By Suzanne LaKamp, OD, FAAO
Nov. 28, 2018
There’s an OD’s formal education in optometry school and in continuing education, and then there’s the informal learning that takes place. The lessons more experienced optometrists can pass along are among the most valuable you will come across.
I work in a shared OD-MD refractive surgery practice with doctors who have decades more experience than I have. Here are a few powerful lessons the more seasoned ODs in my life have provided to me.
Good Refraction & Quality Corrective Eyewear = Loyal Patients
A doctor I worked with on a medical mission trip emphasized to me the importance of a good refraction and quality corrective eyewear for patient loyalty. Eye health and ocular disease can be more exciting and profitable, but we are still the vision experts first and foremost to the patient.
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There could be serious findings, such as a new retinal detachment, which is diagnosed and treated, or referred out for treatment, but if the refraction and corrective eyewear isn’t right, the patient may still be lost. In the example the doctor shared with me, he diagnosed a retinal detachment, and sent the patient to a retinal specialist for treatment, but then made the mistake of not spending enough time in a subsequent visit on corrective spectacle options. The patient was displeased with his vision in his new, expensive eyewear. It did not matter that the doctor saved his sight from a vision-threatening condition. The patient felt that the doctor failed him by not meeting his vision correction and eyewear needs–a huge quality of life service that ODs are expected to provide. That patient never returned to the practice.
Takeaway: Remakes can be costly and time-consuming for a practice, but it’s worth making sure each patient is happy with their new prescription and glasses. The remake will cost less than a lost patient and bad word-of-mouth or unflattering online reviews.
The most common reason patients see their eye doctor is to attain the best possible vision, whether it is from corrective eyewear or refractive surgery. It is important to meet that patient expectation, and to deliver excellent vision.
Our office does Rx checks and remakes when warranted. We do not have an in-office optical, but we recommend local optical shops that are patient-oriented and focus on quality, which reduces remakes. We also perform careful refractions and use advanced diagnostic technology. Our clinic has pentacams, Scheimpflug imaging, the HD Analyzer, WaveScan, and VARIO topolyzer to help determine patient prescriptions.
Avoid Making Assumptions About Patients
One of the doctors I closely work with has taught me the importance of not assuming too much about a patient before going into the exam room. As clinicians, we often try to formulate an early working diagnosis and plan before seeing the patient. It is important to go beyond the seemingly simple reason for the office visit and pre-testing results.
Avoiding bias early in the exam improves patient care. Sometimes the course of the entire exam can change after simple clarification, or a new finding. For example, a chief complaint may say the patient is unhappy with their distance vision. Sometimes errors can occur during data entry and with intake forms, and in reality, the patient may love their distance vision, but struggle with near vision.
Takeaway: To make sure I have accurate information for the patient’s visit, I always repeat the reason for the visit back to the patient, and review relevant history. I may also ask the patient repeat questions. Correct information is essential to good care and happy patients.
Correct diagnoses and treatments keep the patient returning. Errors lead to patient loss, poor reviews, and sometimes worse. Case reports and presentations we share with colleagues at continuing education, or informally with one another, enhance clinical knowledge. I continue to talk about shared patient cases with the doctors in my clinic. I also like to attend large conferences, such as Vision Expo, annually, so I am up to date about all the eye health and vision challenges my patients come to our office with.
Take Positive Approach When Presenting Exam Findings
One of the most important lessons I learned from shadowing and working with an experienced doctor was to present exam findings positively. Patients are sensitive about how well they see, and their visual outcomes.
Takeaway: Patients need encouragement, especially if dealing with a complication or unexpected news. Calmly discuss your findings, empathize with the patient and present a plan help a potentially distraught patient. Creating a course of action with the patient empowers them and sometimes improves compliance and treatment outcomes.
For example, while uncommon, a patient may not respond well to treatment with PRK or LASIK. The refractive target may be missed, and the patient may not see as clearly as expected. Talking with the patient, actively listening to their concerns, and discussing the next steps, can turn a negative situation around. Patients aren’t thrilled with an unexpected outcome, or to hear that they may need enhancement surgery to improve vision. Extending the offer to have the patient e-mail, or call the doctor, directly improves the patient care experience. Patients will refer friends and family when they feel cared for, even if vision results are not as expected at times.
Studying patient outcomes improves the experience for future patients. Learning what works, and what doesn’t, drives progress. In refractive surgery clinics, SurgiVision is a tool that tracks patient outcomes on a per-doctor basis. We have doctors in our clinic who analyze the data and try to improve visual outcomes. We also have advanced imaging technology in our clinic, such as the WaveLight Topolyzer VARIO, which also helps makes better outcomes more likely.