October 2008

 

AAO PREVIEW

 

Atlanta, November 8-11, 2008

Depressed patients can struggle coping with post-LASIK


by David Laber EyeWorld Staff Writer

   

Two patients can have the same post-op results, but depression and other psychiatric problems could cause one of the patients hardship

Many ophthalmologists may balk at asking patients questions about their psychological health, but spending about one minute doing so could result in more appreciative patients at worst and identify potential lawsuits.

Jennifer Morse, M.D., psychiatrist, San Diego, will be delivering the keynote address at the American Academy of Ophthalmology (AAO)’s annual meeting’s section on dissatisfied patients. Dr. Morse’s address, “Understanding the Dissatisfied Patient,” will cover the behavioral and psychological factors that affect patient satisfaction after surgery.

From a technical aspect, LASIK is achieving excellent results, Dr. Morse said, so there must be some neurologic disconnect between what the eye is seeing and what the brain is processing.

“What we’re trying to do is raise awareness that other factors come into play” other than just the surgeon’s techniques and equipment, she said. And by simply asking patients upfront about whether or not they are clinically depressed or taking any anti-depressants could alert surgeons that the patient may be unhappy with even good surgical results.

More chair time pre-operatively

Dr. Morse said many physicians fear that asking a patient how they are feeling could open Pandora’s Box and significantly increase nonsurgical time spent with the patient. “We tend to overestimate how long it will take,” Dr. Morse said.

But according to one study, this is not the case. A conversation about a patient’s mental health can be done in a couple of minutes, she said, and in a study of emergency room physicians, results found that this short time investment meant a great deal to the patients.

Currently, some practices address this conversation by using a questionnaire, which is a good step, but Dr. Morse said some patients will not be as open about their mental health on paper as opposed to during a face-to-face conversation.

“Some surgeons worry about offending patients” so they do not feel comfortable asking patients questions about how they have coped with past surgical procedures; if they have any emotional problems; or if they have been treated for depression or other psychiatric problems.

So she suggested prefacing the questions with statements such as “I want to know more about you as a person so you can have the best experience you can” or “This procedure has an extremely high satisfaction rate, but there are some people that are not satisfied after surgery, so that is why I am asking you these questions.”

Aim to improve results, not filter patients

Just because a potential patient does suffer from depression does not mean this person is no longer a candidate for a refractive procedure.

“The goal is not to say, ‘You’ve had depression or you’ve been on this medication for years, so I’m going to screen you out.’” Dr. Morse said, “The goal is to simply look at the individual and develop some more focused counseling so that the patient will have the best experience.”

Gaining a better understanding of how a patient will react to the surgical results can allow for the surgeon to better counsel the patient pre-operatively and/or post-operatively.

The relationship between the physician and patient is paramount to the patient. The patients need to know that someone is interested in them and their individuality, she said.

If it turns out during the conversation that the patient does have psychiatric problems, the surgeon may want to suggest that the patient should wait until he/she is determined to be stable by his/her psychiatrist.

Consequently, having such a discussion can be critical for the surgeon as well to stave off potential litigation.

“If someone has a problem after surgery and whether or not they decide to seek legal means is very much related to the relationship they had during the pre-operative, operative and follow-up phases,” Dr. Morse said.

Contact Information

Morse: 619-405-5919, jmorsemd@aol.com

Depressed patients can struggle coping with post-LASIK Depressed patients can struggle coping with post-LASIK
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