October 01, 2011
2 min read

Psychology an important part of ophthalmic care

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Michael D. DePaolis, OD, FAAO
Michael D. DePaolis

I have long felt practicing optometry is a delicate balance. To be an effective care giver, optometrists must be one part visual scientist, one part health care provider and one part psychologist. While we are well trained in the first two areas, the latter is a skill set we learn along the way. It is a reality we all acknowledge – and live – especially when you consider the following scenarios.

Consider the 52-year-old whom you have just diagnosed with chronic open angle glaucoma. While his IOPs, discs, ocular coherence tomography images and visual fields support the diagnosis, he is essentially asymptomatic and, therefore, skeptical about initiating lifelong eye drop therapy. What about the 62-year-old female smoker with a maternal history of age-related macular degeneration who presents with macular drusen? While she is amenable to your recommendations for AMD prophylaxis, she is doubtful she will be able to stop smoking. Finally, there is the 70-year-old with perfectly placed multifocal IOLs resulting in 20/25 and J2 uncorrected visual acuity. Despite this exceptional outcome, she is not pleased with the quality of vision, even though you counseled her on this preoperatively.

The common thread among these patients is evident: you have made the right calls as a vision scientist and health care provider but now must work your magic as a psychologist. It is the reality we deal with repeatedly on a daily basis to ensure an optimal outcome.

The psychology of patient care can be especially challenging when you consider human nature and compliance. There is an impressive body of literature that tells us noncompliance transcends all socioeconomic strata, race and gender, as well as type and severity of medical condition. Additionally, some argue compliance is affected by today’s doctor-patient dynamic, a dynamic in which patients rarely view their doctors as demigods, but rather as partners in health care. While many feel this loss of authority is dangerous, I will contend it is not necessarily a bad thing.

Seeing things from the patient’s perspective can be quite revealing. Not only does it provide the doctor with a better understanding of patient concerns, it also allows the patient to see the doctor’s empathetic, understanding and compassionate side. While we must remain firm with our therapeutic decisions, many patients are more likely to comply if approached in this fashion.

In this month’s Primary Care Optometry News, we have a number of articles concerning the psychology of patient care. Dr. John Potter provides us with an exceptional article on conflict resolution. Jennifer Byrnes’ report on smoking cessation offers great tips and resources for helping patients break this addiction. Finally, Dr. Al Rosenbloom reminds us of how valuable an experienced clinician is in mentoring young optometrists with such issues.

I encourage you to take a few moments and read each. I am confident you will find them valuable resources in achieving optometry’s delicate balance.