Good patient communication is one of the most important attributes of a successful practice and a new website aims to help smooth that process with an extensive image library.
After a long career in both general practice and in a university environment, I have observed how students communicate with the patients they see. If I asked the students what they considered the most important part of an eye examination, they would typically suggest things such as the binocular indirect ophthalmoscope or optical coherence tomography. They’re typically shocked when I explain that the most important part of an eye examination is the last three minutes.
I have had to explain that after having gone through a whole series of tests, most patients are somewhat befuddled and would little understand or remember what had been done and why. What therefore becomes important is that last minute or two when you summarise what you have done, hopefully reassure them, and give them a reason why they should return to see you.
Often this is straightforward; something along the lines of ‘Your two eyes are working together very well, there’s little change in the focus of your eyes, I can find no eye disease… let’s see you again in two years to make sure you stay like that’. That is easy and will be appreciated and remembered.
The problem arises when you need to qualify the advice given. Having been in the position to listen to students explain their findings, I have observed a definite disconnect between advice given and the patient’s understanding. For example, in one case of borderline disc cupping, I could not criticise the student’s detailed explanation. However, when I subsequently questioned the patient, I was amazed at their total misunderstanding of the condition. Indeed, the patient was quite frightened.
This is something that is just impossible to follow up in the pressure of general practice, but having noted this in several other student cases, I decided to investigate further how it could be improved.
How People Learn
Broadly speaking, people learn in three distinct groups, which sometimes overlap.
- Audio learners, who learn largely by listening,
- Visual learners, who learn by largely looking and seeing, and
- Kinaesthetic learners, who learn by largely touching and feeling.
Audio learners comprise approximately 30% of the population; visual learners approximately 65%; and kinaesthetic learners approximately 5%.
Most clinicians are audio learners; they have been to university and have learnt by listening to lectures. However, two-thirds of the patients they see are visual learners. Thus, you have the situation of an audio learning optometrist explaining a clinical condition to a visual learning patient, who also probably has little or no understanding of the human eye or its anatomy and physiology.
The result is that while most patients will smile and nod, they may have little or no idea of what you have actually said or advised. If they are confused or frightened, the chances are that you will not see them again.
The Development of a Manual
To overcome this, I developed The Optometrist’s Practitioner-Patient Manual in book form. The concept of the manual was a series of simple diagrams and pictures of every condition or question that could be asked and then shown to patients while at the same time giving a verbal explanation to accompany it. The verbal explanation could then be as short or long as time allowed and suited to the patient’s interest and intellect.
But print runs of books expire, so with the help of colleague James Mann, the Manual has been updated, enlarged and reproduced as a website. This now contains over 250 pictures and simple diagrams covering:
- The eye (in general),
- Spectacle lenses,
- Abnormal conditions (anterior and posterior),
- Contact lenses, and
- Binocular vision.
Of course, an advantage of a website over a printed manual is that it can be updated and or further features added over time.
The website can be used on either a laptop or iPad.
How to Use the Website
While the site may not be necessary in routine clinical examination, where it should be used is if you wish to demonstrate something you have observed and want to explain to the patient. You then ‘talk’ to the picture displayed depending on the time available, the patient’s interest, the patient’s intellect, and at a level that will not be frightening.
This should take no more time than the normal verbal explanation. The huge advantage is that it will now be understood by the visual learners and also assist the audio learner.
Some conditions are also difficult to explain verbally. How does one answer a mother’s question as to what her son with a colour vision deficiency sees, or how it will be inherited? How does one answer a child’s question as to why they see better if they screw up their eyes? How do you explain Fuch’s dystrophy or capsular opacification to a visual learning patient? As another example, the website can be used to show a person with mild diabetes a picture of early retinopathy and then discuss the importance of early diagnosis. Explaining that retinopathy will produce no symptoms will ensure that the patient will return whenever you advise
Accessing the Website
The website is available at: theoptometristscompanion.com.
The website is a subscription service – available for the cost of less than a cup of coffee a month –but a small selection of images is available as a ‘taster’.
The main thing is to get into the habit of using it where relevant. On a personal basis, I found it to be a terrific practice builder and generator of new referrals. I hope the same will apply to you.
Tony Phillips is an Associate Professor at Flinders University and has also been in both private practice for many years. He was formerly Principal Optometrist at Flinders Medical Centre and The Adelaide Women’s and Children’s Hospital.
James Mann is a website and app developer.