As I See It

Lessons in the art of communication

Make sure you and your patients are speaking the same language.

By Paul S. Koch, MD, Editor Emeritus

While I consider myself an adequate communicator and believe my patients are well informed, sometimes I am reminded that I am still learning.

IT’S GOTTEN SO COMPLICATED

When I started out in medicine, the discussion about vision after surgery was pretty simple. “After your eyes heal, you’ll get your new glasses.”

Now we have to talk about distance vision, near vision, monovision, toric vision, multifocal vision and lasers. Myopic patients are particularly difficult. We have to determine whether they want to remain nearsighted after surgery or whether they want to trade in their driving glasses for a pair of readers. Most patients never realize they have a choice, so this discussion takes some time.

Which brings us to today’s communication conundrum, a myopic patient who reads without glasses. We talked about distance vision and near vision and she said she wanted near vision, that she’d wear glasses for distance. After our visit, she sent us an e-mail to confirm this. Distance with glasses. Near without glasses. I targeted her to maintain her pre-op -2.50.

WHO’S ON FIRST?

So, imagine my surprise when I learned from my technician that she was livid about her results. She said I promised her — no, I guaranteed her, she said — that she would not need glasses for near vision. I rechecked the chart. She was J1+ uncorrected.

I was puzzled when I entered the room. We clearly had our lines crossed, but where?

She began by telling me she could not see distance without glasses, but she could when she wore her old glasses. She was happy with that.

But she said she could not see near. I handed her the reading card. She read it right to the bottom line. Hmm, but you can see near? No I can’t, she insisted.

I was vexed and befuddled.

“What don’t you understand, you idiot?” she scolded. “Driving, that’s distance. Television, that’s near. Reading, that’s close-up. You gave me close-up vision, not near vision.”

Now I understood. She did not want to read without glasses, she wanted to watch television without glasses. Our definitions of “near” were different. I didn’t pick up on that during the consultation.

That’s when I learned I have to stop saying “near vision.” Now I must call it “reading vision.”

IN TRIBUTE

Speaking of communicators, R.I.P. my brilliant friends Richard Kratz and George Waring. It is hard to imagine where phacoemulsification and refractive surgery would be without them. They were giants in our specialty, and two of the true gentlemen of medicine. OM

Paul S. Koch, MD is editor emeritus of Ophthalmology Management and the medical director of Koch Eye Associates in Warwick, R.I. His e-mail is pskoch@clarisvision.com.