By Melody Huang, OD
May 15, 2019
Your patients know you’re an eye health and vision expert, but they often don’t know why they should follow your treatment plans. As an optometrist who works in multiple practices, I have had the opportunity to observe a wide range of eye conditions, and patient reactions to having those conditions. Here’s how I manage my communication with the patient to ensure the best treatment outcomes.
Educate: You Can Lose Vision Without Symptoms
In the primary eyecare practice where I work, glaucoma is one of the more difficult diagnoses to discuss with patients. For one, glaucoma is typically asymptomatic in the early stages, so it may be hard for a patient to understand why they need treatment. Some patients, who feel no pain and have no vision loss, may be less likely to follow your treatment plan. I’ve encountered many patients who confessed they stopped using their glaucoma drops because they “felt fine” or weren’t sure why their previous optometrist prescribed them “expensive drops they had to use every day.”
This is where patient education plays a big role. I cannot count how many times a patient has thanked me simply for showing them their fundus photos, OCT, or other test results because no one ever had before. This takes extra time, but it can increase patient understanding and compliance.
For example, if I diagnose a patient with early glaucoma, I show them a photo of their optic nerve alongside a photo of an optic nerve with damage from advanced glaucoma. I also show them an illustration of potential visual field loss if glaucoma is left untreated. A picture is a powerful tool when you are trying to convince someone they need to pay for glaucoma eye drops and use them on a daily basis!
Be Honest Yet Kind
It’s important to be honest with your patients and to set their expectations. But it’s equally important to be compassionate and understanding. Make sure you tell them about the potential course of the eye disease, but also reassure them that there are ways to manage and/or treat their disease. Let them know they can take their health into their own hands and give them specific instructions on what to do. Patients tend to feel better if they know there is something they can do about the situation.
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For example, if you just diagnosed a patient with macular degeneration, you could say something like, “Mr. Smith, I understand this diagnosis may be a lot to take in, but I want to assure you that we will work to come up with a treatment plan that will keep your eyes healthy as long as possible. Though there is a risk of progressive vision loss, having macular degeneration doesn’t mean you will go blind. Many patients maintain excellent, stable vision when they follow their treatment plan. We’ll make sure you leave with a clear plan in place.”
Communicating a serious diagnosis may require more finesse if an elderly patient presents with a caregiver. Try to assess the situation first. If the patient is well-oriented and aware of the situation, include them both in your conversation. Seat yourself so you can address the patient and caregiver at the same time. It’s important that the caregiver feels included as a part of the team who will ensure the patient follows your treatment plan carefully. If the caregiver understands the severity of the disease, they will be more likely to take your treatment seriously.
If the patient is clearly not well-oriented and is heavily dependent on their caregiver, you may need to direct your information to the caregiver since they are probably the one who administers medications and ensures treatment plans are being followed.
Put Instructions in Writing
I find that giving the patient a clear list of written instructions works well. A list breaks down information into easy-to-digest pieces, and writing it down ensures your patient won’t get confused or forget what you said. After all, many of the patients you are diagnosing may be elderly and tend to forget or get confused more easily. It’s also a good idea to explain why you are prescribing the treatment so the patient understands how it will benefit them. This will increase patient compliance. Another option is to e-mail this information to your patient so they have it in their records.
Going back to our patient from before, here’s a sample of what you might say: “Mr. Smith, I have your treatment plan written down for you, but let’s go over it together. First, I’d like you to get a pair of prescription sunglasses because increased sun exposure can cause your macular degeneration to progress.
Second, I’m prescribing you these eye vitamins because clinical studies show they can help prevent the progression of macular degeneration.
Next, I’d like you to put this grid that I showed you on your fridge so you can check your eyes on a daily basis and monitor for any changes, which can indicate your macular degeneration has gotten worse. We will also schedule you a follow-up in about six months to check for any progression. We’ll give you a copy of the instructions and your appointment date.”
Assess Your Patient’s Response
After you give your diagnosis, pause for a moment to assess your patient’s response. If your patient’s reaction is calm and they seem eager to know what to do next, go ahead and review your treatment plan. If your patient seems anxious or distressed, ask them if there is anything you can clarify and reassure them of. Sometimes the patient just needs to hear your explanation again, so they have a chance to process everything you tell them.
The biggest question most patients have after hearing a diagnosis of advanced glaucoma or advanced macular degeneration is, “Will I go blind?” This can be a tough question to answer, since you do want to be honest with the patient, but you want to give them reassurance at the same time. You can say something like, “There is a risk of blindness with this condition, but having this diagnosis does not mean you will go blind. There are many things we can do to help prevent you from losing any more vision. And if you do lose more vision, there are optical devices and glasses specifically designed to help you maximize the vision you still have.”
Give the patient as many options as possible and let them know that all is not lost if they do lose some vision.
Follow-Up 1-2 Weeks Later
Depending on the severity or urgency of the diagnosis, it’s a good idea to call the patient a week or two after their visit to see if they are following your treatment plan and to see if they have more questions. They will be more likely to take your treatment plan to heart and understand the importance of it. Your patient will know that if their doctor is calling them personally, it must be important!
Melody Huang, OD, is a freelance optometrist and writer practicing in Los Angeles, Calif. To contact her: firstname.lastname@example.org