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Refractive Surgery | Jun 2009

The Patient Experience

Aim to make patients feel enthusiastic before and after surgery.

Refractive surgery is an opportunity for patients to increase their self-perceived quality of life. For us to help patients accomplish this goal, we must give each person our undivided attention from the minute he walks into our clinic. If, as refractive surgeons, we want our patients to feel like they have experienced high-quality care and achieved the refractive outcome they desired, we must adequately plan each treatment and consider many variables, always keeping their goals in mind. This article highlights important variables to consider in your own practice, with the objective of providing the best patient experience possible.

In my opinion, refractive surgery is a cultural approach to correcting visual problems; we are not treating patients affected by a pathology, but rather healthy people who want to improve their quality of life. Therefore, compared with specialists who treat pathologies, such as retina surgeons, we have a different approach to find and match each patient's goals with their treatment. This path, based on psychology, motivations, expectations, daily life, and visual needs, must be arrived at using a deep personal encounter between the surgeon, the staff, and the patient.

The most important variable in the patient experience is surgery quality. Although this specification should not need mention—because, after all, it should be understood—there still are situations where basic tactics for quality surgery are overlooked. Given that we cannot avoid this concern, every surgeon should take a look within his own practice to evaluate what changes are necessary to achieve consistent patient satisfaction. This begins with routinely conducting research, as education is the most powerful tool to maintain a good practice and make our patients happy. Researching top-level surgery, updated techniques, and standards of care and safety will help us to produce great outcomes.

No less important, however, we must learn to pay attention to detail. Some examples include continuous training for staff members, such as how to answer a telephone call, give appropriate information to a potential patient, treat a patient postoperatively, or welcome a patient when he arrives at the practice.

Ever-changing technologies used in refractive surgery directly impact the practice. The more high-quality, demanding surgery we offer our patients, the more important it becomes to assure them that the process will be a comfortable, easy-going experience. This approach is a different interpretation of medicine and science, especially from that found in Mediterranean cultures where many physicians tend to display their power over patients. On the contrary, we must put ourselves on the same level as our patients, trying to figure out what they want from us beyond the formal request of correcting their vision. If patients believe that the refractive procedure has been straightforward, you have done your job of providing them with an easy preoperative process and excellent surgery; patients will continue feeling confident in you and your refractive center if the quality of their aftercare is also outstanding. Even though refractive surgery is difficult, the patient should have the sense that it is not.

In the past 10 years, refractive surgery experts have helped to develop a basis for the definitions of high-standard, scientifically approved procedures. This scientific community is composed of great innovators who, while researching new ways to solve problems, always take safety, ethics, and outcomes into account. We must also strive to accomplish those same goals, continually researching refractive surgery, developing our own clinical aspects, and maintaining constant links with scientific societies and researchers who are investigating the most challenging issues of our discipline.

We must learn to provide our patients with superior care to complete the full patient experience. One component is the diagnostics and techniques we use, each of which must provide the utmost comfort for the patient. In my clinic, we offer only bilateral procedures and avoid the use of sutures when feasible. Patients want immediate visual recovery; they want to return to their daily activities the day after surgery.

We perform procedures that ensure the patient will begin the recovery process the day after surgery with no pain or visual discomfort. Immediate postoperative visual capacity should be better than it was the day before surgery, and even though some visual adjustment may be needed, it should not compromise the patient's daily working life. They immediately perceive the positive effect of the surgery because of their increased visual acuity.

We check patients' responses to surgery and their outcomes several times. We also regularly assess patients' satisfaction using a specific questionnaire that considers socio-demographic information, overall impression of the procedure, comparison of visual expectations with outcomes, surgery procedures, visual outcomes, adjustments, technical quality and know-how, interpersonal relations and communication abilities, internal organization, access/physical environment, psychological aspects, and overall satisfaction.

Moreover, we also monitor our patients' visual capabilities, general satisfaction, and well being. A patient counselor mat be enrolled to act as a one-on-one tutor. Their sensitivity and experience should go a long way to make the patient happy.

Patients should feel enthusiastic after surgery. The most important element in this equation is communication; let the patient know that he will receive high-quality care from a well-educated refractive surgeon who provides quality surgery and outcomes. When these requirements are met, patients usually are enthusiastic after surgery.

Any time the patient is not happy after surgery, our experience has shown that a lack of communication at a certain point of the process was the culprit. In these situations, do not simply move on to the next surgical case and vow to do better—you must invest time, dedication, and frequent feedback with this patient to learn how you could have made him feel more comfortable. Decipher what went wrong, when it went wrong, and why it went wrong.

Many times, if the patient is invited to frankly express his concern, doubts, or dissatisfaction, it will increase our chances of making things right with the patient. We can schedule additional consultations, diagnostic testing, or enhancement procedures. Some patients just need more attention and care postoperatively than others. Tables 1 through 3 depict three recent refractive patients who were referred to me after they were unhappy with their initial results. After follow-up conversations and care, all three patients were happy with their final outcomes.

The mission of refractive surgery should be to provide patients with vision as close as possible to perfection, without causing any intra- and postoperative pain. We recommend bilateral eye surgery for all cases. A better quality of life for the patient is sometimes difficult to achieve, but it should not be impossible. The more time we invest into our practice and the more individual attention we give to patients, the more likely we will successfully provide them with the optimal patient experience. The next generation of refractive surgeons will know to focus more on the patient to routinely provide him with safe, effective, and painless surgery.

Roberto Pinelli, MD, is the Scientific Director of ILMO, Brescia, Italy. Dr. Pinelli states that he has no financial interest in the products or companies mentioned. He is a member of the CRST Europe Editorial Board and may be reached at tel: +39 030 24 28 343; e-mail: pinelli@ilmo.it.