Doctor Patient Relations

3 Exam-Room Conversations that Will Help Build Your Practice

By Thuy-Lan Nguyen, OD

Sept. 11, 2019

Your patients need your expertise and guidance. Before they leave your exam chair, have three essential exam room conversations to ensure you deliver the care, services and products they need.

Here are a few important discussions to have with each patient.

Until four years ago, I was co-owner of a private practice in South Florida. I now teach at Nova Southeastern University College of Optometry, where I continue practicing optometry in the optometry school clinic.

An Eye Exam is More than a Vision Check
Most patients need it pointed out that a comprehensive eye examination may include a prescription for glasses and contact lenses, but it also includes a full evaluation of the patient’s eye health.

Why is it important?
With online refractions becoming more popular, it’s more important than ever to explain to patients that checking their full ocular health is part of our comprehensive eye examination. It’s helpful to point out that many patients are able to see “20/20,” but still have ocular conditions that could have serious vision and health consequences if left unchecked and untreated.

Why this conversation can be challenging to new ODs:
This conversation may not come naturally to an unseasoned OD if they are seeing patients for the first time. In school, they are taught how to diagnose and manage disease, but some patients still don’t understand the full scope of optometry. So, new graduates may be surprised when a patient doesn’t know that ODs are capable of performing full ocular health examinations.

How do I start the conversation?
A good way to start the conversation with a patient is first by listening to them. After getting a patient’s chief complaint and medical history, I explain to each patient, “I’m going to check your vision and give you a prescription for new glasses, but it’s important I check the full health of your eyes as well.”

What valuable information will this conversation provide me with?
Having this conversation at the beginning of the examination helps to reassure the patient and justify the examination fee. If they have risk factors, I educate them in advance of what I am looking for and what I’m hoping to rule out. And if at the end of the examination, their eyes are free of disease, I educate them again, and they are relieved and thankful.

How can this information lead to the practice providing the patient with products and services?
At the end of the comprehensive eye examination, even if a patient’s eyes are considered healthy, they have a better understanding of what optometrists do and they feel more comfortable coming back if they develop sudden and unusual symptoms. This prevents patients from seeing an optometrist for just the spectacle prescription and then going to an MD for care that ODs are capable of.

 

Healthy Contact-Lens Habits
For every contact-lens patient that I see, I educate them repeatedly on how to wear their contacts, what specific products to use and when I need to see them back for another evaluation. Every single patient. Every time I see them. Even if they have been wearing contact lenses successfully for years.

For example, for my patients wearing daily disposable contact lenses, I still remind them to take their contacts out faithfully every night and throw their contacts out every night. I remind them, no sleeping, showering, swimming or water with their contacts. I remind them that they don’t need to use any cleaning solutions, and if they need drops, I prescribe a specific brand-name drop, even if it is over the counter.

The next year, when they come back, I ask them, “How often do you sleep in your contact lenses?” I ask them, “How long do you keep one pair of contacts before you throw them away?” I know what I prescribed, but I want to know what they are actually doing with their contacts. I expect them to give me a strange look when I ask those questions. And if they answer correctly, I tell them, “That was a trick question, you passed the test!”

For my patients wearing specialty contact lenses, I prescribe a specific overnight cleaning and disinfection system. I prescribe specific non-preservative saline and artificial tears. So, every time I see them, I ask them what brand-name solution they use overnight. I even ask them where they purchase their non-preservative saline. Some products are only available online, so if they tell me they purchase everything in a store, I know they are using the wrong product.

Why is it important?
Compliance to contact-lens wearing schedule and specifics is critical to patient success and to minimize the risk of complications. I tend to be extremely repetitive because patients forget a lot of what a doctor tells them. Doctors will often tell patients what to do and what to purchase, but when the patient gets home, they may forget important details.

Why this conversation can be challenging to new ODs:
This conversation may not come naturally to a new OD because it is so repetitive. We might see multiple contact-lens patients in any one day, so after having the same conversation over and over again, we are tempted to become lackadaisical ourselves. ODs often rely on our technicians to have these conversations. But if patients tend to forget what the doctor tells them, they are even more likely to forget what the tech says.

How do I start this conversation?
Even if my technician has taken a full history, I ask questions about compliance. Patients will often give different answers depending on who asks the questions.

What valuable information will this conversation provide me with?
If a patient is having symptoms or complications, they often blame the contact lenses prescribed. However, in many cases, it is not the contact lenses that are the problem; it’s their wearing schedule or that they are using the wrong products.

How can this information lead to the practice providing the patient with products and services?
Being consistent with your recommendations reinforces the idea that not all over-the-counter products are created equal. Consistency always increases patient compliance, success and satisfaction with the contact lenses prescribed, as well as the services provided.

 

Back-Up Glasses for Contact-Lens Wearers
For every contact lens wearer, I ask, “Do you have glasses to wear when you aren’t wearing your contact lenses?” No matter what their answer is, I tell them the importance of having glasses in addition to their contact lenses. I remind them, even if they love their contact lenses and they wear their contacts every day, it’s important to have glasses for emergencies.

At the end of each comprehensive eye examination I tell established contact-lens patients that I am finalizing both their eyeglass and their contact-lens prescriptions. If they lose their back-up glasses, if they break or if they want a new style, their eyeglass prescription is available to them.

Why is it important?
Contact-lens wearers who have back-up glasses are less likely to over-wear their contact lenses and develop complications. Contact-lens wearers who have back-up glasses are less likely to get mad at the doctor when they run out of contact lenses. They are more likely to be able to wait a day or two until their ordered supply arrives and they are less likely to order their contact lenses online in an emergency.

Why this conversation can be challenging to new ODs:
This conversation may be difficult to an unseasoned OD because they may worry that it will be perceived as a doctor just wanting to sell expensive glasses to their contact-lens patient. But there is a big difference between selling something for profit and prescribing a medical device for the best interest of the patient.

And many patients with high-refractive errors will be resistant. They will say repeatedly that they cannot wear glasses. They will say that they don’t see with glasses. I respond by agreeing with them that, yes, their vision is more comfortable with contacts, but that glasses are important in the event of an emergency such as a red eye, when they can’t wear contact lenses temporarily.

I still want them to see the world, I assure them. And if they want to give their eyes a break from the contact lenses at the end of a long day, I want them to be able to relax and see what they need to see.

How do I start the conversation?
The best way to initiate this conversation is by asking the simple question, “Do you have back-up glasses?” If they say no, I ask, “How do you see the world when you aren’t wearing your contact lenses?”

What valuable information will this conversation provide me with?
This conversation adds to the overall experience that a patient has with their optometrist. Patients may not remember the details of the refraction or the dilated fundus examination, but they often remember their conversations with the doctor. It is how we build relationships with our patients and keep them coming back every year.

How can this information lead to the practice providing the patient with products and services?
The conversations we have with patients about their glasses and contact lenses may lead to sales and profit for the office. But in the long run, they also build trust between doctor and patient. They provide for better patient experiences. These conversations may seem like common sense, and they can definitely become repetitive for the doctor, but they provide critically important information to the patient. It’s the knowledge that the optometrist has that keeps a patient loyal and coming back for more services annually.

 

Thuy-Lan Nguyen, OD, teaches at Nova Southeastern University College of Optometry. To contact her: TLNGUYEN@nova.edu

 

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