can’t take this medicine anymore, but I also can’t live with these spots floating in front of my eyes all the time.”

The physician murmured sympathetically. “Yes,” he said, “we’ve been through several antibiotics already.” Thinking, he paused, and then turned to the patient. “There is another option,” he said. “I could give you an intraocular injection – that means ‘in the eye’ – of an antibiotic instead of having you take the antibiotic orally. What do you think?”

The patient asked a few questions, and then agreed to the course of treatment. She would return in an hour with her husband, who could drive her home afterwards.