This article is more than 5 years old. Information may no longer be current.
Embracing the premium patient experience
Click Here to Manage Email Alerts
For many doctors, our role as healer precludes thoughts of ever getting sick ourselves. When we do, it initiates a profound shift of awareness — not only in our sense of ourselves, which is invariably bound up with the “invincible doctor” role, but in the way that we view our patients and the doctor-patient relationship experience.
Recently, I had the opportunity of being a surgical patient when I underwent spinal fusion surgery on my lower back, which included a 4-day hospital stay. As a doctor becoming a patient, I was interested in comparing what I considered a “premium experience” in the spinal world and how it relates to what we offer our ophthalmic surgery patients.
Due diligence
Like every patient, our nature is to make sure we have the best surgeon for our specific surgical condition. Typically, word-of-mouth weighs the heaviest when it comes to referrals, followed by a referral from another doctor.
Mitchell A. Jackson
Some patients may take it a step further, as I did, and do the due diligence, seeing more than one specialist for the condition at hand. As part of my due diligence, I traveled to two of the most prestigious spine centers in the U.S. and also visited two known spine specialists in my own Chicagoland area.
In the end, after evaluating my options based upon what was most important to me, I went with my original instinct — the surgeon and staff that provided me with the most premium experience.
Expectations
Patient expectations are indeed different from surgeon expectations at the outset. The good news is if you as the surgeon keep expectations realistic from the first visit, you will look like a hero with the expected outcomes. In my case, I had intractable pain 24 hours a day, 7 days a week; my only realistic expectation as a patient was to be pain-free, and fortunately this occurred. My spine surgeon has already had several referrals from me as a result.
At my practice, we place a premium on our patients’ expectations, comfort and convenience. From thoughtful consideration of issues to answering questions and thoroughly addressing concerns, we focus on providing expert care in a comfortable, welcoming practice environment. Addressing posterior capsule opacification, astigmatism management, possible cystoid macular edema risks and ocular surface contribution to the overall visual outcome is a great starting point in meeting patients’ expectations. As a result, our word-of-mouth referrals have blossomed.
Fear factor
Every patient has fear when it comes to surgery — fear of blindness, in our profession. In my case, I did not sleep the night before my procedure as I feared paralysis. Although these types of horrific results are statistically rare with experienced surgeons, patients have fear and it must be addressed as part of the original expectations discussion. Fear may also just be an excuse for other issues, such as the additional financial burden with premium IOLs and/or femtosecond laser cataract surgery.
Our business manager specifically reviews the costs covered by the insurance carrier, the costs of the surgical center and the costs of the surgeon in explicit detail at the patient’s preoperative counseling visit. It is during that visit that additional advanced diagnostic testing is also completed, such as corneal topography, retinal optical coherence tomography imaging, axial biometry, and other advanced ocular measurements needed to select the appropriate IOL. All fears, financial and technological, are softened at this visit.
The procedure
Finally, the day of the procedure arrives, and the only thing on a patient’s mind is having no pain, no anxiety, no complications and a good if not great outcome. My experience was full amnesia and not remembering anything after I entered the operating room until I was back in my hospital room on a patient-controlled analgesia pump.
In ophthalmic cases, achieving the same relaxing amnesia effect can be achieved with a combination of anesthetics, such as preoperative topical nonsteroidals, intracameral mixtures of lidocaine and phenylephrine (“shugarcaine”), topical anesthetic gels, injectable anesthesia with a recombinant form of hyaluronidase, intravenous toradol, midazolam, fentanyl, and/or low dose ketamine (10 mg to 50 mg titratable). The bottom line in a surgical patient is that no pain will yield great gain to your patient’s happiness, to you professionally and to your practice’s bottom line.
Following the protocol
Up to 50% or more of patients across the entire field of medicine never fill their medications. In a patient undergoing an elective surgical procedure, such noncompliance can be disastrous to the outcome, usually resulting in some form of malpractice liability to the physician, especially when not taking appropriate preventive steps.
During preoperative visits with my surgical patients, I let them know exactly what my protocol is verbally and in writing, with a family member or significant other present as a witness. As part of their informed consent, patients also will fill out an acknowledgment form to follow the protocol in terms of branded vs. generic eye medications, follow-up visit schedule and the expected “dos and don’ts” after surgery.
Following my spinal surgery case, I have a long 6- to 12-month physical therapy responsibility as part of the protocol to get me back to where I was before surgery, but with the original problem fixed. I remind patients that the surgeon is responsible for about 80% of the outcome and the remaining 20% is on them.
Gratification
As for me, I was happy to achieve the five W’s I had set out to achieve with my spinal fusion surgery: wiggle (my toes), walk, wink (my vision), without pain, and with much gratitude to all those in the hospital and outpatient services — from the doctors, nurses and nurse aides to the food/janitorial services, physical therapists, my spine surgeon, and my creative rehab physical therapy enforcer.
Our eye patients wish for the same with a slight adjustment to their desired 5 W’s, but ultimately, they will be grateful for our service as surgeons with all our supporting staff that we bring to them on a daily basis. In the end, I am glad to be able to keep bringing the premium experience to my patient base.
Stay tuned for my next column on managing astigmatism and fine-tuning outcomes.