Off the Cuff: When Patient Education Misses the Mark

A few weeks ago I was flying home from the SECO meeting in Atlanta. We had some impressive delays due to tornadoes and thunderstorms in the area, but eventually the flight was cleared to head to Phoenix. (Thank you to my fellow delayed passengers Drs. Melissa Barnett and Doug Devries for the company.) Once seated, the lady sitting next to me began telling me about how she was flying to Phoenix to help her daughter, who had recently graduated college, find an apartment. She told me about her son, her husband, where they lived, what she did, what her husband does, etc. for hours. Oddly, she never told me her name.

Once she found out I was an eye doctor, she was telling me how she had cataract surgery even though I already knew from the pupil sparkling off her IOL. She had gotten the Panoptix multifocal IOL but she was seeing halos and glare, and thought something was wrong. Her surgeon had recommended an YAG capsulotomy, but she was going to get a second opinion before she did that. I asked why. She said, “He explained the cataract was like an M&M. He said he opened the front of the candy shell and took out the chocolate. Now he says he wants to laser a hole in the back of the shell. Why would I let him do that when he already took out the best part of the M&M?” I had never heard the M&M reference before. I understood her surgeon's analogy, but I also understood her confusion with the removal of the “best part.” After telling her the cataract surgery process, optical properties of multifocal IOLs, and what a posterior capsular opacity was without confectioners’ references, she said she finally understood and would get the YAG when she got home.

I pride myself on my patient education. To hear this obviously intelligent woman be told her crystalline lens was like an M&M and be left in total confusion, feeling quite smug, I was blaming the surgeon and his seemingly lacking patient education skills. But yesterday, I got my own smugness put in check. A long-time glaucoma and keratoconus patient that I had seen for years called saying I never told her she had glaucoma. She was freaking out. She was seen at another office because she was unable to get an early appointment at our office. I looked at her record, and she was clearly diagnosed with low tension glaucoma and educated multiple times. I had reviewed multiple tests with her. We had modified medications a few times. My best guess is that she confused low tension glaucoma with not actually having glaucoma since her pressures weren’t high. Who knows?

That interaction yesterday made me think of my seat mate's cataract surgeon. Maybe his education was spot-on but this patient didn’t or couldn’t hear it because of the idea of surgery…on her eyeballs, all the lens options being thrown at her, laser versus manual surgery, financial aspects, the idea of not having to wear glasses overriding it all. I know with Dr. Epstein’s doctors visits in the six months before his passing and even with my own visits, when the news is unexpected and/or overwhelming, all the patient education in the world won’t connect when all the thoughts are churning in your head while you simultaneously acknowledge the doctor is still talking, and you’re obviously missing something important. Sometimes patient education can miss the mark when patients are unable to process or even hear the intended message, regardless of our best efforts.

Shannon L. Steinhäuser, OD, MS, FAAO Chief Medical Editor ssteinhauser@gmail.com

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Write to Dr. Shannon L. Steinhäuser, OD, MS, FAAO at ssteinhauser@gmail.com. The views expressed in this editorial are solely those of the author and do not necessarily represent the opinions of Jobson Medical Information LLC (JMI), or any other entities or individuals.