Article Date: 3/1/2001

STRATEGIC SKILL BUILDERS: Continuing Education
COMPLIANCE

Encouraging Patients to Understand the Rationale for Routine Examination
How to keep them coming back.
By Donna Higgins, O.D., Prairie du Chien, Wis.

To maintain a successful practice, you have to keep patients coming back. A part of providing the best care to our patients is making sure they follow up with whatever routine care is necessary. This requires techniques that encourage patients to understand the rationale behind recommended routine examination. Following are some techniques that have worked well in my practice.

NO "CANNED" SPEECHES

It's essential that patients know there's a valid reason why you want them to return for a routine exam. You need to make them see that returning is in their own best interests. A convenient way to present this is to include it in your discussion with each patient at the end of his exam.

One "canned" speech won't work for all patients. Every patient is different, and the reason why routine examination is important will be different for everyone, as follows:

Whenever we finish examining a patient, we have reasons for deciding when he should be recalled. We know what we'll be watching for. Don't assume your patient knows this, too, without an explanation. You have valid reasons for recommending routine examination, reasons that are in the patient's best interest. It's simple enough to share those reasons with him.

"BUT I DON'T LIKE TO GO TO THE DOCTOR!"

Many people go to a doctor only when absolutely necessary because they find doctor visits frightening or otherwise uncomfortable and unpleasant. Anything you can do to make your office, and the patient's experience there, pleasant and comfortable will encourage more people to return for a routine exam. The following are examples of simple things that can make a difference:

  • the decor of your office

  • a waiting room set up so that people can face each other and chat to make waiting more tolerable

  • a play table for children keeps kids occupied, providing a more pleasant environment for them and everyone else.

Other, more complex ways to make patients comfortable include:

We all see patients who have serious ocular disease and may have legitimate reasons to be frightened of routine doctor's visits. The way to handle this is to make it clear that you are this patient's strong ally in dealing with the situation. The patient has a reason to come in that goes beyond monitoring a frightening condition; they will be seeing someone who will help them through the scary situation.

SCARED AWAY

An issue related to fear associated with a doctor's office is what to do with the non-compliant patient. Intentionally frightening a patient in an attempt to force compliance (for example, showing a non-compliant contact lens patient a gory picture of a corneal ulcer) can often result in the opposite effect from what you want. Most of us lose trust in someone who does hurtful things to us. A doctor who intentionally frightens -- or worse, gets angry and scolds a non-compliant patient -- is probably going to lose that patient's trust. It's not likely someone will heed the advice of a doctor he doesn't trust.

A second risk of frightening a patient is the possibility of inducing an even deeper non-compliant attitude. Many people avoid doctors because they don't want to find out there's something wrong. Intentionally frightening someone is like saying, "You have to come in every year so I can tell you about all the horrible things that are wrong with your eyes." There's not much incentive in seeing a doctor annually if it means new worries and anxiety.

A better approach is to maintain an attitude of concern that your patient must not understand the risks he's taking by not coming in as often as advised. You might still describe the possible adverse consequences. You might even show a patient a gory picture of a corneal ulcer or tell him a horror story about diabetic retinopathy that wasn't caught soon enough.

If you present a patient with the frightening consequences of non-compliance, you must present them as a means of educating him about the bad things that really can happen. It has to be clear that you're not trying to frighten him; you're trying to prevent all these consequences. The patient must understand that routine examination is a way to avoid the scary things. What you're offering him is a way to feel and be safer, not more frightened.

Give the patient a polite reminder that he has responsibilities for his own health. For example, for a diabetic patient who hasn't been good about annual exam, you might say:

"These are all the things that can happen to your eyes when you have diabetes. I'm trying to keep them from happening, but I need your help. I need you to come in once a year so we can watch for all this."

"BUT DOCTOR, IT COSTS TOO MUCH!"

A frustration most of us have probably faced is patients who don't want to spend on health care. Patients who don't maintain a routine examination schedule for financial reasons have to be convinced that their money will be well spent. Here are some ways to accomplish that:

EXPLANATION, PLEASE

Patients who have some understanding about what's going on with their eyes are more likely to comply with routine examination recommendations. A basic understanding is essential for patients with ocular disease that requires monitoring. The challenge is getting the patient to listen to and understand your explanations. Try these techniques:

REPEAT, REPEAT, REPEAT

Repetition reinforces and will increase compliance with and understanding of your re-examination recommendations. Here, staff involvement is more effective than your own. Keep these points in mind:

IT HAS TO BE FOR THEM

An annual exam may be the most common recommendation, but it isn't a "one-size-fits-all" option. We all have patients whose needs are adequately and safely met with re-examination on a bi-annual basis. If you want patients to believe you when recall on a 6-month basis is advisable, you have to be honest when recall every 2 years is a prudent schedule.

Remember this rule: Whatever is in the best interest of your patient, ultimately, is in the best interest of your practice. A doctor who genuinely puts the patient's best interests first in all decisions will readily be perceived that way by most patients. Advice that is perceived as being trustworthy and valid is much more likely to be heeded.

The general principle common to all of these techniques is providing patients with a viable and understandable motivation for routine examination that's in their own best interest. Presenting the rationale for routine examination in an effective way is, arguably, one of the most important clinical skills a doctor can have for providing the best possible care to a patient. 

Dr. Higgins is a 1980 graduate of Illinois College of Optometry. She has owned a private practice in Prairie du Chien, Wis., for 21 years.


Optometric Management, Issue: March 2001