Does the Patient Know Who You Are?

“My clients get to see me at their allotted appointment time, so why have I been kept waiting for an hour?” was the opening statement made by one banking executive to his ophthalmologist on entering her office recently. It’s probably a greeting that many clinicians will recognise as an opening gambit: busy ophthalmology practices with full appointment lists are normal, and running late is par for the course. It may seem obvious that every patient should be given the amount of time they need, rather than the amount of time written on the appointment list, but do patients understand why?

Perhaps it’s even more relevant to ask whether patients actually know what their ophthalmologist ‘does’, and what to expect when they are referred? The issue of job misconceptions was highlighted in a recent study (1) which found that many professionals, from architects to accountants, commonly say their clients misunderstand them and what they do, and that “image discrepancies” have a real impact on how they perform their jobs.

For an ophthalmologist, patient misconceptions might mean that you’ll have to go back to basics and explain who you are and what you do, the very first time they walk through your door.

“A patient will come to me on referral, but what they may not realise when I discuss their diagnosis at an outpatient clinic and tell them that they need an eye operation, is that I’ll be the person performing the procedure,” comments Melanie Corbett, consultant ophthalmologist at the Western Eye Hospital in London, UK. “Patients not infrequently assume that, just as their optometrist has passed them on to me, I’ll pass them on to the surgeon. They are often reassured to find out that they are talking to the individual who will perform their eye surgery, and this can make them more likely to be forthcoming about their symptoms and history, which can aid in treatment decision-making.”

Similarly, patients may not realise why they’ve been kept waiting for their appointment, and this can get a consultation off to a rocky start. “Ophthalmologists can’t necessarily stick to rigid timetables,” Corbett continues. “Patients need to be treated as individuals, not time-slots, and emergencies will have to take precedence over routine appointments. This means that for many clinics, running late is a normal part of everyday practice. Patients are generally fine once they are given the reasons, but they may need a nudge to understand that an appointment at the ophthalmology clinic isn’t the same as an appointment at the bank.”

Expectations once they are in the system also vary greatly. In the UK, for example, patients may not realize that their eye surgery is free of charge. And while some individuals will put complete trust in any decisions their consultant ophthalmologist makes, others – often the more highly educated people – will expect to have every minutiae of their diagnosis, disease or condition explained, and every treatment or surgical option and potential outcome outlined to them.

Does the doctor always know best? “People living with a chronic and stable, but possibly fluctuating ophthalmic disorder may be better placed than I am to know whether their treatment needs to be modified when they are experiencing ‘down’ periods,” Corbett says. “I can monitor for side effects of treatment, assess the severity of their condition and make decisions if therapy needs to be changed because the condition is worsening, but I can’t presume that I will always know better than patients who have years of first-hand experience managing their own disorder.”

It’s a case of managing the patient, as well as each clinical diagnosis, on an individual basis to ensure they understand why they have been referred, who you are, what you can do for them and what their diagnosis and treatment options are. “The more we can explain to our patients, the more likely they are to stick to treatment programs prescribed, maximizing the chances of successful treatment, and ultimately saving time and money.”