Preventing, managing unhappy patients

Atlanta-It's the kind of experience every eye-care provider dreads. Refractive surgery was successful, and the patient's post-operative vision is 20/20, yet he or she is unhappy and ready to tell the world about this negative experience-and maybe even plans to contact a lawyer.

With continued improvements in technology, better preoperative screening and post-operative education, reassurance, and treatment to keep the anterior segment healthy, the number of these unhappy patients will decline, said David Lampariello, OD, FAAO, in an educational program at the SECO annual meeting.

"Be proactive when dealing with the patient who is unhappy. We all get nervous when they come in, and we try to shut them out. But if you sit and listen to them and try to fix their problems, in most cases they will be some of your best patients, even if they're not 20/20," said Dr. Lampariello associate professor, New England College of Optometry, Boston.

Better patient selection

"We need to do a good job of selecting our patients," Dr. Lampariello continued. "Particularly in co-managing refractive surgery patients, we want to determine the motivation and expectations of our patients. Discuss the risks, benefits, and other options that they may have and complete a thorough preoperative evaluation.

"Always remember that this is an elective surgery," he added. "Don't let a patient talk you into doing a procedure when you really deep down feel that they're not going to have a good outcome. The way I look at it when a patient comes in for a consult is that they're not a candidate until proven otherwise."

Dr. Lampariello outlined a number of strategies for avoiding or managing unhappy patients. One essential step when discussing surgery is to explain that healing time differs for each patient and each eye and can also be affected by age, ocular surface condition, and the type of procedure performed.

It is also important to be clear and detailed when explaining the limitations of the procedure. He mentioned that he had recently changed the way he describes the post-operative phase, since many patients who were told they would need glasses to read subsequently complained that they couldn't see their cell phones or watches with unaided vision. Dr. Lampariello now refers to "near activities" and spells out exactly what they are.