Eyeworld

18 Ophthalmology Business • July 2017 Dr. Marks provided another example to highlight his point. A woman in her 40s came to see him with a hurt back a couple of days after shoveling snow. "The old Dr. Michael Marks would have said, 'She sprained her back. She's 42 years old, I'll give her some medication, physical therapy, and I'll be out of the room in 2 min- utes.' But that's not the way you're supposed to deal with patients," he said. He asked her what she thought was going on. "She told me, 'I'm afraid I've got cancer in my back.' I almost fell out of my chair," Dr. Marks said. "I said, 'That's an unusu- al diagnosis, can you tell me why?' I love the expression 'Tell my why' because you're engaging the patient for more information." Dr. Marks learned the woman's neighbor, who was a similar age, had hurt her back the previous year shoveling snow. This neighbor went from doctor to doctor trying to get an X-ray taken but to no avail. A few months later, the neighbor learned she had breast cancer that had me- tastasized to her spine. She later died from the disease. Dr. Marks then asked his pa- tient, in light of this information, what she thought he should do. She wanted an X-ray. Dr. Marks told her the X-ray could come back perfectly normal, but his patient told him that it at least would calm her fears. The X-ray did indeed come back normal. Dr. Marks discussed options with her; she declined therapy and said she would take the anti-inflammatory medication. She was instructed to call him back in 10 days if she was still in pain. Ten days later, he got a call. "I said, 'Are you OK?' She said, 'Dr. Marks, 'I'm perfect.' I said, 'You're perfect? Why are you call- ing?' She said, 'Because you listened to me, calmed my fears, and I think that if my friend had come to see you, she'd still be alive today.' I still get chills when I think about that," Dr. Marks said, adding that in all like- lihood the friend's cancer was proba- bly advanced and her outcome would have been similar. "But it's part of the reason that we know when a doctor has not addressed the concerns of the patient; they'll continue to doctor shop because they didn't get someone who agreed with their pre- conceived notion or addressed their concerns. You can't know about their preconceived notion unless you ask them." Dr. Marks said he teaches a 4-hour physician communication course for residency programs, hospi- tal systems, and others. Malpractice insurers have been requesting this course of those they cover as well. "Malpractice companies recog- nize it: Physicians [who] communi- cate well don't get sued," Dr. Marks said. "What we're trying to do is convey to the surgeon, to the physi- cian, any healthcare provider, is that communication with patients is a non-technical skill that you have to practice and work on if you want to do it well," he added. Rosa Braga-Mele, MD, profes- sor of ophthalmology, University of Toronto, Canada, said she thinks ophthalmologists are, in general, sensitive to the fact that this special- ty has its own unique medical jargon, even against other physicians. "I think we do fairly well in com- municating with our patients at a patient level, rather than a physician level," said Dr. Braga-Mele, who has taught a course in patient-physician communication. Anat Galor, MD, associate professor of clinical ophthalmology, Bascom Palmer Eye Institute, Miami, said speaking with patients in plain language is something that has come naturally to her. "I always try to bring things down to very simple language to get the concept to be as well understood as possible," Dr. Galor said. Dr. Galor explained that some of her colleagues have performed experiments where they explained to a patient the options after cataract surgery and then gave the patient a quiz to see how much he or she got out of that conversation. "It was shocking to see how little they got. I think we need to do a better job not only thinking about how we communicate but effecting patient understanding," Dr. Galor said. Dr. Braga-Mele said she'll watch the patient's body language while she's explaining something (if they seem attentive or their eyes become glazed) to see if her points seem to be getting through. She'll also ask patients if they have questions about anything she just said or will ask them to repeat back what they un- derstand in order to assess how well she communicated with them. She said if a patient is given bad news during a visit, it's important to schedule a follow-up appointment for a short time afterward. "If you're providing bad news to a patient on the very first visit, they're not going to hear anything but the bad news. They're not going to hear their treatment options, they're not going to hear what's go- ing on, so it's very important to book a follow-up visit in a short period of time to make sure the patient has fully absorbed everything," Dr. Bra- ga-Mele advised. Dr. Braga-Mele said she main- tains an open door policy to take calls or fit patients in if they have follow-up questions. Tackling the issue of health illiteracy According to the 2003 National Assessment of Adult Literacy, con- ducted by the National Center for Education Statistics, only 12% of the population was considered proficient in health literacy; 53% were consid- ered to be at an intermediate level. 4 Health literacy, according to the continued from page 17

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