Working as an administrator in a refractive and cataract surgery center, I often hear our patients say postoperatively, “If I had known, I would have done it ages ago,” and “I made such a big deal out of nothing.”
All surgery is stressful, but eye surgery seems especially stressful to patients because it involves sight—one of the most important senses. When I ask patients what they are most frightened of, the answer I hear most often is, “Going blind.”
Patient education, therefore, should focus on eliminating the fear of the unknown. This can be achieved by helping patients to understand what the surgery is about, how it is performed and when, what they will experience during the procedure, and what they can realistically expect pre-, intra-, and postoperatively.
PREPARATIONS
Patient education starts even before the patient walks through your door. Asking patients to prepare for an appointment by completing a health questionnaire is a good start. This can be achieved by sending a form electronically or in the mail, along with your in-house brochure and instructions on how to get to your office and where to park.
Once in your office, patients tend to be overwhelmed, and they may forget to relay important details completely or do so at a poor time—such as a patient telling you that she pregnant as you are entering the operating room. What might be of importance to us, the medical team, may often seem irrelevant to our patients. They may not think to mention what sports they practice or the trip they are taking to the other end of the world the day after surgery.
Do not rush patients, and take time to listen to their worries and answer their questions. Assist them, especially senior citizens, in understanding their treatments, and convey clearly any additional information that coincides with their treatment, such as when and why they have to come in and whether they have to fast beforehand. Above all, remember that the preoperative process can be a confusing time for them.
Have your staff help patients go through paperwork; in other words, ask them to read it with patients, not just hand it out to sign. Your staff should not hesitate to ask patients directly, “Do you understand your treatment?” “Did we answer all your questions?” “Is there anything on your mind concerning the procedure?” and “Is there anything else we can do for you?” If you can, have a dedicated phone line for those patients scheduled for treatment, as they will have questions once they get home and start thinking about the procedure.
ANSWERING PATIENTS’ QUESTIONS
Patients are often reluctant to ask questions for a variety of reasons. They may feel like they are wasting the doctor’s time or are afraid of looking ridiculous. You and your team should strive to make patients feel comfortable; they should trust you enough to ask any questions they have. Do not assume patients have prior knowledge of their proposed procedure, as most do not but are not comfortable enough to admit it.
Use of instructional videos—whether in-house or commercially available productions—in your waiting areas can promote patient education. Be careful when organizing your playlist, as some videos can frighten patients. A good strategy is to incorporate videos with general information in the waiting rooms and reserve the more specific videos for patients to watch during their exams, making the experience more private and allowing them the time and space to express their concerns.
Take the time to reassure patients about written consent forms that can sometimes be alarming. Have patient brochures available, and encourage patients to read them before or while waiting for their exams. This will give them time to prepare questions. Informational leaflets can be ordered through most national ophthalmology organizations, such as the French Society of Ophthalmology (SFO) or Institut National de Prévention et d’Education pour la Santé (INPES) in France and the American Academy of Ophthalmology (AAO) in the United States. Alternatively, you can create your own leaflets to suit your patients and your practice.
THE RIGHT LEVEL OF COMMUNICATION
Most of us have busy practices; however, we must find ways to balance wanting to get to the next patient with giving each patient adequate time. Remember to use easily understandable words and keep the language as simple as possible. Substitute plain language for medical terms (eg, say “double vision” instead of “diplopia”), as patients may not be comfortable with specialized terminology. If they do not understand, patients are likely to go online at home and may read catastrophic comments or horror stories about surgeries gone wrong. If you have a website, make it user-friendly and include links to selected patient education sites.
The best advice I have is to be honest with patients. There is no harm in letting them know what possible side effects they might experience (eg, blurred vision, dry eye symptoms, itchiness, halos). Do not forget: Medical ethics is the bone marrow of our practices. Although you may fear chasing patients away by describing the side effects, patients appreciate knowing what to expect, and, more often than not, they will praise your honesty afterward. Sharing such information preoperatively will save you from the patient who insists that he or she was not warned about the side effects before surgery.
Also remember to include patients’ family members in the process, especially for elderly patients, as they can easily get confused. Having extra seats available for family members is a nice gesture. The more the patients and their families understand before the surgery, the less you will get unnecessary calls or visits afterward.
PATIENT DEMANDS
Unfortunately, you will have to say no to some patient demands, and sometimes patient expectations are too great. In these circumstances, it may be necessary to break the news to patients that they are unsuitable candidates. Concentrating on them and fully explaining why they cannot have the surgery they wish for is helpful. Take extra time for them, as the news might be lifechanging (eg, a dream career not possible anymore, the prospect of a new life without glasses shattered). These patients need to feel that you are listening to them, and, if they do, they will still send referrals, especially when they feel that they have been treated with respect.
Unfortunately, you will have to say no to some patient demands, and sometimes patient expectations are too great. In these circumstances, it may be necessary to break the news to patients that they are unsuitable candidates. Concentrating on them and fully explaining why they cannot have the surgery they wish for is helpful. Take extra time for them, as the news might be lifechanging (eg, a dream career not possible anymore, the prospect of a new life without glasses shattered). These patients need to feel that you are listening to them, and, if they do, they will still send referrals, especially when they feel that they have been treated with respect.
CONCLUSION
Patient education is not just up to you, the surgeon. It should be a team issue, with every member of your staff trained to answer questions and detect patient needs. I am fortunate to work with a surgeon who understands the importance of patient education, and that is reflected in the way we treat our patients. I cannot stress enough that you are the first in line to represent your team and motivate them to take your patients’ fears into consideration. Professional societies such as the American Society of Ophthalmic Administrators (ASOA) can help your office manager to get ideas of where to start and how to properly implement patient education.
All this might sound time- and energy-consuming, but patient education is definitely worth the investment in terms of patient satisfaction and, therefore, the success of your business.
Céline H.L. Reibel is an Ophthalmic Administrator at Presbyview-Chirurgie et Lasers de la Vision Center in Grenoble, France. Ms. Reibel states that she has no financial interest in the ideas presented in this article. She may be reached at tel: +33 6 25 11 58 56; e-mail: celine.reibel@presbyview.fr.
