Answering Patients' Most-Frequently Asked Questions
BY DAVID I. GEFFEN, O.D.
AUG. 1996
When a patient is sitting in your examination chair and inquires about refractive surgery, how do you respond? Can you answer your patients' questions adequately? Can you educate them about all their options? Can you satisfy their quest for knowledge so they won't seek answers in someone else's office?
Our patients expect us to inform them of the most up-to-date developments in eye care. Imagine what they would think if they asked you about the contact lenses they saw advertised on television and you didn't know anything about them. The same is true for refractive surgery. We're seeing patients who've been primed by radio, TV and print ads and who may have preconceived notions about refractive surgery. Your responses to their questions will project you as the expert and validate your position as primary eyecare provider.
AM I A CANDIDATE?
Most often, patients will ask you directly, "Am I a candidate for refractive surgery?" Since the patient is already in your chair, you should know which procedure would be appropriate for his prescription. Don't play alphabet soup with patients. Referring to PRK, RK, AK, ALK and LASIK can be confusing. It's much more meaningful to discuss laser vision correction, radial keratotomy, astigmatic keratectomy, etc.
After taking a case history and doing a comprehensive examination, you should also understand the patient's psychological makeup as well as his refractive status. Patients who are corrected to 20/40 and say they have no problems, or patients who comment that they don't like the hassle of contact lenses are good candidates for refractive surgery. On the other hand, the patient who sees 20/15 and notices an additional 1/12 diopter is not a good candidate, nor are patients who are very happy in their contact lenses or eyeglasses. Patients with vague complaints such as, "My lenses seem to dry out sooner than they used to" or "I don't wear my contact lenses as often as I used to; I guess I've become too lazy," are often good candidates for refractive surgery.
PRESENTING THE FACTS
When I do my case presentation at the conclusion of the examination, I always mention refractive surgery. If the patient seems interested, then I recommend a procedure based on his or her prescription. Currently, I recommend laser vision correction more often than other surgical procedures. For prescriptions outside the FDA-approved range, LASIK is an excellent alternative. I discuss the benefits and the risks of the procedure, and emphasize that we cannot guarantee 20/20 acuity. I also explain presbyopia and if the patient is over 40, I talk about monovision and offer a trial with contact lenses. I discuss halo and glare, haze and the corneal healing response, and I also mention the slight possibility that a patient may be an aggressive healer and what this implies.
Take a balanced approach. If patients feel you're not giving them a fair assessment, they may end up in someone else's office. If you believe a patient is not a good candidate for refractive surgery, tell him, but back it up with good information.
WHAT IS THE SUCCESS RATE?
Patients also want to know how successful refractive surgery is. I quote the results from Summit's 6.0mm data, which most closely equates to the results we achieve, but I don't make promises. In fact, I prepare patients for the possibility of wearing eyeglasses part-time. I emphasize what the study results are, but I put them into perspective for the individual. Explaining the procedure itself helps patients form realistic expectations.
Finally, once you've discussed the pros and cons of refractive surgery, explain the total costs and how the fees break down. It's particularly important that patients understand your key role in any refractive surgery. A comanaged care agreement between you and the patient will define the structure of the care and the costs. CLS
Dr. Geffen is in a joint refractive surgery practice in San Diego.
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