Refractive Surgery?
Not My Patients!

BY DAVID I. GEFFEN, O.D.
JULY 1996

Are you one of those contact lens practitioners who says, "My patients won't have refractive surgery. I'll keep them all in contact lenses."? I used to say this until I started working with two refractive surgeons.

Imagine my surprise the first time I walked into their reception area and saw one of my "satisfied" patients waiting for a post-refractive surgery follow-up visit. Imagine my dismay when this scenario was repeated once or twice a week. Usually the patient was embarrassed to see me and would try to hide. I, too, was embarrassed and shocked to see patients who had seen me for two, four, even 10 years and had been happy contact lens or spectacle wearers. However, the real embarrassment was that these "loyal" patients had never called me to discuss refractive surgery.

ASKING THE TOUGH QUESTIONS

Why did these patients have refractive surgery? Although there are several articles on the psychological profiles of refractive surgery patients, I decided to go directly to the source. When I asked several of these patients why they had decided to have surgery, the most common response was that they had talked to a friend or a co-worker who had undergone surgery and was ecstatic with the result. They said the freedom and lack of hassles is worth every penny they spent.

The second most common reason was that they had seen or heard an advertisement that piqued their interest. Then they went to a seminar or had a consultation that convinced them that refractive surgery was a viable option for them.

Why didn't these patients call me to inquire about refractive surgery? Most said they were reluctant to ask because I had never brought up refractive surgery during their exam and there was no information in my office. They also said they felt I would try to dissuade them from having refractive surgery because of my apparent conflict of interest.

Why didn't these patients return to my office after surgery for their continued primary care? By far, the most common response was that they were embarrassed. They felt I wouldn't understand and would resent the fact that they had the surgery. Therefore, they went elsewhere for continued care and any eyeglasses or contact lenses they still required. They sometimes said they wished they could return to my practice because they weren't satisfied with the care they were receiving elsewhere. Many said they're happy that I'm now associated with refractive surgeons because they feel more comfortable returning to me for their primary care.

DISCUSSING OPTIONS

Have you examined your own patient base in the past two years to see if any of your patients are having refractive surgery? What happened to Mrs. Jones who had seen you consistently for four straight years? Did her insurance change? Did your office become complacent and offend her at the last visit? Or could she possibly have gone to a refractive surgeon?

How can you turn the refractive surgery option into an opportunity in your practice? End every examination with a review of vision correction options for your patients. Discuss eyeglasses, contact lenses and, yes, refractive surgery. As you know, not every patient is a good candidate for refractive surgery or contact lenses. However, you must educate patients about these options so they feel you're keeping them well-informed, which will take them out of the eyecare marketplace.

When you bring up refractive surgery, you may be surprised how many patients say they've been wondering about the procedure. I place brochures about refractive surgery in our reception area as well as in my exam rooms, and I find my patients pick up this information more than any other we have available.

You just can't avoid the issue. PRK centers are advertising on television, radio and in print. You must decide how you will present every vision correction option -- including refractive surgery -- to your patients. CLS

Dr. Geffen is in a joint refractive surgery practice in San Diego.