Eyeworld

March 2016 • Ophthalmology Business 7 assessment tool could give context to outcomes. Risk factor also applies outside of the operating room and can affect bed- side manner and waiting room time as well, Dr. Cremers said. "If you have a doctor who sees all the most difficult cases in the coun- try, the waiting times are going to be higher," she said, nothing that this is something patients should think about when penning reviews but likely don't. "If a surgeon deals with dying children every day, you might under- stand why he's in a rush in your visit and has a bad bedside manner, even though he's a brilliant surgeon," Dr. Cremers said. Dr. Khalifa said that he sees a potential value here in the American Academy of Ophthalmology's Intelli- gent Research in Sight (IRIS) database. In a published response to the Cremers et al. letter, Dr. Khalifa wrote, "To help the general public make healthcare de- cisions and to offset possible misinfor- mation and misinterpretation of data The authors went on to write that "outcome benchmarks, weighted according to total risk profile, should be established by eye surgeons and not public groups." "We hope to see a day where eye surgeons create fair risk-adjusted benchmarks on outcome measures for all eye surgeries before public inter- est groups blindly determine best outcomes for us and our patients," Cremers et al. wrote. Dr. Cremers said weighting each case and its outcome according to respective risk would allow a surgeon's skill to be adequately evaluated. "A patient may have a surgical complication that requires another surgery, and the doctor may have explained the added risk to the patient prior to the surgery. However, unless the patient receives a paper stating, 'This is your risk score for cataract surgery,' he or she may not recall that conversation with the surgeon. The patient may attribute a 'terrible out- come' to a poor surgeon, when in fact the surgery may have been high-risk to begin with," she said, providing an example where a risk-adjusted F rom restaurants to car- penters, dry cleaners to personal trainers, when a customer wants to make a decision for a service among a variety of options, one of the places they'll likely turn for informa- tion is their computer. And physi- cians are in no way immune to online reviews. In many ways such reviews are welcomed, but there is something patients might not consider when posting their thoughts that some oph- thalmologists want taken into account: the risk factor. When patients don't understand or include the level of risk of a condition or of a specific proce- dure, they may rate their experience without including all of the facts. "Whether we like it or not, it's part of the environment we're practic- ing in nowadays," said Yousuf Khalifa, MD, Emory Eye Center, Atlanta. "Pa- tients are making decisions based on what they find online, and if we're not part of that discussion of what they find, we have no way of presenting a more nuanced and more professional perspective." Sandra Lora Cremers, MD, Visionary Eye Doctors, Washington, D.C., coauthored a letter published in the Journal of Cataract & Refractive Sur- gery, advocating for ophthalmologists and their associated member groups to develop a risk-adjusted assessment tool for this purpose. Noting that insurance compa- nies and public interest groups seek transparency on doctors' complication rates, Cremers et al. wrote that this information is "meaningless without weighing metrics according to valid operative risk profiles with agreed-on benchmark for outcomes … ." Surgeons see an opportunity to provide a "nuanced and more professional perspective" in online reviews continued on page 8

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