• Written By: Jennifer Morse, MD
    Refractive Mgmt/Intervention

    The keynote address for the 2008 Refractive Surgery Subspecialty Day program this year was given not by a surgeon, but a psychiatrist, Jennifer S. Morse, MD. The reason: Physicians' communication skills are just as important as their technical skills when it comes to understanding and treating unhappy patients.

    Showing empathy is critical because it's correlated with the patients' ability to cope with their symptoms, Dr. Morse said. She urges surgeons to constantly work to fine-tune their communications skills just as they would their technical skills.

    "Showing empathy is a skill that you must practice," Dr. Morse said. "It's like playing a musical instrument; you have to practice at it. You need to be mindful of your verbal and nonverbal cues."

    Refractive surgeons on the panel agreed with Dr. Morse's prescription.

    Terrence P. O'Brien, MD, said that the physician/patient relationship is the single most important factor in managing an unhappy patient. "Saying I'm sorry helps the patient understand that you do care," Dr. O'Brien said. "Rapport is the single most important factor. The patient wants to feel that you care."

    Resist your natural urge to avoid interacting with unhappy patients, Dr. O'Brien said. Instead, you need to engage them. You need to listen to them to find out exactly why they are unhappy.

    With a 95 percent satisfaction rate, it's easy for refractive surgeons to minimize the complaints of those who experience complications, said, Jeffrey J. Machat, MD. Don't do it. It's the worst thing you can do. "Complications don't affect many patients but it affects them from the moment they wake up until they go to sleep at night," said Dr. Machat. "Listening is what it's all about. You need to take the time to empathize and communicate, despite the (current state of the) economy, in a way that we've never been able to do before."

    But why do some patients seem to experience more pain than others? Dr. Morse explained that pain is an individual experience.

    "You really can't say they are embellishing their pain. You must never give them the cue that you are discounting or minimizing their complaints," Dr. Morse said. "It comes down to a single issue-you have to take the time to listen more and talk less. When you talk, you're asking questions. You need to be investigating what dissatisfaction means to that patient. Allow the patient to tell you what it means to them and what satisfaction means to them." Dr. Morse said that much more study is needed to identify the role of pain and depression on patient satisfaction and healing.

    In collaboration with Drs. Steve Schallhorn and David Tanzer, she has begun some of that work. They recently conducted a study that showed patients with higher levels of depression and negativity were about three times more likely to be less satisfied with their vision after refractive surgery.

    So, do physicians simply screen out anyone with a history of depression? It's unclear. The proposed study of LASIK Quality of Life sponsored by the Academy, ASCRS, FDA and the National Eye Institute may provide more answers about the interplay between psychology and satisfaction after LASIK.

    In the meantime, Dr. Morse suggests that ophthalmologists include some basic questions about mental health on their screening questionnaire, such as:

    • Do you have a history of depression, anxiety or other mental disorders?
    • Are you currently experiencing depression, anxiety or other psychological complaints?
    • Have you ever been treated by anyone for these symptoms?
    • Are you currently being treated with any medication or other forms of treatment for a mental health problem? If so, what?