Now we’re talking: Patient communication

Photography by Steve Craft

Excerpted from page 36 of the May/June 2023 edition of AOA Focus

Effective patient communication is a key ingredient to a thriving optometry practice. Yet as the health care system—and the world at large—has changed rapidly in just the past few years, the tried-and-true methods of communicating with patients are due for an upgrade.

As the population’s medical needs become increasingly complex, doctors of optometry are working to ensure patients understand the severity of their diagnoses. As optometry practices communicate with patients not only in person and by phone, but also via email, text, video and more, practice managers are making sure their staff have appropriate scripts. And as the COVID-19 pandemic put social determinants of health in the spotlight, optometry practices are honing their skills around access and equity.

From building patient trust to staying relevant in the age of artificial intelligence (AI) to promoting diversity and inclusion, AOA Focus asked four optometry professionals about the most pressing patient communication issues of the day. Their responses, compiled from separate interviews, have been edited and condensed for clarity and length.

How can optometry practices communicate with patients in a way that establishes individualized relationships?

“[A patient is] more than just a wallet with legs. He or she is a VIP: very individual person. It’s important that we look at their family history, look at their lifestyle, and make recommendations based on what we’re seeing in the paperwork and through our discussions with the patient—from the tech to the doctor to the optician.

If you have a grandparent with macular degeneration—even though you’re not showing signs of it now—I’m going to talk with you about what to look for and how to be preventative. When you talk in those terms, you’ve made it individualized to that patient. It’s not just your 20th exam of the day, going through the same motions for every patient.

Ask them what they do for hobbies. ‘You paint miniature figures? You hold those six inches from your face? That’s going to be a different prescription than normal progressive lenses.’ If they’re going to Hawaii for vacation, ask, ‘Do you have good polarized sunglasses?’ If they mention training for a triathlon, ‘Do you have the right pair of sun wear for running and cycling?’

You’re not just selling them something. It’s about establishing a relationship. We can help patients enjoy their life with multiple pairs of glasses. It’s about helping them understand we can not only help your visual acuity, but we also can improve your lifestyle.”

-Joy Gibb, practice manager and optician at Daynes Eye and Lasik in Bountiful, Utah

How can we help patients understand complex and serious diagnoses?

“Getting [patients] to understand the severity of their diagnosis is one of the main concerns I have in terms of patient care. At the conclusion of the exam, I go through every condition they have. I typically will tell them, ‘I’m going to start with the front of your eye, and we’ll go to the back.’ If they’ve come in with a specific complaint, I summarize that again to convey the possible treatment or next steps.

I try to put it into terms they would understand. Visuals are a great accessory. Show them a picture of their condition, whether that be with fundus photography or finding a similar image online. If you’ve done an OCT, show them the scan so they can see specifically what you’re looking at. In the back of my mind, I think, ‘If I was telling a family member with no background in optometry, would they understand this?’

For example, if I have a patient with a retinal tear, they might get overwhelmed by their diagnosis and shut down. They’re not listening as intently as they should to understand the next process. Sometimes I ask if there is someone with them in the waiting room who they would like to come into the exam room and be an extra set of ears. I’m also always willing to call a family member at the patient’s request.

At the end of the exam, I like to give them a printout of their medical conditions. You also can do this with a medical record, though access might be limited. I like to provide additional resources that explain their condition in more detail. Additionally, the patient gets a hard copy of their after-visit summary, which includes their treatment instructions (e.g., drops, lid hygiene, etc.). I also use what we call a

‘drop sheet.’ This is a physical piece of paper the patient takes where I write down their eye drop treatment: when to take the drop, how often, the color of the cap, etc.”

-Jessica Schiffbauer, O.D., oversees the optometry department at the Medical College of Wisconsin in Milwaukee

“It used to be that when we’d communicate ‘bad news’ to patients, doctors began with the evidence, such as tests and other interventions that led to making the diagnosis. A newer way we’re learning from our colleagues is to begin with [the diagnosis]: ‘Unfortunately, you have macular degeneration.’

What is the advantage? This allows the patient to have their emotional response in the room. I can then address their true concerns, which is being a better doctor. We’re always trying to figure out the best way to serve the patient. If all we’re doing is giving them a diagnosis, then artificial intelligence is going to do that better than us soon. What makes the doctor the doctor isn’t just delivering the diagnosis, but educating the patient.”

-Michael Earley, O.D., Ph.D., associate dean of academic affairs at The Ohio State University College of Optometry

How can we ensure optometry office staff are effective communicators?

“We have a meeting every Friday with the staff. I’m big on working with staff on scripting and communication with patients because I believe it can make or break a conversation. I tell my staff, ‘It’s not what you say. It’s how you say it.’

I read an article recently about how to maximize your profits with vision insurance. A doctor gave some scripting examples in the article. He said, ‘If the patient gives you pushback on the cost of high index lenses, say that we can make your lenses much thicker and heavier.’ I told the staff, ‘That is absolutely the wrong way to approach a patient. Instead, you could tell the patient that while you understand it’s pricey, high index is the best choice for comfort and cosmetics, and it’s what the doctor recommended.’ With these two different approaches you can see one would probably anger the patient, or at least leave a bad taste in their mouth, and the other would bridge the gap. 

We have a text messaging system that we use to communicate with patients. I give the staff scripts on how to communicate with patients as far as good punctuation and grammar. Phrases like ‘How may I help you today?’ instead of ‘What do you need?’ Because we have a younger staff and they’re used to texting all the time, I work with them on not abbreviating or using emojis. We dig into good grammar and straightforward communication with patients.”

-Jennifer Stroupe, CPO, practice manager at Olive Branch Eyecare in Mississippi

How can we communicate in a way that respects diversity and conveys inclusion?

Dr. Earley: “You have to do everything you can to make the patient feel welcome. My goal is to form a relationship with the patient so we can address their treatment as a team. They’re not going to be part of my team unless they feel accepted. If I could have a pin that says, ‘My pronouns are he and him,’ that signals that I understand that not everyone’s pronouns are he and him just because of the gender they were assigned at birth. If you’re not inclusive of what defines that patient as a person, then that patient is just a disease. Pronouns are simple to advocate for by simply asking the patient, which we have our staff do every time now.”

Stroupe: “It’s very important to serve the patient where they are—not where I want them to be. We have quite a few deaf patients visit our practice. We contract with a company called Deaf Connect in Memphis that provides an interpreter for deaf patients. We set that all up. We also have a Hispanic population. We try to keep someone on staff who is fluent in Spanish so we can serve those patients. We also use Google Translate if we don’t have someone here who can translate. We can type in, ‘What is your date of birth?’ and the computer can say it in Spanish. When a patient comes in, I want them to feel 100% comfortable with being themselves.”

How do you communicate with patients about issues around social determinants of health?

Dr. Earley: “We run a clinic at a homeless shelter. We can’t expect our patients who are living in a homeless shelter to have the same access. We can’t tell them to go to CVS and pick up a Bruder mask and lid wipes to treat their blepharitis. Let’s be realistic. What else can we use? What can we get donated? What separates us from the machines is that ability to have a conversation and determine your barriers to care.

“[Sometimes I find out about patients’ barriers to care] by asking open-ended questions: ‘Do you see any problems with our plan?’ Then the patient might say, ‘I don’t have access to the internet, so I can’t get this on Amazon’ or ‘I don’t think I have the money for that. Will insurance cover it?’ I don’t have all those answers, but someone in my clinic can look into it.

“If follow-up visits aren’t covered by insurance, then we’ll change the plan. Instead of having you come in once a week, I might have you come in every three weeks and give you homework to do. Let’s stretch it out if it’s going to be out of pocket.”

Gibb: “I don’t care what insurance a patient is on, I’m going to do everything I can to get them into the best visual situation. Maybe that means when I suggest products in the dispensary, there’s a good, better and best option. Even if they can’t afford the best, we can still get them in good—we control their vision and they’re not going online and getting the wrong prescription. There may come a time when the best is what they can afford.

“Contact lens fitting fees are a hot topic, especially for new wearers. When a mom calls and says, ‘My 12-year-old wants to try contacts for the first time,’ we explain that it is a separate appointment. Your child will not feel pressured to get in and out of the exam room quickly. They will work with our technician to ensure they know how to put in and take out the contacts. They’ll go home with trials and solutions. For that price, we’ll also include a two-week follow-up so the doctor can make sure the lenses are the healthiest for your child’s eyes. Insurance usually doesn’t pay for it, so here’s what it’s going to cost you. As soon as you put it into medical terms, people are more willing to go for it. Their child’s vision is worth that sitting fee.”