Three rules guide patient discussions regarding surgery
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During our surgical training, we are taught the intricacies of technical procedures, the elements of surgical judgment and the basic science basis for clinical practice.
An equally important aspect of ophthalmology focuses on patient discussions. We are not simply operating on an eye, but rather we are operating on a person’s most important sense, their vision. The nuances in the communication allow us to understand our patients’ desires, make specific recommendations and set reasonable expectations.
Source: Uday Devgan, MD
1. Connect with patients and let them speak
The first rule for any patient discussions is to let them 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.
2. Make a specific recommendation based on your expertise
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. If you give a list of potential options, how does the patient figure out which is best?
Let’s put this another way: You are smart and you are a physician who graduated from medical school with honors, but if you need a hip replacement surgery and I ask you which of the many different hip implants you want, you will have a hard time deciding. Now look at our patients who just want to have the best possible vision for their daily needs. How are they to know which lens implant will work best given their anatomy? Your patients do not truly understand astigmatism like you do, and they will not know if a toric lens is right. But you know — tell them how you would want to have surgery if the surgery were being planned for your eyes.
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 underlying theme is to give the same patient experience and high level of care that you would like to receive.
3. Explain the surgical procedure and what to expect
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 difference between phaco chop and divide-and-conquer techniques.
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. With guidance and practice, this became routine.
If you are performing an unusual procedure, such as a scleral-fixated IOL, 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.
If you would like a template to help with patient discussions, I can highly recommend the book What I Say by Robert Osher, MD, and Jack Parker, MD, PhD. This guide covers more than 100 commonly encountered situations, such as explaining a posterior capsule rupture to patients. It is a fantastic resource for improving your patient communication skills.
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 physicians.
A video of this topic can be watched at https://cataractcoach.com/2021/08/07/1188-three-rules-for-patient-discussions/.
My review of What I Say is here: https://cataractcoach.com/2021/09/18/1230-surgeon-patient-communication/.
- For more information:
- Uday Devgan, MD, is in private practice at Devgan Eye Surgery and partner at Specialty Surgical Center in Beverly Hills. He can be reached at 11600 Wilshire Blvd. #200, Los Angeles, CA 90025; email: devgan@gmail.com; website: www.CataractCoach.com.
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