Article Date: 6/1/2004

"My Doctor's the Best!"
Do patients say this about you? They will once they learn that you care about making them feel the best.
By Stephen Cohen, O.D.

A new patient tells you she used to see Dr. Smith before she moved to your town because "She was one of the best." Do you ever wonder what put Dr. Smith among the best and how you can get on that list?

With the exception of select medical pioneers, the elite have an elusive set of inclusion criteria, particularly in primary care professions like optometry. So, who's the best? The answer is fairly simple: The ones who make their patients feel the best. Your ability to do that starts with caring and communication.

Common pitfalls

Caring and communication is a simple formula, right? Of course you care about your patients, and you don't have any problems communicating.

The reality is, poor communication is one of the main reasons for malpractice lawsuits, and many patients change doctors in search of "someone who has something new to offer." Many doctors fall victim to these common pitfalls:


I Have What?


Terms like seg height, PD, presbyopia and IOP are second nature to us, but not to our patients. Why lose patients in an explanation that's intended just for them?

Studies show that when people hear an unfamiliar word, they shift their attention from the speaker for several seconds to summon its meaning. What's more, unfamiliar words may create anxiety. If you tell a patient she's becoming presbyopic, she may worry she's contagious or in danger of going blind.

To speak to patients effectively, we should define every technical word we use. There are two approaches:

1. Define or describe the term before you say it. For example, say, "When the vision in one eye is not fully correctable by glasses or contact lenses, we call it amblyopia."

2. Use the term first, and then describe it. You might say, "You have what we call amblyopia. Now let me explain what that means."

By using the technical term in an easily understood context, we can decrease the likelihood that patients will temporarily "check out."

1. Time is (not) on our side. A recent study by the American Optometric Association estimated the average time we devote to each patient has dropped from 25 to 20 minutes. We're all challenged with imparting more information in less time.

2. Don't ask, don't tell. Patients will ask about a new procedure or product, right? Wrong. Patients aren't responsible for keeping up with the latest eyecare advances. And patients generally think if their doctors don't tell them about an option, it's because they -- patients -- won't benefit from it. Patients interpret not only what we say but also what we don't say.

3. A rose is a rose. The words we use affect the messages we send. Technical words don't impress patients -- they confuse them. We need to speak to people respectfully in lay terms. (See "I Have What?")

We also need to be aware of the tone of some words. Words like compromise, tolerable and adequate can send a negative message. For example, when discussing bifocal contact lens options, instead of saying, "It will be a compromise between your distance and near vision," you can change the tone of the message by saying, "We want to create the best possible balance between your distance and near vision without affecting either one negatively." Instead of discussing what progressive lenses won't do, we should talk about what they will do.

4. Filtered or unfiltered? Miscommunication can happen when you say one thing and your patient hears another. We've all experienced it: You gently tell a patient she's beginning to experience the normal vision changes that happen when we reach our 40s. When she returns the following year, she says you warned her that her vision was "going down the tubes because I'm getting old."

To avoid miscommunication, we have to understand that we all speak and listen through "filters." Through the filter of my position and experience, I intended to sensitively explain what was happening to my patient's vision. She received my message through the filter of her prior experiences, fears and perceptions. We can't control our patients' filters, but we can try to assess them and choose our words carefully.

5. People don't care how much you know until they know how much you care. Regardless of how much time you spend with a patient or the words you use, your overall demeanor is a major part of your communication and, subsequently, how your patients judge the quality of your care. Patients read your tone of voice, mannerisms, eye contact and body language. If you answer questions as you're heading for the door or spend more time writing in the patient's chart than looking at the patient, you might be perceived as uncaring.

We're all challenged with imparting more information in less time.

Helpful strategies

I'm sure we all can identify with these pitfalls, but the following suggestions should help you avoid them.

1. Warm up. Practice the message you want to deliver about commonly encountered vision problems, such as presbyopia. To be objective, try writing down your usual explanation to see how it reads. You may be surprised by how bleak a picture you're painting. For example, dwelling on the difficulty of adapting to progressive lenses sends a different message than describing how patients typically benefit from these lenses and adapt to them in just a few days.

2. Encourage name-calling. Referring to a patient by name shows respect and interest. You might include a space on your forms where patients can fill in their preferred name. Encourage your staff and patients to use names, too. If your assistant says, "Your next one is in room 3," remind her to use the patient's name. And if your patient says, "Can your girl set up the follow-up visit?" respond by saying, "Pam will be happy to help you."

Leaning in slightly toward your patient, making eye contact and nodding your head sends a message of engagement and interest.

3. Clean the filter. Although you can't change your patients' listening filters, you can quickly determine whether they understand your treatment instructions by asking them to repeat them back to you. And before you leave the exam room, you can gain credibility and closure with two questions: 1) Have I answered all of your questions? and 2) Have we addressed your vision concerns to your satisfaction?

4. Cure "Bubba Gump" syndrome. You may remember Bubba's stream of consciousness in "Forrest Gump": "You can have boiled shrimp, fried shrimp, shrimp gumbo, shrimp scampi." Although we're as enthusiastic about our practices as Bubba was about his shrimp boat, we must find ways to explain new options succinctly. Strategies include distributing educational literature and recapping key statements at the end of the exam, such as "We now have 1-day disposable contact lenses." These measures take very little time and ensure your patients leave the office with new information.

5. Spread the word. Share what you discussed with patients with the optician or other clinician who will see them next. If you review the exam room discussion with the optician in the presence of the patient, all of you will have the same understanding. This also reassures the patient that the information is passed on accurately.

6. Reflect on your body language. Become more aware of your body language by practicing patient interactions in front of a mirror or reviewing videotapes of yourself. For example, crossing your arms and legs may feel natural, but your patient may perceive this negatively. Leaning in slightly toward your patient, making eye contact and nodding your head sends a message of engagement and interest. The tone and inflections of your voice and your animation and enthusiasm sends a positive message.

Putting it all together

Want to be one of the best? Better communication skills improve patients' perceptions of your clinical skills. Don't just learn all about the latest in diagnosis and treatment. Learn how to educate your patients about their condition effectively. In essence, don't provide "eye care" until you provide "I care."

Dr. Cohen is in private practice in Scottsdale, Ariz.


Building Your Practice 'Family'

Not long ago, small, private practices were known for their family atmosphere. Today, be-cause you're seeing more patients in a day, these relationships are more difficult to sustain. And while patient retention is more important than ever, some patients simply aren't coming back, not for lack of quality care but because they aren't feeling a personal connection.

Even with all the demands on your time, you can build strong, positive relationships and make your practice seem more like a family. Here are some simple strategies to try.

Introduce yourself online

If you have a Web site for your practice, you already have a head start. Use your site to introduce yourself and your staff, both in words and images, and to list the services you offer. Photos of the office's interior and exterior make it a familiar place, even before patients arrive. You can describe your office's accessibility for infants, children and patients with disabilities and encourage them or their families to e-mail questions or comments. Having this information before the appointment makes for a more pleasant and efficient visit for everyone. This extra care and attention makes a lasting impression.

Offer personalized solutions

Ask patients to fill out a brief lifestyle questionnaire at least once a year to assure that your decisions are based on current information. What you learn from the lifestyle form can be as valuable as a thorough patient history. Ask patients about daily tasks and the importance of each. Ask what they want from their vision correction and if their current correction meets those goals.

Asking about lifestyle changes should be just as routine as asking about changes to address, phone number and insurance. I recall one patient who'd worked for 20 years as an administrative coordinator, mostly doing computer work. After a year of retirement, however, she was outdoors all the time, hiking and gardening. Her lifestyle -- and her vision priorities -- had changed dramatically. If we hadn't asked about her lifestyle, we would have missed an opportunity to meet this patient's needs.

Information from a patient's lifestyle questionnaire, combined with your clinical expertise, will guide you toward personalized solutions. For example, most patients own several pairs of spectacles because their everyday tasks and visual demands are so different. For the same reason, you should offer patients the option of multiple types of contact lenses. Some patients, especially presbyopes, abandon contact lenses altogether if one pair can't satisfy all their needs. If you can offer spectacles and contact lenses, or different contact lenses for work and sports, you're more likely to satisfy your patient. Let patients be involved in the decision-making when it comes to their vision correction options.

Make it personal

When patients, who may see you only once a year, think enough of you to talk about their child's graduation, the birth of a grandbaby or even the death of a loved one, then you've done a good job. Some doctors and their staff members note children's names or the dates of upcoming special events in a patient's chart. At the next visit, they remember to ask the patient about her wedding or her tour of Italy.

In some practices, the doctor or staff sends cards to patients wishing them a happy birthday, congratulations or sympathy for events shared during their visit. These reminders create a bond between you, your patient and your practice.

Ask their opinions

It's not easy to open yourself up to criticism, but valuing your patients as individuals means welcoming their opinions. If you respond to what they say, you'll get lucrative rewards in the form of loyalty, retention and referrals.

Offer suggestion surveys -- either in person or online -- to new and existing patients. These surveys will uncover any misperceptions, areas of inefficiency and room for improvement in your practice, but you'll also learn what things patients appreciate most.


Each patient should have your full attention and feel as if he's the most important patient of the day. Every extra moment you can spend with a patient is worth it, but even a limited amount of time is improved enormously with eye contact and focused listening.

Rise above the rest

What's the best retention tool? Exceptional care in a warm, friendly environment. By building strong bonds with your patients, you set yourself apart. Get to know your patients ... again.

-- Paige Pantall, C.O.A., A.B.O.C., N.C.L.E.C. Jacksonville, Fla.



Optometric Management, Issue: June 2004