Manage patient expectations

Structure discussions and education around the specific needs of cataract and refractive surgery patients.

With recent advances in cornea-based and lens-based surgery, there are now more options than ever to treat our patients. However, as technology continues to advance, so too must the way we set patient expectations for refractive procedures.

In this article, I share some tips to help set the proper expectations for patients who are considering refractive surgery.

Set guidelines

Set and communicate guidelines within your practice to help determine whether a patient is a candidate for a certain technology. With guidelines in place, personnel can help to assess candidacy at every step of the patient interaction, from the initial call to front desk personnel — where, perhaps the patient’s age can indicate she is likely presbyopic — to diagnostic testing where the technician can continue this discussion.

For example, a 60-year-old patient presents and I perform the diagnostic imaging. Within 30 seconds, I can tell him, “Mr. Smith, it looks like the three main things that are affecting your vision are nearsightedness, astigmatism, and presbyopia.” The patient is often impressed that I learned this information in that short of a period of time. He will often respond with, “Yeah, I’ve had those first two for many years ... but I don’t know what that last one is.” Bam! Teaching and expectation setting moment.

I will respond with, “Good news is we now have solutions for all three of the conditions that are bothering you. We will do a lot more homework today to determine which of our options may be right for you, and Dr. Jones will go over that with you. We will educate you on what all three of those conditions mean and what your treatment options are.”

Individualize discussions

The most important lesson I can give for setting proper expectations is take the time to prepare. Avoid a prepared speech that has no individualization. For example, if a patient enjoys near-vision tasks, I might explain multifocal IOL technology by saying, “Now, Mr. Smith, there is nothing as good as the natural lens, but this is the best technology to date that allows you to perform tasks up close while providing distance vision.” Without a customized approach, the practice can miss a key element of the patient’s goals.

Prior to surgery, it is important to take the time to address any conditions that may prevent the patient from achieving his goals. Otherwise, a pre-existing condition, such as dry eye, turns into a condition that was caused by the procedure.

Educate the patient

I have found it is best to determine what procedures are appropriate for patients before educating them. One very effective method is for the physician to review the information and make a preliminary recommendation. Then, the staff can use digital methods to educate the patient on the technology the doctor recommended.

You can set up video playlists to educate patients about all the conditions affecting their vision and the solutions for managing these conditions. I like for these playlists to contain information on why the patient is experiencing the visual difficulties, the recommended options to correct the difficulty, and any summary, including financial. For example: “Mr. Smith, Dr. Jones has reviewed the pictures we took earlier and he would like for us to educate you on several corrective options. The information will give you background into what the doctor will discuss with you when he visits shortly.” The patient now knows the doctor is aware the patient is waiting and knows of the patient’s situation. It also helps set expectations with the patient during the visit. The ending videos of the playlist summarize the information and will prepare the patient that, for instance, he will have some out-of-pocket expenses associated with a multifocal IOL.

Communicate expectations

Now, it is up to the surgeon to confirm the technology he recommends and then set proper expectations with the patient. Remember: If you don’t spend the time pre-operatively, you will find yourself spending more time post-operatively, often trying to explain why a procedure didn’t achieve what the patient expected.

As staff members, we will likely continue the conversation after the surgeon leaves, and answer any residual questions, so be prepared. Every technology has its pluses and minuses. I’ve adjusted how I deliver the expectations of the minuses. For instance, halos around lights can be a side effect of refractive procedures. Oftentimes, when I mention this to patients, they will respond with, “Well, I already have that now.”

This is where I have evolved my messaging: Instead of just saying halos are something the patient will just have to deal with, I try to paint a picture where, for instance, the LASIK or cataract patient is now mostly spectacle independent but may wear yellow-tinted night-driving glasses. I ask the patient to consider why we don’t think twice about purchasing sunglasses for driving during the day, yet we complain about glare at night rather than look for solutions that will help us perform that task.

Additionally, if you are discussing technology, such as multifocal IOLs, spend time determining the near needs of the patient by simulating and matching the needs of the patient to a certain technology. Show the patient a simulation (near card, images, etc.) and even have them initial the agreed-upon target goal so you can remind them of the goals postoperatively. If the patient states they don’t do much reading very close but spend eight hours a day on the computer, hold the near card at the distance of their computer and have them point to a font size that would be acceptable to them after surgery. Have them initial that target and then, at the postoperative visit, pull out the initialed form and assess whether you have reached the goal.

Reiterate messages in marketing materials

Identify methods of delivering information about your offerings to your patients, both internally, such as the videos used in the above mentioned playlist, and externally. When it comes to external marketing, there are many media platforms at our disposal, such as direct mailers, display advertising and web tools, specifically your website and social media.

Once you’ve made the decision on how you will deliver the message, I find it beneficial to frame the messaging around the benefit to the patient instead of branding of a specific technology. Patients ultimately may not care about what type of laser or lens implant you have. What they do care about is the benefit that particular technology or technique will provide to them. If you have multiple offerings, this method allows you to fit the expectations of the patient to a certain technology instead of pigeon-holing yourself and trying to make a certain technology fit every patient. These materials also provide another avenue for your patients to learn and ask questions.

Reiterate post-surgery

Each time the patient returns for a postoperative visit, it is important to take the time to educate the patient about the post-operative process and to reinforce what was previously discussed. For instance, if you see patients early in the morning the day after LASIK, many of them will notice halos around headlights at night. They aren’t expecting this, so it is important to reassure them about the neuroadaptation process. When I check the visual acuity of patients postoperatively, I often start where they were on the chart and work down.

If your visual acuity chart shows the associated visual acuity next to the letters (for instance, a 20 appears next to our 20/20 line), ask them what number they see on the left hand of the screen. When they say “20,” ask, “What do you think that means?” They will sit for a second and then say “20/20?” That usually gets a huge smile, especially if family is present. We have to remember, while this is routine for us, this is a life-changing experience for patients. OP