Which patients deserve empathy?

April 16, 2015

In his latest blog, Arun Gulani, MD, discusses deciding whether or not a patient deserves empathy for their medical situation, even when they are 'attorneys who sue eye surgeons for a living.'

Editor’s Note: Welcome to “Eye Catching: Let's Chat,” a blog series featuring contributions from members of the ophthalmic community. These blogs are an opportunity for ophthalmic bloggers to engage with readers with about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Arun C. Gulani, MD, founding director and chief surgeon of Gulani Vision Institute, Jacksonville, FL. The views expressed in these blogs are those of their respective contributors and do not represent the views of Ophthalmology Times or UBM Advanstar.

 

Empathy, a word we reviewed in our last conversation leads us into this blog.

It was a “regular” day at my practice. Patients had landed from different states and countries, all referred by highly esteemed and very able eye surgeons for complex LASIK, cataracts, complications, previous refractive conditions, and some who had self-researched and travelled since they had been turned away with the label, “Not a Candidate.”

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Surgeons and attorneys as patients characterize a regular day at my institute. That day, my morning had begun as usual-listening ardently to each patient’s story, reiterating to them that their ophthalmologists did indeed do the best they could and then making an individual surgical plan for their vision recovery.

Among these was an attorney patient who had traveled from Texas to see me following complication of her previous surgery and had associated radial keratotomy with LASIK surgery, Fuchs dystrophy, and cataract with changing vision, along with high ammetropia and irregular astigmatism.

In my typical fashion, I personally evaluated her, refracted, and checked all the diagnostics to review her options, including guarded prognosis.

Most patients we see are happily shocked to see a doctor sitting down for such a long time with each one of them and earnestly discussing with them and their family in detail regarding their options, without any pressure for surgery or financial gains. Therefore, I was surprised when this patient at the end of my extensive review, uttered the words “I'm not sure I want to proceed.”

Next: Stunned

 

Being used to patients chomping at the bits to proceed with surgery having travelled long distances and my desire to halt them all and first spend time reviewing a personalized plan, options and prognosis, I was stunned by these words.

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Shocked as I was, I was quiet but for some reason, I heard a voice in my head saying to her, “do you know that I do not need even need to see you? I do not advertise or do any deals or lure any patient to come to me. It is my surgical results and rock-solid integrity that has patients from all over the world being referred to me by excellent eye surgeons themselves.”

 This voice further increased in crescendo: "Additionally, I do not get swayed by industry talks neither do I do kickbacks for anyone.  No one, not even my staff is incentivized for any of our services. I have patients right now in my institute from all over the planet looking forward to seeing me and I will be lecturing about my techniques all over the globe this year.”

While this voice in my head continued, I kept my regular composure and uttered the words, "You should not proceed with any surgery with me. I would like you to go back home and think about my plan.”  I saw the dejected look in her and her attendant’s eyes, but I had made up my mind. The voice in my head softened, now as if speaking to me and confirming my actions, “ You have a tremendous track record and maybe your being humble instead of arrogant and always trying to be available, instead of leaving the room in minutes (like most ‘efficient’ doctors do), must have come across as an anomaly to her.”

That night as I slept, I wondered, was I right in my actions? I go above and beyond most practices to care for patients like they were family. This despite the fact they fly to me with full confidence and I don’t ever have to “sell” my services. I have shocked many patients by inviting them to share my lunch while they are dilating, showing up at their hotel to say “Hi,” inspiring their children, letting them take fun pictures and videos. I even drove myself once to get lunch for a recent patient from Australia when I learnt that he missed his flight and rushed to see me without having any breakfast. 

Next: This is empathy…right?

 

My thoughts continued: “I have never differentiated between patients, whether they are billionaires in private jets, or everyday people who may have come from just across the street.”

Neither was this patient’s being an attorney nor her being a complex case the cause of my reaction. What part of this real and personal care did this patient not understand? This was Empathy at its best, wasn’t it? The voice in my head said “of course it is!”  I fell asleep.

The next morning, the patient came back with her attendant and assured me that she wanted to proceed with the surgery, and also that she had researched my background and outcomes for years  and knew that only I could do her case and give her some hope where all other eye surgeons had told her there is nothing they could do.

With my normal empathy for all patients that I thought I had mastered and practiced every day in my profession, I decided to help her and proceed with my surgical plan.

The voice in my head again sounded off: “Think about it, not only are you agreeing to operate on an attorney who sues eye surgeons for a living but the relation has started off on a wrong foot. Also, all her multiple ‘top’ eye surgeons in the nation gave up on her. Additionally, she is a very complex case with very difficult predictability.”

I stayed back again late that night planning her surgery amidst all my “high-tech equipment” calculating her lens powers and options along with how I would even perform the surgery with so many RK cuts, and yet protect her Fuchs endothelium and then to come up with vision in this young patient that she could use in her demanding profession.

Next: Outcome

 

Surgery was successful in technique and outcomes and she reached 20/20 unaided vision.

The next day as we met, she expressed her gratification and also decided to discuss with me her feelings which I ardently sat down to listen.

She expressed how she had never met a surgeon who, being so highly reputed could be so personal and spend so much time in evaluating and planning, and then even delivering her vision when everyone said it was impossible, and she was immensely grateful for this outcome. She said she had already called her attorney friends in Texas with similar post RK vision issues and they will be flying to see me next week.

Then she uttered the world "empathy.” She explained that in her pre-op visit, when she said she was not sure to proceed and I canceled her surgery, all she meant was, she was surprised that someone was actually willing to take her case and help her where most surgeons normally gave up and refused to see her because of her profile being an attorney and additionally, being such a complex case.

Both myself and the voice in my head were suddenly silent.

I patiently listened to her lecturing me about how, despite the fact that I may have prepared myself and my institute as a unique scenario in the world of medicine giving so much time to every patient, not letting anyone wait and not advertising or doing any deal and yet performing with results-to a patient who's been repeatedly told "no”- it is a stunning surprise to finally have the opportunity.

Next: Revelations

 

As I write this blog, our Texas patient has become a close friend. Her referred friend (also an attorney from Texas with a very complex RK cataract case) underwent surgery successfully and returned back home.

A few days later, I accompanied one of my family members for a medical problem to see a so-called “Super-Specialist” physician up north and was let down from the get-go right from the long waiting to see the doctor, despite having an appointment time to insensitive staff and finally meeting this “distinguished doctor,” who seemed cold and visibly depressed about her profession right from her appearance to the demeanor and then a very cold, short statement instead of a discussion that pretty much signaled us out of that office with no hope.

On my flight back home, I reveled in the fact that I was different and would never become like that doctor and, despite being blessed in having patient's flying to see me from all over the world, I will continue to give them my time, never become arrogant, never bend down to the “assembly line” medicine patterns, while I shall continue to work very hard to help each patient reach the best vision potential in living up to not only patient’s expectations, but also that of my esteemed colleagues who referred them to me.

As I drove back to my office straight from the airport to meet with some visiting surgeons, I found gift wrapped in the mail on my desk a book that was sent to me by our Texas patient. It was titled "Empathy!”