Eyeworld

EW FEATURE 36 by Jena Passut EyeWorld Staff Writer Surgeons responsible for educating patients about IOL choices Some tools include videos, brochures, face-to-face interactions F or Stephen V. Scoper, M.D., Norfolk, Va., educat- ing patients about IOLs starts with the very first in- teraction after diagnosis. "We have changed the attitude of all the staff in how we talk to pa- tients," Dr. Scoper said. "Just the word 'cataract' can frighten a pa- tient, so we've flipped that com- pletely around." Rather than a bland, straightfor- ward diagnosis, Dr. Scoper instead says, "Good news, Mrs. Jones. You have cataracts. We can offer you so much more than we could 10 years ago." That positive attitude infects the entire office, from the first phone call to the meeting with the sur- geon, but it's especially important at the front desk, Dr. Scoper noted. "The people who work at my front desk are required to do several things when a patient walks in the door," Dr. Scoper said. "They stop what they're doing, make eye con- tact with the patient, and they smile at the patient. Then the patient comes over, and they look at the pa- tient and say, 'Welcome to Virginia Eye Consultants. We're so glad you're here.' Just that simple thing gets patients off to a good start." For the entire 2-hour visit, the "excitement" Dr. Scoper wants to re- inforce about advances in IOL tech- nology builds, and the technicians and refractive surgery coordinator chat with the patient about the dif- ferent options available while they test the patient to see which IOL would fit best. Tools for informing patients Meanwhile, in a practice in Califor- nia, patients are being informed first about their options via high-tech videos, which are sponsored by the three IOL companies. D. Rex Hamilton, M.D., direc- tor, Laser Refractive Center, Jules Stein Eye Institute, University of California, Los Angeles, uses colorful videos from 3D-Eye Home and 3D- Eye Office (Eyemaginations Inc., Baltimore) to educate his patients. He emails those videos to patients via 3D-Eye Home and allows them to view them at the practice via 3D- Eye Office. "3D-Eye Home allows you to email videos that are targeted to whatever diagnosis the patient has and shows him or her the technol- ogy of the IOLs," Dr. Hamilton said. "It's helpful because then the patient has some knowledge coming in the door, and that's a real advantage in terms of time that you're spending with the patient." James A. Katz, M.D., the Mid- west Center for Sight, Chicago, said his office sends brochures to patients before they come for their pre-op exam to determine which types of lenses they will get. "Careful patient education is probably the most important part of determining who's a good candidate for the procedures for these presby- opia-correcting IOLs," he said. "The brochures guide them somewhat in that they get the information ahead of time. They don't always know what they fit into, but at least they have some information about these different types of lenses before we get in the room." Change equals results One big change in his regimented step-by-step process has resulted in positive results for the business, Dr. Scoper said. "In most practices, the doctor sees the patient, makes the recom- mendation, and then the patient goes to the surgery coordinator or refractive coordinator to hear 15 or so minutes about the lens, how much it costs, etc.," Dr. Scoper said. His refractive coordinator, on the other hand, sees the patient be- fore the doctor examines him or her, providing information about the di- agnosis and costs of the premium lenses and helping the patient estab- lish a line of credit to pay for the im- pending procedure. "Before this, we could not achieve more than 10-12% conver- sion, and I do about 2,000 cataract surgeries myself a year; with my partners it's about 3,000," Dr. Scoper said. "Our conversion rate now hov- ers consistently around 30-35%. That was a decision I made in my practice that changed everything." He must be doing something right. Dr. Scoper's practice recently was named Small Business of the Year by the Hampton Roads Cham- ber of Commerce, the first time a medical practice has ever been given the honor. Dr. Scoper said he's proud of heading a successful business. "All practices and all doctors want to be financially successful. All of us at any job want to get paid for what we do," he said. "I'm never ashamed of a medical business mak- ing a profit. We should never give things away. Still, our primary con- cern should always be good care of patients and recommending what is best for the patient. If we try to take good care of patients, we'll be finan- cially successful." Ethical obligations to the IOL patient Of course, expanding profits and booming business are exciting, but are surgeons ethically required to tell patients about all of the IOL op- tions, even if they don't perform those surgeries themselves and even if that means the patient will go elsewhere for those lenses? All three surgeons interviewed for this article believe so. "I feel there's an obligation to fully disclose all the different types of lenses to patients so they are aware of all the options, but I will definitely tell them when I don't think it's appropriate to put a multi- focal lens in," Dr. Hamilton said. "I think they deserve to know these lenses exist, No. 1 for their own knowledge, and No. 2 so after the fact I'm not asked why I didn't put this lens in their eye." Dr. Katz said he offers all types of FDA-approved premium lenses, but that his partners sometimes don't, "so they will refer out if they feel it's appropriate. The surgeon has February 2011 Ethics of IOLs August 2011 AT A GLANCE • One surgeon uses positive messag- ing to get patients excited about the latest IOL technology • Videos, email, brochures, and staff interacting with patients are also part of the educational process • Surgeons agree that they are ethically obligated to tell patients about all of their options, even if that means referring a patient to another physician • After input from patient, techni- cians, and other staff, final recom- mendation is made by the surgeon At Dr. Scoper's office, all employees are required to greet patients with a smile. There, positive messaging helps educate patients about the latest IOL technologies Source: Teresa L. Cartwright

• Cover