Perceptions
The Human Factor
A patient's emotional state can have a big effect on outcomes.
BY MONICA MONICA, M.D., PH.D., NEW ORLEANS, LA.

You perform refractive surgery on two patients. After the procedures, they both have residual myopia of 0.50 sphere, but one complains he can hardly see, and the other feels he doesn't even need glasses. A few days later, you learn that the first patient is worried about her grandson, who is facing a serious surgery.

You treat a woman for blepharitis, but improvement is minimal even though you've followed all the appropriate protocols. Later on, you find out that she's going through a nasty divorce.

Despite your best efforts, your patient's ophthalmic migraines are getting worse. At a follow-up appointment, he divulges that he's about to lose his job.

As an ophthalmologist, you're concerned with the health of your patients' eyes, but you can't ignore the impact of your patients' psychological health on your interventions. Your patients' mindset can have a dramatic impact on clinical outcomes.

ILLUSTRATION: GREG ROMAN

Most of your patients are probably under stress. You may see elderly patients who have economic worries and single moms trying to cope with the strains of raising a child on their own. You may face patients who've recently lost a job and are concerned about their healthcare coverage. Today's families are often fractured; the 1950s nuclear family of Ozzie and Harriett is long gone. All of this, and more, can affect your patients' eye health and their responses to therapy.

Accounting for your patients' psychological health might seem like a lot of effort. How can you spare the time, especially when your schedule is already packed and you're under pressure to increase patient volume? But if you don't assess your patients' mental states, you'll miss valuable clues about why they may not be responding to therapy as expected, despite excellent ophthalmic care.

You probably know long-time patients well enough to tell whether something is bothering them. For others, pay attention to such items as body language and verbal clues. Simply talking to your patients may provide enough information about their current states of mind and how those circumstances might warrant a change in your therapies.

From a practical standpoint:

• If you have to perform surgery, try to pick a time when your patient's psychological calendar is clear. You don't want to operate when a patient is selling his or her house, for instance.

• If you sense something is bothering your patient, show respect by first asking permission to probe into the matter.

• Offer the option of talking to a counselor, clergy member, or psychologist. Make a referral if needed.

• Teach your office staff to be alert to potential psychological problems and to alert you if they see something extraordinary going on in a patient's life.

• Tell the patient you'd like to bring him or her back for a follow-up visit at no charge. This goodwill measure will benefit both you and your practice.

Here's one more tip: Pay attention to how you're feeling. As clinicians, we'd all like to say that we leave our private problems at our office door. But we're human, too, and events affecting us outside of our practices may also affect our work inside the office. If you're aware of your own emotions and know how to cope, you'll have a better chance of providing excellent care for your patients every day.