Patient awareness: Assumptions, expectations, and reality

After writing about lens care for more than two years, I wondered if my well had run dry. So this morning while on a flight, I perused PubMed and waited patiently for a new idea. When it didn’t come, I decided to turn to the guy next to me in 1A for a fresh perspective.

We often retweet large studies about how poorly patients comply with their lens routines. So, I thought I would find out firsthand through casual conversation what the typical consumer has to say. My motivation is this: many of us may read about noncompliance but are tempted to resist its high prevalence in our own practices because of the education level, status, or personality of our patients and how we assume they behave. Or, at the very least, we buy into the stereotypes and presume we know who’s behaving and who’s not.

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Before we talk about patients being noncompliant, let’s take a step back to look at patient awareness. To do what’s right, you have to first know what’s right. How aware are patients of what lenses they wear and how to wear them, or what solutions they use and how to use it? 

The hands-off wearer  

My first target, in 1A, is a male in his early 50s and a national account manager for a company that sells suspension systems. He was on a business call before take off, but then he buried himself in a novel the entire flight. And though he is a frequent traveler, he took the 7:20 a.m. instead of the 9:30 a.m. to allow extra connection time. What does this tell us about him? 

Assumption

He’s a very successful professional, so we assume he’s meticulous on some level and knows how to follow a plan. He uses his time efficiently but understands the value of balance. And he’s a planner, willing to invest extra time to prevent being rushed or stressed. 

Expectation

He knows the brands he uses and knows how to use them. He sometimes cuts corners but still feels like he’s in control and doing the right thing, more or less.

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Reality

Contact lens brand: “I’m not sure.” Solution: “I don't know what I bought last.” He told me he wears his lenses one or two times per week and throws them away every five to six weeks, but he was pretty sure it’s a monthly lens. And his response to the final question, “Do you rub your lenses?” was, “Ummm, I’m not sure what you mean by that, but I try to touch them as little as possible!”

Patient perception

The lens will be cleaner the less it is touched.

Next: The strategic late replacer

The strategic late replacer

My second target was in seat 3D, another male in his early 50s and a national account manager, this time for a large trucking company. He was reminded early on to put away his laptop for takeoff and landing. But the flight attendant must have seen the smoke rolling off this man’s fingers because he didn't bother to ask again on the way down. The passenger continued to peck away frantically until just shy of the gate…when I interrupted him.

Assumptions

His work ethic and determination seem unparalleled. The lists remind me of myself: everything squeezed in here and there so he doesn’t forget a thing or let anyone down. And considering his perfectly pressed shirt, fancy watch, and flesh-colored earplugs, he seems OK with spending a little extra money to have nice things. But then among his stack of papers was a crossword puzzle completed with a black felt tip pen, throwing caution to the wind with no regard to the potential mess a mistake could make…or could he be that confident?

More from Dr. Brimer: Patient perception vs. reality with compliance

Expectation

This guy is very successful, likely no stranger to rules, regimens, and routines. He’s disciplined and determined to things to perfection. Surely he carries out his cleaning and wearing directives to a T, knowing exactly what he wears and what he uses.

Reality

Contact lens brand: “Preservier?” Trying to figure out the brand, I asked how long he wears his lenses before throwing them out. His response was, “Two weeks-but longer if I use a good solution, maybe two months.” I immediately perked up! He said, “When I use Kirklands multipurpose I can go longer, but I can’t do it with Target brand. ReNu (Bausch + Lomb) is OK.” He rubs his lenses in the morning before applying them. Why in the morning? “Lazy, I guess.” As we continued to talk, he finally remembered that he wears Acuvue Oasys for Presbyopia.

Patient perception

The lenses must be safe and clean, despite their age, as long as they are tolerable.

Next: The nonchalant patient

The nonchalant patient

My next victim is a middle-aged single guy and the head server at an elite restaurant. He has a flamboyant and magnetic personality, and on any given night he can be found dashing about the room doling out hugs and kisses to old friends as well as those he’s just met. When something goes wrong, you see him shrug his shoulders and grin as if to say, “Oh well!” as it rolls off his back. However, he’s not indifferent to quality and expectations. He is determined to deliver a good experience, all the while making it look effortless.

Assumption

He centers his energy on relationships as opposed to details and tasks. Though structure and rules may not be his strong suit, he takes pride in his job and is very good at what he does. Lightheartedness is a trait to be envied, but it is sometimes accompanied by an inability to heed instruction or warning the first time around. He believes in living in the present and enjoying life.

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Expectation

He has no idea what contact lenses he wears or what he uses to clean them. He doesn't know how old they are because he just throws them away when they feel uncomfortable.

Reality

Contact lens brand: “Whatever doc gives me for free. I don’t know, the one that comes in the little box instead of the bubble pack.” Solution: “I don’t know-he gives me that too. But I’ve bought the Costco one before.” When asked if he rubs them, “Are we still talking about contact lenses? Uh, no.” He does change the solution daily, whatever it is. After hearing a few options, he recognized Acuvue Oasys for Presbyopia as his lens.

Patient perception

He doesn’t have to worry with any details of caring for his lenses or even his eyes, as long as he maintains his friendship with the doctor.

Next: The insurance-lacking over-wearer

The insurance-lacking over-wearer

Next up, a cook who was yanked from the kitchen by the flamboyant server, understandably a bit shy at first. He’s young, mid-20s, lives at the beach, but looks to be a hard worker.

Assumptions

Unfortunately, we see a young man in his mid-20s living at the beach, and we all jump to the same conclusions. Of course, this likely evolved because they kept living up to the stereotype: he’s cost conscious, cuts corners, takes risks, believes he’s invincible and that most guidelines in place are unnecessary and shouldn't apply to him. But maybe he’s the one who broke free of the mold?

Expectations

There’s a chance he knows what he’s wearing, but he wears them way too long and takes extreme shortcuts regarding their care-on the days he removes them at all.

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Reality

Contact lens brand: Acuvue Oasys. Solution: “I just changed to peroxide, Clear Care (Alcon), so I can wear them longer, about six to eight weeks.” He’s on his last pair and trying to stretch it out even longer. But with a glimmer of hope and mischief in his eyes he says, “I just found a Canadian website that will refill your contacts without an Rx! Needing a new prescription every year is a racket.” He had his last exam two years ago, just before his insurance ran out. “I should go, I can afford it.”

Patient perception

He is outsmarting the system without consequence.

Next: The expensive taste

The expensive taste

My last participant is in his 60s, a retired senior vice president from a major cola company. He now volunteers in the U.S. Coast Guard Auxiliary, owns an established bar 1,000 miles away, and maintains multiple vacation homes. Most days, he drives a new black Charger, dressed with a blue racing stripe across the top. He works out, cares about his appearance, and insists on choosing the first bottle of wine at dinner.

Assumptions

He’s been extremely successful in life and has much to show for it. He works hard in his retirement because he would be bored otherwise. Though he’s not wasteful, money is no issue and won’t stand in his way when it comes to personal comfort or even luxury. He lives in the present and makes efforts to consciously embrace life. He is driven and passionate, and sometimes acts out of emotion. 

Expectations

He may know the lens brand, or he may just buy what’s prescribed and never think about it again. He definitely knows his solution, because he pays attention to product names and quality. He doesn’t really acknowledge the potential for consequences, so it doesn’t occur to him to clean his lenses properly.

Reality

Contact lens brand: Acuvue Oasys. Solution: Biotrue (Bausch + Lomb). He told me that for the past two years he couldn’t get two full weeks of wear out of the lenses before having to throw them away. He switched to Acuvue TruEye just this week. I asked if during that time he ever considered changing solutions to see if it improved his comfort. With both disappointment and surprise, he replied, “No, I didn’t.” He denies rubbing his lenses.

Related: Corneal size does matter in contact lens fit 

Patient perception

The solution has no real effect on the wearing experience.

Unpleasantly surprised

So, admittedly, my sample size was small and certainly not an even representation of sex or demographics. But the goal was not to gain statistics. It was an attempt to think about how we consciously or subconsciously categorize patients and thereby presume their behavior, and how wrong we can be! It is so easy-and even comforting-to think that our patients are likely abiding by the instructions we’ve given, especially when they present as responsible adults.

When I started with 1A, my hope was to find one person in my travels who surprised me (in a good way). Several times, I assumed the wearer would be compliant and knowledgeable, but he wasn’t. So, while there were surprises, they were not reassuring ones.

At the risk of sounding like a broken record, the challenge at hand is to make time to review lens care and stress compliance with our established wearers too. And if we are to make assumptions of their behavior based on stereotypes, the safest one to make is that they don’t even know what they should be doing.