I fear the upset and frustrated patient. They can ruin my day. They can bring the whole office down. They don’t care how many people still need to be seen, they don’t care about appointment times or schedules and they certainly want to be heard. They are angry. Why?
Patients get angry when they don’t understand why they can’t see. Patients get angry when they are not heard. They don’t understand. They don’t understand the complexity of the disease. They don’t understand that they don’t understand. They don’t understand why new prescription glasses don’t fix the problem. This now becomes my problem.
My job is to prevent anxiety, frustration and anger. My preferred method is through education, but at times this is not so easy. Because retinal disease is not intuitive (the mechanisms by which you lose vision are not so obvious), there is a great deal of information that needs to be taught. If I can not teach a patient in a way that makes sense to him, then I am not doing a good enough job. The goal is to get my message across to the patient. Thus, it is imperative that I develop a manner, or style, which is effective in teaching a patient about his disease. This includes aligning their expectations appropriately. If I am successful, then we can prevent the cascade of destruction.
Retinal disease takes a lot of time to explain. Studies have demonstrated that patients (even you!) retain less than 10% of the information covered at a doctor visit. In addition to the teaching, I have to make sure that patients expectations are correct and that patients are aware that complications can occur. I tend not to sugarcoat the process, especially the possible bad things that can happen (aka complications) or the fact that the vision may not fully return.
I don’t want there to be any surprises. If a patient sustains a complication or the vision doesn’t improve as the patient hoped, I want to make sure that we discussed these possibilities. It makes my relationship stronger as I become a trusted source. Conversely, had we never discussed possible complications or the patient thought I promised great vision, trust becomes eroded. It is really hard to back-peddle if an untoward event occurs that was not discussed. This produces the anxious, frustrated patient.
Clearance Sale – Ever go shopping and the items you purchased were more heavily discounted than your realized? Did you question the motives of the cashier? No, you asked no questions and wanted to get out of the store before some mistake was discovered.
Everyone Happy – Similarly, if a patient does better than expected, then everyone is happy. No long discussions why vision is better than predicted. No long explanations as to why we didn’t sustain any complications. No stress or anxiety. I am happy, the office is happy. Most importantly, the patient is very happy.
Good news does not need to be sold.
Randall V. Wong, M.D.
Ophthalmologist, Retinal Specialist