Premium surgeons strive to increase efficiency to please even toughest patients
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The well-known sitcom Everybody Loves Raymond, which aired from 1996 to 2005, is centered on the life of everyman Raymond Barone, a sportswriter living with his family on Long Island.
As we all know, Raymond was dryly sarcastic and took almost nothing seriously, making jokes in every situation. He was indecisive in family arguments, and his personal life was fraught with conflicts. In real-life exam lanes with patients, we as premium surgeons encounter a Raymond almost every day. And the Raymond we encounter may have many types of personalities, conflicts and/or complaints, usually with a good visual outcome postoperatively.
I write this specific column now as I probably had one of my worst Raymond patients recently, who took up excessive chair time and consistently left me 2 hours behind on his exam day — I just never could please this patient. After 33 years of experience, I wanted to share with my premium colleagues my top five pearls on how to deal with our everyday Raymond encounter in the clinic.
1. Do not just set expectations — really set expectations.
How many times do you wish you preoperatively told your patient with a no-view-of-the-retina cataract that it would take two procedures to gain their sight postoperatively? If the lens drops during a case, the surgeon may be blamed if two procedures are needed. However, the premium surgeon is not at fault if the patient delayed their surgery until a high-risk stage of cataractogenesis was achieved.
Please let all your premium IOL patients know that they will have halos and glare postoperatively with extended depth of focus (EDOF) and/or trifocal IOL technology in 100% of cases, and the brain will need some time for neuroadaptation or “neuroresignation,” as my good friend and colleague Carlos Buznego likes to call the process.
And lastly, the Duke and PHACO studies showed almost all patients have some degree of dry eye before cataract surgery, and if this is not discussed preoperatively, it will continue to exist postoperatively, and again the premium surgeon will be blamed for causing it. So, do not forget to optimize the ocular surface preoperatively to improve outcomes postoperatively.
2. Select the correct premium IOL for your patient.
Customization is key in gaining patient acceptance and true 20/20 happiness postoperatively. Objectively, with all the usual diagnostic testing (topography, tomography, OCT of the macula, dynamic meibomian imaging, biometry,) make sure the patient qualifies for a premium IOL in the first place. The problem, although it is a good problem, is that we have many more options now in our armamentarium, and I find the preoperative lifestyle questionnaire truly finds out a lot about a patient subjectively. For example, in my opinion, avoid a trifocal and/or EDOF-trifocal IOL technology in someone who does a lot of night driving. Most patients will say they do not drive at night, but in the winter in the Midwest, nighttime starts at 3 p.m. I remind patients that night driving does not always mean 8 p.m. year-round.
3. Proper diagnostic testing is critical.
So many second opinions come to our clinic because patients had a residual refractive error with a certain premium IOL, but topography and/or tomography was either not performed preoperatively or ignored preoperatively, such that the patient had no laser vision correction capability to be enhanced postoperatively for residual refractive error. Also, I am a big fan of dynamic meibomian gland imaging preoperatively to make sure patients even have meibomian glands to create an adequate oil layer to the tear film to avoid one of the biggest postoperative culprits, in my opinion, of unhappy patients: vision fluctuation, especially with near tasks. With our Light Adjustable Lens (RxSight) option, we include a thermal pulsation treatment such as iLux (Alcon) or TearCare (Sight Sciences) preoperatively as part of the refractive package to optimize the ocular surface.
4. Avoid open-ended questions in the lane.
When most premium patients are dissatisfied, they have a specific issue, so find out that issue before entering the room and have a solution for the problem. It is the cliché “I have bad news and good news” approach to a patient: “The bad news is you have a residual refractive error, but the good news is I can fix it with a LASIK touch-up, which was part of what you paid for in your refractive package.” Always enter the lane with a solution.
5. Show premium patients what they paid for.
At the 1-week second-eye postoperative visit, I show all my premium patients, happy or not, what they paid for by placing –2.50 sphere “purple glasses” over their eyes. I ask them to read up close, and they find out the difference from the insurance basic option of needing glasses full time for all near vision tasks.
In summary, every practice has their “Raymond” every day, and how you approach that patient starts preoperatively — objectively and subjectively — and continues to the point at which hopefully Everybody Loves Raymond in the end.
Stay safe and healthy in this new world of COVID variants.
- References:
- Gupta PK, et al. J Cataract Refract Surg. 2018;doi:10.1016/j.jcrs.2018.06.026.
- Trattler WB, et al. Clin Ophthalmol. 2017;doi:10.2147/OPTH.S120159.
- For more information:
- Mitchell A. Jackson, MD, can be reached at Jacksoneye, 300 N. Milwaukee Ave., Suite L, Lake Villa, IL 60046; email: mjlaserdoc@msn.com.
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