A Physician's Duty: educate your patients

By: Polly Neely

When I say LASIK or PRK, I would say the majority of people know what I am referring to. What they know is it is for people who don’t want to wear their contact lenses or glasses anymore, but do they know what happens? Do they know what their present visual state is? Are they myopic, astigmatic, presbyopic, hyperopic or have keratitis, etc.? Chances are that’s where you lose the majority vote. Just because potential patients may recognize the name of a procedure, doesn’t mean they know the extent of what it entails, which is why the physician educating the patient is so important.

In that, LASIK, PRK evaluation patients hear terms like, “Your manifest refraction shows that you are -4.00 x 1.25 x 95 distance and .50 near.” What does that mean? What is a manifest refraction? Well most doctors will give this explanation, “The refraction is when they ask do you see better 1 or 2.” Then the patient will say, “Oh yes, I remember that.” Ok that is their refraction. Most will not ask anymore, they’ll accept their refraction fee and move on.

If they have a refractive consultation, the patient may be told that their cornea is too thin for LASIK, so they should have PRK or SMILE. 

They’ll wonder, “SMILE? Where does that belong in an eye surgeon’s office? How have I lived my whole life and not known my cornea is too thin?” Now they have questions but here’s the dilemma, the doctor will tell them this and then directs them to the surgical counselor to go over all the options. They will then say okay and politely let the doctor go to the next patient and move on in the process to the surgical counselor. The counselor will begin to pull out papers explaining procedures that the patient medically qualifies for, how much they will cost, appointment options, and many overwhelming papers to read and sign. These papers are usually consents for surgery, that state somewhere in there that the patient completely understands the procedure that will be performed on their eyes and that they are okay with all of that. However, in most cases, they are so overwhelmed in the whirlwind that they may not be confident in moving forward.

Most patients who have come this far have done some homework on their own using “Dr. Google” or friends, or perhaps a consult before this one. They know these terms are used and understand them enough to know they still want to get rid of their contact lenses or glasses.  

The staff will probably tell them that their cornea will be cut with a femtosecond laser or a microkeratome. A flap will be made, but don’t worry, it will go back over the cornea bed smoothly and remain there without complications unless an injury occurs. Okay, makes sense.

Now comes the part you know most about and unfortunately in a lot of cases becomes the deciding factor, the price. They will think, “Which tier, category, column, totem pole do I fall in for my surgery? I am column 2 in the 1st category of totem pole 3?” Why? Well their astigmatism will be corrected, their refractive power is at level 3, and they have thin corneas so the pricing will be ‘this’. At this point, many patients tend to think, ‘My friend had this done for $1,000 less and when I called for your pricing, I was not quoted in this price range.’ Then they hear, “Well, we can’t really tell what the cost will be until we know your refractive state, eye health, and choice of procedure.”

I tell all this to say, a patient cannot make their choice of practice/surgeon based on pricing because of the overwhelming amount of bait and switch practices out there. We’ve all seen the advertisements for “LASIK and PRK for $299 per eye.” So of course they think, well, why wouldn’t I go there rather than pay the place I just called where their starting price was $1,500 to $3,999 per eye?

So they go to the $299 per eye practice and walk out paying $1,475 per eye because they had high refractive power, more than .50 diopters of astigmatism and bought the lifetime plan.

Once this is done, many patients still couldn’t explain why it cost what it did and will that surgeon be there to honor their lifetime plan should they need to have more surgery?

This is the duty of the physician. Physicians must not only vaguely educate patients, but MUST take the time to ensure the patient understands not only the procedure options, but also the why behind every decision they make. This also protects patients from making unwise decisions based on price or pressure because they don’t see the full picture. The ‘name’ and description of a procedure is not enough, take the time to listen to your patients and make sure they are fully aware of the life changing results you can give them and how it will improve their life. It’ll make all the difference when it comes to satisfying patients and building that patient relationship.