Plans go awry, and surprises can happen to anyone. But when it’s our comanaged patients who experience unforeseen complications, the best approach is a direct one.
Recently I saw how badly things can go wrong when the surgeon fails to communicate. One of my referring optometrists sent a patient to a different ophthalmologist because the patient didn’t want to travel to our practice. The surgeon performed laser-assisted cataract surgery with planned monovision. He did the near eye first, with a –2 D monovision target, and all went well. In the second eye, however, the laser paracentesis wound leaked, so the surgeon sutured the wound. That was certainly a reasonable choice, but the operating surgeon never mentioned it to the optometrist. And, as it turns out, the suture was too tight and induced 5 D of astigmatism. So a week later, the OD asks me to evaluate his very unhappy patient for an IOL exchange. The patient is in a panic by this time because she’s supposed to leave for a trip, can’t see well in the distance, and has been told she needs to wait for 6 to 8 weeks to remove the corneal suture.
In the end, I was able to resolve the situation by simply replacing the suture at a more appropriate tension, which was still Seidel-positive when I removed it, but I think this case highlights a number of steps where things could have been handled better. The need for a suture isn’t exactly a red-alert complication, but it behooves the surgeon to make a phone call to alert the referring OD to even minor issues like this, just so that all parties are aware of what to watch for postoperatively.
Secondly, when a comanaged refractive cataract surgery patient is unhappy for any reason, the surgeon should see that patient back right away — at the patient’s convenience. That means staff needs to know not to wait until the “next available” appointment, which could be weeks away, but to juggle things around so the surgeon can see that patient back within a few days if necessary.
And, ideally, the optometrist should reassure the patient, communicate concerns to the surgeon, but leave the exact plan of action open-ended. It is always harder to have a conversation with the patient about options if the referring doctor has already framed the issue in such a way that the patient has a very specific expectation.
The moral of the story is that when the unexpected happens, much is on the line: the patient’s health and expectations; your practice’s good name; and your relationship with your referring optometrist.
Disclosure: Yeu reports she is a consultant/adviser for Alcon, Allergan, ArcScan, Bausch + Lomb/Valeant, Bio-Tissue, BVI, i-Optics, J&J Vision, Lensar, Kala Pharmaceuticals, Novartis, Ocular Science, Ocular Therapeutix, Ocusoft, Omeros, Science Based Health, Shire, SightLife Surgical, Sun, TearLab, TearScience, Veracity and Zeiss; does research for Alcon, Allergan, Bausch + Lomb, Bio-Tissue, i-Optics, Kala and Topcon; and has an ownership interest in ArcScan, Modernizing Medicine, Ocular Science, SightLife Surgical and Strathspey Crown.