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Managing your mental outlook: Are you limiting your own success?

Getting past common roadblocks may help boost premium IOL conversion rates.

Question: When it comes to the topic of premium IOLs, there are always discussions about how to best manage patients’ expectations of their visual outcome and visual quality after implantation. I’ve been trying to add premium IOLs to my practice, but so far the patients don’t seem enthusiastic. I have followed all the expert advice on how to successfully boost my premium IOL conversion rates, but I’m not sure it’s worth the time and effort. Any advice?

Answer: First, I have to wonder if your lukewarm attitude negatively impacted your patient’s enthusiasm for premium IOLs, rather than you becoming discouraged after making your best efforts to increase your conversion rates. Our mental outlook, positive or negative, creates a ripple effect. In my discussions with eye surgeons, I find that some surgeons unknowingly create barriers to a successful premium IOL practice through their own beliefs about what to expect from IOL patients and their ideas on patient selection.

I’ve put together three typical comments with discussion to illustrate such beliefs and expectations. See if you can find the roadblocks to success.

1. “When people pay that much for premium IOLs, they demand premium results. The experts say that to help prevent postop patient complaints, you have to underpromise in the preop counseling to create reasonable expectations, and then you overdeliver in the results. So, what I hear is that these patients are going to be demanding and require extra time managing their expectations. Even then, they may complain postop, and I’ll have to deal with it and remind them that I told them they might still need glasses. And so far, that’s what I’ve seen, and my premium IOL conversion rate has stayed low all year.”

This is a great example of how automatic thoughts can gradually produce a negative outlook with a self-fulfilling negative outcome. If you are someone who associates the word “demanding” in the phrase about demanding premium results with an image of a difficult-to-please, not easily satisfied, tiresome person, then you already put a speed bump in the road to practice success. When you carry negative beliefs and energy (often unconsciously) about a patient, device and/or procedure into a room, the patient often becomes aware of the negative “vibe,” and it negatively impacts the patient’s perception of the surgeon, acceptance of the recommendations and preop counseling, and postop patient satisfaction.

Also, there’s a fine line between underpromising and providing information with such lackluster or negative slant that a significant number of patients will decide that a premium IOL simply isn’t worth the extra cost. Often when we already have negative beliefs that people will complain, be demanding, and/or be dissatisfied with us if they have a certain procedure or device implanted, we unconsciously act to try to steer them away from that choice, thus limiting our practice’s opportunities for success.

2. “I’ve had two patients who weren’t satisfied with their premium IOLs despite adequate preop counseling. One wanted the implant removed and replaced with a monofocal lens. It wasn’t worth all the extra phone calls, visits and dealing with their unhappiness. I like happy patients, so I stopped offering premium IOLs.”

Well, that’s one sure way to limit the growth of your practice in these economic times. Let’s face it: We all prefer happy patients. But that doesn’t mean the majority of surgeons avoid performing elective procedures because a few patients aren’t satisfied.

Perhaps it is time to re-examine this “two strikes and you’re out” thinking about premium IOLs. It’s like telling a patient, “No, I won’t offer you a more technologically advanced IOL like the one you heard about (and that would provide you with a better visual outcome overall) because I had a couple of patients who didn’t like theirs, so I just decided not to implant premium IOLs at all.”

Can you imagine me telling psychiatric patients, “No, I don’t prescribe those newer, more expensive, psychotropics with better efficacy and side effect profiles. Two of my patients said they felt worse on them, and it wasn’t worth the extra phone calls, visits and dealing with them being upset at me”?

3. “I don’t discuss premium IOLs with patients I don’t believe can afford them because I don’t want them to feel less satisfied with standard IOLs by making them aware of the advantages of premium IOLs. I usually make a judgment based on the information in their record and from meeting them, such as their address, occupation, lifestyle and hobby interests, how they are dressed — just things like that.”

This belief set creates serious limitations for a surgeon’s success in a number of ways. When you decide not to even discuss the possibility of premium IOLs because you’ve made a personal judgment about someone’s financial situation, you’ve not only limited their options, but you’ve also taken away their right to participate in the decision-making process.

There are many people, some with substantial financial means and some with limited resources, who choose not to spend their money on real estate, costly sports or hobbies, or expensive clothes. Yet given the option of certain advantages with premium IOLs and the value they place on their vision, they would gladly pay the additional cost after a well-communicated discussion with the surgeon.

Some might not choose premium IOLs, but you can’t assume that they will automatically be less satisfied with their choice of a standard IOL simply because they have been made aware of the advantages of a premium IOL. The problem here lies in the surgeon making assumptions that again limit the possibility for an increased premium IOL conversion rate.

In summary, it’s important for all cataract and refractive surgeons to review their expectations and beliefs about premium IOL patients and offering premium IOLs in a practice in order to remove mental roadblocks that may substantially limit a practice’s success.

Jennifer S. Morse, MD, is in private practice as a consultant for medical and surgical psychiatry in San Diego, Calif. She can be reached at 610-405-5919; e-mail: jmorsemd@aol.com.