L&T: L&T 101

Jun
2008

Making The Grade: A Patient History Lesson


An anonymous pundit once quipped, “Surveys prove surveys work.” But let's be honest. No one wants to fill out more paperwork. The staff is already too busy and the doctor is constantly running at full speed to try to keep up with the daily schedule. Why would we want to add another piece of paperwork to the already overflowing amount of duties the patient, doctor and staff need to perform?

The answer is simple. We need to know the patient’s medical history and how they use their eyes during various activities. We also need to have a time-effective way of gathering that information, especially with managed care relentlessly driving practice efficiency. We have two options: we can let the doctor play “20 questions” in the chair with the patient or we can ask the patient to provide the information through an easy survey prior to seeing the doctor.

The survey is not only more efficient, it is also more complete. Patients often neglect to mention health information details to their doctor. It is also easy for the patient to overlook lifestyle activities during the exam, when a doctor’s recommendation can make a big difference in their enjoyment of a hobby.

An example of a lifestyle issue/opportunity is swimming. This is an easy lifestyle  question to miss without a written checklist of activities. Competitive swimmers will typically practice six days a week, twice a day. If the swimmer is nearsighted, prescription goggles will allow the swimmer to see the pace clock, see the coaches’ instructions and see the other swimmers. If we miss this question in speaking with the patient, the swimmer misses an opportunity to improve their performance and enjoyment of the sport, and the practice loses an opportunity to bring in incremental revenue.

Medical History Survey
Most practices already ask medical questions in their office paperwork. A good example of a medical history questionnaire can be found online at Transitions Optical’s online marketing web site: www.TransitionsTom.com. Using a written health history survey is important to insure you collect and discuss any pertinent information. If you have a simple “X in the box” format on the forms it is quick and easy for the patient to fill out and the doctor to review.

Lifestyle Activity Survey

The Optometric Oath states: “I will advise my patients fully and honestly of all which may serve to restore, maintain or enhance their vision and general health.” Obviously, we cannot do this if we don’t know how our patients use their eyes. Yet many practices leave these questions to the vagaries of the chairside chat.

There are several ways to integrate the survey into your practice. One of the newer ways is to include your activities survey on the practice web site, so the patient may complete it before coming in for their eye exam. Another high-tech way to survey patients is with electronic methods such as computer-driven screens.

Lifestyle surveys can also be done when the patient comes into the practice, either as a separate sheet or as a part of the current incoming patient form. This is the most frequently used method and typically adds only a minute or two to the patients’ time in reception.

There is a huge amount of value in taking the time to survey the patients’ lifestyle activities. A. Dennis Olmstead, OD of Eye Care Associates of Charlotte in Charlotte, Mich. is a believer in using the survey. “It has made us more efficient and effective in our examination of patients. It helps us direct our patient conversations and insures that we offer our patients the products and benefits they expect when they come to our practice.”

Kyle F. Hoskins, OD of InVision Eyecare Associates in South Bend, Ind. emphasizes, “The lifestyle survey helps me understand what the lifestyle vision needs of the patient are and make recommendations to solve their visual problems. It makes me more thorough and takes a little more time. The survey is a tool to develop better informed patients in the exam lane.” It also has positive results in both patient satisfaction and the financial performance of the practice. Dr. Hoskins notes his staff “feels the extra time spent by the doctor discussing lifestyle needs and recommending the appropriate solutions makes their job much easier and quicker, and makes it more likely the patient will purchase the appropriate eyewear for their needs.”

Amy M. Keller, OD of Reed City, Mich. believes lifestyle surveys perform a key role in performance as an optometrist. “The survey gives me a good starting point to discuss options with patients. They may not purchase the recommended products this
visit, but it gets them thinking for their next visit. It is important for me to not only give them a prescription, but also recommend the materials and products that are available for their particular needs. If I don’t inform them, they may choose something inferior and not even realize there are better products out there.”

What to Include in a The survey
The best places to start as we consider questions to include in our lifestyle survey are areas that we know typically produce challenges to our patients’ vision. Some common areas include computer use, glare from blinding sunlight, glare from oncoming headlights, near-point tasks, occupational strains such as bookwork or blueprint reading, mid-point tasks such as music and contrast issues such as shooting and golf. Other areas include potential hazards to vision, such as hobby woodshops and sports with impact hazards like racquetball. Other good sources of questions to include in our survey are recreational specialties with vision-specific products, such as
prescription dive masks for diving and specialty lenses for golfing.

We should also consider commonly voiced concerns of our patients. These concerns could include focusing abilities while knitting or doing needle point, needs for extremely sharp near vision for coin, card and stamp collectors, contrast sensitivity for hunters and outdoor sportsmen and color vision for photographers and artists. It is important to make our questionnaire easy to use without requiring a lot of time. Using checkboxes wherever possible make the task of completing the form a breeze for the patient and easy to review for the doctor. The medical history survey and lifestyle activities can also be combined into one form to reduce the amount of paper given to the patient.

Another Helpful Survey
An additional survey that some practices administer is the patient satisfaction survey. This survey is given at the end of the patient’s visit to inform the practice of the patient’s overall satisfaction with their visit to the office and asks specific questions about each interface within their visit. Most practices that use this survey will limit the number of patients surveyed for cost and efficiency reasons. Ideas for sample size can be as simple as every other Tuesday or the fourth week of the month or even the fifth patient every day. Patient satisfaction surveys are valuable yardsticks of the performance of the practice in the patients’ eyes. Sometimes the perceptions of the patients are much different than what the practice expects. The measurements are especially helpful for the doctors, since most of their workday is spent in the exam rooms and they are not able to observe the performance of their staff on a regular basis.

Information that may be included in the patient satisfaction survey can include available times for exams, courtesy of staff, selection of products, explanation of the patients’ vision systems, timeliness of product delivery and value received. Another topic could be satisfaction with their vision benefits, if applicable. Questions such as selection of frames covered, lens materials and treatments covered and ease of use are possible areas to explore.

Dr. Keller has used the patient satisfaction survey off and on for about five years. The staff surveys patients every Wednesday. Dr. Keller began using the satisfaction survey to make sure the practice was addressing the needs of their patients and spot trends or concerns that the patient may not raise during the examination process. Her survey covers a variety of topics, from cleanliness to ease of appointment scheduling. When the practice first began surveying the patients, they found some negative responses on the amount of time spent waiting in the reception area. Dr. Keller remarked, “We responded with extra efforts to keep on schedule and make sure we explain the reasons for any delays in seeing the patients at their appointed time. This negative soon became a positive.”

Surveys are a choice
Does the practice need to do all of these surveys? The answer to that question will depend on several factors. The experience level of doctors and staff, the amount of time available to spend with patients, the personality of the staff, and even the level of managed care will impact the choice. Doni Wolf of Bridgeport Eye Center in Bridgeport, Texas enjoys the opportunity to discuss lifestyle activities with patients rather than using a survey form. “I always ask about hobbies, computer use, driving habits, sports, etc. I can tailor my questions to the patient based on age and our past interactions with the patient.”

The best way to determine if survey forms will benefit your practice is to try using one for a few weeks. At the end of the trial, discuss the impact the survey has had with the entire staff. Remember that with any new process, you may need to tweak the format to improve it for your particular needs and try it again. At the end of your trial you should ask three main questions: 1. Did the survey make us more efficient in our delivery of care? 2. Did the survey have a positive impact financially? 3. Did the survey enable us to produce more highly satisfied patients? If the answers to these questions are yes, then a well-designed survey is a good choice for you.


Eric Rollins president of Rollins Consulting LLC, a Michigan-based firm serving independent eyecare professionals and optical retailers.



 

|