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Cover Focus | Mar/Apr '14

Art of the Doctor-Patient Conversation

As all surgeons know, there is far more to a “satisfied” patient than an optimal surgical result. The patient experience is much more complex than a postoperative outcome; it involves many factors that collectively form patients’ perceptions of the quality of their care and the success of their treatment. Some of the primary nonsurgical factors that influence that perception relate directly to communication, specifically to the language, tone, and mannerisms used by you and your staff. Below are some of the key tenants to effective communication with patients and their relatives, which, ultimately, will lead to increased patient happiness.

1. Do not alarm the patient.

The first thing to do is make sure that all members of your comanagement team, including your technicians, do not use any vocabulary or mannerisms that will alarm the patient and his or her family members. I cannot overstate the importance of this. In the past, I had a case in which the patient’s first eye was implanted with an advanced-technology IOL, and the case was going well, but when it came time to operate on the second eye, I learned that my own optometrist had left the patient with the perception that the implanted lens was probably not the best IOL for her.

Regardless of the optometrist’s intentions or if those exact words were even actually articulated to the patient, it does not matter. At the end of the day, perception is reality. That patient was certainly alarmed and wanted to cancel the procedure on her other eye because she felt another doctor indicated it was the wrong decision. That is an extreme situation, but it exemplifies the importance of ensuring that everyone is on the same page when it comes to minimizing patient anxiety through communication—both staff to staff and staff to patient.

2. Reassure the patient.

In addition to preventing patient alarm, it is equally as important to keep patients feeling reassured and confident in their care. Say a patient is not doing as well as he or she expected to in the postoperative period, reassure that patient that you will work together to find a solution and reach that desired outcome. As part of this, make sure that your team avoids saying things like, “Oh, I’ve never seen that before!” (You’d be surprised.)

I tend to be in the OR two to three times a week, and I constantly go over educational pieces with my team—how to talk to patients, how to calm them down, etc. Even if there genuinely is an issue, say things are not looking as good as they should be, I tell them to reassure the patient that everything is going to be fine and then refer the patient to me.

3. Consider using scripts.

Consider the language you want you and your staff to use when conversing with patients. Lately, we have been doing evaluations of my team regarding what they are saying to patients. As a result, we have begun scripting everything for the first time ever. I never did this before, but I had been feeling like I never really knew exactly what people were saying to patients and their family members. No matter how seasoned an employee is or how good he or she is at the job, I do not always like what I hear. There are too many variables, so scripting really helps to ensure that everyone is using language that will be beneficial for patients and their perception of their care at our practice.

4. Evaluate your terminology.

Words carry weight and power. Therefore, in considering the language we use with patients, I decided to move away from the word premium (in terms of premium IOLs, premium practice, premium patient experience, etc.). When a patient hears the word premium, it automatically has a connotation of price and expense, without really explaining the value. It is not a value-based proposition. This is not necessarily a bad idea if you are talking about running a purely refractive practice, but the majority of IOLs implanted in the United States in the near future are not going to come from refractive lens exchange, but from cataract patients.

With words like premium, patients do not automatically understand the value of what they are paying for and it may put them in a defensive position. I have seen this time and time again, where a patient comes in and the first thing he or she tells me is, “I just want what is covered by Medicare.” They read the literature and see premium-this or premium-that, and it becomes like First Class versus Coach. It is not something that is advisable, nor is going to convert IOLs.

For these reasons, in my practice I have changed the word premium to advanced, which we have found to make a big difference. Advanced-technology seems more approachable and thus desirable. Who doesn’t want to pay for advanced technology? I tell the patient that there is nothing wrong with the basic IOL, but it is an older technology; this is the advanced technology, etc. It prevents patients from instantly thinking about price (as with premium) and allows them to first understand the value of an advanced-technology option.

Ehsan Sadri, MD

Ehsan Sadri, MD, is in practice at Atlantis Eye Care in Newport Beach, California. Dr. Sadri may be reached at (949) 642-3100; esadrii@gmail.com.