Patient Consultation & Screening Workup

BY DAVID I. GEFFEEN, O.D.
DEC. 1996

The two main objectives in a patient consultation for refractive surgery are to determine if a patient is a good candidate for surgery, and to provide enough information for the patient to make an informed decision.

PATIENT CRITERIA

To determine if a patient meets the criteria for refractive surgery, we recommend the following tests as a minimum:

The case history will determine the patient's general health status and identify any medications he is taking. It will also reveal how stable the patient's vision has been for the past few years.

Acuities will give you an idea of the patient's sensitivity. For instance, a patient who is 20/40 and says everything is fine may be a good candidate for refractive surgery, but a patient who is 20/20+ and says his vision is fuzzy may not be a potential candidate.

Topography is the preferred means of determining corneal irregularities. If you don't have a topographer, do a careful keratometry, looking especially at the clarity of the mires. Irregularities may indicate early keratoconus.

Biomicroscopy will show the general corneal integrity. Note any scarring, irregularities and endothelial abnormalities.

OFFERING OPTIONS

After you accumulate the appropriate data, you must analyze your findings and make your recommendation. Today, due to heightened consumer awareness, we can no longer just tell patients what to do. We must educate them and involve them in the decision-making process.

At this point, I briefly describe the different types of refractive surgery procedures. Next, I discuss the procedure I would recommend for that patient based on the data. It's crucial to know which procedure the surgeon prefers with different types of patients. It can be embarrassing as well as undermining to patient confidence if you make one recommendation and the surgeon makes another.

It's also important to tell patients about nonsurgical options for vision correction. They may have been told they couldn't wear contact lenses, or they may not realize that refractive surgery will not correct presbyopia. Be sure to review the possible complications of the procedure, and make sure patients understand the time course of recovery and the possibility they could need an enhancement procedure. Discuss the corrections that may be necessary after surgery such as spectacles for reading or night driving.

OTHER AIDS TO DECISION-MAKING

Patients find it helpful to have printed material available to take with them. This allows them the opportunity to discuss their decision with family members. A follow-up letter thanking the patient and telling him to call you with any questions is a great finishing touch.

Staff also plays a critical role in consultations. In many offices, the staff spends more time with patients than the doctor. Everyone on your staff must present a consistent message. Since it may take patients six months to decide whether or not to have refractive surgery, they may call your office several times with questions and concerns. Prepare scripts so you staff knows how to respond appropriately, and role-play in office meetings so they'll feel comfortable delivering your message. A well educated staff is crucial to reinforce your recommendations.

Remember, this is an opportunity to let new patients know of your expertise in refractive surgery counseling and follow-up care. It also demonstrates the other services your office can provide for them and their families. CLS

Dr. Geffen is in a joint refractive surgery practice in San Diego. Send us your feedback: spectrum@boucher1.com.