Article

Overcome patient communication barriers

Advice on getting your glaucoma patients to open up to you and your clinic staff.

The art of exchanging or imparting information to others has gotten more complex as we have transitioned into a more technological age. Notwithstanding, the basic forms of communication (verbal, non-verbal, written or visual) and the individual parts of that communication (the sender, message and recipient) remain the same. Although this may sound simple, effective communication can be complex.

Efficiently communicating with any patient is extremely important, especially those with chronic conditions. In the early stages of glaucoma, for example, a lot of patients don’t have readily apparent symptoms, making it hard to convince them that they have a vision-threatening condition. Effectively relating this message to patients helps their understanding of their disease and can improve compliance to their prescribed therapy or management requirements. From a patient perspective, proper communication could allay concerns or fears. In the 2019 National Glaucoma Impact Survey by the Glaucoma Research Foundation (GRF), 76% of patients were very or extremely concerned about losing their vision and how that would impact their independence. Younger patients also reported feeling angrier and more depressed than older patients as a result of their disease.

Proper communication takes time and effort, including a need for understanding individual needs — both doctor and patient — and a willingness to listen. As you juggle the many requirements of providing health care, spending extra time may seem impossible. Thankfully, many resources are available to help you achieve effective communication in and out of the office.

FIRST IMPRESSIONS

Making a good impression when we first meet patients always goes a long way to boosting their confidence. A direct gaze, a firm handshake and an introduction of yourself and your role in the care team is a good way to start conversation. Obtaining a good history directly from the patient could reveal some pertinent clinical information that may otherwise be missed by someone without full medical insight.

In our current world of EMR, excusing yourself to go over the patient’s notes or records may be a courtesy that some patients appreciate if you haven’t had the time to do so before entering the exam room.

The staff in our office are part of the first-impression process. A knowledgeable, open and friendly staff create a welcoming environment for patients, who may sometimes come in with some anxiety. Finding the best people to fit roles in the office is helpful to patient-staff interaction and can also help improve the work environment.

We all have different personalities, and an understanding of our personality type helps us to make sure we communicate with patients in ways that work best for them. The Myers-Briggs Type indicator is an example of a personality indicator that is readily available for use. Someone like the “provider” on the Myers-Briggs Type indicator, who is more of an extrovert with a positive attitude, would fit well in a front desk position, while a “supervisor” on that indicator will make a good head tech or scribe. Having physicians and staff members perform this or a similar test could be very insightful and provide an understanding of our patients’ personalities to assist with identifying their communication preferences.

EDUCATE AND EMPOWER

As doctors, our most common form of communicating with patients is usually educating them on a new diagnosis or discussing their current health. Using simple terms and scenarios or comparisons that are more applicable to the patient’s everyday life helps improve the learning process, as this makes the subject more relatable.

A common analogy I use often is that the drainage system of the eye is like the plumbing of the kitchen sink. The secret is to balance inflow and outflow by keeping the faucet open at a level that the drainage keeps up so there is no backup of water. In clinical terms, this would resemble high pressure in the eye. The strainer over the drain is likened to trabecular meshwork, the plumbing in the house is likened to Schlemm’s canal and the public drainage system are the collector channels. Treating glaucoma requires turning down the faucet or repairing the drain. There are different eyedrops or surgeries that help decrease the fluid coming in and others that address the drainage. For example, gonioscopy-assisted transluminal trabeculotomy (GATT) a type of trabecular stripping procedure is like removing the strainer off the kitchen sink drain.

Using visual aids while explaining glaucoma, such as a layout of ocular anatomy, is another great strategy to help patients understand their condition. Sometimes using patients’ own testing results could be a powerful tool. Reviewing a visual field test that shows progression as the peripheral field loss closes in could be the eyeopener the patient needs to prompt improved self care or to understand the explanation for needing more aggressive treatment with may be surgical.

Patients have several resources available to them, both in both print format and online. A very helpful resource I give to my patients at the time of diagnosis of glaucoma or at the time of their referral is “Understanding and Living with Glaucoma,” a handbook provided by the GRF; I also provide an enrollment for the foundation’s quarterly newsletter, “Gleams.”

Directing patients to specific articles of interest on the GRF website as well as other similar reputable websites ensures they have good learning resources. For example, a video on the GRF website by Constance Okeke, MD, MSCE (https://www.glaucoma.org/news/blog/tips-and-advice-for-the-glaucoma-patient-video.php ) provides some information that the physician can review and build upon, so time in the office can be spent on other issues.

THE IMPORTANCE OF LISTENING

Listening is a big part of communication, especially when it comes to patients. Physician listening not only gives patients an opportunity to inform us about new problems, but also gives them a chance to recite instructions they received to assure us they understand them. In patients with moderate-to-severe glaucoma, their comments about feeling their vision is getting worse is something to pay attention to. In most cases, they are right and would require more aggressive treatment from us.

Perceiving a problem or the specific need of a patient and giving direction to the issue builds trust. Remember, patients are also people trying to live a somewhat normal life; visualizing or hearing about the difficulties they have and working to overcome them increases the trust they have in the care you provide.

When I hear statements such as, “I am having a hard time writing my checks” or “If I could only read I would be happy” or “I got this bruise because I keep bumping into things on my right because I don’t see them,” I recommend low vision evaluation/aids like magnifiers or better lighting to make specific activities easier. My practice keeps a list of resources and services for the visually impaired handy for those who may need it. This includes aids that help them overcome difficulties in performing simple tasks, such as dosing aids to help get drops in their eye or local Lighthouse programs for the blind. You will be surprised to find patients who say no one ever told them that these resources were available to them.

USING TECHNOLOGY

Technology has become a big part of our individual lives, and making the most of social media and applications to help patient communication is now common practice. For many years, the AAO offered numerous patient education-oriented videos to play on a television in practice reception areas.

More recently, several useful applications have become available to glaucoma patients. They vary from medication-dosing reminders such as Eyedrop Alarm to prescription medication applications and visual assistance applications such as GoodRx and Be My Eyes, respectively. Facebook is particularly popular with older populations that are more likely to have glaucoma and may be a good place for a support group. Currently available on Facebook are the Glaucoma Eyes group and the Glaucoma Support group.

Another online support group is The Glaucoma Service Foundation to Prevent Blindness in Philadelphia, which offers an online glaucoma chat room on the first and third Wednesday of every month at 8:30 p.m. EST. These groups allow people with glaucoma share their stories and offer each other support.

All these technological avenues for communication are easily accessible on a patient’s smartphone or tablet for use at home.

ENCOURAGE PREPARATION FOR VISITS

Adequate preparation is essential to a good visit. Going to the doctor’s office can sometimes be overwhelming, creating anxiety about the state of disease for some patients. This sometimes creates a situation in which patients don’t derive as much benefit as we would like from our interactions at the physician’s office. Better preparation for a patient’s visit helps prevent this and alleviate some of their concerns, which aids in better communication.

To make a visit purposeful for both the patient and the physician, ask the patient to come with a clear list of symptoms, current medications, a record of their perceived progress and any questions they may have. While 58% of patients report that their physicians routinely discuss future treatment options with them, only 34% say they feel “very” or “extremely” well-informed about new options.

Encouraging patients to keep a journal is also a good way to help them keep track of their disease. This not only makes finding answers to staff questions during office visits easier for patients, but it also creates an opportunity for them to think in advance about any questions they might have about new treatment options or innovations in the pipeline, if need be. (https://www.glaucoma.org/treatment/7-ways-to-make-the-most-of-your-glaucoma-doctor-visit.php )

ENLIST AND ENGAGE SUPPORT

It is important to tap into the individual support systems of each patient. This could be a family member or friend who comes to appointments to help reinforce information given to the patient, or members of a glaucoma support group. I find including the family member or friend in the conversation when talking about difficulties in complying with the prescribed therapy is helpful because the person may realize areas where he or she can offer assistance (ie, administering the drop or reminding the patient of the purpose and importance of using the medication).

Another tip when discussing issues surrounding surgical decision making: I am sure to make eye contact with the family member or friend to see if he or she understands as well, because sometimes it will be that person’s understanding and influence that will help the patient comply with the when recommendations when confusion or fear are flooding the patient’s mind.

Members of your team, including the technicians and nurses, are also part of the patient care group and should be encouraged to help. Your staff can be very resourceful, so ask them to engage with patients on their visits. They can help patients with setting eyedrop alarms on phones, reminding them about their medications or providing an answer to a common concern or correcting a misconception.

CONCLUSION

Communication in all forms is a process that we, as clinicians, have to continually perform. The key to its success is creating the time to speak with patients and effectively achieving our patient-oriented goals. It’s important to remember to evaluate our current practices as they concern our patients and change our approach if something is not working.

Hopefully, our efforts on all sides produce the open, clear, informed communication lines we want to foster. OM

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