As I See It

Let's Stop Bad-Mouthing Cataract Surgery

The zeal to sell upgrades leads some to malign our greatest success.

By Paul S. Koch, MD, Editor Emeritus

I'm getting a little tired of people—sales representatives, administrators and surgeons—talking down cataract surgery. Cataract surgery is the most successful operation ever devised, and confers the most significant impact on the general population. It should be celebrated among our little group and we should be proud of everything we've accomplished this past generation. Why, then, do I keep hearing people denigrate modern cataract surgery in an attempt to sell premium lens upgrades?

High Standards

I recently reviewed my notes from several national meetings, regional get-togethers and face-to-face time with people offering good ideas for building a premium lens practice. The suggestions mostly followed several distinct themes. Here's the approach recommended most often: “You don't want the standard operation, Mrs. Jones, do you?” Preferably said with a barely concealed sense of disgust at the thought.

What? First, if someone asked me that I would reply, “Darn tootin' I do. I want the standard operation, not some oddball one. I'm no guinea pig!” Absolutely, I certainly do want the wonderful standard-of-care operation that has made so many people happy throughout the world. Why wouldn't I?

Before going further, I would like to share the opinion that all of our excellent operations are “standard” operations using FDA-approved IOLs. If you're talking about a simple remove-the-lens and put-in-a-mono-focal-IOL, I refer to that as a “basic” operation, which is what I think it is. I learned that phraseology from the cable TV people, who refer to their packages as “Basic Cable” and “Premium Cable.” That distinction makes sense to me.

Fear and Loathing

Here's another group of suggestions that often get repeated. “You don't want the government-issued IOL, do you?” or the more recent, “You don't want the Obamacare lens, do you?” If someone asked me about a “government-issued IOL,” I would say, “Idiot! What are you talking about? I'm a civilian. I have Blue Cross. This isn't the VA Hospital.” I suppose this line of questioning does produce results or else I would not hear it so often, but it doesn't pass my bovine excrement test.

Another refrain is, “You'll have to sign this disclaimer if you decide to have the standard operation because I won't be held responsible,” or some such malarkey. My gosh, where do I begin on this one? You may ask the patient for a disclaimer that you offered a premium IOL to prove that you did so, in case the patient regrets his choice later, but to not want to be responsible for the results of our wonderfully magnificent basic operation seems a little gutless, no?

The common theme here is trying to frighten patients into signing up for and paying for elective services that perhaps they want, and perhaps they would benefit from, but that no one ever needs. It's an optional upgrade, no more than that, so the high-pressure sales tactics strike me as a mite unseemly.

No More Bully Pulpit

Many of us see the value of premium IOLs, have put them in our own family members, and perhaps have had them ourselves. We may also feel that they are an opportunity not to be passed up, and so we sincerely want our patients to benefit from them.

My view, however, is that we should not be denigrating cataract surgery as we know it to make a premium lens appear better because that pathway is neither fair nor accurate.

Instead, we should be able to articulate a compelling reason why buying a premium lens is so much better than the pretty darned excellent thing we're offering already. It's not that one suffers by comparison; it's that the other offers unique benefits not found in the first. Following this path lets us accurately portray both options so the patient can make an accurate decision, without being bullied into a corner.

During the Vietnam War, there was a famous bit of doublespeak when a commander said, “We had to destroy the village in order to save it.” That seems to be our attitude about the state of cataract surgery these days. Granted, reimbursements are not what they once were, and premium procedures can be a new source of revenue that supplants our losses. But let's stop distancing ourselves from our greatest success. Instead, take pride in it. OM

Paul S. Koch, MD is editor emeritus of Ophthalmology Management and the medical director of Koch Eye Associates in Warwick, RI. His e-mail is: paulkoch@kocheye.com.