Achieve buy-in to prescribed management via these action steps

An Optometric Management reader recently asked me for advice on the question, “Do I really need drops?” from a glaucoma patient who received her diagnosis from a separate doctor. Apparently, that doctor didn’t convince her of the drug’s necessity. I think this common scenario illustrates the importance of enhancing patient relationships.

To accomplish this, I recommend these three action steps, which have enabled me to get patient buy-in to treatment.

1 Establish trust

To build a relationship of trust, I have listened to patient concerns and verbally recognized the challenge of taking treatment every day for a commonly asymptomatic condition. Also, when seeing a previously diagnosed patient, I have reassured them that their former provider’s recommended treatment was based on their evaluation and testing. (Regarding this latter point, I have found that speaking ill of a colleague is a quick way to lose patient respect and trust.)

A patient script that I’ve found establishes patient trust:

“Mr. Jones, we are glad that you are a part of our practice, and we really appreciate the information that you have provided regarding your glaucoma diagnosis and prescribed treatment. It can be challenging to take drops every day for a condition that we may not feel and may not specifically notice in our vision until its more advanced stages. It looks like your previous doctor has done a great job with the testing needed to help develop a treatment plan for you.”

2 Make the diagnosis

To determine whether the patient does, indeed, have glaucoma and need treatment, I have asked myself these questions:

1. How does the optic nerve look? Does it show characteristic glaucomatous damage? (See “Recognize Optic Nerve Damage,” at bit.ly/OM2301GlaucomaColumn .)
2. How does the VF and OCT testing look in the context of the optic nerve evaluation? Is there S3F correlation? (See “Look for Context and Correlation,” at bit.ly/OM202303GlaucomaColumn .)
3. Is there sufficient, reliable data (pre-testing IOP levels, gonioscopy, pachymetry, etc.) to form a correct diagnosis and recommend appropriate, sufficient treatment?

A patient script I’ve used to illustrate the need for drops:

“Mr. Jones, based on your previous records and our evaluation today, I can see why your previous provider was concerned about glaucoma. At this time, I’m recommending you use the prescribed drops. Within a few weeks, I’ll repeat a few of these important tests to ensure that their results are repeatable and reliable. Additional testing helps increase certainty and can help us better decide whether you’ll still need to use these drops.”

3 Readjust, if necessary

To determine whether to readjust disease management, I have asked myself:

1. Does this patient need treatment after all?
2. IF yes, is the current treatment sufficient?

A patient script to communicate my findings, to obtain patient buy-in:

“Mr. Jones, now that we have been able to repeat some important testing, and based on your age and stage of glaucoma, I’m recommending we continue/discontinue/increase your treatment at this time...”

Getting buy-in

These action steps have enabled me to increase the likelihood of patient compliance. OM

DR. LIFFERTH is clinical editor of Optometric Management. He practices at Center for Sight, is a member of the Optometric Glaucoma Society, and a Glaucoma Diplomate of the American Academy of Optometry. For additional glaucoma cases, you can also follow Dr. Lifferth on his Instagram account: glaucomaqd. Email him at glaucomaqd@yahoo.com.