How to convey complex medical information to my retinal patients?

A common feedback from my patients, both in public and in private practice, is that they understood their condition well after coming to my appointments. This improves patient attendance and adherence to treatment.

One particularly challenging group of patients to manage are those with diabetes with poorly controlled blood sugar and severe retinopathy. I recall a case of a Pacific Islander man in his forties, with bilateral proliferative diabetic retinopathy, macular oedema, cataracts and poorly controlled blood sugars. His attendance record for his other medical appointments was poor, but he consistently attended all my medical retina clinic appointments. As a result, his eyes are well-managed with quiescent diabetic retinopathy, and he achieved good vision after his cataract surgeries. I even motivated him to take better care of the rest of his medical issues and re-engage with the other healthcare professionals.

Here, this patient understands the nature of his eye disease and the importance of his eye treatment. But how do I consistently convey complex medical information to all my retinal patients in a way so that they understand their conditions and treatments?

Run an efficient clinic so you have time to discuss issues

Time is essential for a good discussion. If the clinic is rushed and you are already behind, it is very hard to devote enough time to an individual patient to ensure complete understanding. In my private practice, I have 30 minute appointments so I ensure there is sufficient time for me to explain the information and discuss any questions that arise.

In the public setting, our appointment time is around 10-15 minutes, so it is imperative to run the clinic efficiently. Many of my medical retina patients can be assessed using OCT and Optos ultra-widefield imaging prior coming through to my consultation, so this cuts down on the time for examination. Furthermore, I usually take a few minutes to familiarise the patient's medical and ophthalmic record, so I can move quickly to their current issues rather than having to re-visit their previous history.

It is useful to start your consultation with a quick summary of the patient's medical condition, e.g. "I see that you have been coming here every three months for your diabetic eye disease. You have already had some laser treatment, but there are still some floaters. I also see that you have been working hard on your diabetes control with some improvement in the HbA1c...". This reassures the patient that you know what you are dealing with, and also save time as your patient does not need to repeat any information.

On the other hand, it is actually better to let your clinic run late and spend enough time with each patient, rather than rushing through the clinic to get all the patients seen on time. When I was working in Moorfields Eye Hospital, the clinics were always overbooked, and patients routinely waited for hours to be seen. Initially, I tried very hard to work as fast as possible to get everyone seen quickly, but this just resulted in unhappy patients, as they did not feel that they had enough time with the doctor. After all, if you have waited for hours to be seen, you want to be listened to and have a top notch appointment.

Subsequently, I took my time and ensured all my patients were well looked after, and I realised that, even if one has waited for a long time, the patient would still have a good experience if they had a good appointment. After all, if the clinic is over-booked, there are seven patients ahead of you, and your caring ophthalmologist devotes 15 minutes to discuss your condition in detail, it is natural that you will have to wait for around two hours to get seen (15 minutes x 7 = 105 minutes)!

Use OCT scans, Optos images and eye model to aide understanding

Terms that are second nature to eye care professional, such as subretinal fluid, proliferative diabetic retinopathy, neovascularisation, etc., make no sense to most patients. Some of my patients even confuse wet age-related macular degeneration with watery eye, and wonder why their eyes still water after intravitreal injections!

So, use visual aids to help explain their condition.

I always start by using an eye model and to show my patients where their retina is - back and inside of the eye, just like a wall paper. So what is happening in the front of the eye (dry eyes, cataracts, etc) has nothing to do with the retina.

Then I moved to the Optos imaging to show an image of their retina, and point out if there are any abnormalities. Last, I explain to them that the retina is transparent, so to see thickness and swelling, an OCT scan is essential to visualise the cross-section of the retina.

In some patients, such as those with proliferative diabetic retinopathy, their vision can be normal even with severe disease. By allowing them to see their pathology and its response to treatment, these patients will understand the importance of their appointments and treatments.

Answer questions

Invariably, my patients will have questions during and after their appointments. If you have taken the time to have a detailed discussion and explain their conditions well, most of their questions will have been answered, and the patients will leave the consultation satisfied.

But I always make a point to ask them if they have any further questions, just in case. I also give them my email address (on my business card for my private patients, and on the clinic letter in my signature block for my public patients), so if they have any questions after the appointment, my patients can always contact me.

How does this help my practice

Essentially, patients that understand their condition well are much more likely to attend appointments and interventions that may be unpleasent (such as intravitreal injections). In the field of medical retina, most of my patient load consist of repeated visits for the treatment of chronic eye condition (neovascular AMD, diabetic maculopathy, etc), so this adherence to treatment is crucial for good outcomes.

So, if you think your patient can benefit from my approach to patient care, please click here to send me a referral. I am more than happy to help.

About Dr Leo Sheck

Book your appointment now to see Dr Sheck

Dr Sheck is a RANZCO-qualified, internationally trained ophthalmologist. He combined his initial training in New Zealand with a two-year advanced fellowship in Moorfield Eye Hospital, London. He also holds a Doctorate in Ocular Genetics from the University of Auckland and a Master of Business Administration from the University of Cambridge. He specialises in medical retina diseases (injection therapy), cataract surgery, ocular genetics, uveitis and electrodiagnostics.