Connect with Your Patients ONE TO ONE
Effective care requires both medical and "people" skills.
By Frank J. Weinstock, M.D., F.A.C.S.

As practicing ophthalmologists, we primarily concentrate on performing surgery and prescribing medications. But there's another important discipline for which many of us haven't received formal education in our training programs -- the nonmedical aspects of patient care.

In this article, I'll discuss the importance of seeing our patients as individuals who have specific hopes, fears, concerns and limitations. As I'll outline here, by focusing on developing our so-called "people skills," we can best meet the total needs of each patient.

We can start by considering why it's so difficult to get some individuals to see a physician. Most of the time it comes down to such basic issues as fear, cost and inconvenience. Patients are often petrified about visiting the ophthalmologist due to their fear of going blind. So many times we mention to a patient that he has healthy eyes and that there's no concern of losing vision, at which time the patient gives a sigh of relief along with the comment "I thought I was going blind."

Provide clear explanations

We know that these kinds of fears are extreme and irrational, and can only lead to increasing problems for the person who's reluctant to be treated. But it's also our responsibility as physicians to do all we can to allay the fears of patients.

A major cause of patient concern, and often a trigger for legal actions against physicians, is a lack of communication on our part.

I may think that I always explain everything in a perfectly clear manner because I understand what I say. However, it's more important that the patient understands my message. Perception is reality. No matter how well I think I'm doing in providing information to a patient, it means absolutely nothing if the patient doesn't understand my message.

How do we as physicians get our message across? We can:

• Discuss the condition in terms that the patient understands. The term "macular degeneration" is often better replaced by "poor circulation."
• Make sure a family member accompanies the patient to the office to ensure productive, two-way communication. Remember, the patient is often apprehensive.
• Supplement verbal discussions with relevant informational material, including large-print brochures and educational videos, which the patient can read or view at home. You can prepare some of your own informational material, which can be personalized and printed on the office computer. For a more professional look, use the services of a local printer. Educational material is also available through the American Academy of Ophthalmology, patient support organizations and pharmaceutical companies. Although less personal, this information is usually very good and the graphics much better than what you can design in the office.
• Ask the patient questions to determine whether he understands what's been said, or if he's even listening.
• Be on the lookout for patients who have hearing or language communication problems that require additional assistance. Although any interpreter is helpful, it's ideal to have an interpreter who not only knows the language, but understands medical terms.

Family members can help

We can't divulge information about the patient without permission, but we can get information to his family by discussing it with the patient with a family member present. When the family member hears me tell the patient "You shouldn't be driving a car because of your poor vision," the patient won't be able to hide this. The family then can reinforce my instructions and help make sure that the patient doesn't drive.

We also run into the patient who refuses to read or go out because of poor vision. The family can be very helpful in encouraging this type of patient by getting him to do more to maximize the use of his eyes and improve his quality of life.

A family member may also provide information that the patient will, either intentionally or unintentionally, attempt to hide. For example, the patient may have had several automobile accidents, or might be described by a family member as tending to "lean to one side."

Reassure the patient

It's good to have patients write down their concerns and bring them with them to the office. At the end of the exam, ask the patient if he has any questions and encourage him to call if any questions come to mind after he leaves the office. It's rare that patients will call me with additional questions, and I've never had to deal with a patient who bombarded me with calls.

Another opportunity for positive reinforcement is during the checkout procedure, when the patient should be asked if the doctor "has answered all of your questions." If the answer is no, the patient should be taken aside and provided with answers to all of his questions.

If you recommend surgery, it's understandable if the patient asks to think about it for awhile and make a final decision at home, where the environment is less stressful. However, you should make it crystal clear to the patient exactly why the recommended surgery will help him and improve his life.

When talking to the patient, pay attention and show the patient that you care. Listen to what the patient is saying and to what he "isn't saying." Doctors are good at answering questions before they're asked, or while they're being asked. Show some patience yourself. The patient will often describe all of his symptoms or explain his concerns if you give him a chance to finish.

There are patients who don't want their families to have any information about their visual status. In this type of case, it's important to spend the extra time to make sure that the patient understands his situation and knows exactly what he should and shouldn't do in his daily life, particularly in such critical areas as driving and taking medications.

Many people are forgetful or don't understand directions, especially when they're complicated, such as when a patient must take multiple medications for glaucoma. Anticipate this by providing a large-print chart, with times of the day and places to mark each medication and when it's due.

In the same vein, show consideration to patients with poorer vision by having large-print magazines and informational material in the reception areas.

Provide solutions

A diagnosis of presbyopia is a routine case to us, but it can be quite traumatic for many patients. It may mean the loss of their youth and the onset of old age. The thought of bifocals is terrifying to many people. Explaining the benefits of progressive lenses, or the ability to wear contact lenses, or monovision refractive surgery in the case of an individual's total aversion to glasses or contact lenses, will often allay the patient's fears. Be sure to discuss the benefits of progressive lenses. A solution that offers no visible bifocal and restoration of the ability to focus at all distances may be a great relief to the patient.

Explore the concerns and needs of patients with refractive errors. With all patients requiring glasses, explore their specific needs and lifestyles. Then recommend the types of lenses that will benefit the individual patient. For example, antireflective lenses are indicated for attorneys, teachers, clergy and other individuals for whom appearance is a high priority. Don't simply hand prescriptions to patients without some guidance as what might be the best lens or frame choices.

Be realistic

With cataract, refractive or other surgery, it's especially important to explore the patient's expectations to determine if they're realistic or not, and if the expected (by the patient) result is achievable. With any surgery, especially refractive and cataract surgery, the patient comes in with predetermined ideas. These ideas may result from talking to friends or seeing ads, which may not tell the whole story. Patients may wrongly assume that they'll never need glasses again.

Be clear about the potential need for bifocals and explain that the rare patients who don't get full correction may still need contact lenses or glasses.

Glaucoma patients present a special problem. With ocular hypertension or open-angle glaucoma, you may prescribe drops that can be irritating or have side effects. Glaucoma patients must return for regular exams for a condition, which in its early stages, produces no discernible effect upon their vision. They must "take our word" that the treatment and regimen are necessary if they're to be helped. Again, it's important that you take the time to explain exactly why the treatment you've prescribed is essential.

With any visual loss, from glaucoma, macular degeneration, diabetes, stroke or other eye conditions, we must offer explanations and alternatives to patients. The patient, or family, shouldn't feel guilty about loss of vision.

When vision loss is involved, treatment must involve both professional care and nonmedical assistance. Provide patients with information about specific low-vision facilities or practitioners, and inform them about The National Association for Visually Handicapped, the American Foundation for the Blind and other organizations that might be of help. Have a specific packet of information for patients with poor vision. This should include information on "talking books" and parking permits for the handicapped. Also, inform patients about reliable sources of information and support on the Internet that are relevant to their specific problems. You should have a list of those Web sites that have proved beneficial to other patients.

When money's a problem

Lastly, recognize that some patients can't afford exams, glasses, medications or surgery. The office should have the information as to where they might get help. For young people, the local Lions Club may provide exams and glasses. Other organizations in town may do the same. State agencies, such as a Bureau for the Visually Handicapped, may take care of surgical expenses.

When medications are required, but are too expensive for the patient, don't forget the largesse of the drug companies, which will usually provide medications to needy individuals at no charge. Glaucoma patients who otherwise might go blind especially appreciate this. It's not always easy to find out that patients are in need of financial help. You and your staff should be vigilant and pick up on subtle comments that might be made by the patient. Then you should follow up on them.

Our formal training focused on diagnosing and treating diseases with equipment, medicine and surgery. But we also must be aware of the more human aspect of our profession that centers on providing nonmedical care to our patients. By combining professional talents with superior people skills, we can offer the most effective and complete care for our patients.

Frank J. Weinstock, M.D., F.A.C.S., is in practice with Canton Ophthalmology Associates, Inc., Canton, Ohio, and is a professor of ophthalmology at Northeast Ohio Universities College of Medicine (NEOUCOM). Dr. Weinstock, who has written extensively for Ophthalmology Management, can be reached via e-mail at fjstock@aol.com.