Cultivating the Physician-Patient Relationship in Ophthalmology

A strong physician-patient relationship is an integral component of providing patient care. Although the frequency difficult encounters not well described in ophthalmology, multiple studies have found that challenging account for at least 15% ambulatory interactions.1Hinchey S. Jackson J. cohort study assessing a walk-in primary care clinic, predictors and outcomes.J Gen Intern Med. 2011; 26: 588-594Crossref PubMed Scopus (86) Google Scholar,2Collins K. Hopkins A. Shilkofski N.A. Levine R.B. Hernandez R.G. Difficult encounters: pediatric residents' communication skills training needs.Cureus. 2018; 10: e3340PubMed Scholar Importantly, clinical potential to take toll on provider satisfaction3An P.G. Rabatin J.S. Manwell L.B. Linzer M. Brown R.L. Schwartz M.D. Burden care: data from minimizing error, maximizing outcomes study.Arch 2009; 169: 410-414Crossref (80) as outcomes.4Kelley Kraft-Todd G. Schapira L. Kossowsky Riess h. influence patient-clinician healthcare outcomes: systematic review meta-analysis randomized controlled trials.PLoS One. 2014; 9: e94207Crossref (368) Scholar,5Mamede Van Gog T. Schuit et al.Why patients’ disruptive behaviours impair diagnostic reasoning: experiment.BMJ Qual Saf. 2016; 13-18Crossref (39) As physicians, we fundamental ethical responsibility provide best possible our patients. Given effects physician well-being, it important recognize interventions necessary heal patients come only medications or surgery but also form interpersonal interaction.6Johnson Do physicians duty repair relationships with so-called “difficult” patients?.AMA J Ethics. 2017; 19: 323-331Crossref (3) With this mind, question remains: what are ways ophthalmologists manage strengthen relationships? The first step may be reframe concept “difficult patient.” shown number characteristics (such co-morbid complex conditions, mental illness, neurocognitive disorder, threats legal action against provider) more common considered by systemic factors high workload increasing pressure work efficiently) inexperience, fatigue, burnout) contribute significantly difficulty encounter.1Hinchey Scholar,7Robiner W. Petrik Managing patients: roles psychologists age interdisciplinary care.J Clin Psychol Med Settings. 24: 27-36Crossref (7) Scholar,8Lorenzetti R.C. Jacques C.M. Donovan C. Cottrell Buck understanding physician, patient, situational factors.Am Fam Physician. 2013; 87: 419-425Google impact those can seen variety scenarios. For instance, if when clinic running smoothly, consider visit difficult. However, same hour late experiencing burnout, interaction far likely perceived Therefore, instead labeling “difficult,” suggest using terminology acknowledges multifaceted nature difficulty, such “challenging interaction,” describe encounters. Developing strategies managing dynamic no easy task, especially considering many outside physicians' control. several practices been described. “breathe-out” technique, example, strategy aims modulate bias emotion regulation encouraging self-reflection centeredness.9Edgoose Regner Zakletskaia Breathe out: trial structured intervention improve clinician satisfaction visits.J Am Board 2015; 28: 13-20Crossref (8) technique consists 2 sets questions answered before after predicts will answering improved visits who were clinician.9Edgoose To date, very little has written about interactions ophthalmology specifically, remain unanswered. Does serving population level visual impairment lead miscommunication? Could encounters? Ophthalmic wait times often longer because imaging dilation. degree might affect relationship, all? Some insights into recent which residents reflected story conversation patient's family, colleague. Qualitative narrative analysis resident answers identified “differing expectations” 1 4 main themes expressed narratives.10Scott I. Smiddy Schiffman Feuer Pappas Quality life low-vision services.Am Ophthalmol. 1999; 128: 54-62Abstract Full Text PDF (229) suggested these findings, within specialty, one most dynamics expectation management. Vision plays central role ability perform aspects daily life. In fact, showed low vision scored lower physical functioning limitations than did congestive heart failure depression.11Mishra Browning D. Haviland M.J. al.Communication ophthalmology: results needs assessment pilot program.J Surg Educ. 75: 417-426Crossref (10) even acuity treatment, any residual disturbance could still noticeably limit person's activities their quality An example scenario discussion section Ravin's paper describing case impressionist painter Claude Monet.12Ravin Monet's cataracts.JAMA. 1985; 254: 394Crossref (23) years, Monet suffered bilateral cataracts, diminished his impaired paint. 1922, was pronounced blind, he decided undergo cataract right eye. markedly surgery, experienced distortion changes color vision. This probably caused astigmatism, aphakia, chromatic aberrations aphakic glasses. him great distress over letters wrote ophthalmologist.12Ravin reviewing correspondence between clear that, despite acuity, expectations functional outcome met. Although, techniques ophthalmic procedures tremendously since time Monet, unmet understandably cause significant modern Several demonstrated expectations. 722 undergoing eye 61% met passed predicted outcomes.13Tielsch Preoperative postoperative among surgery.Arch 1995; 113: 1312Crossref (73) trend other well. Another measured 466 patients' laser-assisted situ keratomileusis (LASIK) perceptions procedure. although both perception scores high, had higher scores, indicating “quality gap.”14Lin Sheu Pai al.Measuring LASIK services.Health Life Outcomes. 7: 63Crossref (30) addition general importance day-to-day life, there reasons above. Recently, young, healthy opting elective non–vision-threatening conditions.15Dawn Lee P. Patient medical surgical literature applications ophthalmology.Surv 2004; 49: 513-524Abstract (52) understandable patients, they require function day without corrective lenses. Additionally, unlike procedures, some surgeries are, times, marketed directly Other carry out-of-pocket costs. It increased results. Even procedure outstanding, gap reality easily strain interaction. along adopting breathe-out aimed reframing goals regulation,9Edgoose actively decreasing particularly ophthalmology. Furthermore, following successful related during conversations families, colleagues: formulating explanations, taking time, cultivating relational skills.10Scott Examples include conducting thorough documented informed consent health literacy appropriate spending extra upset,10Scott kind empathetic tone conversations.10Scott Cultivating improving while face physician's control, helpful reflect surrounding integrations areas medicine. based limited available area, further research needed fully meantime, must continue important, complex, multifactorial topic striving patient-physician relationships. authors completed submitted ICMJE Disclosure Potential Conflicts Interest none reported. received funding support. reported relevant contents disclose.