At A Glance

  • Optometrists must explain both diagnoses and treatment plans to patients as effectively as possible to ensure comprehension and compliance.
  • Tactics you can employ to best communicate with your patients include building relationships, being aware of your body language, providing visual aids, and asking open-ended questions.
  • Describing a disease or condition in terms the patient can understand is one way to boost comprehension, engagement, and outcomes.

All optometrists attended classes on binocular vision, ocular disease, contact lenses, pharmacology, and more during optometry school, but classes teaching us how to be effective communicators with our patients were never a part of the curriculum. In today’s world, it seems as though the average person has the attention span of a goldfish—about 6 seconds. To deal with this situation, optometrists must be able to explain both diagnosis and treatment plan to each patient as quickly and simply as possible, and then we must check to make sure patients fully understood what we told them.

Communicating effectively with patients can help ensure their compliance with or adherence to the treatment plans you develop, but it is a difficult skill to teach and a difficult one to develop. Below are several tactics you can employ to help elevate your communication skills with your patients.

TACTICS FOR EFFECTIVE COMMUNICATION

Build a Relationship With the Patient

When you first encounter a patient, introduce yourself with a good, firm handshake. Make eye contact, call the patient by his or her appropriate name, and use a confident but gentle tone of voice. Threatening, arrogant, or condescending tones may cause patients to tune you out, which can lead to noncompliance with their treatment plans. You should instill in patients the feeling that you, their doctor, are on their team and that they will be working with you to get the best results possible.

Be Aware of Your Body Language

Nonverbal cues are just as important as verbal clues. Avoid having your arms or legs crossed, face the patient at eye level, and look directly at the patient when reviewing your findings. Never simultaneously talk to the patient and type in your electronic health record. Be aware of facial cues, lean in slightly as you listen to the patient, and avoid interrupting.

Ask Open-Ended Questions

Review the pros and cons of the treatment being offered, and then ask open-ended questions to check whether or not the patient has fully comprehended what you have said. Avoid asking yes-or-no questions.

Incorporate the Patient’s Complaint Into Your Diagnosis

Repeat the patient’s chief complaint during your explanation of the diagnosis. For example, “You stated that you have had decreased vision over the past few years in your left eye and were told that you had a lazy eye. However, after further testing, we have discovered that you have keratoconus.”

Provide Visual Aids

Educational materials, such as printed materials, websites, resources, colorful visual aids, and social media support groups, can help patients develop a better understanding of their disease or condition (Figure). Use of analogies and drawings, in conjunction with visual aids, can help patients understand their disease. If family members or friends are present, they should also be included in these explanations and given the opportunity to ask questions. Then, the clinician should ask the patient and others present to share back what they have learned about the disease. This is a good way to determine whether or not they have understood and retained the information you’ve presented.

Figure. A visual aid can help patients diagnosed with keratoconus, for example, understand their condition.

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Figure. A visual aid can help patients diagnosed with keratoconus, for example, understand their condition.

Counseling

After taking the steps outlined above, you can recommend the best course of action for treatment and let the patient know what the expected follow-up treatment timelines will be. Sometimes patients believe that we are going to reprimand them if they are noncompliant. Make it clear that you are there to help them. If they have not adhered to your treatment recommendations, try to find out what the obstacles were that prevented them from following instructions.

Examples of Effective Communication

Following are a few examples of explanations for common ocular diseases that we use regularly. While you are giving an explanation, it is important to directly state what condition or disease you have diagnosed, the typical course of the disease, how the disease has caused the symptoms the patient is noticing, and the treatment options available. Always try to find something positive to say when delivering a diagnosis. Be sure to allow your patients and accompanying individuals the opportunity to ask as many questions as they might have.

Keratoconus

Mr. Smith, based on the mapping we did of the front part of your eyes, called the corneas, we have discovered that your corneas are irregularly shaped, a condition called keratoconus. This is why you have noticed decreasing vision over the past 3 to 4 years, as you described earlier. Keratoconus is a degenerative disorder that progresses faster in younger patients. Keratoconus does not cause blindness. Because you are in your 40s, the rate of progression of your condition will not be significant.

Keratoconus is difficult to correct with glasses, as you have already discovered. To give you the ability to see more clearly, the use of specialized contact lenses, called scleral lenses, will be required. I recommend that we fit you for these specialized contact lenses because you have a moderate amount of keratoconus. These lenses will improve your vision and allow you to function better.

Do you have any questions about keratoconus or about scleral lenses?

Glaucoma

Mrs. Jones, based on the results of today’s examination, we have discovered that you have glaucoma in both of your eyes. Your glaucoma is worse in your left eye than your right. Glaucoma is a condition in which the patient’s optic nerve (a simplified way of referring to the optic disc, where the nerves exit the eye) slowly enlarges over time, causing loss of peripheral vision. Glaucoma has the potential to progress to complete blindness in the most advanced cases. It is painless, so patients have no idea that damage is occurring until they start to lose vision.

As you can see in these photos of your retina, the size of your left optic nerve is larger than that of your right optic nerve. You can also see the hemorrhage on your left optic nerve. Correspondingly, your visual field test shows that you have lost more peripheral vision in your left eye than in your right, as you can see here.

The way we try to slow or potentially stop the progression of glaucoma is by lowering your intraocular pressure through the use of eye drops, laser treatment, and, if needed, glaucoma surgery. Thankfully, most patients can control their glaucoma using eye drops alone. I don’t want to start you on drops today, though. I would like to see you back in 2 weeks to repeat your peripheral vision test for accuracy and to get another pressure reading to see how your intraocular pressure fluctuates. At that time, I will let you know how we can best treat your glaucoma.

It is very important that you return in 2 weeks because if your glaucoma is not treated you will continue to lose vision, and that vision loss will be permanent.

Do you have any questions about anything I have explained to you about your eyes or about glaucoma in general?

Macular Degeneration

Ms. Johnson, the reason you are having trouble seeing, especially in your left eye, is that you have a disease called macular degeneration. The macula is the portion of your retina that controls your central vision. Your macula has started to deteriorate. These are your retinal photographs and scans, and this is the macular region that has started to degenerate. This portion of the left macula has bleeding under it, and I suspect that you have a form of macular degeneration known as wet. I need to refer you to a retina specialist who will do some further testing on this portion of your retina before going over the treatment options.

My staff will make this appointment and write down the date and time for you. Thankfully, we now have very good treatment options for wet macular degeneration that didn’t exist 15 years ago.

It is the standard of care to have all patients with your level of macular degeneration start taking eye vitamins. They have been shown in many studies to help slow the progression of the disease, and they will not interfere with any of your other medications.

Do you have any questions about your eyes or about macular degeneration in general?

THE Positive EFFECTS OF EFFECTIVE COMMUNICATION

Optometrists diagnose diseases using our knowledge, experience, and the ever-evolving technologies available to us. Of paramount importance in the career of an optometrist is ensuring positive patient outcomes. Positive outcomes are possible when patients are compliant with or adherent to their treatment plans.

The best way to ensure adherence is by communicating effectively with patients about what we are treating and why we are treating it in this manner. Using the tactics outlined above, you can improve your ability to communicate with your patients, thereby improving the likelihood of them achieving the best possible outcomes.