By Arian Fartash, OD
Jan. 17, 2018
We do our best to provide a comfortable, relaxing environment, but try as we might, some of our patients still are anxious. Extreme patient anxiety can affect an exam negatively and be highly disruptive to office flow and environment.
Fortunately, there are strategies to help calm anxiety-ridden patients, allowing us to work with them to provide the best care and a positive experience.
Coming from someone who has major dental phobia and anxiety, I have not only learned the signs of anxiety, but also have gained insight into how to soothe and treat anxious patients in the exam room.
How Do I Know My Patient Is Anxious?
• They tell me they get nervous at exams
• Heavy breathing and sweating
• Unable to give responses that make sense
• They seem distracted
• They say they feel light-headed
Slow Down & Explain
If the patient shows symptoms of anxiety without telling me how they feel, I usually slow down the exam and start outlining everything we are going to do ahead of time. I will also try to lighten the mood with humor, maybe by telling a joke. Another tool that I use is to ask if the patient has any pets or children. Usually talking to a patient about something that brings them joy will distract them from their anxiety and calm them down.
Be Careful How You Frame Questions
I have noticed that asking questions about sight-threatening family eye problems can spark anxiety sometimes. However, these questions are unavoidable because we need a good family history to effectively screen patients. It is all about the wording. I’ll usually start by saying, “To ensure we keep your eyes healthy, I would like to ask a few questions regarding your family history.” This way, the patient has the question posed in a positive light before we dive into what may not be so positive about their family history, and possible future eye risks. I may then go on to say, “Some of these conditions that I am asking about sound scary, but it does not mean you have them or will get them.”
Watch for Extreme Reactions to Diagnoses
Recently I noticed a young patient had severe SPK from contact lens over-wear. When I delivered the news that we would need to start treatment and cease the use of contact lenses, the patient began to pant and told me he felt very dizzy. I quickly realized he was getting anxious from the news. I calmly told him that I thought that the news I had given him may have upset him, and that there was no need to worry because we would work together to heal his eyes properly, and take precautions so it would not happen again.
I told him to close his eyes and breath deeply while I lowered the lights and got him a cup of cold water. When I returned, I gave him the cup of water and noticed the color in his face was returning. However, I did not let him get up from the exam chair. A lot of times a patient can fall if they stand up too quickly when they are nervous. So, we sat in the room and talked about his weekend plans for a few minutes as a distraction before we left the room.
Stay Calm Yourself
I deliver difficult diagnoses news very, very calmly.
For example, I noticed on a retinal photo that a patient was developing macular degeneration, which had started to affect the patient’s vision in one eye. In the simplest terms, I explained to the patient that there were retinal changes seen in the back of their eye, which could be related to the decrease in vision they were experiencing. I then told the patient that to get baseline information about their eyes, I wanted them to do an extra test at another office, so we could better keep track of the retinal changes. I ended my conversation with the patient by reassuring them that we were going to work together to keep their eyes healthy and preserve their vision.
Use Simple, Everyday Words
Avoid medical jargon. Using scary, big words can intimidate patients, and you also don’t want them to start Googling these terms either because they may find things on the internet that are untrue and terrifying.
One-on-One Often is Best
I find it’s best to see anxious adult patients alone in the exam room. Having one-on-one conversations without the comment of a third party is much better because their friend’s, or family member’s, well-intended comments can add confusion and frustration to the patient.
With the right strategies, you can get a good exam from anxious patients, so you can serve their needs, and ensure they return for care.
EDITOR’S NOTE: There is a rich literature on calming patients. To read one, CLICK HERE.
How do you calm anxious patients? What strategies have you found work best?
Arian Fartash, OD, is a freelance optometrist in California, who has also gained expertise in social media marketing. To contact: firstname.lastname@example.org