The psychology of the dry eye patient

Can we talk? We’re all friends here, right? Safe zone and all?

Man, I just had a DAY in the clinic. My first five patients all had dry eye syndrome (DES), all were dramatically better than when they started, and nobody was happy. You take care of DES patients so you know what I mean. There’s no question that all of the developments that we’ve seen have made it easier to take care of DES and other forms of ocular surface disease than any time in history. The reason more people don’t jump at the chance to do what we all do is because, despite all of these wonderful developments, we are still taking care of dry eye PATIENTS.

After struggling through a morning that felt like wading in quicksand, I sat back and spent some time thinking about the psychology of the DES patient. I’ve previously described the archetype of the classic DES patient as a woman between the ages of 35 and 60, married, with children, employed and with some post-secondary education under her belt. While it’s helpful to understand and be comfortable with this demographic, it leaves out a lot of information about the various types of emotional makeup of DES patients, men and women, and how that affects both the patients and us as we care for them.

For guidance in this quest to better understand my patients I turned to the eminent scholar, Winnie the Pooh. (As an aside, for life guidance in general I commend to you “The Tao of Pooh”). Indeed, studying the characters surrounding Pooh not only gave me a deeper understanding of my DES patients, but just thinking about Pooh and his pals finally made me smile after my very tough morning. Let’s spend a little time together in the Hundred Acre Wood, shall we?

Chapter 1: In Which We Meet RABBIT

At SkyVision we joke about taking care of “Linda Blair,” famous for her role in “The Exorcist,” who comes in with her head spinning, hurling invective. While this “Linda” certainly invokes our demographic archetype, she doesn’t really provide much insight into how she’s feeling, at least not in a way that we can translate. Rabbit, on the other hand, is a character that we see every day in the DES clinic. He’s unhappy, and more than that, he’s pretty angry. Rabbit is also a bit of a know-it-all; he reminds me of the DES patients who have been treated at any number of other clinics before they get to you. His anger, and in our case his DES symptoms, have made him somewhat unsocial, and he’s not all that happy to be seeing you.

How does Pooh approach Rabbit with all of his anger and unhappiness? To begin with, Pooh is impossible to insult, no matter how hard Rabbit tries to get a rise out of him. This is key: it’s important for us to have a very thick skin when patients are openly angry about their symptoms. Pooh addresses each of Rabbit’s concerns or complaints and then quickly moves on, not allowing Rabbit to dwell on any particular negative. Pooh moves through all of Rabbit’s issues, big or small, as he hones in on one, single, very positive outcome: Rabbit’s honey pot. This approach works just as well when we are faced with an angry, contentious patient. Don’t get defensive or allow yourself to be insulted by the tone of your patient’s voice. Listen to all of the complaints, acknowledge that you have heard them, and then relentlessly seek to achieve one very positive outcome at that visit.

Click here to read the full publication exclusive, The Dry Eye, published in Ocular Surgery News U.S. Edition, December 25, 2014.