What Do You Recommend?
Effectively explain your recommendations to patients by balancing confidence, communication and personal connection.

Time and time again, a successful doctor-patient relationship reinforces the truth that what you say is as important as what you do. In fact, what you say is sometimes more important!

I've heard patients say, "You should see my optometrist -- I love her!" How does a doctor earn this kind of enthusiasm? Most likely, patients don't know the doctor's GPA, board scores or successful treatment rates. What they do know is that the doctor made an important connection -- a connection built on clinical care that incorporates:

• Confidence in the testing, diagnosis and treatment plan
• Effective and sensitive communication of these elements
• Personal rapport between doctor and patient.

These traits aren't gifts; they're skills that each of us can develop.

Learn all the time

For those of us "works in progress" who want to enhance our communication skills, where do we begin? First, understand your own communication style. The Myers Brigg Personality Inventory is a good tool to use.

Second, become astute at assessing each patient's preferred communication style (best done by listening), and then customize your approach to each patient.

If you're committed to adapting your communication style to the patient in front of you, you're almost assured of having the patient follow your recommendations.

	When a child has a vision problem, you need to reassure parents the problem isn't their fault and you're going to partner with them through the next steps.

Address the first complaint first

According to focus groups, a common frustration among patients is a provider who doesn't clearly address their chief complaint and give them a confident recommendation. For example, consider a patient who visits your office for a routine exam with a chief complaint of decreased near vision. Even if you diagnose glaucoma during the exam, you don't want the patient to leave your office without knowing whether to update his or her spectacles prescription.

While you're summarizing your findings and discussing recommendations, most patients are listening for information that addresses the main reason they visited your office. To make good use of your time and theirs, begin your summary with that chief complaint. Quite simply, keep the main thing the main thing.

Remember that you're the expert

When you visit your primary care physician with an upper respiratory infection, does the physician list your antibiotic options and ask which one you'd like to take? I didn't think so.

Eyecare providers are notorious for doing just that. For example, you've probably heard a colleague ask, "Would you like contact lenses that you change every day? Every week? Every 2 weeks? Every month? How about every 3 months?"

It's much more efficient and effective to say, "We have contact lenses that can be changed from every day on up. After evaluating your vision and eye health, I recommend that we start with a 2-week disposable lens. At your follow-up visit, we'll check that it's working. If not, we'll consider other options."

When we deliver our recommendations, it's essential to avoid putting the decision on the patient. We're the experts, and patients want us to make the decisions. Some patients might ask for other options, and we can be ready to explain them. In fact, it's comforting to patients to hear that there are other alternatives if the first choice isn't effective.

What about those difficult recommendations?

When you're delivering your recommendations to patients, some situations require more finesse than others do. In my opinion, two situations provoke either an emotional response or surprise and confusion: 1) discussing children and 2) reporting ocular findings that point to underlying systemic disease.

When you tell parents that their child has a vision problem, you need to reassure parents that 1) the problem isn't their fault, 2) a vision problem typically won't cause loss of sight and 3) you're going to partner with them through the next steps.

Whenever patients have something wrong with their eyes that suggests a systemic etiology, the conversation becomes more challenging. Patients don't come to their eye doctors expecting to hear that what they call "poor side vision" is due to a cardiovascular event they didn't know they'd experienced.

It takes more skill and preparation to have this discussion. Take a few minutes to think about your delivery, anticipate questions and prepare your responses. Additional testing or consultative appointments will take time. Your job is to keep track of those appointments, integrate the data and continue to be supportive as the scenario unfolds for your patient.

Leave patients satisfied

Patients need to be clear and confident about your recommendations when they leave the exam room. When I'm satisfied that they're satisfied, I often give them supporting documentation, such as brochures, to take home. If I want patients to have other information, I find it on the Internet and mail it to them after the visit.

I also see patients out of the exam room myself. I try never to be too busy to escort a patient to the contact lens department, the optical boutique or the checkout desk. I want to be able to shake her hand, receive a hug or simply do what it takes to communicate how much I appreciate the chance to care for her.

It's also important for patients to have a way to follow up. I always tell them, "Remember, I'm never more than a phone call away." They're confident in my recommendations because they know how much I care.

Dr. Hoscheit practices at Summit Eye Associates in Gastonia, N.C.