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Physicians need to understand importance of patient discussions regarding surgery
Letting patients speak, making specific recommendations, and explaining the procedure and risks are important parts of the surgical process.
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I was very fortunate to have exemplary mentors during my residency training who taught me everything from the science of ophthalmology to surgical techniques. Among the most important lessons was learning how to prepare patients for surgical procedures, discuss the issues and answer their questions appropriately. Robert A. Goldberg, MD, an oculoplastic surgeon, and Bradley R. Straatsma, MD, JD, a specialist in ocular oncology, both have a superb talent in connecting with patients on a deeper level. These are some of the pearls that I gleaned from working with them 15 years ago at the Jules Stein Eye Institute at UCLA.
Connect with the patient
The first rule for these patient discussions is to let the patients speak. As simple as it sounds, patients often are unable to complete their thoughts and sentences because a hurried physician cuts them off abruptly. Our patients trust us with their most precious sense, their sight, and we need to understand their concerns, questions and issues before proceeding with surgery. Be seated next to the patient, put down the pen, and listen to their thoughts and apprehensions. Address each of their concerns, being careful to paint an accurate picture of the potential risks vs. benefits of your proposed procedure.
Take the time to see the situation from the patients’ perspective: They are worried about their ocular condition, they are about to undergo a surgical procedure, and they do not know what to expect. When patients ask many questions after doing research on the Internet, understand that they are well-read and sophisticated patients with a desire to know more. Help them sort out the information and make an informed decision.
Be formal and polite, not casual and abrupt, in your discussions with patients. Bringing the family members of the patient into the exam room can often put the patient at ease and help in decision making. Give a specific recommendation to the patient and not a list of options. Patients are seeing you for your expertise in ophthalmology, and they want you to guide them toward what is best.
And when the consultation is complete, realize that patients will go home and spend hours thinking about their visit with you and their upcoming surgery. They will think of more questions and may need a follow-up phone call or email conversation with you to finalize the details. The key to remember: Give the same patient experience and high level of care that you would like to receive.
Explain the surgical procedure
Our commonly performed surgeries, such as cataract surgery, are only routine to us. For each patient, every surgery is critical and of utmost importance. Focus on explaining the patient experience more so than the specific technical details of surgery. Patients want to know that you are targeting their vision for distance, but they are not as concerned with your choice of IOL calculation formulae. Similarly, patients want to know if the surgery will hurt but will not understand the nuances of a single plane vs. multiplane corneal incision.
Figure 1. This incision for cataract surgery was created with a femtosecond laser and positioned to barely nick the limbal vessels for added long-term stability and healing. There was a learning curve to program and position the laser to achieve this desired result.
Images: Devgan U
Figure 2. In addition to the cataract, the patient sustained ocular trauma that resulted in disinsertion of the iris from the root for approximately 2 clock hours. At the time of cataract surgery, an iridoplasty was performed to suture the iris back into position. It was explained to the patient that in his unusual situation, it would be possible to improve the iris appearance but not make it perfect. The suture from the corneal incision was removed, and the patient was pleased with the outcome.
When using a new device or instrument in surgery, understand that there will be a learning curve. While we can gain experience in the wet lab using model or porcine eyes, we will continue to hone our skills with the new equipment for hundreds or even thousands of cases. For my cataract surgeries, I like the incisions to barely nick the limbal vessels to ensure long-term wound stability and closure. When I began to use the femtosecond laser for cataract surgery, I had to carefully program and position the laser to achieve the same effect (Figure 1). With guidance and practice, this became routine.
If you are performing an unusual procedure, such as an iridoplasty (Figure 2), your total experience may be only a handful of cases. Explaining the additional risks of this procedure to the patient is important in making an informed decision. In these cases, patients will understand that they have an unusual condition, and they will be more conservative in their expectations.
One of the most enjoyable aspects of being an ophthalmologist is interacting with patients, particularly before and after surgery. Taking the time to talk with patients, establishing deeper connections and explaining the details of surgical procedures will lead to happier patients and a more rewarding experience for the physicians. It also explains why both Dr. Goldberg and Dr. Straatsma always greet patients with a smile.