The Consult on Refractive Surgery
The Consult on Refractive Surgery
How to provide complete patient education without falling behind.
Leah Colby, O.D.
Refractive surgery is a tough topic to discuss with your patients in this economy. However, I think it's our job, as doctors, to let our patients know all the possible refractive options for their vision correction.
And yes, I hear the masses sighing, “How can I possibly talk about digital photos, OCT results, high-definition lenses and then LASIK and still see the other patients without running two hours behind?” Two words: separation and delegation. And two more words: bottom line. As we've modified our system to include a discussion of refractive surgery, we've added an additional $10,000 to $15,000 per year to our bottom line—the result of the comanaging fees associated with these procedures.
Transitioning from clinical director of a TLC Laser Eye Center to private practice more than eight years ago was a huge eye opener. It made me respect practices that referred eight-to-10 patients a month in the heydays of refractive surgery. And by paying attention to this patient population today, we've increased our conversion rate while maintaining the best use of time.
In our practice, refractive surgery patients will have two separate visits to our office: a comprehensive medical eye exam and the LASIK consultation. While it's nice to respect the patient's time and perform both during the same visit, it's virtually impossible to maintain exam flow without tying up your technicians and doctors as you try to squeeze in all the information necessary for a consultation.
The comprehensive exam
As part of our patient history during the comprehensive eye exam, we ask every patient about their interest in LASIK or refractive surgery. It is critical to ask how serious they are about pursuing LASIK surgery within the next several months. If they are seriously considering surgery, we perform a cycloplegic dilation and refraction to spare the patient a second dilation at their return LASIK consultation visit.
The doctors address a few basic questions about surgery during the exam. However, we are vigilant about our time constraints that wouldn't allow us to deliver the most thorough information about refractive surgery at this time. We have found that by inviting patients to schedule a LASIK consultation, we can maintain our standards of high-quality education that patients expect, and need, to be informed about their surgery.
The LASIK consultation
The LASIK consultation is largely delegated to our technicians. We have designed a LASIK pre-operative checklist (see “LASIK Counseling Checklist,” below) that technicians discuss and review with the patient before the doctor sees the patient. This eliminates 20-to-30 minutes the doctor would otherwise spend outlining the “basics of LASIK”—time the doctor can utilize seeing other patients. If there are more complex questions, they are noted for the doctor to cover in the medical portion of the consultation, in addition to re-evaluating the tests that were performed to determine surgical candidacy.
With this process, we are converting 90% of interested patients to surgery and make much better use of our scheduling to accommodate these patients. While our system works well for us, it may not work well for every practice—as always, modify it, make it yours and make it work for your bottom line. OM
|The LASIK Counseling Checklist|
|The following are a sampling of items to consider for a LASIK counseling checklist. Click here for a download of the complete checklist.|
__ Explain how LASIK corrects vision.
• Use book analogy and patient's pachymetry values.
• Discuss custom LASIK and benefits of this technology.
__ Discuss typical healing and possibility of under- or over-response to laser.
__ Discuss possibility of needing an enhancement; approximately one in 10 patients may decide to have an enhancement.
__ Discuss patient's degree of prescription and chances of reaching 20/40 or better unaided visual acuity.
__ Remind patient that LASIK is NOT a guarantee that he/she will never have to wear glasses again.
__ Discuss presbyopia and need for eyewear after age 40.
__ Discuss possible need for temporary distance, night driving or other corrective eye-wear. Educate patient the correction is temporary until an enhancement may be performed and is not covered in the cost of the LASIK procedure. Also, inform patient as he/she ages, the need for correction may also arise (i.e. reading glasses).
__ Discuss initial side effects, including star-bursting, glare, fluctuating vision and dryness and possible complications, such as ingrowths, corneal flap complication, DLK, flap wrinkles and infection.
__ Discuss required medications.
__ Inform patient of day-of-surgery expectations.
__ Inform patient of expectations and limitations after surgery.
DR. COLBY OPERATES EYEWEST VISION CLINIC AND OPTICAL IN ROGERS, MINN. SHE WAS NAMED THE “YOUNG OPTOMETRIST OF THE YEAR” BY THE MINNESOTA OPTOMETRIC ASSOCIATION. TO COMMENT ON THIS ARTICLE, E-MAIL OPTOMETRICMANAGEMENT@GMAIL.COM.
Optometric Management, Issue: June 2011