BLOG: Empowering words for the refractive discussion
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A number of studies have shown that, among patients undergoing cataract surgery, 80% would seriously consider a refractive implant if they fully understood what it offers.
Yet adoption in the United States has remained below 20% since these lenses were first approved more than 20 years ago. Market research shows that physicians perceive an awkwardness in the relationship with patients when they ask patients to consider paying more for a more spectacle-free surgical outcome. This inhibits doctors from having the discussion with patients, and many relegate the important task to a staff member who is a much less credible source of information. To patients, it sounds like an upsell that the doctor was not interested enough to have presented the options himself or herself.
But patients want to have this conversation with the doctor, who is the most trusted source. And the simplest way to dispel that awkwardness is to address it openly at the beginning of the discussion, as I have done for many years.
I introduce refractive implants at the end of the consent conversation about surgery, after I discuss risks. I say, “The majority of our patients are interested in advanced technology implants that are designed to give some freedom from glasses, even though these lenses have an extra cost that is not covered by insurance. I want to be very clear that I’m not here to sell anything to you, but when I do your surgery, I’m going to put an implant in your eye that is going to set your vision for the rest of your life. We don’t expect your prescription to change significantly in the future because, unlike the lens we are removing, your implant will never change its power. You will never receive a product that you will use as much as your lens implant because you’re going to be looking through it every waking minute for the rest of your life, so it’s important for you to understand what your choices are. But this is also a financial decision for you, and I’m happy with whatever you choose, as long as you understand your choices.”
The most important part of this statement is that I am not interested in persuading but rather informing the patient, and this must be true. The patient’s choice of a refractive implant does mean additional income to the practice, but it also means significant additional work. Most crucial to me is that the patient makes an informed rather than a particular choice. More importantly, this statement gives permission for the patient to say no to me and my staff, so he or she is more likely to listen to what follows rather than be defensive. Nobody likes an upsell.
Next, I generally present a basic lens first, portraying its value positively and as accurately as I can. After that, I present the refractive option that I think best fits the patient’s needs, based on a preoperative questionnaire that will soon be available to everyone as part of Alcon’s SMARTCataract system. This questionnaire explores in detail the patient’s visual problems, lifestyle, visual desires and candidacy for different implant options. Finally, I briefly present to the patient a third option that also might fit his or her needs.
Our practice has almost 80% of patients choose some type of refractive option with surgery. Oddly enough, that matches closely the proportion of patients who say they would consider these implants if they understood all their options. We feel good about that as a sign that we have helped our patients understand all sides of the refractive decision. For us, the discussion of refractive options is as appropriate as the discussion about risks, and the patient deserves to hear it from the surgeon in the most balanced and truthful way.
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For more information:
John A. Hovanesian, MD, FACS, an ophthalmologist specializing in cataract, refractive and corneal surgery at Harvard Eye Associates in Laguna Hills, California, can be reached at drhovanesian@harvardeye.com.
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