Ophthalmology Business

DEC 2012

Ophthalmology Business is focused on business topics relevant to the entrepreneurial ophthalmologist. It offers editorial, opinion, and practical tips for physicians running an ophthalmic practice. It is a companion publication of EyeWorld.

Issue link: http://digital.ophthalmologybusiness.org/i/98302

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Page 9 of 27

continued from page 8 Ever since Adam Smith described the modern marketplace in The Wealth of Nations, we've acknowledged that buyers need to be as reasonably well informed as possible for markets to run well. That's because buyers' informed purchasing decisions will force (competing) sellers to deliver the best quality services and products at the best prices. Alternatively, chronically unsophisticated, uncomprehending buyers might find themselves at the mercy of sellers and be manipulated into wanting what they get rather than getting what they want. Interestingly, studies suggest that most ophthalmology patients receive a very detailed informed consent process, even though an article by Kimberly Wynkoop in the Summer 2011 Ophthalmic Risk Management Digest stated that "an inadequate informed consent process was the single most important driver of PIOL malpractice claims" that the Ophthalmic Mutual Insurance Company received. So, despite the elaborate informed consent process that ophthalmologists provide patients, it seems that many patients don't think of it as ending with the delivery of services, but rather see it as extending into an indefinite, post-purchase future. But patients who complain after surgery about the quality of their informed consent might be confusing it with their physician's post-treatment communications or communicational style, which might strike the patient as distant, uncaring, incomprehensible, or evasive. This latter speculation is quite likely because we know that physicians sometimes fail to handle disgruntled patients artfully, and as the insurance company's claim experience showed, these patients sometimes initiate a lawsuit. For them, poor "informed consent" is simply a proxy for what they experience as poor customer relations. continued from page 7 procedures. Patients can also keep track of their compliance rates and chart their intraocular pressure information on a continuous graph. The extra features allow for a more interactive experience between patient and physician, Dr. Harbin said. Patients can send their compliance information directly to their doctor or a family member. The app responds with email updates, congratulating good compliance rates and encouraging lagging patients to improve their usage. Premium users can also sync their medication schedule between their phones and the EyeDROPS website. Future versions may include "gamification" or rewards features that allow users to compete for a high compliance record. With more than 500 EyeDROPS app users worldwide—from India and Asia to across the U.S.—Dr. Harbin said feedback has been positive among both eyecare professionals and patients. "Eye drop takers have a lot to think about—confusing regimens, taking multiple drops at different times, keeping track of their pressures, their prescriptions," he explained. "They appreciate when you can give them a helping hand. If we can keep them taking their drops regularly and correctly, we can make a big difference in their treatment." The EyeDROPS app is available for Android phones through Google Play and for iPhone through the App Store. At both sites, search for "EyeDROPS." OB Contact information Harbin: Harpasint@gmail.com In any event, those ophthalmology ads I read in Orlando are only the beginning of the informed consent process in the ophthalmologic marketplace. Rightly or wrongly, many patients might understand informed consent as an ongoing affair that extends after their surgery occurs. Maybe they understand informed consent as a mechanism for enabling marketplace trust—a trust that becomes especially fragile when their outcomes are less than what they expected. Consequently, I would urge ophthalmologic practices to think hard about the quality of their providing information. Do they check their communication practices for their comprehensibility, especially with patients who have trouble understanding and processing information? Have they adequately discussed and prepared the patient for the possibility of complications and a less than perfect outcome, even when the ophthalmologist has scrupulously followed the standard of care? Is the patient adequately prepared to accept some degree of responsibility in such cases, i.e., that an important ethical as well as legal consequence of a good informed consent is that patients realize they are assuming some degree of risk by consenting to purchase a procedure about which they have been duly informed? Fulfilling these informed consent obligations helps in realizing the best in customer relations. And while not all ophthalmologic consumers will be satisfied all the time, skillful information exchange can help realize the best that a marketplace in ophthalmology can provide. OB Editors' note: Dr. Banja is a medical ethicist, Emory University, Atlanta, and the public member of the ASCRS Governing Board. Contact information Banja: jbanja@emory.edu 10 Ophthalmology Business • December 2012

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