Doctor Patient Relations

Top 5 Terms to Ban in Optometry

By Brian Chou, OD, FAAO

Medical terminology can have a profound impact on patient psychology. Take, for example, the procedure, magnetic resonance imaging (MRI). In the late 1970s, when it was known as nuclear magnetic resonance (NMR), consumers were skeptical since “nuclear” had a connotation of involving unnecessary health risk. As a consequence, experts in the medical field changed the procedure’s name because of the unfounded public’s fears of “nuclear” medicine. Today MRIs are a routine procedure.

There are instances in eyecare, where we do not carefully think about our terminology. How many times have you, or a colleague of yours, documented in your exam record something like, “Educated patient on signs and symptoms of retinal detachment”? Although this is ingrained in our parlance, we do not actually teach our patients about the signs of RD. Symptoms are experienced by patients whereas signs are clinically observed by the practitioner. We do not teach patients to look for decreased intraocular pressure, Schaeffer’s sign, or a relative afferent pupillary defect.

We also throw around other terms without much thought. Yet they can have a negative effect on the patient’s psychology and the value of our profession. Here is a list of my prime offenders in increasing level of offending effect.

5. Preliminary testing. We’ve grown up taking tests in school with the aspiration of passing and over achieving. None of us wants to fail or even get a “C” in our classes. Yet test-taking anxiety can come up when our ancillary staff tell patients, “I’m going to do some tests on you before you see the doctor.” Patients believe tests are an indicator of their aptitude. In reality, we are measuring visual performance. While a student is at fault for failing their school test because they did not study enough, it is not the patient’s fault if they are unable to see all the pseudoisochromatic color plates or if their intraocular pressure is greater than 21 mmHg. These are measurements which help the doctor diagnose and treat the patient for their own wellbeing.

Better term: preliminary measurements.

4. Contact lens insertion. You insert a quarter into the vending machine, and you insert a key into the keyhole. But do you insert a contact lens into an eye? Still, we wonder why some of our patients forcefully jam their contact lenses into their eyes, risking corneal injury.
Better term: contact lens application.

3. Trial contact lens. Patients believe that “trial contacts” are free samples and that they can try on as many as they want until they find one that works for them without the doctor. Some patients believe that when they run out of contact lenses, they can avoid spending money by getting trial contact lenses. The reality is that these lenses allow the doctor to diagnose whether the contact lens provides optimal eye health, wearing comfort and vision. They allow the doctor to create a valid contact lens prescription. Using better terminology here can reduce inappropriate patient requests.
Better term: diagnostic contact lens.

2. Contact lens fitting. Existing contact lens wearers sometimes complain that their doctor assessed a “fitting fee” when their prescription stayed the same. The consumer mindset is that they could have “fit” themselves without the doctor, no different than going to the clothing store and fitting themselves for new jeans. In these cases, the patients should have been educated that the doctor evaluated their eye health and the potential to improve vision or comfort by modifying the contact lens parameters or prescribing a new lens design. The term “fitting” is so ingrained in our industry parlance that it may be hard to change. Regrettably it does not encapsulate our services of over-refraction or evaluating for corneal neovascularization or other signs of hypoxic stress. What we need is a term that better describes what we are do, so that our patients recognize the value of professional contact lens services.
Better term: contact lens prescribing.

1. Vision insurance. The historical function of insurance is to protect against catastrophic financial disaster. If your home burns down, homeowner’s insurance can help you rebuild. If you have a heart attack, medical insurance protects you from expensive medical treatment which could otherwise drain your savings. Medical insurance is about sickness and disease, and in our industry, it’s about treating the red inflamed eye, glaucoma or the like — not about glasses and elective contacts. The term “insurance” has somehow gotten polluted such that consumers believe that it could apply to regularly scheduled wellness activities like getting a haircut or massage. Instead, what we call “vision insurance” is not true insurance. It is an allowance that employers offer to attract and maintain the best employees. Why does this matter? Patients who understand the function of their wellness vision plan are empowered to spend above and beyond what their “insurance” covers for eyewear and get better product.
Better term: Vision benefits.

Do you think carefully about word choice when speaking with your patients? What have you discovered about the kind of language that works best?

Brian Chou, OD, FAAO, is a partner with EyeLux Optometry in San Diego, Calif. To contact him: chou@refractivesource.com.

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