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Where Have All the Billions Gone?
When it comes to eye care, arm your patients with reliable information.

What's the most pressing problem in health care today? According to Arthur Caplan, it's the scarcity of reliable information that "consumers" need when choosing a doctor or understanding a procedure. We don't know what we're getting for the billions of dollars that we spend on healthcare each year, he says. "It's a scandal," he concluded in a recent issue of Philadelphia Magazine.

We could easily dismiss his comments as those of a headline-grabbing consumer activist, except that Arthur Caplan directs the University of Pennsylvania's Center for Bioethics.

And we could argue over the use of the word "consumer" instead of "patient." But the point remains: Across the entire healthcare spectrum, no party, including doctors, communicates to patients the value of healthcare services. Or, to put it another way, doctors have an opportunity to improve the healthcare system by educating patients.

The challenges of education

As Sarah Marossy, O.D., notes in this month's cover feature, "Contact Lenses vs. Surgery," beginning on page 34, patient education presents several challenges in eye care. First, optometrists must overcome a time trap. It would take more chair time than most practices could afford to explain all the vision corrections options available, from eyeglasses to contact lenses to surgery. (See Dr. Marossy's article for solutions to this dilemma.) Using years of education and practice, the doctor can narrow down the choices to those that are most appropriate for the patient.

In limiting the choices, the doctor may not present every option available to his patient or explain why some modes of vision correction are more appropriate than others for this particular patient. This leads to another challenge: The doctor's professional recommendations don't always meet the patient's expectations, which are often based on far less clinically reliable sources, such as advertising, friends and family. ("Aunt Bertha says I should try LASIK, but my doctor never mentions it.")

Cover the bases

Ideally, the patient leaves each office visit understanding which modes of vision correction are appropriate and which are not. The patient is ready to enthusiastically pursue (or continue) the recommended course of treatment. In the eyes of the patient, both the doctor and staff demonstrate their expertise and communicate the message that their practice provides unsurpassed levels of care.

Anything less might result in a scandal.