The art of communication

A practitioner who excels at communication can transform an ordinary patient experience into one that prompts them to recommend a practice to family and friends.

At the other end of the spectrum, conveying a clear message and responding appropriately to patients can stop a challenging situation in practice from escalating into a complaint.

At the heart

For optometrist Sarah Morgan, an industry expert in communication and Vision Sciences Fellow at the University of Manchester, being able to listen carefully to patients and ask the right questions is “absolutely key.”

“Communication is at the heart of everything that we do no matter what discipline or specialty of optometry we go into,” she shared.

Ms Morgan spends some of her time educating undergraduate optometrists to apply their newfound optometry knowledge in practice.

Communication is at the heart of everything that we do

She highlighted the importance of younger practitioners considering the impact of seemingly minor eye conditions, such as cataracts, on their patient.

“Younger optometrists know some context – that cataracts are easily treated – but they forget that the patient hasn’t got that context,” Ms Morgan emphasised.

“People don’t know that presbyopia happens to everyone and everyone will get cataracts if they live long enough.”

She added that the gap between what an optometrist knows and what the person in the chair understands is “at the crux” of communication in practice. 

Spending some time to educate the patient not only helps to alleviate their fears, but it also helps build a patient’s confidence in their practitioner, Ms Morgan highlighted.

When asked about communication challenges in practice, Ms Morgan pointed out that many optometrists feel apprehensive about making a recommendation that will result in the patient spending more money.

Although practitioners may be hesitant about recommending a more expensive product, they should also consider the clinical benefit of that recommendation.

“It can be something simple like you have a patient wearing spherical contact lenses and they really would benefit from having a toric lens. The difference is massive to the patient wearing experience,” Ms Morgan said.

Her advice for navigating this scenario is to lead the patient step-by-step through the reasoning of why the recommendation is being made, and not be afraid of answering any questions that the patient might have.

The personal approach

A principle that helps to guide positive communication in practice is for optometrists to treat each patient as if they are a member of the family.

“Look at the age of the patient and think ‘Is this someone who is the same age as my parents, grandparents or child?’ Then really challenge yourself to think about how you would go about this with a member of your family,” she outlined.

Ms Morgan elaborated that this approach fosters a positive conversation because it encourages a greater degree of empathy.

A practitioner will only recommend a product to a patient if they would do so with a relative.

“I think to our credit we are overly paranoid about the commercial impact of what we are recommending to patients. We end up not allowing them new and better things,” she said.

“If it was our family, we would put all of that to one side,” Ms Morgan shared.

Find out at the beginning who is in your chair

Understanding the patient

Another key to good communication in practice is to gain an understanding about the patient’s occupation and background early on in the examination.

Ms Morgan observed that practitioners should make this a priority even though ‘occupation’ is often listed close to the bottom of the record card or electronic entry.

“Find out at the beginning who is in your chair,” she said.

“What does their world looks like? If they are retired or out of work, find out what they did in the past or what sort of work they are looking for,” Ms Morgan highlighted.

Knowing what an individual’s occupation involves helps to shed light on their level of understanding.

To illustrate this point, Ms Morgan relayed an experience where she was examining a man who said he was retired.

When she asked what his occupation was before retirement, he sheepishly said that he worked as an ophthalmologist.

“That affects the whole examination right from the beginning. Imagine if I had only known he was retired and explained to him what a cataract is,” Ms Morgan emphasised.

Asking about a patient’s occupation can also help an optometrist to understand their visual requirements in their daily life.

Ms Morgan encouraged practitioners to make sure that they listen carefully to patients and refrain from interrupting them.

“We could be missing key information that would inform the focus of the examination and the advice that we give,” she said.

It is also important to capture the vocabulary that patients use, rather than ‘translating’ the words a patient uses into optometry terminology.

For example, if a patient comes in and tells the optometrist that they have been seeing tadpoles and cobwebs in their vision, these are the words the practitioner should use rather than floaters.

Capturing a patient’s choice of words tells them that the optometrist has listened and understood, Ms Morgan observed.

“I think mirroring the language the patient has used is very important,” she concluded.

Beyond comfort zones

Optometrist Gordon Ilett is an AOP Board member and was recently elected chairman of the eye care charity, SeeAbility, after serving as a trustee for eight years.

Mr Ilett highlighted that children with learning disabilities are 28 times more likely to have a problem with their vision, while adults with learning disabilities are 10 times more likely than the general population to have a vision problem.

Testing the vision of patients with a learning disability often involves an optometrist stepping outside of their comfort zone, Mr Ilett said.

Alongside communication challenges, there may be complex visual problems and difficulties examining the patient.

“When you start seeing patients with complex learning disabilities you will feel a little bit out of your depth. That is OK,” he emphasised.

“Remember that you are the person who is having a go and therefore you are doing more for than many others have done in the past,” Mr Ilett added. 

When you start seeing patients with complex learning disabilities you will feel a little bit out of your depth. That is OK

Advance preparation

Asked for his advice on communicating with patients with learning disabilities, Mr Ilett advised finding out their preferred method of communication in advance of the consultation.

This can take the form of a pre-assessment questionnaire – for example, SeeAbility has a Telling the optometrist about me form that can be downloaded online  

During the examination, the optometrist should take care to communicate directly with the patient rather than a person who is accompanying them.

Mr Ilett also stressed that optometrists should not assume that patients unable to communicate verbally do not understand what is being said.

“They may understand everything that is going on and wish to give you a response,” he shared.

The person accompanying the patient may be able to inform the optometrist about how the patient is responding – for example, through sign language, a smile, blink or facial expression.

Mr Ilett said that when seeing patients with learning disabilities, it often helps to keep the questions short and relatively direct.

Restating a question in a different way if a patient does not respond immediately can be confusing for someone with a learning disability, he shared.

“One of the characteristics of a learning disability is that it takes you longer to process information. Give the person time to understand what the question is,” he said.

“If you change the language that you use then it can become a different question that then takes longer to process,” Mr Ilett added.

Mr Ilett shared the importance of communicating the next steps in a sight test to avoid alarming a patient.

Patients with autism often feel uncomfortable when their personal space is invaded, he said.

“You have got to be a bit careful about letting people know when you are going to be coming close to them,” Mr Ilett shared.

Optometrists should also remember to give adequate warning in advance of the lights being turned off in the consultation room.

“It can be scary to turn the lights off on people – it is not often that you are plunged into darkness,” Mr Ilett observed.

I am now much more comfortable in knowing what those tests are for and I am able to spend longer communicating with the patient

Lessons over time

Over the course of his career, Mr Ilett has become more aware of the importance of good communication in practice.

He said that as a young practitioner he was very conscious of performing the function of carrying out the necessary tests and filling out the requisite boxes.

“I am now much more comfortable in knowing what those tests are for and I am able to spend longer communicating with the patient,” he shared.

“It makes you more successful because people understand the advice that you are giving and are likely to follow it in an appropriate way,” Mr Ilett concluded.

Image credit: John Holcroft