Managing cooperatively with patients

As optometrists, or any physician, it is our responsibility to set a standard of confidence from the first time the patient calls our office or visits our website. (Adobe Stock / N Felix/peopleimages.com)

Do you ever stop and think about what attributes are important to you that would create a sense of loyalty? More specifically, when you think about the places, things, or services you trust, what do they have in common? Take, for example, the food you eat. Unless you are on Soylent or have taken a vow to eat the same thing every day for the rest of your days, then deciding what to eat is arguably one of the most frustrating decisions of every day. The choice of nutrient consumption is a daunting task to do at home. So when you decide to eat out and avoid the dreaded “What should we make?” you want consistency, quality, and service that you are not going to get at home.

Loyalty and trust are based on meeting expectations, being consistent, and feeling that you are getting the most from that establishment. Now think about visiting a clinician. Should that be any different?

As optometrists, or any physician, it is our responsibility to set a standard of confidence from the first time the patient calls our office or visits our website. Furthermore, we need to make our offices a welcoming experience that supports our patients’ potential anxiety. Our staff plays a leading role in this relationship as they are the first and last impression your patient will encounter. However, at the end of the day, your actions will ultimately decide whether that patient will entrust the whole office with their eyes.

I have written in the past that there are little things that we can do to establish this trust—most notably providing our patients with relevant clinical information. Nowhere is that more necessary than in proactive discussions around eye health and eye wellness. Color me naïve, but I don’t think optometry has adopted the wellness model.

We are still reactive and responsive to patients’ queries or symptomatology. Yet time waits for no one and regarding ocular health—specifically the ocular surface—we are chasing an assault that seems to be on 4x speed. I am an acolyte of the Occam’s razor manner of diagnosing ocular surface disease. Attributed to William of Ockham, it is defined as follows¹: “The simplest explanation is preferable to one that is more complex. Simple theories are easier to verify. Simple solutions are easier to execute.” I suppose another way of saying this is KISS (keep it simple stupid).

Look, lift, pull, push

When it comes to being proactive regarding the ocular surface, an algorithm detailed by Chris Starr, MD, and Priya Gupta, MD, easily provides a cornucopia of information.²

The acronym LLPP (look, lift, pull, push) is to first look. Look around the eyelids, cheeks, and hands and around the side of the head for anything that is aberrant. This also means to have the patients keep their eyes closed and look at the base of the lashes. Surprisingly, the collarettes that are pathognomonic for Demodex can be missed when the eyes are open. You also want to look for lid closure. A lot of morning symptoms can be attribute to the loss of lid closure. If any suspicion of inadequate lid closure is suspected (eg, vision is worse in the morning), then the Korb method of having a patient close their lid naturally and placing a trans-illuminator at the upper lid will elucidate an inadequate seal by virtue of light escaping onto the cheek.

Second is to lift and pull the upper lids, looking for capped glands, lid laxity, and epithelial basement membrane dystrophy under the lid and trichiasis, which will hamper your patient’s vision and comfort.

Lastly, we push on the meibomian glands. As stated, we are here to provide a health report and where else in the eye can we assess further damage to the ocular surface than those pesky lipid-filled glands? When you give a gentle push (the blink provides a modest 3.0 psi), you should see that golden flow of meibum. Anything less of that is a glaring red flag for any patient’s ability to maintain homeostasis because when the tears evaporate, the stress on the tear film is unforgiving.

That simple LLPP is a way to provide a road map for your patients to start managing their ocular surface before they have symptoms.

Adding to patient care

This informative health check should be pertinent in every aspect of the ocular health. We do glaucoma evaluations (IOP, ONH evaluation, ocular coherence tomography, family history, etc) to rule out the disease, we dilate to look for anything not within normal limits of the retina and we look at the lens to determine its clarity.

When discussing with your patients, lose your crystal ball and prognosticating when or if they may have symptoms. Rather, give your patients the facts. High-risk patients need to know the risks; any patient with lenticular changes should be aware of the oxidative stresses that are playing on the lens every minute of every day. Furthermore, get patients excited about the current technology.

Patients don’t always know what they don’t know. We need to inform them of what new procedures may benefit them or new therapeutics that may make a difference in their lives. This also goes to discussing why they may not be a good candidate for some new treatments. A great example would be a patient who has irregular corneas and thus multifocal lenses are not a great option; however, lenses that utilize an extended depth of focus are more suitable.

Patient relationship and advocacy

Another opportunity to avail yourself to your patients is to be humble and positive, such as not apologizing for being behind schedule but rather, thanking them for being patient while you were giving your others the time they needed. However, there are other tangible things that can solidify the doctor-patient structure. An obvious example is diagnosing a condition for which a patient may have been unable to find resolution from other doctors by doing your research and staying current with evidence-based diagnosis and treatment. Yet I also feel that being a patient advocate will ultimately be the most consistently altruistic action we can provide, taking every step to provide, as an old rep once told my cookie-starved staff that he brought, only “good clinical data.”

This declaration of advocacy can be demonstrated by updated equipment that speeds up the examination, such as digital phoropters and integrated pretesting equipment, as well as modernizing the frame selection and utilizing social networks to educate as well as dispense information that you know your patients will benefit from.

Trust is something earned. Loyalty is earned by the way you make people feel. Be a selfless provider who delivers the type of options that your patients may not know from which they may benefit. You do that and they will come back.

References

1. Duignan B. Occam’s razor | Origin, Examples, & Facts. In: Encyclopædia Britannica. ; 2018. https://www.britannica.com/topic/Occams-razor

2. ASCRS Preoperative OSD Algorithm. ascrs.org. Accessed June 30, 2023. https://ascrs.org/clinical-education/cornea/ascrs-preoperative-osd-algorithm