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New generation of cataract patients changing approach of practices
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 Richard L. Lindstrom |
At the recent OSN New York 2011, which was well attended and dominated by cataract surgeons, we asked the following question: Do you think patients undergoing cataract surgery are more demanding today than 10 to 20 years ago? An amazing 92% of the audience voted yes and affirmed their strong opinion with resounding applause when the answer was projected.
Having personally practiced in the ’70s, ’80s, ’90s, ’00s and now entering my fifth decade in 2011, I must agree. So, what is going on here? While we have no definitive studies confirming the answer, I have a few thoughts.
The cataract patient of today is definitely getting a better outcome on average than ever before. While there remains significant room for improvement, especially in regards to refractive outcomes and the reproducibility of results from one patient to another and from one surgeon to another, cataract surgery is by any standard a modern medical miracle. So, I do not think we are offering our patients an inferior product to what we did in past decades.
First, and most important in my opinion, patient satisfaction is in the eyes of the beholder. Patient-reported outcomes are exactly that: the patient’s opinion.
What has changed about patients? Many things have changed, especially their age. Cataract patients are increasingly members of the baby boomer generation, totaling 78 million people. They are very different from their parents, classically termed the greatest generation, who lived through the hardships of the Great Depression and World War II. They were much more trusting of government and authority and felt blessed just to have access to a caring physician. Their typical response to a discussion of risks, benefits and alternatives is “whatever you think is best, doctor,” and the opening conversation on day 1 after surgery often begins with a “thank you” to the surgeon.
Not so for the baby boomer, who typically, along with his or her spouse, has researched the doctor, the risks, the potential benefits and the alternatives in depth on the Internet and through a few well-placed calls to trusted confidants. These patients often come with a written list of questions, and when their vision is less than 20/20 or there is any discomfort or ocular injection, their first response is an anxious “What went wrong, doctor? I am very disappointed.” This is the dominant patient we will be treating for the next 40+ years, so we had best get used to it.
Likely to make them even more demanding is the fact that they will be required to personally bear more of the costs of their care as well. Our patients are transitioning from well “patients” to savvy, demanding, well-educated “consumers.” They want — no, demand — good value, and they are not afraid to ask for it and hold their caregivers responsible if they do not deliver.
As I read the business literature, I have learned that there are three potential value propositions that a business or practice can offer: lowest price (Walmart), highest technology (Internet shopping) or highest touch (Nordstrom). One can combine two of these but never all three as a service offering. So, as a practice, we can choose several value propositions. Because surgical care cannot be provided over the Internet, our offerings are somewhat more limited than for a commodity such as contact lenses.
As surgeons, we can lead with low price, high tech or high touch. Combining a secondary value results in one choice being low price/high tech, as low price/high touch can lead to commercial failure. This is the extraordinarily efficient practice in which the surgeon performs four to six procedures per hour in the operating room and sees eight to 12 patients in the clinic. Or, we can be high touch/high tech as, again, high touch/low price can also lead to commercial failure. In this practice, surgeons may perform two to three procedures per hour, meeting with the patient and family before and after each surgery, and see four to six patients an hour in the clinic.
Ten years ago, I was more of a low-price/high-tech surgeon, doing my best to maximize patient volume in the OR and clinic as prices were fixed by third-party payers and the typical patient was a member of the greatest generation. Today, I find myself transitioning to an approach that is more high touch/high tech. I have slowed down to two to three procedures per hour in the OR and reduced my clinic volume to six patients per hour. This transition is primarily being driven by the desires and demands of the baby boomer and echo boomer patients who ever more dominate my practice. It can work commercially today because of the financial magic of the increasing patient-shared responsibility for the costs of this high-touch/high-tech care.
With an ever-increasing number of patients willing to pay personally for a lifestyle-enhancing refractive outcome goal through refractive cataract surgery and refractive corneal surgery, I can now make this type of practice work well financially. It is an enjoyable practice transition for a surgeon in his or her 60s, and I believe more surgeons may well adopt this model in coming years.
My typical patient who opts for refractive cataract surgery and refractive corneal surgery demands more time and attention to detail, and he or she clearly requires a high-tech approach by a surgeon who is well skilled in the art and science of generating the desired refractive outcome goal, but I find patient satisfaction is extremely high when patients achieve their desired lifestyle-enhancing refractive outcome goal. Study after study and my personal experience confirm that the two main factors in generating patient satisfaction in refractive cataract and refractive corneal surgery simply require a quality surgery without complications that generates the desired refractive outcome in a patient-centered friendly environment. This high-touch/high-tech approach is not for every surgeon or every practice environment, but there is a growing demand for it in advanced countries, and I am finding it personally rewarding to slow down a little and spend more time again with my patients.