In the early days of LASIK, there was a lot of talk about
how best to manage disappointed patients. Message boards and websites were
booming with horror stories posted by infuriated, depressed patients whose
outcomes did not match their expectations. Likewise, Review’s coverage of
refractive surgery was heavily slanted toward how you could best deal with
these unhappy patients—on both a clinical and an emotional level.
In October 2001, for example, the cover of Review’s Refractive Surgery Report was filled with images depicting severe DLK, keratectasia, and other “LASIK Letdowns,” as we referred to them in that month’s featured continuing education program. Included in the report was an explanation of emotional responses to less-than-ideal surgical outcomes, as well as a feature on how to soften the blow of “LASIK Realities” in patients who needed glasses post-op. Year after year, you’d find more of the same in this popular annual report.
Fast forward to the present day. While conversation about devastating outcomes still persists in small circles, it has died down substantially. Obviously, enhanced technology and subsequent improved outcomes are largely responsible for this shift. But, to an even greater extent, the entire dialogue surrounding refractive surgery has changed—within the eye care profession as well as between doctor and patient. Nowhere is this change more evident than within the pages of this month’s issue.
This year’s Refractive Surgery Report opens with a frank editorial by John Potter, O.D., M.A., who tackles a not-so-glamorous topic, but arguably the single most critical one in elective eye care: informed consent. (See “ Bridge the Gap in Informed Consent”). Dr. Potter, who works for TLC, has spent the last six years devoted to resolving disputes and conflict resulting from refractive surgery. He says, “In my experience, most patients involved in a dispute or conflict generally argue that they were not adequately informed about the possibility of unexpected results following a procedure. Likewise, the surgeons who operated on these patients almost always reply that they definitely provided informed consent and have the signed and properly-executed document in the patient’s record to prove it.” Obviously, both doctor and patient cannot be telling the truth. Or can they? Was something lost in translation? Dr. Potter’s provocative editorial challenges O.D.s to find a middle ground between their big-picture views and their patients’ more self-centered ones. If so, then patients’ ears will be open during this vital discussion and, in the event that a complication does occur, the doctor will remain a trustworthy resource, rather than a negligent villain.
No doubt, Dr. Potter would be proud of a program that one of his colleagues, Jim Owen, O.D., created for his practice. Called “Just Like My Mom,” Dr. Owen’s program helps him ensure that his premium IOL patients understand all of the limitations of these lenses because, although they are exceptional, no lens is perfect for every patient. In “A Patient-Centric View of Premium IOLs,” Dr. Owen says that when his own mother was ready for an IOL, he “never once said ‘apodization’ or tossed around other jargon.” Instead, he translated a highly scientific discussion into a much more meaningful one by asking very specific and direct questions such as, “Will you be OK with glare at night?” and “Are you willing to wear reading glasses for small print and close work?”
This small adjustment in how you present options can make an enormous difference in patients’ postoperative satisfaction levels as well as in the technology’s future success, which so often is influenced by public perception. Without a doubt, professional media coverage of refractive surgery has changed—and not because there is just cause for higher expectations (which, obviously there is). Rather, the focus has shifted because doctors have been more effective in educating patients and in managing their expectations preoperatively.
