Eyeworld

EW FEATURE 59 matter what the doctor thinks that the patient's outcome is," said John Potter, O.D., F.A.A.O., vice president of patient services, TLC Laser Eye Centers, Dallas. "What matters is the patients' perception of their vision. They almost always couch it in terms of vision loss, not vision gain. "The doctor is in an awkward position of trying to get a patient to think differently, but vision is a brain thing, not an eye thing. The biggest adjustment that the operat- ing surgeons, ophthalmologists, and optometrists who are involved in the pre- and post-operative care need to understand is that patients' vision loss is real to them. The nor- mal strategies and tactics refractive surgeons use don't work." To effectively deal with the un- happy patient, the physician should first show appreciation for the situa- tion the patient finds himself in. "This has to be sincere," Dr. Potter said. "You might say, 'I can appreciate that this is really disap- pointing to you; this is not what you expected.'" Next, the doctor should develop some sense of affiliation with the pa- tient. "Normally, when there is con- flict, the doctor shrivels up and be- comes cold and distant," Dr. Potter said. "That's exactly the reverse of what the patient needs. He needs someone to relate to him, be human." Third, give the patient auton- omy; allow him to make the deci- sion on how to move forward. For instance, give the patient who is un- happy about having to wear readers after vision correction two to five options. Oftentimes, when the pa- tient is presented with further sur- gery or struggling to see by not wearing glasses, he will choose to use spectacles. Fourth, the doctor should sit at the same level as the patient, look him directly in the eye, and say, "I understand." Finally, a physician should un- derstand his role and be willing to refer the patient to someone else. "There's no shame in a doctor saying, 'I can't do this,'" Dr. Potter said. If the patient is still unhappy about his surgical outcome, there are several ways to move forward. "The surgeon has to remind the patient of the pre-operative discus- sion, try to explain to him what was told pre-operatively and docu- mented in the record," Dr. Abbott said. "Then, the surgeon can either look for a solution to try to make the patient happy, which may in- clude surgery to correct whatever the problem is or getting a second opinion to show that, indeed, he did have a good outcome but his expec- tation was not realistic from the be- ginning." Dr. Potter agreed that a patient should be encouraged to get a sec- ond opinion. "I've had many patients get sec- ond opinions, and all it does is sup- port me," he said. What if the patient insists on getting his money back? "If you feel you gave a good in- formed consent, things are well documented, and the patient is un- happy because he didn't understand, I don't think you need to give a re- fund," Dr. Abbott said. However, if the complaint is le- gitimate, he said he would either pay for the secondary consult, give a partial refund, or help pay for glasses. "It's OK to do those things, but it's certainly not mandatory. Take it on a case-by-case basis," Dr. Abbott said. "It does not admit guilt or that you did something wrong. It's there to help support a patient who you feel has a legitimate issue with what happened." A refund does not equal an ad- mission of guilt, Dr. Potter agreed. "Surgeons have been taught that if you give a patient his money back, you're admitting you've done something wrong," he said. "That's the wrong mindset. I'll make a trade. I'll give the patient back X dollars, whatever he paid, and I will negoti- ate a release on the surgeon's be- half." Alan E. Reider, J.D., M.P.H., a Washington, D.C.-based attorney who represents ophthalmology prac- tices throughout the country, said the instinct is for surgeons to refund money. "Obviously, it's going to be a lot cheaper to do that than get em- broiled in any kind of adversarial sit- uation," he said. "You don't want the patient to file a complaint or a lawsuit because, even if you were successful, you're going to spend more money to defend yourself than you would to refund." Mr. Reider agreed that physi- cians should have the patient sign a release before issuing the refund. The release should be simple and straightforward, he added. "You don't want to make it overly formalistic because that might make the patient concerned," he said. "It should be a simple letter, making no admission that there was anything wrong done and releasing you from any other claims the pa- tient may otherwise have in connec- tion with this." EW Editors' note: Drs. Abbott and Potter and Mr. Reider have no financial inter- ests related to their comments. Contact information Abbott: 415-502-6265, richard.abbott@ucsf.edu Potter: 636-534-2300, johnwpotter@gmail.com Reider: 202-942-6496, alan.reider@aporter.com February 2011 October 2011 Challenging refractive cases Managing unhappy refractive patients Poll Size: 422 EyeWorld Monthly Pulse EyeWorld Monthly Pulse is a monthly reader pulse on trends and patterns for the practicing ophthalmologist. Each month we send a short 4-6 question online survey covering different topics so our readers can see how they compare to our survey. If you would like to join the current 1,000+ physicians who take a minute a month to share their views, please send us an email and we will add your name. Email: ksalerni@eyeworld.org and put EW Pulse in the subject line; that's all it takes. Copyright EyeWorld 2011 52-67 Feature_EW October 2011-DL33_Layout 1 9/29/11 4:51 PM Page 59

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