DIAGNOSTIC DISCUSSIONS

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It’s helpful to have patients understand corneal topography procedures like
those done with NIDEK’s MM-1.

Two practitioners talk about how to effectively present anterior segment diagnostic tests to patients.

Most practitioners are occasionally faced with the challenge of explaining to patients why they need a certain diagnostic test to aid in the diagnosis of their ocular condition. This plays out many times a day in practices for anterior segment diagnostic tests like corneal topography, slit lamp photography, endothelial cameras, and anterior segment ultrasound. To help you discuss these procedures with your patients, below are the steps we use to enhance our patients’ understanding of our diagnostic tools.

STEP 1: ORIENT
PATIENT TO THE TEST
This really involves four simple stages:

Explain what you are looking for. In most instances, patients really just need to understand what the test is for and why it is important, yet many doctors fail to provide those basic facts.

Explain how this tests works and what it will tell you. The key here is to keep this simple. With the exception of a few engineers, a simple “it works this way and tells us this” will suffice.

Ask if they have questions. Once again, a key step that is often missed, patients need the opportunity to ask clarifying questions. Be prepared for the “but do I really need this test” question. Do you have a good reason to do the test? Will it provide you with more information? Will it assist in your diagnosis? Are you doing it just to pay for the device? These clarifying questions often serve to make medical necessity clear in the mind of the doctor as well as the patient.

SAMPLE ORIENTING STATEMENT FOR TOPGRAPHY “This test is called topography. It maps the curvature of the front part of the eye, known as the cornea. With this device we are able to look for irregularities in the cornea. It is also helpful in the fitting of contact lenses as well as the evaluation of how contacts are fitted on your eye. In some cases, your insurance may cover part of this procedure. If not, you will likely be responsible for $X out of pocket.”

 
Explain the potential costs to the patient. If a procedure is necessary, most patients will pay what their insurance doesn’t cover. Patients just want to know up front what the general costs will be and what their responsibility is. There are some patients who will add the “just try to bill my insurance” line. If you know their plan will not cover a particular procedure, always bill up front. Refunds are always less expensive than sending to collections or not collecting any money at all.

STEP 2: PERFORM TEST
Tell patients what they will experience from their perspective (see “Sample Orienting Statement for Topography,” below). Though you or your staff may perform this test many times a day, it is likely it’s the first and only time your patient has ever had it done. Let the patients know if it will touch their eye. Don’t hide their experience. If you don’t know what they will experience then take the test yourself.

STEP 3: EXPLAIN RESULTS
Always explain the results of the test in words patients can understand. You can add value to the test by discussing how the test will help your ability to diagnose, manage, or follow the disease condition.

Anterior segment testing can greatly aid in the diagnosis of ocular disease and the fitting of contact lenses. A little explanation goes a long way in helping patients understand the necessity of these tests. As a result, patients will leave with the impression that the exam you performed was more in depth than any they’ve ever had before.


Jenny Kiernan practices at Eye Consultants of Colorado, Conifer, CO, and Scot Morris is its clinical director.

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