FEMTO FACTOR

FS and strategic conversations

How to have efficient, effective discussions with patients.

By Scott LaBorwit, MD

The femtosecond laser will be in your surgical center soon and it’s time to start talking to patients about this exciting new option for their cataract surgery. With this new option, however, comes a time-consuming patient learning curve. How do you provide patients with all the information without overwhelming them? What expectations will they have? Will they be willing to make the investment in laser-assisted cataract surgery (LACS)? While patients learn about LACS, you’ll need to learn how to manage time and patient flow efficiently. Here’s how I address these challenges.

FIND THE RIGHT BALANCE

These are important questions to consider when developing a strategy for introducing any new technology to your practice. You need to educate patients in a time-efficient manner, and promote the technology without patients feeling pressured to choose it. When I was introducing LACS in my own practice, I realized that what I didn’t want to say to my patients was just as important as what I did want to say.

For example, I didn’t want to rush them into a decision. Instead, I would tell my patients that I would talk to them about their surgical options and they could let my surgical coordinator know their decision once they’d made it. This way, I could preserve the doctor-patient relationship and present an honest assessment of risks and benefits without patients feeling pressured to make an immediate decision or feel uncomfortable if they didn’t opt for laser-assisted surgery.

I also knew I didn’t want to discuss costs with patients. I’ve found that once patients hear a number, they have a hard time listening to anything else. Instead, I explained that although there would be differences in their own out-of-pocket costs, their insurance would cover whichever cataract surgery option they chose. I then let them know that my surgical coordinator would provide them with specific details about their insurance coverage and the cost of each procedure.

DON’T OVERPROMISE

Finally, I explained that LACS technology would help reduce astigmatism affecting uncorrected distance vision — but never said they wouldn’t need glasses for distance vision following the procedure. Not all patients will be plano in the distance after LACS, and if the patient has a refractive IOL surprise or residual astigmatism, I would need to do an additional refractive procedure.

Managing expectations is always helpful for patients, and it also reduces my own stress. I find it’s best to avoid over-promising or making guarantees. Better to leave a patient pleasantly surprised than to have them disappointed with their results.

BEWARE TMI

Too much information can overwhelm patients, so we keep technical conversations as short and simple as possible. In the end, I only spend an extra minute with each patient to explain LACS.

While my patients are dilating, the TV plays “Johnny Carson” and “Candid Camera” re-runs to help them relax. I examine patients after their pupils are dilated and all testing is completed. If I need to recommend cataract surgery, I discuss its risks and benefits in general terms, without getting into the specifics of different procedures. Then I ask if the patient would like to meet with my surgical coordinator to schedule; only after the patient schedules a procedure do I talk about LACS.

If a patient is a candidate for LACS, I explain that instead of going right into the OR on surgery day, the patient is brought into the laser room first, where I use the femtosecond laser to do key parts of the procedure, before we go into the OR for the cataract removal. I explain the details, risks and benefits of LACS, and why I recommend it. Removing myself from the conversations about cost and decision-making helps me feel more comfortable recommending LACS and lets me focus on educating patients. Over the past 2.5 years, 65% of my eligible patients have chosen LACS.

EFFICIENCY DOESN’T HAVE TO SUFFER

We have also adjusted the office flow for better efficiency. We schedule all cataract evaluation patients in clusters to optimize flow, staffing, time efficiency and patient expectations. When I see the patient, all of the testing is finished and I know the patient will flow through the office in a timely manner. This helps eliminate my own concerns about time management as I consult with each patient.

My surgical coordinator reviews costs and completes a simple form that clearly indicates which procedure the patient has chosen and the associated cost. Some patients need more time to research or digest the LACS technology before making a decision. In those cases, the surgical coordinator invites the patient to call when he is ready, and reminds the patient that we need 10 days’ notice prior to surgery.

Introducing a new technology or surgical technique to your practice requires more than surgical training. A plan for promoting it to patients is essential to help you make patients feel comfortable with the new procedure, without taking too much of your time. A successful strategy likely includes simple, straightforward patient education by the surgeon, supported by a knowledgeable staff member who can walk patients through the details of cost, insurance and scheduling — all in a low-pressure way. OM

Scott LaBorwit, MD, is a principal at Select Eye Care, with locations in Towson and Elkridge, Md., and is an assistant professor, part-time faculty, at Wilmer Eye Clinic of Johns Hopkins Hospital, Baltimore. His e-mail is Sel104@me.com. Disclosures: Dr. LaBorwit is a consultant to and speaker for Alcon.