Doctor Patient Relations

Improve Communication in a Pediatric Eye Exam

By Gina M. Wesley, OD, MS, FAAO

Parents schedule a visit to the eye doctor to see if their child needs eyewear or a new Rx. But, with good communication, you can teach them that something far more important is taking place: ensuring their child’s eye health and optimal academic performance.

Children are frequently examined in our office for comprehensive examinations, or what we call “well-checks.” It is sometimes hard for parents, especially those who may not have any ocular issues of their own, to understand the importance of checking children yearly for ocular issues. Ensure that every time a child comes in, you re-educate parents about the “why” of annual exams. For example, in today’s tech-savvy world, I remind parents that children are manifesting refractive and binocular issues at a much higher rate than ever before. By having the child come in annually to check their ocular health and vision status, we can verify their success in school and later, in life. This also results in those children developing good exam habits for life. Every time you see these patients, you not only benefit from exam reimbursement, but educating them about your other products and services, such as non-Rx sunglasses and screening retinal tests that are not covered by insurance, all of which add to your bottom line.

Doctor-Parent Communication Keys

Explain to parents that children need annual examinations to monitor eye health and vision.

Let children and parents decide who is in the exam room.

Speak directly to children–even when parents are present.

Manage the pediatric exam flow much as you would for an adult patient, fully explaining your diagnosis to both children and parents and leaving time for questions and then handing parent and child off to an optician.

Manage parents’ emotional response when a problem is found with compassion and empathy, taking time to fully explain the issue and treatment options. Let them know you welcome their questions. –ROB Editors

Speak Directly to the Child

I let the parent’s and child’s comfort determine whether the child is alone or accompanied by the adult during an exam. Either way, at the end of the exam, I talk to the child directly about my findings in as complex terms as I think they can understand. I think it’s important to establish trust with a child, and by talking to them directly, as opposed to talking about them as if they aren’t there, you can establish an understanding relationship. If there are higher complexities to discuss, I talk to the parent, as usually they are the ones with questions about complex issues. Still, it’s important to ask the child if they have questions, too. You may be surprised, as I have sometimes been, at the clarity with which a child “gets” what’s going on and how this relates to their every-day vision.

The same applies for teens as children: I let parent and child determine if mom/dad will be present in the exam room. For example, I find most often that parents are fine letting their teen be examined alone, which I prefer for candor in discussing their contact lens habits or vision concerns. If the parent is in the exam lane, there is no reason to address the parent separately unless they have specific questions. I want to be sure teens feel that I respect them and their input, to again, establish trust. If the parent is not in the exam lane, I will repeat the important highlights of the exam afterwards, but also allude to the fact that the child should be able to relay what I’ve explained in more detail if needed. Again, if the parent has more questions at that time or after they leave, I always invite them to contact the office. Editor’s Note: Children 18 years old and older are considered by HIPAA to be adults and you need the “child’s” permission to discuss the exam results with the parent.

Manage Parent Emotions

I think the hardest scenario I face is when a parent is upset or in denial that their child has an issue that needs to be treated. There are often feelings of guilt on the part of the parent, even in a simple diagnosis of mild myopia. It’s important to reassure the parent that no matter what the situation, they have done the right thing by bringing their child in to be examined. I also stress the importance of the treatment plan, and I think it’s vital for both the child and parent to hear what it is and why we need to do it. For instance, I particularly emphasize to both parent and child the risk of permanent vision impairment in the case of treating amblyopia. The parent is, though, the person who must ultimately understand. I will literally say to the parent, “You are responsible for making sure your child follows this plan, or you will cause them to permanently damage their vision. Our window of effective treatment time is small, so the more you adhere to what I tell you to do, the more likely we will correct and protect your child’s vision.”

Hand Off Child (and Parent) to the Optical Shop

I treat the patient flow for a child almost the same as an adult. After explaining my diagnosis and treatment plan, I ensure there are no further questions from the parent or child. I also let them know they are free to contact me after they leave if they think of any other questions. At that point, I page my optician to the exam lane and re-prescribe/re-iterate my recommendations. For instance, I might say to my optician, “Bobby is very lucky, as I found what was causing his vision problems and all it will take to solve those issues is his first pair of glasses! I have prescribed impact-resistant lens material as well as good quality AR to ensure the lenses are protected from scratches, are kept clean, and are warrantied. I’ve also discussed the importance of sun protection, so please go over all those options with him and his mom (dad). We did also talk about how he is a great contact lens candidate, and that daily replacement lenses would be the best option for safety, comfort and ease of use. He can return to the office at anytime for that fitting. Either way, I’ve already let him and his mom (dad) know he will be automatically scheduled for his exam in one year to make sure we follow him for new vision changes. However, they know they may return to our office anytime to check vision changes or issues.”

Emphasize Need for Yearly Family Comprehensive Exams

Remember, a child’s exam is a great time to indirectly remind parents about the importance of their own ocular health and what you do in an exam. If a child is doing well, I will say, “The great news is that your eyes are doing very well right now, and the only thing you need to be sure of doing is protecting your eyes from the sun with sunglasses. However, as I see every day in my practice, great vision and eye health can change very quickly and often very subtly. My office mission is to ensure lifelong ocular health, and that includes prevention and early detection of eye issues, which is why every patient needs to be seen yearly. We will put you in our schedule for an exam about a year from now, and notify you of that appointment about one month prior. That way, you can change it if needed, but it will keep you on track for optimal eye health.”

Related ROB Articles

Children in Contact Lenses: Introduce and Train Young People to Wear Contact Lenses

Make Your Practice Teen-Ready

Pediatric Frames: Balance Child and Parental Preferences

Gina M. Wesley, OD, MS, FAAO, is the owner of Complete Eye Care of Medina in Medina, Minn. To contact her: drwesley@cecofmedina.com

 

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