Communicating With Your Eye Surgeon
Chat Highlights
October 12, 2005

On Wednesday, October 12, 2005, Dr. Rick Wilson, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Communicating With Your Eye Surgeon."

Moderator:  Tonight's topic is "Communicating With Your Eye Surgeon."  Patients' priorities and assessments of their surgeons depend heavily on the communication between physicians and patients.  Many patients point to a need for improved and clearer communication.  Is more emphasis being placed on that need in the training of doctors?

Dr. Rick Wilson:  I think there is more emphasis on that area than when I went to medical school, but still probably not enough.  The learning and sensitivity training, etc., help, but it all comes down to the personality of the doctor, the time he or she has, and the "chemistry" with a particular patient.

P:  Are all ophthalmologists surgeons?

Dr. Rick Wilson:  All ophthalmologists are trained to be surgeons, but some choose to specialize in the medical or laser therapy of certain diseases, or even contact lenses.

P:  What defines a glaucoma specialist?  Do they all perform glaucoma surgery?  How about cataract surgery?  How do I find out what my doctor's specialty is?

Dr. Rick Wilson:  A glaucoma specialist has trained an extra year just in glaucoma, which may include plenty of glaucoma surgery.  Unfortunately, not all of the general ophthalmology residency programs require enough surgery for the residents to become proficient. Some established glaucoma surgeons can be located on the American Glaucoma Society website: www.glaucomaweb.org. You should know whether the doctor taking care of you is a glaucoma specialist or not.  You can now find that information on the Web.

[Editor's Note: Also try the search feature on the Website of the American Academy of Ophthalmology. http://www.aao.org/aao/find_eyemd.cfm ]

P:  What are the most common forms of surgery for glaucoma?

Dr. Rick Wilson:  Laser peripheral iridectomy, trabeculoplasty, and cutting surgery (trabeculectomy).  Aqueous shunts are becoming more popular.

P:  What questions should patients ask their surgeons before agreeing to have surgery?

Dr. Rick Wilson:  I feel the best approach is for the doctor to provide written literature on the procedure, preferably something he or she wrote.  The patients can then read the brochure several times, so some of it sinks in, despite the adrenalin.  Then the patients can ask their questions.

I often give patients a pen to use to write down their questions, before they return from the waiting room.  Clearly, they will need to be assured that the surgery is necessary, to understand how it works, and to be able to weigh the risks and benefits.  If they have decided to proceed, they need to know what to expect during surgery and the postoperative period.  Usually, the surgical co-coordinator will be able to answer all the logistical questions.

P:  What kind of questions can the technicians answer?

Dr. Rick Wilson:  The technicians have heard the doctor answer the questions many times a day, and can usually give fairly learned answers to many questions.

P:  Do you ever speak to your patients during surgery?  I'm asking because the nurse anesthetist cautioned me not to speak to the doctor during my trabeculectomy. (I had no such intention). It would have made a great difference to my anxiety level, however, if the surgeon had said something like, "We're halfway through.  Everything's going well."  Further, the anesthetic wore off before he finished suturing, but I was hesitant to tell him it hurt because of the admonition.

Dr. Rick Wilson:  Usually, under local anesthesia, the doctor's reassuring the patient is part of the anesthesia.  If the doctor talks to the patient in a calm voice, the patient usually requires much less sedation and anti-anxiety medication.  As you say, just knowing whether the surgery is going well and how much longer the surgery will take goes a long way in keeping the patient calm and satisfied.

Moderator:  When my doctor was positioning the light before starting my cataract surgery, he sang, "When the moon hits your eye like a big pizza pie, that's amore."

P:  How much do you tell your patients?  My former glaucoma doctor was always upfront with me, but it didn't help that he was negative.  Are doctors taught how to present information to patients?

Dr. Rick Wilson:  Since glaucoma is usually a lifelong disease, the doctor-patient relationship usually lasts that long, or at least for the career of the doctor.  The doctor, therefore, needs to be honest, while still being encouraging and providing support.  If he or she glosses over something, or tells a white lie that is later found out, that usually damages the relationship with the patient.

P:  How soon after surgery do you speak with the patient and family about the surgery?

Dr. Rick Wilson:  I talk to the patient throughout the surgery if they are alert enough, and certainly at the close of the procedure.  I then immediately go out to talk to the family and reassure them, so they don't have to worry any longer than necessary.

P:  Is it appropriate to ask a surgeon in a teaching hospital if he or she will perform the entire operation?

Dr. Rick Wilson:  If that is important to you, it is certainly appropriate.

P:  How much information should a patient expect to be given about medications that will be taken before and after surgery, what to expect for follow-up care, etc.?  Is it necessary for the patient to know everything about every pre- and post-operative eyedrops?

Dr. Rick Wilson:  We provide a written page describing the drops to be taken before and after surgery.  I only go over side effects if they are frequent or onerous, for example, a dilated pupil with atropine.

P:  What do you do if a patient refuses to have surgery and clearly needs it?

Dr. Rick Wilson:  If I cannot persuade patients to have surgery when they need it, I extensively document everything in the chart, with my signature and the technician's, to help protect me from the Philadelphia lawyers.  I then ask the patients to seek a second opinion, and return in several weeks to go over everything again.  If they still refuse, I offer them a transfer to another doctor, as I hate to have a patient getting worse on my watch.

P:  Aren't patients who keep looking for the magic cure, and never staying with one doctor for long, doing themselves harm?

Dr. Rick Wilson:  There is a line between seeking enough opinions to satisfy yourself that the correct treatment is being suggested, and switching doctors to find the least invasive suggestion or avoiding surgery.  The latter approach will lead to disjointed care if the patient switches doctors many times.

P:  When a frightened patient demands to be treated aggressively for glaucoma before the preliminary tests and examinations have been completed, what do you do?

Dr. Rick Wilson:  I educate them about their present status, and the additional information I need to be able to make a decision about which way to proceed.

P:  How can a patient learn how skillful a certain surgeon is?

Dr. Rick Wilson:  By reputation, as gleaned from other ophthalmologists, and from other patients.  That is not always easy to do.

P:  I went to the ER (emergency room) when I had conjunctivitis.  The resident eye doctor on duty couldn't figure out how to turn on the slit lamp.  My husband helped him.  I'm in fear of having to go again. When does a specialist go to the emergency room to see a patient?

Dr. Rick Wilson:  A resident should know how to use a slit-lamp microscope unless it was an unusually peculiar one.  That may not have been a resident eye doctor, but a resident in emergency medicine or just general medicine or surgery.  Usually, a specialist goes to the ER in a teaching hospital when the house officer needs help with a case.  Patients who have private doctors can call them when they have a problem, and the doctors may meet them at the ER.

P:  The resident was a first-year ophthalmology resident.  My glaucoma surgeon's instructions are to go to the emergency room when he's not in his office.

Dr. Rick Wilson:  Have a great week.  I'll let you know the latest information when I return from the AAO (American Academy of Ophthalmology) meeting.

On October 19, Dr. Nagra discussed "Corneal Limbal Stem Cell Transplant" in the Chat room. Click here for highlights of that meeting.

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