EyeWorld Asia-Pacific December 2011 Issue

December 2011 15 EW FEATURE When managing expectations early doesn’t help, doctors may be required to take extra steps to soothe an angry post-op patient T he refractive surgery is over and the patient’s visual acuity is 6/6. The entire process, from the initial meeting to the recovery room, was a bona fide success, according to the surgeon. So why is the patient in the surgeon’s office 2 weeks later complaining bitterly that his vision is “ruined”? Not much will befuddle a good surgeon more than dealing with a post-surgical patient whose results look excellent on paper but who insists his vision does not meet his original expectations. There are several ways to handle such a dilemma, according to three experts who spoke to EyeWorld. First, Richard L. Abbott, MD, San Francisco, Calif., USA, immediate past chairman of the board of Ophthalmic Mutual Insurance Co., said surgeons may head off this type of complaint through managing and understanding their patients’ expectations early on. “Any time you pay out-of- pocket, that raises the bar for expectations,” he said. “What we as physicians and refractive surgeons think of as successful may not be in the mind of the patient. That could even be 20/20 [6/6] or 20/15 [6/4.5] vision. “It really depends on what the patient’s expectations were going into the surgery and how well that was managed and explained to the patient, either by the staff or by the physician.” A thorough pre-op exam can detect which patient will not be a good candidate for the elective surgery, both in terms of the patient’s eye health and personality, Dr. Abbott said. “One of the things the surgeon has to do is assess the patient, how flexible he is, and how well he is grasping some of the issues,” he said. “If the patient is not, the surgeon should postpone the surgery or even not do it if the patient has unrealistic expectations. That’s where a good staff person can alert you. I pay attention to my staff, and if I get a warning signal from them, I will often turn these people down.” But what if there was no indication pre-op that the patient’s expectations were too high and he or she might be unhappy no matter what? Again, it’s not enough to fall back on the numbers and post- op test results that indicate the patient’s vision is fine or better. “It doesn’t matter what the patient’s visual acuity is; it doesn’t matter what the doctor thinks that the patient’s outcome is,” said John Potter, OD, FAAO, vice president of patient services, TLC Laser Eye Centers, Dallas, Texas, USA. “What matters is the patients’ perception of their vision. They almost always couch it in terms of vision loss, not vision gain. Managing unhappy refractive patients by Jena Passut EyeWorld Staff Writer AT A GLANCE • Get to know the patient’s expectations early on to decide if they are reasonable, experts advised • Understand that a patient’s perception of vision loss is real to him, and treat him accordingly • Unhappy patients can be encouraged to seek a second opinion • Giving a patient his money back after surgery does not mean that the surgeon is guilty of wrongdoing, the experts agreed “The doctor is in an awkward position of trying to get a patient to think differently, but vision is a brain thing, not an eye thing. The biggest adjustment that the operating surgeons, ophthalmologists, and optometrists who are involved in the pre- and postoperative care need to understand is that patients’ vision loss is real to them. The normal strategies and tactics refractive surgeons use don’t work.” To effectively deal with the unhappy patient, the physician should first show appreciation for the situation the patient finds himself in. “This has to be sincere,” Dr. Potter said. “You might say, ‘I can appreciate that this is really disappointing to you; this is not what you expected.’” Next, the doctor should develop some sense of affiliation with the patient. “Normally, when there is conflict, the doctor shrivels up and becomes cold and distant,” Dr. Potter said. “That’s exactly the reverse of what the patient needs. He needs someone to relate to him, be human.” Third, give the patient autonomy; allow him to make the decision on how to move forward. For instance, give the patient who is unhappy about having to wear readers after vision correction two to five options. Oftentimes, when the patient is presented with further surgery or struggling to see by not wearing glasses, he will choose to use spectacles. Fourth, the doctor should sit at the same level as the patient, look him directly in the eye, and say, “I understand.” Finally, a physician should understand his role and be willing to refer the patient to someone else. “There’s no shame in a doctor saying, ‘I can’t do this,’” Dr. Potter said. If the patient is still unhappy about his surgical outcome, there are several ways to move forward. “The surgeon has to remind the patient of the postoperative discussion, try to explain to him what was told preoperatively and documented in the record,” Dr. Abbott said. “Then, the surgeon can either look for a solution to try to make the patient happy, which may include surgery to correct whatever the problem is or getting a second opinion to show that, indeed, he did have a good outcome but his expectation was not realistic from the beginning.” Dr. Potter agreed that a patient should be encouraged to get a second opinion. continued on page 22