What I Say: Conversations That Improve the Physician-Patient Relationship

Physicians of all disciplines know (or quickly learn the hard way) that effective and compassionate communication is arguably the single most important determinant of patient satisfaction. For cataract surgeons, the words said before, after, and even during the operation are often more important to the patient's happiness than the objective quality of the surgical result.

What I Say: Conversations That Improve the Physician-Patient Relationship is designed to help cataract surgeons to hone their verbal interactions to be as sharp as their surgical skills. Muddled, clumsy, or impromptu explanations diminish the doctor-patient relationship and could prevent patients from receiving the surgery they need or appreciating the results they get.

Knowing in advance which words to use in difficult situations is analogous to knowing how to manage a complication before it occurs. The results are inevitably better when a physician has considered every possible outcome instead of attempting to come up with exactly the right solution on the spot. Rather than figure out the right words by trial and error, however, What I Say has recommendations on exactly what to say to build strong and trusting patient relationships.

Drs. Robert Osher and Jack Parker have compiled conversational scripts from Dr. Osher's 40-year career in ophthalmology, as well as contributions from over a dozen international mavens of bedside manner into a strategy guide through even the most difficult patient conversations that inevitably surround cataract surgery.

Topics include:

• Lowering Expectations for Spectacle-Free Vision
• The Torn Posterior Capsule
• Refractive Surprise
• The Dropped Nucleus
• The Unhappy Patient Despite a Good Result

Containing examples of conversations with cataract surgery patients where informing and reassuring take top priority, What I Say: Conversations That Improve the Physician-Patient Relationship was created to aid cataract surgeons in their preoperative, intraoperative, and postoperative interactions with patients. With the advice contained inside, surgeons will be able to motivate patients, calibrate expectations, and diffuse frustrations in every possible scenario.

Contents

Dedication

Acknowledgments

Expert Contributors

Preface

Foreword by Richard L. Lindstrom, MD

Introduction

Chapter 1. Preoperative Conversations

The High Myope

Robert H. Osher, MD

Significant Astigmatism

Robert H. Osher, MD

The Patient on Flomax or Similar Type of Intraoperative Floppy Iris

Syndrome-Producing Drug

Robert H. Osher, MD

The Patient on Anticoagulation

Robert H. Osher, MD

Pseudoexfoliation Syndrome

Robert H. Osher, MD

Posterior Polar Cataract

Robert H. Osher, MD

History of Previous Trauma

Robert H. Osher, MD

History of Previous Vitrectomy

Robert H. Osher, MD

History of Previous LASIK, PRK, or RK

Robert H. Osher, MD

The Patient Interested in Presbyopic Correction

Michael E. Snyder, MD

The Patient Interested in Monovision

Graham D. Barrett, MBBCh, FRANZO, FRACS

I Want My Cataract Removed by Laser

Samuel Masket, MD

Lowering Expectations for Spectacle-Free Vision

Robert H. Osher, MD

Coexisting Blepharitis

Robert H. Osher, MD

Coexisting Dry Eye

Robert H. Osher, MD

Coexisting Epithelial Basement Membrane Dystrophy

Robert H. Osher, MD

Coexisting Keratoconus

Douglas D. Koch, MD

Coexisting Fuchs' Corneal Dystrophy

Robert H. Osher, MD

Coexisting Macular Degeneration

Robert H. Osher, MD

Coexisting Diabetic Retinopathy

James M. Osher, MD

Coexisting Epiretinal Membrane

James M. Osher, MD

Coexisting Risk Factors for Postoperative Cystoid Macular Edema

Robert H. Osher, MD

Coexisting Ocular Hypertension

Anup Khatana, MD

Coexisting Glaucoma

Iqbal “Ike” K. Ahmed, MD

The Patient With a Cataract So Advanced, the Fundus Cannot Be

Visualized

Robert H. Osher, MD

Complications in the First Eye

Robert H. Osher, MD

The One-Eyed Patient

Robert H. Osher, MD

The Terrified Patient

Robert H. Osher, MD

The Nasty Patient

Robert H. Osher, MD

What's the Worst Thing That Can Happen to Me During Surgery?

Robert H. Osher, MD

Routine Patient Discussion at the Conclusion of the Initial

Examination

Robert H. Osher, MD

Chapter 2. Intraoperative Conversations

What I Say to the Patient Before Surgery When He or She Is

in the Preoperative Area

Robert H. Osher, MD

Draping and the Claustrophobic Patient

Robert H. Osher, MD

When the Patient Is on the Operating Room Table

Robert H. Osher, MD

The Moving Patient

Robert H. Osher, MD

How to Talk to the Anesthesia Person Assigned to my Room

Robert H. Osher, MD

When the Phaco Machine Fails…And It Will, Sooner or Later

Robert H. Osher, MD

The Torn Posterior Capsule

Robert H. Osher, MD

Can't Place Premium Intraocular Lens

David F. Chang, MD

Can't Place Any Intraocular Lens

David F. Chang, MD

The Dropped Nucleus

Robert H. Osher, MD and David F. Chang, MD

Can't Place Microinvasive Glaucoma Surgery Device

Jack S. Parker, MD, PHD

The Patient With a Bruise

Robert H. Osher, MD

What I Say to the Patient Immediately After Routine Surgery

Robert H. Osher, MD

Chapter 3. Postoperative Conversations

What I Say to the Patient on the First Postoperative Day

Robert H. Osher, MD

Bonus: Postoperative Instructions and Medication Sheet

Robert H. Osher, MD

One Day Postoperative: My Vision Is Worse Than Before Surgery!

Robert H. Osher, MD

Dysphotopsias

Robert H. Osher, MD

When the Patient Complains About the High Cost of

Postoperative Drops

Robert H. Osher, MD

Posterior Capsular Opacification

Robert H. Osher, MD

Refractive Surprise

Robert H. Osher, MD

When a Laser “Touch-Up” Is Necessary After Cataract Surgery

Richard L. Lindstrom, MD

The Unhappy Patient Despite a Good Result

Robert H. Osher, MD

The Unhappy Multifocal Patient

Richard J. Mackool, MD and Robert J. Cionni, MD

When the Patient Asks for a Second Opinion

Robert H. Osher, MD

When the Patient Comes to See You for a Second Opinion... 91

Warren E. Hill, MD, FACS

Dislocated or Wrong Power Intraocular Lens

Robert H. Osher, MD

Retained Chip

Robert H. Osher, MD

Cystoid Macular Edema

Robert H. Osher, MD

Persistent Postoperative Inflammation

Robert H. Osher, MD

Decompensated Cornea

Jack S. Parker, MD, PhD

Endophthalmitis

Christopher D. Riemann, MD

Chapter 4. Bonus Chapter: What I Say to the Referring Physician

or Optometrist

Before Surgery, If I Agree With the Plan for Cataract Surgery

Robert H. Osher, MD

If I Disagree With the Indication for Cataract Surgery

Robert H. Osher, MD

Immediately After Surgery

Robert H. Osher, MD

At the Postoperative Visit

Robert H. Osher, MD

Financial Disclosures

Index