New M.D.

Learning Communications Skills

By Allen Chiang, M.D.

What kinds of words do you use when discussing the goals of blepharoplasty with a savvy patient? How do you open the conversation with a patient who is seeing better after cataract surgery, but has a nuclear fragment in the vitreous because of an operative complication? Unfortunately for the young ophthalmologist, there is no textbook or reference manual for such situations.

Communication is an Art

In medical school and in residency, the focus is on attaining a fund of knowledge and surgical proficiency. Along the way there is a sprinkling of courses on the physician-patient relationship, but for the most part the emphasis is on nailing that upcoming board exam or achieving a satisfactory surgical outcome. Learning the art of communicating with patients effectively in order to define reasonable treatment goals and revisit them in the event of a complication is often left to happenstance. It is simply not part of the formal curriculum, or at least is not emphasized at most teaching institutions.

Entering my second year of residency training has introduced the exciting privilege of learning how to perform a variety of laser and operative procedures. As a result, I find my relationship with patients taking on a whole new dimension. Whether it is a preoperative discussion about the goal of a specific procedure or a postoperative discussion about a particular complication that arose, both can be quite challenging for a greenhorn to handle with any measure of grace. It is more than a matter of selecting the right words. Herein lies the art of managing patient expectations well.

Earning Patients' Trust

There are few things that parallel the trust that a patient places into a surgeon's hands. Clearly, academic aptitude and surgical skill can only be part of the equation that allows this trust to take place. In spite of the fact that we live in an age of managed healthcare, the practice of ophthalmology, at its core, is still an art centered on a relationship between a patient and his or her surgeon, not a business transaction. How that relationship is cultivated and to the degree that a mutual understanding is achieved often plays a pivotal role in determining success. Put another way, from my observations it is possible to be a technically excellent ophthalmologist and yet suffer mediocrity in terms of patient satisfaction.

On the other hand, at Jules Stein I have worked with several outstanding examples of ophthalmologists who have mastered this art. These attendings are often easily identifiable by their grateful patients and abundance of referrals.

Learning from an Expert

I vividly recall how one of these attendings helped a senior resident handle one of the situations that I posed in the introduction to this column, of explaining the complication of a dropped nuclear fragment. Instead of addressing the complication right away, as a nervous and stressed resident might have done, he highlighted the improvement in visual acuity achieved by the surgery as an important goal that had been met. This allowed the patient a moment to reflect on the success of her surgery and provided an optimized setting in which to discuss the complication. When mentioning the need for assistance from another specialist, a retina surgeon, he emphasized that they would all be working together to take good care of her, imparting a sense of concern and avoiding any hint of abandonment. I remember marveling inside as the patient left the clinic as a satisfied patient rather than as an an angry one.

In summary, it may be a gradual process that spans many years before one masters this art of managing patient expectations. There are few textbooks or courses on this subject, so it would be wise for us as young ophthalmologists to find and pay special attention to those attendings or colleagues who are particularly experienced in this regard.

Observe, take copious notes, and begin implementing what you learn with your own patients. Aside from learning how to perform the surgery itself, this may be the most essential and meaningful thing we need to learn as new M.D.s. OM