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Taking the Wait out of Waiting Room

Some tips to make the patient experience easier

Maryalicia Post

Posted: Monday, March 2, 2020

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.

I’m certainly not alone. There are some excellent observations on the waiting experience here and a report on a study into the subject here.

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.

Bedside manner

You never have a second chance to make a good first impression

Maryalicia Post

Posted: Thursday, January 30, 2020

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’.

Steeling your resolve

How to give up on giving up

Maryalicia Post

Posted: Sunday, December 29, 2019

Photo by Jude Beck on Unsplash

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.

Fine-tuned vision

Maryalicia Post reflects on the lasting impact of a hoof to the head

Maryalicia Post

Posted: Friday, December 13, 2019

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.

Times move on but ocular damage due to sport continues. Paintballing is among the newer hazards. And so are the bullets and darts from the popular children’s toy, the Nerf gun.

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.

An innovator and a role model

EuroTimes Executive Editor Colin Kerr remembers Sir Harold Ridley and a momentous moment for the ESCRS

Colin Kerr

Posted: Thursday, December 5, 2019

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.”

Innovation today

Truly original changes need a particular kind of environment

Aidan Hanratty

Posted: Wednesday, October 2, 2019

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.

Life Behind The Lens – David Spalton (Athens 2019)

Notes from an American in Paris

Maryalicia Post shares some hard-earned tips for visitors to the French capital

Maryalicia Post

Posted: Thursday, September 12, 2019

Photo by John TownerWhat 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.

Leveraging digital media

How one hospital built awareness and leads by drawing from the digital marketing toolkit

Rod Solar

Posted: Thursday, August 29, 2019

I think it’s common knowledge now that if you want a healthy body, there’s no magic bullet. The celery diet is neither sustainable nor effective alone. You need to combine a balanced diet with an active lifestyle, plenty of rest and recuperation, and a positive mindset. It’s this combination that achieves the best results. 

We can apply this concept to your practice. If you want a healthy marketing function, you can’t rely on a panacea to solve all of your marketing challenges. Equally, you can’t expect a shotgun approach to work either – firing as many pellets as possible and hoping something hits. The best results come from a synergy of approaches aimed at very focused objectives. 

In 2018, the ESCRS Practice Management Conference set its attendees a challenge; create a marketing campaign that:

Helps create awareness about the practice clinic;
Results in an increase in inquiries and new patients that translate into additional revenue.

Ready to take on the challenge using a multidisciplinary approach was The Beirut Eye & ENT Specialist Hospital (BESH). 

BESH is one of the top specialist eye hospitals in  the North Africa and the Middle East region. It offers a complete range of services covering all subspecialties in the ever-growing field of ophthalmology.

BESH took the criteria set out by ESCRS and designed a digital marketing mix to generate awareness about glaucoma and promote the company. And it won!

In fact, it exceeded all expectations; reaching thousands of individuals, screening hundreds of patients, collecting data for more than one-thousand patients and scheduling hundreds of follow-up consultations.   

Sharing the company’s success story at this year’s ESCRS will be BESH General manager and Director, Michael Cherfan. 

He will be revealing the company’s winning approach and sharing helpful advice and tips so that you too can leverage digital media to improve awareness of your clinic, increase inquiries, attract new patients and ultimately drive revenue. 

Specifically, he will explain how you can design an interdisciplinary digital platform that focuses on four main channels:

Social media
SEO / Google

By the end of this presentation, you will have the knowledge and awareness of how one clinic completely revamped their digital presence to benefit from improved publicity and more leads.

The ESCRS Practice Management and Development Programme will take place on Monday 16 September from 08.00 – 18.00

An unexpected ophthalmic emergency

Divers come to manta ray's aid as ophthalmology goes underwater

Aidan Hanratty

Posted: Monday, July 22, 2019

Giant manta rays can reach up to seven feet in length. That’s a whole lot of body to come up against whatever ends up in our seas and oceans. One such ray recently found herself with metal hooks in her eye. Thankfully, some conscientious divers were on hand to help out the poor creature.

“I went for a few dives down just to see how she’d react to us being close to her,” said Jake Wilton, photographer and diving instructor.

“This wasn’t my imagination, again and again it came back, turned over, and paused in the water, and – plainly – was looking to us to be helped,” added Monty Halls, photographer, naturalist and marine biologist.

Just like in ophthalmology, the doctor had to gain the trust of the patient.

“Jake went down again and again and again and the animal didn’t move away, because I think the manta knew that Jake was trying to get the hooks out,” Halls said.

He managed to remove the hooks with pliers, to everyone’s relief.

“I went down again one last time to say goodbye – she actually stopped and just waited there,” said Wilton.

“Many divers dive ‘to get away from it all’, to disappear into a place completely separate from the rest of the world,” says vitreoretinal and cataract surgeon and diving enthusiast Leigh Spielberg. “It is a form of escapism into the beauty and silence of the sea.

“One’s day job is usually as far from one’s mind as possible while exploring under water. However, in this video, the divers were confronted with what might be considered an ophthalmic emergency; a hook was lodged in or around the manta ray’s eye,” he said.

“As someone who has operated my fair share of ocular trauma, I am aware of the difficulty and potential danger associated with ocular foreign objects, but these divers, presumably non-ophthalmologists, seem to have done a great job combining their hobby with impromptu ophthalmic care for this gentle giant,” Dr Spielberg concluded.

A message from my potted palm

The prompt I needed to declutter my email inbox

Maryalicia Post

Posted: Monday, June 24, 2019

I got an email from my potted palm the other day. I was reminded of the letters I sent home from summer camp when I was a kid. No preamble, no ‘hope you’re well’.. Just straight into the complaint. The plant was reporting that it was thirsty and needed more sunlight. As it happened, I felt exactly the same, so I could hardly blame the plant. Still, receiving an email from a palm tree reminded me I’d been meaning to cut the clutter in my email box… and prodded me to start looking at all the good advice out there on the net.

If you are finding a marked increase in the volume of your email, it may be helpful to know it’s not you – it’s us. It’s a worldwide phenomenon. As a travel writer, for instance, I’m getting email from the tourist bureau of every place I’ve ever visited including some I hope never to visit again. Although the inbox of an ophthalmologist or other medical specialist is not as overloaded as that of general practitioners, there’s no escaping the trend and the overall trend is up across the board (regardless of your field of endeavour). An article in MD focuses on the physician’s problem and offers suggestions for dealing with it. Another handy list of tips is here.

Perhaps you’ve chosen to offer your patients the option of email communication with you – and there are arguments for and against offering this service. If you have opened email communication with patients, you’ve probably set up a secure email address for the purpose and may well have messages screened by an assistant, which makes life easier. Detailed advice for managing patient emails can be found here.

All this negative talk about emails doesn’t paint the whole picture. One article describes emails as “an exciting landscape of freedom amidst the walled gardens of social networking and messaging services”. It talks about the feeling we all sometimes experience when a welcome message comes bounding in; it concludes that “email is exciting”.

And so it can be. To be honest, I didn’t really mind receiving that message from a thirsty plant and was glad to be reminded to water it (as for the sun shortage, I’ve ordered a grow light). Obviously, I could unplug the Bluetooth-enabled gizmo I stuck in the soil, thus cutting off communication at the root. But I’m not sure I am ready to ghost the palm tree so early in our relationship. A message from a potted palm seems ‘special’, like hearing from a distant star. Come to think of it, I’ll probably find a transmission from a distant star in my inbox one day. And when I do, it will be exciting.