Chat Highlights
Communicating With Your Ophthalmologist
November 8, 2000

On Wednesday, November 8, 2000, Dr. Rick Wilson, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Communicating With Your Ophthalmologist."

Moderator:  The topic tonight is "Communicating With Your Ophthalmologist."  Dr. Rick, how do you think the Internet has changed the doctor-patient relationship?

Dr. Wilson:  I think that it is much easier for patients to access information about glaucoma, so many of them come to their doctors with some knowledge. For some, that is excellent. For others, a little bit of knowledge is a dangerous thing.

P:  Could you elaborate on the "little bit of knowledge is a dangerous thing?"

Dr. Wilson:  For example, many patients look up all the side effects of a particular medication or surgery. That is all they can focus on when they come in to see me. It is difficult for me to get them to understand the danger of long-term side effects from the perspective of their ongoing disease.  

P:  You're right.  I tend to focus on the side effects and not the chance that I'll go blind if I don't take the drops. 

P:  Patients often say they have difficulty communicating with their doctors.  Do you have any suggestions?  

Dr. Wilson:  Communicating when one is very anxious is extremely difficult and does interfere with patient-doctor communication.

P:  How do you feel about patients coming in with a list of questions and writing down your answers?

Dr. Wilson:  I am happy if my patients have a list of questions and write down my answers.  Many times the patients are older and don't have the retentive memory they had 20 years before and are anxious, making remembering what I am saying even more difficult.

P:  In your practice, do you supply patients with written material to educate them about  glaucoma, treatments, etc.?

Dr. Wilson:  Yes, we do. 

P:  How do you get a glaucoma doctor to give figures on his rate of success with surgery? They always seem offended when I ask, and they quote "industry-wide" figures instead of their own.

Dr. Wilson:  Doctors who are not in academic medicine may not have looked at their success rate, amazing as that sounds. It takes quite of bit of time to do a retrospective study of  the success of a particular form of treatment.

P:  My glaucoma doctor, who has a large practice, gets back to me promptly when I call him. He knows I don't call unless it is necessary.  But my cornea doctor has not returned my call for a whole week. How do you feel about "important" phone calls, Dr. Wilson?

Dr. Wilson:  I feel phone calls are important. However, many patients are understandably caught up in their problems.  They don't understand that the doctor may be an hour and a half  behind seeing patients because three of them were late earlier in the day and that he may have two emergencies sitting in his office with IOPs in the 50's. That is why I say that I will get back to the patient, but it may not be till after-hours,  unless it is a real emergency.

P:  All the literature I've read says success depends on the skill of the surgeon.  How do you go about finding the best surgeon? 

Dr. Wilson:  One way is to visit  the American Glaucoma Society web site, which lists all its  members on a map.  If you choose one of them, you may not be getting the "best" surgeon, but you will have a better chance of getting someone who does a lot of surgery and has been given the stamp of a serious glaucoma specialist by the Society.

P:  I like to take my husband with me when I have an important visit with the doctor.   Sometimes I get nervous, and I think my husband will hear what I miss.

P:  Patients in chat have said they are afraid of offending their doctor by saying they would like to get a second opinion. Do you think they need to worry about that?

Dr. Wilson:  Some doctors feel threatened by patients asking for a second opinion. I think the benefit of a second opinion, if either the doctor or patient is unsure of the path to take, far outweighs the harm of hurting the doctor's feelings.  Doctors should recognize the anxiety that glaucoma causes a patient and be understanding of the motives behind the request for a second opinion.

P:  It's very difficult for a lay person to remember explanations given, and while trying to absorb information, often can't think of  appropriate questions to ask until after returning home and reviewing the information.  

Dr. Wilson:   I agree.   Prepare as you would for any important meeting, with the information you want to learn and what decisions need to be made.

P:  If you lived up in the part of Canada I do, you would be happy to see any eye doctor.  Right now my doctor is the only one around for 200 miles.  One doctor has left and the other is sick.  The government doesn't care. 

Dr. Wilson:  That's a very serious problem.  I agree in spades.

P:  How would you recommend inquiring about something we heard elsewhere so as not to have our doctor feel threatened. For example, if you say something here that seems to raise a question about medication, and I tell my doctor I heard it from a doctor on the Internet, I don't think he'll be too happy.  

Dr. Wilson:  If you say Dr. Wilson at Wills Eye Hospital said it, at least your doctor should recognize that the information is from a reputable source.

P:  When I told my doctor I got information from you, he was quite impressed and really listened.  I don't think he felt threatened.

P:  Some patients worry that if they have surgery by a specialist in another city, their own doctor will not want to take care of them afterwards. Should they be concerned about that?

Dr. Wilson:  Yes, that is a serious problem as well. You may need to find a doctor who will cooperate with a specialist in another city.  Remember, the global fee pays for post-operative care up to three months after trabeculectomy or shunt surgery. Seeing another doctor beside the surgeon during that period means the second doctor does not get paid unless there is a prior agreement for the second doctor to bill for the post-operative care.

P:  If you knew the next treatment in line for you would be a trab, what would be the three or more most important questions to ask the doctor?

Dr. Wilson:  1. What is the success rate in your hands?  2. What are the complications and their likelihood?  3. What will the post-operative period be like for me?

P:  What is the average length of time you spend with your patients in a routine exam?

Dr. Wilson:  It varies from a pressure check, which might be as little as five to eight minutes, to a 20-minute yearly exam.  New patients may take a half hour, sometimes more, depending upon the severity of the problem and the amount of explaining required.

P:   If a patient goes to a doctor for a second opinion, how much should be done by the doctor and how much by his technicians and fellows. When I was in New York 12 years ago, I spent about five minutes with the doctor, trailed by his entourage.

Dr. Wilson:   If the workup is by a fellow who is a graduate of a residency program and is training in glaucoma, then he would be expected to do most of the work-up. He is costing the department $60,000 or more dollars, so had better be increasing efficiency in order to justify his stay. The attending physician should review the fellow's work-up, check parts of it, and communicate the findings and plan to the patient.

P:  If a patient has repeatedly told a tech that he wants the glaucoma doctor to check his IOP, but the tech just ignores his request, what should the patient do? 

Dr. Wilson:  If the doctor refuses to take the patient's IOP, then the patient may need to see someone else.

On November 15th, Dr. Rick Wilson discussed "Glaucoma Associated with Systemic Problems" in the Chat room. Click here for highlights of that meeting.

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