Soft Skills Help with Hard Patients

The line between a patient’s satisfaction and dissatisfaction can potentially be drawn in the consultation room. According to Başak Bostancı MD, the surgeon can be a master in corneal and refractive surgery, but if the patient is not treated as a human being with a neurosensorial system and a lifestyle, the most excellent result can still produce an unhappy patient.

“Satisfaction and dissatisfaction are psychological states and not visual acuity measurements,” she said.

Dr Bostancı explained that dissatisfaction is driven by five main factors: expectation-outcome mismatch, personality-technology mismatch, ocular surface instability, incomplete lifestyle analysis, and the absence of structured preoperative counselling.

For these reasons, when dealing with new patients, Dr Bostancı always starts with defining priorities: not by asking if they want to be spectacle free, but rather what matters the most between distant, intermediate, or near vision. If everything is important, nothing is going to be prioritised, she said. Openly explaining concepts like trade-off and neuroadaptation can scale down expectations to a level where the patient will no longer demand surgical perfection from the surgeon, while avoiding panic in the postoperative phase. After that, she usually asks the patient to summarise what they expect from the surgery.

Confirming the alignment is the third step. If the patient cannot articulate what they expect, there is no alignment, and the surgeon should stop and repeat the process. In her consultation, Dr Bostancı uses a three-level counselling model, explaining to the patient what will happen postoperatively and why it will happen before asking what this means for the patient, preparing for alternatives if the patient is not happy with the trade-off.

Too many options could overwhelm the patient, and this can increase anxiety, she cautioned. Her method consists of openly ruling out what is unsuitable for the patient, narrowing down to two realistic choices, weighing their pros and cons to reduce the risk of regret.

Red flags such as reporting low tolerance to visual changes, tiny imperfections, or asking for perfect vision at all distances must be considered, but not to the point of completely dismissing certain lenses. Perfectionism is not a contraindication—unrecognised perfectionism is, she said.

Expectations are also set by the surgeon’s language during the counselling phase. Absolute language like ‘perfect’ and ‘no halos’ should be avoided, and more probabilistic language should be used instead. This does not decrease the surgeon’s credibility; on the contrary, it shows trustworthiness, she said.

Postoperative counselling is also important to define the narrative. Instead of being dismissive, Dr Bostancı recommends being more open, telling the patient the effects are part of the neuroadaptation process.

“Dissatisfaction does not come from the optics alone,” she noted. “Dissatisfaction comes from misalignment during conversation. For this reason, counselling is not a soft skill, but something we must all be working on.”

Dr Bostancı spoke at the 2026 ESCRS Winter Meeting in Helsinki.

Başak Bostancı MD, FEBO is Assistant Professor of the Bahçeşehir University of Istanbul, and a cataract and refractive surgeon at World Eye Hospital, Istanbul, Türkiye. drbbostanci@gmail.com