As a practicing ophthalmologist, I saw many patients who had developed blurred vision, glare, or trouble reading. These patients needed to understand that cataracts were the cause of their vision problems and how the cataracts developed and how they should be treated. I would begin the explanation by using a large, plastic eye model to show the lens’s position and how a clouded lens would affect vision. I would then discuss surgery as the proposed treatment. It didn’t take long before my scribe had my monologue memorized, able to repeat my phrases essentially word for word. Realizing this, I could have simply directed the patient to watch a “standardized” video of what to expect when having cataract surgery.
Perhaps this would have addressed my patient’s needs, but would it address my patient’s wants? I do not think so. Patients want more than simply learning about a problem and how to treat it. Patients want reassurance. While I summarized the proposed surgical treatment, I watched for signs of anxiety or lack of understanding. Ultimately, my patient wanted to have confidence that I was the right person for the job and that I would do whatever was necessary to make things turn out well.
I believed that delivering the message personally was important. I was both providing knowledge and gaining trust as I described the surgery and its potential risks and benefits. It has been well documented that patients facing surgery may remember only half of what they have been told ahead of time. Given that statistic, even if patients cannot recall many details, I hoped that my patients felt comfortable that their questions had been answered, that surgery was indicated, and that they were in good hands. I was reminded of the aphorism: “They may not remember what you said, but they remember how you made them feel.”
Finding the right balance between patients’ needs and wants cannot be easily achieved by asynchronous learning from a website. Virtual learning may satisfy a given patient’s needs, but the personal touch goes a long way to satisfying the wants. Making eye contact with my patients and ensuring that all their questions were answered helped in establishing a relationship based on trust. With all the changes occurring in health care, striking the balance between needs and wants becomes an even greater challenge, but taking the time to do so serves both patient and physician well.
Paul Pender practiced clinical ophthalmology for 38 years, specializing in the medical and surgical treatment of eye diseases. He completed his residency at the world-renowned Wills Eye Hospital. His honors include a lecture series in his name by the New England Ophthalmological Society and the Secretariat Award from the American Academy of Ophthalmology for his work on webinars for clinicians.
Pender is passionate about patient-centered care. He believes that the patient-physician relationship should serve as the fundamental building block for health care reform. He is an advisor to Vxtra Health, a company committed to collaborating with physicians to earn trust and to reduce health care costs. By limiting the drain on health benefits budgets by intermediaries (health insurance companies, pharmacy benefits managers, and hospital systems), Vxtra Health establishes a path toward a new model of care, based on price transparency and fiduciary responsibility, starting with self-insured middle market employers.
He writes on timely medical issues on his website, his KevinMD author’s page, and other popular social media. He is the author of Rebuilding Trust in Health Care: A Doctor’s Prescription for a Post-Pandemic America (2020) and the ebook Standing Up and Speaking Out for Patients and Doctors: First Steps Toward Focused Health Care Solutions (2023).
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