How to avoid patient dissatisfaction

Issue: September 1995

There are several ways optometrists can avoid patient dissatisfaction with surgery and promote smooth referrals. Optometrists must be able to pick a qualified surgeon to work with. But even with a qualified surgeon, optometrists also must be able to predict what can go wrong and know how to treat those complications when they arise. Finally, ODs need to give patients a reasonable idea of what they can expect their postsurgical vision—both short- and long-term—to be like.

Joseph P. Shovlin, OD, stressed the last item as crucial. "If somebody is a –27, that patient is probably not going to be in the 61 range," he said.

With the apparently imminent approval of the excimer laser for photorefractive keratectomy (PRK), Shovlin said part of this patient education will be careful use of Food and Drug Administration (FDA) trial data, which he said "do not typify the real world."

Clinical trial data for PRK will probably be better than typical practice outcomes because "the best patients are always chosen," said Shovlin. He compared the FDA PRK results to the extended-wear contact lens data, where no corneal ulcers developed in the clinical trials because the ideal candidates always participated.

"One thing that an optometrist always has to remember is: Do no harm," he continued. "You're there to help patients who are unhappy with their refractive error, and you have three ways to do that: contact lenses, spectacles and refractive surgery."

He advised ODs not to be scared off by the potential problems that refractive surgery can present: "You need to offer refractive surgery. It's a good procedure, and many patients don't want contact lenses and spectacles."

Shovlin said of post-refractive-surgery patients who need contact lenses: "They're difficult patients. In many cases you're called upon to fit patients who are unhappy because they didn't want to wear contact lenses to begin with."

But if the patient is aware that a contact lens could be part of the postsurgical treatment, the optometrist will be ahead of the game. Shovlin said, "If you give your patients a complete description of the surgical procedure, give them a prediction of expected surgical outcome and associated morbidity to the cornea, and educate them carefully to the alternatives in the office, then you've done your job."