CataractCoach 1188: three golden rules for patient discussion
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- čas přidán 18. 07. 2021
- Physicians need to understand importance of patient discussions regarding surgery
Letting patients speak, making a specific recommendation, and explaining what to expect are important parts of the surgical process.
I was very fortunate to have exemplary mentors during my residency training who taught me everything from the science of ophthalmology to surgical techniques. Among the most important lessons was learning how to prepare patients for surgical procedures, discuss the issues and answer their questions appropriately.
(1) Connect with the patients and let them speak
The first rule for these patient discussions is to let the patients speak. As simple as it sounds, patients often are unable to complete their thoughts and sentences because a hurried physician cuts them off abruptly. Our patients trust us with their most precious sense, their sight, and we need to understand their concerns, questions and issues before proceeding with surgery. Be seated next to the patient, put down the pen, and listen to their thoughts and apprehensions. Address each of their concerns, being careful to paint an accurate picture of the potential risks versus benefits of your proposed procedure.
Take the time to see the situation from the patients’ perspective: They are worried about their ocular condition, they are about to undergo a surgical procedure, and they do not know what to expect. When patients ask many questions after doing research on the Internet, understand that they are well-read and sophisticated patients with a desire to know more. Help them sort out the information and make an informed decision.
Be formal and polite, not casual and abrupt, in your discussions with patients. Bringing the family members of the patient into the exam room can often put the patient at ease and help in decision making.
(2) Make a specific recommendation based on your expertise
Give a specific recommendation to the patient and not a list of options. Patients are seeing you for your expertise in ophthalmology, and they want you to guide them toward what is best. If you give a list of potential options, how does the patient figure out which is best?
Let’s put this another way: you’re smart and you’re a physician who graduated from medical school with honors, but if you need a hip replacement surgery and I ask you which of the many different hip implants you want, you will have a hard time deciding. Now look at our patients who just want to have the best possible vision for their daily needs. How are they to know which lens implant will work best given their anatomy. Your patients don’t truly understand astigmatism like you do and they will not know if a toric lens is right. But you know - tell them how you would want to have surgery if it was your cataract surgery being planned.
And when the consultation is complete, realize that patients will go home and spend hours thinking about their visit with you and their upcoming surgery. They will think of more questions and may need a follow-up phone call or email conversation with you to finalize the details. The key to remember: Give the same patient experience and high level of care that you would like to receive.
(3) Explain the surgical procedure and what to expect
Our commonly performed surgeries, such as cataract surgery, are only routine to us. For each patient, every surgery is critical and of utmost importance. Focus on explaining the patient experience more so than the specific technical details of surgery. Patients want to know that you are targeting their vision for distance, but they are not as concerned with your choice of IOL calculation formulae. Similarly, patients want to know if the surgery will hurt but will not understand the nuances of a single plane vs. multiplane corneal incision.
When using a new device or instrument in surgery, understand that there will be a learning curve. While we can gain experience in the wet lab using model or porcine eyes, we will continue to hone our skills with the new equipment for hundreds or even thousands of cases. For my cataract surgeries, I like the incisions to barely nick the limbal vessels to ensure long-term wound stability and closure. When I began to use the femtosecond laser for cataract surgery, I had to carefully program and position the laser to achieve the same effect. With guidance and practice, this became routine.
One of the most enjoyable aspects of being an ophthalmologist is interacting with patients, particularly before and after surgery. Taking the time to talk with patients, establishing deeper connections and explaining the details of surgical procedures will lead to happier patients and a more rewarding experience for the physicians.
The best pearl is LISTEN TO THE PATIENT! In fact , understanding and respecting the other person’s state of mind works wonders in any sphere of life . Thanks for highlighting these lovely pearls !
Used to be called “bedside”manners . Sit, listen, hear and understand patient as unique, individuals.
Some fearful, most will want to have confidence in the outcomes of surgery.
Just completed a NIGHTMARISH cataract surgery at The Wilmer Eye Institue at Johns Hopkins Hospital in Baltimore, MD, due to an utterly chaotic Cornea Department and the surgeon who took none of the steps above. In fact, during my attempts to talk to her over a period of six months in preparation for this surgery, she was either walking or running away from me. I was patronized and treated like a child, while my desired eyesight outcome as well as my concerns for pain control during surgery were ignored and overridden by the doctor. This resulted in a heated argument in the surgical suite between the patient (myself) and the surgeon about the lens to be implanted. Despite every single document signed by me authorizing an implant for DISTANCE, she intended to implant a mid-range lens. With me hooked up to monitors and anesthesia starting, the surgeon heatedly argued with me to accept the mid-range lens. Had I not been sufficiently alert with the ability to advocate for myself in this difficult situation, I would have ended up with the wrong lense implanted for LIFE. If I could start this process over, I would steer clear of cataract surgery at Wilmer. Despite numerous red flags throughout this process, due to the utterly chaotic communication and environment of the cornea service at this well-regarded teaching hospital, I would choose a doctor in private practice who respected his/her patients as well as the guiding principles put forth above by Dr. Devgan.
If I lived ANYWHERE near LA, I'd come to you for my Cataract Surgery! Really enjoy your videos and your very personable style. 'You Get It'. Your '1. 2. 3' Golden Rules say it all. I have Cataract Surgery scheduled for next month in Florida and a Consultation a week before the surgery. Will be interesting to see if the Doctor follows your 1, 2, 3 Rules! Thanks again for your complete videos. I am a Subscriber.
OMG! I wish my surgeon could see this, but my surgeon doesn't have the time to listen to me and refuses to offer an email address for comments/questions!!! I tried the premium lense cataract surgery anyway, but am horrified at the super expensive results and must go through it all again. Boo hoo poor me, but this video should be MANDATORY for all cataract surgeons to understand!!!
I wish I wash having my surgery with you. Unfortunately I am in the U.K. so I can’t but perhaps my surgeon should listen to your videos. You understand how a patient feels and worries. Thanks.
Big and great thanks to you sir @Uday Devgan for your teaching videos
Your faithful student Ali from Iraq
Great pearls!!!...
Thank you so much sir.
One may add the following
to your points , especially for 3rd world countries:
the economic aspects including the choice of differing costs of IOL's.
Most of this seems like good customer service to me! Thank you! 😊
Brilliant, no one wants to feel like the facility is just a money machine, in other words, you are saying use the power of love. Amen to that.
Thank you! I really enjoyed this talk! You inspire me!
Love your videos! They are great value!
Excellent sir
Amazing points to consider. Thank you
I draw and paint for fun. I often see a violet tint in the afternoon and evening. An interior designer would be very upset with seeing a violet tint on fabric. I was told by a resident that I would get used to it. It's been six months since the surgery.
Because you nick the limbal blood vessels for best post healing, do you ever stop anti-coagulants prior to surgery?
no need to stop anti-coagulants since the tiny amount of blood from the limbal vessels is less than a drop of blood
Dr. Devgan, you have no idea how I wish I had found your videos before I greed to have this surgery. It was a Toric IOL in the right eye. My cataract was mild, I could see without glasses pretty well, I am a snowboarder at 69 yr. I could see well enough with just googles without glasses underneath. The Dr. said it would be good to get the Toric lens because it would correct my astigmatism. He was rushing me ( I felt) during the first visit back in November. He said to go do my snowboard trips before surgery because after I would not be able to go. Had the surgery early March . Before the surgery I had lots of questions, but he didn't respond to the emails ( red flag right?) Instead one of the fellows responded. I said I wanted to talk to the dr. Instead she called me on the phone. She said I would save money over time not having to buy glasses. In reality I've been wearing glasses all my life, so not the biggest concern. I should have listened to my gut feeling. The dr. is at a famous east coast eye institute, a teaching hospital. I read all the papers, but after the surgery I reread the fine print. It said that the dr. would be present for critical portions of the procedure, but might not be present for non critical portions. What does that even mean. I should have read and reread all of it but I didn't. I am exactly 15 days post op. Still on the 3 x's/day Prednisolone eye drops. My vision has never been worse in my entire life! He took pics 2 days ago, said no fluid behind the eye, said lens not rotated, said it's the correct prescription, said cornea is still swollen. He said not to worry keep drops 3x'day for 2 more weeks then only 2 /day until I see him again. The blurry vision is not due to not being able to read the chart the test shows I have almost 20-20 vision but my vision is totally blurry it's worse at a distance than it is at say 3 feet to 10 feet out. The Toric was suppose to be to improve distance vision and then I'd use reading glasses.
He never followed your 3 pearls I asked him multiple times from day 1, if the Toric would be right, I was concerned about axis precision having had issues with improperly made glasses many times. I asked him the day of the surgery how he was going to make sure the lens would be oriented perfectly, he said that's why he was doing some mark on my eye just before going in to the surgery. I asked if he was doing the surgery, he said yes. Now I'm not even believing that because post op there was a female fellow who was answering my emails NOT him. Two days ago she was the one first in the examination room. It's a teaching hospital she might have been the one who did the surgery not him.
If you answer that's great, but I'm interested in people reading this and listening to you. My vision is messed up, I am about as unhappy as I can ever remember. I have no idea what can be done to fix this problem. Maybe it will sort itself out, but at the moment I am completely visually impaired in my right eye. I had the right lens removed from my eye glasses and essentially I am functioning with the left eye only. Even without glasses my vision in my left eye is good, not blurry. I don't think he was helpful and I don't believe he is telling me what is really going on.
sorry to hear about your issues with your previous surgeon and associates. I wish that you came to me for your surgery and then you would have had much better results.
@@UdayDevgan i can still come to you for the repair that I think may be inevitable. Thank you for taking the time to respond.
@@Cocora22 I no longer fix problems caused by surgery done elsewhere. Just too busy at this time. In the future if you need the other eye cataract surgery done then come see me.
@@UdayDevgan thank you!!!!
@@Itsme-ni9jk Here's the biggest irony of the situation.......A retina specialist and the Dr. she sent me to misdiagnosed what I have. I don't know the exact name of the issue but it's actually a retina problem so the cataract surgery was totally unnecessary because the problem is still there. On top of that I still wear F#$#@ing glasses for astigmatism and these lenses cost a small fortune! I wonder why I really dislike doctors................thank you for your empathy, live and learn, never to old to learn.
Wish you would have been in uk doing mine as I got none of this, I only saw the surgeon for 5 minutes to go through a paper to sign and that was it, I now have numerous problems with my eyes where not happy
be formal & polite
not causal & abrupt.
underpromise & overdeliver 💖