Article Date: 9/1/2001

Patient Education
PART lI - Discovering the Key . . .. . . to effectively educating patients.
Scottsdale, Ariz.

A surefire way to raise a bullfighter's red cape in front of an O.D.'s eyes is to talk about "selling." As medical professionals, we consider the concept of "selling" taboo, and we often designate it as "the staff's job."

The reality is that we "sell" every day to every patient we see. We "sell" them on the idea that they were wise to choose our office, and would be wise to return for future care. We "sell" them on the concept that referring friends, family members and co-workers would be a good idea.

If you still can't come to terms with this terminology, let's change the term "selling" to "educating." We may feel uncomfortable with selling, but I'm sure we all agree that we have a responsibility to educate our patients about options available to them. Options such as bifocal and aspheric contact lenses, progressive lenses, anti-reflective coatings and more offer real benefits to our patients.

The bottom line is: Are we doing our job if we make it incumbent upon our patients to specifically ask for these features before we'll discuss them?


Raising the bar

Last month, in part one of this two-part series, I shared with you a number of ways in which my private practice emphasizes exceptional patient satisfaction ("Unlocking the Keys . . . to Exceptional Patient Satisfaction").

We've made patient satisfaction a keystone of our practice, and it's helped set us apart from the growing competition. As I'd discussed, improving the level of patient satisfaction in your practice need not be excessively time-consuming or expensive. The same is true when raising the bar for patient education.

This time, I'd like to share what we've done to take patient education to a new level.

UV or not UV . . . that is the question. Our patients want our best professional recommendations. When you bring up an option, it's "prescribing." When a staff member mentions the same option, it's "selling." Our staff members want our assistance. They recognize the distinction between selling and prescribing, and they often request that the doctor educate patients about these options in the exam room.

For example, surveys show that although 9 out of 10 patients place some interest and value on ultraviolet (UV) protection in contact lenses, only 1 in 10 hears about it from us! About 7 out of 10 patients would prefer to hear about this feature from us, and more than half of those surveyed would want to change the brand of lenses based upon this one feature alone. Another survey indicated that 75% of soft contact lens wearers would enjoy hearing about new products and services, and about 7 of 10 wearers would be willing to pay more for these new benefits.

Hurricanes and tornadoes get all the publicity, yet termites do the most damage. This is a catchy way of saying that little things can have the biggest impact. Relating this to patient education, it's so important to inform patients about the details of their conditions or about products best for them. But let's face it: The ultimate challenge in educating patients comes down to time constraints.

The recent "AOA workforce study" predicts that in coming years the average time per exam will drop even further, from 25 to 20 minutes. At the same time, we're seeing more patients than ever. In less than 20 years, the average number of comprehensive eye exams per year has increased from 1,400 to more than 2,200.

Not only are we doing more in less time, but patients are also more demanding than ever. One of the main reasons patients change doctors is that they perceive that someone else has something new to offer. But even if we know that by keeping patients informed of advances and options we help retain them as patients, the dilemma is finding out how to accomplish this with less and less available time, and more and more to tell.

Patient education also supports three critical areas that ensure the health of our practices. I call them "the 'three Rs' of patient education." They are:

1. Retention. If we keep educating patients, we're more likely to retain them. And it's a well-established fact that it costs less to keep current patients than to attract new ones. While we might choose to invest in advertising, keeping our existing patients informed, and therefore loyal, costs nothing but a little time.

What You Don't Say Can Hurt You

Some practitioners say that when patients ask about bifocal contacts, then they'll discuss them. Studies show that a main reason people believe they can't wear contact lenses (no, it isn't dry eyes or that "stiga" thing) is because "their doctor never told them they could." It's not only important how we say things, it's also important what we don't say. The attrition in contact lens use with age supports this. Here's a look at the statistics:

  • Although about half of our patients (ages 18 to 34) who require vision correction wear contact lenses, when these individuals become presbyopic, less than 3% wear contact lenses.
  • At the same time, a Boomer turns 50 every 10 seconds.
  • More than 94% of people over age 50 require vision correction -- the largest growing demographic group we encounter.

Informing these patients about this viable option will help to combat this incredible attrition in contact lens wear. It will also garner referrals from patients who we've successfully fit, as well as from patients who've merely heard about the option.

2. Recall. Most of us use some form of recall system, whether it's postcards and letters, phone calls or pre-appointments. Regardless of the method, each time we successfully recall a patient, we see a rise in production. One practice wanted to determine the financial impact of increasing monthly recall rates. To do so, they tracked the number of exams of former patients for a given month and multiplied any increase by their average patient production. They found that for each month, the return rate climbed (for example, the average patient returned every 22 months instead of 23), there was an increase in production of more than $19,000. Keep in mind that this represents the effect of getting our existing patients to more closely adhere to our recommendations.

To illustrate, let's say a patient learns he has no change in his prescription and no eye health problems. When he receives a recall notice, he'll wait until he notices a change in his vision before making an appointment. Conversely, if he consistently leaves the office knowing more than when arrived, he's more likely to view the recall notice as a reminder to make an appointment to learn what's new.

3. Referrals. Educating patients greatly increases the possibility of referrals. An educated patient can inadvertently become our best marketing tool. Here's an example: One of my patients had been successfully wearing monovision toric contact lenses for some time. We educated her about a new disposable bifocal contact lens shortly after its introduction. Although it ended up she wasn't a candidate for the lens, she asked whether it might work for her husband. Not only did she tell him about it, she made an appointment for him. Shortly thereafter, we successfully fit him.

A fascinating reality about presbyopic patients is that they tend to "hang out" with (surprise) other presbyopic patients. Presbyopia has become an almost "rite of passage." Next to our hair turning gray, it's the biggest sign of aging. Not only is this a common topic during Saturday night restaurant outings, it's a common source of hazing between friends. These people seek alternatives to glasses.

The bifocal contact lens option provides a huge referral opportunity for our practices, but it's only one of many available to us. Other topics could include computer vision syndrome (estimated to cost industry about $1 billion a year), pediatric vision care (where the average pediatrician screening lasts about 10 seconds) and laser-assisted in situ keratomileusis (LASIK) (with now close to a million procedures per year).

Making the unobvious, obvious. We often read or hear about advances in eye care. It would be prohibitive to discuss these with every patient. However, it's fairly routine that patients will spend at least a few minutes waiting in our office. Whether it's in the reception room (nobody in our office refers to this area as a "waiting room"), exam room or dilation area, patients typically spend some of this flipping through dated magazines or scanning plaques and certificates on the wall. Here are three active steps you can take to make better use of this "down" time:

1. Most of us incorporate some patient history questions into our patient information form. We add a few items to the form to encourage follow-up conversation. For example, we include a few "yes/no" questions about a patient's computer use, sunglass use, problems with glare and sports and leisure activities.

Another section could include a checklist of "areas of interest," including: contact lenses, computer vision, sports vision, alternatives to bifocals, children's vision, protective eyewear and refractive surgery. A member of your staff can review these forms with patients to provide them with related education material (brochures, etc.) before the exam. This can save you time as you provide follow-up education related to the patient's specific interests.

2. Design a brief in-office education form for your returning patients called "Since We Last Saw You." We laminate ours, and give it to patients before their exams. The form reinforces that we're dedicated to keeping patients up to date on new technology in eye care.


Contact Lens Management Plan


We give our contact lens patients the following form to help explain how our services benefit them and to justify our fees, if they question them. To us, the items will seem routine. However, eye care isn't routine to our patients. They typically don't know what differentiates one type of exam from another, and often, one provider from another. So, consider giving the following information to your contact lens patients as well:

We're dedicated to providing you with the most comprehensive contact lens care possible. To ensure your long-term success, we will:

  • evaluate your visual acuity with your current contact lenses

  • determine any contact lens prescription change

  • assess the fit of your current contact lenses

  • microscopically evaluate the health of the front surface of your eyes

  • measure the shape of the front surface of your eyes

  • review the results of this evaluation, and discuss available options with you.

As one of the largest contact lens practices in the state, we provide consultation services to major contact lens manufacturers and typically receive new products before they're available to eyecare providers. This allows us to keep you informed of the latest advances in contact lens technology.

We also highlight recent advances and invite patients to ask for additional information. We close with the following mission statement: "Since we last saw you . . . our practice has continued its commitment to keep abreast of all advances in eyecare. This will help to maintain the health of your eyes and ensure the quality of your vision."

The cost to produce these color copies and laminate them is nominal. We update them quarterly or sooner, if needed.

3. Many of us find it challenging to interest patients in non-prescription sunglasses. If you have a spectrometer, consider designing a poster with the following wording: "Do your sunglasses really protect your eyes? UV radiation can contribute to cataracts and other eye diseases.

"With our computerized UV scanner, we can test your sunglasses to ensure they're providing an adequate level of UV protection. Ask us about this quick, free screening test."

You might also keep a pair of low-quality sunglasses in the exam room to hold them in front of the projector to show the distorting effect of cheap lenses. Lastly, if you have a glare demonstration kit, compare the patient's current sunglass lenses to polarized lenses.

Addressing the "fee" issue. No optometrist I know relishes the thought of justifying fees to patients. As profit margins on materials keep declining, we need to emphasize our exam and contact lens service fees to remain profitable.

First and foremost, we need patients to perceive value in the services we provide.

Many practitioners charge an additional fee for routine annual contact lens exams. Often, patients question this fee -- particularly when their contact lens prescription hasn't changed. An in-office form can help to remedy this potential area of contention. (See "Contact Lens Management Plan" to view what we distribute to our patients.)

Once we're actually in the exam room, we can educate our patients about options with just a few sentences. Here's how:

Phrases such as these provide quick, solid educational information without being pushy, and they often open the door for follow-up discussion.

Taking the active approach

If you want to retain your patients, reinforce your recall efforts, obtain referrals, promote your services and increase practice profitability, then you need to educate each patient at every opportunity -- and do this actively, not passively.

Brochures and other educational tools provide us with good adjuncts to educating patients, but these passive educational tools aren't sufficient enough. Instead, we need to take a more active role with every patient.

Although we might find it hard to find the time to make changes, or we may be resistant to challenging the status quo, doing so will keep our offices productive, our staffs motivated and our patients educated.

Dr. Cohen is in private practice and recently completed a term as president of the Arizona Optometric Association. He's also lectured nationally and internationally on topics such as contact lenses, practice management, managed care, patient education and paraoptometric patient care. You can reach Dr. Cohen via e-mail at

Optometric Management, Issue: September 2001