How to help the unhappy patient after successful surgery

Annette Chang Sims, MD

As valued members of a surgical practice, it makes sense that technicians care about postoperative outcomes. It is always exciting when a patient comes in thrilled with an improvement in vision.

But on occasion, a patient presents with a good surgical outcome and is unhappy with the result. These cases are not only disappointing but also can be puzzling to the office staff. It is important to not overlook the cause of the patient’s disappointment because an investigation often uncovers a problem with an easy solution.

Unrealistic expectations
Much time is spent on innovation and technology to improve visual outcomes from surgery. However, the unhappy patient is not always a result of inferior technology or technique. An unhappy patient may be a consequence of simple misunderstanding.

The most common reason a patient is unhappy following successful eye surgery is that his expectations exceeded the outcome. Patients are often referred by friends or family members who were happy with their surgical outcomes. So, a patient who is interested in surgery may be looking for a “knock-your-socks-off” result. While this is obviously not a medical term, it is real expectation-and that is the root of the problem.

A patient may not take into consideration the differences in vision prior to surgery. For example, a patient with hand-motion vision may be ecstatic he can see 20/400 the day after surgery. This level of acuity is exciting for a patient who previously could not make out shapes. A friend who had an excellent postoperative outcome may want the same ecstatic response to surgery without knowing that his visual acuity is still much better than the patient who can see 20/400.

The money factor
Another factor that affects patient expectation is the out-of-pocket cost of a procedure.

Patients have become accustomed to health insurance covering much of the cost of medical procedures. This environment is changing, and patients are seeing higher premiums and deductibles. Additional out-of-pocket costs build the patient’s postoperative expectations. It is the “get-what-you-pay-for” way of thinking.

Consider that the use of the word “premium” to describe intraocular lens implants imparts the suggestion that patients should have “premium” vision following surgery. The expectation of “premium” is highly variable. It is important to emphasize the potential side effect profile of premium lenses and the likelihood of spectacle independence at various focal distances. While this conversation is largely handled by the physician, the staff should communicate to the physician warning signs that the patient may not fully understand the likely outcomes of surgery.

Negative perception
Aside from expectations, patients may be unhappy if they perceive negative events during surgery. Patients with a good visual outcome but poor surgical experience will present at their postsurgical visits with a sense of dissatisfaction.

Because most eye surgeries are performed with the patient awake, special attention needs to be made to provide a good experience for the patient. It is important to set the stage for trust by being attentive to the patient and communicating often and openly.

Pain should be promptly addressed because it can be interpreted as a complication.

Extra sounds and dialogue should be eliminated because a patient’s perception of surgery may be influenced by things heard and misinterpreted in the operating room.

For example, a nurse spilled iodine on the floor following prep and said, “Oops.” The patient was already prepped and draped and did not see what had happened. Despite an uncomplicated surgery and good postoperative result, she insisted a complication occurred and was not disclosed to her. Years have passed, and whenever she has an ocular symptom, she blames the complication that did not occur.

Positive office vibes
This process does not start and end with the operating room experience. Patients will judge their experiences from the moment they call to make an office appointment. Every member of the office staff plays an integral part in setting the tone of competence, caring, and efficiency.

The salutation by the office receptionist will affect a patient’s perception of his value as a patient. Clinical staff will be constantly judged by the patient. The patient’s perception of care can be affected by small and seemingly insignificant tasks such as keeping a tidy workspace, eliminating personal conversations, and maintaining an ever-present smile.

Hospitality is just as importance as surgical skills in influencing a patient’s perception of the surgical experience.

What patients don’t know
It is important to keep in mind that although surgery is routine for an ophthalmology practice, it is a once-in-a-lifetime experience for a patient.

A patient is not expected to know something as benign as a foreign body sensation in the postoperative state may not represent a complication. Some patients are not aware that blurry vision may occur after surgery.

Reassurance goes a long way. Highlighting an improvement in visual acuity following surgery can help put a patient’s mind at ease. Keeping the patient informed about the sequence of events helps also ease the mind of a person who is nervous about the procedure.

It is important to remember that the patient is the centerpiece of the experience. Patience is a necessary tool to calm the nerves of an anxious patient going through the surgical process. This means answering the same question time and time again without hints of frustration is worth the energy to achieve a good outcome.

It’s not personal
Most importantly, do not take it personally when a patient treats you poorly.

People getting eye surgery feel quite vulnerable. They have made a leap of faith in trusting the surgeon and staff. When a person lacks control and has a fear of the unknown, overwhelming feelings of anxiety can lead to challenging behavior. While this behavior may not seem reasonable to you, you are not the focal point of the experience.

Remember that you have the power to improve a situation. Patients are looking to the staff to lessen their fears and reassure them a good outcome is in their future.

Looking ahead
Patient satisfaction takes on a greater importance now as government reporting systems are tying reimbursements to patient satisfaction. The government recognizes that low surgical complication rates and good visual acuity are not the only metrics important in assessing quality patient care. Patient satisfaction surveys are becoming a requirement to assess overall quality of care.

While good vision is the reason why a patient seeks an ophthalmic practice, good care is what a patient is really looking to experience. This care is evaluated by patients from the moment they enter the door to the moment they exit.

The tools to achieve patient satisfaction are not limited to new glasses or surgery. Patient-focused care involving good communication, caring style, and efficient practices are the main ingredients to achieving patient satisfaction. Without these elements, even good postoperative visual acuity can lead to an unhappy patient.