Virtual eye health and vision examination: Why not?

Editor’s Note: Welcome to “Eye Catching: Let's Chat,” a blog series featuring contributions from members of the ophthalmic community. These blogs are an opportunity for ophthalmic bloggers to engage with readers with about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Donna Suter, president of Suter Consulting Group. The views expressed in these blogs are those of their respective contributors and do not represent the views of Ophthalmology Times or UBM Medica.

I get excited walking through the technology aisles at the big shows, don’t you?

The advancements I’ve seen in my relatively short career offer such hope for those with sight-threatening conditions like glaucoma and macular degeneration. My astigmatism practically goes away when I use HD spectacle lenses. (And don’t even get me started on the joy of contact lenses! My red eyes and ghost images are a thing of the past.)

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We really are at a crossroads in eye healthcare. Wouldn’t a virtual exam be ‘just as good’ as a trip to the eye doctor? To today’s busy consumer, how can we justify leisurely sitting in front of a computer or in a kiosk versus an in-office visit that takes sixty plus minutes and includes that awkward part – dilation?

Listening – A powerful weapon in the battle for clear vision

While all the benefits of technology implied above are true, they leave out the human touch you and your staff provide. Yes, sophisticated diagnostic instrumentation may have identified the problem in terms of what systems are compromised, generated a manifest refraction, and suggested a treatment plan. Based on the technicians’ notes, you might also enter the exam room with an appropriate plan of action in mind.

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But up to this point in the examination, you haven’t talked to the person. And while it doesn’t happen very often, it is possible that there may be some additional information that you are unaware of that could cause you to change your mind about what the best course of action should be.

The savvy practitioner may begin the doctor portion of the exam by saying, “Bill, we’ve taken a look at your visual systems, but before I begin, is there anything about your eyes or your vision you would like for me to be aware of?”

Generally speaking, there are three things that today’s eyecare practitioner does during his or her time with the patient.

1.     Listen to confirm. Confirm that there is no other information that could cause you to change your decision about the appropriate action to take.

2.     Make a strong recommendation.

3.     Gain the patient’s agreement.

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Once you have listened to the patient’s response to your opening question and confirmed (using more great technology and your marvelous decision-making skills) that there is no reason not to proceed with the course of treatment you have planned, discuss the situation with the objective of gaining the patient’s agreement.

Keys to gaining agreement

Gaining agreement: Eye health treatment plan plus enhanced visual acuity

Like the steel tracks that guide a train, the dual rails of Eye Health Treatment Plan and Enhanced Visual Acuity should parallel each other into a future of crisp, clear vision in life’s most challenging visual circumstances.

Most patients will agree to the eye health treatment plan once their problems have been brought to their attention in a calm, professional, business-like way. Not so with recommendations to enhance visual acuity.

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One way to increase patient compliance is to explain the adverse effects caused by the limited vision in order to invoke agreement.

Doctor: “Bill, I’m pleased to say that your eyes are free of disease and that you are doing a good job with managing your diabetes. There is no sign of diabetic retinopathy.”

Patient: “That is good news. I’ve been trying really hard to walk every day and eat well.”

Doctor: “Because of your diabetes, Bill, it is important that I see you again in a year. We’ll make that appointment for you before you leave today.

“Now let’s talk about seeing clearly and how you can have better vision at work. My technician said that you complained of headaches and shoulder pain in the afternoons and that your department had been upgraded with computers. You are on a computer looking up parts for customers?”

Patient: “That sounds about right.”

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Doctor: “You have something called presbyopia, Bill. It’s in the early stages. Using computers at work make it more noticeable. Fortunately, there is help. Specialty glasses that filter out blue light and glare combined with progressive lenses developed for people who use computers should do the trick. I’m making a note in your chart for my optician to explain that technology to you.”

Patient: “Do I have to get my glasses today?”

Doctor: “Absolutely not. But I do request that you allow my optician to explain the lens option that I’m recommending. Is that fair enough, Bill?”

Patient: “Sure, anything for you Doc. Just don’t ask me to spend any more money.”

Doctor: “It sounds like you are concerned about price, Bill. You can get your glasses anywhere you wish. I just want you to see as clearly as possible at work. What this means is investing in computer glasses.”

Patient: “I don’t want anything fancy. And, I’ve heard buying glasses over the Internet saves money.”

Doctor: "I'm really glad you mentioned this to me, Bill. I understand how you might feel that our eyewear is expensive. Some of our patients have felt that way in the past and have purchased their eyewear elsewhere. But once they found they couldn’t duplicate our quality, our service, and expertise on the product, or our 365-day guarantee, they have reconsidered and purchased eyewear from our optical.  Our optician will explain the technology and lenses enhancements we’ve discussed. Where you purchase is your decision, Bill. I just appreciate you trusting us with the health of your eyes.”

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Patient: “Thanks Doc. I wouldn’t go anywhere else.”

Doctor: “Here’s some information about diabetic retinopathy as well as a lens guide to show the optician. My tech has marked the spectacle lens technology in the guide that we discussed. Do you have any more questions for me, Bill? (Brief pause)”

Doctor while standing up: “Our optician is an expert on computer lenses and he will be demonstrating the technology as well as answering any more questions you may have. I promise he will take good care of you.”

5 recommendations for greater success

Recommendations

The conversation chronicled above demonstrates that having a plan turns even awkward conversations about purchasing elsewhere and expensive products in the optical into an opportunity to thank the patient for his or her loyalty.

The following recommendations will lead to greater success in your practice.

1.     Refer to patients by name. Take advantage of a great opportunity to make your patients feel important by remembering to call them by their LAST name with an appropriate title (Mr. or Ms). What a great way to gain loyalty by showing respect. Naturally, as in the case of our fictitious patient Bill, if you know the patient, call him or her by their first name. Make a point to call each patient by their name at least three times during your time with them, doctor.

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Tip #2

2.     Patients don't buy lenses or coatings that they don't feel are needed. Active listening is as important as the words you say. While you don’t want your patients to ramble on for too long, you must give them an opportunity to express their concerns and you must take the time to address those concerns.

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Tip #3

3.     Need is established by asking lifestyle questions. We suggest that lifestyle questions be asked before being sent to the optical to pick up a copy of your prescription. This process is best begun in pre-testing using a lens guide. The technician begins filling in the best choices, the doctor adds his comments and gives the lens guide to the patient or to the optician in front of the patient.

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Tip #4

4.     The more a patient knows about your products and services and how to use them, the easier it becomes for him to see the value. Furthermore, an informed patient feels more in control and on top of the situation.

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Tip #5

5.     Because patients are stressed during their visit, the left-brain, or reasoning side, shuts down and patients are hearing from the right, or emotional, side of the brain. What this means to you is that patients will not remember what you told them about eye disease or lens technology. This means it is important to reinforce key points with printed materials.

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If you are concerned about time...

Listening and making a spectacle lens technology recommendation based on patient need takes planning. For some, it might be necessary to role-play with employees!

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Doctors who send patients to the dispensary staff without explaining their recommendations are wasting one of the practice’s most important tools – the power of respecting the patient by really listening to what is happening when he or she is most visually challenged.

Telling a patient, “Your vision has changed and you need new glasses. The optician will show you some frames and explain how your vision plan benefits work,” is not the best approach.

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Don’t have enough time? To get an idea of long it takes, read aloud the sample dialogue and recommendations to Mr. Bill Presbyopia. In a conversational tone of voice and normal cadence, the recommendation and optician endorsement take between 45 and 55 seconds. Ideally, the doctor can deliver the recommendations while escorting the patient to the optician.

The most successful dispensing practices know that these are seconds well spent.