It’s good to talk, but you have to get your message across when you converse with your patients. ESCRS Practice Management and Development Programme Manager Colin Kerr reports.
Rod Solar,Director of Practice Development Consulting, LiveseySolar
As the COVID 19 pandemic continues to restrict interactions between ophthalmologists and their patients, social media is becoming increasingly important for surgeons who need to reach out to their patients in the new era of social distancing and restricted movement.
Many opthalmologists are doing this through Facebook, LinkedIn, Instagram, Twitter and other platforms but are they reaching their targets?
“You have to be really clear about what social media is about and how it’s not just media, but it’s also social,” says Rod Solar, Director of Practice Development Consulting, LiveseySolar.
” The key thing to remember there is that it’s a conversational medium, it’s an interactive medium. It’s good that ophthalmologists are using social media, but what they are doing is that they are using it like a broadcast medium. So, they put up a picture, they put up a video, they put up a post and they say: “Here is my message to the world.”
“What they are not doing,” says Solar, “is engaging in conversations. They are not asking questions, they are not challenging people to respond, they are not inviting people to take some small action. What you need to do with social media is not only post your own material, you also have to request commentary, you also have to engage in conversation and not only that, you have to go onto other social media properties and engage in the conversation elsewhere.”
Traditionally, the only point of contact between a patient and the ophthalmologist was by phone. According to Solar, one of the key things to remember in the new era of social media is that the job of an ophthalmology practice staff member who may answer the phone, is not just to answer the phone but to also engage in the conversation on social media in, giving them the tools to interact with patients where they want to talk.
“For example,” he says, “in the past we had our practices in a specific location and people had to come to that specific location to talk to us after they had telephoned us for an appointment. These days with the internet and social media we have the ability to interact with people in so many different areas and that is what they expect from us. Long gone are the days when the only way of handling patients was on the telephone.”
Solar also stresses the importance of engaging with patients through online questionnaires.
“This helps ophthalmologists to understand what the patient’s issues are, how they assess their vision now and what kinds of problems they have. Once they fill in that form, we guide them with logic to proceed to whether or not they are qualified to go ahead with a consultation or whether we should guide them to another location or another service or just some general information online about what they might need. That way we are using the internet to triage people before we invite them to a consultation. That helps us to exclude people who are not suitable for consultation and it also helps us to educate people so that by the time they get to the consultation they are well-informed.”
When patients are shopping online, one of the first questions they will want answered is how much will these goods or services cost? Some ophthalmologists may be reluctant to have this conversation for both practical and ethical reasons, but Solar says it’s important to be upfront about the costs of specific procedures.
“The surgeons I work with value quality over quantity and being upfront about yours costs, in my opinion, is a mechanism for demonstrating your quality,” he says. “Some people may equate cost with quality. If they see something with a low price tag, they will immediately assume that the quality is poor. If they see something with a higher price, they will assume that the quality is sufficient to warrant that higher price.”
* Rod Solar, is Director of Practice Development Consulting of LiveseySolar . This article is based on a EuroTimes Eye Contact interview available on the ESCRS Player at https://player.escrs.org/eurotimes-eye-contact/how-can-i-market-my-ophthalmic-practice-rod-solar-paris-2019
Award highlights innovations from ophthalmologists and their practice staff
Julien Buratto, winner of the 2019
ESCRS Practice Management and
Development Innovation Competition
It’s time to get your entries ready for the second annual ESCRS Practice Management and Development Innovation Award. Intended to highlight innovations from ophthalmologists and their practice staff, entries for 2020 must focus on a recent innovation that’s been introduced into the practice, including activities to help your practice and patients cope with the Covid-19 pandemic.
From the addition of plexiglass barriers, masks for patients and re-arranging waiting rooms, what are the ways that you have adapted to deal with the pandemic, while making patients and staff feel safe and welcome? This year’s Innovation Award is an opportunity to share the creative ways that ophthalmologists in Europe have risen to the challenge of Covid-19.
The ESCRS Practice Management and Development Committee created the Innovation Award in order to provide a platform for ophthalmologists to demonstrate to colleagues their entrepreneurial and marketing skills used in their clinics and practices.
The entry can focus on any aspect of clinic operations or community outreach, but it must be proven and measurable — both in qualitative and quantitative terms.
For this year, the Practice Management and Development Committee will select a shortlist of entries, who will be invited to present their projects at the 38th annual meeting of the ESCRS in October in Amsterdam. The winner will be chosen by audience vote and will receive a €1,500 bursary to be used to attend the 39th ESCRS, scheduled for Barcelona in 2021.
You can find more details on the competition, as well as how to enter, by clicking on the link here.
Shortly following the WHO announced a global pandemic, we locked ourselves in a room for two full days to map out the future for our cataract and refractive surgery clients. We resolved to make informed predictions of how the COVID-19 Crisis will impact the elective surgery market in the short and medium-term and what this could mean for you and your practice, clinic or hospital.
We developed a solid framework to help practice owners strategically plan for the expected (and predictable) changes that are coming. With this information, we hope that you can take strong and specific actions to help you maintain and protect your practice (which in this economy would be an achievement), and could even enable you to achieve modest growth.
Don’t react. Respond
We all have a lizard brain, a monkey brain, and a visionary brain. Be diligent not to stimulate your lizard brain – the one that makes you fight, flight or freeze. Resist the comfortable denial of the monkey brain – this is not the time to blindly do what others do.
Instead, it’s time to stay in your visionary brain as much as you can. It will be hard. The choices you’ve made and will need to make will tax your resolve. Your visionary brain that likely led you to start your practice in the first place. That’s the calm, deliberative, creative, and optimistic brain that asks – “what do I want to see in the world, and how do I want to engineer it?”
Phase 1: Denial (1-2 weeks before your shutdown)
In the denial phase, your market is conducting “business as usual”. People are distracted, but they’re carrying on. This group is in full-on monkey-brain mode and is carrying on as they always have done. These folks will keep their appointments because, for them, nothing has materially changed. That is the minority, and they’re typically younger Millennials – your LASIK market. If your country is in Phase 1, you have an immediate opportunity to help some patients but you need to act now.
Phase 2: Panic (two to three weeks of shock)
During this phase, there is an immediate and sudden contraction of supply and demand for elective healthcare services as physiological, and safety needs supersede everything else. Your inquiries will likely slow to ZERO in this phase. Don’t market to anyone in the panic phase. The key at this time is to prepare appropriately for the next three phases.
Phase 3: Boredom (six to 12 weeks after your shutdown)
In the boredom phase, people will be hungry for information and entertainment that distracts them from current events and the sheer monotony of life inside four walls. This is your chance to create and disseminate content that is either informative, educational or entertaining while maintaining a sensitive tone to current affairs – less aspirational, more grounded in utility. Most importantly, make this content interactive.
Phase 4: Hope (One to 16 weeks from your shutdown)
After 12 to 16 weeks from your shutdown, we will be through the worst of it, and people will begin planning for their future. There will likely be steep economic decline followed by a period of bumping along the bottom, like an aeroplane, struggling to take off.
Hear me now and quote me later – this recession will likely mark the end of elective surgery as a commodity. Position it as a luxury and adjust your service-level accordingly.
Phase 5: The ‘new’ normal (four months from your shutdown up to two years)
In February, I’d only read the phrase “social distancing” once. Now, it’s everywhere. And unless experts’ most optimistic models come to pass, we should expect to be subject to social distancing.
Consider a typical reception/waiting room that’s about 7×7 metres (23×23 feet) with 32 chairs all neatly placed together – set mere inches apart. Now take those chairs and distance them by 6 feet/2 metres each – in every direction. Now, in a space you could fit 32 people, you can only fit nine chairs. Your reception room capacity has just reduced by 72%.
Another point worth mentioning is, no matter how safe you feel your environment is, people who’ve avoided restaurants for two months aren’t about to go out for dinner twice a week. If you decide to do anything this week, add video appointments to your service offering. Before the Coronavirus, they were already becoming a standard feature in today’s society – particularly the health sector. Today, they are a must if you want to protect your patient pipeline during the coronavirus crisis shutdowns, and beyond.
Now is the time to help, to share, and to support each other through this challenge.
* Rod Solar, is Director of Practice Development Consulting of LiveseySolar
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Some tips to make the patient experience easier
Most of us have a complicated relationship with time. We willingly spend it, save it, kill it, but nobody likes wasting it. And waiting for an appointment often feels like time wasted. In a perfect world, every ophthalmologist patient would arrive on time, be seen within 10 minutes and leave the clinic with thoroughly positive feelings about the experience. That’s certainly a goal worth striving for and there are lots of online suggestions to help you achieve it. This is one. And this is another.
But a late patient, an emergency, a complication can block the best-laid patient flow. What then?
If a wait is unavoidable, the best plan B is to make the delay seem shorter than it is. The waiting room facilities are key. I know because the waiting room of a practitioner I visit occasionally is a textbook case of what can be wrong. A gruff ‘take a seat’ floats up from behind the bunker that is the receptionist’s station when a new patient arrives. Behind this bunker, which takes up most of the available floor space, the receptionist is cut off from the patients, lifting her head only occasionally to call out a name. Metal chairs are strung out along the wall where patients perch like birds on a wire. There’s nothing to look at on the walls bar flu vaccine posters. Magazines are stacked high, some so old you can still join the debate on whether Prince William will ever marry Kate Middleton. A TV plays forlornly and unwatched.
What I’d like would be good Wi-Fi so I could work on my phone or iPad while I wait. I’d appreciate comfortable chairs, grouped informally. Some green plants would make the room seem warmer, along with an interesting painting or wall decoration. A few attractive ‘coffee table’ books would be diverting. There would not be a TV, though low background music would work. Crucially, the receptionist would know my name, let me know if the wait was going to take longer than 10 minutes and apologise sincerely if the wait, however unavoidably, goes into overtime.
A simple formula for improvement of the waiting room is covered in this article – which has checked just about everything on my wish list and a few things more. It works off the premise that the place where the patient experience begins should be considered the ‘reception area’ not the ‘waiting room’. When the mindset shifts from the practitioner’s viewpoint of ‘waiting’ to the patient-oriented concept of ‘reception’, the way forward seems a bit clearer.
You never have a second chance to make a good first impression
Time was when a good bedside manner was something a physician had or didn’t have, like a great smile or a firm handshake. Doctors equipped with natural charisma were assured of a loyal band of patients. Others settled for grudging respect. Today ‘bedside manner’ has morphed into ‘patient-physician communication ‘. It is no longer an optional extra, nor is it restricted to the bedside. As technology plays an ever-greater part in practices such as ophthalmology, the need for the human interface becomes ever more evident.
The concept of the bedside manner’ dates back to the late 19th Century, when a Dr Osler brought trainee doctors into the hospital to see and talk to patients – and the system of ‘internship’ was born. Ever since, patients have come to expect good communication with their doctors. And they’re right to do so. Research confirms that a good bedside manner measurably affects outcome.
Unhappily, this need goes hand in hand with more pressure on the physician for the finite amount of time he or she has available to spend with each patient. In one disastrous attempt to bridge the gap, a California hospital made video recordings to be played to the patient in place of an ‘evening round’ by the doctor. As a result, one patient was reminded via a video recording that he was past medical help. The patient died the next day but family members who were in the room when the video played never forgot the shock. (The hospital apologised.)
And here’s an account of one patient’s experience with an ophthalmologist. The doctor’s excitement at discovering that his patient had a very rare condition coupled with his enthusiasm for sharing the discovery with his staff made him forget he was dealing with a human being and a very vulnerable human being at that.
While the ophthalmologist’s practice may not focus on literal ‘bedside’ scenarios, the need to reassure and connect with patients is as compelling as in any other practice. In his popular blog, Dr Ron Rosa OD offers specific suggestions for the ophthalmologist to consider. They range from the surprising – “Beware of your posture” – to the challenging – “never stop caring”. More generalised tips are here.
Perhaps the most useful thing to keep in mind is that you never have a second chance to make a good first impression. Get the patient’s name right, call them by their last name plus Mr or Mrs (unless they are under 18 or you’re invited to use their first name). Look interested. Don’t retreat behind a screen more than necessary. And remember that a sincere smile and a welcoming handshake still set the tone for a successful ‘bedside manner’.
How to give up on giving up
Did you know that the 12th of January is ‘Quitter’s Day’? According to a survey undertaken by Strava, 12 days into the new year is the day most people give up on their new year’s resolutions.
I’ve skirted that disaster by not having started yet. My resolve is to read the Guinness World Records’ longest novel. It’s Proust’s In Search of Lost Time. I downloaded it in its entirety to my Kindle for a mere 42 pence. That was the easy part.
As an ophthalmologist your resolution may focus on achieving a satisfactory work/life balance. A recent edition of EuroTimes Eye Contact took up that question. Sorcha Ní Dhubhghaill talked to Luke Sansom and Joséphine Behaegel about the challenges facing ophthalmologists in finding a work-life balance. They stressed that cooperation and understanding between physicians and their family members was essential to achieving this goal. The Mayo Clinic offers advice too. This article on work/life balance for the physician suggest some practical approaches.
Whatever your resolutions, you’ll go farther if you take small steps. Research (Int J Psychiatry Med 2012;43(2):119-128) suggests a better work/life balance could start with an introduction to mindfulness; first step: to research resources near you. Mindfulness can be learned on your own, through books, apps or YouTube videos but good instruction speeds you on your way.
Don’t insist on going it alone. Ask for support. Just as work/life balance requires the cooperation of family and friends, a resolution to improve the business side of your ophthalmology practice, would involve your co-workers. Patient satisfaction or dissatisfaction often begins at the door with the ophthalmologist’s assistants and receptionists.
No matter what your goal, there’s an app for keeping track of your progress. One of the most popular is HabitBull, which is free for iPhone and Android. Another is Strides, which is free on the web. There’s an interesting discussion of the best of apps here.
And there’s an article on the likelihood of success with one of these apps and how to improve your chances here.
As for my own resolution, estimated reading time for In Search of Lost Time is 80 hours. So 13 minutes a day for the next 365 days should do it. Wish me luck.
Maryalicia Post reflects on the lasting impact of a hoof to the head
Someone asked me the other day if I have 20/20 vision. And actually, I don’t know. What I can say is that I can see quite well as soon as I get my eyes ‘tuned’. That requires me to tilt my head slightly to the left and down, which – I like to think – gives me the appealing look of an alert robin while at the same time bringing the two eyes into agreement as to where things are.
I must say I don’t much notice this procedure. I’ve been ‘tuning’ them for decades – ever since I had the misfortune to fall under a galloping horse and get hit in the head by a hoof. The little crescent on my velvet riding cap marked the point of contact. The broken stirrup strap explained the fall. When I woke up in hospital about six hours later my right eye was stuck up in the corner of my eye socket and remained there for six months.
I wore an eye patch during that half a year. As I was still smoking small cigars then I made a lasting impression on those who met me for the first time. Another thing that has been remembered – by those for whom I poured a cup of tea or coffee in those days – was how they had to position their cup under the spout of the pot so that what I poured landed in the cup some of the time.
During those six months, I met a lot of friendly fellas at the eye hospital In Dublin; mostly hurlers who had been clobbered with a hurley stick. Not many years afterwards, the first steps were taken to reduce the number of eye injuries hurlers used to accept as par for the course. We enjoyed our sessions in front of a device trying to bring two sets of drawings into one, exchanging comradely high fives when we came close.
As for me, I’ve given up horses (and cigars). I’m planning to channel my inner robin and focus, on the garden.
It’s a jungle out there. I’ll keep my eyes tuned.
EuroTimes Executive Editor Colin Kerr remembers Sir Harold Ridley and a momentous moment for the ESCRS
The end of every year is a time for reflection, for looking forward to a new year and looking back on the year gone by. Some people will look further back, maybe to a previous decade or a decade before that. So as we say goodbye to 2019 and look forward to 2020, let’s go back a little further, to 1999.
This was a momentous year for the ESCRS and in particular for the then president Thomas Neuhann MD, who presented Sir Harold Ridley with the Grand Medal of Merit in Vienna in 1999.
The story behind that great event is recounted by Dr Neuhann in an extract from European Society of Cataract & Refractive Surgeons – A History (Gill & McMillan 2013).
The 50th anniversary of the intraocular lens accorded me the extraordinary privilege of honouring Harold Ridley,” he says. “The occasion deeply touched my heart. His IIIC had been more a conspiratorial circle than a society and now, the whole thing having come of age, the ESCRS was a well-regarded worldwide society and lens implantation is learned in residency. And he had lived to see that happen.”
It was on that occasion that Dr Neuhann came up with the idea of the Grand Medal of Merit, to be an extraordinary distinction not to be awarded every year but just when there is an outstanding personality. “And I had the honour to present the first Grand Medal to Harold Ridley,” he says. “It is unusual for an eye doctor like myself to feel the breath of history. That was one of those rare moments.”
Dr Neuhann met Harold Ridley on the 40th anniversary of the IOL in the US, before meeting again on the occasion of the 50th anniversary. “It was not long after that,” says Dr Neuhann, “that I realised that every country in the world had paid respect to him with the exception of Great Britain, I still have to laugh that I had the courage — some might even call it arrogance — to write to the Right Honourable Mr Tony Blair, prime minister to the Queen. I proposed Ridley for the honours list of the following year, pointing out we were lucky he had lived over 90 years, and urging that he be paid the honour that was due while he was still alive.
“I learned after some time, that he got his knighthood. Ridley was a role model to me, scientific yet practical and with the courage of his convictions: Ridley stood his ground through all the bitter moments of disrespect, which as we know today was not proof that his invention was unworthy — but said more about the limited intellectual capacity of his critics. His set an example which can serve as an inspiration: while you should always be open to learn you are on the wrong side, as long as no one has a better argument — stick to your convictions.”
Truly original changes need a particular kind of environment
Does regulation result in decreased levels of innovation? Looking at the history of ophthalmology, one has to wonder if the advances made by the greats such as Harold Ridley and Charles Kelman would have been possible if the arms of medical ethics and safety were as prevalent as they are today.
“Things were different in those days,” said Prof David Spalton in a EuroTimes Eye Contact interview with Paul Rosen MD. “These days, with ethics and regulation – I think there’s always room for someone with a brilliant new idea to do things differently, but I don’t think anyone could do it in the same way that they did, which was really without any ethics, consent or that sort of thing.
“It’s a good thing now, things are better regulated and that must be in the patient’s interest.”
Harold Ridley, who first saw the possibilities of intraocular lenses and indeed brought them to reality, performed his first operations in secret, such a revolutionary procedure it was at the time.
It’s important to remember that while the reward was truly great, for many millions of patients, there was also substantial risk in his novel idea. “Had Harold Ridley’s first operation gone wrong, we might not be here,” said Prof Spalton.
Indeed, the materials used to sterilise early PMMA lenses leached into the eye, causing anterior uveitis, to give just one example of something that could ideally be prevented by regulation. “Times were different back then – surgeons had an idea and they could try it out and experiment,” adds Prof Spalton.
Charles Kelman, a showman by nature as well as being a pioneering ophthalmologist, took the opposite approach, going on television talk shows to expound about the possibilities of his approach, which he famously arrived at after many failed attempts over a course of nearly three years searching for a method of cataract removal that would require no hospitalisation.
It almost goes without saying that phacoemulsification is now the norm, and advances like femtosecond laser-assisted surgery have been shown only to be as good as phaco.
It’s unclear what the next major change in ophthalmology will be, but artificial intelligence is sure to play a part, Prof Spalton believes. “Automation, robotic surgery is coming in, and we’re going to see that taking an increasing role.”
He also suggests that eye trackers could be combined with femto lasers for lens removal. Maybe not just yet, but the rate of progress to date has been such that nothing can be ruled out.
Whether such things will be helpful in creating a truly accommodative lens, the next hurdle for ophthalmology according to Prof Spalton, remains to be seen. The only change we can be certain of, is change.
Maryalicia Post shares some hard-earned tips for visitors to the French capital
What do Gene Kelly and I have in common? Singing? Dancing? No, and not a cheeky grin either. He and I were each An American in Paris. In his case it was for two hours in the famous film; in mine it was for six years in real life. In that time I made a few observations that might be helpful to anyone planning a visit. I realise they are only my conclusions seen through the lens of my personal experience, but if they’re of any use to you – you’re welcome.
1) The French are ‘serious’… by which I don’t mean they are reluctant to laugh. I mean shop attendants, waiters, bus conductors et al seem to have a more professional approach to their job than you might find elsewhere and expect to be treated with due courtesy. On going into any shop greet the staff with ‘bonjour’. (If there are other customers include them with a smile). In a bakery, for example, do not rush in and snap ‘one croissant’. Start with Bonjour and end with Merci.
2) You can’t go wrong if you wait to be shown where to sit, even in an informal cafe. If in any doubt, just stand and look bewildered; someone will point you to a seat, and you’re off to a good start.
3) Don’t feel rebuffed if sales attendants ignore you. In most cases the custom is for them to be available when/if you want help and to stay away until addressed. And, nothing personal, but a French waiter is not automatically your new friend. A smile may not be on the menu.
4) Expect your appearance to be checked out by both men and women in public places like the Metro. Parisians go to some trouble to look their best and assume you do too; being invisible is not the goal.
5) In general, don’t go looking for examples of ‘how rude the French are’. Don’t construe a runny omelette, bloody lamb or smelly cheese as indifference. Au contraire. It’s the way ‘they’ like it and they assume any reasonable person would as well. Make a polite request for a change if necessary.
6) Use whatever French you have. I got used to asking a question in French which would be answered patiently in English, leading to my next question in French, also answered in English… a kind of bilingual duet. When the answer comes in French, buy yourself a drink.
7) If you can’t walk to your destination even in your most comfortable shoes (which you should bring for this very purpose), take the Metro. The best reason for taking the Metro is to avoid taking a taxi. Here’s a useful Metro guide.
8) Are there really rude people in Paris? Oh yes, and they all drive. If you take a taxi you may well find yourself up close and personal with a very rude person indeed. He or she may pretend not to know where you want to go – I always write out the destination and show it in advance – or will bury you under an avalanche of explanations in French as to why he or she is approaching the city via Versailles. Meanwhile, the meter runs on. I pre-book a car to meet me at the airport as this scam seems endemic at CDG. However, if you must, well, c’est la vie. Here’s a good guide to taking a taxi in Paris.
Bon voyage and merci.