Being a practice management consultant, I find working on the front lines with client doctors the most interesting aspect of my profession. It's incredibly rewarding to watch doctors interact with their patients -- and to help them learn new skills that improve communication and patient care.

Here, I'd like to share four strategies that every ophthalmologist can use to improve patient care, communications and overall satisfaction.

Every practice uses "Welcome to Our Office" forms to gather patient demographic data, along with medical and ocular history. These forms are created in numerous formats, with various degrees of detail. Generally, these forms ask the patient, "Who are you? Where do you live? What's your reason for coming to see us today? Have you ever had these diseases/surgeries before? Which medications do you take? Who will be paying for your visit today?"

But rarely does a "Welcome to Our Office" form ask the patient how he uses his eyes in relation to his visual lifestyle. In my experience, this is the most neglected aspect of care in ophthalmology practices. At the same time, it's the key to much of ophthalmology's future.

Why?

Because refractive surgery is shifting patient demographics within the ophthalmic marketplace toward ophthalmology. This means that if you perform refractive surgery, younger, non-Medicare, relatively healthy patients will be coming in to see you. These patients have significant disposable incomes. They focus on fashion and usually give themselves what they want. They'll be among the most demanding patients.

Because of this shift in patient demographics, to be successful in the ophthalmic marketplace of the future you'll need to understand how your patient uses his eyes during the course of a day. (This is true for all your patients, of course -- not just the "Yuppies.") Regardless of what other questions you ask, you'll need to have the patient answer the questions: When do you use your eyes? How do you use your eyes? Why do you use your eyes? Where do you use your eyes?

I can't emphasize this point enough. Although most ophthalmologists acknowledge the importance of visual lifestyles, many are totally focused on being chief-complaint-oriented. They find it difficult to devote energy to anything else.

However, the payoff is substantial. Gathering this visual lifestyle information at the beginning of the eye examination and learning to translate your patient's responses into appropriate eyewear recommendations will go a long way toward providing better patient care. Plus, it will make your patient happier, more productive and an enthusiastic advocate of your practice. In addition, if your practice has a dispensary, this new way of looking at patients will help you to dramatically boost sales and profits.

In short, learning about your patients' visual lifestyles will improve your level of patient care and help your bottom line.

Simply put, scripting is specific language used when interacting with patients. Scripting ensures that everything you want said to each patient is said in every possible instance.

Scripting is important because it allows you to think out every "what if" scenario in advance. Once you feel comfortable about what you want your staff to say to patients, you can start training your staff members and putting a system into place to monitor their performance.

A good example of scripting is what happens every time you take a seat on a commercial airliner. Before departure, the flight attendant goes through a carefully edited set of scripts and demonstrations required by the Federal Aviation Administration. Although those of us who fly regularly are familiar with these scripts, it's likely that a first-time flyer will be onboard, and so we all get re-educated. That's what happens in a zero-defects environment.

The downside of scripting is that the words can become so routine that they lose meaning. For example, I once walked into a McDonald's and ordered a cup of coffee. The cashier droned out, "Would you like an apple or cherry pie with that?"

Now I had no intention of buying a pie when I entered this McDonald's, but I wanted to see what would happen if I said yes. So I did.

The cashier was stunned. She was so used to people saying no that she didn't even wait for my reply, but kept on working. Her response was so obvious that I asked her about it. She couldn't remember the last time someone had said yes.

However, every day you experience scripting at restaurants, hotels and retail stores. You're rarely aware of it because employees reciting their scripts are so good that they make it sound fresh and new nearly every time. Couldn't your staff do that? Because, let's face it, medicine is a zero-defects environment if there ever was one.

In ophthalmology practices, I've found scripting extremely fruitful at the front desk when staff members are scheduling appointments and in the dispensary when they're presenting products. It's also helpful for your technicians, primarily because much of what they do is in a room where they're alone with a patient and therefore unsupervised. You'll find that your staff can use scripting fruitfully in any patient encounter.

All of us have been patients at one time or another. In some cases, those visits to the doctor have been for things that had the potential to be medically significant -- maybe even life-threatening. Remember the anxiety you felt as you waited weeks before the appointment, prepared for the visit, drove to the appointment and waited in the examination room until the doctor saw you?

Patients are anxious about their health, and that includes eye examinations. Doctors and ophthalmic technicians heighten this anxiety when they fail to explain what they're doing to the patient.

Take the slit lamp examination, for example. Most doctors will prepare the patient for the idea that the slit lamp light will be bright, but won't tell the patient what the instrument actually does. You should say something simple, such as, "This instrument is called a slit lamp. It's a vertically mounted microscope that will allow me to look at the external and internal structures of your eye."

If you want, add something to the effect, "It'll help me look for signs of cataracts, glaucoma and other serious eye problems." You can even go so far as to tell your patient what you're seeing at each step of the exam. A play-by-play, if you will.

If you use a scribe and say, for instance, "The CD is 0.3 with a scleral crescent," you'll probably only make your patient's anxiety worse; he doesn't know whether that's normal. Your patient may think, What does that mean? How bad is that?

So if you use a scribe, tell your patient, "I'm going to say a lot of medical terms to my assistant, after which I'll explain it all to you." That simple statement will ease his anxiety. He'll probably unclench his fists.

My fourth recommendation ties in with the first: learning about your patient's visual lifestyle.

Once you've completed the exam, it's time to consult with the patient and offer your treatment plan. You should also give the patient an eyewear prescription.

As stated previously, it's nearly impossible to make appropriate eyewear recommendations when you don't have a clear understanding of your patient's lifestyle. And it's equally important that you understand enough about the features, advantages and benefits of the optical products available in the ophthalmic marketplace, or in your own dispensary, to be able to make an appropriate recommendation.

This doesn't mean you need to know the intermediate corridor width of every progressive lens design your dispensary uses -- that's your optician's area of expertise. But you should know the basics, such as that progressive lenses can be categorized into hard designs, soft designs and blended designs.

So, if your patient says reflected glare bothers him when he drives, recommend Polaroid sunglasses. If another patient complains that her plus lenses are heavy and make her eyes look larger, recommend hi-index aspheric lenses.

This means educating yourself, something ophthalmologists are traditionally good at. I assure you that this will benefit you, your patients and your practice.

In the end, it'll be well worth the minimal effort.