How do you put nervous patients at ease? How do you set aside your own bias and assumptions to make a balanced, informed, well-considered clinical decision? Insight explores why soft skills are arguably as important as clinical skills for optometrists.
Albert Einstein’s philosophy, ‘If you can’t explain it simply, you don’t understand it well enough’, holds an important lesson for communicating with patients, Specsavers head of clinical performance Mr Nick Gidas says.
Gidas is passionate about developing optometrists’ soft skills and spoke about effective communication at Specsavers Clinical Conference last year.
“As optometrists, we can have all the clinical knowledge required, but unless we’re able to impart that knowledge in a way that has meaning for our patients, we’re probably not going to get the best health outcome or give our patient the best experience,” he says.
“Taking it a step further, effective communication is not only when the information is received and understood, but understood well enough, where that person can relay that information to another person. That’s when we truly know that it’s been understood.”
Communication is a skill and – like any clinical skill – for it to perform at its best consistently, requires training and development. It is one skill among a host of soft skills optometrists can deploy in what is predominantly a people-facing profession, to ensure patients receive optimum care, and keep returning.
Poorly performing soft skills that fall short of the mark can have negative repercussions.
According to Specsavers data collated over the past three years, overwhelmingly 98% of patients feel cared for. However, in those rare circumstances where they don’t, it is communication that is most commonly identified as the cause.
Gidas highlights two negative outcomes of ineffective communication.
“The first is wasted time. If we think about those important moments where optometrists are discussing the patient’s case history, results, management plan, recommendations, or transferring care as part of a handover, when we’re ineffective in those moments, we’re adding time because we’re creating confusion, and indecision,” he says.
“As a result, the patient may not have time to go through the dispensing process, or we inconvenience them by asking them to come back on another day.”
The second major impact of ineffective communication is emotional.
“When we’re ineffective in those moments, we are the ones leading that conversation that creates confusion and indecision. Our patients may be prescribed a product that may not turn out favourably or they may need to come back for a remake. Worse still, they may decide they don’t trust us, and not come back for future health care they need.”
In his 27 years as a practising optometrist and the last seven in a clinical performance support role, Gidas has had conversations with thousands of optometrists and patients.
“I can honestly say that no two conversations have been the same, and that’s simply because no two people are the same. I’ve had to adjust what I’ve said and how I’ve said it many times, so the person I’m communicating with is able to receive that information the first time and understand it.
“As optometrists, our purpose is to improve the quality of life of every patient that we see, whether we do that through early disease detection and management, through education or a product recommendation, or referral to a specialist or a support group. We are delivering information that we need our patient to receive and to understand.”
He continues: “Anything that blocks that from happening is what we need to be accountable for. In our profession, perhaps the biggest block is our language. These are words that are comfortable and familiar to us in the way we say and hear them, but that’s because it’s part of our everyday language. For our patients, they aren’t as familiar, and for some it may be the first time they’re hearing about an eye health condition or a prescription. We need to ensure we’re finding ways to communicate that are relatable and understandable.”
Discussing a patient’s history is a case in point.
“Commonly what I hear are words and phrases like, ‘How’s your distance? How’s your reading? Is this for a routine test?’. Unless we’re following up these questions by asking our patients, ‘What does distance mean for you? What does reading mean?’, then we’re not communicating effectively,” he says.
“If our purpose is to improve the quality of life of every patient, it stands to reason that our line of inquiry through case history should be about understanding the patient’s lifestyle and their barriers to good vision.”
He says to develop effective communication as a skill, optometrists need to understand the attributes that make an effective communicator.
“One of the strengths of an effective communicator is being a good listener. If we can grasp this, it’s going to help us communicate and consult more effectively, because that’s what helps you navigate through conversations. It helps you be in the moment, answer questions, tackle challenges, and provide the right guidance and advice,” Gidas says.
“The other major strength is remembering it is not about you – it is about your patients. You have to remove your assumptions and provide relevant information in a way that your patients can understand.”
When taking a patient’s case history, Gidas recommends asking lifestyle-oriented questions, such as: ‘Where is it important for you to have clear, comfortable vision?’, ‘What activity were you performing when you experienced eye strain?’ – and listening to what patients say.
“This approach means the patient is always receiving the message in a way that matters to them, but not necessarily the way you think it best sounds,” he says.
One of the most common challenges optometrists encounter is how to best communicate with a patient who has a weak prescription, or minor change to an existing prescription, where the optometrist is not able to easily demonstrate a noticeable change in acuity.
“There is a fear of upsell because the patient is not able to read any additional letters on a distance or reading chart,” Gidas says, adding he has been asked how to handle this type of situation numerous times in his role at Specsavers.
“Generally, in those instances, the optometrist transfers responsibility to the patient with words such as ‘It’s up to you; it’s only a small change’ without any other information.
“But, if we’ve asked the right questions and listened to the response, then those patients we can help with only minor changes in prescription will give us that information when they tell us their story in their own words – words like ‘fatigue’, ‘eyestrain’ and ‘blur’.”
Effective communication is a two-way street, Gidas says, and devoting time to developing the skill of communication has immense benefits.
“Getting it right more consistently the first time does save time, which is valuable for the patient, and it saves emotions, because we give them a great outcome more consistently. It encourages that patient to self-care, which is important for future outcomes, and it builds relationships because in that moment, your patient feels like they’re the most important person in that time with you.”
Part of a growing skill set
Paediatric optometrist Ms Soojin Nam relies on her interpersonal skills to set the tone when welcoming new patients into her practice.
“Some children can be quite frightened or apprehensive about getting their eyes tested, especially if it’s their first time. Being able to create rapport early on and as quickly as possible to put those little patients at ease – I think that’s a real skill that can only be beneficial,” she says.
“It starts from the moment they come into the practice. I tell my paediatric patients, ‘I’m so excited you’re here to see me today. We’re going to have so much fun during the eye test’. Even something as little as that sets the tone for the rest of the eye test.”
Nam is part owner of three Eyecare Plus practices, and sole owner of an additional three Eyecare Plus practices, all located in Sydney.
“I graduated in 2000 and started my first practice in 2001 after winning a Shell LiveWIRE business competition. As part of the award, I was incredibly fortunate to receive a year’s worth of professional PR to grow the business,” she says.
Over time, as opportunities presented themselves, Nam slowly increased the number of practices she owned. She says every stage of business growth requires a different set of management and leadership skills, but soft skills are applicable at any stage.
“There are a number of soft skills you need in the workplace, but in an optometry practice there are certain ones that really come to the fore, most notably interpersonal skills, communication skills, decision-making and problem-solving ability, and time-management skills,” she says.
When dealing with parents who might be concerned about their children’s vision problems, Nam draws on her empathy and ability to communicate with parents in a calm, professional manner, to ease their concerns.
“If it’s an adult patient and they genuinely have a visual concern that’s causing them stress, one of the biggest assets I have in my practice is time. As an independent optometrist, I’m not under time constraints – it’s not one of my KPIs. That changes the way I approach the patient’s visual needs because I’m focused on solving their presenting concerns. If I feel they need more time with me, I simply book them in. I always go with the adage that people don’t care how much you know, until they know how much you care.”
Although Nam has a certain degree of liberty to spend more time with patients as needed, sometimes the decision-making process can stump her, and she leans on her networking skills to seek answers, be it clinical or business.
“When it comes to making decisions, the more experience you have, the more it’s going to be beneficial, and that only comes with time. I’m certainly not afraid to ask for help and saying ‘I don’t know’. Making good decisions comes down to your experience, intuition and logic and seeking out as much information as you possibly can. When you’re making clinical decisions, you really want to have the largest, widest range of problem-solving solutions in your toolkit to be able to solve the patient’s visual problems.”
Managing teams across six practices, Nam says soft skills not only apply to how she interacts with patients, but staff too, to help create a harmonious workplace environment.
“Communication and teamwork in many organisations are often an area that can pose a challenge. If communication is not free flowing and open, then it’s most likely the cause of perceived difficulties. If a patient has a positive experience with a dispenser but are then disappointed with the optometrist, the whole thing was a failure for them, and vice versa, if they have a negative experience with reception staff, but have an amazing experience with the optometrist – it really takes the entire process to deliver the service the way it’s meant to be delivered.”
When she purchased her first practice, Nam remembers being told “having more than one practice is very difficult and not many can manage more than two or three”.
Nam was motivated early in her career to challenge the status quo. “One practice was manageable, three was definitely the most challenging, six is when it became a lot easier because you have the economy of scale. My skill set, as a business manager, had to adapt at every stage. Managing three employees is a completely different experience to managing 50,” she says.
Subtle cues
As the former head optometrist of the established practice theeyecarecompany, now part of the George & Matilda Eyecare network, Dr Margaret Lam understands that establishing rapport helps understand patient’s health and medical needs, as well as their occupation and lifestyle needs.
“Patients benefit from strong interpersonal skills from their optometrists. In the context of optometrists communicating with their patients in close physical proximity, one patient’s definition of ‘comfortable personal space’ may vary widely to another, so it is very important to read subtle social cues from a patient,” says Lam, who recently started a new role as the head optometrist of 1001 Optical in Bondi.
While showing warmth and openness to welcome a patient, she advises looking for subtle cues to help patients feel comfortable, so they feel confident sharing their personal history.
“All the simple things are important, such as an optometrist maintaining appropriate non-verbal and verbal communication cues, maintaining appropriate eye contact, adopting a friendly, warm manner, speaking in a communication style that makes your patient comfortable, listening actively to your patient’s concerns, avoiding medical jargon, expressing complex concepts to patients in a way that is simple and easily understandable, and showing sincere interest in their overall health and well-being, all these soft skills are critically important,” she says.
Lam, who is also national president of peak body, Optometry Australia, says optometrists can use open-ended questions to encourage patients to share more information about their symptoms, medical history, and lifestyle.
“Starting with open-ended questions before seeking clarification, and then leading them to arrive organically at management solutions that work for a patient will help to keep the patient aligned with you on your recommendations for their eyecare.”
“Then, at the beginning of an eye exam, when you’re ready to examine a patient’s eyes, setting a clear plan and expectations for the eye test in the patient’s mind is also very important, as the patient takes away the sense that their eye test was thorough, methodical and purposeful, and attentive to their needs. Doing this gives the patient structure and aligns you and your patient’s expectations, and allows a patient to feel you’ve met and even exceeded their expectations for their eye exam,” she says.
“For example, once you understand what vision-related concerns your patient has after taking their history, it is worthwhile – at the start of the eye exam – to explain your goals for what can be tested and achieved in their eye exam. You can discuss what their expected outcomes will be, and what they should expect from you as far as what type of advice and management plan you will share at the end of their consultation.”
Before any decision making takes place, Lam recommends optometrists seek clarification and confirmation that they understand what the patient has shared with them, to minimise any misunderstandings.
“It is good practice to summarise the information you have gathered to ensure you have correctly understood the patient’s concerns. Clarifying with the patient can reduce any potential misunderstandings.”
It is important that it feels like a consultative decision when assessing if the patient will be comfortable adhering to the management plan being offered, Lam says.
“Explaining next steps that they will need to follow in their vision and eye management plan are also helpful. Professor Charles McMonnies has published excellent research showing that writing down your recommended management plan for a patient results in double the number of patients complying with an optometrist’s recommendations for their eye health management and advice.”
The onus is also on the practitioner to ensure all their health recommendations are in line with the most up-to-date advice they can provide their patients at the time of the eye exam.
“We’re fortunate to be in a field where improvements in clinical care, and thanks to the ever-expanding body of ongoing research, improvements in standards of what is best practice for patients is expanding quickly. We’ve seen an increase in accessibility to subspecialty expertise, with strengthened close working relationships with ophthalmology, and close collaboration with general practitioners and allied health care practitioners,” Lam says.
“All of these changes improve patient outcomes considerably, when we are all working together closely for a patient’s best interests. In the event a patient has a condition that is extremely time sensitive, this can be the difference between a patient losing their vision or retaining it.”
“Having a science and health background, optometrists rely heavily on evidence-based practice to guide their health care recommendations. We consider the patient’s individual needs, values, and preferences, find an appropriate solution compassionate with the patient’s needs, and a solution that we try and ensure the patient is on board with accepting. We explain potential outcomes in order so that we can help a patient take preventative steps to protect their own vision or eye health,” Lam says.
As a practitioner with more than 22 years clinical experience, and 20 years business experience, Lam believes soft skills in optometry are as important as the technical and clinical skills of an optometrist.
“Cultivating those soft skills, including qualities such as compassion, empathy, resilience, and adaptability, are important to provide the best care possible for our patients. Optometrists should also work collaboratively with other healthcare professionals, embrace diversity and inclusivity, and maintain professionalism at all times, as ultimately, this enhances a patient’s ability to follow the advice of their eyecare professional and improve a patient’s long-term vision and eye health outcomes.”
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