Eyeworld

EW NEWS & OPINION March 2015 45 by Lauren Lipuma EyeWorld Staff Writer to the mentality of seeing patients as cases. Although students learn about the importance of humanism and empathy in medical school, she said, these lessons are not fostered in medical training and as a result, are lost. "I don't think that any of us go into medicine, or nursing, or the health professions to treat people as diseases and not care about them as individuals," Dr. Wen said. "This is not something that we want to do, but it is something that in medicine we learn through role modeling. "For example, in emergency medicine, instead of saying 'Ann Taylor, the 57-year-old woman in that room,' we might say, 'the 57-year-old with chest pains,' or 'the chest pains in room 5,'" she said. Certain situations, such as grand rounds, also make it diffi- cult to connect with patients, Dr. Khandelwal said. "We used to do live patient grand rounds where you could meet the patients, examine them, and discuss their condition and possible treatment as a group every week," she said. With limited time, however, and the difficulty in getting patients to attend, her team now reviews cases on PowerPoint presentations most of the time. Pertaining to ophthalmology Ophthalmology is unique, Dr. Khandelwal said, in that it is a highly specialized field but also provides continuity of care. She thinks ophthalmologists see patients differently than other specialties because of the impact that vision has on a patient's life. "For my dry eye patients, for example, I end up finding out more Is the human element disappearing in modern medicine? T he modern medical era has introduced many changes to the practice of medicine, especially when it comes to the doctor/patient relation- ship. Some physicians think that modern practice conditions have weakened the connection between doctor and patient, fostering a men- tality of treating patients as cases rather than individuals. As a result, both a patient's experience and qual- ity of care can suffer. "I think physicians want to think of patients as people to be cared for, but the rules in medicine are quickly changing," said Sumitra Khandelwal, MD, assistant professor of ophthalmol- ogy, Baylor College of Medicine, Houston. "Reimbursement is declining, while overhead, due to increasing demands such as EMR and the purchase of new technology, creates a situation where a physician needs to see more patients in order to make ends meet." "As we have more limited time to see people, and also as our field becomes more subspecialized, it becomes even easier in a sense to see people as [a] condition rather than who they are," said Leana Wen, MD, director of patient-centered care, Department of Emergency Medicine, George Washington University, Washington, D.C. A longtime advocate for individ- ualized patient care, Dr. Wen thinks that the language and culture of medicine unintentionally contribute Treating the person and not the case about their hobbies and what both- ers them and what their goals are," she said. "However, ophthalmolo- gists do tend to focus on what is in front of them—the eye. It's a small important organ and therefore easy to not take into account the rest of the patient's story." This mentality has the ability to impact not only a patient's experi- ence but the quality of care as well. "Your subjective perception of your care very much ties into the objective representation of it," Dr. Wen said. "We know, based on numerous studies, that having continued on page 47 Joint panel recommends FDA approval of drug-device combination for CXL for 2 ophthalmic diseases A joint panel of the FDA's Dermatologic and Ophthalmic Drugs Advisory Committee and Ophthalmic Devices Panel voted to recommend approval of Avedro's (Waltham, Mass.) drug-device combination of riboflavin ophthalmic solution and UVA light for crosslinking for both progressive keratoconus and corneal ectasia. On Tuesday, Feb. 24, the panel voted on the question "Has substantial evidence of efficacy and safety been demonstrated for the drug-device combination of Photrexa Viscous and Photrexa (riboflavin ophthalmic solution) and the KXL System (UVA light) to support approval?" twice, once regarding progressive keratoconus and once regarding corneal ectasia following refractive surgery. Results for the progressive keratoconus vote were 10 yes, 4 no, and 1 abstained. Results for the corneal ectasia following refractive surgery vote were 6 yes, 4 no, 4 abstained, and 1 was not present. The panel heard testimony from both the sponsor and the FDA before moving on to public testimony. Concerns were expressed from the panel members regarding the study protocol and data. Thomas John, MD, Tinley Park, Ill., spoke on behalf of the American Society of Cataract & Refractive Surgery (ASCRS) as a member of the ASCRS Cornea Clinical Committee. "ASCRS strongly supports the approval of corneal collagen crosslinking [CXL] for the treatment of ectatic corneal disease," he said. He said the ASCRS membership thinks "the peer-reviewed literature, including uncontrolled observational trials and well-conducted prospective clinical trials, as well as the personal experience of many of our members, demonstrate the safety and efficacy of CXL." David Glasser, MD, Columbia, Md., spoke representing the Cornea Society. Without an approved device there is inadequate access to safe crosslinking care, Dr. Glasser said. He offered support for the approval of crosslinking as a safe and efficacious tool, which can halt the progression of keratoconus and ectasia before it advances to the point of requiring more advanced surgical options. The FDA will now decide on whether to approve Avedro's drug- device combination of riboflavin ophthalmic solution and UVA light for crosslinking for these indications. EW "One way of thinking of people as individuals is to ask them something personal. We know stories are what humanize us and what connect us, so identify every patient with a particular story." –Leana Wen, MD trust is critical, that good com- munication fosters that trust, and increasing trust will increase patient compliance and will improve patient outcomes. So I don't think it's just about patients' perception … but it very much ties into their overall outcome at the end of the day." Connecting better In emergency medicine or procedur- al fields, it is difficult to humanize a patient, Dr. Wen said, because the patient is there for one reason, and with limited time, the physician

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