Jack S. Parker
ORLANDO — The audience of Cataract Surgery: Telling It Like It Is was witness to a master class in the impact of language — clarity, specificity, frequency and timing — when speaking with a patient.
Resident training teaches you how to deal with complications, but it “never [teaches] you what to say to the patient, to the family. You want to be encouraging. You want to be hopeful but honest,” Jack S. Parker, MD, PhD, said.
Parker moderated a panel of surgeons who excel at patient-physician communication: Deepinder K. Dhaliwal, MD, LAc, Douglas D. Koch, MD, Richard L. Lindstrom, MD, and Robert H. Osher, MD. Parker posed scenarios to the “living legends” on what phraseology to use when speaking with patients.
Parker first posed a scenario of preoperative counseling of a patient with significant astigmatism.
“Hello, I am Dr. Osher. ... I noticed you have astigmatism. Do you know what astigmatism is?” Osher said he continues, no matter how the patient answers, with: “Well, you are close.”
He then explains that a cornea should be “round like a marble” but the patient’s cornea “is misshapen like a spoon.” Osher shows the patient their topography and says, “See, this is your cornea. ... It is like a bird flying over an island. ... When the island is round like it is supposed to be, it is solid green, but look what you’ve got — these two big red mountains, and then I point to the scale. See how big these mountains are. ... They don’t like mountains.”
Parker then asked the panel how to discuss outcomes after cataract surgery.
Lindstrom said he tells patients about how cataract surgery is an “an opportunity to reduce their dependence on glasses.”
Koch said he uses this explanation when speaking with a patient about presbyopia: “You have an opportunity to reduce your need for glasses and have a greater range of vision — distance, intermediate and up close — with these [multifocal] lenses, but if you get these lenses, you are going to have some little halo or flare or glare around headlights or streetlights at night, which most people adapt to very well but something you would not have with a single focus lens.”
“I often say that there is no perfect lens. We can’t turn back the clock,” Dhaliwal said.
Richard L. Lindstrom
Lindstrom advised that if a patient requests astigmatism or presbyopia correction, a surgeon should make a recommendation that is in the best interest and needs of the individual patient vs. outlining the many approaches and leaving the decision to the patient alone.
Parker then turned the discussion to what to say when explaining a complication such as a torn posterior capsule.
“I tell the patient that during surgery there was a break in the membrane that normally supports the implant in the standard way, and that when I did a vitrectomy, some of the gel came forward,” Koch said, concluding with telling the patient that he was able to remove all of the cataract and put the IOL in place. “I will also tell them on the postop day ... that there may be some increased risk of a retinal detachment and advise them of the warning signs.”
“The moral of this story is always be honest with the family. Be transparent but not to alarm them,” Osher said.
“I have figured out what makes patients the most unhappy after cataract surgery. It’s their friends,” Dhaliwal said. She advised the audience to encourage each patient to keep their IOL selection, which the surgeon and the patient made together, private as it is individual to the patient and discussing it with friends can lead to undue frustration.
“Don’t forget that something like 2% to 5% of patients are never happy with anything,” Lindstrom said, despite the surgeon’s compulsiveness and desire to please everyone. “It is impossible to make some patients happy.” – by Joan-Marie Stiglich, ELS
Parker JS. What I say panel discussion. Presented at: Cataract Surgery: Telling It Like It Is; Feb. 12-16, 2020; Orlando.
Disclosures: Dhaliwal, Koch and Lindstrom report no financial disclosures related to this panel discussion. Osher and Parker are the co-authors of the book What I Say: Conversations That Improve the Physician-Patient Relationship. The publisher of the book is SLACK Books, which is a sister company of Healio.