Providing a meaningful human experience in your practice is well worth the effort, but in a fast-paced clinical environment that requires some practical communication techniques. When you get to know patients and focus on communication, you build long-lasting relationships with patients. In addition, you prepare yourself to take a highly informed clinical approach, connecting symptoms to activities, developing treatment plans that fit patients’ lifestyles, and uncovering barriers to compliance – all within the standard timeframe of a patient visit.
Get more from the conversation
I enjoy making small talk, but I use a few strategies to make the most of it. After we chat, I keep focusing on effective communication about ocular symptoms and therapies. Here are a few tips:
• Introduce yourself in advance. My web bio and the video we play in our waiting room include information about where I’m from, where I’ve worked, and my hobbies, ending with, “I love to talk about my new puppy—don’t be shy about asking to see pictures.” Patients feel like they know me before they walk into the room, and we start talking immediately because I’ve already invited them to the conversation.
• Make it personal. My practice is part of a big corporation located in a competitive market. Nevertheless, I want patients to feel seen and cared for like it’s a mom-and-pop shop, and I think it sets me apart from a business perspective. In my experience, taking time to learn about my patients also helps me determine the best treatment regimen for them, plus it encourages them to make their best effort to comply with treatment.
• Make good eye contact – sit down and use a scribe. You can’t listen and engage with people without good eye contact. This is especially true for older patients who often rely on watching the speaker’s face to hear and understand. Always sit down just as you would for any other conversation – don’t loom over people. Use a scribe if you can. With a scribe, I can face my patients, not turn away from them to type.
• Take notes for next time. People like to be remembered. Any time a patient mentions something significant about their life like hobbies, major family events, or future plans, my scribe makes a sticky note in the chart. At later visits, I check the sticky notes before I go into the room, so I can say, “How was your cruise?” or “Are you going to Massachusetts for the holidays again this year?”
• Ask clinical questions about daily life. As you transition to the exam, you can find out more about primary complaints or, if it’s a routine exam, uncover problems like dry eye disease. Rather than asking about specific symptoms, I often ask open-ended questions like, “What do your eyes feel like at the end of the day?” I get information about their complaint as well as their activities (for example, if discomfort makes them stop reading at night or if their eyes feel bad after they use a swimming pool). An open-ended approach tells me a lot about compliance, too. For example, instead of asking a patient with glaucoma if they’re using their drops four times a day, I ask, “How many times have you missed your eye drop this week?” and “Is it hard to fit eye drops into your schedule?” Their answers give me a clear idea of whether their signs and symptoms are the result of noncompliance or advancing disease.
When we’re seeing 30 to 40 patients a day, taking time to talk with patients can seem like a waste of valuable time, but it becomes so routine that it moves along quickly. And the rewards are so worth it. Patients want to come back to us. Even if I’m running late with complex cases, they’re more at ease with waiting. They know that when they get in the room, we’ll catch up and I’ll take the time to listen and understand them.
Deliver individualized care
Getting to know my patients allows me to give them better care, and they see and feel the difference. For example, after chatting with a patient about his golf game, I asked if he’s happy with his progressive lenses while he’s playing. He told me, “They’re OK.” I suggested that distance-only sunglasses would be easier for him. A year later, he came back and said, “Wow! That changed everything!” He told all his friends on the golf course. This is a great way to receive more referrals at the office.
In more complex cases like dry eye disease, knowing my patients helps me create an effective management plan. I have an older demographic here in Venice, Florida. Recently I saw a 70-year-old pseudophakic patient with signs and symptoms of dry eye disease. Our sticky notes reminded me that she was very outdoorsy, so I asked about her pickle ball game and if she and her husband had been taking their boat out lately. In both cases, she said she was spending less time outside because the wind and sun made her eyes burn and water.
During the slit lamp examination, where fluorescein staining showed superficial punctate keratitis, I asked how often she thinks about how her eyes feel, even when she’s not outside. I asked her to describe the feelings. She complained of grittiness, burning, and watering, especially when her eyes were tired at the end of the day. As the conversation went on, we added fluctuating vision and light sensitivity to the list. It was difficult to express her meibum. I explained that there's no cure for dry eye disease, but I can prescribe an eye care regimen that lets her wake up every day without thinking about her eyes and get back to the outdoor activities she loves.
We went through our dry eye handout while I circled and explained my choices for her. I explained that there are a lot of dry eye nutraceuticals, but I recommend one called HydroEye (ScienceBased Health) because it’s clinically tested and includes GLA (gamma-linolenic acid), a unique anti-inflammatory omega fatty acid that we can’t get in our diet. (Women also like that it’s good for their skin and nails, and hormone regulation.) I recommended a preservative-free artificial tear, Refresh Mega 3 (AbbVie), four times per day. This tear is fast-acting and has flaxseed oil to reduce evaporation. I explained that she could pick up a heat mask in our practice or order one online, and she’d need to use it twice a day for ten minutes to improve her meibomian gland function. Because this patient put such strong demands on her eyes, especially spending time outside in the wind, I also did punctal plugs the same day rather than waiting to see if other measures worked.
I scheduled the patient back for two months later. She was back to playing pickle ball, and she was happy to comply with the regimen because she was getting great results. These successful outcomes are typical of what I can achieve with a personalized treatment plan based on patients’ needs, lifestyles, and capacities to comply. It’s well worth taking time to listen to my patients.
