Mixed messages between ophthalmologists and patients

  I recently received the following text message from a good friend: “Hi Leigh, quick question: my aunt went to her ophthalmologist hospital because she was seeing floaters in her right eye. She said the diagnosis is a retinal detachment and that she should ignore it. Her next appointment: 6 months from now. Does this make sense?” Whoa, wait a minute. Any ophthalmologist would recognise that something was amiss. But where, between diagnosis and this text message, had the mistake occurred? Time to investigate. I assumed that the ophthalmologist had made the correct diagnosis. I was certain that my friend hadn’t made the mistake; he was just the messenger and I was convinced that the patient was doing her best to relay the information she had received from her doctor. I thus suspected a communication breakdown between doctor and patient. I asked my friend to request a copy of the clinic report, which stated what I had expected: a posterior vitreous detachment. As is common in these situations, the patient had probably heard her doctor say that the vitreous had detached from the retina. However, this is a common source of confusion: I have noticed that the juxtaposition of “detached” and “retina” in the same sentence is often incorrectly recalled. In fact, this is a common reason that patients come to our clinic for second opinions. To avoid this confusion, I’ll say, “The gel in the eye has contracted, which is a normal occurrence, and it has freed itself from its connections at the back of the eye.” If patients ask about their retina, I’ll clearly state, “Your retina is not detached. This is a benign condition,” after which I explain that the patient must remain alert for flashes and new floaters. Studies have shown that up to 80% of medical information provided by healthcare practitioners is forgotten immediately, and that the greater the amount of information presented, the lower the proportion correctly recalled. Furthermore, almost half of the information that is remembered is incorrect. Thus, my motto is “Keep it Simple.” https://www.medpagetoday.com/PublicHealthPolicy/GeneralProfessionalIssues/66566 Telling a patient that cataract surgery will occur under “topical anesthesia” often falls on deaf ears. Instead, I’ll say “eye-drop anesthesia, using the same drops I used today to measure your eye pressure.” If my patient has diabetes, I refer to my medical retina colleagues as diabetic eye specialists. Glaucoma colleagues are eye-pressure specialists. Of course, if a patient has had glaucoma for 25 years it’s a different story, but for new patients, simplicity and clarity are paramount. Admittedly, as a retinal surgeon, I have it easy. My diagnoses are mostly simple to understand (retina is on or off; bleeding is present or absent) and vitreoretinal treatment adherence usually involves only a few weeks of eye drops. Conversely, our glaucoma colleagues understand that good communication is highly correlated with better patient adherence. My goal is to allow the patient to remember their diagnosis and treatment for as long as necessary and then, hopefully, let it all fade into the past.

Tags: patients, teaching