Medical Model

Improve Your Diagnosis Communication

By Jeanmarie Davis, OD


Improve communication with patients about diagnoses to make treatment and long-term care a greater success. This will result in a loyal patient who will stick with you for treatment.

As doctors, we focus rightly on our clinical skills and ensuring we have safeguarded our patient’s eye health and vision with accurate diagnoses and treatments. In the attention paid to this dynamic, however, many of us overlook the importance of doctor-patient communication about the diagnosis. You fully understand the condition you have just diagnosed, but does the patient sitting in your exam chair understand? Failure to adequately and compassionately explain a diagnosis can result in failed treatment and a patient who will seek a doctor elsewhere who is a better and more sensitive communicator. Here is what I have learned over the years about effectively communicating a diagnosis.

Diagnosis Education is a Value to Patients

Patients value the way their doctors communicate with them. The way a diagnosis is delivered to a patient can significantly affect the doctor-patient relationship, the doctor’s credibility, the patient’s compliance and loyalty. The way doctors deliver a diagnosis to patients can have more impact on practice-building than how much time they spend with the patient. Providing a diagnosis to a patient is very personal to that patient. While a diagnosis may be routine to the doctor, it is of the utmost importance to the patient. They want to have a thorough understanding of what is happening to them ,why it is happening and what they can do to either prevent it from worsening or reversing it altogether.

Watch Out for Unexpected Areas of Sensitivity

Sometimes even a minor diagnosis can result in patient discomfort. For example, presbyopia is a very sensitive diagnosis that is complicated by the fact that often patients will mask the fact that they are age sensitive. It is important not to make statements that associate presbyopia with “middle age” or “old age.” A more appropriate way to describe presbyopia is to say: “These are changes we will all experience at some point and we have several options available to enhance your vision.”

Consider the Patient’s Personality

The patient’s personality can play a large role in successful communication of a sensitive diagnosis. Some patients will need more time and hand holding–you may need to actually bring in a tech to help with a patient who needs more time. It is important to give patients enough time to pull themselves together before leaving the office, but at the same time, most patients understand that the doctor can only spend a limited amount of time in the room with them. A tech can stay a few minutes more, get them water and help them get presentable to walk out in public again. It is difficult to read some patients. Often times they will surprise us.

Start Diagnosis Education Process Early

I always tried to prepare my patients prior to receiving the actual diagnosis. As soon as I detected a risk factor for a serious disease I would start to educate my patients on the disease I was testing for and preparing them for the diagnosis. I would explain what the treatment options and prognosis were. My patients were aware that they were being followed and tested for a serious disease. The testing followed a course of several visits at which each time provided the opportunity to remind the patient why the testing was being done, review the disease and answer any questions. Once a diagnosis was made I reviewed the results with the patient, explained their diagnosis, the stage of their diagnosis, their treatment options, their prognosis and answered any questions they had. We would have had several conversations regarding this diagnosis, and the patient, and often times their family members, would have had the opportunity to ask questions, understand and become comfortable with the diagnosis by the time we were able to confirm it.

Help Patients Understand Seriousness of Some Conditions

It is important to stress the serious nature of a disease like macular degeneration or glaucoma, but this must be done gently and with great sensitivity. This is the time to slow down, make sure the patient understands and comfort the patient.

If the prognosis is good: Make it one of the first things stated to the patient and then educate the patient on details of the disease using easy-to-understand language. Emphasize the importance of proper compliance and follow-up even with a good prognosis to reduce risk and minimize progression and answer any questions they may have.

If the prognosis is questionable/uncertain: The patient should be educated that there are still questions to be answered and that you will see to it that they will receive the best care possible. The importance of proper compliance and close follow-up should be emphasized. Let them know if there is a specialist or specialty clinic that you would recommend for a second opinion or concurrent treatment.

If the prognosis is poor: These are the most difficult diagnoses to make and the patients and their families may become emotional. The patient should be told that it is in their best interest to seek a second opinion from a specialist. This will not only provide the patient with an additional clinical resource, but will help the patient feel as though you are taking a personal interest in ensuring the best care possible for them. Feeling personally cared for by their doctor is very important to patients. If this is the first time the patient has been examined for vision loss that appears to be permanent, it may be in the best interest of the patient to confirm these findings on another visit before making that final diagnosis to the patient.

Provide Educational Materials

Having written materials is helpful to patients. The two most important materials are instructions on how to use their medication and information on the disease in easy-to-understand language. A practice web site is an ideal place to house this information. Illustrations of a patient’s own eye for their record are usually well received. General illustrations for the web site that help a patient to understand a disease process can also be helpful. Care should be taken that photos for the web site are not too graphic.

Written instructions are always good with a serious diagnosis regardless of how the patient takes the news as it aids compliance. Close follow-up, particularly early on, will also help to monitor compliance, follow therapeutic response and check on their emotional state of mind.

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Jeanmarie Davis, OD, is manager, technical, Global Performance Development for Alcon. To contact her: drdavis2020@yahoo.com.

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