Article Date: 1/1/2002

What You Say and What Your Patients Hear
Common communication blunders to avoid.
BY BOB LEVOY, O.D., Roslyn, N.Y.

Following an exam, how many of your recommendations for annual comprehensive eye exams, contact lenses or perhaps refractive surgery do patients follow? If patients don't follow as many as you'd like, your communication skills may need a check-up.

Do you hear what they hear?

You probably haven't had your communication skills critiqued in a long time -- if ever. And no one is likely to tell you about your shortcomings as a communicator.

The easiest, most practical way to learn how you come across to others is to audit yourself by tape-recording your interactions with patients. Perhaps you'll be pleasantly surprised with what you hear -- or maybe you'll be taken aback. Either way, it's worth a listen.

Solving common blunders

Check out these solutions to common communication blunders that you may unintentionally make:

Too technical. We doctors sometimes explain our recommendations in language that patients don't understand. Rather than risk looking foolish, many patients just nod their heads and pretend to understand.

Simply stop talking and ask the patient if she understands or has any questions. If she doesn't understand, try a simpler explanation and answer any questions using as simple terms as possible. Don't expect patients to accept what they don't understand.

Too rushed. When explaining glaucoma, for example, and the importance of medication and follow-up exams for the five-hundredth time, it's easy to fall into the trap of speaking so fast that patients can't follow (especially when you're pressed for time). Again, patients pretend to understand even when they don't. The predictable result? Lack of adherence to therapy.

Asking patients if they understand is one way of monitoring their comprehension. However, that question puts the burden on them to paraphrase what may have been an overly technical or rushed explanation.

Instead ask, "Does the way I'm explaining this make sense?" This phrasing puts the onus on you, where it belongs. That way, it's easier for a patient to simply say that she doesn't understand.

If a patient asks you to clarify something you've already explained, don't show exasperation, such as by taking a deep breath, audibly sighing or talking down to the patient. (Remember how Al Gore acted that way during the presidential debates with George W. Bush -- and how it damaged his image?)

Too pushy. It's natural to want patients to accept your recommendations for vision therapy, contact lenses, premium lens options and the like. But continuing to "sell" after a patient says "No" or "I'd like to think about it" may come across as pushy. You may mean well, but speech that a patient perceives as "high pressure" will undermine trust and make him uncomfortable.

Today's more discerning, more demanding patient has less patience than ever for the "hard sell," and more opportunity to obtain eye care and eyewear elsewhere.

Give patients a chance to say "No" to anything that might improve their visual comfort, efficiency, safety or appearance. Try to guard against coming across as overbearing. And don't sacrifice long-term relationships for short-term profits.

Talk too much. Another well-intentioned habit that no one will ever tell you about is the tendency to talk too much or tell a patient more than he wants or needs to know.

Listen to yourself on tape. You may start to squirm if you hear yourself going on and on. Why do some O.D.s go overboard with patient education? Among the reasons:

If you think you may be guilty at times of overexplaining, here's a strategy that may help: After 1 or 2 minutes of explaining the etiology of dry eye or whatever the subject, stop talking and ask the patient, "Is this interesting?"

If the patient says "Yes," then keep going. Even better, if the patient says, "Yes, and you're the first doctor to explain this to me," give yourself a pat on the back and keep talking -- you've hit a home run.

However, if the patient responds to your question with only a shrug and a look of little or no interest in hearing more about the subject, then cut your explanation short. You'll save time and have a happier patient.

Just listen to yourself

Audit yourself to see if you're as good a communicator as you think you are. But keep in mind that the legality of taping a conversation without a patient's knowledge and consent varies from state to state. Check with your attorney to learn what obligations you have in this matter.

And remember: The issue isn't how technical, pushy or talkative you are -- it's how a patient perceives you.

Dr. Levoy is a seminar speaker. Butterworth-Heinemann will publish his newest book, 101 Secrets of a High Performance Optometric Practice, next year. You can reach him by e-mail at


Optometric Management, Issue: January 2002