By Justin Bazan, OD
When you test patients with the latest instrumentation—and explain how the tests benefit them–you demonstrate that your comprehensive exam is state-of-the-art.
My practice makes an enhanced patient experience a priority, and key to that is delivering the most comprehensive examination using state-of-the-art instrumentation. For that reason, my associate and I don’t just test patients using instrumentation. We walk patients through the testing process by explaining what each piece of instrumentation is, why we are using it and how it will help us assess the patient’s vision or eye health. Our thorough explanation of each step of the testing process makes the examination more meaningful to patients increasing the perceived value of the service we deliver. Here is a rundown of how we approach discussion with patients about the instrumentation in our office.
All of the following basic tests are included in the exam fee. Photos that document specific eye health issues are billed to the patient or their insurance.
Lensometer–Old Hat to Us, Exciting to Patients
The first piece of instrumentation the patient runs into in our office is our lensometer. We ask patients to bring all eyewear, prescription and non-prescription, including all sunwear. When my technician demonstrates this basic piece of equipment, patients are pleasantly surprised. Most didn’t know such a device existed, so the idea that it was able to read the prescription in their eyeglasses without testing their eyes is amazing to them. We might say to a patient: “Before we start to pre-test and the doctor takes measurements of your vision in the exam room, we are going to take a look at the prescription in your glasses using this machine. This often gives the doctor a good starting point for a new prescription.”
Use of this instrumentation lets patients know that all eyeglasses can protect their eyes from UV rays. We no longer offer uncoated plastic lenses, so when our technician assesses glasses using the UV tester, we explain that all high-index lenses help block UV rays and that polycarbonate lenses do, as well, which is one of the reasons we no longer offer uncoated plastic lenses. I might say: “This next machine measures how well your eyeglasses protect your eyes from UV rays. All the eyeglasses we make for patients protect eyes from UV rays. Let’s test your glasses out to see how well they do.”
Patients often assume this big machine is the dreaded eye pressure “puff test,” so our technician anticipates this fear by immediately forewarning them that it’s not the awful puff test. From experience, we also anticipate that the patient will think they are flunking the test or doing something wrong if the picture goes in and out of focus. We might say: “We’re just going to show you a picture and measure the power of your eyes to give us a preliminary reading of your needed prescription. Don’t worry if the picture goes in and out of focus. That’s perfectly natural and just part of the process of the machine reading your needed level of correction.”
With many patients so afraid of the puff test, I introduce this test as the no-puff glaucoma test: “This is going to measure the pressure in your eye. I’m just going to hold it here [demonstrating on myself], press the button and you’re going to hear a little beep and that’s it. NO PUFF.”
The first piece of instrumentation patients encounter in the exam room is the classic phoropter. They have probably experienced this instrument before, but I use it differently than many other doctors. I compare the results of the lensometer to the autorefractor and then determine my starting point from those two previous readings. Here is how I explain this to the patient: “We’ll work together to get the right prescription so you can see perfectly. I’m inputting the readings from those last two instruments. I’m using those previous readings just as a starting point. Now we’re going to double-check and perfect your prescription.”
Any time you put the patient’s head in a machine, you need to reassure them it’s not the puff test. It is important to anticipate anxieties patients will have and ease those fears by explaining what you are doing. After giving them that reassurance, I explain that I will next take a look at the inside of their eyes: “Now I’m going to examine the inside of your eyes to make sure they are healthy. All you’re going to notice is a bright light.”
I also am talking to the patient as I am conducting the examination. I tell them what I am seeing and how it is relevant to them. For instance: “Now I am looking at your lids and lashes because lids have oil glands in them and if those glands are not functioning properly, your eyes may be dry impacting how comfortable–or uncomfortable–your contact lenses are to wear.”
Dilating drops are a source of fear for many patients. A lot of doctors will just cock a patient’s head back and administer the drops without explaining what they are doing or why. We take a different approach: “Now we are going to get a much better look at the back of your eyes by dilating your pupils. These drops are going to hold your pupils open. Don’t worry, the drops we use here are mild and are not going to dilate your pupils for too long. We also have a reversal drop which we can use after the exam to speed up the process of un-dilating your eyes. Your near vision will probably come back in about an hour. Your eyes will be more sensitive to light, but we’ll give you a complimentary pair of these [imitation Ray-Bans branded with practice logo] which you can keep.”
While waiting for their eyes to dilate, I show them my model of an eye sliced in half and show them what I will be seeing when I examine them: “This is what I’m going to be looking at [pointing to the retina on the model] to make sure I don’t see any damage or disease. Sometimes you may not feel anything but there could be a problem in your retina that could harm your vision. For instance, a small hole here might not show up in your vision, but that small hole can lead to a big problem if we don’t take action.”
I then tell them about the vessels that supply blood to their eyes and how those vessels are the same as those that run throughout the body so they can sometimes reveal disease like diabetes and high blood pressure. I then point out the optic nerve: “This is the optic nerve which connects the eye to the brain. This important to check because if you have glaucoma, which is nerve damage to the eye, I will also be able to see that here.”
Explain Miner-Like Light Strapped to Head
Since I will use this added light to examine their eyes, I explain to patients that this strange looking thing is nothing to worry about: “This light is just going to help me get a better look at the back of your eyes. Don’t worry, it’s not some weird laser that’s going to blind you!” I then demonstrate that the device just serves to light up and magnify the images I see by demonstrating the light and magnification on my own thumb.
When Pictures Are Taken
Most of our patients get pictures taken, so I explain that it’s just a normal part of the process and nothing to worry about: “Everything looked great, but I wanted to get a better look at the back of your eyes and take a picture. I’m seeing some changes way far out on the retina but these changes are common and probably don’t mean anything. To be on the safe side, though, we will monitor them over time and watch for any additional changes.”
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Justin Bazan, OD, Vision Source, Park Slope Eye, Brooklyn, NY, started his own practice cold. He speaks regularly on strategies for marketing your practice via social networks. Contact: firstname.lastname@example.org.