Doctor Patient Relations

How to Set Expectations with Patients to Make Successful Outcomes Likelier

By Jennifer L. Stewart, OD

Oct. 21, 2020

When you create treatment plans, or plans for improvement, your patients have to know what to expect. If they expect more dramatic results than are likely, or results delivered faster than is possible, you will have a discouraged and frustrated patient on your hands. I find setting expectations effectively to be an important ingredient to success both in my primary eyecare practice and in my sports vision practice. Here is how I set expectations with patients so the goals we work toward are productive, achievable and result in satisfied patients.

Educate that Treatment is Just One Piece of a Larger Puzzle
We set expectations about our training at the beginning. Our training is part of an athlete’s “circle,” which also includes strength training, nutrition, sleep, recovery, skills training and mental training. We explain to athletes (and parents) that consistent performance vision training will help an athlete improve, but we are not working in a vacuum. All of the other training and recovery activities also need to be done and optimized.

Ask Patients What Their Goals Are
We ask what an athlete is hoping to achieve – is there a specific issue they are having, or are they coming to us to improve overall athletic performance?

We had one athlete who wanted to improve overall skills. He was at an age in which sports were increasingly important in his time with peers. We set a program to work on overall coordination, reaction, anticipation, decision making and focusing. I will never forget receiving a three-minute voicemail from him talking about his role in his team winning a dodge-ball game in gym class. He was beyond thrilled to play a role and get the congratulations of his teammates. His teachers also noticed an improvement in his focus and attention in class, and other adults mentioned to his parents how much he seemed to have matured and how his confidence had grown. He even set a goal of trying out for a travel basketball team, which prior to his training would never have been a thought. We were able to impact not only his athletics, but his whole school and social experience, which was extremely rewarding!

Stay Optimistic, But Let Patients Know Success is Not Guaranteed
When we do the initial evaluation for each athlete, the parent is usually present. I also send an e-mail summary to the athlete’s parents discussing our findings, my goals for their child and what the training program will aim to work on. We reassess athletes periodically and expect improvement, but I caution parents that this is not guaranteed. If athletes take a long period off from training, or have a reevaluation on a day they may not be performing optimally, we may see a lack of improvement.

Setting Expectations is Especially Important When Prescribing Multifocal CLs & Progressive Glasses
Before I present multifocal contact lenses to a patient, I ask them what their goals are. Then, I set expectations. I usually say, “If I can get you to 75-80 percent of your goals, I will consider it a success.” If they are looking to see everything perfect at every distance, then I will discuss distance-only contact lenses with reading glasses on top. I tell patients we may not arrive only at one solution, just as you wouldn’t expect to wear one pair of shoes for work, weekends and sports.

Multifocal contact lenses give patients the freedom of not relying on glasses, but may not be perfect in all situations. I rarely use the word “compromise,” but instead talk about different ways we may need to correct vision. For example, “Multifocal contact lenses should work for you in almost all situations once we have found the correction prescription. However, for situations such as sports or sustained reading work, we may have to supplement with other solutions, such as reading glasses and distance-only contact lenses.”

We do the same with progressive lenses. I tell patients that progressives work for most people most of the time, but we may have to add a separate pair for work for multiple screens, or distance-only for TV in bed or driving.

Our practice has a high success rate with multifocal contact lenses and progressives, in part because we set expectations up first. It takes more chair time upfront, but I find we have significantly fewer contact lens checks and glasses remakes because patients have realistic expectations.

Think About How Best to Impart Your Message
I spend a lot of time working on my verbiage and my message delivery in the exam room. My goal is to be as direct and efficient as possible, and to provide information in a clear and concise way. I have shadowed other colleagues in their offices to hear how they speak to patients, and have learned a great deal from this.

I have one colleague in particular who sees double the patients an average OD sees in a day (at least), yet every patient I have referred to him raves about how thorough he is and how much time he spends with them. He is the master of communication. He is direct and informative, and conveys a large amount of information in a short amount of time. Having colleagues you can shadow and learn from is invaluable in learning how you can improve your communication to patients.

Jennifer Stewart, OD, is a partner in Norwalk Eye Care in Norwalk, Conn. She also is founder and chief vision officer of Performance 20/20, a sports vision training center in Stamford, Conn. To contact her: 


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